Prevalence, factors associated and coping mechanisms of low self-esteem among adolescents with sickle cell disease attending Mulago National Referral Hospital Sickle Cell Clinic

Abstract

Background: Sickle Cell Disease (SCD) is a chronic genetic disorder affecting about 112 per 100,000 live births globally, with adolescents being a vulnerable population. Beyond the physical symptoms, SCD has a profound impact on an adolescent’s mental health due to increased morbidity. Learning positive coping strategies is crucial in SCD management as it reduces depression and strengthens family bonding. However, there is limited information about low self-esteem among adolescents with SCD in Uganda. Objective: To determine the prevalence, factors associated, and coping mechanisms of low self-esteem among adolescents with SCD attending the Sickle Cell Clinic (SCC) at Mulago National Referral Hospital (MNRH). Methods: This was a sequentially explanatory mixed methods study conducted at the SCC of MNRH, between January 2024 and March 2024. 356 adolescents were enrolled, and quantitative data on prevalence and factors associated with low self-esteem was assessed using Rosenberg self-esteem (RSE) and interviewer-administered questionnaires. Qualitative data on coping mechanisms was collected from nine adolescents (five with normal and four with low self-esteem) using in-depth interviews and three key informant interviews among health workers. Results: The prevalence of LSE was 21.6% (95% CI 17.6-26.3%), with low school absenteeism (PR 0.94, p=0.012), increased physical activity (PR 0.94, p=0.005) and limited social involvement (PR 1.16, p=0.014) as associated factors to LSE. Coping mechanisms were; medication adherence, eating healthy with drinking plenty of water, engaging in social activities and hobbies, praying, and awareness of their peers with SCD. Conclusion: Adolescents with SCD are at risk of developing low self-esteem. Thus, healthcare providers, parents, and teachers should encourage and support adolescents with SCD to engage in safe and manageable physical and social activities and promote experiences of success and positive peer relations which are important sources of self-esteem.