Research Article
Volume 2 | Issue 2 | Article ID: 52 | DOI: 10.56101/rimj.v2i2.52

Knowledge of HIV and other sexually transmitted infections and place of delivery among urban women in South-West Nigeria

Miracle Adesina1✉, Isaac Olufadewa1, Ruth Oladele2

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1 Slum and Rural Health Initiative, Ibadan, Nigeria.

✉ Corresponding author: Miracle Adesina
Email address: miracle.adesina@srhin.org

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Received
24 Aug 2022		 Accepted
01 Nov 2022		 Published
30 Nov 2022

Abstract

Background: HIV and other Sexually Transmitted Infections (STIs) pose serious risks to health security especially to women, therefore, knowledge of their complications and attitude toward sexual health is important in planning preventive and treatment strategies among women in Nigeria. This study aims to assess the knowledge of HIV and other STIs and its association with the choice of place of delivery among urban women in south west Nigeria.

Methods: Data for urban women in south-west Nigeria was collected from National Demographic Survey (DHS) 2018. It evaluated their knowledge of HIV and other STIs in relation to the location of most recent childbirth. Chi-square (χ2) test and binary logistic regression analysis were conducted to establish association between variables using SPSS.

Results: 4604 women were surveyed. Some (21.9%) of the respondents had poor knowledge of HIV and other STIs. Women who had secondary school education were 1.7 times and 2.6 times more likely to have knowledge of HIV and other STIs respectively (OR=1.737; p<0.001; CI=1.402 - 2.153; OR=2.604; p<0.001; CI=1.934 - 3.507). Women who delivered their first child in public healthcare facilities were 1.7 times more likely to have good knowledge of HIV and STIs (OR=1.674; p<0.001; CI=1.233 - 2.275).

Conclusion: Women education and choice of place of delivery are important factors for knowledge of HIV and other STIs among urban women. Therefore, it is essential to implement more educational programmes specifically targeted at less educated women in urban regions of Nigeria.

Keywords: HIV, Sexually Transmitted Infections (STIs), Knowledge, Urban women, South-west Nigeria.

1. Introduction

Knowledge of STI and their complications and attitude toward sexual health are important in planning preventive and treatment strategies (1). Level of knowledge of adult and reproductive health, including STDs tend to be higher in societies where people enjoy greater degree in freedom of communication, seek health advocacy, and engage in peer communication (2-4). Most of the people may be aware about HIV/AIDs because of the awareness created by media and government programs; however, knowledge about STIs other than HIV/AIDS do not get such attention and consequently, are not recognized (5).

Sexually transmitted diseases (STDs) increase the likelihood of HIV transmission as well as other reproductive health consequences, such as chronic lower abdominal pain, infertility or life -threatening pregnancies. Most STIs are asymptomatic and go unnoticed and untreated. Both symptomatic and asymptomatic STIs can cause serious morbidity, including pregnancy complications, cancer, infertility, and enhanced HIV transmission (6). However, HIV prevalence continues to be high among women of reproductive age, and transmission of HIV from mother to child (MTCT) is a major concern and remains a public health priority (7-8). Childbearing is an important event in the life of most women and is positively associated with the ultimate goals of happiness, completeness, and family integration (9).

The place of delivery chosen by women is therefore very important with health facility being the most ideal (10). The choice of delivery place has consistently been found to be associated with maternal and neonatal outcomes (11). Various factors impact the choice of women regarding the place of delivery, some of which are out of their control (12). There is a dearth of literature on knowledge of HIV and other sexually transmitted infections and place of delivery among urban women. Hence, there is need for studies to investigate the level of knowledge of young women about STIs (13). Therefore, this study aimed to assess knowledge of HIV and other sexually transmitted infections and place of delivery among urban women in south west Nigeria.

2. Methods

DHS characteristics

National Demographic Survey (DHS) use largely standardized questionnaires and methodologies and cover a range of topics, including socio-economic, demographics; reproductive, maternal and child health; family planning, sexual behaviour and nutrition. The surveys are nationally representative and include men and women aged 15–49 years old and children under the age of 5 years residing in non-institutional settings. Participants in the surveys were sampled following a three-stage stratified cluster design using a list of enumeration areas (EAs) obtained from the Nigerian 2006 population census. EAs are units selected systematically from localities that constitutes the Local Government Areas (LGAs) – subdivisions of the 36 administrative states that are classified under six developmental zones in Nigeria. For the 2018 NDHS used in this study, 4604 women were interviewed. These DHS reports are publicly available; datasets are accessible upon application including study aim and analytical plans from DHS MEASURE (https://www.dhsprogram.com/).

Variables

Outcome variable: Outcome variable was location of most recent childbirth. This was measured by asking the respondent about the place of delivery for the most recent childbirth, and was divided into home, public healthcare facility, private healthcare facility and others.

Covariates/individual-level factors

Age was categorized into seven groups: 15–19years, 20–29 years, 30–39 years, 40–49 years

Education attainment was grouped into four bands: never been to school, primary, secondary and higher education.

Marital status: grouped into single, married, cohabiting, widowed, divorced, separated.

Husbands’ education was grouped into: No education, primary, secondary, higher and don`t know.

Total children born was grouped into: 1–3 years, 4 – 6 years, 7 – 9 years, and 10 – 12 years.

Data Analysis

Data were analysed with Statistical Package for the Social Sciences (SPSS) version 25. Women who have had a childbirth during past five years were included in the analysis. The main advantage of this method is that it mimics certain characteristics of randomized controlled trials and thereby minimises the bias due to non-randomisation in observational studies. Knowledge of HIV and other sexually transmitted infection was calculated. Following descriptive analysis, Chi-square (χ2) test was performed to check for the significant associations between the explanatory variables and place of delivery. Variables that were found to be significantly associated in the χ2 tests (at p<0.25) were selected for final regression analysis. In the final step, binary logistic regression model was used to calculate the odds ratios (OR) of the associations between knowledge of HIV and other STIs and place of delivery.

3. Results

Socio-demographic Characteristics of Respondents

The mean age of the respondents is 30.4±9.4 years. Some of the respondents (33.1%) were between 30 – 39 years of age, 59.9% had secondary education, and 50.9% of the respondents’ partners had secondary education. Many (58.6%) were married, 90.5% had been in one union, 43.8% had between 1 – 3 children and 51.5% were involved in sales. Almost half of the respondents (47.8%) had their first delivery at a public health facility, also, 48.2% had their second child in a public healthcare facility. Some (17.1%) delivered their third child at home while many (58.6%) had their fourth child at home (Table 1).

Table 1: Socio-demographic Characteristics of Respondents (n=4064)

Knowledge of HIV and other sexually transmitted infections

Almost all the respondents (96.3%) had ever heard of sexually transmitted infections (STIs). All of the respondents said that not having sex at all reduces the risk of getting HIV, most (80.6%) mentioned that use of condoms during sex reduces the risk of getting HIV and majority (88.0%) said that having one sex partner only who has no other partners reduces the risk of getting HIV. Many of the respondents (72.9%) reported that HIV can be contracted from mosquito bites, 76.0% agreed that HIV can be contracted by sharing food with a person who has AIDS, while 76.3% reported that HIV can be gotten by witchcraft or supernatural means. Also, most of the respondents (88.1%) stated that a healthy-looking person can have HIV, 23.7% stated that a wife was not justified to ask the husband to use a condom if he has STI, some respondents (33.2%) would use drugs to avoid HIV transmission to baby during pregnancy and many (69.7%) would not buy vegetables from a vendor with HIV (Table 3). Overall, 21.9% of the respondents had poor knowledge of HIV and other sexually transmitted diseases while 78.1% had good knowledge of HIV and other sexually transmitted diseases (Table 2, Figure 1).

Table 2: Knowledge of HIV and other sexually transmitted infections
Figure 1: Respondents Knowledge on HIV and other sexually transmitted diseases

Association between socio-demographic characteristics and knowledge of HIV and STIs.

Chi-square analysis revealed that there was statistically significant difference between selected socio-demographic characteristics and knowledge of HIV and STIs. There was statistically significant association between age and knowledge of HIV and STIs (X2=34.479; p-value<0.001). Furthermore, chi-square analysis showed that there was statistically significant association between educational level and knowledge of HIV and STIs (X2=227.168; p-value = <0.001). There was statistically significant association between partner’s level of education and knowledge of HIV and STIs (X2=73.302; p-value = <0.001). Also, a statistically significant difference was shown between parity and knowledge of HIV and STIs (X2=32.329; p-value = <0.001). Chi-square analysis found statistically significant association between current marital status and knowledge of HIV and STIs (X2=19.387; p-value=0.002) (Table 3).

Table 3: Association between Sociodemographic and Knowledge of HIV and STIs

Association between place of delivery for first birth and knowledge of HIV and STIs

Chi-square analysis revealed that there was statistical significance between place of delivery for first birth and knowledge of HIV and STIs (X2=18.444; p-value<0.001). Chi-square analysis found that there was statistical significance between place of delivery for second birth and knowledge of HIV and STIs (X2=14.046; p-value=0.003) (Table 4).

Table 4: Association between Place of Delivery for Birth and Knowledge of HIV and STIs

Influence of Socio-demographic Characteristics on Knowledge of HIV and STIs

Logistic regression analysis revealed that those between 30-39 years were 1.7 times more likely to have knowledge of HIV and STIs as compared to those between 15-19 years (OR=1.737; p<0.001; CI=1.402 - 2.153). Also, those who had secondary school education were 2.6 times more likely to have knowledge of HIV and STIs compared to those who had no education (OR=2.604; p<0.001; CI=1.934 - 3.507). Partners who had higher education were 2.6 times more likely to have knowledge of HIV and STIs compared to partners who had no education (OR=2.585; p<0.001; CI=1.701 - 3.929). Those who had between 1-3 and 7-9 children were 1.3 times more likely and 50.2% times less likely to have knowledge of HIV and STIs compared to those who had no children respectively (OR=1.252, p=0.014, CI=1.047 - 1.497; OR=0.498, p<0.001, CI=0.346 - 0.717). Furthermore, respondents living with a partner were 37.6% times less likely to have knowledge of HIV and STIs as compared to those who were single (OR=0.624; p=0.004; CI=0.454 - 0.857) (Table 5).

Table 5: Factors Affecting Knowledge of HIV and STIs

4. Discussion

The study was carried out among 4064 urban women between in the reproductive age (15-49 years of age). Some of the respondents (33.1%) were between 30 – 39 years of age while 59.9% had secondary education. HIV and other sexually transmitted infections (STIs) constitute major public health concerns in Africa and particularly in Nigeria. A comprehensive knowledge of the modes of transmission is necessary to evolve an effective preventive strategy. Almost all the respondents (96.3% and 95.6%) in this study had heard of STIs and AIDS respectively. Similarly, around 90% of respondents in another study had heard about HIV/acquired immune deficiency syndrome (AIDS) (14). Also, 21% of the women had poor knowledge of HIV and other sexually transmitted diseases while 78.1% had good knowledge of HIV. The high level of awareness in this study may be due to various interventions including the health education provision by Nigeria's HIV/AIDS control program (National Action Committee on AIDS) through radio jingles, print and electronic media. Contrary to the result of this study, in a similar study among rural dwellers in Nigeria, only 13.1% of the participants had knowledge of STIs (15). This shows that there might be a difference between the knowledge of HIV among urban and rural women in Nigeria. Although, the disparity in the knowledge could be related to the peculiarities of the rural areas where means of disseminating information may not be as efficient as in the urban (14). Low STI knowledge has been shown to be connected with unsafe sex practices and HIV (16). It was observed in the current study that most of the respondents practiced safe sex; and majority (88.0%) had one sex partner only who had no other partners. This may be as a result of the observed high knowledge of HIV and other STIs among the study respondents.

Misconceptions about HIV transmission are still prevalent in Sub Saharan Africa, despite recent significant improvements in public awareness of the disease (17). An analysis of women’s knowledge of HIV in Nigeria revealed that while awareness of HIV/AIDS was generally high among the population, accurate knowledge on HIV transmission was generally low; only 24% of a total of 9882 people had comprehensive knowledge of modes of HIV transmission (18). This study reported some misconceptions about the transmission of HIV. Many of the respondents (72.9%) reported that HIV can be contracted from mosquito bites,76.0% agreed that HIV can be contracted by sharing food with a person who has AIDS, while 76.3% reported that HIV can be gotten by witchcraft or supernatural means. Similar results were reported by Nahar et al. (19), where about 60% of the respondents believed that HIV could be transmitted through the mosquito bite. Also, studies in Kenya and Ghana discovered that some respondents believe the HIV virus could be spread through mosquito bites and touching an infected person (20). In addition, the view that a healthy-looking person cannot be HIV positive or that HIV can be cured by sleeping with a virgin, eating fresh vegetables, and making ancestral sacrifices is still a notion in many parts of SSA (21-22). This clearly shows that a major gap in knowledge exists among urban women about the means of transmitting/ acquiring HIV and other STIs. The need for targeted education at eradicating myths and misconceptions about HIV transmission may be emphasized, given that some urban women reported a good HIV knowledge, yet still hold on to misconceptions about HIV transmission.

This study found a statistically significant association between age and knowledge of HIV and STIs. Respondents between 30-39 years were 1.7 times more likely to have knowledge of HIV and STIs as compared to those between 15-19 years. In agreement to the result of this study, findings from the 2012 survey showed increasing odds of good knowledge of both STIs and HIV infections with age (23). The proportion of participants with good knowledge of STIs including HIV infections was high among those aged 25–49 years in the 2005 and 2007 surveys particularly those from the Northeast region of Nigeria (23). On the contrary, good knowledge of STIs was associated with being a male in the 2007 survey report (24).

Logistic regression analysis also found that those who had secondary school education were 2.6 times more likely to have knowledge of HIV and STIs compared to those who had no education. Lan et al. (24) also found that higher education resulted in good knowledge of HIV and other STIs. Also, according to Lan et al. (24) women with low education or low economic status had less knowledge of STI than those with higher education or economic category. Also, those who had between 6-10 children were 54.8% times less likely to have knowledge of HIV and STIs compared to those who had between 1-5 children. The World Health Organization (WHO) lists education as one of the key determinants of health and explains that higher education levels are linked with better health outcomes (25). Knowledge of HIV and other STIs among the respondents was significant associated with partner’s level of education. Partners with higher (tertiary) education were 2.6 times more likely to have good knowledge of HIV and other STIs. More-educated people typically have stronger socio-cognitive abilities, leading to better ability to assimilate risk information and higher self-efficacy to act on such knowledge. Also, more-educated individuals tend to have more income and thus more control over their lives and ability to act on knowledge; they also tend to place higher value on the future and thus be more motivated to take preventative measures (26-27).

Furthermore, respondents’ marital status was statistically significant with marital status. Respondents that were currently living a partner were 37.6% less likely to have good knowledge of HIV and other STIs. However, previous studies have established that Marital status was significantly associated with the seroprevalence of HIV and the odds of being HIV-infected were two times higher among formerly married women compared with other women (28).

The current study found that almost half of the respondents (47.8%) had their first delivery at a public health facility. There was statistical significance between place of delivery for first birth and knowledge of HIV and STIs. Women who delivered their first child in public healthcare centres were 1.7 times more likely to have knowledge of HIV and STIs as compared to those who delivered their first child at home. Likewise, those who delivered their second child in private healthcare centres were 3.0 times more likely to have knowledge of HIV and STIs as compared to those who delivered their second child at home. This could be attributed to the sensitization and awareness programmes for pregnant women on HIV and other STIs during ante-natal visits to such facilities. Respondents with 1 – 3 children were 1.3 times more likely to have good knowledge of HIV and other STIs.

5. Conclusion

This study found that almost all urban women in South West Nigeria had heard of sexually transmitted infections (STI) and majority had good knowledge of HIV and other sexually transmitted diseases. However, some misconceptions about HIV and other STIs including contraction of HIV from mosquito bites, by sharing food with a person who has AIDS and by witchcraft or supernatural means were reported by some of the women. Also, most of the women had delivered their first and second birth in a public health facility. Significant association was established between the knowledge of HIV and age, level of education and place of delivery.

6. Recommendations

Based on the findings of this study, these recommendations were made

  • There is need to intensify campaigns on HIV and other STIs transmission in the urban areas of Nigeria to debunk misconceptions about the transmission of HIV using both traditional methods of information dissemination and leveraging new media such as the social media.
  • In order the bridge the gap in the knowledge of HIV, educational programmes on HIV and other STI should target more less educated women in urban regions of Nigeria.
  • There is a need to articulate program, which include messages aimed at reinforcing safer sex practices for women who are already sexually active.
  • Also, interventions should also be focused on women living with partners with a view to sensitizing them to the risk of HIV infection in order to increase the effectiveness of prevention strategies.

7. Limitations

However, a drawback in this study is the use of cross-sectional data, which is inadequate to establish causality. More so, the study utilized secondary data; therefore, measurement of certain variables such as exposure to behaviour change communication through HIV/AIDS-related interventions across various groups and over time was not possible. Finally, the use of composite index to measure knowledge and attitude as provided by DHS data could lead to estimation bias.

8. Ethical approval

The Nigerian DHS is conducted according to the local Nigerian research ethics requirements. Data for this analysis were accessed via the publicly available DHS data sets, with access granted through the DHS programme. As this was a secondary data analysis, further research ethics approval was not required; however, in accordance with DHS regulations, all data extracted from the NDHS for the purpose of this study were handled as confidential and survey respondents remained unidentified. This study conforms to the principles of the Declaration of Helsinki.

9. Availability of Data

The dataset used and/or analysed during the current study are available from the corresponding author on reasonable request.

10. Competing Interest

The authors declare that there is no competing interest.

11. Funding

This study was not funded.

12. Authors contributions

IIO: Conceptualization, Resources, Writing—Original Draft, Writing—Review and Editing, Supervision and Project administration. MAA: Conceptualization, Resources, Writing—Original Draft, Writing—Review and Editing. TAA: Conceptualization, Resources, Review and Editing. RIO: Conceptualization and Review.

13. References

  1. Upchurch DM, Mason WM, Kusunoki Y, Kriechbaum MJ. Social and behavioral determinants of self‐reported STD among adolescents. Perspectives on Sexual and Reproductive Health. 2004 Nov;36(6):276-87.
  2. Ackerson LK, Ramanadhan S, Arya M, Viswanath K. Social disparities, communication inequalities, and HIV/AIDS-related knowledge and attitudes in India. AIDS and Behavior. 2012 Oct;16(7):2072-81.
  3. Powell HL, Segrin C. The effect of family and peer communication on college students' communication with dating partners about HIV and AIDS. Health Communication. 2004 Oct 1;16(4):427-49.
  4. Wolf RC, Pulerwitz J. The influence of peer versus adult communication on AIDS-protective behaviors among Ghanaian youth. Journal of health communication. 2003 Sep 1;8(5):463-74.
  5. Anwar M, Syed Sulaiman SA, Ahmadi K, Kham TM. Awareness of school students on sexually transmitted diseases (STDs) and their sexual behaviour: a cross-sectional study conducted in Pulau Pinang, Malaysia. BMC Public Health. 2010 Jan 30;10(47).
  6. Francis SC, Mthiyane TN, Baisley K, Mchunu SL, Ferguson JB, Smit T, Crucitti T, Gareta D, Dlamini S, Mutevedzi T, Seeley J. Prevalence of sexually transmitted infections among young people in South Africa: A nested survey in a health and demographic surveillance site. PLoS medicine. 2018 Feb 27;15(2):e1002512.
  7. Ginsburg AS, Hoblitzelle CW, Sripipatana TL, Wilfert CM. Provision of care following prevention of mother-to-child HIV transmission services in resource-limited settings. Aids. 2007 Nov 30;21(18):2529-32.
  8. Manzi M, Zachariah R, Teck R, Buhendwa L, Kazima J, Bakali E, Firmenich P, Humblet P. High acceptability of voluntary counselling and HIV‐testing but unacceptable loss to follow up in a prevention of mother‐to‐child HIV transmission programme in rural Malawi: scaling‐up requires a different way of acting. Tropical Medicine & International Health. 2005 Dec;10(12):1242-50.
  9. Nyarko SH, Amu H. Self-reported effects of infertility on marital relationships among fertility clients at a public health facility in Accra, Ghana. Fertility research and practice. 2015 Dec;1(1):1-6.
  10. Sialubanje C, Massar K, Hamer DH, Ruiter RA. Understanding the psychosocial and environmental factors and barriers affecting utilization of maternal healthcare services in Kalomo, Zambia: a qualitative study. Health education research. 2014 Mar 22;29(3):521-32.
  11. Kifle MM, Kesete HF, Gaim HT, Angosom GS, Araya MB. Health facility or home delivery? Factors influencing the choice of delivery place among mothers living in rural communities of Eritrea. Journal of Health, Population and Nutrition. 2018 Dec;37(1):1-5.
  12. Dickson KS, Adde KS, Amu H. What influences where they give birth? Determinants of place of delivery among women in rural Ghana. International journal of reproductive medicine. 2016 Oct;2016.
  13. Hossain M, Mani KK, Sidik SM, Shahar HK, Islam R. Knowledge and awareness about STDs among women in Bangladesh. BMC public health. 2014 Dec;14(1):1-7.
  14. Ikeako LC, Ekwueme OC, Ezegwui HU. Vulnerability and knowledge of sexually transmitted infections among female traders of reproductive age in Enugu, Nigeria. Annals of medical and health sciences research. 2014;4(1):118-22.
  15. Ogbe JO. Knowledge, sources of information and practice of condom use in the prevention of sexually transmitted infections (STIs) among rural dwellers in Delta State, Nigeria. Studies on Ethno-Medicine. 2011 Aug 1;5(2):107-14.
  16. Mayaud P, Mabey D. Approaches to the control of sexually transmitted infections in developing countries: old problems and modern challenges. Sexually transmitted infections. 2004 Jun 1;80(3):174-82.
  17. Sano Y, Antabe R, Atuoye KN, Hussey LK, Bayne J, Galaa SZ, Mkandawire P, Luginaah I. Persistent misconceptions about HIV transmission among males and females in Malawi. BMC international health and human rights. 2016 Dec;16(1):1-0.
  18. NARHS P. National HIV/AIDS and Reproductive Health Survey. Federal Republic of Nigeria Federal Ministry of Health, Abuja, Nigeria. 2012.
  19. Nahar N, Akter J, Mahbub MS, Sultana R, Khan FI, Faruque M, Ara BR. Association of socio-demographic issues with level of knowledge of HIV/AIDS among injecting drug users in Dhaka City in Bangladesh. South East Asia Journal of Public Health. 2017 Dec 31;7(1):42-7.
  20. Tenkorang EY. Myths and misconceptions about HIV transmission in Ghana: what are the drivers? Culture, health & sexuality. 2013 Mar 1;15(3):296-310.
  21. Bogart LM, Skinner D, Weinhardt LS, Glasman L, Sitzler C, Toefy Y, Kalichman SC. HIV/AIDS misconceptions may be associated with condom use among black South Africans: an exploratory analysis. African Journal of AIDS Research. 2011 Jun 1;10(2):181-7.
  22. Ross MW, Essien EJ, Torres I. Conspiracy beliefs about the origin of HIV/AIDS in four racial/ethnic groups. Journal of acquired immune deficiency syndromes (1999). 2006 Mar;41(3):342.
  23. Morhason-Bello IO, Fagbamigbe AF. Association between Knowledge of Sexually Transmitted Infections and Sources of the Previous Point of Care among Nigerians: Findings from Three National HIV and AIDS Reproductive Health Surveys. International Journal of Reproductive Medicine. 2020 Jan 2;2020.
  24. Lan PT, Lundborg CS, Mogren I, Phuc HD, Chuc NT. Lack of knowledge about sexually transmitted infections among women in North rural Vietnam. BMC infectious diseases. 2009 Dec;9(1):1-9.
  25. The Determinants of Health [Internet]. World Health Organization. 2016 [cited 17 August 2022] . Available from: http://www.who.int/hia/evidence/doh/en/
  26. Harling G, Bärnighausen T. The role of partners’ educational attainment in the association between HIV and education amongst women in seven Sub‐Saharan African countries. Journal of the International AIDS Society. 2016 Jan;19(1):20038.
  27. Fagbamigbe AF, Adebayo SB, Idemudia E. Marital status and HIV prevalence among women in Nigeria: Ingredients for evidence-based programming. International journal of infectious diseases. 2016 Jul 1;48:57-63.
  28. Pollack H. Making Americans healthier: Social and economic policy as health policy. Russell Sage Foundation; 2008 Jan 25.