AWARENESS AND KNOWLEDGE OF SECONDARY SCHOOL STUDENTS

TOWARDS SEXUALLY TRANSMITTED INFECTIONS

ABSTRACT

This study was designed to investigate knowledge, and awareness of secondary

school students towards sexually transmitted infections in Nsukka Education Zone.

Objective. To determine the awareness and knowledge of sexually transmitted

infections among adolescents in Nsukka zone, South Eastern Nigeria. Methods. The

study was a descriptive cross-sectional design. Five hundred and fifty adolescents

selected from public and private secondary schools in Nsukka Local Government

Area of Enugu State were recruited using a multistage sampling technique. Results.

Four hundred and ninety-nine (92.4%) respondents had heard about sexually

transmitted infections before, the three most important sources of information being

electronic media (68.7%); teachers (68.1%); and print media (44.9%). Eighty percent

of the respondents knew only one STI and the two most commonly mentioned ones

were HIV/AIDS (78.0%) and gonorrhea (23.0%). More than 75% of the respondents

knew the modes of transmission of STIs while some of them equally had

misconceptions. The most important symptoms mentioned were weight loss (77.4%),

painful micturition (68.9%), and genital ulcer (54.1%). On the whole, only 6.9% of

the respondents had good knowledge of STIs; the rest had fair and poor knowledge.

Conclusion. Secondary school adolescents in Nsukka Local Government Area have

only a fair knowledge of sexually transmitted diseases. STI studies should be

inculcated into the school curriculum and media publicity/enlightenment campaigns

about them should be intensified.

CHAPTER ONE

INTRODUCTION

Sexually transmitted infections (STIs) are those diseases that are contracted mainly

through sexual intercourse. They include curable ones like gonorrhea, syphilis, and
chlamydia infection as well as incurable but modifiable ones like HIV, herpes

simplex, human papilloma virus (HPV), and hepatitis B infections [1, 2].

Adolescents and young adults, aged 15–24 years, are more at risk for STIs than

older adults. The World Health Organization estimates that 20% of persons living

with HIV/AIDS are in their 20s and one out of twenty adolescents contract an STI

each year [3]. Youths are more likely to practice unprotected sex, have multiple

sexual partners, and have transgenerational and transactional sex. The cervical lining

in female adolescents and young women makes them more predisposed to STIs. In

addition, they may have problems getting the required information, services, and

supplies they need to avoid STIs. They may also experience difficulties in accessing

STI prevention services because they do not know where to find them, do not have

transportation to get there, or cannot pay for the services. Even if they can obtain STI

prevention services, they may not feel comfortable in places that are not youth

friendly [4].

Untreated or poorly treated STIs are associated with a lot of complications. In

males, gonorrhea as well as chlamydia trachomatis infection causes epididymitis

which can result in infertility in the future. In addition, inflammatory urethral stricture

may arise from poorly treated gonococcal urethritis in the future. This may lead to

urinary retention and possibly chronic renal failure if not properly managed. For the

females, pelvic inflammatory disease, dyspareunia, infertility, chronic pelvic pain,

increased risk of ectopic pregnancies, abortions, stillbirths, and perinatal and neonatal

morbidities can occur, jeopardizing their future reproductive competences [5].

Knowledge of STI and their complications is important for adequate prevention

and treatment, as people who do not know the symptoms may fail to recognize their

need and so may not seek help. Knowledge of other STIs apart from HIV/AIDS is

low in the developing world [6–8].

Importantly, literatures on the awareness of STIs in Enugu State are quite scanty if

any. This study was conducted to determine the level of knowledge of adolescents in

Nsukka Local Government Area of Enugu State, Nigeria, about sexually transmitted

infections, to identify their specific health educational needs and make appropriate

recommendations to the Government and Ministry of Education.

Statement of the Problem

Adolescents, especially those in secondary schools are likely to engage in risky

sexual practices and this increase their chances of contacting sexually transmitted

infections or infections. It is no longer an old tale about the existence of sexually

transmitted infections (STIs) as it used to be relegated as superstitious. Just like the

popular slogan that “AIDS is real” similarly, sexually transmitted infections abound

but the problem is that adolescents and especially, secondary school students who

indulge in sexual practices seem to have little or no knowledge of STIs and the right

awareness towards it.

In a bid to explore and experiment on sex and its related activities, adolescents

seemingly lurk in total ignorance of the existence, symptoms, mode of transmission,

control and right awareness towards sexually transmitted infections. However,

ignorance, they said, is not an excuse to grave consequences of contacting STIs.

Sequel to the above statement, the problem of this study simply addressed in a

question form is; what do adolescents in secondary schools know on the symptoms,

mode of transmission and control of sexually transmitted infections. Also, what is the

awareness of secondary school students in Nsukka Education zone towards STIs.

Purpose of the Study

The main purpose of this study is to find out the level of knowledge and awareness of

Secondary School students towards STIs in Nsukka Education Zone. Specifically, the

study aims at the following:

i. To ascertain the level of knowledge of students on the signs and symptoms of STIs.

ii. To find out the extent to which the students know of the mode of transmission.

iii. To ascertain their knowledge of the control of STIs

iv. To find out the awareness of students towards STIs.

v. To determine the influence of gender on students level of knowledge of STIs.

Significance of the Study

The findings of this study if published will be of immense benefits to the ministry of

Education, teachers, parents, curriculum developers and the general public.

It is hoped that the findings of this study will spur the Federal Ministry of Health and

Ministry of Education to articulate effective programmes on sex education for

Secondary School Students. It is hoped that these ministries will train and equip peer

educators who will further educate secondary school students on the right knowledge

and awareness towards sexually transmitted infections; steering through it’s related

health hazards and consequences.

The study will also help teachers and counselors to know and acknowledge students

knowledge and awareness to sexually transmitted infections and how best they can

help students in the area of sexuality.

The result of the study will help to reawaken parents and teachers on their roles in

educating the adolescents on sexual matters. It will at the same time help to challenge

our adolescents to healthy sexual relationships in order to avoid contacting HIV virus

and STIs, unwanted pregnancies and abortion among others.

To the general public, it is hoped that the findings of this study will; and especially

Elders and the Clergy, they would also acknowledge their personal dispositions to

guard the adolescents in words and action towards wholesome awareness and

knowledge to sexually transmitted infections.

Scope of the Study

The study is designed to find the level of knowledge and awareness of Secondary

School students of Nsukka Educational Zone towards Sexually transmitted infections.

The study will investigate the students’ knowledge and awareness towards Sexually
transmitted infections, focusing on signs and symptoms, mode of transmission, and

control.

Research Questions

To carry out the study, the following research questions were formulated to guide the

study,

i. What is the level of knowledge of students on the signs and symptoms

of STIs?

ii. To what extent do students know the modes of transmission of STIs?

iii. To what extent are students aware of the control of STIs?

iv. What are the students’ awarenesss towards STIs?

v. What are the influence of gender on students’ level of knowledge of

STIs?

Hypotheses

The following null hypotheses will be tested at 0.05 level of significance to guide the

study.

HO1: There is no significant difference between the mean responses of male and

female students on their knowledge of various STIs.

HO2: There is no significant difference between the mean scores on awareness of

students towards STIs based on gender

 CHAPTER TWO

REVIEW OF RELATED LITERATURE

Literature related to this work will be reviewed under the following sub headings:

conceptual framework, theoretical framework, empirical review and summary of

literature review.

Conceptual framework

 Concept of knowledge

 Concept of perception

 Concept of attitude

 Concept of HIV and AIDS

 Concept of Adolescence

 Concept of Education

Theoretical Framework
  The Hunter’s Theory

 Theory of Planned Behavior

 Social Action Theory

Review of Empirical studies

 Senior Secondary School knowledge on prevalence of HIV/AIDS

 Students’ perception on reducing the spread of HIV/AIDS

 Attitude and Awareness of Students towards HIV/AIDS

Summary of Literature Review

Conceptual Framework

This section will review concepts of knowledge, perception, attitude, HIV/AIDS,

adolescence and education

Concept of Knowledge

Knowledge is a social act (firestone and MCELroy, 2003). Knowledge is experience

or information that can be communicated or shared (Christensen, 2001).knowledge

seen as made up of data and information can be thought of as ,much greater

understanding of a situation, relationship, causal phenomena and the theories and

rules (both explicit and implicit) that underline a given domain or problem.

Knowledge is defined as what we know, knowledge involves the mental process by

comprehension, understanding, learning that go on in the mind and only in the mind,
however much they involve interaction with the world outside the mind and

interaction with others (Wilson, 2002).

According to Wilson (2002), Knowledge can only be in the minds of people.

Although not directly expressed the definition includes the empiricist (interaction

with the world) and the rationalistic (‘’comprehension, understanding and learning’’)

viewpoint on the creation of knowledge. However, it is not directly mentioned that

knowledge claims need to be justified. Adding to his knowledge definition, Wilson

(2002) says that knowledge is bound to the thinking structures of each individual and

when they wish to share it theory compose messages which are then decoded by

which the messages were altered.

Knowledge is human faculty resulting from interpreted information, understanding

that germinates from combination of data, information, experiences and individuals

interpretation. Variously defined as things that are held to be true in a given context

and that drives us to action if there were no impediments (Andre Boudreau, 2012).

‘Capacity to act’ (Karl Sverby, 2001). says that people tend to seek knowledge as

objects that can be identified and handled in information systems and tend to work

technologically oriented fields such as computer and information science

Knowledge is a fluid mix of frame experience, values, contextual information and

expert insight that provides a framework for evaluating and incorporating new

experiences and information. It originates and is applied in the minds of the knower.

In organization, it often becomes embedded not only in documents or repositories but

also in organizational routes, processes, practices and norms (Davenport and prusak,

1998). Knowledge is the awareness or understanding of a Circumstance or fact,

gained through association or experience. In an organizational context, Knowledge is

the sum of what is known and resides in intelligence and the competence.

Concept of Perception

Perception is concerned with the process by which our five senses are organized and

interpreted (Solomon and Rabolt, 2004). Perception can be defined as the process by

which an individual selects, organizes and interprets stimuli into a meaningful and

coherent picture of the world (Schniffman and Kanuk, 2000). People can form

different perceptions of the same stimuli because of three perceptual processes,

selective attention, selective distortion and selective retention (kotler,2004).

Perception is concerned with how individual see and make sense of their environment

(Fill PP 123). Perception also leads to decision making and decision to act and not to

act depends on how you develop motivation (Kotler, 2003). Perception, broadly

speaking is a biological and cognitive function is vague (not clearly expressed).

Perception is the study of how sensory information is processed into perceptual

experience (Elyss Twedt, Dennis R proffit, 2015).

Perception varies from person to person. Different people perceive different things

about the same situation; but more than that, we assign different meanings to what we

perceive, and the meanings might change for a certain person. One might change

one’s perspective or simply make things mean something else. The meaning of
something will change when you look at differently. You can look at anything

differently and it will have a different meaning. There is no fixed meaning to

something; one can always change perspective and change meaning.

Concept of Attitude

An attitude is a favourable or unfavourable evaluation of something. Attitudes are

generally positive or negative views of a person, place, thing or event – this is often

referred to as the attitude object. People can also be conflicted or ambivalent toward

an object, meaning that they simultaneously possess both positive and negative

attitudes toward the item in question (Mattern 2010). An attitude can be defined as a

positive or negative evaluation of people, objects, event, activities, ideas, or just about

anything in your environment (Zimbardo 1999). Attitude is a relatively enduring way

of thinking, feeling and behaving toward an object, person, group or idea. Attitudes

almost always involve a certain amount of bias or prejudging on our part. When we

apply a label such as “stingy” or “psychotic” to a person, we both state an attitude and

reveal the way in which we perceive the person. In a sense, then attitudes are

perception that involves emotional feeling or biases and they predispose us to act in a

certain way. Attitudes are generally concerned with activities. (Hornby, 2007)

identified attitudes as the way that one thinks, and feel about somebody, something,

the way one behaves towards somebody/something that shows how one thinks and

feels. It is therefore a person’s tendency to react towards another person, object or

institution in a favourable or unfavourable manner. Attitude is either positive or

negative.

In the view of National Teachers Institute (NTI) (2000), attitude indicates depth of

feeling that is degree to which a person, idea or institution are rather inferred either

through what the individual does or says. The institute further added that individual

display one attitude or another and attitude takes time to develop and it is often

difficult to alter the feeling. The institute asserts that it is more difficult to get

adolescent change his attitude than an adult. An attitude is the relatively stable overt

behaviour of a person which affects his status. Attitudes which are different to a

group are those social attitudes or values. The attitude is the status that manifest as

behaviour. This differentiates it from habit and vegetative processes as such and

totally ignores the hypothetical ‘subjective states’ which have formerly been

emphasized. Operationally, attitude in the context of this study has to do with positive

or negative evaluation of HIV and AIDS in our environment. That is an enduring way

of thinking, feeling and behaving towards the issue of HIV and AIDS.

Concept of HIV and AIDS

HIV as defined by the World Health Organization (WHO, 1995) stands for Human

Immunodeficiency Virus that affects only human beings. As noted by Williams,

(2000) HIV attacks the human immune system, the body’s defence against invading

disease. It damages the immune system by systematically destroying an important

type of white blood cell, CD4 cells or T cells. As noted by Muriel and Sylvia (2001)
HIV is the Virus that causes AIDS. It is a virus that affects human beings and causes

a lowering of the body’s immune system. This situation makes it impossible for the

body to fight certain infections. HIV destroys certain white blood cells. These cells

are critical to the normal functioning of the human immune system, which defends

the body against illness. When weakens the immune system, a person is more

susceptible to developing a variety of cancers and becoming infected with viruses,

bacteria and parasites (WHO, 2006).

On the other hand, AIDS which is Acquired Immune Deficiency Syndrome is a term

not often used by doctors today as they prefer to talk of advanced or late HIV

infection. It is the outcome of damage to the immune system by HIV. When the body

is severely weakened by HIV, it can be attacked by a number of serious disease

conditions like Pneumocystio Carinni, Pneumonia (PCP) and Tuberculosis (TB).

Such conditions are referred to as AIDS (Kawonza, 1999). The UNAIDS (2002)

Opined that AIDS exerts a heavy toll on its victims and it compromised people’s way

of life and dramatically increased the risk of death. As noted by WHO, (2006) a

person who is tested positive for HIV is considered to have progressed to AIDS when

a laboratory test shows that his or her immune system is severely weakened by the

virus or when he or she develops at least one of about 25 different opportunistic

infections, diseases that might not affect a person with a normal immune system but

that take advantage of damaged immune systems.

AIDS manifest after about 10 years of HIV infection an indication that it is a

condition that brought about by the HIV Virus according to United State on AIDS

(USAID, 2008). A person gets infected and experiences the AIDS signs and

symptoms like rapid weight loss, persistent fever or profuse, night sweats, dry cough,

swollen lymph glands in the armpits or neck, diarrhea that last for more than a week,

pneumonia, white spots or unusual blemishes on the tongue, depression and other

neurological disorders (United State on AIDS, (USAIDS, 2008). In the views of

Ogunyombo (1999), there are white blood cells in the body which are very useful for

fighting against the infection but HIV destroys the cells. When the blood cells fall to

unsafe levels, it is said that the person is having AIDS.

The centre for Disease Control and Prevention (CDCP) according to WHO (2006)

defines AIDS to mean that a person has had either a positive test for HIV antibodies

along with the occurrence of infections that take advantage of an impaired immune

system or CD4 lymphocytes count of 200 or less. CD4 lymphocytes are those white

blood cells that are in charge of immune system function.

When students have understanding of HIV/AIDS and its effects on health, they will

behave well and live a healthy life.

Concept of Adolescence

The concept of adolescence has been variously defined by scholars based on their

perceptions and culture.(Conger, Kegan and Mussen, 2004) stated that adolescence is

a period of transition between childhood and adulthood. It is a period that varies from
culture to culture and is a time when individuals learn to be socially responsible for

themselves and for their actions. It is considered to last from ages 10 to 19 and from

puberty to full biological/ physiological maturation. They further stated that within

this time frame, females in particular are affected by various developmental

transformations including physical, emotional, and social changes. Adolescence is a

period of rapid transitional developmental changes from children to adulthood

(Nworah, 2004). It is a period when the physical and physiological change that

accompanies the transition from childhood to adulthood becomes manifest and

continues into adulthood. The author further remarked that it is a period usually

between the ages of 10 to 21 years, marked by the development of the child to adult,

extending from puberty to independence. This implies that it is a period of great

energy and changes of mood, which can come in form of cheerfulness, anger and

other times withdrawal. Adolescence period is characterized by maturity of

reproductive organs and behavioural changes, with corresponding interest in sexuality

and desire for sexual expression. There is usually a tendency for the adolescents to

express themselves sexually (Samuel, 2010). Sexual behavior among secondary

school students have over the years become an issue of great concern especially with

the upsurge of HIV and AIDS pandemics. According to UNAID (2013), an

increasing number of youths within the age of 10- 20 years have continued to be

infected with HIV/AIDS (UNAID, 2013). Half of the entire world populations whose

ages are between 10 – 20 years are among the most vulnerable to HIV and AIDS
infections. (UNAIDS,2013). Many adolescents around the world are sexually active

and because many sexual contacts among them are unprotected, they are at the risk of

contracting HIV/AIDS. Those of childhood or full adulthood, ultimately define the

period of “adolescence”.

Understanding the period of adolescence is crucial to solving the problem of

HIV/AIDS amongst students.

Concept of Education

Education is the process of receiving systematic instructions especially at a school or

university according to Oxford Dictionary of English (2016). Education is the wealth

of knowledge acquired by an individual after studying particular subject matters or

experiencing life lessons that provide an understanding of something, it requires

instruction from some sort from an individual or composed literature.

Western or formal education was started in Nigeria in 1842 by the Christian

missionaries who managed the system and later in 1859, secondary education was

established. Students spend six years in secondary school. Three years of JSS (Junior

Secondary School) and three years of SSS (Senior Secondary School). By senior

Secondary School class two students are taking the GCE O’level exam, which is not

mandatory but some students take it to prepare for the Senior Secondary Certificate

examination.
HIV/AIDS has emerged as the single most formidable challenge to public health

human rights and development in the new millennium. School children of today are

exposed to the risk of HIV/AIDs which was quite unknown to their predecessors a

few years ago. The epidemic of HIV/AIDS is new progressing at a rapid pace among

young people. Studies have reported that young people from a significant segment of

those attending sexually transmitted infections (STIs) clinic and those infected by

HIV. Students are vulnerable to HIV/AIDS because of lack of sex education, media

campaign on HIV/AIDS prevention, seminars on relationship issues and even their

belief that they cannot contact HIV/AIDS. Programme managers and policy makers

have often recommended that schools can act as the centre point for information and

education on HIV/AIDS. Hence, school education has been described as a social

vaccine and it can serve as a powerful preventive tool.

People leaving with HIV/AIDS are stigmatized and most students find it difficult to

relate with people diagnosed with HIV/AIDS. Students’ behaviours (especially

secondary school students) towards reducing HIV/AIDS are not encouraging; some

feel that those diagnosed with the virus are now out cast (that is they are no more part

of them). Students pattern of prejudice or discrimination ranges from devaluing,

discounting and discrediting against people living with HIV/AIDS in Enugu North

Local Government of Enugu State.

Education is very powerful and is the only means that students would be taught to

know, have better perception and show positive attitude towards HIV/AIDS and

towards people living with it to bring reduction in cases about HIV/AIDS.

Theoretical Framework

The theoretical framework will focus on The hunters’ Theory, Theory of Planned

Behaviour, Social Action Theory

The Hunters Theory

The hunter’s theory is the most commonly accepted theory. SIVcpz (Simian

immunodeficiency virus) found in chimpanzees are transferred to humans as a result

of chimps being killed and eat en or their blood getting into cuts or wounds on the

hunter. Normally the hunter’s body wound have fought off SIV, but on a few

occasions its adapted itself within its new human host and became HIV – 1. The fact

that there were several different early genetic make-up (the most common of which

was HIV-1 group M), would support this theory. Every time it passed from a

chimpanzee to a man, it would have developed a slightly different way within his

body and this produced a slightly different strain. “Retro-viral transfer from primates

to hunters is still occurring even today”. An article published in the Lancet in 2004

also shows how retroviral transfer from primates to hunters is still occurring even

today. In a sample of 1099 individuals in Cameroon, they discovered (10%) were

infected with SFV (Simian Foany Virus) an illness which like SIV was previously

thought only to infect primates. All those infections were believed to have been
acquired through the butchering and consumption of monkey and ape meat.

Discoveries such as this have led to calls for an outright ban to bush meat hunting to

prevent Simian viruses being passed to humans.

With regard to knowledge, perception, and attitude about HIV/AIDS towards

reducing it, the relevance of the theory is to bring to the notice of the general public

including students about Simian immunodeficiency virus and it negative effect to

health.

Theory of planned behavior

The theory of planned behavior is designed to help programme implementer design

interventions that effectively address a particular behavior. It is especially intended

for those designing interventions that target health – enhancing individual behavior

that may be socially unacceptable such as condom use, Smoking cessation, self

check-ups, voluntary resting and medication adherence.

1. Behavioural belief (Sample question: If I make this decision, what will the

outcome be?)

2. Normative belief (Sample question: What do others expert me to do?).

3. Control belief (Sample question: Am I confident in my ability to behave this

may)

According to theory if planned behavior: An HC3 Research Primer (PDF): When

combined, attitudes towards the behavior, Subjective norm and perceived behavior
control result in the formation of an intention. Understanding these beliefs and the

intentions they produce can provide dues on how to impact behavior change.

This theory holds that individuals are more likely to intend to behave healthy

behaviours if they have positive attitude about the behaviour, believe the subject

norms are favourable towards those behaviours correctly. This theory holds that

outside factors and restrictions can prevent an individual from performing behaviour

even when they have an intention to do so. Therefore implementers need to study the

beliefs that control the subjective norm, the intention to perform a particular

behaviour and the actual behaviour that is traditionally performed.

In theory of planned behaviour the following factors influence behaviour

1. Knowledge: All knowledge that is necessary to take decisions. Some

knowledge is not correct there can be many misconcepts and myths when it

comes to sexuality sexual behaviour and sexual reproductive health and rights

2. Attitudes: Perceived advantages and disadvantages and perceived barriers and

benefits of a certain behaviour. For example, the barriers and benefits of using a

condom.

3. Risk Perception: The perception on one’s actual risk, which is different from

knowing about the risks. People tend to underestimate their own risks, and

overestimate the risk of others for example when you known that when you

don’t use a condom during sexual intercourse, that you will contact HIV/AIDS
 but you perceive the risk as low and when truly it is high. A result can be that

you will not use a condom.

4. Social influence: The positive and negative influence of others such as norms in

the society or peer pressure. Social influence has two component

a. Actual influence

b. Perceive influence

For instance, when you don’t think you boyfriend or girlfriend wants to have sex that

is perceived influence; whereas in reality this is not the case (actual influence).

This theory is pined at behavior, perception, attitude, knowledge about health and this

would be of immense help to this present study towards reducing health issues such

as HIV/AIDS by implementers.

Social Action Theory

Social Action Theory (SAT) is an integrative systems model of social – motivational,

cognitive and environmental processes which provide a novel and potentially

productive framework for understanding behaivour perception and knowledge of

HIV/AIDS.

Social Action theory (SAT) was developed as an extension of individual level

psychological theories to address the broad complexities of public health the

overarching goal is the detection and manipulation of environmental and self –

regulating skills/deficits that can promote health behaviours and habit (Johnson,

Carrico, Chesney, and Morin, 2008)

From these original roots, SAT has since been applied to HIV risk reduction and the

prevention of HIV/AIDs risk behaviour.

Social Action theory (SAT) elaborates upon existing HIV/AIDS related social-

cognitive models that emphasize cognitive appraisals (a personal interpretation of

situation and possible reactions to it) and beliefs by focusing on social motivational

and contextual influences that energize and shape behaviour, specifically highlighting

the ways in which important self – foals frequently practical routines, social –

emotional competence and social power effect substance and use and other risky

behaviours (Ewart 2005)

Applied to knowledge, perception and attitudes of secondary school students towards

reducing HIV/AIDS SAT views the importance of engaging in a personal regulatory

resources and social power afforded by environmental context (variables that have

historical impact on students as well as those relevant in the society) in combination

with the individuals psychopathology (the scientific study of mental health) and

affect, HIV – related attitudes and knowledge and self regulatory skills/deficit.

Social Action theory (SAT) has four components which are

1. Environmental influence (i.e. childhood trauma and characteristics of last

sexual intercourse)
 2. Forms of psychopathology and affect (substance use, depression, anxiety,

borderline and antisocial personality disorders and negative emotionality

3. HIV – related attitudes, perception and knowledge (condom attitudes,

HIV/AIDS knowledge and one’s perception towards HIV)

4. Self – regulatory skills/deficits (trait non planning impulsivity, delay

discounting and risk taking propensity)

Empirical Review

The purpose of this empirical review was to cover broad area of qualitative research

work done with statistical findings about knowledge, perception and attitude of

secondary school students towards reducing HIV/AIDS.

Senior Second School Students’ Knowledge about the Prevalent of HIV/AIDS

Omeonu and Kollie (2010) Studied knowledge and attitude of secondary school

students on risk behaviour of HIV/AIDS. The aim of the study was to identify the

level of knowledge students upheld towards risk behaviours that encourage the spread

of HIV/AIDS. In addition, the study sought to identify the difference in awareness

level of male and female students in the spread of HIV/AIDS. A descriptive survey

design was utilized with a sample population of 206 respondents. Findings of the

study revealed that:

1. Male and female students have adequate knowledge of HIV/AIDS

2. It was revealed that secondary school students have no positive attitude towards

risk behaviour in spreading HID/AIDS. That is to say that the students showed
 neither positive nor negative attitude towards risk behaviour in transmitting

HIV.

The present study focuses on sensitizing students to show positive attitude towards

risk behavior that will bring about reduction in HIV/AIDS.

Egbezor and Echendu (2012) investigated the impact of HIV/AIDS education

programmes on sexual behaviour of female students in Nigeria secondary schools.

The study utilized 200 female students and reported the following results.

1. Female students in Urban Schools seem to be more conscious of HIV/AID

infection and appear to modify their sexual behaviour towards avoiding HIV

infection.

2. In the Urban Schools, mean rating for female students deciding to delay sex

until marriage is 2.44 and 2.10 for rural female students.

3. The mean rating for female students insisting on their male partner using

condom is 2: 65

4. In Urban Schools, the mean rating for female students urge to have multiple sex

partner s is 2.37, while for rural school s is 2.65 the mean rating for female

students willing to go for HIV test is 3.75 for urban schools and 2.60 for rural

schools
 5. Female students in urban schools mean rating for resisting the pressure for

unprotected sex is 2.67 and 3.26 for rural schools

The study concluded on the impacted of HIV/AIDS programmes on sexual behaviour

of female students. The present study is not limited to female students alone but both

male and female on their knowledge about HIV/AIDS which will be of immense

benefit in reducing it.

Similarly, Ojo (2011) conducted a study to assess HIV/AIDS knowledge and risk

behaviour of students in Ekiti – State, Nigeria. The study utilized a sample population

of 433 students of which 207 are males, while 226 are females. Awareness of

HIV/AIDS questionnaire (AHQ) was used. The age distribution of the respondents

was as follows: 15 – 17 years (196), while 18 and above (237) The result indicated

that there was no significant gender main effect and gender differences in the

knowledge of undergraduates on the risk behaviour of HIV/AIDS pandemic. Also the

study revealed that the knowledge of HIV/AIDS for both sexes was equal.

The present study is based on student having the right knowledge not minding the

gender so as to reduce the modern pandemic (HIV/AIDS).

Makwe and Adenyuwa (2014) assessed knowledge of students about sexually

transmitted infections (STIs) and AIDS by finding out their understanding about the

means of transmission of STIs and AIDS, and preventive measure available. The

study utilized a population sample of four hundred and five (405) students. The study

was a descriptive survey method, utilizing simple descriptive statistics of percentages.

Findings revealed that

1. Knowledge of STIS (37.4%): HIV/AIDS (91%). Types of sexually transmitted

infections (STIS) (gonorrhea, 89.3%), syphilis 81.2%. It was reported that

television was the highest source of knowledge (82%), while school education

(81.5%). The study concluded that the students awareness about STIS and

HIV/AIDS was considered relatively on the high side. Also, the study

concludes that Gonorrhea and Syphilis were the most known types of STIS

among the students’ respondents.

The present study is hinged on the knowledge of HIV/AIDS of student towards

it reduction and not on gonorrhea and syphilis; this study is basically

determining the students knowledge, attitude and perception towards reducing

HIV/AIDS.

Students’ Perception on reducing the spread of HIV/AIDS

Shanka, et al (2009) Conducted a study on perception and knowledge about

HIV/AIDS among students in West Nepal. The sample population of this study

consists of 163 students. The Mann. Whitney test was used for dichotomous variable,

while Krushal – Eallis test for other variables.

Results of the study revealed the following:

1. The foreign and self financing students were observed to need greater training

to tackle HIV/AIDS
 2. Biology students had better knowledge and attitude than others.

3. Students were of the misconception that HIV/AIDS is a more dangerous

disease than hepatitis B.

4. Over 305 of the students would avoid social contact with HIV/AIDS

5. Students agreed with the statement that homosexuality is a crime.

The present study is channeled towards students’ right perception to reducing

HIV/AIDS.

Arogundade (2012) investigated HIV/AIDS awareness as a predictor of secondary

school dating behaviour in South-West Nigeria. The researcher carried out a cross –

sectional design with a simple population size of 1600 (M = 800 and F. 800) with

school students in age 16. The Awareness/Attitude to AIDS scale (AAS) and the

Dating Behaviour Questionnaire (DBQ) were used to collect data for analysis.

Results showed that

1. There is significant difference in students dating behaviour on the basis of their

knowledge of the occurrence and prevalence of HIV/AIDS where t = 4.82, df

1191, P < 0.05

2. There is significant difference in students dating behaving on the basis of their

awareness of mode of contracting HIV/AIDS, where t = 2.09, P < 0.05

3. There is significant difference in students dating behaviour on the basis of their

awareness of HIV/AIDS, where t = 1.38, P > 0.05 (P. 11)

 The study is based on dating behaviour of students in respect to their attitude,

knowledge and awareness of HIV/AIDS. The present study reveals other ways of

contracting HIV/AIDS other than through dating behaviours

Attitude and Awareness of Students towards HIV/AIDS

A study was carried by Onoja (2004) using adolescents male and female in Otukpo

metropolis of Benue State of Nigeria. The study aimed at finding out the awareness of

HIV/AIDS and influence on the attitude of secondary school students sexual

behaviour. The study adopted a descriptive survey using as subject 250 male and

female students in Otukpo Benue State. The instrument for data collection was

questionnaire and the data generated were analyzed using mean and standard

deviation. The findings among others revealed that the subjects were aware of the

presence of HIV/AIDS but the awareness has no influence on their attitude towards

sexual issues.

The present study is ensuring that student’s adequate knowledge about HIV/AIDS is

utilized by them to bring about HIV/AIDS reduction.

Donkor (2012) carried out a study investigating attitudes knowledge and practices of

voluntary counseling and testing for HIV among second any school students in

Ghana, West Africa, using a cross sectional method. The target population was

secondary school students with a total of 6549. The sample population of the study

was 100 students. The majority of the student participants fell in age group of 21

years.
 The results of the study showed that

1. Majority of the respondents (81%) indicated that they had heard about

voluntary counseling and testing (VCT), while (19%) denied previous

knowledge of VCT

2. Respondents 70% felt that VCT help individuals to their HIV status

3. Twenty one percent (21%) of the respondents indicated that those positive of

HIV should seek medical attention, while six percent (6%) suggested protective

sex practices.

The study reported that eighty – eight percent (88%) of the respondents are positive

with regards to voluntary counseling and testing (VCT), while about 65 of the

respondents felt that those who went for VCT are promiscuous. Forty-nine percent

(49%) of the respondents felt that HIV positive people should not be integrated into

the society. Forty percent (40%) of the respondents indicated interest in accessing

VCT services if available while 25% indicated no interest.

This present study brings to the knowledge of the students that a person living with

HIV/AIDS can still live and be integrated into the society as normal people and not

outcast.

Summary of Literature Review

The conceptual framework gave comprehensive explanations to words which formed

the framework of the research topic; it provided conceptual meaning to knowledge,

perception, attitude, HIV/AIDS, adolescence and Education.

Theories of learning upon which this research topic is predicated were exhaustively

discussed under the theoretical framework; three major theories were discussed

namely, the hunters’ theory, which emphasized on bush meat as a cause for HIV-1.

Theory of planned behavior and social Action theory which target at health –

enhancing individual behaviours and the detection and manipulation of environmental

self- regulating skills/deficits that can promote health behavior.

Relevant literatures related to the research topic were thoroughly reviewed under the

empirical review using variables in the study as benchmarks.

The review of empirical studies did not show consistent results. Most of them were

concerned about gender, about dating behaviours and about Sexually transmitted

diseases (STDs). They did not really lay much emphasis about student’s perception

about people living with HIV/AIDS and about student’s attitude towards reducing

HIV/AIDS.

CHAPTER THREE

MATERIALS AND METHODS

3.1 Background to Study Area. Nsukka Local Government Area (LGA) is one of the

sixteen LGAs in Enugu State.

There are many public and private primary and secondary schools and three tertiary

institutions within Nsukka Local Government Area.

3.1.1. Target Population. We targeted male and female secondary school students, in

public and private secondary schools in Nsukka zone, Enugu State, Nigeria.

3.1.2. Study Population. The study population was SS1–SS3 students attending

public and private secondary schools in Nsukka zone. In Nigeria, students spend 6

years in the primary and 6 years in secondary school. The first 3 years in the

secondary school are referred to as Junior Secondary 1–3 or JS1–JS3. The latter 3

years are referred to as Senior Secondary 1–3 or SS1–SS3. On completion of the

senior secondary school, students are meant to proceed to a university or another

tertiary institution where they spend a minimum of 4–6 years depending on the course

of study.

3.1.3. Study Design. This was a prospective cross-sectional descriptive survey.

3.1.4. Sample Size Determination. Sample size for the study was determined using

the formula for calculating single proportions by Abramson and Gahlinger [10]. The

total number of secondary school students in Nsukka zone was above

10,000. Therefore the sample size formula

𝑝 (1 − 𝑝) × 𝑍𝛼2

𝑛= , (1)

𝑑
was used, where 𝑛 is minimum sample size, 𝑍𝛼 is standard normal deviate,

corresponding to 95% confidence level at which 𝑍 = 1.96 for a two tailed test, 𝑝 is

proportion in the target population estimated to have a particular characteristic

(prevalence of STI from a previous study was 34%) [11] and 𝑑 is degree of accuracy

desired or maximum allowable difference from true proportion which was set at 5%

(0.05);

𝑛 = (0.34 × 0.66 × (1.96)2)/(0.05)2 = 345.

In order to make up for incompletely filled questionnaire, the number was

increased to 500 but 550 respondents were interviewed.

3.1.5. Sampling Technique. Multistage sampling technique was used for the study.

A complete list of all the private and public secondary schools in Nsukka zone

LGA was obtained from the Ministry of Education. Using systematic random

sampling method, 3 private and 3 public secondary schools were chosen. The number

of students chosen from each school was proportionate to the total population of

students in the school. Simple random sampling (balloting) was used to select an arm

from each of the class levels (SS1–SS3). The total sample size was shared among

these chosen classes by proportionate allocation using the formula

Total Class Size

Class sample size =

Total School Size (SS1 to SS3) (2) × Total Sample Size.

This yielded the number to be drawn from each class. Simple random sampling

technique was then to be used to draw out the number from each class using a table of

random numbers.

3.1.6. Data Collection Instrument and Methods. A pretested, self-administered

questionnaire was used for data collection. The questionnaire elicited information on

the sociodemographic characteristics of the respondents and their knowledge of STIs.

The questionnaire was pretested among students whose schools were not chosen as

part of the study.

3.1.7. Data Analysis. Data analysis was done using SPSS version 16. Univariate

analysis (frequencies and percentages) was done. In determining the level of

knowledge of each respondent about STI, a seventeen- (17-) point scale developed by

the researcher was used. Question 9 with 4 stems on names of STIs known; question

10 with 7 stems on knowledge of modes of STI transmission, and question 11 with 6

stems on knowledge about symptoms of STI of the questionnaire were scored.

Therefore, the total points obtainable by a respondent were seventeen (17). Each

correct response was scored one mark and nonresponse or wrong response was scored

zero mark. Those who scored six points or less (≤6) were considered as having poor

knowledge; those who scored between seven and twelve (7–12) were considered as

having fair knowledge, while those who scored between thirteen and seventeen(13–

17)wereconsideredashavinggoodknowledge.
3.1.8. Ethical Issues. The major ethical concern was that of confidentiality. The

questionnaires were completed privately and anonymously. All records and relevant

materials were stored in locked cabinets and accessed only by authorized personnel.

Ethical clearance was obtained from the Ethics and Research Committee of the

University of Nsukka zone Teaching Hospital. Permission to carry out the study was

sought from the Ministry of Education and the Principals of the various schools.

Written informed consent was also obtained from the participants.

CHAPTER FOUR

RESULTS

A total of 540 out of 550 questionnaires administered were correctly filled out and

returned (response rate, 98.2%).

Table 1. The respondents were mainly aged between 10 and 19 years. Of these, 109

(20.2%) of them were aged between 10 and 14 years while 429 (79.4%) were aged

between 15 and
19 years. The mean age was 15.7 ± 1.5 years. A total of 128 (23.7%) respondents

were in SS1, 253 (46.9%) in SS2, and 159 (29.4%) in SS3 classes. Three hundred and

twenty-seven (60.6%) of the respondents were females; 482 (89.3%) were from

public schools; 511 (94.6%) were Christians and 468 (86.7%) belonged to Yoruba

ethnic group.

Table 2. A total of 499 (92.4%) respondents were aware of sexually transmitted

infections while 41 (7.6%) were not aware. The three major sources of information in

decreasing order of importance were the radio and television 343 (68.7%); teachers

340 (68.1%); and newspapers 224 (44.9%).

As shown in Table 3, 80.2% of the respondents knew only one STI, and 3.7%

mentioned sickle cell anaemia (a genetic disease) as an STI.

Table 3. A total of 433 (80.2%) respondents knew only one sexually transmitted

infection while only 15 (2.8%) respondents knew four. The most popularly mentioned

ones were HIV/AIDS 421 (78.0%) and gonorrhea 124 (23.0%). Twenty (3.7%) of the

respondents incorrectly mentioned sickle cell anaemia as a sexually transmitted

infection.

As shown in Table 4 more than a tenth (12.2%) to about a

quarter(22.0%)oftherespondentshadmisconceptionsabout the mode of transmission of

sexually transmitted infections.

Table 4. The most popularly known modes of transmission were unprotected sex 473

(87.6%); sharing of infected sharps 446 (82.6%); and infected blood and blood

products 395 (73.1%). There were equally misconceptions that STI can be transmitted

by coughing/sneezing 119 (22.0%), sharing toilets 87 (16.1%), and sharing plates 66

(12.2%).

Table 1: Sociodemographic characteristics of the respondents.

Characteristics Frequenc Percenta

y ge

Age 109 20.2

10–14

15–19 429 79.4

20–24 2 0.4

Total 540 100.0

Sex 213 39.4

ale

Female 327 60.6

Total 540 100.0

Ethnic group 468 86.7

Yoruba

Igbo 47 8.7

Hausa 10 1.9
 Others 15 2.8

Total 540 100.0

Class 128 23.7

SSS 1

SSS 2 253 46.9

SSS 3 159 29.4

Total 540 100.0

School type 482 89.3

Public

Private 58 10.7

Total 540 100.0

Religion 511 94.6

Christianit

Islam 29 5.4

Total 540 100.0

Ethnicity 468 86.7

Yoruba

Ibo 47 8.7

Hausa 10 1.9

Others 15 2.8

Total 540 100.0

 As shown in Table 5, only 48.3, 48.0, and 47.2% of the respondents could identify

genital swelling, body rash, and genital discharge which were very common

symptoms. This implies that more than 50% of the respondents could not identify

these common symptoms of STI.

Table 5. The three most commonly known symptoms of STI were weight loss

(77.4%); painful micturition (68.9%); and genital ulcer (54.1%).

Table 6. Overall, 103 (19.1%) respondents had poor knowledge and 400 (74.1%) had

fair knowledge while 37 (6.9%) had good knowledge of sexually transmitted diseases.

Table 2: Awareness of sexually transmitted infections and sources of information.

Awareness of STIFrequency Percent

(𝑛) = 540 age

Percent

age
Sources of information

Frequency

infectio
There were multiple responses.
ns
Table 3: Number and types of

sexually transmitted known by

respondents.

Number of Frequency (𝑛=540) Percent

sexually age

transmitte

infections

known

None 41 7.6

One 433 80.2

Two 51 9.4

Four 15 2.8

Name of Percent

sexually age

transmitte

d infection

HIV/AIDS 421 78.0 Gonorrhea 124 23.0

Herpes simplex 35 6.5

Sickle cell anaemia 20 3.7

There were multiple responses.

1. Discussion

The study examined awareness and knowledge of sexually transmitted infections

among adolescents in Nsukka zone, South Eastern Nigeria. Nearly all the respondents

were aware of sexually transmitted infections. This finding is consistent with that of a

study conducted in Malaysia, in which 92% of the respondents reported awareness of

STDs [12]. It is also similar but higher than that of a study conducted among Thai

adolescents in which 9 out of ten respondents were aware of STDs [13]. It is also

higher that of a study conducted in Northern Nigeria in which 67% of adolescents

were aware of STIs [14]. Awareness about sexually transmitted infections in general

has increased over the last three decades since the advent of HIV/AIDS due to the

widespread publicity given to the disease. However, awareness about other STIs

might not be encouraging.

Table 4: Modes of transmission and misconceptions about modes of transmission of

sexually transmitted infections.

Frequ Perce

ency∗ ntage

Mode of transmission 47 87.6

Unprotected sex 3

Needles and syringes 44 82.6

6
 Blood and blood 39 73.1

products 5

Mother to child 38 70.9

Misconceptions 11 22.0

about modes of 9

transmission

Coughing/sneezing

Sharing toilets 87 16.1

here were multiple responses.

s of

about sexu
Table 5: Knowledge of
sympt ally
respondent transmitted
oms
infections.

Symptoms Frequency∗ Percentage

There were multiple responses.

Table 6: Overall knowledge of sexually transmitted infections among the respondents.

 Level of Frequency Percent

knowledge

Poor 103 19.1

knowledge

Fair knowledge 400 74.1

Good 37 6.9

knowledge

Total 540 100.0

The major sources of information were the radio and television (electronic media),

teachers, and newspapers. This contrasts with reports of a study conducted among

adolescents in North Western Nigeria in which the major sources of information were

school lessons, mass media, and health magazines [14] and that conducted in

Thailand in which the major sources of information were school, Internet, and

hospital/clinic [13]. The fact that the electronic media are the major source of

information is due to the fact that most people have access to transistor radios and

adolescents especially have cell phones sets with in-built radios. These give them

continuous access to the news. Teachers and schools are playing increasing roles in

disseminating information about STIs. This is as a result of sexuality education which

is being progressively incorporated into the school curriculum.

Moreover,studentsaretaughtaboutSTIsinsubjectslikeBasic Science, Biology, and

Home Economics.
 In this study, only 3% of the respondents could mention four STIs while majority

of them (eight out of ten) knew only one sexually transmitted infection which was

HIV/AIDS. Gonorrhea was the next most popularly mentioned STI but it was only

known to two out of ten of the respondents. Respondents who knew about herpes and

syphilis were less than ten percent altogether while others like HPV infection,

hepatitis B, and chlamydia were not mentioned at all. This finding is similar to that

reported by studies conducted in Tanzania, North Central Nigeria Thailand, Germany,

and Europe in general in which the most commonly known STI was also HIV/AIDS

[15–19]. However, knowledge about other STIs like gonorrhea, syphilis, chlamydia,

and HPV was much lower than that of HIV/AIDS, different from what was obtained

in this study and also from one study to another.

These studies show that while widespread publicity has been given to HIV/AIDS,

other STIs with severe complications and which also predispose to HIV/AIDS have

been relatively ignored. It is imperative that awareness be created about these STIs as

well.

About 4% of the respondents had the misconception that sickle cell anaemia is an

STI. While this reveals the level of their ignorance about the cause of the disease, it

can also fuel the existing stigmatization and discrimination against people with this

genetic disorder. A misconception of this nature was not found in other peer-reviewed

literature.
 Majority of the respondents knew that STIs could be transmitted through

unprotected sex, sharing of infected sharps and via infected blood/blood products.

This is consistent with the reports of various other studies conducted within and

outside the country though these studies focused mainly on HIV/AIDS [19]. In

another study conducted among Thai university students, almost everyone knew that

sexual intercourse was a route of transmission of STD [13]. In this study, the

respondents’ knowledge about the transmission of HIV/AIDS could have informed

their choices of infected sharps and transfusion with infected blood/blood products

since most of them could not even mention the STIs that were transmitted via these

routes apart from HIV/AIDS.

There were misconceptions about routes of transmission as well. The respondents

felt that STDs can be transmitted through coughing and sneezing 22%, by sharing

toilets 16%, and by sharing plates 12%. This is similar to but higher than that reported

among Thai students, about 8.7% of which felt that sharing clothes/things was a route

of STD transmission. Misconceptions about STD transmission weaken the motivation

to adopt safer sexual behaviour and strengthen stigmatization against people such that

they may be discouraged from accessing healthcare services.

In this study, the three most commonly mentioned symptoms of STI were weight

loss, painful micturition, and genital ulcer. This contrasts with that reported among

Thai students in which the most commonly mentioned symptoms of STI were

penile/vaginal discharge and genital itching [13]. It also contrasts with that of a study
conducted among youths in North Central Nigeria in which the most popularly known

symptoms of STIs were rash, painful urination, and painful intercourse [16]. The

differences in symptom mentioned in these studies could be due to the STI type the

adolescent was aware of. They could also be due to the nature of the questions asked.

Whereas open-ended questions were used in this study, close-ended ones were used in

the other studies with various options which could have allowed for guessing.

Overall, less than a tenth of the respondents had good knowledge; about three-

quarters had fair knowledge, while approximately one-fifth had poor knowledge of

sexually transmitted diseases. The majority of the respondents could only mention

one STI and some even mentioned a genetic disease as an STI; about a quarter had

misconceptions about the modes of transmission of STI, while some could not

identify some common symptoms of STI.

CHAPTER FIVE

CONCLUSION

The study concluded that secondary school adolescents in Nsukka zone are mostly

aware of sexually transmitted infections but lack in-depth knowledge about these
diseases, their symptoms, and modes of transmission. Comprehensive health

education about other sexually transmitted infections (apart from HIV/AIDS) should

be inculcated into the secondary school curriculum. Media enlightenment campaigns

about these diseases should also be emphasized.

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Appendix A. Questionnaire on Sexually Transmitted Infection

Identification

Name of School

Class
 Date

A.1. Sociodemographic Characteristics of Respondents

(1) Age (in years)

(2) Sex of respondent

Male

Female

(3) Religion

Christianity

Islam

Others (specify).............................................

(4) Ethnic group

Yoruba

Igbo

Hausa

Others (specify).............................................

(5) Class

SSS1...............

SS2....................
 SS3......................

(6) Type of School

Public

Private

A.2. Knowledge of Sexually Transmitted Infections (STIs)

(7) Have you ever heard of sexually transmitted infections (STIs)?

Yes No

(8) What is your source of information?

TV/radio

Newspaper

Public talks/seminars

Billboards/posters

Hospital/health workers

Teachers

Friends/relations Others (specify)

(9) Do you know any sexually transmitted infection? Mention the ones that you

know
(10) How do people contract sexually transmitted infections? Write either Yes/No/I

do not know in front of the options given

From needles and syringes

Blood and blood products

Sharing the same plate with infected person

Unprotected sexual intercourse

From mother to child

From sharing the same toilet with an infected person

Exposure to cough and sneeze from infected persons

(11) What are common complaints in people with STI? Write either Yes/No/I do not

know in front of the options given

Weight loss

Burning pain when passing urine Discharge from genital area

Wound/sore in the genital area

Body rash

Swelling/boil around the genitals

Others (specify).............................................