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KNOWLEDGE
AND ATTITUDE OF SECONDARY SCHOOL STUDENTS TOWARDS SEXUALLY TRANSMITTED DISEASES
ABSTRACT
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.
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CHAPTER ONE
INTRODUCTION
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,
1
13
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
14
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
15
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
16
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
17
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
18
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
19
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
20
investigating
the knowledge and attitude of Secondary School students towards Sexually
Transmitted Diseases in Nsukka Education Zone.
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.
21
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:
i. To
ascertain the level of knowledge of students on the signs and symptoms of STDs.
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 STDs
iv. To find out the attitude of students towards
STDs.
v. To determine the influence of gender on
students level of knowledge of STDs.
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.
22
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.
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.
23
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 STDs?
ii. To what extent do students
know the modes of transmission of STDs?
iii. To what extent are students aware
of the control of STDs?
iv. What are the students’ attitudes
towards STDs?
v. What are the influence of
gender on students’ level of knowledge of STDs?
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 STDs.
HO2: There
is no significant difference between the mean scores on attitude of students
towards STDs based on gender.
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