Research Finds Poor Awareness and Photoprotective Behaviors Among Individuals With Albinism in Nigeria

Persons with albinism (PWAs) living in Uyo, Nigeria, are at great risk of developing photodermatoses and even skin cancer due to poor awareness and lack of proper photoprotective behaviors, according to a recent report published in the Journal of the European Academy of Dermatology and Venereology.¹

The report found that 80% of PWAs in this region acknowledged the daily use of photoprotection, though they also uncovered an overall low sun-protection strategy usage of 5% with a mere 10% knowledge rate.

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Background and Methods

While oculocutaneous albinism persists globally, PWAs living in the sub-Saharan region face greater burden of disease, given factors such as pervasive social stigmatization, limited access to health care and resources, and high levels of solar radiation.²

A 2023 study published in Nigeria Acta Scientific Medical Sciences² found that a significant proportion of PWAs local to Ogun State, Nigeria, reported poor (43.84%) or very poor (26.03%) quality of life, particularly in physical health and financial satisfaction. Another study from the International Journal of Medicine and Health Development³ reported that despite high burden of disease in PWAs living in southeastern Nigeria, only 22.5% of individuals had known about sunscreen for more than 10 years, and 90% of participants had poor knowledge about what constitutes an effective sunscreen.

With these statistics in mind, researchers Ighorodje et al conducted a cross-sectional study at an albinism outreach event in Uyo, Nigeria, using consecutive sampling related to PWAs' knowledge and use of photoprotective behaviors. Good photoprotective knowledge was defined as using 4 or more protective strategies, and good sunscreen usage was defined as use of sunscreen with a minimum of 1 additional form of photoprotection.

Responses were collected from parents or guardians of PWAs if the individual was under the age of 18.

Findings

Among the 50 participants (PWAs), 60% were female, and 62% were under 18 years of age. Researchers also collected additional socioeconomic data, such as marital status, occupation, income, level of education, religion, and tribe (Ibibio, Oron, Annang, Efik, and others).

Researchers found that knowledge (80%) and usage (90%) of photoprotective strategies were poor, with 90% of individuals unaware of the meaning of SPF and 66% of PWAs unclear on the correct application of sunscreen, including reapplication frequency.

While awareness of sunscreen was 54%, most individuals reported learning about it primarily from other PWAs. Furthermore, more than half of surveyed individuals were unable to clarify the differences between sunscreen formulations, including mineral versus chemical.

Nearly 3 out of 4 (>72%) reported that they had not applied sunscreen in the most recent 30 days, citing cost as a barrier.

Access and barriers to care proved to be significantly common among the PWAs surveyed, with a mere 14% reporting the ability to reach a dermatology clinician within 30 minutes of their home.

In total, 66% of PWAs had heard of sunburn, while 50% had heard of skin cancer, and 28% had heard of freckles as photodermatoses. Fewer still, 16% of individuals exhibited an awareness of photoaging, and 4% had heard of solar elastosis or actinic keratosis.

Conclusions

Limitations of the study included its limited scope and use of one-time assessment, which may mean its findings are not universally applicable. However, these results should be used to inform PWAs and their health care providers in order to improve patient care.

"Photodermatoses, and particularly skin cancer in PWA is a public health issue. This study reveals a concerning lack of advocacy and persisting challenges amongst PWA in Uyo to achieve strict photoprotection," according to study authors Ighorodje et al.

Study authors further recommended dermatology clinicians provide continuous education by utilizing multimedia resources in various local languages to provide ongoing education, work with support groups to strengthen efforts and reach more individuals, and promote national or state initiatives to improve the affordability and accessibility of photoprotective measures.

References

1. Ighorodje EE, Nga CN, Atansi CC, Ukpong OY, Fabiyi MO, Nelson UAU. Photoprotective behaviours amongst persons with albinism in Uyo, Nigeria. J Eur Acad Dermatol Venerol. Published online June 14, 2024. https://doi.org/10.1002/jvc2.482
2. Ijioma CE, Ejikem PI, Abali IO, Areh JE, Ogwu CI, Odarah JE, et al. Quality of life and photodermatoses in people with albinism in ogun state. Nigeria Acta Sci Med Sci. 2023; 7(10): 2–17.
3. Ojinmah U, Onyekonwu C, Obi I, Uche-Ejekwu J, Onodugo N, Anyanechi C, et al. Sunscreen use among albinos in Enugu, South-Eastern Nigeria. Int J Med Health Dev. 2021; 26(3): 139.