Published on 03.07.23 in Vol 6, No 1 (2023): Jan-Dec
Preprints (earlier versions) of this paper are available at http://preprints.jmir.org/preprint/44441, first published Nov 19, 2022.
Original Paper
Epidemiology and Perception of Acne Among Adolescents in Jos, Nigeria: Cross-Sectional School-Based Study
ABSTRACT
Background: Adolescents who make up a vast majority of the secondary school population are at a stage at which they are largely affected by acne. This condition, which is widely visible and easily recognized by peers, has numerous misperceptions surrounding it, which may influence attitudes toward people affected by it. There is a paucity of information on the prevalence of acne and how adolescents in Jos, Nigeria, view the condition.
Objective: This study aimed to determine the prevalence of acne, perceived risk factors, and the accuracy of self-report among adolescents in Jos, Nigeria. The study also sought to understand perceptions surrounding acne in this age group.
Methods: This descriptive cross-sectional study was conducted among adolescents attending private and public secondary schools in Jos, Nigeria. In total, 482 students were recruited through a multistaged stratified random sampling method. A self-administered semistructured questionnaire was used to collect information on history of acne, perceptions of causes, and the attitude toward those who have the condition. All participants were examined for the presence of acne. Univariate, bivariate, and multivariate analysis were conducted using SPSS (version 26; IBM Corp).
Results: The self-reported prevalence of acne was 44% and that upon clinical examination was 55%. Self-report showed a moderate degree of agreement with clinical diagnosis (Cohen κ=57.3%; P<.001). Predictive factors for the presence of acne in general were age of ≥15 years (odds ratio [OR] 1.79, 95% CI 1.12-2.87; P=.02), being in a private school (OR 2.17, 95% CI 1.38-3.42; P=.001), and being in a senior secondary class (OR 2.14, 95% CI 1.32-3.47; P=.002). The female gender (OR 3.03, 95% CI 1.64-5.61; P=.001) and religion (OR 3.24, 95% CI 1.27-8.24; P=.02) were predictive for acne only among adolescents aged <15 years, while a positive family history was predictive in those aged ≥15 years (OR 2.04, 95% CI 1.15-3.61; P=.02). A distinct perception and attitude pattern surrounding acne was observed, as a significant proportion (84/131, 64.1% vs 47/131, 35.9%; P=.02) of those who related acne to a biological phenomenon had acne themselves; however, while the belief that acne is caused by skin lightening practices was significantly more common in those without acne (19/28, 67.9%) than in those with acne (9/28, 32.1%; P=.01). One-fourth of the adolescents (n=122, 25.3%) had no idea of the possible causes of acne.
Conclusions: Though acne is a prevalent skin condition among Nigerian adolescents, many misperceptions and unfavorable attitudes surround acne and persons affected by the condition. Our findings have revealed the need to work with the school health program to educate the general adolescent population about acne and to refer and manage teenagers with acne.
JMIR Dermatol 2023;6:e44441
doi:10.2196/44441
KEYWORDS
Introduction
Acne vulgaris is a disease of the pilosebaceous units of the skin of the face, neck, chest, shoulders, and back. The condition typically starts at puberty and is induced by abnormal follicular keratinization, excessive sebum production, Propionibacterium acnes colonization, and localized inflammation. In addition to the typical lesions of comedones, papules, pustules, nodules, and cysts, there may be scarring and postinflammatory hyperpigmentation [
, ]. According to the Global Burden of Disease study [ ], the estimated global prevalence of acne in 2010 was 9.38%, and acne ranked as the eighth most prevalent skin condition worldwide.Few conditions exist where there is significant prevalence of acne across countries and cultural groups. Reported prevalence varies in accordance with age groups and is influenced by the different methods used in studies. Identification of acne by experts through clinical examination in certain studies have revealed a prevalence almost equivalent to the total number of adolescents examined [
- ]. Studies based on adolescent self-report have also reported substantial prevalence rates (49.8%-83.4%) [ - ]. Self-report by affected individuals has shown some validity as fair to good agreement with experts’ diagnosis has been demonstrated, albeit insufficient for both treatment and research purposes [ - ].The etiology of acne is multifactorial, and diet has frequently been implicated as a risk factor in acne occurrence and severity. High-glycemic-index foods, including those with high carbohydrate and sugar content, combined with low intake of vegetables and high intake of dairy products have been associated with the occurrence or severity of acne [
, ]. These factors are known to be individualized and influenced by genetics; thus, family history has also been identified as a predisposing factor [ ]; other commonly documented factors are heat and humidity, overweight, use of skin and hair care products such as pomades [ , ]. Furthermore, there are many acne-related beliefs held with little supporting evidence, which influence health-seeking behaviors and attitudes toward persons with acne [ , ]. Inadequate awareness of acne has also been linked to stigma, discrimination, low self-esteem, depression, and suicidal thoughts in affected adolescents who are still undergoing physical and psychological maturation. Thus, taking into account adolescents' knowledge of acne is useful in developing approaches to health education and management [ - ].Studies have reported that the prevalence of acne in adolescents and youths in Nigeria is between 30% and 90.7%, with documented associated factors possibly unique to those regions where the studies were conducted—mostly Southern Nigeria [
, , , ]. For instance, Jos, seated on a plateau that has cooler weather with food items cultivated and consumed that are unique to the state, may have a distinct epidemiology of acne among its adolescents. This study, therefore, aimed at ascertaining the prevalence of acne among adolescents in Jos, Nigeria, associated factors, and the reliability of self-report when compared to clinical diagnosis. An additional goal of the study was to document adolescents' perceptions about the causes and attitudes toward persons with acne.Methods
Overview
Jos is the capital of state of Plateau in North-Central Nigeria, with a significantly cooler temperature than that in other states in Nigeria. It is the center of cultivating vegetables and tubers, which are distributed to other parts of the country. Many settlements in Jos are characterized by persons of similar religion or tribe with their distinctive cultures. Schools are, therefore, influenced by this pattern, such that their populations reflect that of the host community. Furthermore, access to schools in the country is largely based on socioeconomic status as students from poorer homes attend public schools with lower funding while children from families of upper socioeconomic class, who can afford private schools, attend private schools [
].This cross-sectional study was conducted among adolescents at 4 secondary schools in 2 Local Government Areas (LGAs) of Jos Metropolis within a 4-week period, between September and October 2022. Multistage random sampling was used to select 482 students in the schools in Jos North and Jos South LGAs (1 private and public secondary school in each LGA). The eligibility criteria for schools were that they were coeducational day schools with all 6 class years—the first 3 years termed as junior secondary and the last 3 as senior secondary. Participants were chosen from a sampling frame of each school, which included every class throughout the school using a predetermined sampling interval.
Information regarding demographic characteristics, first-degree family history of acne, perceptions regarding the causes of acne, and the impression that study participants have of others with acne were collected using self-administered questionnaires. All participants had their anthropometric measures (weight and height for BMI calculation) taken and examined privately for acne by a pediatric dermatologist. Participants with a BMI of <18.5 were classified as undernourished; those with a BMI of 18.5 to 24.9 as normal, and those with a BMI of ≥25 as overnourished. All forms of acne (inflammatory and noninflammatory) were recorded as “Acne present.” Data collected were entered into SPSS Statistics for Windows (version 26.0; IBM Corp).
Data were tabulated as frequency and percentage values, while numeric variables were presented as means. The Pearson chi-square test and Fisher exact test were used to analyze the association between categorical groups, and multinomial logistic regression was performed to explore the relationship between the predictor variables and the presence of acne. Odds ratios (ORs) with 95% CIs were used to state the measure of relationship between variables. A P value of <.05 was determined to be the level of statistical significance.
Ethical Considerations
The study was approved by the Research and Ethical Committee of the Jos University Teaching Hospital, Jos (JUTH/DCS/IREC/127/XXX1/2750). Permission was sought from each school, and written informed consent was obtained from the guardians or parents of the students prior to their involvement. Participation was voluntary, and each student could withdraw from the study at any time.
Results
Respondent Demographic Characteristics
Of 482 students selected and provided consent forms for their parents or guardians, 14 of them refused to consent, did not have capacity to fully understand and fill in the questionnaire, or were absent, so they were replaced by the next student on the list whose parents or guardians had provided consent.
The age range of the participants (9-21, mean 14.6, SD 2.2 years) was wider than expected in Nigerian secondary schools (11-17 years). There were more female (292/482, 60.6%) than male students. The general ratio of male and female students was 1:1.5; however, the male:female ratio in public schools (1:2.1) was higher than that in private schools (1:1.2). Students’ BMI ranged from 12.9 to 29.9 (mean 19.5, SD 3.1) with only 24 of 482 (5.0%) being overnourished (having overweight and obesity) and 189 (39.2%) being undernourished (
).