Sexually transmitted infections (STIs) are of public health importance as over 1 million STIs are acquired daily worldwide. One-third of the new cases of curable STIs affect younger persons aged less than 25 years. Sexually transmitted infections can lead to severe complications beyond the immediate impact of infections as such.
This study assessed knowledge of, attitude towards and preventive practices of STI among young unmarried persons in Surulere local government area (LGA) of Lagos State, Nigeria.
The study was conducted among young unmarried persons in Surulere LGA, Lagos State, Nigeria, between June and November 2018.
A descriptive cross-sectional study was conducted among 450 young unmarried persons selected using a multistage sampling technique. An interviewer-administered questionnaire was used to obtain data. Analysis was carried out with Epi-Info 7.2.2.2 software. Chi-square was used to test for associations. Level of significance was at
The mean age was 19.9 + 2.5 years. Majority of the respondents (84.7%) had heard of STIs. About two-third (65.6%) had good knowledge, while majority (98.6%) had good attitude towards the prevention of STIs, but less than half (34.0%) had good preventive practices. Knowledge of STI was statistically significantly associated with age, level of education, attitude and preventive practices of the respondents.
Most of the respondents were aware and had good attitude towards prevention of STI, but gaps exist in knowledge and preventive practices. Hence, targeted education to improve the knowledge and preventive practices against STI among young unmarried persons is recommended.
Worldwide, over a million people acquire a sexually transmitted infection (STI) daily. Every year, there is an estimated 357 million new infections with one of the four STIs globally: chlamydia (131 million), gonorrhoea (78 million), syphilis (5.6 million) or trichomoniasis (143 million).
Young people are at high risk of getting an STI for the following reasons: young women’s bodies are biologically more prone to sexually transmitted diseases (STDs), lack of access to healthcare, confidentiality concerns and multiple sexual partners, among others.
Sexually transmitted infections can lead to severe complications beyond the immediate impact of infections. Some STIs, such as herpes and syphilis, can increase the risk of human immunodeficiency virus (HIV) acquisition threefold or more. Gonorrhoea and chlamydia are major causes of pelvic inflammatory disease (PID) and infertility in women.
Young adults are also exposed to diverse sources of influence (multiple sexual partners, lack of condom use) transecting different levels of causation.
Literature on the knowledge and preventive practices of STIs in Lagos State is quite scanty, if any at all, especially in Surulere local government area (LGA), which is one of the highly sociable urban areas, with numerous bars, clubs, lounges, malls and pubs, highly populated by young persons. Hence, this study was conducted in Surulere LGA in Lagos State to determine the knowledge of, attitude towards and preventive practices adopted by young unmarried persons against STIs.
Lagos State is located in southwestern Nigeria with an estimated population of 21 million as of 2015. Surulere LGA is one of the 20 LGAs in Lagos, a residential and commercial LGA located on the mainland in Lagos State, Nigeria, with a total land mass of 27.1 km2. In the last census of the year 2006, there were 503 975 inhabitants, with a population density of 21 864 inhabitants per square kilometre, split across different age groups: 0–14 years, 29.3%; 15–64 years, 67.8%; and 65+ years, 2.9%.
The study population consisted of young unmarried youths who must have spent at least 6 months in the selected communities in the LGA. The study was a community-based, descriptive, cross-sectional study. The Cochrane’s formula for descriptive study,
A pretested, interviewer-administered, semi-structured questionnaire adapted from the reviewed literature
Data analysis was performed using Epi-info 7.2.2.2. Results were represented in frequencies and percentages. Chi-square test was used to test for associations with the level of significance set at
For the level of knowledge of each respondent about STI, every correct answer attracted one point, while every incorrect answer or non-response attracted a zero. The scores were converted to percentages and graded as poor (< 50%) and good (≥ 50%). For attitude questions on Likert scale, the mean score was calculated. Scores below the mean were classified as poor, while those above the mean were classified as good attitudes. In assessing the preventive practices against STIs, every correct answer scored one point, while an incorrect answer or non-response scored zero. The total score for each respondent was converted to percentage and graded as poor preventive practices if < 50%, and good preventive practices if > 50%.
Ethical approval for this study was obtained from the Health Research and Ethics Committee (HREC) of the Lagos University Teaching Hospital (ADM/DCST/HREC/APP/410). Written informed consent was obtained from each respondent, with assurance of confidentiality of information and their right to withdraw from the study at any point in time. The participants were informed that participation in the study was voluntary.
A total of 425 out of 450 questionnaires administered, which were adequately answered, were analysed with a response rate of 94.4%. The age range and mean age ± standard deviation (s.d.) of the respondents were 15–24 and 19.9 ± 2.5 years, respectively. Most (75.8%) of the respondents were Christians of Yoruba ethnicity (68.0%), and 64.0% had tertiary-level education (
Socio-demographic characteristics of respondents.
Socio-demographic | Frequency ( |
% |
---|---|---|
15–19 | 179 | 42.1 |
20–24 | 246 | 57.9 |
19.9 ± 2.5 | - | |
Male | 210 | 49.4 |
Female | 215 | 50.6 |
Christianity | 322 | 75.8 |
Islam | 99 | 23.3 |
Traditional | 2 | 0.5 |
Others | 2 | 0.5 |
Yoruba | 289 | 68.0 |
Igbo | 97 | 22.8 |
Hausa | 8 | 1.9 |
Others | 31 | 7.3 |
No formal education | 1 | 0.2 |
Primary | 11 | 2.6 |
Secondary | 141 | 33.1 |
Tertiary | 272 | 64.0 |
Viruses (68.3%) and bacteria (48.6%) were the most common known causes of STIs among the respondents. Majority of the respondents (85.8%) knew that HIV or acquired immunodeficiency syndrome (AIDS) is a type of STI; however, a few believed that diarrhoea (23.9%), sickle cell disease (26.7%), tuberculosis (25.4%) and malaria (18.3%) were examples of STIs. Majority (97.8%) of the respondents rightly knew that STIs did not have any gender predilection, as it can affect both men and women, and 96.7% knew that STIs were commonly transmitted by unprotected sexual intercourse. More than half (61.9%) of the respondents also recognised blood transfusion as a means of STI transmission; however, less than half (46.9%) of the respondents identified ‘mother to child’ route as a means of STI transmission (
Respondents’ awareness, knowledge of causes, types and transmission of sexually transmitted infections.
Variable | Frequency | % |
---|---|---|
Yes | 360 | 84.7 |
No | 65 | 15.3 |
Electronic media | 245 | 68.1 |
Print media | 180 | 50.0 |
Public talks or seminars | 210 | 58.3 |
Internet | 276 | 76.7 |
Billboard or posters | 124 | 34.4 |
Church or mosque | 123 | 34.2 |
Hospitals or health workers | 189 | 52.5 |
Teachers or schools | 274 | 76.1 |
Friends or relations | 200 | 55.6 |
Bacteria | 175 | 48.6 |
Virus | 246 | 68.3 |
Fungi | 157 | 43.6 |
Bad hygiene of the man | 142 | 39.4 |
Bad hygiene of the woman | 138 | 38.3 |
Drinking unclean water | 83 | 23.1 |
Having sex during menses | 168 | 46.7 |
Mosquitoes | 66 | 18.3 |
Witchcraft | 76 | 21.1 |
Malaria | 66 | 18.3 |
Gonorrhoea | 255 | 70.8 |
Chlamydia | 162 | 45.0 |
Diarrhoea | 86 | 23.9 |
Herpes simplex virus | 150 | 41.7 |
Sickle cell disease | 96 | 26.7 |
Human papilloma virus | 161 | 44.7 |
Hepatitis B virus | 139 | 38.6 |
Syphilis | 252 | 70.0 |
HIV/AIDS | 309 | 85.8 |
Tuberculosis | 84 | 25.4 |
Trichomoniasis | 80 | 22.2 |
Yes | 352 | 97.8 |
No | 8 | 2.2 |
Sharing clothes | 272 | 75.6 |
Sharing needles | 197 | 54.7 |
Unprotected sexual intercourse | 348 | 96.7 |
Mother to child | 169 | 46.9 |
Kissing | 123 | 34.2 |
Blood transfusion | 223 | 61.9 |
, denotes multiple response to the question.
STI, sexually transmitted infections; HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome.
More than half (58.1%) of the respondents knew that it is possible to be infected with no clinical symptoms. Pain on urination (84.2%) was the commonest STI symptom, while infertility (74.4%) was the most known complication of STI identified by the respondents. In addition, most (64.7%) of the respondents knew that not all STIs can be cured, while majority of the respondents (92.2%) agreed that STIs are preventable. Overall, about three-quarter (66%) of the respondents had good knowledge of STIs (
Respondents’ knowledge of symptoms and complications of sexually transmitted infections.
Variable | Frequency | % |
---|---|---|
Yes | 209 | 58.1 |
No | 151 | 41.9 |
Chest pain | 271 | 75.3 |
Vaginal discharge | 297 | 82.5 |
Weight loss | 105 | 29.2 |
Penile discharge | 255 | 70.8 |
Genital itching | 286 | 79.4 |
Stomach pain | 169 | 46.9 |
Pain during urination | 303 | 84.2 |
Swelling around the genitals | 284 | 78.9 |
Headache | 233 | 64.7 |
Blood in urine | 232 | 64.4 |
Infertility | 268 | 74.4 |
Ectopic pregnancy | 137 | 38.1 |
Miscarriage | 208 | 57.8 |
Cervical cancer | 213 | 59.2 |
Testicular cancer | 190 | 52.8 |
Pelvic inflammatory disease | 238 | 66.1 |
Premature birth | 129 | 35.8 |
Yes | 127 | 35.3 |
No | 233 | 64.7 |
Yes | 332 | 92.2 |
No | 28 | 7.8 |
Good knowledge | 236 | 65.6 |
Poor knowledge | 124 | 34.4 |
, denotes multiple response to the question.
STI, sexually transmitted infections.
Respondents’ attitude towards prevention of sexually transmitted infections (
Statement | SA |
A |
I |
D |
SD |
|||||
---|---|---|---|---|---|---|---|---|---|---|
Frequency | % | Frequency | % | Frequency | % | Frequency | % | Frequency | % | |
Young people should be educated on STI in academic institutions | 300 | 83.3 | 43 | 11.9 | 16 | 4.4 | 0 | 0 | 1 | 0.3 |
People with STI should not be isolated and avoided | 202 | 56.1 | 98 | 27.2 | 29 | 8.1 | 23 | 6.4 | 8 | 2.2 |
Condoms should be used during sexual intercourse to avoid STI | 264 | 73.3 | 66 | 18.3 | 26 | 7.2 | 2 | 0.6 | 2 | 0.6 |
Screening for STIs is good | 262 | 72.8 | 77 | 21.4 | 17 | 4.7 | 3 | 0.8 | 1 | 0.3 |
If unsure on symptoms of STI, a health personnel should be contacted | 269 | 75.1 | 72 | 20.1 | 13 | 3.6 | 4 | 1.1 | 0 | 0.0 |
Young adults with STI must get treated | 280 | 77.8 | 69 | 19.2 | 8 | 2.2 | 3 | 0.8 | 0 | 0.0 |
I would advise my partner to seek treatment if STI symptoms are noticed | 298 | 83.0 | 49 | 13.7 | 7 | 2.0 | 4 | 1.1 | 1 | 0.30 |
Multiple sexual partners play a role in the transmission of STDs | 265 | 73.6 | 46 | 12.8 | 37 | 10.3 | 8 | 2.2 | 4 | 1.1 |
The use of emergency contraceptive pills does not protect against STI | 216 | 60.0 | 75 | 20.8 | 41 | 11.4 | 22 | 6.1 | 6 | 1.7 |
Watching pornography can contribute to risky sexual practices that can lead to STI | 186 | 51.7 | 83 | 23.1 | 36 | 10.0 | 28 | 7.8 | 27 | 7.5 |
STI, sexually transmitted infections; SA, strongly agree; A, agree; I, indifferent; D, disagree; SD, strongly disagree.
Respondents’ overall attitude towards the prevention of sexually transmitted infections.
Attitude | Frequency ( |
% |
---|---|---|
Positive | 355 | 98.6 |
Negative | 5 | 1.4 |
Respondents’ preventive practices against sexually transmitted infections.
Variable | Frequency | % |
---|---|---|
Yes | 106 | 24.9 |
No | 319 | 75.1 |
10–14 | 11 | 10.4 |
15–19 | 63 | 59.4 |
20–24 | 32 | 30.2 |
Abstinence | 92 | 86.8 |
Use of condoms | 100 | 94.3 |
Faithful to one sexual partner | 78 | 73.6 |
Regular screening | 72 | 67.9 |
Contraceptive use | 38 | 35.9 |
Having sex while standing | 20 | 18.9 |
Vaccination | 37 | 34.9 |
Taking drugs before sex | 27 | 25.5 |
Taking alcohol before sex | 19 | 17.9 |
Yes | 84 | 79.3 |
No | 22 | 20.8 |
At every intercourse (always) | 58 | 69.0 |
Often | 14 | 16.7 |
Rarely | 12 | 14.3 |
1 | 57 | 53.8 |
2–4 | 39 | 36.8 |
5–8 | 10 | 9.4 |
Yes | 54 | 50.9 |
No | 52 | 49.1 |
Yes | 5 | 4.7 |
No | 101 | 95.3 |
Good | 36 | 34.0 |
Poor | 70 | 66.0 |
, denotes multiple response to the question.
STIs, sexually transmitted infections.
A large number (79.3%) of the respondents used condoms, and more than half (69.0%) used it always during sexual intercourse. About half (53.8%) of the respondents had one partner, while 49.1% and 95.3% have never been vaccinated for hepatitis B and human papilloma virus, respectively.
Age, level of education, attitude and preventive practices were all found to be statistically significantly associated with the knowledge of respondents about STIs (
Sexually transmitted infections are among the world’s most common diseases, with an annual incidence exceeded only by diarrhoeal diseases, malaria and lower respiratory infections. Each day, almost one million people acquire a new STI; more than 340 million new cases of curable STIs and even more new viral (non-curable) infections occur each year worldwide. Up to 80% of curable STIs occur in developing countries of the world, with adolescents and young adults having the highest rates of these diseases. In developing countries like Nigeria, STIs are among the leading causes of disability adjusted life years (DALYs) lost for women of reproductive age, exceeded only by maternal causes and HIV.
In this study, 450 young unmarried persons were assessed for knowledge of, attitude towards and preventive practices of STI. The mean age of the respondents was 19.9 ± 2.5 years and most (64.0%) had tertiary education, which is in line with similar studies carried out in Shone Town Ethiopia (18.6 ± 1.9) and Malaysia, where majority (78.3%) were undergraduates.
Most (66%) of the respondents had overall good knowledge of STIs contrary to a study in Ado-Ekiti, Nigeria, which reported only 6.9% of the respondents as having overall good knowledge of STIs.
Majority of the respondents in this study knew that unprotected sexual intercourse was a major means of transmission of STIs, while less than half knew about transmission of STIs via mother to child – this finding is consistent with the reports of various other studies conducted within and outside the country.
A statistically significant association was found between age and level of education with knowledge of respondents about STIs (
With regard to attitude, almost all respondents in this study were of the view that ‘young people should be educated about STI in academic institutions’ – this finding is comparable to that of an Indian study.
Association of age, sex, attitude and preventive practices of respondents with knowledge of sexually transmitted infections.
Socio-demographics | Knowledge grade |
||||||||
---|---|---|---|---|---|---|---|---|---|
Poor |
Good |
Total |
Statistical test |
||||||
χ2 | df | ||||||||
9.991 | 1 | ||||||||
15–19 | 65 | 43.9 | 83 | 56.1 | 148 | 100 | |||
20–24 | 59 | 27.8 | 153 | 72.2 | 212 | 100 | |||
17.308 |
3 | ||||||||
No formal | 1 | 100 | 0 | 0 | 1 | 100 | |||
Primary | 2 | 28.6 | 5 | 71.4 | 7 | 100 | |||
Secondary | 58 | 48.3 | 62 | 51.7 | 120 | 100 | |||
Tertiary | 63 | 27.2 | 169 | 72.8 | 232 | 100 | |||
9.650 | 1 | ||||||||
Positive | 119 | 96.0 | 5 | 4.0 | 124 | 100 | |||
Negative | 236 | 100.0 | 0 | 0.0 | 236 | 100 | |||
7.271 | 1 | ||||||||
Good | 30 | 83.3 | 6 | 16.7 | 36 | 100 | |||
Poor | 40 | 57.1 | 30 | 42.9 | 70 | 100 |
denotes Fisher’s exact.
χ2, chi-square value; df, degree of freedom;
About a quarter of the respondents in this study were sexually active during the time of this study; this is in line with the finding in a study in Ogbomoso, Nigeria, and Malaysia.
Some common misconceptions found among the respondents in this study about the prevention of STIs were: about 36% and 25% felt that contraceptive use and taking drugs before sex, respectively, are known protective measures against STIs, while alcohol intake before sexual intercourse was also regarded as a prevention method by about 18% of the respondents. In a study conducted in China, some of the respondents reported that taking antibiotics before or after sex, taking a shower before or after sex or using a sex detergent wash before or after sex could prevent STIs.
About half of the respondents in this study had one regular partner and the majority used condoms, and most of them used it always (at every sexual intercourse). This finding is contrary to the report of a study among youths in Nairobi where less than half of the respondents use condoms and in southern Ethiopia where 29.0% use condoms and 11.9%, respectively, use it always.
Overall, about two-third (66.0%) of the respondents in this study had poor preventive practices against STIs. Knowledge of respondents of STIs was found to be statistically significant with the preventive practices of STIs (
Most of the respondents in this study were aware of and had good attitude towards the prevention of STI, but gaps still exist in their knowledge of STIs. Preventive practices of STIs are very poor among the respondents. Therefore, targeted education on behaviour change communication aimed at young unmarried persons in communities is highly recommended to improve their knowledge and thereby implementation of preventive practices against STIs.
This study had some limitations. Firstly, our study participants were from only one LGA out of the 20 in Lagos State. This study was conducted in a community, and the results represent the views of the respondents in that community alone, which might be different from others in other parts of the state. The presence of recall bias in this study is also very likely. Therefore, further research with a larger population with adequate power and sample sizes is recommended.
The authors thank the respondents for being part of the study and the research assistants for collection of the data.
The authors have declared that no competing interests exist.
O.E.O. was responsible for the concept, design, drafting, data analysis and manuscript revision, while O.D.O. was responsible for data collection, data analysis and manuscript writing. D.O. participated in design and manuscript review, and O.G.E. was responsible for editing and manuscript review. All the authors approved the final version of the manuscript.
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Data sharing is not applicable to this article as no new data were created or analysed in this study.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.