Sexually, Transmitted Infections

... ~ ... ~··-~~"--- ............ r \ 'o . .;; P.,-;"-.... ...., A5. Ol..l.Di /!',~';) I ' ./ ,. ,, -\ ( ,/' ·)·;,_ ' A LR ' ~l ~ \ I IJ r1 } ~ 0 corner:.- ;·~ _·• 0 .. ' .,,,/1:) 3G. \ ~ ~--·,. i_. .. "1 ' ... .~ \ ~'.,.,,,.foo:> :·~ SEXUALLY TRANSMITTED INFECTIONS: PREVALENCE, BEHAVI OURAL PATTERNS AND COPING STRATEGIES AM ONG ADOLESCENTS IN OYO STATE, NIGERIA. LIBRARY ADEDIMEJI ADEBOLA- ALADE B.Sc.(Hons) Sociology (Ibadan), M.Sc. (Ibadan) A THESIS IN THE DEPARTMENT OF SOCIOLOGY SUBMITTED TO THE FACULTY OF THE SOCIAL SCIENCES IN_PARTIAL FULFILMENT OF THE REQUIREMENTS FOR CODESRIATHE AWARD OF THE DEGREE OF DOCTOR OF PHILOSOPHY OFTHE UNIVERSITY OF IBADAN. February, 1998. ABSTRACT Sexually Transmitted Infections (STis) are major causes of reproductive health and socio- economic problems world wide and they affect ail segments of the population including men, women and children. Statistics from the World Health Organisation (WHO) showed that an average of 685,000 new cases of infections occur everyday, while every year, there are 250 million new cases. These figures are estimated to increase annually. Adolescents have been identified as a group for whom the prevention of STis is an urgent necessity given the rislcy nature of sexual activities and lack of barrier contraceptive use among them. Although there are no adequate statistics on the prevalence of STis among adolescents in Nigeria, it is estimated that they account for between 15 and 30 percent of al! reported cases of infections and often times, due to the exorbitant cost of procuring treatment,LIBRARY many of those infected do not seek health care from qualified medical personnel.- In spite of the reality of STis as a major problem among adolescents, ve1y little is known about their treatment seeking behaviour. For example, how do they cope with the problem of infection especially where they lad( access to adequate medical facilities?. In light of these, the study set out to achieve the following objectives: 1. ProvideCODESRIA information on adolescents' knowledge of sexually transmitted infections. 2. Examine the patterns of sexual behaviour among adolescents and the implications for the spread of infections. 3. Examine how socio-demographic factors, including age, sex, education, residence, etc. will influence and thus determine attitudes to infections. 11 4. Estimate the prevalence of infections among adolescents and identify common infections among them. 5. Investfgate the coping strategies adopted by victims of infections and the implications for health seeking behaviour. 6. Identify existing strategies adopted by victims of infections and the factors that determine the choice of a particular method of treatment. 7. Investigate the psycho-social consequences of infections on the victims and significant others. 8. Malœ policy recommendations for the control of infections among adolescents. The nature of the study necessitated a comparative study between urban and rural adolescents. A multistage sampling technique was utilised to select a total of 977 adolescents between the ages of 15 and 24LIBRARY years to participate in a general survey and 200 adolescents of the same- age category in a clinic survey. Respondents for the general survey were selected from Ibadan (defined as the urban area) and Tapa and Oolo; two rural communities located in Ifeloju and Ogbomosho South local government areas of Oyo State. In addition to the surveys, focus group discussions and cases studies of victims of infections were also conducted. The information collected was analysed by both quantitative and qualitative methods. Two theoreticalCODESRIA models, the theory of Social Action and the Voluntaristic theory of Action, were used in providing explanations for the observed patterns of behaviour of adolescents with regard to STis. The findings showed that many adolescents (43. 7%) engage in irregular, unplanned and unprotected sexual activities and this tended to increase the rate of transmission of infections among them. Although the level of awareness of STis was high, (84% males vs. 86% iii ferhales) it was clifficult for young people to recognise an infection when they are infected. Only a few (24%) could identify the symptoms associated with even the · most common infection mentioned (gonorrhoea). Apart from knowledge of symptoms, many young people grossly under estimated their risk of exposure to infections and for this reason only a few of them (37%) had ever taken any measure to prevent being infècted. Estimates of the prevalence of STis also suggests that STis were a common problem among young people. In the general survey, about 15% of the respondents reported a history of infection while in the clinic survey, adolescents constituted about 48% of ail those who reported at health facilities for treatment of infections. Those in the 20-24 year age category also reported the highest rates (37.6%) infections. The findings also showed that many LIBRARYinfected young people do not immediately seek qualified medical attention- when they are infected, preferring instead, to try other kinds of treatment methods which only worsened the situation. Similarly, the rates at which infections spread may increase more than at present because attitudes toward partner notification as well as seeking treatment for partners are poor. Only 15% of males and 19% of females who were infected informed their partners about the infections and a fewer proportion were willing to procure treatment for their partners. In spite of these attempts, many of the partners were alsoCODESRIA reported to have refused to go for treatment. The cost of treatment and the structural-environmental factors are two important factors which hinder adolescents from having access to qualified health personnel for the treatment of infections. In addition, societal norms and values as well as the peer group still remain powerful factors which determine the psycho-social consequences and the behavioural patterns of victims infected with IV an STI. In view of the findings, some recommendations which could guide the design of intervention programmes and policies to reduce, if not completely eliminate, the problem of STis were made. These recommendations include setting up intervention programmes that aim at behaviour modifications, provision of health education as a strategy for reducing the spread of infections. identifying individuals already infected and those at risk, recognising the important role of public health care providers in the control of STis and finally, incorporating private sector health care providers in the efforts at controlling the spread of infections. LIBRARY - CODESRIA V ACKNOWLEDGEMENTS Throughout the duration of the Ph.D. programme, quite a number of people took an active interest in the progress of the work and especially expressed concem for a successful completion. The efforts and concerns of such people are deeply appreciated and it is in this wise that I want to acknowledge the worthy contributions of the following people. First, to GOD alone must all the glory, honour and adoration be given, not only for giving me the wherewithal to complete the programme, but also in sparing my life till this moment to reap the fruits of my labour. For His numerous blessings and merdes, and for the vict01ies he gave me, I say thank you LORD. The quality of this work would not have been possible without the efforts of my ldnd and caring academic adviser, Dr. ObafemiLIBRARY Gboyega Omololu. In fact, the idea of the problem area which the study addressed- emanated from the several discussions we had. Indeed, I am most grateful for his constructive criticisms, patience and understanding even at the point where I had almost given up hope. I want to thank him for believing so much in me and this in no small measure provided me with a lot of inspiration. lt is' really not possible to fully express the depths of my gratitude to him, my only prayer is that GOD Almighty enable him to reap what he has sown. I must showCODESRIA my sincere appreciation for the love and concem of members of my immediate and extended families, The Adedimeji's and The Adebayo's. I especially acknowledge the efforts of my biological parents, Mr. and Mrs. Laiwola Adedimeji for giving me all the opportunities they could afford to give and for several other things which they had done for me. Similarly, I want to thank my parents in-law, Mr. and Mrs. l.P.L Adebayo for their support, morally, financially VI and in other respects especially at such times when it seemed the work would never be completed. May the Almighty grant them long lives to reap the fruits of their labours. I want to also seize this opportunity to acknowledge the concems and prayers of my brothers and sisters, especially Toyin, Bimpe, Omolade, Olumide, who has since relocated to the United States and Oluwaseun, and most especially, that of my 'better half', Aderonke Adeola without whose support, encouragement and understanding, I may never have been able to complete the programme. I want to thanl<:. her for standing by me when it mattered most. Indeed, I am very grateful. I wish to also acknowledge, with thanks, the various contributions made by my teachers, senior colleagues and contemporaries here at Ibadan and at Ago -Iwoye. Indeed, their contributions and suggestions have gone a long way in ensuring the quality of the work that has beenLIBRARY produced. I will like to specially acknowledge Prof. Olayiwola Erinosho, an academic- "per excellence", my head of department at Ogun State University and a father in every sense of the word. Indeed, his life has been an excellent mode!, which I have found very rewarding to emulate. His concem in the progress of the work and anxiety about the completion of the programme served as morale boosters when the going was tough. The kindness of Dr. Uche Isiugo-Abanihe is also hereby acknowledged. At the initial stage of the report wiiting, his comments on the first draft were really very helpful. Others,CODESRIA whose worthy contributions are also duly acknowledged include these 'fine' academics: Prof.

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