MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH And MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH Khonesavanh Inthavong THESIS TITLE Knowledge of safe sex and STIs among students at Vientiane High School, Vientiane Capital, 2019 MASTER OF PUBLIC HEALTH CODE: 8720701 HANOI-2019 MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH And MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH Khonesavanh Inthavong THESIS TITLE Knowledge of safe sex and STIs among students at Vientiane High School, Vientiane Capital, 2019 MASTER OF PUBLIC HEALTH CODE: 8720701 Supervisors: Dr.Vanphanom Sychareun, Dr. Le Thi Kim Anh, MD, PhD Dean, Faculty of Public Health Faculty of Fundamental Sciences Department of Biostatistics HANOI-2019 i ACKNOWLEDGEMENTS This independent study would not have been possible without the help and support of many people. I am very thankful to the Ministry of Health of the Lao PDR and LEARN project, the University of Health Sciences (UHS), the Hanoi University of Public Health (HUPH) for funding and support during my study at UHS in Laos and HUPH in Vietnam. The help of the Medical Products Supply center is also gratefully acknowledged for allowing me to study at UHS and HUPH.
My sincere and deep gratitude goes to my advisors Dr.Vanphanom Sychareun, PhD (Dean, Faculty of Public Health of Laos), Dr. Le Thi Hai Ha,PhD (Faculty of Social Sciences, Behavior and Health Education of Vietnam), and Dr. Le Thi Kim Anh, MD, PhD ( Faculty of Fundamental Sciences Department of Biostatistics) ( for their valuable advice, constant supervision and encouragement throughout a hard time when completing my dissertation. I would like to express my sincere gratitude to Dr.
Kongmany Chaleunvong for his kind suggestions and valuable comments on data analyses. I would like to acknowledge the valuable comments and encouragement from Prof. Bui Thi Thu Ha who was the examination chair of my Independent Study Committee. I wish to thank Assoc.
Vu Thi Hoang Lan, Dr. Visanou Hansana, who were members of the study committee. I am most grateful to the headmaster, teachers and students of Vientiane High School who kindly accepted to help and participate in this research. This study could not have been completed without their generous assistance.
I am grateful to all the lecturers, teachers, coordinators and all staff of the UHS and HUPH for their continuous assistance and helpful advice. I would like to thank my classmates for their kindness during the period of my studies at the UHS and HUPH. ii Finally, I would like to thank my family for their love, understanding, support, and encouragement during the time I studied at the UHS and HUPH. Khonesavanh Inthavong iii ABBREVIATIONS AND ACRONYMS AIDS Acquired Immune Deficiency Syndrome CSE Comprehensive Sexual Education HIV Human Immunodeficiency Virus HPV Human Papilloma Virus LSB Lao Statistics Bureau RMNCAH Reproductive, Maternal, Newborn, Child and Adolescent Health STIs Sexually Transmitted Infections STD Sexually Transmitted Disease SDGs Sustainable Development Goals SE Sexual Education SRH Sexual Reproductive Health WHO World Health Organization iv Contents List of Tables.
vi Chapter 1 LITERATURE REVIEW.1 Definition of safe sex and STIs .2 The consequences of unsafe sex and STIs .3 Sources of knowledge about safe sex and STIs .4 Situation for knowledge about safe sex among adolescents .5 Situation regarding a knowledge of STIs .6 Factors associated with knowledge of safe sex and STIs .7 Theoretical conceptual framework: .8 Conceptual framework of knowledge for safe sex and STIs in Vientiane High School. 27 Chapter 2 SUBJECTS AND METHODS.2 Setting and duration.6 Data collection method .8 Definitions, measurements and questionnaire concept .1 Socio-demographic characteristics of participants .2 Knowledge of participants about safe sex .3 The knowledge level for safe sex .4 The knowledge of participants about knowledge of STIs .5 The knowledge level of STIs .6 Communication about a knowledge of safe sex and STIs between students and family members/peers .7 Sexual education in the school.8 Mass media sources of information on family planning and STIs/HIV/AIDS. 49 Univariate analysis of factors associated with knowledge of safe sex and STIs using regression analysis .10 Association between demographic characteristics and family factors with knowledge of safe sex and STIs .11 Association between the communication of knowledge about safe sex and STIs with families and peers.12 Association between school factors with knowledge of safe sex and STIs .13 Association between accessibility to information resources from the mass media and a knowledge of safe sex and STIs .14 Association between religious factors associated with knowledge of safe sex and STIs .15 Multivariate logistic regression analysis of factors associated with students’ knowledge of safe sex and STIs. 60 Limitations and bias.
90 Annex 3: Adolescent Consent Form. 95 Annex 4: Parental/Legal Guardian Consent Form. 96 Annex 5: Lao ethical approval. 97 Annex 6: Vietnamese ethical approval.
98 Annex 7: Thesis comment. 99 Annex 8: Minutes of explanation. 109 vi List of Tables Table 2.1 The proportion of students and classrooms which were selected from each grade level .2 Socio-demographic background of students .3 Students’ knowledge of safe sex .4 Level of knowledge about safe sex .5 Knowledge of students about STIs .6 Level of knowledge among students about STIs .7 Communication about knowledge of safe sex and STIs between students and family members/peers during their school life .8 School factors related to sexual education .9 Mass media sources of family planning and STIs/HIV/AIDS information .11 Univariate logistic regression analysis associated with demographic and family structures linked with student knowledge of safe sex and STIs .12 Association between communication of knowledge about safe sex and STIs with family members and peers with knowledge of safe sex and STIs .13 Univariate logistic regression analysis of school factors associated with knowledge of safe sex and STIs .14 Univariate logistic regression analysis of resource factors from mass media associated with students’ knowledge of safe sex and STIs .15 Univariate logistic regression analysis of religious factors associated with knowledge of safe sex and STIs .16 Multivariate logistic regression analysis of the factors associated with knowledge of safe sex and STIs. 58 vii Independent Study Title Knowledge of safe sex and STIs among students at Vientiane High School, Vientiane Capital, 2019 Author Mrs.
Khonesavanh Inthavong Degree Master of Public Health Major Field/ Faculty/ University University of Health Sciences, Faculty of Public Health, and Hanoi University of Public Health Independent Study Advisor Dr.Vanhphanom Sychareun, PhD, Dean, Faculty of Public Health and Dr. Le Thi Ha Ha, PhD, Faculty of Social Sciences, Behavior and Health Education, and Dr. Le Thi Kim Anh, MD, PhD, Faculty of Fundamental Sciences Department of Biostatistics Academic Year 2018-2019 viii Executive summary Knowledge of safe sex and sexually transmitted infections (STIs) is of vital importance for adolescents because it serves as a protective factor helping to prevent unsafe sex, STIs and teenage pregnancies. Adolescents are at a high risk of a number of negative health consequences associated with early and unsafe sexual activities, including STIs, unintended pregnancies and teenage pregnancies.
Thus, knowledge of safe sex and STIs is necessary for adolescents to reduce their risky sexual behaviors and their negative consequences. The aim of this study is to describe the knowledge of safe sex and STIs among high school students at Vientiane High School, Vientiane Capital, and Lao PDR and to identify related factors associated with acquiring knowledge of safe sex and STIs among high school students. The design of this study was analytical cross-sectional. This study was conducted in Vientiane High School from January to February 2019.
Questionnaires were completed by 337 respondents selected by stratified random sampling. A standardized self-administered questionnaire was used to collect information from respondents. The data collected was entered and analyzed by the EpiData and Stata 13. Descriptive and inferential statistics were applied to determine the factors associated with knowledge of safe sex and STIs.
The main results: Among 337 respondents, the results showed nearly half of the participants (49.5%) had a good knowledge of safe sex and 51.9% of respondents had a good knowledge of STIs. The results also found some factors related significantly to knowledge of safe sex including students who lived with other people (AOR=2.3), students who had studied about family planning (AOR=1.9) and students whose religious beliefs were acceptable to the use of birth control. These factors were the main determinants that increased the knowledge of safe sex (AOR=1. In addition, the factors positively associated with knowledge of STIs consisted of students who studied in a higher grade, namely 12th year (AOR=0.6,), students who had studied about family planning (AOR=1.1,) and students ix who had studied about STIs including HIV/AIDS (AOR=5.
They were associated significantly with a more comprehensive knowledge of safe sex and STIs (P-value<0. In this study, most of the participants were aware of safe sex and STIs. However, the knowledge of adolescents was inadequate. Barely half of the adolescents had a good knowledge of safe sex while half of the students had a good knowledge on STIs.
The associated factors identified with knowledge of safe sex and STIs were studying family planning and STIs topics in class, and practicing a religion that was acceptable to the use of birth control. These clearly helped to improve the knowledge of safe sex and STIs. There is essential requirement to have a comprehensive sexual education, particularly by adding more subjects content for safe sex and STIs to each grade in schools. More content knowledge about family planning and STIs/AIDs needs to be added to support the awareness of adolescents in order to protect them.
Besides this, religions should be more progressive and approve the use of birth control when necessary. Keywords: Adolescent, knowledge, family planning, sexual education and sexually transmitted infections. 1 INTRODUCTION Knowledge of safe sex and sexually transmitted infections (STIs) is of vital importance for adolescents (WHO, 2000) who need to be enamored with a protective awareness of the ways to prevent unsafe sex, STIs and teenage pregnancies (Hendrana, Mutyara, & Rowawi, 2015). During the adolescent period, teenagers are at a high risk from a number of negative health consequences associated with early and unsafe sexual activities, including STIs and unintended pregnancies (Kotchick, Shaffer, Miller, & Forehand, 2001).
Several studies have investigated that many adolescents are involved in sexual activities that elevated their risk to having reproductive morbidity, including unwanted pregnancies, abortions, STIs and HIV/AIDS because of a lack of basic knowledge about reproductive biology and prevention methods (Titiloye & Ajuwon, 2017). Regarding the knowledge of STIs, 93% of adolescents did not know any symptoms of STIs, 50% could not identify any cause of STIs and 76% did not know that STIs could be prevented (Lan, Lundborg, Mogren, Phuc, & Chuc, 2009). Adolescents also did not know how to avoid a pregnancy or were unable to get contraceptives, including emergency contraception (WHO, 2018b). Globally, each year an estimated 333 million new cases of curable STIs occur worldwide with the highest rates among 20-24 year olds, followed by 15-19 year olds (WHO, 2018d).
Besides that, more than one million STIs are acquired every day. Each year, it is estimated there are 357 million new infections involving STIs (WHO, 2016). Moreover, an estimated 23 million girls aged 15 to 19 years have unintended pregnancies in developing regions (WHO, 2018a).9% of Lao adolescents give birth by the age of 15-18 and 4.7% of adolescents have a live birth before age 15 (MOH & Lao Statistics Bureau, 2018). Adolescents often do not adopt safe sexual behaviors which results in unwanted pregnancies and unsafe abortions, as well as a high prevalence of STIs, which increases the risk of HIV infection (UNFPA, 2015).
A study in Vientiane reported that 33.4% of adolescents aged 15-19 years have had pre-marital sexual intercourse 2 and 62.7% of adolescents had their first sexual experience before the age of 15. In the last six months prior to the survey, 48.5 % of adolescents did not use condoms during sexual intercourse (Sychareun et al.