ISSN 1821-6544
African Communication Research
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African Communication Research
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This issue dedicated to
Health Communication in Africa
African Communication Research, Vol. 3,  No. 2  (2010)
African Communication Research, Vol 3 , N o. 2  (2010)
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African Communication Research
Contents
Volume 3, No. 2         September, 2010
Review Article:
How effective is HIV and AIDS communication in Africa?
Eliza M. Govender,
University of KwaZulu-Natal, Durban, South Africa 205
Newspaper coverage of health issues in Nigeria
Vitalis Torwel and Coboh Rodney
Benue State University, Makurdi, Nigeria
235
The failure of radio to communicate knowledge of sickle cell
disorder in Nigeria
Edidiong Umana and Ayobami Ojebode
University of Ibadan, Ibadan, Nigeria
253
Ethnicity and doctor-patient communication in Kenya
  Ann Neville Miller
University of Central Florida, Orlando, Florida, USA 267
How participatory is “participatory communication” for HIV/
AIDS awareness in South Africa?
E.M. Govender, E. Durden, and S. Reddy
University of Kwazulu-Natal, Durban, South Africa 281
The effectiveness of interpersonal communication for HIV/AIDS
positive persons in Tanzania
Noel Joram
St. Augustine University of Tanzania. 305
Applying health communication strategies to the classroom in
South Africa: A value-based entertainment education
approach
Amy Chesser
       Wichita State University, Wichita, Kansas, USA 341
African Communication Research, Vol 3 , N o. 2  (2010)
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The failure of radio to communicate
knowledge of sickle cell disorder in
Nigeria
By Edidiong Umana and Ayobami Ojebode
Abstract
The study aimed to find out how much residents in Akwa Ibom knew about the
sickle cell disorder. In a survey of 300 people, we discovered that only few people
(32.9%) had adequate or fairly adequate knowledge of sickle cell disorder (SCD);
only about 45% were definite that they would not marry a carrier if they too were
carriers. Radio, the most important source of health information for about 73% of
our respondents and though praised for health education and information in Nigeria,
says nothing about SCD. Workers in the radio station were themselves not aware of
the prevalence of, or they felt incompetent to educate their listeners about, SCD. It
is our belief that these people know little or nothing about SCD because radio says
nothing about it. There is need for non-media forces to call media attention to and
in fact use media to educate people about SCD in Nigeria. Nigeria government also
must show commitment to SCD education.
Key words:  Sickle cell disorder, SCD, Nigeria, radio
Introduction:
Unknown to many, the prevalence of the sickle cell disorder (SCD)
in Nigeria is greater than that of HIV/AIDS. About 40 million Nigerians
have the sickle cell trait and about 4 million have the full disorder
(Azolibe, 2007; Ohaeri & Shokunbi, 2001). By implication, more than
25 per cent of Nigerians carry the sickle cell trait. If any two of these
carriers marry and bear children, one out of every four of their children
is most likely to have the sickle cell disorder. This calls for extensive
Author Biographical note
Ayobami Ojebode (ayo.ojebode@gmail.com) is Senior Lecturer and Coordinator of
Postgraduate Programmes at the Department of Communication and Language Arts, University
of Ibadan, Nigeria. He  has been visiting research fellow at the Centre for Research on Inequality,
Human Security and Ethnicity (CRISE), Oxford University, at the College of Communications,
Pennsylvania, USA, and at  the African Studies Centre, University of Leiden, the Netherlands.
His area s of research and publication include media and democracy, indigenous communication
and development communication.
Ms Edidong A. Umanah (ediumanz@yahoo.co.uk), MA in Communication and Language
Arts, University of Ibadan, Nigeria with a specialization in Health Communication, is a specialist
in  sickle cell education and works with the media to develop educational programming to create
awareness of sickle cell conditions.
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education and information for unmarried Nigerians. This kind of
health education and information is one of the roles for which the
Nigerian radio has received substantial applause (See Ojebode, 2008;
Adekunle, Olaseha & Adeniyi, 2004; Atanda, 1997). Yet, the question
remains as to how well radio has performed  in educating and
informing Nigerians with regard to SCD. In this paper, we examine
first the content of radio broadcasts regarding SCD and what factors
enhanced or limited the performance of radio in SCD education and
information. Then the study reports how much is known by radio
listeners in Akwa Ibom region of Nigeria about SCD and whether this
information is likely to lead listeners to take action regarding SCD.
Health challenges in Nigeria and the response of the broadcast
media
Nigeria faces tremendous health challenges. Though it is one of the
leading exporters of crude oil globally, it is poorer than many other
African countries in terms of health performance indices. WHO
(2008a) statistics show that life expectancy at birth for Nigerian men is
48 years; for women it is 49 years. This is lower than in Ghana, Gambia,
Uganda, Senegal and Cameroun. Healthy life expectancy (HLE) for
Nigerian men is 41 years; it is 42 years for women. Again, this is lower
than the case in several African countries. For instance, in Ghana HLE is
49 for men, 50 for women; in Gambia it is 48 for men and 51 for
women (WHO, 2008a). From every 1,000 children born in Nigeria,
about 191 will die before they are five years old, as against Uganda’s
134, Ghana’s 120, Senegal’s 116, or Gambia’s 114. The same body of
statistics shows that 447 among every 1000 Nigerian men are likely to
die before they celebrate their 60th birthday. But in Senegal, it is 307
among every 1000 men; in Benin, Nigeria’s neighbor, it is 349 and in
Ghana it is 350 of every 1000 men.
HIV/AIDS prevalence is high in Nigeria: in 2007, there were 170,000
deaths resulting from HIV/AIDS (WHO, 2008b). There are about a
million Nigerian children orphaned by AIDS (WHO, 2008a). Among
young female Nigerians, the prevalence rate is 2.3; but it is 1.3 in
Ghana among the same set of people. Among young Nigerian men,
HIV/AIDS prevalence is 0.8 which is higher than Ghana’s 0.4 (WHO,
2008b). The general HIV/AIDS prevalence rate in Nigeria is 3.1 which
again is higher than what obtains in many African countries (WHO,
2008b). Nigeria is one of the few large populations to cross the 5 per
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the failure of radio to communicate knowledge of sickle cell disorder
cent prevalence threshold having the fourth largest number of people
living with HIV/AIDS in the world (WHO, 2004).
Health funding in Nigeria is poor. For the year 2007, whereas the
total per capita expenditure  on health in Uganda was $130, and in
Ghana $93, in Nigeria it was $45. Even much poorer countries like
Senegal spent more on health per capita ($69) than Nigeria (WHO,
2008a). This explains why Nigeria has consistently ranked among the
lowest in health performance indicators globally. For instance, in 2005,
it ranked 187th among 191 countries (DFID, 2005). A comparison of the
figures in the last few years shows little or no improvement (See,
Gureje, 2005; DFID, 2005; WHO, 2004).
While not exonerating the Nigeian government for the obvious
neglect of its responsibility, many have called attention to the point that
many of the health problems in Nigeria could be prevented by the
affected individuals themselves if there would be proper information
and education (Soola, 1991; Omotade, 1995; Gureje, 2005). Even while
acknowledging the fact that the media are not an all-powerful magic
bullet, some of these scholars have challenged the media to take the
lead in educating and informing their audience in matters of
preventable health conditions (Soola, 1991; Adekunle et al, 2004;
Ojebode & Adegbola, 2007).
In response to that challenge, most broadcast stations in Nigeria,
both commercial and state, devote substantial air time and effort to
health education. Their efforts come in the form of health talks,
interviews with guest physicians, health jingles and testimonials. In
many respects radio takes the lead over television in health education
(Adekunle et al, 2004; Ojebode, 2005; Ojebode & Adegbola, 2007).
Radio is particularly suited to the Nigerian situation for a number of
reasons. The total adult literacy rate is only 69 per cent (UNICEF, 2008),
and health messages in handbills, newspapers and books will not reach
many  The electricity power supply is extremely poor which makes
television viewing infrequent.  Radio is mobile, cheap to own and run
(Olorunnisola, 1997). Radio jingles are especially potent educational
formats in Nigeria (Ojebode, 2005). They are easily memorized and
remembered by listeners, and when the facilities permit, they are
applied.
Studies have been conducted that evaluate the performance of the
media in disseminating health information in Nigeria in the areas of
family planning (e.g Adekunle et al, 2004); HIV/AIDS (Onyechi, 2007;
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Edidiong Umana and Ayobami Ojebode
Ojebode and Adegbola, 2007); malaria prevention (Greer et al, 2004;
Goodman, Brieger, Unwin, Mills, Meek and Greer, 2007), oral polio
vaccination (Makanju, 2006), cancer (Ojebode and Adegbola, 2007)
and even in fighting schistosomiasis (Olaseha and Sridhar, 2006). We
searched for a study on the use of mass media for educating Nigerians
about the sickle cell disorder but, surprisingly, could not find any.
The magnitude of the sickle cell problem in Nigeria
The evaluation of the use of media in addressing the need for
information regarding sickle cell disorders is important because of the
enormity of the problem in Nigeria. According to Ohaeri and
Shokunbi (2001), sickle cell disorder (SCD) afflicts about 100 million
people worldwide. Of these, four million are in Nigeria. The magnitude
of the disorder in Nigeria is best appreciated when one considers that
more than one in four, or 40 million Nigerians, are carriers of the sickle
cell trait and that, annually, 20 per 1,000 babies are born with the
disease, translating to over 150,000 babies born annually with sickle
cell anaemia (Sickle Cell Foundation, 2008; Akinyanju, 2007). If this is
compared to other affected African countries, and indeed several others
put together, it is evident that Nigeria has the largest sickle cell gene
pool in the world (Akinyanju, 2001; Adeyemi, Adeniran, Kuti, Owolabi
& Durosinmi, 2006). One newspaper has tagged Nigeria the “capital or
headquarters of sickle cell disorder in the whole world” (The Nation,
2008, p. 18).
Certain socio-cultural and infrastructural factors contribute to the
spread of the SCD in Nigeria. Many intending couples do not conduct
genotype tests because insisting that a partner conduct blood tests is an
implicit expression of distrust in their moral chastity.  In many
traditional Nigerian communities, this casts a slur not only on the
intending spouses but, especially, on their parents. In some parts of
Nigeria the parents, under the cloak of religion, literally “force” their
daughters into marriage in their early teens. Such parents do not
bother to find out the genotype of the intending husband nor are the
girls given the right to question this.
The third possible reason for the spread of SCD is the poor state of
the laboratories and the incompetence of laboratory staff in Nigeria. In
our preliminary investigations for the study, we came across a middle-
aged man who conducted his genotype test twice in the laboratories of
different secondary health facilities and got two different results.  Not
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the failure of radio to communicate knowledge of sickle cell disorder
only this, it costs substantial money and waiting time to conduct any
test in Nigeria (Greer et al, 2004; Goodman et al, 2007).  In many
villages, travelling to the city where the health facilities are, waiting in
line for hours or days, and having to return on a later date for the
results, costs a lot of money and time, and can be generally
discouraging.
      We strongly suspected that, added to all the reasons above, is
ignorance. How much do Nigerians know about SCD, its causes,
prevention and management? What are the sources of their
information on SCD? How much and what quality of information do
these sources of information offer? These were the questions that
motivated this study.
The Study
The study began as a simple small-scale survey to ascertain what
Nigerians know or believe about SCD, but our findings kept pushing
the original boundaries of the study further. Our survey showed that
radio was a major source of health information for our sample, so we
decided to examine what SCD messages there were on radio. The
findings of the content analysis led us to interview the radio station
staff and health workers.The survey was conducted in Akwa Ibom
state. By the 2006 census, Akwa Ibom has a population of 3.9 million,
mostly fishing and farming families. The SCD prevalence rate in Akwa
Ibom is unknown but there are no grounds to suggest that it is better
than the national average.  Akwa Ibom is among the few states in the
country that do not have sickle cell clubs or centres.
To draw respondents for our small-scale survey, we adopted cluster
and convenience sampling techniques. Each of the three senatorial
districts in the state constituted a cluster, and from each of these we
chose a hundred respondents giving a total of 300 respondents.
Attempts were made to ensure that the selection cut across age,
educational, marital, gender, religious and rural-urban categories in the
society.  The 90 per cent response to the questionnaire is very
acceptable.
We interviewed 15 community health workers in three hospitals,
and six staff of Akwa Ibom Broadcasting Corporation (AKBC) radio
who were involved in producing and presenting health programs. We
collected and analysed all the jingles and health talks that AKBC radio
had aired in the previous twelve months and interviewed six members
of staff with a 23-item interview guide.
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The Findings
As Table 1 indicates, the knowledge of SCD in this sample of
respondents is poor. We had three points of test: questions about the
nature of SCD, about the causes of SCD and about the consequences
of SCD. Only 32.9 per cent gave correct information on at least two of
these three points of test. We rated such respondents as having
adequate to fairly adequate knowledge of SCD. Eighty-one of them
(30.0 per cent) gave correct information on just one of the three points.
We considered these to have inadequate knowledge of SCD. A hundred
respondents (37.0 per cent) had no idea at all or got it all wrong.
Table 1: Knowledge about sickle cell disorder
Knowledge of SCD Adequate/fairly adequate 89 32.9% 
Inadequate 81 30.0% 
No idea/wrong idea 100 37.0% 
Total 270 100% 
 
Which factor would Religion/Spirituality 103 38.2% 
you consider in Character 102 38.0% 
choosing whom to HIV  64 24.0% 
marry? Beauty 53 20.0% 
Genotype 47 18.0% 
Family background 41 15.0% 
Education 39 14.5% 
Wealth 14 5.2% 
Health 14  5.2% 
Age 7 3.0% 
Employment 9 3.3% 
 
Would you marry Would marry 56 29.2% 
someone you loved Would not marry 86 44.8% 
even if both of you Undecided yet 50 26.0% 
were sickle cell Total 192 100% 
carriers? 
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the failure of radio to communicate knowledge of sickle cell disorder
The knowledge of behavior relating to SCD was also poor. We asked
our unmarried respondents to state the factors they would consider
before choosing a marriage partner. About 38.2 per cent would
consider the intending spouse’s religion and spirituality, 24 per cent
would consider HIV status; but only 18 per cent would consider the
genotype. In fact, beauty was considered more important than
genotype. Not only this, 29 per cent of unmarried respondents would
marry someone whom they loved even if both of them were sickle cell
carriers. Fifty-six per cent of our married respondents did not check
their genotype before marriage, and 63 per cent of unmarried respon-
dents would not check their genotype before marriage.
Radio was the most important source of health information for 73.2
per cent of our respondents but 65.4 per cent could not remember ever
hearing any SCD information on radio. Most (66.8 per cent) listen to
radio daily, and 85.5 per cent had control over at least a radio set.
    The health workers we interviewed confirmed the sickle cell
ignorance in Nigeria, and some blamed the media, the government and
health advocacy groups for it.  A doctor said:
Awareness is really low especially in the rural areas. People are
ignorant of SCD…The urban dwellers who get information about
SCD are the ones influenced by the information…they are the ones
that might go to carry out blood tests.
According to him, urban dwellers receive information through such
other means as public health campaigns in schools, and IEC materials
distributed in cities. These materials do not get to the rural areas.
Another respondent put the task squarely on radio, which, according
to her, is the only way of reaching rural and non-literate people. Health
workers claimed that people with higher levels of education knew
more about SCD. Said a nurse:
Most of the people who come here for ante-natal do not know their
genotype. But those who are privileged to have education go for
their genotype tests even before marriage.
We felt this was to be expected. After all, educated people could
access information on SCD from other sources such as magazines and
books. Of the 89 respondents (33 per cent) who gave correct
information on SCD, 71 (80 per cent of the correct answers) had
secondary school education and above. Health workers had educated
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or enlightened their patients on SCD when such patients, especially
women, attend ante-natal clinics. Health workers claimed that they did
not use radio to educate people about SCD because the stations did not
invite them to give SCD talk or interviews.
Our analysis of AKBC radio health talks and jingles showed that the
station did not give any talk or air any jingle on SCD in the one-year
period that we examined. Seventeen (73.9 per cent) of the health pieces
were on HIV/AIDS; 4 (17.3 per cent) were on tuberculosis while 2 (8.7
per cent) were on malaria. Why did AKBC have nothing on SCD? All
our interviewees at AKBC Radio believed that it was the emphasis on
HIV/AIDS that dwarfed attention to other conditions including SCD.
One of them said:
Everyone, everywhere is talking about HIV/AIDS. Wherever you
turn to it is AIDS. So we think of HIV more than we think of SCD.
That informs the kind of counsel and education we give our
listeners. I don’t think we ever talked about SCD in this station; I’m
not sure.
Another reason advanced for the absence of sickle cell information
on radio was lack of sponsorship. Interviewees informed us that there
are several groups which sponsored health talks on HIV/AIDS,
tuberculosis and malaria. These groups paid some money to the
stations and some of them bring recorded messages which the radio
simply aired. There was no such support for SCD. An interviewee
ventured the argument that “because SCD is an African problem,
Western donors do not see the need to support its eradication”.
Another but more implicating reason given was that the staff and
management of the station were not aware of SCD as a major health
challenge, and the State Ministry of Health has not alerted them. Or
otherwise, there would have been more SCD information on radio.
I know there is SCD but I did not know its prevalence. We in the
media do not know everything. Someone has to alert us, maybe
the Ministry [of Health] or the management or an NGO. If
someone told us that one quarter of Nigerians have SCD, we too
would have been alarmed and would have cried out to the young
[unmarried] ones.
The government lacks commitment to people’s welfare, and the
station tends to emphasize programs that will generate revenue. A radio
worker put it in more damning terms:
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the failure of radio to communicate knowledge of sickle cell disorder
We lack the technical skills to give enlightenment and education on
this matter. But that is a minor problem. We lack initiative. We don’t
do things unless someone else is doing it (sic) or someone asks us to
do it (sic). We are not, I’m sorry to say, we are not smart. Our
management lacks commitment. We have all these programs on
AIDS because they bring money to the station. AIDS is a money-
spinning machine. And our government is not interested in people’s
welfare. All they do is politics to make them richer and keep them in
power.
Another one said that being government employees, they are meant
to please government. “It doesn’t matter if you do not serve the people
or enlighten them. Just be sure you do not say what offends
government and you will be fine”.
Discussion
Discussants of news selection criteria (Boyd, 1997; Folarin, 1998;
Yopp and Haller, 2005) have suggested that when a problem is of a
great magnitude and impact, it attracts media attention. Our study
shows this not to be true in the case of SCD in Nigeria. It is true that
the HIV/AIDS situation in Nigeria is severe, but it is also true that
many more people are likely to suffer from SCD issues than from HIV.
The sickle cell disorder threat is actually of greater magnitude and its
potential impact  has extremely serious consequences for the health of
the nation. Despite this, the attention of radio workers is not
sufficiently drawn to SCD to the point that they could begin to
enlighten their listeners about it. Even if they lack the technical skills,
they could invite health workers for informative interviews and talks.
The lack of commitment to the SCD cause by government is
perhaps the strongest explanation for sickle cell ignorance in Nigeria. If
government were committed, it would have mandated radio stations to
mount a campaign with or without sponsorships. Adoption of
neoliberal economic policies by government in Nigeria is taking a
severe toll on the commitment of broadcast media to public service
and development programming. Following the deregulation of broad-
casting in Nigeria in 1992, state-owned broadcasting stations were
asked to become fiscally self-sustaining. This gave ascendance to profit
over social responsibility, and resulted in a continual drop in
development and public service programs (Ojebode, 1998).
In media studies circles, the debate on whether or not the media
have effects on people is no longer an issue. What is in question is how
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much effect and under what conditions (Littlejohn, 1999). Our study
does quite indirectly suggest that the media might have influence on
their listeners, at least at the cognitive level (Hybels and Weaver, 2001).
Lack of SCD information on radio seems to correlate with SCD
ignorance among listeners and this seems to suggest, though not
conclusively, that the presence of SCD information might correlate
with reduction of SCD ignorance among listeners.
The question of who sets the media agenda has been engaged almost
only in political communication circles (See Olorunnisola, 2006).Health
communication researchers have not paid enough attention to this.
Recommendations
     In many cases, the media do not just set agenda and prime an issue
just because it is there. Often, some external subtle and implicit
pressure brings the media searchlight to beam on an issue. Our study
suggests that media must be primed in order for it to set the social
agenda with health in its proper position on the agenda. It appears that
the overwhelming attention given to HIV/AIDS is setting media agenda
in a way not favorable for SCD and other health conditions that may be
as critical as, if not more critical than, HIV/AIDS.
     The question of who sets the media agenda has been engaged almost
only in political communication circles (See Olorunnisola, 2006).
Health communication researchers have not paid enough attention to
this. In many cases, the media do not just set agenda and prime an
issue, just as Atanda(1996, pp 3-34) has idicated.
A nexus of political and economic factors combine to make radio fail
to contribute to sickle cell knowledge in Nigeria. Government is not
committed to SCD education, SCD programs are not sponsored and so
yield no profit for stations, radio workers are ill-prepared and station
management puts money first. The place to begin is with a change of
attitude by the ministries of health and information and station
management.
SCD advocacy groups in Nigeria (such as the Sickle Cell
Foundation) need to refocus their advocacy. Rather than simply
providing care and support for those suffering from SCD, they should
be more proactive and more focused on informing the public. They
should make efforts to educate carriers on the need to choose their
spouses wisely. They should also be more active in media advocacy.
They are in a good position to prime the media pump. National and
international donor agencies should support SCD education and
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the failure of radio to communicate knowledge of sickle cell disorder
intervention. Nigeria government at various levels must create
awareness about SCD, and make efforts to carefully discourage, and
possibly outlaw cultural and other practices that provide a fertile
ground for the spread of SCD or stigmatize those suffering from SCD.
The blame for SCD ignorance is beyond radio.
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