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A Study of Aspects of Academic Performance And A STUDY OF ASPECTS OF ACADEMIC PERFORMANCE AND ITS DETERMINANTS AMONG PRIMARY SCHOOL CHILDREN WITH ASTHMA ATTENDING THE UNIVERSITY OF NIGERIA TEACHING HOSPITAL, ENUGU, NIGERIA A DISSERTATION SUBMITTED TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF FELLOWSHIP IN THE FACULTY OF PAEDIATRICS BY NDUAGUBAM OBINNA CHUKWUEBUKA MBBS 2004 May 2015 0 DECLARATION I hereby declare that this work is original unless otherwise acknowledged. The work has neither been presented to any other College for Fellowship nor has it been submitted anywhere for publication. …………………............................................................. DR. NDUAGUBAM, OBINNA CHUKWUEBUKA i ATTESTATION We hereby certify that this work was carried out by Dr. Nduagubam O. C. under our supervision. We have also supervised the writing of the dissertation. ……………………………………….. DR. T. OGUONU, FMCPaed Senior Lecturer / Consultant Pediatrician Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu State. ……………………………………….. DR. N. OJINNAKA, FWACP Professor / Consultant Pediatrician Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu State. ……………………………………….. DR. R. IBEKWE, FMCPaed Senior Lecturer / Consultant Pediatrician Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu State. ii DEDICATION This work is dedicated to children with asthma all over the world, to my wife, Tersy and our children, Ikenna, Chioma and Inya-Ishor. iii ACKNOWLEDGEMENT I owe a special gratitude to my supervisors, Dr T. Oguonu, Prof N. Ojinnaka and Dr R. Ibekwe for their approachability and guidance towards the successful completion of this work and for their inspiration which was a source of strength to me throughout this study. My acknowledgement also goes to Prof B. Ibe, Prof G. Adimora, Prof I Emodi, Dr. N Ikefuna, Dr. A. Ubesie, Dr. E. Aronu, Dr. H. Obu, Dr. B. Tagbo, Dr. A. Ayuk, Dr. O. Ezenwosu, Dr. J. Eze, Dr B. Edelu, Dr. C. Eke and Dr J Chinawa, all Consultant Pediatricians in the Department of Paediatrics UNTH, for their concern and suggestions during the study. This study would not have been possible without the co-operation of the head teachers and teachers of the various schools visited during data collection as well the tireless efforts of my statistician, Mr. Ikenna Uche. I am truly indebted to them. I am grateful to my parents, Aji Nv’ Owa, Igwe and Nono Nduagubam, who gave my effort the needed blessing. I wish to acknowledge my wife, Theresa Agbo Nduagubam, for her understanding and sacrifice throughout this work. Finally, I thank God Almighty for His constant love, preservation and strength. iv TABLE OF CONTENTS Pages DECLARATION ...……………………..……………… i ATTESTATION ………………………..……………… ii DEDICATION …………………………..…………… iii ACKNOWLEDGEMENT ……………………………………….. iv TABLE OF CONTENTS ……………………………………….. v LIST OF TABLES ……………………………………….. vi LIST OF FIGURES ……………………………………….. viii LIST OF ABBREVIATIONS ……………………………………….. ix SUMMARY ………………………………………... x INTRODUCTION ...……………………………………… 1 LITERATURE REVIEW ………………………………………… 3 AIM AND OBJECTIVES .………………………………………... 20 METHODOLOGY .………………………………………... 21 RESULTS .………………………………………... 31 DISCUSSION .………………………………………... 61 CONCLUSION .………………………………………... 71 LIMITATIONS OF THE STUDY .……………………………….……….. 72 FUTURE RESEARCH NEED ……………………………………..….. 73 REFERENCES ...………………………..……………... 74 APPENDICES ..……………………………………….. 83 v LIST OF TABLES Pages Table I: Age and sex distribution of the subjects and control 33 Table II: Comparison of median overall and specific subjects scores of subjects and controls 36 Table III: Comparison of median overall and specific subjects scores of male subjects and controls 37 Table IV: Comparison of median overall and specific subjects scores of female subjects and controls 38 Table Va: Comparison of academic performance of male and female subjects 39 Table Vb: Comparison of median overall and specific subject scores of male and female subjects. 39 Table VIa: Comparison of academic performance of male and female controls 40 Table VIb: Comparison of median overall and specific subject scores of male and female controls 40 Table VII: Age specific comparison of median overall scores between subjects and controls 41 Table VIII: Comparison of academic performance and asthma control of subjects 43 Table IX: Age specific comparison of academic performance and asthma control of subjects 44 Table X: Comparison of asthma control and school absence among subjects 48 Table XI: Association between academic performance and number of days of absence of subjects and controls 49 Table XII: Age specific comparison of school absence between subjects and controls 50 Table XIII: Mean ± SD overall and gender-related DAPQ scores of subjects and control 52 vi Table XIV: Age specific comparison of mean DAPQ scores of subjects and controls 53 Table XV: Relationship between academic performance and socio-economic class in subjects and controls 56 Table XVI: Multiple linear regression result of predictors of academic performance in subjects 58 Table XVII: Multiple linear regression result of predictors of academic performance in controls 59 vii LIST OF FIGURES Pages Figure 1a: A scatter diagram showing the relationship between IQ and academic performance among subjects 54 Figure 1b: A scatter diagram showing the relationship between IQ and academic performance among controls 54 viii LIST OF ABBREVIATIONS ACT – Asthma Control Test ACSS – Asthma Control Scoring System ACQ – Asthma Control Questionnaire ANOVA – Analysis of Variance ATAQ – Asthma Therapy Assessment Questionnaire ATS – American Thoracic Society C-ACT – Childhood Asthma Control Test DAPA – Draw-A-Person Age DAPP – Draw-A-Person Point DAPQ – Draw-A-Person Quotient DAPT – Draw-A-Person Test ERS – European Respiratory Society GINA – Global Initiative on Asthma IQ – Intelligence Quotient LASS – Lara Asthma Symptom Scale MAP – Missouri Assessment Program PIAT – Peabody Individual Achievement Test PACT – Palmetto Achievement Challenge Test SB – Stanford- Binet SPM – Standard Progressive Matrices SPSS – Statistical Package for Social Sciences UNTH – University of Nigeria Teaching Hospital WHO – World Health Organization WISC – Wechsler’s Intelligence Scale for Children WJ – Woodcock–Johnson WRAT – Wide Range Achievement Test ix SUMMARY There is a paucity of data on the academic performance of Nigerian children with asthma. In order to address this gap in knowledge, this study examined aspects of the academic performance of children with asthma in Enugu, Nigeria with the aim of determining the influence of asthma on school absence rate, intelligence quotient (IQ) and socio-economic status. The academic performance, intelligence quotient and school absence rates of 120 children with asthma (subjects) and that of age-, sex- and socio-economic class- matched children without asthma (controls) attending primary schools in Enugu metropolis were studied. The overall academic performance as well as performance in selected key subjects was assessed using scores achieved in examinations in the 2012/2013 academic year. Intelligence quotient was assessed using the Draw-A-Person Test (DAPT) while school absence rate was extracted from the class attendance register. Socio-economic class was ascertained using the classification by Oyedeji while the level of asthma control in the subjects was assessed using the Childhood Asthma Control Test (C-ACT). Statistical Package for Social Sciences (SPSS) software for Windows® version 19.0 (IBM Inc Chicago Illinois USA, 2011) was used for analysis. Descriptive statistics such as mean and median were obtained for continuous variables while categorical variables were summarized using frequencies and percentages. The comparison of means of IQ that was normally distributed was done using Student’s t-test and Analysis of Variance (ANOVA) while other variables that were not normally distributed such as Academic performance and school absence were compared using the Mann-Whitney U test. Association between categorical variables was determined using chi-square. Level of significance was set at p < 0.05. x The median (range) overall academic scores for the subjects and controls were 79.04% (36.08% - 99.57%) and 80.01% (50.65% - 97.47%), respectively. The difference was not statistically significant (U = 6804, p = 0.461). There was also no significant difference in the academic performance of subjects and controls in selected subjects: - English Language (U = 6408, p = 0.141), mathematics (U = 6633, p = 0.292), science (U = 7074, p = 0.815) and social studies (U = 6151, p = 0.051). The overall academic performance of subjects with poor asthma control was not significantly different from that of those with good control (U= 1235, p = 0.486).The subjects had more days of absence from school (U = 5103, p = < 0.001) compared to controls. School absence had no significant relationship with academic performance among subjects (x2 = 3.915, d.f = 2, p = 0.141) and controls (x2 = 0.586, d.f = 1, p = 0.444). The IQ of the subjects (123-28 ± 21.45) did not differ significantly from those of controls (118.41 ± 19.87; t = 1.826, p = 0.069). There was a significant positive correlation between IQ and academic performance among both subjects (r = 0.218, p = 0.017) and controls (r = 0.308, p = 0.001). There was also a significant positive correlation between socio-economic class and academic performance among the subjects (r = 0.194, p = 0.034) but
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