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East African Journal of Public Health
East African Public Health Association
ISSN: 0856-8960
Vol. 3, Num. 2, 2006, pp. 19-22

East African Journal of Public Heath, Vol. 3, No. 2, October 2006, pp. 19-22

LEVELS OF KNOWLEDGE AND SOURCES OF INFORMATION ON SEXUALLY TRANSMITTED INFECTIONS AMONG SECONDARY SCHOOL YOUTH IN DAR ES SALAAM, TANZANIA

Anna Tengia-Kessy1 and Hussein Kamugisha2

Correspondence to: Anna Tengia-Kessy,  P. O. Box 65015, MUCHS, Dar es Salaam, Tanzania. E-mail: akessy@muchs.ac.tz

1Department of Community Health, 2Medical Student, School of Medicine, MUCHS.

Code Number: lp06011

Abstract

Objective: The main purpose of this study was to explore sources of information and levels of knowledge on sexually transmitted infections (STIs) among youth in secondary schools in Ilala district, Dar es Salaam.
Methods: A cross sectional survey was undertaken among secondary school youth selected randomly from three public secondary schools. A self-administered questionnaire was used to gather information on socio-demographic characteristics, sexual activity, STIs-related knowledge and sources of information on STIs among the respondents.
Results: A total of 312 youth aged 12-22 years participated, 54.3 percent being female. The large majority of the participants were aged 15-18 years (57.3 percent). About 28 percent of the respondents (40.4 percent of boys and 16.9 percent of girls) reported to have experienced sexual intercourse. While teachers were reported to be the least source of information on STIs, the mass media, particularly television was perceived to be the commonest source from which a greater part of the youth got such information (23.4 and 75.0 percent respectively). Generally, less than three-quarters (70 percent) of the students had a good level of STIs-related knowledge and this knowledge was significantly associated with increasing chronological age and current level of education of the respondents (Chi square for trend = 15.06, p = 0.000 and 13.06, p = 0.000 respectively). 
Conclusion: Despite STIs being rampant among young people worldwide, these findings suggest a high sexual activity among the respondents and a relatively low level of knowledge on STIs. Moreover, although family life education has been integrated into the school national school curriculum, majority of the students got information on STIs via the media. In view of the findings, it is recommended that additional efforts are required to raise the level of knowledge on STIs amongst the youth in schools to enable them make informed sexual decisions. It is also imperative that heath messages targeting youth take into consideration the acceptability of the medium exploited.

Introduction

Young people (youth) between ages 10 and 24 years comprise the largest and fastest growing population segment in sub-Saharan Africa. From 1980 to 1995, the population of this age group grew to 56 percent (1). Early and unprotected sexual activities expose youth to the risk of contracting sexually transmitted infections (STIs) including human immunodeficiency virus (HIV) infection. STIs are a major public health problem especially due to their potentially serious complications when untreated as well as their relationship with HIV transmission. They cause considerable morbidity and premature mortality.Worldwide, young people under the age of 25 years, who represent nearly half of the world’s population, experience over 100 million new cases of STIs annually (2).

Various surveys indicate that as in many other developing countries, a high proportion of young people in Tanzania have unprotected penetrative sex by the age of 16 years (3-5). While 33 percent and 25 percent of primary school boys (12-20 years) and girls (12-19 years), respectively reported past experience of sexually transmitted diseases (STDs) in Mwanza (6), a point prevalence range of 5-14 percent for various STDs in a rural community-based sample of 1,104 youth has also been observed (3).

Despite the fact that use of condoms as a protective measure against STIs was not investigated in this survey, several factors have however been reported to discourage use of preventive measures for STIs amongst the youth population sub-group. Issues like condoms reducing sexual pleasure, financial constraints, poverty and social norms that perpetuate women’s subordination (7) as well as traditional views of manhood (8) have been incriminated.

Evidence from existing literature indicates that whilst basic sexual health information is reported by young people to be primarily acquired from peers, information on STIs including HIV/AIDS and pregnancy prevention amongst youth in Tanzania is usually acquired from the mass media (4,6,9). Only a small proportion of students reported parents as primary sources of information on issues of sexual health. In a related study in Dar es Salaam, it was observed that a relatively low proportion of parents were willing to talk to their children on sex related issues (10). The study further noted that a third of the parents were of the opinion that such issues should be taught at school, indicating that sex related matters are sensitive and parents shun away from discussing them with their children. On the other hand, the quality of information parents pass over to their children is doubtful and parents themselves worry that they do not have the information to give to their children (11). There are however, indications that young people prefer to receive sexual health information from parents, health workers and teachers whom they also consider as credible sources of such information (9). 

This study explored sources of information and levels of knowledge on STIs among secondary school youth in an urban setting so as to equip the relevant organizations and institutions with evidence based information when addressing STIs among youth in schools.

Study subjects and methods

A cross-sectional questionnaire survey was conducted among youth aged 12-22 years in three randomly selected public secondary schools in Ilala district, Dar es Salaam, in August 2005. Ilala district was randomly selected from the three administrative districts of Dar es Salaam region. The district has a total of seven public secondary schools, two public hospitals and several primary health care facilities. A total of 312 students from the various classes who were present on the day of data collection were systematically sampled from the students’ attendance register books for inclusion in the survey.  The participating schools were Azania and Benjamin William Mkapa (co-education) and Jangwani Girls’ secondary schools.  Azania and Jangwani schools have both day and boarding students while Benjamini William Mkapa is entirely a day secondary school. All the sampled students consented to participate in the survey.

Data was collected by a self-administered anonymous questionnaire, intentionally designed in Kiswahili language to facilitate a better understanding among the respondents. The instrument collected information on socio-demographic characteristics, sexual activity, STIs-related knowledge and probable sources of information on STIs.  The questionnaire had mainly close-ended questions and was earlier on pre-tested at Biafra Secondary School, a co-education day secondary school situated in Kinondoni district in Dar es Salaam. The research team closely supervised the students while filling-in the questionnaires.

Ethical clearance:

Permission to conduct the study was obtained from all relevant secondary school authorities. The purpose of the study was explained to all respondents. A written statement was also included on the introductory part of the questionnaire that further explained the study purpose, emphasizing on the confidentiality of the research information and voluntary nature of participation. Due to the sensitive nature of the research information, no names of respondents were required and the school teachers were requested to avoid coming close to the class room while the students were filling-in the questionnaires.

Data analysis

The levels of knowledge were determined by arbitrarily classified scores regarding the number of correct responses on questions relating to awareness of the different types of STIs, symptoms, modes of transmission and preventive measures against STIs. A score of one point was assigned for each correct response, and the maximum score was sixteen. Respondents scoring 50 percent and above were classified as having good level of knowledge while anyone with less than 50 percent of the score was classified as having a poor level of knowledge. Data from individual questionnaires were coded, entered and analyzed using Epi Info 6 computer software. Chi square test was used to test for association between the dependent and independent variables while chi square test for trend was used to analyze trends in proportions.

Results

The study sample on which the results are based constituted of 312 secondary school youth in Ilala district in Dar es Salaam, of which females were 54.3 percent. The ages of the respondents ranged from 12-22 years and over half (57.3 percent) were in the age group 15-18 years. About one-fifth (20.2 percent) of the students were in their third & fourth years of secondary school education (Forms III &IV) whilst 41.0 percent were in their first & second years of study (Forms I&II) and 38.8 percent of them were in high school (Forms V&VI). About two-thirds of the respondents were Christians and the rest were Muslims as summarized in Table 1.

The main sources of information on STIs were explored and the responses obtained are summarized in Table 2. Television was the major source of information as reported by 75 percent of the respondents. Furthermore, over 60 percent of them got information from either the radio or newspapers while 53.7 percent reported parents as their source of information. Teachers were however the least (23.4 percent) mentioned source of such information.

Table1: Social and demographic characteristics of secondary school youth who responded to a questionnaire survey on knowledge and sources of information on STIs

Characteristic

No.

Percent

Sex(N=302)

 

Male

138

45.7

Female

164

54.3

Age in years (N=302)

 

 

12-14

22

7.3

15-18

173

57.3

19-22

107

35.4

Education level (N=312)

 

 

Form I –II

128

41.0

Form III-IV

  63

20.2

Form V-VI

121

38.8

Religion(N=284)

 

 

Christians

191

67.3

Muslim

93

32.7

Table 2: Sources of information on sexually transmitted infections (N = 312)   

Source

 

Percent

Television

 

75.0

Radio

 

64.1

Newspaper

 

62.5

Parents

 

53.7

Friends

 

45.5

Teachers

 

23.4

Multiple responses

The levels of knowledge on STIs as well as the relationship between the different levels and socio-demographic characteristics of the respondents are summarized in Table 3. On the average, about 70 percent of the respondents had a good level of STI-related knowledge. Compared to the younger age groups as well as students in the lower education levels, youth aged 19-22 years and those in Forms V &VI had significantly better knowledge on STIs (Chi square for trend = 15.06, p = 0.000 and 13.06, p = 0.000 respectively). The proportion of male youth who had good level of knowledge was higher than that of females (75.4 & 68.3 percent respectively), but this difference was not statistically significant (Chi square = 1.84, p = 0.175). Similarly, no statistically significant difference in the levels of education on STIs was observed with regards to the religious affiliation of the youth (Chi square = 0.47, p = 0.491).

Table 3: The level of knowledge on STIs in relation to age, sex, religion and level of education among the secondary school youth

Characteristic

Level of Knowledge

Age (years)

Good

Poor

Total

No.

%

No.

%

 

12-14

10 

45.5

12

54.5

22

15-18

118

68.2

55

31.8

173

19-22

89

83.2

18

16.8

107

Total

217

71.9

85

20.1

302

Chi square for trend = 15.06, p = 0.000

Sex

 

 

 

 

 

Male

104

75.4

34

24.6

138

Female

112

68.3

52

31.7

164

Total

216

71.5

86

28.5

302

Chi square = 1.84, p = 0.175

Religion

 

 

 

 

 

Christian

135

70.7

56

29.3

191

Muslim 

62

66.7

31

33.3

93

Total

197

69.4

87

30.6

284

Chi square= 0.47, p = 0.491

Education level

 

 

 

 

 

Form I –II

75

58.6

53

41.4

128

Form III-IV

50

79.4

13

20.6

63

Form V-VI

96

79.3

25

20.7

121

Total

221

70.8

91

29.2

312

Chi square for trend = 13.06, p = 0.000

Overall, out of the respondents who volunteered information on their sexual experience (Table 4), about 28 percent of them had experienced sexual intercourse in their lifetime and their proportion increased significantly with advancing age (Chi square for trend = 26.89, p = 0.000). The proportions of sexually experienced youth were 40.4 and 16.9 percent respectively for male and female students and that significantly more male respondents reported to be sexually experienced compared to their female colleagues (Chi square = 20.32, p = 0.000).

Table 4: Distribution of secondary school youth in relation to sexual experience

Characteristic

Ever had sex

Total (N)

Yes

%

Age in years

 

 

12-14

22

1

4.5

15-18

166

34

20.5

19-22

101

47

46.5

Total

289

82

28.4

Chi square for trend = 26.89, p = 0.000

Sex

 

 

Male

136

55

40.4

Female

160

27

16.9

Total

296

82

27.7

Chi square = 20.32, p = 0.000

Discussion

Findings of this study have revealed that less than three quarters of secondary school youth in Dar es Salaam have good level of knowledge on STIs and that their main source of information on STIs was the media, especially the television, radio and newspapers. These findings are similar to observations from other small-scale surveys in the country (4,6) in which mass media was reported to be the most common source of reproductive health related information. All these findings largely contradict the widely acknowledged fact that schools are an important arena to promote the sexual health of young people as well as the several-signed United Nations’ Conventions that emphasize the right of young people to education and information. On the other hand, such observations are however, not surprising as young people have indicated a perception that significant adults such as teachers and parents are usually reluctant to discuss issues related to sexual health even when included in the teaching of an integrated family life education course in the school system (12).Furthermore, little is known about what parents, teachers and other significant adults know with regards to sexual and reproductive health of the young people although these persons in one way or another have the potential to influence adolescent health related behaviours.

While knowledge alone is not a major determinant of health related behaviours, it is however, an important pre-requisite. From this survey, only about 70 percent of the respondents, despite being in secondary school had good level of knowledge on STIs. The rank of knowledge significantly increased with advancing age and level of education. These findings support observations reported in related studies that comprehensively explored levels of sexual health and HIV/AIDS transmission and prevention knowledge, which demonstrated low levels of knowledge amongst particularly younger adolescents (4,13).

Interestingly, whilst research elsewhere revealed gender differences in the levels of knowledge with girls knowing more names of STDs (14), apparently the proportion of male youth who had good level of knowledge in the current study was higher than that of females, although the difference was not statistically significant. As the main source of information on STIs was stated to be the media, the possible explanation could be that male youth have comparatively better opportunities in accessing these media sources while their female colleagues are busy with household chores during their free times.

About 28 percent of the interviewed students (40.4 percent of boys and 16.9 percent of girls) reported to have experienced sexual intercourse. Studies in other areas similarly show high indulgence in sex among these young people. For example, self reported sexual involvement has been documented to be as high as 70 percent among in and out of school youth aged 15-24 in a rural district in Tanzania (3). It was observed in Nigeria that 50 percent of secondary school students   were sexually active, and most of them had their sexual debut between 15-19 years (15). In Ghana, 41 percent of female and 36 percent of male youth reported being sexually experienced (16), while at least 50 percent of young people are sexually active by the age of 16 in South Africa (7). The relatively high proportion of self reported sexual involvement among the respondents in this survey, given the reality that less than three-quarters had a good level of knowledge regarding STIs creates a significant threat to the sexual and reproductive health of secondary school youth in Dar es Salaam.

Conclusion and Recommendations

Overall, these findings suggest a high sexual activity among the respondents. Despite STIs being rampant among young people worldwide, secondary school youth in Dar es Salaam have a relatively low level of knowledge on STIs. Moreover, although family life education has been integrated into the school national curriculum, majority of the respondents still get information on STIs via the media. In view of these findings, it is recommended that programs should be put in place to raise the level of knowledge on STIs amongst the youth to enable them make informed sexual decisions. It is also important that heath messages targeting these youngsters take into consideration the type of the media employed.

Acknowledgements

The authors would like to express sincere thanks to the Muhimbili University College of Health Sciences for funding this research. Same appreciation goes to the Ministry of Education authorities and the heads and staff of the participating secondary schools for allowing entry into the schools. The authors are further deeply indebted to the youth who volunteered their valuable time and information that made this work possible. 

References

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