Mental health literacy on postpartum depression among university staff in Nigeria

Abstract

Introduction

Postpartum depression (PPD) is an important public health problem which often goes unrecognized and untreated, especially in low-income settings. Poor mental health literacy of community members has been shown to create barriers to help-seeking for PPD.

Objective

The study assessed the mental health literacy of postpartum depression (PPD) among staff members in a Nigerian university.

Methods

This was a cross-sectional survey that employed a case vignette format. A questionnaire, consisting of a socio-demographic form and a case vignette, was distributed to a convenient sample of 400 staff members in the faculties of pharmaceutical sciences, veterinary medicine, and agricultural sciences. Data were analysed using the IBM SPSS Statistics (version − 20). Descriptive analysis (frequencies, percentages, mean, and standard deviations) were used to summarize the findings. The relationship between socio-demographic characteristics and knowledge score of PPD was assessed using chi-square analysis. Statistical significance was set at p-value ˂0.05.

Results

The majority of the respondents were females 195 (54.0%) and were between 18 and 30 years of age (35.5%). Only 16.3% of respondents correctly identified PPD and nearly half (44.9%) of the respondents opined that the condition is ‘very serious. Poor knowledge of PPD was statistically significant associated with age [X² (4) = 18.252, p = 0.001], marital status [X² (3) = 16.888, p = 0.001], and educational qualification [X² (3) = 59.729, p = < 0.001], while medical help- seeking of PPD was statistically significant associated with age [X² (4) = 13.982, p = < 0.007], and educational qualification [X² (3) = 10.716, p = < 0.013].

Conclusion

The overall knowledge of postpartum depression among the staff members of the university was relatively poor and more female staff members than male staff members could identify postpartum depression. The study findings highlight the need to create awareness and improve knowledge of PPD through campaign-specific mental health programmes, educational programmes, integration of mental health programmes for university staff development to aid in early identification, intervention, media, and other targeted strategies such as creating a culture that encourages open discussions about mental health and provides accessible support services and, developing and implementing policies that address mental health in the university and the country at large.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44192-025-00249-8.

Introduction

Postpartum depression (PPD) is an important public health problem that often goes unrecognized and untreated [1]. Postpartum depression can start right after or develop two to six weeks after delivery and last for more than a year [2]. Tearfulness, despondency, emotional lability, guilt feelings, sleep issues, appetite loss, impaired self-esteem, suicidal tendencies, mood swings, and feeling down and sad are some of its symptoms [3]. Maternal postpartum depression affects the attachment and bonding between mother and child, thus affecting the infant’s development including the cognitive and social-emotional development of the child [4]. Postpartum depression has been linked to a variety of negative outcomes; deterioration of interpersonal relationships and marital life [5] as well as an increased risk of suicide [6]. Despite numerous interactions with medical staff during pregnancy and after delivery, the majority of women do not freely report their stress, depression, or anxiety symptoms or seek therapy for these conditions [7]. In most African countries, including Nigeria, there is an apparent inadequacy of health facilities, maternal health service delivery, and healthcare manpower suggesting many cases of postnatal depre ssion are undetected in women or when detected may be poorly treated [8].

Postpartum depression has emerged as a critical public health challenge with significant global variations in prevalence and presentation. The most recent comprehensive estimates indicate that approximately 17.22% of mothers worldwide experience PPD [9], though this figure masks important geographical and socioeconomic disparities. Women in high-income countries generally report lower prevalence rates (6–13%) compared to their counterparts in low- and middle-income nations [10]. This pattern is particularly evident in Asia, where reported prevalence ranges dramatically from 3.5 to 63.5% across different populations [10], with more stable estimates of 11–16% observed specifically in India [10].

The elevated burden of PPD in resource-constrained settings appears concentrated among particularly vulnerable subgroups. Multiple studies have identified disproportionately high rates among women living in poverty [11], those with pre-existing mental health conditions [11], and survivors of intimate partner violence [9]. Interestingly, while some regional variations exist across Africa, comparative analyses have found no statistically significant differences in PPD prevalence between Northern and Sub-Saharan African countries [12], suggesting that socioeconomic and psychosocial factors may transcend geographic boundaries in their influence on maternal mental health.

The Nigerian context presents its complex epidemiological picture. Recent studies have documented prevalence rates ranging from 21.8% in Jos [13] and 22.9% in Enugu [14] to 35.6% in Lagos [15], revealing substantial intra-national variation. Researchers attribute these discrepancies to multiple interacting factors, including differences in assessment methodologies, varying definitions of the postpartum period, distinct screening criteria, and local contextual variables ranging from economic conditions to periods of social stability or crisis [16]. This methodological and contextual complexity underscores both the challenges in comparing prevalence estimates across studies and the need for standardized approaches in PPD surveillance.

Post-partum depression recognition presents some unique challenges. Many women believe that their symptoms are a normal part of parenthood and are caused by fatigue, relationship strain, and personal weakness [17] rather than depression, and these beliefs and/or symptoms are frequently reinforced by family members including husbands or partners who often discourage mothers from seeking help [18]. Women who recognized their symptoms as postpartum depression were concerned about the potential negative consequences of seeking help including being labeled as an unfit mother and mentally ill [18]. The causes of postpartum depression must be understood since incorrect cause attribution can prevent those who are affected from getting the proper care [15]. Previous studies have shown that several risk factors are implicated in postpartum depression rather than a single cause. In addition to a history of depression or anxiety, stressful life events, a lack of social support, a troubled marriage, neuroticism, low self-esteem, difficulties with child care, temperamental infants, the baby blues, obstetric complications, low socioeconomic status, single marital status, unintended or unwanted pregnancies, preterm birth, and multiple pregnancies are some of the risk factors that each woman will experience differently [15, 19]. Previous research findings highlight how crucial it is to improve community mental health literacy of postpartum depression [20]. In 2012, Jorm identified the elements of mental health literacy, which consist of: (a) understanding ways to prevent mental disorders, (b) recognizing the early signs of a developing disorder, (c) being informed about available treatments and help-seeking options, (d) knowing practical self-help strategies for addressing mild issues, and (e) having the first aid skills to assist others facing a mental health crisis or showing signs of a mental disorder [21].

Awareness and knowledge of a condition are important predictors of help-seeking for that condition. University staff members tend to possess higher health literacy due to their academic environment and access to various sources of information [22]. University staff members can impact the knowledge of PPD by providing support, influencing the perception and attitude toward post-partum depression, and also, contributing to education and awareness of PPD to both students and other members of the university community. Therefore, their level of understanding about a particular condition can serve as a benchmark for what may be expected from populations with fewer resources and opportunities. To the best of our research, no study has assessed the mental health literacy of PPD among staff members of a university community. The current study aimed to explore the mental health literacy and help-seeking for PPD within a university staff context.

Hypotheses

We hypothesized that staff members of a university can correctly identify postpartum depression in a case vignette, and women are more likely to correctly identify PPD in a case vignette than men. Previous studies have reported gender differences in the knowledge of postpartum depression [23, 24].

Methods

Study design

This was a cross-sectional survey that employed the use of a validated questionnaire to assess the mental health literacy of postpartum depression among staff members of faculties of pharmaceutical sciences, veterinary medicine, and agricultural sciences at the University of Nigeria. These faculties collectively represent the spectrum of health sciences (Pharmaceutical Sciences), biological sciences (Veterinary Medicine), and applied sciences (Agricultural Sciences), allowing us to examine PPD literacy across different scientific domains with varying exposure to mental health concepts. Preliminary institutional data indicated these faculties have both the largest proportion of female staff members (65–72% across selected faculties) and the highest concentration of staff in the 25–45 age range (the typical childbearing years), making them particularly relevant for PPD research.

Study setting

The University of Nigeria, commonly referred to as UNN, is a federal university located in Nsukka, Enugu State, The University of Nigeria was the first full-fledged Indigenous and first autonomous university in Nigeria, modelled upon the American educational system. It is the first land-grant university in Africa and one of the five most reputed universities in Nigeria. The university has 15 Faculties, 102 academic departments, also 3434 staff, both academic and administrative. The University offers 82 undergraduate programs and 211 postgraduate programmes.

Study population

All staff members in the faculty of pharmaceutical sciences, faculty of veterinary medicine, and faculty of agricultural sciences of the University of Nigeria Nsukka campus, who were willing to participate in the study. The three faculties were conveniently selected because they are located in the same area at the main campus of UNN and these faculties are health sciences inclined and might be knowledgeable on the subject matter.

Instrument for data collection

A two-part vignette was used for data collection. The first domain was used to obtain socio-demographic characteristics (age, gender, highest educational qualification) while the second domain assessed the knowledge and help-seeking attitudes regarding postpartum depression using a case vignette (supplementary material). To ensure cultural and contextual relevance, the validation process of the questionnaire involved some key steps. First, the vignette presented to participants depicted a character who had just given birth and displayed significant signs of depression as outlined in the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition [25]. To increase relatability and cultural appropriateness, the character’s name was carefully selected to reflect a native name that would resonate with the study population. The questionnaire then underwent face validation, a process where experts in the field reviewed the content for accuracy, clarity, and cultural relevance. Additionally, to further ensure the instrument’s appropriateness for the target population, a small group of individuals from the study population who were not included in the survey, were asked to review the questionnaire. This allowed for feedback on the wording, clarity, and relevance of the questions in the specific cultural context.

Data collection

The questionnaires were conveniently self- administered on paper to 400 staff members at the various faculties (pharmaceutical sciences, veterinary medicine, and agricultural sciences) at the time of the study.

Data analysis

The collected data was coded, entered into Microsoft Excel spreadsheet, and analysed using IBM Statistical Product and Service Solution (SPSS) 20. Descriptive statistics (frequencies, percentage) was used to summarize the study’s findings. The Pearson Chi-square test was used to determine the association between main variables (PPD and medical help-seeking) and sociodemographic characteristics. Statistically significant value was set at alpha < 0.05.

Results

Approximately 195 (54.0%) of the respondents were females and were within 18 to 30 years of age (35.5%). Most of the respondents were married 228 (63.2%) and their highest educational qualification was Bachelor of Sciences (B.Sc) 155 (42.9%). Other details are in Table 1. Table 2 shows that only 59 (16.3%) of the respondents correctly identified PPD and nearly half (162, 44.9%) of the respondents opined that the condition is very serious. About a quarter of the respondents (99, 27.4%) agreed that it would be difficult to treat the symptoms and 161 (44.6%) of the respondents were sympathetic towards the vignette character. Less than half of the respondents (121,33.5%) opined that the vignette character should get medical treatment for her condition (Table 2). Table 3 shows that a higher proportion of the respondents aged 18 to 30 years were able to identify PPD [X² (4) = 18.252, p = 0.001] and a higher proportion of the married respondents could not identify PPD [X² (3) = 16.888, p = 0.001]. Most of the respondents who had a first degree could not identify PPD [X² (3) = 59.729, p = < 0.0001], while a greater proportion of the respondents who were academic staff members could identify PPD [X² (3) = 38.718, p = < 0.001]. Regarding seeking help for the vignette character, a higher proportion of the respondents aged 18 to 30 years selected medical help [X² (4) = 13.982, p = < 0.007], while a higher proportion of respondents who had a first degree would seek for non-medical treatment for those with postpartum depression [X² (3) = 10.716, p = < 0.013]. Other details are shown in Table 4.

Table 1.

Socio-demographic characteristics of respondents (N = 361)

Variables	Frequency	Percentage (%)
Gender
Male	166	46.0
Female	195	54.0
Age (years)
18–30	128	35.5
31–40	114	31.6
41–50	68	18.8
51–60	46	12.7
> 60	5	1.4
Marital status
Single	109	30.2
Married	228	63.2
Widowed	12	3.3
Divorced	12	3.3
Number of children
None	113	31.3
1	45	12.5
2	86	23.8
3	52	14.4
4	42	11.6
> 4	23	6.4
Highest Education qualification
WASSCE	115	31.9
Bachelor’s degree	155	42.9
Master’s degree	68	18.8
PhD	23	6.4
Staff category
Academic	135	37.4
Non-academic	226	62.6

WASSCE- West African Senior School Certificate Examination

Table 2.

Knowledge of postpartum depression among staff members (N = 361)

Variables	Frequency (n)	Percentage (%)
Do you think there is anything wrong with Ngozi?
Yes	361	100.0
No	0	0
If so, what is wrong with Ngozi?
Postpartum depression	59	16.3
Motherly depression	49	13.6
Family problem	19	5.3
Spiritual problem	28	7.8
Financial problem	21	5.8
Depression	99	27.4
Psychological problem	53	14.7
Stress from giving birth	33	9.1
How serious do you think the condition described is?
Not serious at all	13	3.6
Slightly serious	37	10.2
Moderately serious	38	10.5
Very serious	162	44.9
Extremely serious	111	30.7
How difficult will it be to treat Ngozi?
Not at all difficult	65	18.0
Slightly difficult	79	21.9
Moderately difficult	85	23.5
Very difficult	99	27.4
Extremely difficult	33	9.1
How sympathetic do you feel towards Ngozi plight?
Not at all	7	1.9
Slightly	49	13.6
Moderately	46	12.7
Considerably	98	27.1
A great deal	161	44.6
Who would you refer Ngozi to ask for help?
Medical help	121	33.5
Spiritual help	40	11.1
Advice from mother	42	11.6
Guidance and counsellor	21	5.8
Psychologist	99	27.4
Therapist	38	10.5
What is the most likelihood for Ngozi to seek help?
Very unlikely	5	1.4
Moderately unlikely	18	5.0
Neither likely nor unlikely	130	36.0
Moderately likely	208	57.6

Table 3.

Association between correct identification of PPD and socio-demographic characteristics (N = 361)

Variable	PPD	Non-PPD	X2 (df)	P-value
Gender			0.370 (1)	0.543
Male	25(42.4)	141(46.7)
Female	34 (57.6)	161(53.3)
Age (years)
18–30	21(35.1)	107(35.5)	18.252(4)	0.001
31–40	11(18.3)	103(34.2)
41–50	11(18.3)	57 (18.9)
51–60	14(23.3)	32 (10.6)
> 60	3(5.0)	2 (0.7)
Marital status			16.888 (3)	0.001
Single	14(23.7)	95(31.5)
Married	34 (57.6)	194(64.2)
Widowed	5(8.5)	7(2.3)
Divorced	6 (10.2)	6(2.0)
Number of children			10.937(5)	0.053
None	15 (25.4)	98 (32.5)
1	5 (8.5)	40(13.2)
2	11(18.6)	75(24.8)
3	12(20.3)	40(13.2)
4	13(22.0)	29(9.6)
> 4	3(5.1)	20(6.6)
Highest educational qualification
WASSCE	4 (6.8)	111(36.6)	59.729(3)	< 0.001
BSc	22 (37.3)	133(44.0)
MSc	18(30.5)	50(16.6)
PhD	15(25.4)	8 (2.6)
Staff category			38.718(3)	< 0.001
Academic	43(72.9)	92(30.5)
Non-academic	16(27.1)	210(69.5)

PPD- Postpartum depression, non-PPD (other labels apart from postpartum depression

Table 4.

Association between help seeking and socio-demographic characteristics (N = 361)

Variable	Medical help	Non-medical help	X2 (df)	P-value
Gender			0.305(1)	0.581
Male	121(46.9)	45(43.7)
Female	137(53.1)	58(56.3)
Age (years)			13.982(4)	0.007
18–30	104(40.5)	24(23.3)
31–40	79(30.4)	35(34.0)
41–50	42(16.3)	26(25.2)
51–60	28(10.9)	18(17.5)
> 60	5(1.9)	0(0.0)
Marital status			5.915(3)	0.116
Single	87(33.7)	22(21.4)
Married	156(60.5)	72(69.9)
Widowed	8(3.1)	4(3.9)
Divorced	7(2.7)	5(4.9)
Number of children			15.075(5)	0.010
None	91(35.3)	22(21.4)
1	28(10.9)	17(16.5)
2	51(19.8)	35(34.0)
3	42(16.3)	10(9.7)
4	29(11.2)	13(12.6)
> 4	17(6.6)	6(5.8)
Highest educational qualification			10.716(3)	0.013
WASSCE	77(29.8)	38(36.9)
BSc	108(41.9)	47(45.6)
MSc	50(19.4)	18(17.5)
PhD	23(8.9)	0(0.0)
Staff category			6.013(3)	0.111
Academic	106(40.9)	29(28.2)
Non-academic	152(58.7)	74(71.8)

Discussion

This study assessed the mental health literacy of postpartum depression and help-seeking behaviours among the staff members of a university community and the study revealed poor identification (knowledge) and help-seeking behaviour for postpartum depression. Most of the study participants were females which is similar to the findings of other studies [26, 27] and most of the participants in this present study were young adults. This is in keeping with reports from Malaysia and Portugal [26, 27], which also had young adults as participants (18–39 years).

The vignette character received the following most common labels: ‘Depression’ (27.4%), ‘Postpartum Depression’ (16.3%), ‘Psychological problem’ (14.7%), and ‘Motherly depression’ (13.6%). Some might argue these labels simply reflect the literal translation of ‘depression’ from the respondents’ native languages. However, considering English as Nigeria’s official educational language, it is reasonable to expect university staff, most of whom have a tertiary education, to possess a broad English vocabulary. While these alternative labels suggest some recognition and knowledge of depression, this alone may not encourage appropriate help-seeking behavior or demonstrate true mental health literacy. Unfortunately, there is limited data on university staff members’ mental health literacy specifically regarding postpartum depression, making direct comparisons challenging.

Our hypothesis that more females than males would identify postpartum depression was supported. This might be because most of the participants were mothers and could have experienced some of the symptoms of postpartum depression or had seen someone or a close relative who experienced postpartum depression. Also, women`s support groups might have played a role, making the women in this present study aware and knowledgeable about postpartum depression [24, 27, 28]. However, the overall identification of postpartum depression was poor. Previous studies have reported poor knowledge of postpartum depression in the general population [24, 27, 29], and this finding is similar to a study conducted among postnatal women who were attending immunization clinics in primary health care centre, that only 6% had good knowledge of PPD [2]. The poor knowledge of postpartum depression reflects broader socio-cultural and institutional challenges in mental health literacy [2] and also shows the ignorance, misconceptions, and socio-cultural influence about postpartum depression [29]. Studies consistently report poor PPD awareness in Nigeria, with only 6% of postnatal women in primary care settings demonstrating adequate knowledge [2]. This gap underscores systemic barriers, including cultural stigma, institutional neglect, and misinformation. In many Nigerian communities, postpartum emotional distress is often normalized as “baby blues” or attributed to spiritual causes rather than recognized as a medical condition. Such perceptions, compounded by fear of being labeled “weak” or “unfit,” discourage open discussions and help-seeking [24]. Gendered expectations further isolate affected women, as childcare responsibilities are seldom framed as shared burdens requiring mental health support [27].

At an institutional level, the absence of workplace mental health initiatives exacerbates the problem. Unlike physical health programs, PPD education is rarely prioritized in Nigerian academic settings, leaving staff, especially non-medical personnel, uninformed. University healthcare systems also lack structured referral pathways for PPD, creating confusion for those seeking help. Misconceptions about PPD’s causes (e.g., supernatural forces or personal failure) persist due to limited access to evidence-based resources [29]. Competing health priorities in low-resource settings further marginalize maternal mental health, relegating PPD to the periphery of public health agendas.

Most of the respondents had opined that postpartum depression is a serious health problem that could be difficult to treat. This finding is somewhat close to that of the findings of an Australian study, where 59% of the respondents agreed that postpartum depression is a serious illness and 40% of them reported that it required special treatment [24]. This difference might be the number of respondents and the inability of the study participant to not correctly identify the postpartum depression case vignette.

Seeking medical help for treatments of postpartum depression was suggested by less than half of the respondents. This finding is lower than that reported among the Portuguese population, in which 92.1% agreed that postpartum depression requires professional help [27]. This difference could be in awareness and knowledge of the subject matter, study setting, the number of participants in the study, the method employed, and the questionnaires used in the study. Other studies have reported counselling, seeking help from family members and friends, doctors, and many more as treatment options choice for postpartum depression [24, 26].

According to our findings, age, marital status, educational qualification, and staff category were significantly associated with postpartum depression. Interestingly, we observed that a higher proportion of younger individuals possessed better knowledge of postpartum depression compared to their older counterparts. This result is somewhat similar to that reported by the Kenya [30] and Khartoum [31] studies, they stated that women aged less than 30 years were more likely to develop or have postpartum depression. Also, a similar result was reported among the Portuguese population, age was associated with knowledge and attitude toward postpartum depression [27]. In contrast, another study reported that older women above 35 years are more likely to develop or have postpartum depression [32]. We hypothesize that this disparity may be attributed to the increased access to the internet and other information sources among younger demographics. Furthermore, mental health issues, including postpartum depression, tend to be less stigmatized among younger populations, potentially leading to greater awareness and understanding. In comparison, married individuals had more knowledge of postpartum depression than the singles. This is in concordance with previous research that married people had a better understanding of postpartum depression than single, widowed, or divorced people [26, 29]. Since postpartum depression affects mothers six weeks after childbirth, married people might be more familiar with postpartum depression since it is a condition that affects mothers [33]. Previous research cited that less educated people are more likely to have less knowledge of postpartum depression [24, 27]. Correspondingly, in this study, a higher proportion of those with of Bachelor of Sciences qualification (which was the lowest qualification among the majority of the respondents) had less knowledge of postpartum depression compared to those with higher qualifications. The study population was staff members working in a university environment and were mostly university graduates. Also, although most of the respondents in the study were non-academic staff who were probably employed without a university degree, most of them would have furthered their education by enrolling in part-time programmes in the university. Studies have reported that the socio-economic factors which include poverty, lack of earning opportunities, unfulfilled basic and secondary needs [34], and low education level mediated by psychosocial characteristics [35] have contributed to poor mental health literacy. Cultural and religious beliefs influence perceptions of mental health and have led to taboos and stereotypes and in turn stigmatization [36].

Concerning, the association with socio-demographic characteristics and seeking medical help for PPD; age, number of children, and educational qualification were significantly associated with seeking medical help for postpartum depression. There is a limited amount of information available on the association of medical help of postpartum depression with socio-demographic characteristics, thus direct comparison cannot be made. In our study, a higher proportion of younger respondents with a Bachelor of Sciences (BSc) suggested that the vignette character should seek professional help.

A limitation of this study is the extent to which its findings can be generalized to the general population, since the survey was carried out among staff members in three faculties of a single university using a cross-sectional design, convenient sampling; may not accurately reflect the demographics, characteristics or the diversity of the general population. Other limitations include self-reported and potential response biases (acquiescence bias) because the study population knew the vignette characteristics had a mental issue and may have chosen to tick the extremes of the response option. Also, being non-native English speakers, it seems that some of the respondents recognized postpartum depression but were unable to accurately label using terms like “Motherly depression”. Nonetheless, the strength of the study is the use of case vignettes that did not constrain respondents to choose defined responses as in traditional questionnaires.

The results underscore the need for institutional policies that prioritize mental health education as a core component of workplace wellness. Policies should mandate regular mental health training sessions and support services, ensuring they address PPD literacy specifically. Further, establishing clear guidelines for mental health support within workplace settings will help normalize discussions around PPD and mental health at large. A multi-faceted approach is crucial to addressing the varied needs across demographic groups. Tailored interventions that consider the distinct characteristics of age, marital status, educational background, and role within the university will be more effective in enhancing PPD literacy. For instance, younger staff members or those with fewer children may benefit from focused awareness campaigns, while educational workshops can target groups with lower formal qualifications.

Conclusion

The findings of this study highlight critical gaps in postpartum depression (PPD) literacy among university staff, with significant variations observed across demographic groups. These results underscore the need for targeted, multi-level interventions to improve PPD awareness and help-seeking behaviors in academic workplace settings.

To effectively address this challenge, we recommend three key areas for action. First, universities should integrate PPD education into existing workplace wellness programs, with content tailored to different staff demographics. Second, targeted awareness campaigns should be developed to address specific knowledge gaps while combating stigma through peer-led initiatives and community engagement. Third, healthcare services within university systems should strengthen screening and referral pathways for postnatal mental health concerns.

Future research should explore the long-term effectiveness of workplace interventions and examine how intersecting social identities influence PPD experiences in academic environments. By combining institutional policy changes with evidence-based health promotion strategies, universities can play a pivotal role in advancing maternal mental health support.

This study contributes to growing evidence that workplace settings represent crucial yet underutilized venues for improving PPD literacy. As mental health awareness gains global momentum, academic institutions have both the opportunity and responsibility to lead by example in supporting their staff’s postnatal well-being.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

Concept and design: AI, DOAAcquisition of data: MOU, CGAOAnalysis and interpretation of data: CGAO, AI, DOADrafting of the manuscript: CGAO, AI, DOAProvision of study materials: DOA, MOUData collection: MOU, DOA Statistical analysis: CGAO, AI, DOA.

Funding

There was no funding.

Data availability

Data generated from the study are available on request.

Declarations

Ethics approval and consent to participate

Ethical approval was obtained from the Health Research Ethics Committee of the University of Nigeria Nsukka, Faculty of Pharmaceutical Sciences, Enugu State, Nigeria, with reference number FPSRE/UNN/21/00010. The study was conducted in line with the guidelines and regulations of the Health Research Ethics Committee of the University of Nigeria Nsukka, Faculty of Pharmaceutical Sciences. Oral informed consents were obtained from all participants. They were made to understand that participation was voluntary and there was no consequence for non-participation and the data obtained were for research purposes. No identifiable markers were used for the study such as names, numbers, or any form of markers to ensure privacy. Anonymised data was collected, and all data were treated confidentially.

Consent to publish

Authors give their consent to publish the manuscript.

Competing interests

The authors declare no competing interests.