KNOWLEDGE ON SEXUAL TRANSMITED DISEASE AMONG YOUTHS AGED 20-30
YEARS IN MWINGI CENTRAL WARD
JOHNSON KAMETA MUNYOKI
D/CM/17046/2003
DEPARTMENT OF CLINICAL MEDICINE
A RESEARCH REPORT SUBMITTED TO KENYA MEDICAL TRAINING COLLAGE
IN PARTIAL FULFILLMENT FOR THE AWARD OF A DIPLOMA IN CLINICAL
MEDICINE AND SURGERY.
JULY 2019
i
DECLARATION
This research report is my original work and has not been presented for any examination in any other institution
Signed: ______________________________ Date: ________________________
Johnson Munyoki Kameta
D/CM/17046/2003
Supervisor’s Approval
This research report has been submitted for review with my approval as College Supervisor
1 Signature: ____________
Date: ____________
Mrs. Eunice Kiema.
Department of Clinical Medicine.
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DEDICATION
This work is dedicated to my loving brothers and sister, Mr. Franklin Kameta, Jeff and Joy as well as the entire
family.
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ACKNOWLEDGMENT
My sincere gratitude goes to my supervisor Mrs. Eunice Kiema, tutor in Department of Clinical Medicine. KMTC Mwingi campus who contributed much towards the final success of this research.
Also I thank the staff in Mwingi Level IV hospital that willingly allowed me to carry out the activities in the
hospital and accepted to answer the questionnaires.
A lot of gratitude and appreciation also goes to my loving mum, my brothers and sisters for their contribution
towards financing this project.
The typist also deserves credit for his mastery handling of comprehensive operation. And above all the almighty
God for making this research a success.
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Table of Contents
COVER PAPER………………………………………………………………………………….1
DECLARATION………………………………………………………………………………...2
DEDICATION…………………………………………………………………………………...3
ACKNOWLEDGMENT…………………………………………………………………………4
ABBREVATIONS AND ACRONYMS…………………………………………………………5
DEFINATION OF TERMS……………………………………………………………………..6
ABSTRACT………………………………………………………………………………….........7
DEFINITION OF TERMS. .................................................................................................................................. 8
ABSTRACT............................................................................................................................................................ 9
CHAPTER ONE; INTRODUCTION ................................................................................................................ 10
1.1 Background to the Study ............................................................................................................................. 10
1.2 Problem Statement ....................................................................................................................................... 11
1.3. Study Justification ...................................................................................................................................... 11
1.4. Research Questions ..................................................................................................................................... 11
1.5.1 Broad Objective ........................................................................................................................................ 11
1.5.2Specific Objectives .................................................................................................................................... 12
CHAPTER TWO; LITERATURE REVIEW ........................................................................................................ 13
2.1 Behavioral Factors ....................................................................................................................................... 13
2.2. Relationship between Alcohol Consumption and STIs .............................................................................. 13
2.3. Sexual Abuse and Violence ........................................................................................................................ 15
2.4. Homeless Persons ....................................................................................................................................... 16
2.5. Substance Use ............................................................................................................................................. 16
CHAPTER THREE; MATERIALS AND METHODS ................................................................................... 18
3.1 Study Design ................................................................................................................................................ 18
3.2. Study Area .................................................................................................................................................. 18
3.3 Study Population .......................................................................................................................................... 18
3.3.1 Inclusion and exclusion criteria ................................................................................................................ 18
Table 3.1 Summaries of the Inclusion and Exclusion Criteria .......................................................................... 19
3.4. Variables ..................................................................................................................................................... 19
3.4.1. Dependent variable (s) ............................................................................................................................. 19
3.4.2. Independent variables .............................................................................................................................. 20
3.5. Sampling Techniques for Subject Who Pass the Selection Criteria (inclusion and exclusion).................. 20
3.6. Sample Size Determination ........................................................................................................................ 20
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3.7 Developments of Data Collection Tool/ Instrument .................................................................................... 21
3.10 Validity ...................................................................................................................................................... 21
3.12 Data Analysis Techniques ......................................................................................................................... 22
3.13 Ethical considerations ................................................................................................................................ 22
CHAPTER FOUR; RESULTS ........................................................................................................................... 23
4.1 Introduction.................................................................................................................................................. 23
4.2 Background information .............................................................................................................................. 23
4.2.1 Gender of respondents .......................................................................................................................... 23
4.2.2 Age of the respondent ........................................................................................................................... 23
4.2.3 Level of education ................................................................................................................................ 24
4.2.4 Marital status ........................................................................................................................................ 24
Figure 1.4 marital status ................................................................................................................................ 24
4.2.5 Occupation ............................................................................................................................................ 25
4.2.5 Religion................................................................................................................................................. 25
4.3.0 Knowledge ................................................................................................................................................ 26
4.3.1 Level of awareness ............................................................................................................................... 26
4.3.2 Most common STI ................................................................................................................................ 26
CHAPTER FIVE: DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS. ................................ 33
REFERENCES .................................................................................................................................................... 36
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ABBREVIATIONS AND ACRONYMS
STIs:
sexual transmited infection
WHO:
World Health Organization
HIV:
Human immunodeficiency virus
AIDS:
Acquired immunodeficiency sydrome
STD:
Sexual Transmited Diseases
PID:
Pelve Inflammatory Diseases
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DEFINITION OF TERMS.
Age:
Refers to number of years lived by a respondent
Condom:
It is a protective device made of latex and is used as contraceptive method
Ectopic pregnancy:
It is type of pregnancy in which implantation takes place before uterus
Gonorrhea:
It is an infection caused by bacteria Neisseria gonorrhea
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ABSTRACT
The study provides comprehensive information regarding the knowledge of sexually transmitted diseases among
the youths living in Mwingi central ward. To achieve, the set objective, the overall research has been divided into
five distinct parts which include the introduction, literature review, research methodology, findings or the results,
discussions and conclusions. In the first section, the introduction, detailed background information regarding the
prevalence of STIs among the youths in Mwingi central ward as well as the study objectives has been presented.
Besides, the literature review section has provided detailed information from the previous studies concerning the
predisposing factors to spread of STIs among youths aged 20-30 years in the specified location. In this context,
such factors as behavioral, homelessness and drug abuse have clearly been presented and covered in this section,
literature review. Moreover, the methodological section provides all methods and techniques used in gathering
information related to the selected topic. Some of the typical methods used include and not limit to interviews and
sampling techniques. Furthermore, the research has provided well analyzed data regarding the prevalence and
spread of STIs among the youths aged 20-30 years in Mwingi central ward. Consequently, discussions and
conclusions were formulated in this study based on the results or research findings.
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CHAPTER ONE; INTRODUCTION
1.1 Background to the Study
The overall study focuses on the sexual transmitted diseases such as genital herpes, chlamydia trachomatis,
gonorrhea, and syphilis and trachomatis, vaginitis. In the contemporary society, sexually transmitted diseases
have constantly been causing indisposition among the middle adolescents with a variety of effects. Evidence from
multiple systematic reviews and cohort studies has proven that the STIs have long-lasting consequences which
include cervical cancer, pelvic inflammatory disease, abnormal vaginal bleed, infertility, ectopic pregnancy and
tubal blockage among woman. Besides, according to World Health Organization’s report prepared in 2010, it is
evidential that the youths, regardless of their demographics, are susceptible to the spread of sexually transmitted
diseases. In this context, the underlying literature pieces have highlighted combination of such predisposing
factors as cognitive, social-cultural, early coitus and biological aspects to mainly expose adolescents into high
risk of getting STIs. In the context of Mwingi Central Ward, Studies show that1/8 of women of reproductive age
have different types of STIs. Besides, according to Kitui county health survey (2015), the majorities of youths
have multiple partners and rarely uses condoms. Similarly, it was recorded that a third of youths had used condoms
in their previous sexual activities and STIs infected them. Such means that there is in adequate information
regarding the appropriate of condoms and other STIs prevention methods, particularly, during sexual intercourse.
Therefore, it is advisable to pinpoint and create public awareness about the factors associated with such infections.
Complementarily, adolescents who do not use condoms during sexual intercourse are also contributing to the
rapid spread of herpes simplex virus and human papilloma virus among other youths. According to the current
research contacted at Mwingi sub county 2016 on family and peer level, it is patent that having an old sexual
partner and low family communication level is also related to the spread of sexually transmitted diseases.
Moreover, despite the intensive researches conducted in the several parts Kitui County concerning the causes of
sexually transmitted infections, little has been discovered about the factors leading to spread of STDs among
youth. According to the current recorded reports, some of the factors that encourage spreading of STIs include
drug and alcohol consumption before sex, primary age at initiation of sexual practices and being in erotic affairs
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with several partners whom you engage in sexual intercourse. Therefore, with this background information
regarding the subject matter, this study has been set to form an integral part of the underlying literature on broad
topic centered on the socioeconomic, behavioral and related determinants that facilitate the spread of STIs among
youths aged 20-30 years, particularly in Mwingi central ward.
1.2 Problem Statement
Today, different regions across the country and Mwingi central ward, in particular, have been continuously facing
multiple instances of STIs, particularly, to young individuals aged 20-30 years. Therefore, if this problem is
ignored, the nation will eventually direct more resources to handle the cascading problem and increased mortality
rates among the youths will also be evidenced.
1.3. Study Justification
The purpose of this research was centered on the determination of socioeconomic, behavioral and other related
determinants that primarily facilitate the spread of STIs among the youth (20-30) years. Therefore, this study was
justified because it sought to create public awareness regarding the trends in the spread among youths in Mwingi
central ward and offer suitable recommendation to reduce the alarming rates of STI spread in the aforementioned
region.
1.4. Research Questions
1. What are the critical predisposing factors to spread of STIs among the youth aged 20-30
years?
2. What are the primary causes of the increased prevalence of STIs among the youth?
3. What are the major types of STIs affecting youths across the Mwingi central ward?
4. What are some of the clinical interventions which should be adopted to mitigate the risk of STIs attack
among the residents of Mwingi central ward?
5. What are the clinical features that present with sexual transmitted infection?
1.5 Objectives
1.5.1 Broad Objective
To determine the commonest STIs among youths in Mwingi central Ward
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1.5.2Specific Objectives
1. To determine the socioeconomic factors influencing STIs spread.
2. To determine the complications associated with STIs among the youths (20-30) years.
3. To determine the ratio of STIs among the female and men of age 20-30 years in the selected region
4. To identify the behavioral factors that primarily contributes to the spread of STIs across the country and
Mwingi in Mwingi central ward in specific.
5. To determine the common STIs affecting the youth aged 20-30 years
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CHAPTER TWO; LITERATURE REVIEW
2.1 Behavioral Factors
This chapter conducted a detailed review of the previous literature pieces on the selected topic; factors
contributing to STIs Spread among youths aged 20-30years in Mwingi Central Ward. In this context, a variety of
academic articles were obtained from credible sources and used to acknowledge their contribution in the chosen
research topic. For instance, according to Harling et al. (2013), there is considerable evidence that both the racial
and ethnic factors actively participate in patterning sexually transmitted infections in different regions of the
country (MacDonald, 2016). Based on the study, the scholars articulate that STIs diagnosis is independently
associated with the ethnic identity of people with low income. Similarly, the negative gradient of the STIs risk of
infection is practically associated with increasing levels of income within all racial/ethnic categories in the
country. Besides, Letamo, &Bainame, (2017) present such social factors as multi-partnered sexual relationships
among youths have been continuously influencing the spread of a variety of sexually transmitted diseases. Further,
the two authors reveal that search of partners and increased instances of sexual activities are among the active
social factors which pose increased prevalence of STIs among the youth. MacDonald, (2016) further discloses
that spread of HIV/ AIDs and other principal STIs is typically associated with social factors such as the position
of women in the society, particularly, their lack of power in negotiating sexual relations, cultural attitudes towards
the issue of fertility and social migration patterns. Moreover, the ministry of health, it is self-evident that more
than 65% of people aged between 20-30 years often engage themselves in unprotected sexual intercourse and this,
in turn, predisposes them to higher risk of being infected by sexually transmitted diseases. Further evidence from
this study indicates that one in every five sexually active teens have more than four sexual partners and this trend
significantly increases after a completion of high school studies.
2.2. Relationship between Alcohol Consumption and STIs
Although some studies have failed to find a correlation between alcohol use and unprotected heterosexual
intercourse (Chersich,.Luchters, Malonza, Mwarogo, King'Ola, & Temmerman,2017) most studies show that both
average and extreme alcohol use are associated with greater risk of STDs. From 2015 to 2018, 2,896 young adults
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completed the General Social Survey in Mwingi central ward and respondents who reported that they sometimes
drink ''more than they should" were more likely to have had the following three outcome variables compared to
those who did not: sexual intercourse with two or more partners, intercourse with five or more partners, and
intercourse with a stranger in the past year. A household survey in all areas across Mwingi central ward showed
that having ever had an STD was associated with non-monogamous behavior characterized by; having more than
five sex partners in the last five years; and, at a minimum with, three kinds of drinking behavior: going to a bar at
least monthly, getting drunk at least annually, and having five or more drinks at one sitting in the last year (Fisher,
Bang, &Kapiga, 2017). In addition, a large nationwide survey in 2014 showed that persons who occasionally
drank five or more drinks at one sitting were significantly more likely to have multiple partners, be no
monogamous, and participate in other high-risk sexual activities (Chersich,.Luchters, Malonza, Mwarogo,
King'Ola, &Temmerman,2017).
A number of studies have reported that for men who have sex while under alcohol influence stand a high risk for
relapsing into unsafe sexual behaviors (Fisher, Bang, &Kapiga, 2017). Alcohol use among adolescents and young
adults (20-30 years) has also been found to be associated with high-risk sexual behaviors which, in turn predispose
them to higher chances of contrasting sexually transmitted diseases (Fisher, Bang, &Kapiga, 2017;
Chersich,.Luchters, Malonza, Mwarogo, King'Ola, & Temmerman,2017). In addition, alcohol use has been found
to be a risk factor for HIV-related sexual behviors among runaway youth (Luchters, Geibel,Syengo, Lango,
King'ola, Temmerman, &Chersich, 2011), the mentally ill (MacDonald, 2016), and sero-negative female partners
of HIV-seropositive men. In aa survey of attendees at an STD clinic, drug and alcohol use was found to correlate
with unprotected sex during their most recent sexual intercourse (Fisher, Bang, &Kapiga, 2017). In a multiple
logistic regression analysis controlling for age, race, income, number of sex partners, and other variables, failure
to use condoms was significantly associated with drug and alcohol use at the last sexual encounter for adolescents
and young adults in the selected region.
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2.3. Sexual Abuse and Violence
Sexual violence against women and sexual abuse of children in Mwingi central ward are societal problems of
enormous consequences (Barnett, Miller-Perrin, & Perrin, 2015; Cohen et al., 2013). In this context, Barnett,
Miller-Perrin, & Perrin, 2015 articulated that Approximately 70 women were raped annually in 2012-2014 in
Mwingi central ward. Other studies indicated that approximately one in three young girls and one in six young
boys may experience at least one sexually abusive episode by the time they reach adulthood in Kenya (Barnett,
Miller-Perrin, & Perrin, 2015; Herrera, &skey, 2014). Women who have been sexually abused during childhood
are twice as likely to have gynecological problems, including STDs, compared to women who do not have such
a history (Herrera, & McCloskey, 2014; Gelles, & Straus, 2016). In addition, women with a history of involuntary
sexual intercourse in the selected region (Mwingi central ward) are more likely to have voluntary intercourse at
an earlier age (a risk factor for STDs) and to have subsequent psychological problems (Gelles, & Straus, 2016).
Transmission of STDs as the result of sexual abuse is particularly salient among prepubescent children and young
adults. STDs among children presenting for care after the neonatal period almost always indicated sexual abuse
(Gelles, & Straus, 2016). Sexually abused children been proven to have severe and long-lasting psychological
consequences, may become sexual abusers themselves, and may abuse children (Gelles, & Straus, 2016). In
addition, they may engage in a pattern of high-risk behavior that often puts them at risk for further abuse and
subsequent STDs. Guidelines for the clinical management of children with STDs as a result of suspected abuse
have been published (Cohen, Deamant, Barkan, Richardson, Young, Holman, &Melnick, 2013).
Many young (20-30 years) women who are subjected to sexual violence may not be able to implement practices
to protect against STDs or pregnancy (Cohen et al., 2013). A phenomenon that also may impede protective
behaviors among women is the pairing of older men with young women. The age discrepancy between older men
and younger, sometimes adolescent, females may predispose to power imbalances in the relationship, thus
increasing the potential for involuntary intercourse, lack of protective behavior, and exposure to STDs (Cohen et
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al., 2013). In addition, early initiation of sexual intercourse among adolescent males with an older female partner
has been shown to increase the number of sex partners later in life (Gelles, & Straus, 2016; Cohen et al., 2013).
2.4. Homeless Persons
Estimates of the number of runaway, homeless adolescents and young adults in Mwingi central ward vary from
20 to 80 people (Noell, Rohde, POchs, Yovanoff, Alter, Schmid, & Black, 2017; Meade, 2016). Evidence from
multiple studies indicated that Adolescents living on the streets of Mwingi central ward are at risk for many health
problems, including STDs (Meade, 2016). One study showed that approximately one-third of runaways in Mwingi
central ward facilities had an STD at the time of detention (Noell, Rohde, POchs, Yovanoff, Alter, Schmid, &
Black, 2017). Runaways and homeless adolescents are at increased risk for STDs because they tend to be more
sexually active than other adolescents (Noellet al, 2017); have multiple high-risk sexual behaviors that include
trading sex for drugs or money (Wenzel, 2017); have high levels of substance use (Noellet al, 2017; Wenzel,
2017; Meade, 2016) have multiple high-risk sexual behaviors that include trading sex for drugs or money (Meade,
2016); and are frequently sexually and physically abused by others (Meade, 2016). A survey of the nation
regarding pregnancy prevention and family planning policy found that two counties out of 47 had a written policy
on sexuality education for youths and young adults in out-of-home care (i.e., family foster care, group homes, and
residential care) (Meade, 2016). Therefore, this is a clear indication that there are minimal efforts taken by the
county governments in Kenya to control spread of STIs across the country.
STDs are also a major problem among homeless adults. For example, a study of homeless women in Kitui County
that sought gynecological care revealed that 26 percent had trichomoniasis, 6 percent had gonorrhea, and 5 percent
had pelvic inflammatory disease (Meade, 2016). Another study of homeless persons in the central region of Kenya
disclosed that 8 percent of men and 11 percent of women had positive gonorrhea or syphilis tests and nearly onethird reported a prior STD (Meade, 2016;Noellet al, 2017).
2.5. Substance Use
According to (Meade, 2016;Noellet al, 2017), Substance use, especially drugs and alcohol, is associated with
STDs at both population and individual levels and therefore, the residents of Mwingi central ward are not an
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exception. Based on the population level, evidence showed that rates of STDs are high in geographic areas where
rates of substance use are also high and rates of substance use and STDs have also been shown to co-vary
temporally (Barnett, Miller-Perrin, L., & Perrin, 2015). At the individual level, persons who use substances are
more likely to acquire STDs (Barnett, Miller-Perrin, L., & Perrin, 2015;Meade, 2016). There are several possible
reasons for this association. One is that underlying social and individual factors lead both to higher rates of STDs
and to greater use of substances. Social factors such as poverty, lack of economic and educational opportunities,
and weak community infrastructure may contribute to both outcomes (Meade, 2016). Individual factors, such as
risk-taking and low self-efficacy, similarly contributed to both outcomes.
Use of substances may also directly contribute to risk of STD infection by undermining an individual's cognitive
and social skills, thus making it more difficult to take actions needed to protect themselves against STDs. For
example, at low doses cocaine can decrease inhibitions and heighten sexuality, leading to increased numbers of
sexual encounters and partners and to increased high-risk sexual behaviors (Harling, Subramanian, Bärnighausen,
&Kawachi, 2013). In addition, drug users are at greater risk for STDs as a result of the practice of trading sex for
drugs; in these situations, drug users have a large number of high-risk partners (Harling, Subramanian,
Bärnighausen, &Kawachi, 2013). Those who are involved in frequent and sustained use of substances are most
likely to be at risk for STDs.
Data from the National Household Survey on Drug Abuse indicated that, in 1994, approximately 54 percent of
Kitui county population age 12 and over and 63 percent of those age 18-25 used alcohol in the prior month
(Harling, Subramanian, Bärnighausen, &Kawachi, 2013; Meade, 2016). In addition, approximately 6 percent of
the U.S. population used an illicit drug in the prior month, and there were approximately 500,000 crack cocaine
users during the year.
To illustrate the broad impact of substance, use on STD transmission, the committee focused on the association
of STDs with use of two substances: crack cocaine, often used by disenfranchised groups, and alcohol, which is
commonly used by most residents of Kitui especially adolescents. In the following sections, the committee
describes the evidence for the association between substance use/abuse and STDs.
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CHAPTER THREE; MATERIALS AND METHODS
3.1 Study Design
During the research, a non-experimental research design was erected to examine the combination of factors which
predispose the spread of STIs across Mwingi central ward. In this research, qualitative research methods were
employed to aid in investigating the prevalence of STIs among the youth aged 20-30 years as well as the allied
elements of the chosen topic. The reason behind the selection of the non-experimental research design (fairly
descriptive) is because this type of approach requires minimal resources, time and it is less complex since the
researcher does not require to prove the correlation between variables (dependent and independent).
3.2. Study Area
The actual study was conducted in Mwingi central ward, Kitui County. Multiple factors contributed towards the
selection of the aforementioned location to conduct a study on the selected topic. For instance, evidence there is
little literature concerning factors influencing spread of STIs among the young adults (20-30) years in the region.
Besides, due to the fact that the region is geographically located near my home place, it was seen to be more
suitable for study since minimal resources was demanded to facilitate the entire study.
3.3 Study Population
The target population for this study will be young adults aged between 20-30 years and who are currently residing
Mwingi central ward. In this context, patients within the quoted age brackets (20-30) years admitted in health
centers within the selected geographical area were included in the target population.
3.3.1 Inclusion and exclusion criteria
In clinical trials and any other medical oriented research, scholars often specified both the inclusion and exclusion
criteria for participation in the study. By definition, the inclusion criteria refer to the characteristics that the
prospective subjects must have if they are to be included in the study, while exclusion criteria are those
characteristics that disqualify prospective subjects from inclusion in the study. In this sense, inclusion and
exclusion criteria are usually written in a positive way: if a participant has inclusion criteria, they are in; if they
18
have exclusion criteria, they are out. Inclusion and exclusion criteria may include factors such
as age, sex, race, ethnicity, type and stage of disease, the subject’s previous treatment history, and the presence or
absence (as in the case of the “healthy” or “control” subject) of other medical, psychosocial, or emotional
conditions. With this general information regarding the concept of inclusion and exclusion, this table summarizes
the criteria that were used to select the target study population.
Table 3.1 Summaries of the Inclusion and Exclusion Criteria
Inclusion
Exclusion
People aged between 20-30 years
People between 1-24 years and those above
30yrs
Ethnic groups living within Mwingi central Ethnic groups living outside Mwingi central
ward within the above age group
ward will be excluded from the study
People with past history of STIs will be
People who have had no past history of STIs
included in the study
will be included
Regular alcohol drinkers within the region will Non-substance abusers will be excluded from
be included to test their correlation with STIs the study
prevalence
3.4. Variables
3.4.1. Dependent variable (s)
In scientific works, a dependent variable is what is measured in the experiment and what is affected during the
experiment. The dependent variable responds to the independent variable. The variable is referred to as dependent
because it "depends" on the independent variable. In the project study, for instance, age and geographical location
will be included as the dependent variables.
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3.4.2. Independent variables
The independent variables constitute of those elements which can be changed or controlled in a given model or
equation. They provide the "input" which is modified by the model to change the "output." In the projected study,
the combination of factors predisposing the prevalence of STIs was included as the independent variables since
they were modified in the study.
3.5. Sampling Techniques for Subject Who Pass the Selection Criteria (inclusion and exclusion)
Sampling helped a lot in research. It is one of the most important factors which determined the accuracy of your
research/survey result. If anything went wrong with your sample, then it was directly reflected in the final result.
To attain accuracy in the end results of the study, multiple sampling techniques under the two broad categories;
probability and non-probability were adopted to enhance efficient data collection process in Mwingi central ward.
Based on the category of probability sampling, such techniques as simple random sampling, stratified sampling,
systematic sampling and multi-stage sampling were adopted with the central objective of making comparisons of
the data collected. In the context of non-probability sampling, two major techniques; convenience sampling and
purposive sampling wee jointly adopted to facilitate the process of data collection.
3.6. Sample Size Determination
Before the adoption of the universal formula for determining the sample size, certain steps and procedure were
followed in order to arrive at the most convenient Z-score. The first step centered on the determination of the
population size. For instance, since the study focused on youths aged between 20-30 years, the study population
size was the total number of young adults aged 20-30 years in Mwingi central ward. Upon determination of
pollution size, the margin of error often referred to as confidence interval was put into consideration. Since no
sample population which is perfect, the study decided on how much error to allow. This step was critical since it
determined how much higher of lower than the population mean our research will be willing to let the sample
mean to fall. For example, it looked something like this: “68% of participants said yes to Proposition Z, with a
margin of error of +/- 5%.” Further, before determination of sample size, the study confidence level was allowed
the actual mean to fall at 95% confidence level. Finally, the standard deviation, which defined the confidence that
a research expected from his or her respondents, was also determined in the actual research. Upon the completion
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of the aforementioned steps, the universal formula sample size determination was consulted in order to obtain the
most accurate and suitable sample size for the research.
3.7 Developments of Data Collection Tool/ Instrument
This section concerned with the development of the tools and instruments which were used to collect data related
to the selected topic. In this context, such tools as case studies, one on one interviews, observation field surveys
and questionnaires were jointly used to collect adequate information regarding the key factors predisposing the
prevalence of STIs among the youths aged between 20-30 years. To complement the primary tools and
instruments, peer-reviewed journals and government-based data base were further consulted to provide the
inclusive information regarding the study topic.
3.8 data collection process
Pretesting was contacted before the actual data collection
3.9 Pretesting and piloting
A pilot study was conducted at Mwingi central ward. The research instruments were piloted on a small
representative sample identical to but not including the group that was in the actual study. It involved 20 youths
randomly selected, approached and interviewed. These responded was included in the actual research sample size.
The pretest enabled me to check whether the items are valid and reliable and also correct perfunctory problem
correct misunderstanding, to check language level, eliminate ambiguity at the right time and misinterpretation of
the collected data.
3.10 Validity
Data was gathered from the 354 households for a period of two weeks. Two research assistants helped in data
collection after training for two days. The training sessions involved briefing on the purpose of the study, meaning
of terms used in the study and the importance of maintaining ethical standards when collecting data from the
respondents.
3.11 Reliability
21
The researcher and assistants paid a visit to the homestead and before requested the household head to confirm
the convenient time and date for the interview and completion of the questionnaire. At the appointed time, the
questionnaire was administered. The assistants were hired from the community so as to reduce suspicion and cater
for the communication barriers.
3.12 Data Analysis Techniques
The results obtained from interviews, sampling techniques, questionnaires, online journals, literature review and
theoretical models were combined and interpreted using such techniques as the use of computers and
experimentation. The results obtained were therefore, used to formulate the possible clinical interventions to
mitigate the risk of STIs attack among the youths
Further, the collected questionnaires were first examined by the researcher to confirm completeness and
consistency. The collected data was then coded to facilitate the grouping of the data into categories. Quantitative
data was analyzed with the help of electronic spreadsheet SPSS Program Version 21.0 while qualitative data was
analyzed thematically.
The analyzed data was then presented in frequency distribution tables for ease of understanding and analysis.
Descriptive statistics such as percentages was used to analyze the demographic characteristics, level of education
and economic factors as well as level of awareness their influence on uptake of health insurance. Cross-tabulation
was used to assess the relationship between the various independent variables and uptake of health insurance.
3.13 Ethical considerations
The respondents were not coerced into participating in the research. The purpose of the study was explained to
each household head. The respondents were also assured of confidentiality and that the information obtained
from them was used for the purposes of study only.
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CHAPTER FOUR; RESULTS
4.1 Introduction
The main objective of the study was to determine the commonest STIs among youths in Mwingi central Ward
4.2 Background information
4.2.1 Gender of respondents
Figure 1.0 Gender of the respondent.
male
female
Majority of the responders were women 64:36 females: male.
4.2.2 Age of the respondent
Figure 1.2 Age of the respondent
Age in years
Number
Percentage (%)
23
20-22
15
15%
23-24
12
12%
25-26
20
20%
27-28
28
28%
29-30
25
25%
Total
100
100%
Most of the responders were aged between 27-28 years and the least were aged between 23-24 years.
4.2.3 Level of education
Figure 1.3 Level of education
level of education
50
45
40
35
30
25
20
15
10
5
0
none
primary
secondary
tertiary
level of education
According to the data, 45% of respondents attained their secondary education while 25% of the respondents
attained primary education. The tertiary level was represented by 27% the rest of respondents did not attain any
education and was represented by 3%.
4.2.4 Marital status
Figure 1.4 marital status
24
70
60
50
40
30
20
10
0
single
married
single
married
divorced
divorced
window
window
windower
windower
From the collected data 72% of the respondents were married, 10% were single, 8% window, 6% divorced
and 4% were widower.
4.2.5 Occupation
Figure 1.5 Occupation
occupation
number
Percentage
Employed
41
41%
Casual
45
45%
others
14
14%
Total
100
100%
The data above in the table represented the occupational status in the population 41% of the population were
employed, 45% were casual and 14% were other occupation that they did not specify.
4.2.5 Religion
Figure 1.6 Religion
25
religion
80
70
60
50
40
30
20
10
0
christian
muslim
others
religion
Majority of respondent were Christian with 76% in the population, 22% were Muslim and 2% were others.
4.3.0 Knowledge
4.3.1 Level of awareness
Figure 1.7 Level of awareness
yes
no
According to the collected data 97% of the population had heard about sexual transmitted infection and 3%
had no idea about the disease.
4.3.2 Most common STI
Figure 1.8 Most common STI
26
45
40
35
30
25
20
15
10
5
0
gonorrhea
gonorrhea
chlymidia t. vagnalis
trichomatis
chlymidia trichomatis
genital
herpes
t. vagnalis
others
genital herpes
syphils
others
syphils
Gonorrhea remained to be arming disease in the population with highest percentage of 36%, chlamydia 25%,
trachomatis vaginitis 15%, syphilis 9%, genital herpes 3% and others had 12%.
4.3.3 Effects of sexual transmitted infection
Figure 1.9 Effects of sexual transmitted infection
yes
no
Majority of respondent agreed that they suffer fulminant effects post STIs. This was reflected from the
collected data with highest percentage of 96% while 4% said they never suffer any effects.
4.3.4 Common effects
Figure 1.10 Common effects
27
30
25
20
15
10
5
0
infertility
family
school abnormal ulceration discharge
break ups drop out bleeding of genitals
of the
genitals
others
The graph above represents the effects that affect the population. Family break ups occupied the highest
percentage of 28%, abnormal bleeding of the genital 20%, school dropout 13%, discharge 8%, ulceration of
the genital 6%, infertility 21% and others 4%.
4.4.0 BEHEVIOUR
4.4.1 Ever had sex
Figure 1.11 Ever had sex
yes
no
According to the collected data 96% had engaged in sexual activity while 4% had not.
4.4.2 How often per week
Figure 1.12 How often per week.
28
25
20
15
10
5
0
once
twice
thrice
qountry
others
Majority of respondent had sex twice per week with highest percentage of 22%, 20% had thrice per week,
18% had once per week, 15% had quandary per week and 5% represented others.
4.4.3 Ever used protective measures during sexual intercourse
Figure 1.13 ever used protective measures during sexual intercourse.
yes
no
Majority of the population use protective measures during sexual activity which represented by 51% of the
collected data. 49% of the population never use any protective measures.
4.4.4 If YES Ever suffered any sexually transmitted infection after having saver sex.
Figure 1.14 Ever suffered any sexually transmitted infection after having saver sex
29
yes
no
87% of the population suffered sexual transmitted infection even after using protective measures while 13%
did not become infected.
4.4.5 The type of sexually transmitted infection did you suffer.
Figure 1.15 the type of sexually transmitted infection did you suffer.
12
10
8
6
4
2
0
syphilis
chlymidia
genita herpes
gonorrhea
others
Gonorrhea affected the highest population with a percentage of 10%, chlamydia 4%, syphilis 2%, genital
herpes 1% and others 3%.
4.5.0 ATTITUDE
4.5.1 Major problem in sexually transmitted infection (STIs)
Figure 1.16 major problem in sexually transmitted infection (STIs)
30
yes
no
Majority of the respondent (82%) stated that sexual transmitted infection is a great problem in the society
while 18% stated that the infection is not a great problem.
4.5.2 Important of educating youths about sexually transmitted infection (STIs).
Figure 1.17 Important of educating youths about sexually transmitted infection (STIs)
yes
no
According to the data 94% of the respondent agreed that there is need to offer education to the youth regarding
sexual transmitted infection. While a small population of 6% disagreed.
4.5.3 The main cause of sexually transmitted infection (STIs)
Figure 1.18 the main cause of sexually transmitted infection.
31
40
35
30
25
20
15
10
5
0
lack of faithfulness
lack of protective
measures
many partners
others
In regard to causes, 34% of respondent stated that lack of faithfulness among the partners as the main cause
of sexual transmitted infection. 23% put their focus on lack of protective measures, 13% stated many partners
as a cause while other (30%) focused on other causes of STIs.
32
CHAPTER FIVE: DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS.
5.1 Discussion
According to the data that was collected during the research has been proven that the spread of the
STDs is at its high pick among the different groups who have been detailed to be careless with their
life in terms of the sexual behaviors. For instance, the issued questionnaires proved that the youths
are adversely affected by these infections since they are influenced by their peers to engage into weird
behaviors which in turn contribute to them being infected with the STDs. In the same context, studies
based on the research topic have shown that women who have been sexually abused during childhood
are twice as likely to have gynecological problems, including STDs, compared to women who do not
have such a history.
Additionally, according to the gathered data it is evident that many young (20-30 years) women who
are subjected to sexual violence may not be able to implement practices to protect against STDs or
pregnancy and thus, at a greater risk of being infected. Further, it has been found that runaways and
homeless adolescents are at increased risk for STDs because they tend to be more sexually active than
other adolescents. Similarly, the gathered information proved that such homeless persons in the central
region of Kenya disclosed that 8 percent of men and 11 percent of women had positive gonorrhea or
syphilis tests and nearly one-third reported a prior STD. Moreover, according to this research it is
evident that use of substances may also directly contribute to risk of STD infection by undermining
an individual's cognitive and social skills, thus making it more difficult to take actions needed to
protect themselves against STDs. Also collected data show that use of substances may also directly
contribute to risk of STD infection by undermining an individual's cognitive and social skills, thus
making it more difficult to take actions needed to protect themselves against STDs. The results from
the literature review and the population samples show that racial and ethnic factors actively participate
in patterning sexually transmitted infections in different regions of the country (MacDonald, 2016).
33
Besides, evidence shows that STIs diagnosis is independently associated with the ethnic identity of
people with low income. Moreover, multi-partnered sexual relationships among youths do often
influence the spread of a variety of sexually transmitted diseases. In the similar context, search of
partners and increased instances of sexual activities pose increased prevalence of STIs among the
youth. The review of literature also indicated that the spread of HIV/ AIDs and other principal STIs
are directly associated with social factors such as the position of women in the society. In the similar
context, more than 49% of people aged between 20-30 years often engage themselves in unprotected
sexual intercourse and this, in turn, predisposes them to higher risk of being infected by sexually
transmitted diseases. Furthermore, the results from interviews and population samples indicates that
one in every five sexually active teens have more than four sexual partners and this trend significantly
increases after a completion of high school studies.
5.2 Conclusion
The results obtained were in turn, used to formulate discussions related to the possible measures that
should be erected to control the spread of STIs among the youth aged 20-30 years. Based on the
information gathered in the overall research, a global study conclusion constructed centered on results
obtained after employing different study approaches to the audience of Mwingi central ward. For
instance, inspired by this information that partners who are not faithful are prone to these infection, it
is recommendable that the count government of Kitui to establish measures that should be taken on
those people who are married in this groups. In the same context, this administration should also set
rules that will govern the operation of such set measures to ensure that those overlook them and go
ahead to abuse young girls and women are reprimanded accordingly.
Furthermore, youths should watch over their behaviors and have boundaries with their peers to avoid
being influenced to engage into awkward conducts that can lead them to STDs.In the same setting they
have to be enlightened on the negative impacts of such influences from their peers so that they can get
the sense of avoiding them particularly when they are making decisions based on the guidance. Arguing
34
based on the research results, the Kitui count government should also implement appropriate measures
to protect the homeless individuals who are spending
days and nights around the streets. The
administration should also come up with rules that regulate the use of substances that has highly
contributed to increase spread of STDs.
5.3 Recommendation
1. More health education by the government and Non-Governmental Organizations through behavior
change campaigns aimed at educating youth against sexual habits and how to choose good friends.
2. Youths should be encouraged not to emulate others and not to allow emotions to rule over them.
3. The government should create more job opportunities to avoid idleness which predispose youth
towards sexual habits as a source of capital.
4. There should be need to restrict advertisements of products and phonographic that canalizes the youth
toward the urge of sex.
5. Youths who are victims of STIs should be treated to minimize the complications
5.4 Further research
The research does not explain the time frame between the onset of signs and symptoms and the time of
complication to set in. Therefor more research need to be contacted to revel if there is specific time. Also
more research need to be based on the treatment of STIs to determine and rule out the apotheosis of
recurrence and resistance.
35
REFERENCES
Barnett, O., Miller-Perrin, C. L., & Perrin, R. D. (2015). Family violence across the lifespan: An introduction.
Sage Publications, Inc.
Chersich, M. F., Luchters, S. M. F., Malonza, I. M., Mwarogo, P., King'Ola, N., &Temmerman, M. (2007). Heavy
episodic drinking among Kenyan female sex workers is associated with unsafe sex, sexual violence and
sexually transmitted infections. International journal of STD & AIDS, 18(11), 764-769.
Cohen, M., Deamant, C., Barkan, S., Richardson, J., Young, M., Holman, S., ...&Melnick, S. (2013). Domestic
violence and childhood sexual abuse in HIV-infected women and women at risk for HIV. American journal of
public health, 90(4), 560.
Fisher, J. C., Bang, H., &Kapiga, S. H. (2017). The association between HIV infection and alcohol use: a
systematic review and meta-analysis of African studies. Sexually transmitted diseases, 34(11), 856-863.
Gelles, R. J., & Straus, M. A. (2016). Intimate violence.Simon& Schuster.
Harling, G., Subramanian, S. V., Bärnighausen, T., &Kawachi, I. (2013). Socioeconomic disparities in sexually
transmitted infections among young adults in the United States: examining the interaction between income
and race/ethnicity. Sexually transmitted diseases, 40(7), 575.
Herrera, V. M., & McCloskey, L. A. (2014). Sexual abuse, family violence, and female delinquency: Findings
from a longitudinal study. Violence and victims, 18(3), 319-334.
Kalichman, S. C., Simbayi, L. C., Kaufman, M., Cain, D., &Jooste, S. (2007). Alcohol use and sexual risks for
HIV/AIDS in sub-Saharan Africa: systematic review of empirical findings. Prevention science, 8(2), 141.
36
Letamo, G., &Bainame, K. (2017).The socio-economic and cultural context of the spread of HIV/AIDS in
Botswana. Health Transition Review, 7, 97-101.
Luchters, S., Geibel, S., Syengo, M., Lango, D., King'ola, N., Temmerman, M., &Chersich, M. F. (2011). Use of
AUDIT, and measures of drinking frequency and patterns to detect associations between alcohol and
sexual behaviour in male sex workers in Kenya. BMC public health, 11(1), 384.
MacDonald, D. S. (2016).Notes on the socio-economic and cultural factors influencing the transmission of HIV
in Botswana. Social science & medicine, 42(9), 1325-1333.
Retrieved from: http://htc.anu.edu.au/pdfs/Letamo1.pdf
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752095/
37
APPENDIX (I) INFORMED CONSEND
Date………………………….
Dear Sir/Madam,
RE: PERMISSION TO COLLECT DATA ON KNOWLEDGE ON SEXUAL TRANSMITED DISEASE
AMONG YOUTH AGED 20-30 YEARS IN MWINGI LAVEL (V) HOSPITAL
I am a student at Kenya medical training college Mwingi campus pursuing a Clinical Medicine, Surgery and
community Health course. I am currently requesting for permission to conduct a research study in the area referred
above.
I am kindly requesting for your participation in filling the questionnaires which will be private and confidential.
Your positive response will be highly appreciated.
Thanking you in advance.
Yours faithfully,
JOHNSON.M. KAMETA
38
II TOOL
A STUDY TO DETERMINE FACTORS CONTRIBUTING TO STIs SPREAD AMONG YOUTH AGED
BETWEEN 25-30 YEAR IN MWINGI CENTRAL WARD, KITUI COUNTY
INSTRUCTION
1.0 Do not write your name.
2.1 All information will be kept confidential.
3.2 please tick ( ) where applicable.
5.31 PART ONE: DEMOGRAPHIC INFORMATION
1.0 Gender of the respondent.
(a) Male
(b) Female
2.1 Age of the respondent…………….
3.2 Level of education
(a) None
(b) Primary
(c) Secondary
(d) Tertiary
4.3 marital status.
(a) Single
(b) Married
(c) Divorced
(d) Window
(e) Widower
39
5.4 Occupation
(a) Employed
(b) Casual employment
(c) Others
…………………………………………………………. (Specify)
6.5 Religion?
(a) Christian
(b) Muslim
(c) Others
…………………………………………………………………. (Specify)
5.3.2 PART TWO: KNOWLEDGE
7.6 Have you ever heard about sexually transmitted infection (STIs)?
(a) Yes
(b) No
8.7 If YES which is the mostly common sexually transmitted infection in this area?
(a) Gonorrhea
(b) Chlamydia trachomatis
(c) Trachomatis vaginitis
(d) Genital herpes
(e) Syphilis
(f) Others
………………………………………………………………………….. (Specify)
40
9.8 Are there any effects of sexual transmitted infection?
(a) Yes
(b) No
10.9 If YES what are the effects
(a) Infertility
(b) Family break up
(c) School drop out
(d) Abnormal bleeding of the genital
(e) Ulceration of the genital
(f) Discharge
(g) Other
………………………………………………………………………….. (Specify)
5.3.3 PART THREE: BEHEVIOUR
11.10 Have you ever had sex?
(a) Yes
(b) No
12.11 If YES how often per week
(a) Once
(b) Two times
(c) Three times
(d) Four times
Others
………………………………………………………………… (Specify)
13.12 Have you ever used protective measures during sexual intercourse?
(a) Yes
41
(b) No
14.13 If YES have you ever suffered any sexually transmitted infection after using?
(a) Yes
(b) No
15.14 If YES which type of sexually transmitted infection did you suffer?
(a) Syphilis
(b) Chlamydia trachomatis
(d) Genital herpes
(e) Other
………………………………………………………………….. (Specify)
5.3.4 PART FOUR: ATTITUDE
16.15 In your own opinion, do you think sexually transmitted infection (STIs) is a major problem in this area?
(a) Yes
(b) No
17.16 In your own opinion, is it important to educate youth about sexually transmitted infection (STIs)?
(a) Yes
(b) No
18.17 In your own opinion, what do you think is the main cause of sexually transmitted infection (STIs)?
(a) Lack of faithfulness among the partners
(b) Lack of protective measures
(c) Having many partners
(d) Others
……………………………………………………………………………….. (Specify)
42
III RESEARCH PERMIT
43
IV RESEARCH AUTHORIZATION
44
V STUDY AREA MAP
45