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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 9
| Issue : 3 | Page : 204-209 |
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Knowledge and use of sunscreens among traders at an urban market in Lagos, Nigeria
Erere Otrofanowei1, Ehiaghe Lonia Anaba2, Ayesha Omolara Akinkugbe1, Olufolakemi Adeife-Cole2, Olusola Ayanlowo1, Viola Ikebudu3, Rashmi Sarkar4
1 Department of Medicine, College of Medicine, University of Lagos (CMUL); Department of Medicine, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria
2 Department of Medicine, Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria
3 Department of Medicine, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria
4 Department of Dermatology, Lady Hardinge Medical College and associated Hospitals, New Delhi, India
| Date of Submission | 09-Jun-2021 |
| Date of Decision | 18-Sep-2021 |
| Date of Acceptance | 02-Oct-2021 |
| Date of Web Publication | 30-Nov-2022 |
Correspondence Address:
Erere Otrofanowei
Department of Medicine, College of Medicine, University of Lagos/Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/pigmentinternational.pigmentinternational_
Introduction: Public health awareness on sun-protection practices especially sunscreen use is established in developed countries compared with some other tropical African countries. Open-market traders in Nigeria, who typically have black skin, spend up to 8 hours in daylight with unprotected sun exposure. Aim: To determine prevalence of the knowledge of sunscreen use and to discover if adequate and appropriate sunscreen use is practiced by market traders. Methods: Cross-sectional study on 307 consenting traders at Sandgrouse Market in Lagos, Nigeria. Demographic data and responses to questions on sun exposure and its effects, knowledge and use of sunscreen, source of knowledge, and frequency of application were documented with a predesigned study questionnaire. Data were analyzed with SPSS 22. Results: More females (207; 67.4%) were observed and the mean age was 42.7 ± 12.8 years, though most were within the 35- to 39-year age range. One-third (102; 33.2%) were unaware that sun exposure could damage the skin and only 30 (9.8%) were aware of or knew what sunscreen meant. Commercials or advertisements were the most common source of knowledge and females were significantly more aware of sunscreens (P = 0.018). Conclusion: There is poor knowledge and awareness of the use of sunscreen among urban market traders in Nigeria who have prolonged unprotected exposure during their daily activities. Females were significantly more aware of sunscreens than males but there was no significant difference in the use pattern.
Keywords: Black skin, market traders, sun protection, sunscreen
How to cite this article:
Otrofanowei E, Anaba EL, Akinkugbe AO, Adeife-Cole O, Ayanlowo O, Ikebudu V, Sarkar R. Knowledge and use of sunscreens among traders at an urban market in Lagos, Nigeria. Pigment Int 2022;9:204-9 |
How to cite this URL:
Otrofanowei E, Anaba EL, Akinkugbe AO, Adeife-Cole O, Ayanlowo O, Ikebudu V, Sarkar R. Knowledge and use of sunscreens among traders at an urban market in Lagos, Nigeria. Pigment Int [serial online] 2022 [cited 2023 Mar 27];9:204-9. Available from: https://www.pigmentinternational.com/text.asp?2022/9/3/204/362398 |
| Introduction | |  |
Sun-protection knowledge, awareness, and practice are well established in developed countries where public health awareness is high.[1] The narrative is the reverse in Africa and other tropical countries where knowledge and awareness are lacking or absent; and the intensity of the sun and its deleterious effects are more pronounced. These effects, that are a result of ultraviolet A and B (UVA and UVB), infrared (IR) radiations with formation of free radicals, and even visible light, include increased skin aging, loss of elasticity, dry skin, patchy discoloration or uneven skin tone, benign skin growths, and the much-dreaded skin cancer to name a few.[2],[3],[4]
The concept of dermatoheliosis, a term related to damaged skin because of increased exposure to the sun, is the basis of the multi-billion-dollar cosmeceutical industry aimed at preventing sun-damaged skin or reversing the effects thereof. Photoprotective measures include the wearing of long-sleeved shirts and wide brimmed hats, avoiding the sun, seeking shade in daytime, as well as adequate and appropriate sunscreen use with respect to quantity and frequency of application.[5],[6] The use of sunscreen is uncommon in Africans or people of African descent, who tend to believe that they do not need any skin cancer protection from the UV rays of the sun because of they are dark skinned.[7],[8] Though the risk of melanoma skin cancer is low in black skin − about 9.9% in Nigerians,[9] it is not negligible and many studies have shown that blacks with skin cancer or melanoma to be specific, present at an advanced stage, with increased mortality compared to their fair-skinned counterparts.[10],[11],[12] Nonmelanoma skin cancers as well as unwanted ocular effects of chronic sun exposure are some other demerits of unprotected sun exposure.[13]
Trading is a common occupation in Nigeria and many market traders display and sell their wares in outdoor market stalls. Some even leave their stalls to hawk their wares on the streets in a busy traffic.[14] This practice leaves the skin unprotected from the sun at least 8 hours of the day. Nigeria has more months of intense sun than rain, and there is a daily average of 6.25 hours of sunlight even during the rainy season.[15] This contributes to the occurrence of dermatoses such as melasma, dyschromias, dermatoses papulosa nigra, and solar elastoses to name a few, which the sufferers may attempt to combat by using unsafe or unlicensed skin-care products and practices.[16],[17] The authors sought to determine community prevalence of the knowledge of sunscreen use and to discover whether adequate and appropriate sunscreen use is practiced by market traders, as there is paucity of literature on this in dark-skinned patients.
| Methodology | | |
This was a cross-sectional study carried out on a cohort of 307 consenting traders at Sandgrouse Market − an urban market in the Lagos Island of Central Lagos. The study was conducted in February 2020 following ethical approval (LREC/06/10/1297) from the health research and ethics committee of the Lagos State University Teaching Hospital and permission from the market leaders. Sociodemographic and historical data were documented using a predesigned study questionnaire. Participants’ responses to questions relating to sun exposure and its effects, knowledge and use of sunscreen, source of knowledge, and frequency of application were documented. These items were extracted onto a spreadsheet and analyzed with SPSS version 22 [IBM Statistical Package for Social Science Version 22 (Armonk, New York, USA)].
Data analysis
The IBM statistics was used for data analysis. Percentages, means, and standard deviation were used to present numerical variables, whereas categorical variables were presented as percentages. Student t test was used to compare means of two groups, whereas Chi-squared test and Fisher exact test were used to compare the proportions of two independent groups. The confidence interval was set at 95% and P-value <0.05 was considered significant.
| Results | | |
There were 307 recruited participants in this study. There were more females (207; 67.4%) than males (100; 32.6%); most were within the 35- to 39-year age range and the mean age was 42.7 ± 12.8 years [Table 1].
Regarding the knowledge, awareness, and use of sunscreen, one-third (102; 33.2%) of participants were unaware that exposure to the sun could damage the skin and only 30 (9.8%) were aware of or knew what sunscreen meant. Majority (17; 56.7%) of those who were aware of sunscreens heard about it from commercials (advertisements) on traditional media. Of those who were aware of sunscreen, only four (13.3%) used sunscreen at all and half of them applied it just once in the day, whereas the other two participants used it twice in a day. More females (26; 12.6%) were aware of sunscreens than males (4; 4.0%) and this was statistically significant (P = 0.018) [Table 2] and [Table 3].
| Discussion | | |
This study provides the first assessment on the knowledge of sunscreen and its use in the general population in Nigeria to the best of our knowledge. We found a concerning lack of awareness and knowledge of sun-protective mechanisms or sunscreen use among a cohort of urban traders which may be generalized to the population. Advertorials and billboards were a more effective means of information dissemination and doctors were not a major source of awareness of any sun-protection mechanism.
There were more females than males in this cohort, probably not surprising as women are the traditional gender who trade in open-market stalls in the country. The mean age of participants was 42.7 ± 12.8 years, which falls within the age of the working population in the country. The traders typically spend at least 8 hours of the day, between 8 am and 5 pm in their open-market stalls. A few of them however sell their wares under large umbrellas used as shade from the glare and heat of the sun. Two-thirds (66.1%) of the participants were aware that sun exposure may cause damage to the skin. This is comparable to figures obtained by Wright et al. in South Africa where 56.7% of participants were aware that exposure to the sun during their informal market activities was a hazard.[18] Compared to Whites, Hispanics, and Asians, the knowledge on damaging effects of sun exposure is not as pronounced and mostly related to skin cancer.[19],[20]
Despite the relatively large number of persons aware of the dangers of sun exposure in this study, only 30 (9.8%) knew or were aware of the need for sunscreen use. More females than males were significantly aware of sunscreen use (P = ‒0.018), and more females than males (3:1) used sunscreen, though this was not statistically significant. This is similar to findings by Wright et al. following a study at an informal market in South Africa which also had more females than males, but all were not using sun-protection mechanisms including sunscreens adequately.[18] Al Robaee in Saudi Arabia also reported similar findings with respect to gender differences.[21] The South African study however indicated that the use of traditional clay that has a low sun-protection factor[22] was practiced by most women in the study for traditional purposes and not primarily for its sun-protection effect.[18] Calderón et al. also demonstrated that females used sunscreens more than males in all other ethnic groups sampled apart from the Asians.[19] Females are known to be more conscious of their skin and find it easier to apply regular moisturizers than males.[23] The unwillingness of men to moisturize their skin as part of their daily skin care regime has been attributed to the oily and sometimes sticky nature of some products.[23] It stands to reason that they will be less inclined to apply sunscreens especially if they are not particularly aware of the hazards of the unprotected sun exposure.
The frequency of application for those who applied sunscreen at all was no more than twice in the daytime. All the participants used sunscreen in the morning and half of them reapplied it once during the day. The adequacy of sunscreen use is related to the quantity applied as well as the frequency of application. More often reported as inadequate, people tend to apply less sunscreen than stated on the packaged product.[24] Guidelines state that products should be reapplied at least every 2 to 3 hours, or even more frequently if engaged in outdoor activities that cause sweating.[5],[6],[24]
The source of knowledge of sunscreens from participants in this study was from commercials or advertisements on traditional media such as the local television stations, billboards, or radios and less from social media, friends, or even healthcare practitioners. This may be due to the low socioeconomic class of most of the respondents who may be poorly educated and not have access to cable television where more foreign commercials with sunscreen commercials are broadcast. A study in Brazil demonstrated a correlation between low socioeconomic status and nonuse of sunscreen.[25] Income has been found to be an important predictor of sunscreen use among the Black population in the United States.[20],[26] There is a correlation between increasing income and sunscreen use in Whites, Blacks, and Hispanics; and higher educational levels predicted increased use of sunscreens in Whites and Blacks according to findings from a study by Calderón et al.[19]
Most of the respondents may also likely visit chemist shops or community pharmacies instead of a doctor as the prevailing healthcare delivery system in the country is that wherein the patient pays out-of-pocket or is in a hurry to get quick relief of an ailment. This forestalls visits to family physicians or specialists who have more information to impart during scheduled consultations and proper counseling sessions. Only three respondents said they got information of/on sunscreen use from a healthcare practitioner. Published reports of physician counseling on sunscreen use in Nigeria are mostly related to albinism, vitiligo, and skin cancer and less so with respect to photoaging.[27],[28] Photoprotection counseling is needed and beneficial to Blacks. Healthcare practitioners as well as skin care specialists are better suited to give this information. There are studies that show a deficit in patient counseling on proper sunscreen use in the United States suggesting that physicians need to do more in this area.[29]
The fact that advertorials made the bulk of the source of sunscreen awareness is informative and demonstrates the power of visual story telling. The country, like other Sub Saharan African countries, is awash with skin products which claim to improve skin tone or lighten color and these skin lightening products are rarely, if ever advertised with sun-protection images or sunscreen.[30] The benefits of sunscreen use include, but are not limited to, reduction in wrinkling, prevention of age spots, avoidance of photodermatitis which may occur due to skin contact with photosensitive medicaments and uneven skin tone (whether skin-lightening creams are being used or not).
Education and counseling for sunscreen use in the developed world lays emphasis on its use for skin cancer prevention, and less so on its antiaging properties.[29] With the incidence of melanoma rising in the West, this preventive public health measure is necessary. In Nigeria, there is widespread skin damage from UV radiation and worsening of the phototoxic effects by individuals in an attempt to fix the sun-induced damage by themselves, or by proxy.[27],[28]
In this study, participants aged 25 years and less were already exposed to the sun as they started trading in the market from a young age. There is the likelihood that they will be practicing open-market trading for many more years and if the sun-protection knowledge is not commenced from a young age, they may have a high risk of developing dermatohelioses. Lifestyle habits and attitudes commenced in childhood are more likely to be practiced in perpetuity. The best time to educate the public on sunscreen use and sun-protective mechanism is in childhood.[21] Gilaberte and Carrascoza in Brazil exposed the benefits of sun protection especially the use of sunscreens with inorganic filters (physical sunscreens) in children aged 2 years and above.[31] It is reasonable to expect that children will spend more time in the sun due to play and outdoor activities than adults. A study on sun exposure in children estimated that a daily average of 2.3 hours is spent in the sun especially during school days than weekends.[32] This figure is just about one-third of the sun-exposure time noted in this study.
The recommendation in predominantly Black populations should be to wear protective clothing, seek shade especially at daytime, wear sunglasses, and wear sunscreen every 2 hours during the day during 8 am to 4 pm at least.[24] This study did not get to discuss cost of sunscreens as a barrier to its use, but the cost of sunscreens varies widely depending on the brand. Zinc oxide is a good example of a physical sunscreen with broad spectrum UVA and UVB protection. It is the main component of some infant barrier creams; and may be a good and cheap option for those who can tolerate the whitish cast it leaves on the skin.
| Conclusion | | |
There is poor knowledge and awareness of the use of sunscreen among urban market traders in Nigeria who have prolonged unprotected exposure during their daily activities. Females were significantly more aware of sunscreen than males but there was no significant difference in the use pattern.
Sunscreen use is known to prevent dermatohelioses and skin cancers. This should be the thrust of public health education and advocacy in Nigeria with regards to the prevention of sun-induced dermatoses. Emphasis must be laid on long-term effects of UVA, UVB, and IR radiation on photoaging and skin cancers, in spite of having a dark skin. Radio jingles, television commercials, and billboards should be utilized in delivering short and succinct information on photoprotection in local dialects and best understood language of the people. It is also important that general practitioners, family physicians, and dermatologists counsel patients on the benefits of sunscreen use and examine the skin of patients with a view to identifying premalignant skin changes as early as possible.
Acknowledgment
The authors acknowledge Drs Itohan Oaku, Ireneh Akwara, Oluwatoyin Akinsiku, Kamal Mahmood, Obumneke Ezeanochie, and Basirat Akanbi for their contribution toward this work.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]
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