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British Journal of Healthcare and Medical Research - Vol. 10, No. 4
Publication Date: August 25, 2023
DOI:10.14738/bjhmr.104.15057.
Lawal, I., Danraka, A., Amlogu, A., Akande, A., & Ameh, F. S. (2023). Evaluation of Knowledge Attitude and Perception to Benign
Prostatic Hyperplasia (BPH) Amongst Public Servants in Federal Capital Territory, Abuja, Nigeria. British Journal of Healthcare and
Medical Research, Vol - 10(4). 62-78.
Services for Science and Education – United Kingdom
Evaluation of Knowledge Attitude and Perception to Benign
Prostatic Hyperplasia (BPH) Amongst Public Servants in
Federal Capital Territory, Abuja, Nigeria
Ibrahim Lawal
National Institute for Pharmaceutical Research and Development, Abuja
Abubakar Danraka
National Institute for Pharmaceutical Research and Development, Abuja
Abraham Amlogu
State House Medical Center, Abuja
Abdulmujeeb Akande
National Institute for Pharmaceutical Research and Development, Abuja
Fidelis Solomon Ameh
National Institute for Pharmaceutical Research and Development, Abuja
ABSTRACT
Background: Benign prostatic hyperplasia (BPH) is a disease condition in men
which affects the prostate gland. There is no consensus about a case definition of
benign prostatic hyperplasia (BPH). The incidence of BPH and Prostate cancer has
risen in recent decades, with very minimal preventive screening through prostate- specific antigen (PSA) testing. However, prostate cancer mortality rates have
remained relatively static over decade. The aim of this study was to determine the
knowledge, attitude and perception to BPH and other forms of Prostatic diseases
amongst random community-based population of 307 men (age 40 and above).
Method: A questionnaire-based descriptive cross-sectional study was carried out
amongst male adults above 40 years of age in the Federal Capital Territory (FCT),
Abuja,Nigeria.A semi-structured and pre-tested knowledge, attitudes and practices
(KAP) questionnaire was administered to the study respondents. Statistical
analysis was carried out for frequency, percentages and chi-square measures to test
for levels of significance using SPSS. Result: The dominant age group of the
respondents was 47 to 49 and majority (38.3 %) had tertiary level of education.
Majority of the participants had no knowledge about BPH (67.1 %), Prostate cancer
(51.1 %) and PSA screening. Knowledge of its NHIS coverage is at 22.9%. Of the
22.9% that are aware of BPH only an average of 20% are aware of the causes. Cross
tabulation of knowledge and attitude of civil servants to BPH, Prostate cancer and
PSA test with variables of the demographic data shown significant (p<0.05)
correlation. Conclusion: Most of the participants had no knowledge about BPH,
Prostate cancer and PSA test. Although some of these associations were statistically
significant whilst majority were insignificant, more in-depth studies are required
to further prove this finding.
Keywords: BPH, PSA, Prostate cancer, knowledge, Attitude, Perception.
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Lawal, I., Danraka, A., Amlogu, A., Akande, A., & Ameh, F. S. (2023). Evaluation of Knowledge Attitude and Perception to Benign Prostatic Hyperplasia
(BPH) Amongst Public Servants in Federal Capital Territory, Abuja, Nigeria. British Journal of Healthcare and Medical Research, Vol - 10(4). 62-78.
URL: http://dx.doi.org/10.14738/bjhmr.104.15057.
INTRODUCTION
Benign prostatic hyperplasia (BPH) is a disease condition in men which affects the prostate
gland as a result the proliferation of both stromal and epithelial cells of the prostate in the
transitional zone surrounding the urethra and is a frequent cause of lower urinary tract
symptoms (LUTS) [1]. In BPH, the prostate gland is enlarged and not cancerous. Benign
prostatic hyperplasia is also known as benign prostatic hypertrophy or benign prostatic
obstruction [1]. It is the most common neoplasm in adult males and also a significant cause of
urinary symptoms in adult males [2].
The pathophysiology cause of BPH is unknown or sometimes complicated and poorly
understood, but it is considered a normal condition of male aging. The risk factors for BPH
include Age, metabolic syndrome, diabetes, obesity, hypertension, diet and sex hormone levels
and a few others, aging is the major causative factor of BPH [3]. Typically, these factors do not
occur in combination, but in certain men they can overlap. Experts in this field have considered
androgens or endogenous sex hormones (namely testosterone, Dihydrotestosterone (DHT),
and estrogen) to play a permissive role in the development of BPH. This means that for BPH to
occur, androgens must be present, but do not necessarily directly cause the condition. This is
supported by evidence from a study on castrated males. [3] The symptoms of BPH are often
very mild initially, but they become more serious if they are not treated. Common symptoms
associated with BPH include incomplete bladder emptying, nocturia (this is the urge to urinate
two or more times per night), dribbling at the end of the urinary stream, urinary incontinence,
pain in urination and others [4]. Also, symptoms of BPH can be obstructive (straining or
prolonged voiding) or irritative (reduced voiding volume) or after micturition (incomplete
emptying) [5]. There are different risk factors associated with BPH which on a population level
can be divided into two (2) broad categories. These are the non-modifiable (age, geography and
genetics) and modifiable (sex steroid hormones, the metabolic syndrome, obesity, diabetes,
physical activity, diet, and inflammation) [6]. Age is a major risk factor in the development of
BPH. The prevalence of BPH rises markedly with age. It is the most prevalent disease among
men beyond middle age. Autopsy studies show that histological BPH is present in 50% of men
in their 60s, rising to 90% in men >85years of age [7]. Also, symptoms have been seen to
increase with increasing age. Another risk factor for developing BPH is genetics. Evidence from
studies have suggested that there are genetic components to BPH. Therefore, those with a
family history of the disease are more likely to develop it. [6]. Obesity can also contribute to the
development of BPH. In one study, obese (BMI ≥ 35 kg/m2) participants had a 3.5-fold
increased risk of prostate enlargement compared with non-obese (BMI <25 kg/m2)
participants. [8]. Those with cardiovascular and metabolic diseases are also at risk of
developing the condition. [6]
BPH, if left untreated is associated with several complications of which the most common
presenting complication that requires hospitalization is acute urinary retention. This greatly
affects patients’ quality of life and is an important health issue. Urinary retention is the inability
to completely empty the bladder of urine. Many of the other complications of BPH are in part
due to complications of chronic urinary retention; these include recurrent urinary tract
infections (UTIs), formation of bladder calculi, hematuria, and damage to bladder wall and
kidneys. Finally, there is an important association between BPH and male Erectile Dysfunction
(ED). This has been supported by medical experts and articles [9].
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British Journal of Healthcare and Medical Research (BJHMR) Vol 10, Issue 4, August- 2023
Services for Science and Education – United Kingdom
Worldwide, the prevalence of BPH is very high. Data suggests the prevalence varies from 20 -
62% in men over 50 years and this includes USA, UK, Japan and Ghana [10]. In Nigeria, a study
conducted in the south-west region gave an overall prevalence of 237 per 1000 men (23.7%).
The age-specific prevalence rates increased from 104 per 1000 men in the fifth decade to 429
per 1000 in men >90 years [11]. Efforts at improving awareness about prostatic diseases
should not be directed at malignant diseases but also towards benign conditions which are by
far more common than malignant ones. This will also reduce morbidity and mortality
significantly. Due to the prevalence of BPH in Nigerian men, the exposure of civil servants to
some important risk factors associated with the development of BPH such as Type 2 Diabetes
Miletus and Hypertension, and the complications of untreated BPH necessitates carrying out a
survey on the awareness of civil servants to BPH. This study therefore aims to evaluate the
attitude, knowledge, and perception of civil servants in the Federal Capital Territory (FCT),
Nigeria to Benign Prostatic Hyperplasia.
METHOD
Study Design, Setting and Population
The method used was a questionnaire-based descriptive cross-sectional study carried out
amongst male adults in the Federal Capital Territory (FCT), Abuja, Nigeria. The target
population was male adult civil servants above 40 years of age.
Inclusion Criteria
Adult male civil servants above 40 years living in the Federal Capital Territory (FCT), Nigeria
Exclusion Criteria
Men under 40 years of age, men who are not civil servants, women and children, adult male
civil servants who are not residing in the FCT.
Ethical Issues
Consent was also sought and obtained from each participant before issuing out the
questionnaire to them.
Sampling Techniques
A multi-sampling technique was used in the study. Participants were stratified and selected
based on convenience sampling.
Data Collection
A semi-structured and pre-tested knowledge, attitudes and practices (KAP) questionnaire
containing sections on demography, knowledge, attitudes and awareness regarding BPH
screening was used as the instrument for data collection.
Data Analysis
Data from the participants will be analyzed with SPSS and the results will be displayed in tables
and chart. Knowledge about prostatic diseases will be determined based on responses to 20
knowledge-based questions. Respondents with 0-10 correct responses will be concluded to
have poor knowledge while those with 11-20 will be concluded to have good knowledge.
Attitude of participants to BPH will be judged based on the appropriateness of their responses
to the six questions on attitude of civil servants to Prostate Specific Antigen (PSA) Test.