HIV/AIDS Knowledge among secondary school students in Tanzania: A case of Missungwi district in Mwanza Region

doi:10.21203/rs.3.rs-2010589/v1

Download PDF

Research Article

HIV/AIDS Knowledge among secondary school students in Tanzania: A case of Missungwi district in Mwanza Region

https://doi.org/10.21203/rs.3.rs-2010589/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background

Based on the latest UNAIDS report on the global AIDS epidemic; about 34 million people worldwide are estimated to live with HIV and about 69% of them are found in Sub-Saharan Africa. In Tanzania, people living with HIV/AIDS are estimated to be 1.6 million, of which, 1.3 million belong to the age of 15 years and above.

Broad Objective

The study aimed to assess the general knowledge of HIV/AIDS among secondary school students in Misungwi district.

Methods

A cross-sectional study design was employed involving 330 students. Information concerning knowledge on causes, risk factors, transmission routes, signs and symptoms as well as preventive measures of HIV/AIDS was collected using a self-assessment structured questionnaire. Data were analyzed using STATA. Mean and standard deviation summarized the numerical variables. Categorical variables were summarized using frequency and proportions. A linear regression model was used to determine the relationships between knowledge score and exposure variables. Multivariable were used to control for confounders. Significance level was set at 5%.

Results

Majority of students had the age of 16–18 years old. Male were 64% of the sample. The study found age, sex and level of classes had an influence the knowledge on symptoms, risk factors and general knowledge about HIV/AIDS. Age appeared to influence HIV symptoms, risk factors and general knowledge (p < 0.05). Age was negatively associated with knowledge.

Conclusion

The study found that age, sex and level of classes influence the general knowledge on HIV/AIDS, its symptoms and risk factors. Therefore, stakeholders should continue to provide HIV education to the youth of all ages and sex.

Health Policy

HIV

AIDS

Secondary School

Knowledge

Symptoms

Risk factors.

Human Immunodeficiency Virus (HIV) continue to be a major global public health problem and is among the fastest-growing epidemic in the world. About one hundred million people in the world are living with HIV and more than half of them are youth between the age of 12–30 years (1). Amongst them, about 11.8 million are aged between 15 to 24 of which, nearly 6,000 of them are infected with HIV per day. Yet not all of them know their HIV status (2). Acquired Immunodeficiency Syndrome (AIDS) was first described in the USA in 1981 and the HIV was first microscopically identified by the end of 1983. In Tanzania, the first case of AIDS was identified in 1983 in the Kagera region. Since then, AIDS has been a pandemic expanding in scope and magnitude (3). This is because, among other things, of the sexual desire of the youths. Many people are dying of AIDS-related illnesses. In 2013 there were 1.5 million (1.4 million–1.7 million) AIDS-related deaths in Sub – Saharan Africa. Globally, AIDS-related deaths have fallen by 35% since 2005, when the highest number of deaths was recorded. In sub-Saharan Africa, the number of AIDS-related deaths fell by 39% between 2005 and 2013. However, the region still accounted for 74% of all people dying from AIDS-related causes in 2013(4).

Various studies in the country have shown that, among the age group of pupils in standard six and seven indicated are sexually active. It has been reported that the age at first intercourse to be below 11 years (5). A survey was done in Mwanza on Sexual and Reproductive Health among Primary and Secondary School Students and showed that 80% of boys and 63% of girls have been sexually active. This put them at risk of contracting HIV/AIDS and other STDs. The same survey showed that, 33% of boys and 25% of girls had past STDs experiences (6). This could be due to their limited knowledge about HIV/AIDs as studies across the global show that the vast majority of youth have no idea on how HIV/AIDS is transmitted and protect themselves from the disease. Adolescent girls and young women account for one in four new HIV infections in Sub-Saharan Africa.(2).

Since 2000, various global declarations and commitments with specific goals and targets have been made and set by the world leaders and governments to respond to HIV/AIDS epidemic. Although these global commitments, goals and targets are relevant for adolescents, the implications and accountabilities are rarely specific to this age group. In addition, adolescent-specific data that could give the general information on this age group that is inclusive to those at and not at school are limited. As a result, compared with infants and adults, less is known about the burden of HIV and AIDS among adolescents and progress to date in addressing their needs for HIV prevention, care, and treatment services (7).

Good knowledge about HIV/AIDS in secondary school students is the tool for combating the problem. Studies conducted in Sub-Saharan countries and Tanzania, in particular, show that students have awareness of HIV/AIDS especially on the causes of HIV/AIDS, signs and symptoms, risk factors associated with its transmission mechanism and preventive measures.

Most of the studies conducted were based on secondary schools that were located in urban settings with few of the studies being conducted in rural settings(8–10). Therefore, there is no clear knowledge that can be applied in Sub-Saharan countries. Moreover, these studies dealt with awareness, attitude and perception of HIV/AIDS among Secondary school students without including general knowledge on symptoms, risk factors and transmission.

This gap, therefore, necessitated this study on secondary school students in rural areas schools. Hence, the study feels the gap on the missing information about the rural community. It provides information that helps to inform the government plans particularly those of the Ministry of Education on setting secondary school curriculum on HIV/AIDS education. This study aimed to assess the knowledge of the secondary school students on HIV/AIDS in the Misungwi district in the Mwanza Region.

Study Setting

This study was conducted in Misungwi District in the Mwanza region. According to the 2012 Tanzanian Population and Housing Census, the population of the District was 351,607 of which males were 173,997(49.49%) and females were 177,610(50.51%) (11). Administratively, Misungwi is divided into 4 divisions and 27 wards. There are 27 Ordinary level secondary schools of which 23 are owned by the Government and 4 by private. This district was an appropriate district for the study because it is one of the districts with the highest HIV prevalence (5.6%) in Mwanza after Kwimba (6.1%) (12).

Study design, sampling techniques and sample size

This was a cross-sectional study design that involved a total of 330 respondents in Miswingwi district. This study involved form three and four secondary school students in the district. A multistage cluster sampling technique was used to select five secondary schools. In each secondary school, a lottery method was used to select the average of 74 students who were respondents. Respondents were selected based on the total number of students in each school. Data were collected using a structured self-assessment questionnaire. This questionnaire was developed based on the research objective and was translated into the Swahili language. The questionnaire consisted of 5 sections that include socio-demographic characteristics, assessment of knowledge on symptoms, risk factors, transmission and general knowledge on HIV/AIDS.

Data Processing and Analysis

Data entry and cleaning were done using SPSS version 20 and data analysis was done using STATA version 15.0. Categorical variables were summarized using frequency and proportion. Continuous variables were tested for normality using histogram and summarized using mean and standard deviation. Independent two-sample t-test and one-way analysis of variance (ANOVA) were used to compare mean knowledge scores between groups. A linear regression model was used to determine linear relationships between knowledge score and exposure variables (age, sex and class of the study). All linear regressions assumptions including a test for normality, a test for heteroscedasticity and a linearity test were conducted before regression analysis. Multiple linear regression was used to control confounders. The significance level was set at 5%.

Measurement of Knowledge

Knowledge was computed using scores of the structured questions which were structured for testing the understanding of the students on HIV/AIDS. The knowledge questions were based on causes, risk factors, and ways of transmission of HIV/AIDS. The questions were given wrong and right responses whereby the students who scored high marks were categorized as having a high knowledge of the stipulated components and vice-versa to the ones who scored low marks.

Socio-demographic characteristics

Table 1 presents the population characteristics of the respondents involved in the study. The study enrolled 330 participants of which 75% were aged between 16–18 and less than 1% were aged between 13–15 and 22–24, the rest were aged between 19–21 years of age. About 65% were male and 62% were in form three class.

Table 1

Respondents background characteristics (N = 330)
Variable	Frequency	Percentage
Age (in years)
13–15	3	0.9
16–18	249	75.5
19–21	75	22.7
22–24	3	0.9
Sex
Female	117	35.5
Male	213	64.6
Classes of study
Form three	205	62.1
Form four	125	37.9

Knowledge on causes, risk factors and ways of transmission of HIV/AIDS

Table 3, presents the linear regression analysis that assed the knowledge of students on symptoms, risk factors and the transmission of HIV/AIDS. Results showed that age and sex of the students influenced the knowledge about symptoms of HIV/AIDS both crude and adjusted analysis. On the knowledge about risk factors of HIV/AIDS only the level of classes influenced both crude and adjusted analysis. The explanatory variables did not influence the knowledge about transmission of HIV/AIDS for both crude and adjusted analysis. Age and level of classes (crude and adjusted) influenced the overall knowledge of HIV/AIDS.

Table 3

Effects of Age, Sex and class level on HIV/AIDS Knowledge
	Mean(SD)	Crude		Adjusted
Symptoms		Coef(95% CI)	p-value	Coef(95% CI)	p-value
Age (in years)
15 and below	8.3(0.6)	1		1
16–18	7.3(1.9)	-1.02(-1.61, -0.45)	< 0.01	-1.00(-1.55, -0.45)	< 0.01
19–21	7.1(2.0)	-1.28(-1.98, -0.58)	< 0.01	-1.19(-1.88, -0.51)	< 0.01
22 and above	7.0(2.0)	-1.33(-3.28, 0.61)	0.18	-1.31(-3.30, 0.68)	0.20
	F3,326 = 0.71, p = 0.55
Sex
Female	7.6(1.7)	1
Male	7.1(1.9)	-0.53(-0.93, -0.12)	0.01	-0.53(-0.93, -0.12)	0.01
	t₃₂₈ = 2.48, p = 0.01
Classes of study
Form three	7.2(1.9)	1
Form four	7.4(1.8)	0.20(-0.21, 0.62)	0.33	0.33(-0.09, 0.74)	0.12
	t₃₂₈=-0.96, p = 0.34
Risk Factors
Age (in years)
15 and below	15.0(1.7)	1
16–18	13.7(2.2)	-1.28(-2.92, 0.36)	0.13	-1.55(-3.13, 0.02)	0.05
19–21	13.9(2.3)	-1.12(-2.82, 0.58)	0.20	-1.56(-3.23, 0.10)	0.07
22 and above	13.0(1.7)	-2.00(-4.29, 0.29)	0.09	-2.79(-5.09, -0.48)	0.02
	F3,326 = 0.53, p = 0.66
Sex
Female	13.5(2.5)	1
Male	13.9(2.0)	0.38(-0.15, 0.90)	0.16	0.33(-0.20, 0.86)	0.22
	t₃₂₈=-1.48,, p = 0.14
Classes of study
Form three	13.6(2.2)	1
Form four	14.1(2.1)	0.56(0.08, 1.04)	0.02	0.57(0.05, 1.09)	0.03
	t₃₂₈=-2.26,, p = 0.02
Transmission
Age (in years)
15 and below	5.7(0.6)	1		1
16–18	5.5(0.8)	-0.20(-0.75, 0.34)	0.46	-0.25(-0.79, 0.30)	0.38
19–21	5.5(0.8)	-0.19(-0.75, 0.38)	0.52	-0.25(-0.82, 0.32)	0.39
22 and above	5.0(1.0)	-0.67(-1.74, 0.41)	0.22	-0.78(-1.88, 0.31)	0.16
	F3,326 = 0.44, p = 0.73
Sex
Female	5.4(0.8)	1		1
Male	5.5(0.7)	0.04(-0.14, 0.22)	0.64	0.04(-0.14, 022)	0.45
	t₃₂₈=-0.48, p = 0.63
Classes of study
Form three	5.4(0.8)	1
Form four	5.5(0.7)	0.08(-0.09, 0.24)	0.35	0.09(-0.08, 0.26)	0.30
	t₃₂₈=-0.89, p = 0.38
Total Knowledge on HIV/AIDS
Age (in years)
15 and below	29.0(1.0)	1
16–18	26.5(3.3)	-2.51(-3.53, -1.48)	< 0.01	-2.80(-3.95, -1.65)	< 0.01
19–21	26.4(3.5)	-2.59(-3.81, -1.36)	< 0.01	-3.01(-4.39, -1.63)	< 0.01
22 and above	25.0(1.7)	-4.00(-5.87, -2.13)	< 0.01	-4.88(-6.98, -2.78)	< 0.01
	F3,326 = 0.78, p = 0.51
Sex
Female	26.6(3.6)	1
Male	26.4(3.2)	-0.11(-0.89, 0.67)	0.78	-0.16(-0.94, 0.62)	0.69
	t₃₂₈ = 0.28, p = 0.78
Classes of study
Form three	26.2(3.4)	1
Form four	27.0(3.2)	0.84(0.11, 1.57)	0.02	0.98(0.22, 1.75)	0.01
	t₃₂₈=-2.24, p = 0.03

The study found that there is a significant difference in mean HIV knowledge score on symptoms between male and female students. Similarly, the finding shows that general HIV knowledge differs between class levels and sex. Female students had a high mean knowledge score on HIV symptoms compared with male students (p = 0.01). standard four had a high mean knowledge score on risk factors of HIV compared to standard four students (p = 0.02) as well as total knowledge on HIV (p = 0.03).

This study underlined whether secondary school students had enough knowledge on HIV/AIDS in terms of symptoms, risk factors and transmission. The aim was to inform policymakers and curriculum developers on knowledge of HIV/AIDS to this group. Generally, this study found age, sex and level of classes influenced the knowledge on symptoms, risk factors and general knowledge about HIV/AIDS. Age appeared to influence HIV symptoms, risk factors and general knowledge. Surprisingly, age was negatively associated with knowledge. As age increases, the level of knowledge about HIV symptoms, risk and transmission decreases. We speculate that students who start school at a late age could have little understanding in class. This might be because they come from poor families in rural areas where the language barrier is high. In Tanzania, there are many local languages used in communities apart from the two national languages (English and Swahili). On the other hand, they have no access to social media, TV and radios where they can get health education including knowledge on HIV/AIDS. However, most students who are enrolled in school at the right age are from urban areas where there is access to social media, TV and radios. Our findings are consistent with a study done in Malaysia (13) where it was found that lower age was associated with high knowledge scores. In contrary to the study done in Cameroon (14) which found that there were no significant differences across ages. Another study was done in Iraq (15) and found an association between high knowledge score about HIV/AIDS with older age.

The study found that females had high knowledge of HIV symptoms compared with male students. This could be due to differences in study areas and time. Girls are exposed to different pieces of training than males such as reproductive education and health education campaigns. The findings contradict other findings from Tanzania and elsewhere (10,13,16) which reported the same level of HIV knowledge among male and female students. Another study was done in Iraq (15) and found that there is an association between high knowledge scores about HIV/AIDS and male students.

General knowledge on HIV/AIDS was high among the form four students compared to form three students. This indicates that an increase in the level of classes has a high contribution to the increase of knowledge about HIV/AIDS. Similar findings were done in Tanzania and China (17,18) found that senior students were more knowledgeable on HIV/AIDS than junior students.

Strength and Limitations

One of the strengths of this study is that it can shed light on the level of knowledge on HIV/AIDS to young people and the effectiveness of HIV education campaigns. However, this study cannot be generalized because it was done in one district which its setting might be different in other areas. In addition, this is a cross-sectional study that cannot capture the causality of the factors associated with knowledge on HIV/AIDS. This problem was minimized by including different class levels to capture variation in knowledge on HIV/AIDS to these groups.

Generally, the study has found that secondary school students are knowledgeable on HIV/AIDS symptoms, risk factors and transmission. It found that age, sex and level of classes influence the general knowledge on HIV/AIDS, its symptoms and risk factors. HIV/AIDS stakeholders should continue to provide HIV education to the youth of all ages and sex.

AART Active Antiretroviral Therapy

AIDS Acquired Immunodeficiency Syndrome

HIV Human Immunodeficiency Virus

ICT Information and Communication Technology

MUHAS Muhimbili University of Health and Allied Sciences

MTCT Mother to Child Transmission

PMTCT Prevention of Mother to Child Transmission

SPSS Statistical Package for the Social Science

STDs Sexually Transmitted Diseases

UNAIDS United Nations program on AIDS

Ethical Consideration

Ethical clearance was obtained from the Muhimbili University of Health and Allied Sciences (MUHAS research review board) Permission for field data collection was granted by the District Executive Directors of Misungwi districts. Respondents were duly informed of the purpose of the survey and their rights. Individual consent was obtained from each respondent from the Misungwi districts before the survey. Written consent was obtained from all participants. At the school level, the heads of schools of each school where the study was conducted were informed about the study aims, the data collection procedures and their permission was sought and given.

Acknowledgement

We wish to acknowledge the students of the Misungwi district who participate in the study. Also, we are thankful the MUHAS Research Board, Regional Administrative Secretary of Mwanza region and District Executive Directors of Misungwi district.

Declaration of Conflicting Interests

The author(s) declare no potential conflicts of interest concerning the research, authorship, and/or publication of this article.

Qin Yongsong OANJ. Knowledge, Attitude and Practices of HIV / AIDS among High School Students in Eastern Cape, South Africa. 2016;(January).
Millage A. Young People and HIV/AIDS: Opportunity in Crisis. Intern Audit. 2009;65(3):1–28.
Kamala B a B. Knowledge, Attitudes and Practices on Hiv Prevention Among Secondary School Students in Bukoba Rural ,. Dar es Salaam Med Students J. 2006;14(1):14–8.
UNAIDS. The gap report. 2014.
Oyo-Ita AE, Ikpeme BM, Etokidem AJ, Offor JB, Okokon EO, Etuk SJ. Knowledge of HIV/AIDS among secondary school adolescents in Calabar - Nigeria. Ann Afr Med. 2005;4(1):2–6.
Kigombola A, Md GG. Knowledge, Attitude and Practices on HIV / AIDS, its Transmission and Prevention among Primary School Pupils in Rural Kisarawe. 2007;14(2):48–51.
Idele P, Gillespie A, Porth T, Suzuki C, Mahy M, Kasedde S, et al. Epidemiology of HIV and AIDS Among Adolescents: Current Status, Inequities, and Data Gaps. 2014;66:144–53.
Said H. Kapiga GN and DJH. Knowledge of AIDS among secondary school pupils in Bagamoyo and Dar es Salaam, Tanzania.
Kaale G, Muhanga M. Sexual health knowledge among secondary school students in Morogoro, Tanzania: half full or full empty? Int J Heal. 2017;5(2):120.
Kamala B., Aboud S. Knowledge, attitudes and practices on HIV prevention among secondary school students in Bukoba rural, Kagera region- Tanzania. Dar Es Salaam Med Students’ J. 2010;14(1):14–8.
National Bureau of Statistics (NBS) [Tanzania], Office of Chief Government Statistician [Zanzibar]. 2012 POPULATION AND HOUSING CENSUS: Population Distribution by Administrative Areas. 2013;
UNADIS. United Republic of Developing Estimates of Hiv Prevalence and the Number of People. 2014;24.
Talwar P, Rahman MFBA. Assessment of HIV knowledge among university students using the HIV-KQ-18 scale: A cross-sectional study. South East Asia J Public Heal. 2015;5(1):33–8.
Nubed CK, Akoachere JFTK. Knowledge, attitudes and practices regarding HIV/AIDS among senior secondary school students in Fako Division, South West Region, Cameroon. BMC Public Health [Internet]. 2016;16(1):1–10. Available from: http://dx.doi.org/10.1186/s12889-016-3516-9
Othman SM. Knowledge about HIV/AIDS among high school students in Erbil city/Iraq. Glob J Health Sci. 2015;7(1):16–23.
Shamu S, Khupakonke S, Farirai T, Slabbert J, Chidarikire T, Guloba G, et al. Knowledge, attitudes and practices of young adults towards HIV prevention: An analysis of baseline data from a community-based HIV prevention intervention study in two high HIV burden districts, South Africa. BMC Public Health. 2020;20(1):1–10.
Rushahu BG. Assessment of HIV/AIDS and Life Skills Delivery in Primary Schools in Tanzania. World J Educ. 2015;5(1):131–43.
Arabia S, Alotaibi SM, Alabbas FF, Almoshadq AF, Pacha MS, Alghamdi MK. AIDS & Clinical Research Knowledge and Perceptions of HIV / AIDS among High School Students in Jeddah, Saudi Arabia. 2016;7(8).

Download PDF

Version 1

posted

You are reading this latest preprint version

HIV/AIDS Knowledge among secondary school students in Tanzania: A case of Missungwi district in Mwanza Region

Status:

Version 1

Abstract

Background

Broad Objective

Methods

Results

Conclusion

Introduction

Methods

Study Setting

Study design, sampling techniques and sample size

Data Processing and Analysis

Measurement of Knowledge

Results

Socio-demographic characteristics

Knowledge on causes, risk factors and ways of transmission of HIV/AIDS

Discussion

Conclusion

abbreviations

Declarations

References

Status:

Version 1