Knowledge And Attitude Of Secondary School Students Towards Sexually Transmitted Diseases
This study was designed to investigate knowledge, and attitude of secondary school students towards sexually transmitted diseases in Nsukka Education Zone. The study was guided by five research questions. The population consisted of 2931 students, which were made up of all the students in the day schools from twenty three secondary schools in Nsukka Education Zone. The sample was 220, Ten senior secondary schools were randomly selected from twenty three senior secondary school in Nsukka Education zone.
The research questions were answered using mean and standard deviation while t-test was used to test the hypotheses at 0.05 level of significance. The data presentation was done in order of research questions, and the major findings were as follows; the students have high level of knowledge of sexual transmitted diseases in Nsukka Education Zone. The students are knowledgeable on modes of transmission of STDs. Gender has influence on the level of knowledge of the students on signs and symptoms of STDs. Gender also influences on students’ attitude towards those living with STDs.
Gender has a significance influence on students’ attitude towards those living with STDs in Nsukka Education Zone. The recommendations based on the findings of this research study were; Health workers should create awareness in secondary schools on the sexually transmitted diseases to help the students avoid them. Seminar and workshops should be organized, awareness through Pamplets and leaflets to intensify effort in assisting the students know the dangers of sexually transmitted diseases. More control methods for the STDs should be brought to the knowledge of the students.
1.1 Background of the Study
Sexually transmitted disease (STD) is any disease (such as syphilis, gonorrhea, AIDS, or a genital form of herpes simplex) that is usually or often transmitted from person to person by direct sexual contact. It may also be transmitted from a mother to her child before or at birth or, less frequently, may be passed from person to person in nonsexual contact such as in kissing, in tainted blood transfusions, or in the use of unsanitized hypodermic syringes ( Encyclopedia Britannica, 2008). In a similar thought, Myless, (2001) averred that sexually transmitted diseases are those diseases caused by variety of organisms which are capable of being transmitted sexually. However, Achalu (1993) defined sexually transmitted diseases as group of infectious diseases in which the main form of spread is by sexual activity or contact. The researcher defines sexually transmitted diseases as diseases that can be contacted through unprotected sexually activities.
Sexually transmitted diseases usually affect initially the genitals, the reproductive tract, the urinary tract, the oral cavity, the anus, or the rectum but may mature in the body to attack various organs and systems. Tertiary syphilis, or paresis, for example, may affect skin, bones, the central nervous system, the heart, the liver, or other organs. Persons infected by an AIDS virus may remain outwardly healthy for years before the disease takes hold within the immune system. Sexually transmitted diseases have a long history. The best known of these diseases, syphilis, is caused by the bacterium Treponema pallidum.
Syphilis was first widely reported by European writers in the 16th century, and some medical historians assume that it was imported into Europe by explorers returning from the New World. Other authorities believe that syphilis is of ancient origin and may at one time have been mistakenly identified as leprosy. At any rate, syphilis first became widely recognized and reported about the year 1500, when a virtual epidemic swept Europe (Billings, 1998). Urethritis is the infection and inflammation of the urethra (the passage that transmits urine from the bladder to the exterior of the body). Most cases of urethritis are in fact sexually transmitted. Urethritis that is caused by the gonococcus bacterium (Neisseria gonorrhoeae) is called gonorrhea and is one of the best-known sexually transmitted diseases.
Gonorrhea was named by the Greek physician Galen and is thought to have been known to the ancient Chinese and Egyptians. A disease that became especially widespread beginning in the 1960s and ’70s was genital herpes. Herpes infections are significant not only in terms of the discomfort they cause but also for the potentially serious illness that might occur in infants born to mothers with genital herpes infections. A variety of treatments have been used for genital herpes, but none have been entirely satisfactory.( Encyclopedia Britannica, 2008)
The sexually transmitted disease that caused perhaps the greatest alarm in the late 20th century was acquired immune deficiency syndrome, or AIDS. From the time of its first clear identification in 1981, AIDS spread rapidly, with reported cases rising at a high rate, especially among homosexuals and intravenous drug users in the United States and Western Europe and among heterosexuals in tropical Africa. The high mortality rate from AIDS and the absence of a cure or vaccine against the disease had a sobering effect on sexually permissive societies. Nearly a score of other sexually transmitted diseases are known. All have reasonably effective drug cures. About half of all cases of urethritis that are not gonorrhea are chlamydia, which is caused by an infection with Chlamydia trachomas.
The latter bacterium is also the infecting agent in pelvic inflammatory disease and in still another sexually transmitted disease, lymphogranuloma venereum. The cause for the remaining 50 percent of nongonococcal urethral infections is not known; no organism has been definitely related (Wenger, 1995). Trichomoniasis is an infection of the urogenital tract caused by a protozoan, Trichomonas vaginalis; males usually have no symptoms with this infection, and only a portion of infected females have a vaginal discharge. Candidiasis (yeast infection) is caused by Candida albicans (sometimes called Monilia albicans), which produces in women a thick, whitish vaginal discharge and causes irritation and itching in the genital area.
Males may have irritation of the glans or skin of the penis. Because this yeast is ubiquitous in the environment, these infections are not always sexually acquired. Warts occurring in the genital areas are caused by certain types of papilloma viruses, and these types of warts can be transmitted to other people by sexual contact. Most often, genital warts are nothing more than a nuisance, but occasionally they can become so numerous or so large as to interfere with urination, bowel movements, or vaginal delivery. There is also mounting evidence that papilloma viral infections of the genital tract are a factor in the development of cancer of the cervix and possibly of the genitals themselves.
The word “knowledge’, according to Encarta English dictionary (2008), is defined as general awareness or explicit information of a situation or a fact. It also means information in mind; possession of information, facts, ideas, truths and principles. On the other hand, the above dictionary also defines the word “attitude” as personal view of something; an opinion or general feeling about something. In the pre-colonial period and even during the British Colonial time, sex outside of marriage was considered repugnant and forbidden in Africa.
The people were generally inhibited and did not openly express their opinions and views pertaining to love, marriage and sex. Moreover, it is considered a taboo for teachers and parents to talk with students/children about sexual matters, such as sexual relationships, and STDs in schools as well as at home because of cultural and religious barriers. In contemporary African society, however, there has been extensive interest, inquiry and curiosity in the phenomenon of sexual relations outside marriage, sex is discussed more freely by the larger society and adolescents in particular.
In addition, the issue of sex is at present the subject matter of youth club programmes, television show, art work and public laws. As a matter of fact, there is more divestment and nudity in advertisements, magazines, television show and movies pointing to a general trend to get liberated attitudes and values which promote open discussions of human sexuality that were once considered a taboo. This kind of permissive environment has influenced people to have liberal and permissive attitudes and behaviours towards sexuality both in premarital and extra-marital affairs. The sensitivity of sexuality and youth behavior seems to obstruct education on STDs despite the fact that there is now a stronger commitment to address STDs in schools.
Indeed, experts are in agreement that sexual attitudes and behaviours of present day secondary schools have become more liberal and permissive (Reiss, 1994, Roche, 1996, Bell and Chaskas, 1990.).These experts also pointed out that there are very high incidence of premarital sex in the society. Unachukwu and Nwankwo (1998) pointed out that many of those who have not engaged in coitus during their years of study in secondary school (very few indeed) will do so before they marry. Apparently, today, those who do not experience sexual intercourse before marriage are in minority.
In Nigeria, the traditional values among Nigerians for the sanctity of sex and sex for procreation have been abused in favour of liberal sexual behaviours. There is evidence of high rate of adolescents’ coital sex and premarital sexual involvements among Nigerian adolescents, especially, secondary school students. (Onyemelukwu, 1993). The World Health Organization (WHO, 1993) drew the attention of the world in no mistakable terms to the rise in the incidence and the spread of sexually transmitted diseases, ever since then, nobody or association has refuted the claim. Rather, other numerous sexually transmitted diseases (STDs) were discovered and reported to be in circulation. As a matter of fact, Webster (1992) reported that the incidence of infection of STDs has risen dramatically until it is now recognized as having reached epidemic proportions.
A more widely discussed factor for the spread of veneral diseases (VDS) is on increase in sexual freedom and the frequency of the sexual contacts.( Morton,1991) The commonest STDs include HIV&AIDS, non-specific genital infection (NSGI), Candidiasis, Gonorrhea, Trichomoniasis, Genital Warts, Syphilis, Herps, Genitalia Tines (Crurus), Scabies and Gardenerella Vaginalisis. Others are Hymphorgramutoma, Varecem, Choncroid and Vereophobia among others. The tragedy of the premarital sexuality among adolescents is that they engage in frequent sexual activities without proper knowledge of what is involved (Obikeze, 1997).
In another opinion, Achalu (1996) emphasizes that those who engage in high risk behaviours such as indiscriminate sex with many partners or those who pick partners from the streets have increased chance of being infected. Furthermore, Ijezie, (1997), says that sexual practices such as anal intercourse, oral intercourse, homosexuality, heterosexuality and deep kissing are associated with high risk of contracting these diseases especially the virus that causes AIDS. Also Owolabi, (1995), says that some of the prevalence of STDs in Nigeria is due to sexual promiscuity, and homosexuality, lack of sex education, self medication and drug abuse among secondary school students. The researcher, a school counselor, have observed with dismay that rate at which secondary school boys and girls patronize pharmacy stores for condom and pills is on increase in a bid to control sexually transmitted diseases. At a particular occasion, such pills were found in the school bags of several senior secondary students who seemingly have no knowledge of these pills. To this effect, the researcher is set to ascertain the knowledge of students on the control of STDs
It has been established that sexual promiscuity is on increase among adolescents and especially students but it will be nebulous to conclude that male students in secondary schools have better knowledge and attitude towards sexually transmitted diseases than their female counterparts. A research carried out in India indicates that the knowledge of sexually transmitted diseases and other STIs among adolescent girls in schools is poor when compared to boys. (India report, 2005). In this regard, the researcher will consider gender in this study. Hence, Webster (1992), indicated that attitudes and beliefs around sexual behavior determine the intended sexual behavior of young people. He concluded in his study that most of young people did not believe that girls should remain a virgin and as such; they are naturally predisposed to sexually transmitted diseases.
Several studies on vulnerability to sexually transmitted diseases have indicated that the most common reasons cited for having engaged in unwanted sex by street were being drunk and pressure from a sexual partner (Owen,1996, Morgan, 2004). Bridging the gap between knowledge and practice has emerged as a major behavior change communication challenge to reducing students’ vulnerability to STDs and unwanted pregnancies. It is not certain whether secondary school students are aware of STDs and also; whether they have right attitude towards it. Therefore, this survey will be conducted in order to investigate and assess the knowledge of STDs among secondary school students and their attitude towards sexuality taking into account the high prevalence of the AIDS pandemic. In the light of the above statement, the researcher is interested in investigating the knowledge and attitude of Secondary School students towards Sexually Transmitted Diseases in Nsukka Education Zone.
1.2 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 diseases or infections. It is no longer an old tale about the existence of sexually transmitted diseases (STDs) as it used to be relegated as superstitious. Just like the popular slogan that “AIDS is real” similarly, sexually transmitted diseases 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 STDs and the right attitude 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 attitude towards sexually transmitted diseases. However, ignorance, they said, is not an excuse to grave consequences of contacting STDs. 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 diseases. Also, what is the attitude of secondary school students in Nsukka Education zone towards STDs.
1.3 Purpose of the Study
The main purpose of this study is to find out the level of knowledge and attitude of Secondary School students towards STDs in Nsukka Education Zone. Specifically, the study aims at the following:
- To ascertain the level of knowledge of students on the signs and symptoms of STDs.
- To find out the extent to which the students know of the mode of transmission.
- To ascertain their knowledge of the control of STDs
- To find out the attitude of students towards STDs.
- To determine the influence of gender on students level of knowledge of STDs.
1.4 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 attitude towards sexually transmitted diseases; steering through it’s related health hazards and consequences.
The study will also help teachers and counselors to know and acknowledge students knowledge and attitude to sexually transmitted diseases 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 STDs, 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 attitude and knowledge to sexually transmitted diseases.
1.5 Scope of the Study
The study is designed to find the level of knowledge and attitude of Secondary School students of Nsukka Educational Zone towards Sexually transmitted diseases. The study will investigate the students’ knowledge and attitude towards Sexually transmitted diseases, focusing on signs and symptoms, mode of transmission, and control.
1.6 Research Questions
To carry out the study, the following research questions were formulated to guide the study,
- What is the level of knowledge of students on the signs and symptoms of STDs?
- To what extent do students know the modes of transmission of STDs?
- To what extent are students aware of the control of STDs?
- What are the students’ attitudes towards STDs?
- What are the influence of gender on students’ level of knowledge of STDs?
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 STDs.
HO2: There is no significant difference between the mean scores on attitude of students towards STDs based on gender.
Discussion, Implications, Recommendation, Limitations, Suggestions Conclusion and Summary
The study revealed that the students have good knowledge of the signs and symptoms of HIV/AIDS. Gonorrhea, syphilis, and candidacies. These symptoms include swollen glands, persistent cough, bleeding after sex, burning sensation during urinating, body discharge, skin rashes, itching in the vagina, etc, as the case may be. This is in line with the reports by Bamidele (1998) who observed that painful urination, milk-like discharge, swollen organs, boils, itching and rashes are the most frequently mentioned signs of these STDs.
Furthermore, Kelhinde (2007) reaffirmed that some of the symptoms of STDs include discharge in both men and women, rashes, itching and irritation in the genital region, inflammation of testicals, etc. these symptoms are brought to the knowledge of the student through seminars, workshops and other sources on the common sexually transmitted diseases.
It was also revealed in the study that the students do not have good knowledge of some of the sexually transmitted diseases like chancnoid, trichmoniasis, genital wart and genital herpes. Some of these STDs are not common. It is therefore normal that the students are more knowledgeable about the signs and symptoms of the common STDs like HIV and AIDS, gonorrhea, candidacies, etc. Onwudenjo (1996) confirmed this when he observed that students are more knowledgeable about HIV and AIDS than other sexually transmitted diseases.
The study further revealed that students are aware that the modes of transmission of STDs are through sexual intercourse, blood transfusion, anal/oral sex, etc. In affirmation, Nwankwo and Unachukwu (2003) reported in their study that students knew that AIDS and other sexually transmitted diseases are transmitted through sex, blood to blood contact and injections.
On the same note, Mirian and Morgan (2004) reported that apart from sexually intercourse, using unsterilized needles other people have used for injection is another way of contacting STDs like HIV.
It has been shown in the study that the attitudes of the students towards sexually transmitted diseases are avoiding people with HIV/AIDS, frightened about STDs, sticking to one sex partner, enjoying seminars and teachings on STDs. Malcolm (1996) revealed that attitudes of people towards STDs show that they tend to avoid anything that would make them to be infected with STDs. The study by Karlinger (2001) shows that attitudes of students towards STDs have improved as they are carefully in choosing their friends and in using piercing objects.
5.2 Implication of the Study
The study has implication for the students, health workers and parents.
The study have shown that the students are not adequately informed on the signs and symptoms of some STDs like trichomoniasis, genital wart, genital herpe, and choncroid. Therefore, health workers will now know that more awareness need to be created in Nsukka education zone on their STDs.
Also, the study has implication for the students as has been shown, the study lack knowledge of symptoms of choncroid, genital warts, genital herpes and trichomoniases. The students should be careful so as not to be infected with some of these deadly STDs.
Based on the finding of the study, the following recommendation are made:
- The study revealed that the students are not knowledgeable enough on the signs and symptoms of some STDs like trichomoniasis, genital wart, genital herpe and chancroid. Therefore, health workers should create awareness in secondary schools on these STDs to help the students avoid them.
- It is also recommended that seminars and workshops should be organized, awareness through pamphlets and leaflets to intensify effort in assisting the students know the dangers of sexually transmitted diseases.
- More control methods for the STDs should be brought to the knowledge of the students.
5.4 Limitation of the Study
This study is limited to the knowledge and attitude of only secondary school students in Nsukka Education Zone. Therefore, inferences and conclusions drawn based on the findings cannot be extended to other education zones not covered in the study.
5.5 Suggestion for Further Studies
- More comprehensive study on knowledge and attitude of secondary school students towards sexually transmitted diseases should be carried out in other education zone5s in Enugu State.
- Researchers going into this field of study should also employ interview method alongside the questionnaire method in order to secure more facts and information regarding knowledge and attitude of secondary school students towards sexually transmitted diseases in secondary school.
From the findings of the study, the following conclusions are drawn;
- There is high level of knowledge among the students on the signs and symptoms of sexually transmitted diseases like HIV/AIDs, Gonorrhea, syphilis and candideasis.
- The studys don’t have enough knowledge on the signs and symptoms of trichomniasis, genital wart, gential herpe and chancroid.
- Oral sex, deep kissing, sexual intercourse, blood contact, mother to child transmission, deep kissing are some of the modes of transmission of STDs known to the students.
- Abstinence from sex, testing donated blood and organs, faith in God, use of condom, etc are some of the ways of the students know STDs can be controlled.
- Fear of STDs, avoiding people living with HIV/AIDS, sticking to one sex partner, etc are the students’ attitudes towards STDs.
- Gender does not influence the level of knowledge of the students on the signs and symptoms as well as the attitudes towards STDs in Nsukka Education Zone.
5.7 Summary of the Study
The study borders on the level of knowledge and attitude of secondary school students towards STDs in Nsukka Education Zone. To achieve the purposes of this study, four research questions and two hypotheses were designed to guide the study. Relevant related literature were reviewed in line with the purposes of the study.
A random sample of 107 males and 113 female students were obtained from 10 public schools within the education zone. Structured questionnaires were used to obtain the necessary data for the study from the total of 220 respondents. The data thus obtained were analysed using means for the research questions and t-test for the hypotheses. From the study, the following are observed.
- The students show high level of knowledge of the signs and symptoms of AIDS, Gonorrhea, candidiasis, and syphillis but have little knowledge of the signs and symptoms of trichomoniasis, genital warts, genital herpes and chancroid.
- To high extent, the students know that anal/oral sex, deep kissing, sexual intercourse, blood transfusion and mother to child are modes of contacting STDs.
- To high extent, the students are aware that abstinence, testing donated blood, faith in God, use of condom, etc are the various ways of controlling STDs in secondary schools in Nsukka Education Zone.
- The attitudes of the students towards STDs and fear of the dreaded STDs, avoiding people living with HIV, sticking to one sex partner, etc.
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