CHAPTER ONE
INTRODUCTION

1.1 Background of the Study

Leukaemia is a malignant disorder of the blood and bone marrow in which the body overproduces white blood cells, which causes the immune system of the body to become weak and disrupts the process of normal production of blood cells (Naik et al., 2020; Carpenter, Haut, et al., 2025). In children, there are different types of leukaemia, with the most common ones being acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) (Devantier et al., 2025). Physically, affected children frequently suffer fatigue, pallor and recurrent infections and have a tendency to bruise easily, which may prevent them from participating in school activities (Kivistik et al., 2025; Alhaddad et al., 2025). Emotionally, the diagnosis and treatment process may cause anxiety, depression and social withdrawal (Ruble et al., 2020). Academically, the children with leukaemia may face breaks in learning due to the fact that they are hospitalized and undergoing treatment which can affect the level of concentration and achievement (Frenk et al., 2022). It is important that educators should understand these complex effects in order to offer quality support and inclusion.

Globally, childhood leukaemia accounts for about 30% of all the pediatric cancers with an estimated incidence of 160,000 new cases each year (Alatawi, 2025; Said et al., 2025). Due to the improvement in both diagnosis and treatment, survival rates have also been increased with developed countries reporting five-year survival rates of over 85% for ALL and 65% for AML (Smith et al., 2023; Moore et al., 2025). In Africa, however, survival rates are lower and range from 20% to 50% due to delayed diagnosis, lack of access to treatment and socioeconomic status (Cildogan & Topan, 2025; Biswas, 2025). These statistics identify the disparity in the global cancer outcomes in children and the need for supportive systems that meet the medical and psychosocial needs of children with cancer.

In Nigeria, childhood leukaemia accounts for a substantial portion of paediatric cancers, however, data at a national level is limited and most gets underreported (Garzon et al., 2025; Zhuo et al., 2025). Estimates suggest that leukaemia affects about 1,500 to 2,000 children every year and Oyo State is clearly having a number of cases of this disease because of its high population density and concentration of tertiary hospitals with pediatric oncology services (Taylor et al., 2023; Kawabe et al., 2025). Survival rates are lower than that of high-income countries, mainly because of the following reasons: late presentation, poor treatment infrastructure, and financial burden (Auf et al, 2023; Naik et al, 2020). These figures show a pressing need for comprehensive support mechanisms such as interventions within the educational setting in order to better the outcomes for children with leukaemia.

Schools and teachers play a critical role in the life of children with chronic illnesses as they are places where academic continuity, social inclusion and psychosocial support converge (Carpenter, Haut, et al., 2025; Devantier et al., 2025). Accommodations that can be offered by educators include flexible schedules, altered workload, and customized instructional plans to learn in spite of frequent absences (Kivistik et al., 2025; Alhaddad et al., 2025). Also, educators are able to support understanding and emotional integration among peers, which reduces the experience of isolation and anxiety that commonly come with severe diseases (Ruble et al., 2020; Frenk et al., 2022). The school environment is thus a critical adjunct to medical care that helps to support cognitive as well as emotional development of children with leukaemia.

Cultural and social perception has a great impact on the understanding and management of childhood leukaemia in Nigeria. Cancer, including leukaemia, tends to be stigmatized, fearsome, and fatalistically believed, which results in social isolation of cancer-affected children (Alatawi, 2025; Said et al., 2025). Misperceptions about causes, treatment and prognosis can produce further emotional suffering in children and their families, and have an impact on interactions in educational settings (Smith et al., 2023; Moore et al., 2025). These cultural stories should be known by teachers and school administrators in order to offer informed and sensitive support that overcomes stigma and supports acceptance.

Research that has been conducted looking at the awareness, knowledge and attitudes of teachers towards children with serious health conditions suggests that there is variability in terms of preparedness and understanding (Cildogan & Topan, 2025; Biswas, 2025). Some investigations have indicated that teachers have inadequate knowledge of cancer symptoms, treatment side effects, and even appropriate classroom accommodations and that this can influence confidence and willingness to support affected children (Garzon et al., 2025; Zhuo et al., 2025). However, positive attitudes and sufficient training are related to better educational inclusion and psychosocial support (Taylor et al., 2023; Kawabe et al., 2025). Assessing the perspectives of teachers is therefore important to help design interventions to promote improvements in academic and emotional outcomes of children living with leukaemia.

In the context of primary schools in Ibadan, Oyo State, assessing teacher's awareness and attitudes on the issue of participating in supporting children with leukaemia is of particular relevance. These educators are faced with children who have varying health needs, and play a significant role in the implementation of accommodations, promoting inclusion, and facilitating peer understanding (Auf et al., 2023; Naik et al., 2020). The awareness of the knowledge and attitudes of teachers allows the investigation of professional development plans, the distribution of resources, and the school policies that can enhance the educational process and quality of life of the children in question (Carpenter, Haut, et al., 2025; Devantier et al., 2025). This study is guided by the need to bridge the gap in awareness and encourage supportive learning environment for children with leukaemia that will contribute to improved educational and psychosocial outcomes in Ibadan.

1.2 Statement of the Problem

Despite the dramatic improvements in the treatment of childhood leukaemia, such that survival rates are improving globally and across the UK, children with this disease still suffer from their educational progress and psychosocial well-being (Naik et al., 2020; Carpenter, Haut, et al., 2025). Frequent hospitalizations, long schedules of treatment, and physical side effects have often resulted in long school absences, poor academic performance, and difficulties in sustaining peer relationships (Devantier et al., 2025; Kivistik et al., 2025). Such interruptions may contribute to emotional discomfort, anxiety, and other feelings of social isolation, and it is necessary to consider specific educational support options in primary schools (Alhaddad et al., 2025; Ruble et al., 2020). Children with leukaemia have not been subjected to conscious efforts to help them avoid educational and psychosocial disadvantages even with medical advances.

A critical factor that contributes to these challenges is the apparent lack of knowledge that teachers seem to possess about leukaemia, its clinical presentations and implications of treatment on learning and participation in the classroom (Frenk et al., 2022; Alatawi, 2025). Most of the teachers might be unaware of the symptoms, including fatigue, vulnerability to infections, and issues with concentration, which may lead to classroom engagement (Said et al., 2025; Smith et al., 2023). Furthermore, a lack of familiarity with suitable accommodation such as flexible scheduling, modified teaching strategies and psychosocial support limits teachers’ ability to respond effectively to the needs of children living with leukaemia (Moore et al, 2025; Cildogan and Topan, 2025). This knowledge gap directly affects the quality of inclusion and care children receive in the primary schools.

In addition to knowledge deficits, misconceptions or negative attitudes towards children with serious health conditions may be a barrier to supportive practices in school (Biswas, 2025; Garzon et al., 2025). The beliefs held by teachers regarding the severity, prognosis or social implications of leukaemia can be the cause of the stigmatization process, social exclusion or the unwillingness to make the required academic accommodations (Zhuo et al., 2025; Taylor et al., 2023). These attitudes, of course, whether they are shaped by cultural perceptions or lack of training, can unintentionally compromise the emotional and academic well-being of affected children, and further highlight the importance of assessing the views of educators.

Empirical study specifically done on the awareness and attitude of primary school teachers towards children with leukaemia in Ibadan, Oyo State, is still scarce (Kawabe et al., 2025; Auf et al., 2023). Without such data, interventions to strengthen the preparedness of teachers, promote inclusive practices and offer psychosocial support are limited or poorly informed. Consequently, children with leukaemia may continue to experience avoidable educational interruptions, low levels of academic engagement and psychological distress. These gaps need to be understood and managed then to enable that the increasing number of childhood leukaemia survivors will be able to enjoy supportive, inclusive and equitable learning experiences in primary schools.

1.3 Objective of the Study

The broad aim of this study is to asses of teachers’ awareness and attitudes toward supporting children with leukaemia in primary schools. The specific objectives are as follows;

1. To assess the level of teachers’ awareness of childhood leukaemia in primary schools in Ibadan, Oyo State.

2. To evaluate teachers’ knowledge of the signs, symptoms, and treatment implications of childhood leukaemia.

3. To examine teachers’ attitudes toward supporting children diagnosed with leukaemia in primary schools in Ibadan.

4. To examine the relationship between teachers’ level of awareness and their attitudes toward supporting children with leukaemia in primary schools in Ibadan.

1.4 Research Questions

1. What is the level of teachers’ awareness of childhood leukaemia in primary schools in Ibadan, Oyo State?

2. What is the teachers’ knowledge of the signs, symptoms, and treatment implications of childhood leukaemia?

3. What are the teachers’ attitudes toward supporting children diagnosed with leukaemia in primary schools in Ibadan?

4. What is the relationship between teachers’ level of awareness and their attitudes toward supporting children with leukaemia in primary schools in Ibadan?

1.5 Research Hypotheses

Ho: There is no significant relationship between teachers’ level of awareness and their attitudes toward supporting children with leukaemia in primary schools in Ibadan.

Ha: There is a significant relationship between teachers’ level of awareness and their attitudes toward supporting children with leukaemia in primary schools in Ibadan.

1.6 Significance of the Study

The results of this study will benefit mostly the primary school teachers in Ibadan, Oyo State. Understanding the levels of awareness and present-day attitudes to children with leukaemia will provide teachers with knowledge of the disease, its symptoms, and educational and emotional needs of children with leukaemia. Increased awareness has the potential to improve accommodating classroom delivery, such as flexible teaching, individual accommodations, and good psychosocial interventions. Teachers will also learn about ways to combat stigma and encourage non-stigmatizing relationships at school, so that they can provide a safer and more nurturing learning environment for all students. This knowledge will lead to improved teacher confidence and preparedness in dealing with the needs of children with chronic illnesses and ultimately improve educational outcomes as well as emotional well-being.

School administrators and policymakers will also benefit from the study, because it presents empirical evidence on gaps in teacher preparedness and school support systems. The findings can feed into professional development programs, targeted training workshops and policy initiatives to bring about inclusive education of children with leukaemia. Recommendations arising from the research can be used to inform the allocation of resources, changes to the curriculum, and support services in schools that will ensure that affected children have equal access to opportunities to learn. Schools can have systems in place for monitoring academic progress and psychosocial care promoting a holistic approach to student welfare.

The study will also be of added benefit to parents and caregivers of children with leukaemia in terms of emphasising the role of schools and teachers in complementing home-based care. When educators are aware and responsive, children can experience less disruption to their learning, have fewer feelings of isolation and have greater emotional resilience. The findings may also promote joint efforts between the parents and the teachers, communication, mutual strategies and coordination in covering the child's educational and psychological needs.

Finally, the researchers and scholars will have access to localised information about the knowledge, attitudes, and perceptions of teachers related to children with leukaemia in primary schools. This can be a basis for further studies on educational inclusion, chronic illness management through the school system, and culturally sensitive interventions. The study adds to the wider debate on inclusive education, childhood cancer and psychosocial support and offers lessons that can be drawn for other contexts both nationally and regionally.

1.7 Scope of the Study

The focus of the study is to assess the awareness and attitude of primary school teachers to children diagnosed to be having leukaemia in ibadan and oyoyo state. Empirically, it investigates the knowledge of childhood leukaemia among teachers including knowledge of the signs and symptoms of the illness and its treatment implications, as well as teachers' attitude towards giving academic and psychosocial support to students affected with leukaemia. The research also examines the link between the awareness level of teachers and their attitudes with the goal to know how knowledge can affect the supportive practices in the classroom. Geographically, the research is limited to selected public and private primary schools located within Ibadan, Oyo State in a bid to give the researches a localized context in understanding educational inclusion for children with chronic illnesses. By focusing on teachers as critical agents in the educational environment the study provides information that can help guide school-based interventions and professional development programs and policies aimed at improving support systems for children living with leukaemia in primary schools in the region.

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