Oluchi G Otuneme¹, Oluwasola O Obebe², Titus T Sajobi³, Waheed A Akinleye¹, Taiwo G Faloye¹

1. Department of Medical Laboratory Science, Babcock University, Ilishan Remo, Ogun State, Nigeria.
2. Department of Veterinary Parasitology & Entomology, University of Ibadan, Oyo State, Nigeria.
3. Department of Public Health, Babcock University, Ilishan Remo, Ogun State, Nigeria.

Abstract

Background: In recent years, the prevalence of schistosomiasis, a neglected tropical infection, has increased in underprivileged rural communities characterized by poverty.

Objective: This cross-sectional community-based study was carried out to determine the prevalence of urinary schistosomiasis in a neglected community of Apojola community, South-Western Nigeria at two points in time, spaced three years apart

Method and results: A total of 145 participants were screened and 44.1% were diagnosed to have urinary Schistosoma haematobium infection after sedimentation and microscopy. The prevalence of schistosomiasis among females was higher (45.3%) than that among males (42.4%) but not significantly different (0.723). The prevalence of participants with light infection (26%) was significantly higher than those with heavy infection (11.0%). The predisposing factors with statistically significant association with Schistosoma haematobium infection were age (0.000), level of education (0.002), eating/selling of snails (0.037), occupation (0.000), drinking water (0.001), swimming (0.008), and washing in a river (0.019).

Conclusion: These findings indicate that the study area is still endemic to urinary schistosomiasis after three years of research and school-age children and teenagers are the populations at risk of urinary schistosomiasis. Community health education on the cause, mode of transmission, prevention, and prompt treatment of schistosomiasis is recommended.

Keywords: Urinary Schistosomiasis, neglected community, Nigeria.

DOI: https://dx.doi.org/10.4314/ahs.v19i1.5

Cite as: Otuneme OG, Obebe OO, Sajobi TT, Akinleye WA, Faloye TG. Prevalence of Schistosomiasis in a neglected community, South western Nigeria at two points in time, spaced three years apart. Afri Health Sci. 2019;19(1): 1338-1345. https://dx.doi.org/10.4314/ahs.v19i1.5

 

Introduction

Schistosoma haematobium infection is known worldwide as an important chronic and debilitating disease mainly affecting underprivileged rural Communities characterized by poverty, poor sanitation and hygiene^1,2.

Schistosomiasis is one of the occupational associated infection that can be transmitted to a susceptible host or through recreation that involves contact with water infested with the free living cercariae that penetrate the skin and develops to maturity in the human^3,4. Other probable Schistosomiasis has been effectively controlled in many countries but its burden remains high especially in sub Saharan Africa including Nigeria.^4,5,3factors that influence transmission include environmental factors, water development schemes and people migration³.

In Nigeria, the burden of Schistosomiasis is enormous with an estimate of 101.3 million people at risk^6-9. The huge burden has been associated with water resources and development schemes such as irrigation projects, rice/fish farming and dams^10,11.

Corresponding author: Olaiya Obebe,  Department of Veterinary Parasitology University of Ibadan. Email: olashol@yahoo.com

and behaviour change programs; and occasionally, snail Chemotherapy, water, sanitation and hygiene, education control has been suggested as an important aspect of schistosomiasis control programmes and Entomology, ¹². However, a better understanding of prevalence and risk factors for schisto-somiasis is important in controlling the disease. The high prevalence of urinary schistosomiasis obtained from Apojola community 3 years ago justified the need to assess the extent of control measures. As at the time of visit, Apojola still lack basic amenities such as sanitation facilities, a non-functional water borehole, good roads, health centre and electric power distribution. The present study was designed to determine the prevalence of schistosomiasis in a neglected community of Apojola, south-western Nigeria at two points in time, spaced three years apart

Study area

This study was ‘conducted between May and July 2017 in Apojola community located around Oyan dam reservoir in Abeokuta North local Government Area, Ogun State, Nigeria. Oyan river is located 07° 58’N and 03° 02’E with a catchments area of 1610km². The reservoir has a length of 27km with a maximum width of 67km.and was primarily built to provide hydroelectric power and provide water for domestic and industrial uses. It also meant to supply water for an irrigated project of about 3,000 ha as well as provide fishing ground for the adjoining communities. Inhabitants are immigrant fishermen, a mixture of Moslem Hausas and Christian Idomas (figure 1) Ethical, recruitment, enrolment and sample collection

Figure 1: Map showing the sampling sites in South-western Nigeria

Before the beginning of the study, the objectives and plan were explained to the village authorities to get their cooperation and permission to conduct the survey. The heads informed all the residents to gather at the village square where they received explanation about the objectives of the survey, benefits and their involvement. A total of 181 participants gathered at the village square and only 145 adults who agreed voluntarily to participate and children with parental consent were included in the study. They received labelled containers and were instructed to bring urine samples. Structured questionnaire was administered to each participant to obtain socio-demographic, sanitation and water hygiene information which was then analysed to determine associated risk factors to Schistosoma infection. The protocol for this study followed ethical procedures/guidelines and was approved by the Olabisi Onabanjo University Teaching Hospital, Sagamu (OOUTH) research ethics committee with protocol no OOUTH/HREC/57/2016.

Parasitological procedures

Urine samples were stored in closed containers using ice park and transported to the laboratory to determine the prevalence and intensity of S. haematobium infection. In the laboratory, 10ml of each urine sample was centrifuged at 5000 rpm for 5 min. The supernatant was discarded to leave the sediment, which was placed on aclean glass slide and covered with a coverslip. These slides were observed microscopically using x40 objective lens for the presence of terminal-spined ova of eggs of S. haematobium. A positive sample was indicated by the presence of ova of S. haematobium and expressed as number of eggs/10ml of urine¹³, and the intensity of infection was graded as heavy (> 50 EP10 mL), moderate (10-49 EP10mL) and light (1-9 EP10 mL). A negative sample was indicated by the absence of parasite eggs¹³.

Data analysis

Data entry and analysis were carried out using SPSS version 18.0 (SPSS Inc., Chicago, IL, USA). Appropriate univariate and bivariate statistics were employed. Frequency tables and percentages were used to display categorical data. The Chi square was used to compare categorical data. Statistical significance was determined at the level of p < 0.05.

Sociodemographic characteristics of study participants

A total of 145 urine samples were collected and analysed for urinary Schistosomiasis. The characteristics of the study participants are shown in Table 1. The age range of the study participants was (5–59 years). Of the 145 participants, 59.3% (86/145) were female and 40.7% (59/145) were male, giving a gender ratio of 1.46: 1 (females: males). The majority (55.2%) of the participants were of the age range 5–15years (figure 2). 68.3% of the study participants had primary school education and 58.6% of

the participants are students (Table 1) Prevalence of schistosoma haematobium

The overall prevalence of Schistosoma haematobium infection in the study population is 44.1%. Urinary schistosomiasis was more prevalent among females (45.3%; 39/86)

Table 1: Socio-demographic characteristics of participants in a neglected community, Nigeria

Variables Frequency %

Age (years) 5-15 16-26 27-37 38-48 49-59 Gender Male Female Education None Primary Secondary Graduate Occupation Farming Housewife Student Trading

80 16 20 16 13   59 86   19 99 25 2   35 11 85 14

55.2 11.0 13.8 11.0 8.9   40.7 59.3   13.1 68.3 17.2 1.4   24.1 7.6 58.6 9.7

 

Figure 2: intensity of Schistosoma haematobium infection among participants

than in males (42.4%; 25/59). However, there was no significant different between Schistosomiasis and gender (0.723). There was an association between Schistosoma haematobium infection and variable such as age (0.000), level of education (0.002), eating/selling of snails (0.037), occupation (0.000), drinking water (0.001), swimming

(0.008), and washing in river (0.019) (Table 2)

Intensity of Schistosoma haematobium

The intensity of infection of participants is shown in Figure 2. Light, moderate and heavy infections were detected in the study using centrifugation method for the egg

Table 2: Factors influencing Schistosoma haematobium infection in a neglected community, Nigeria S. haematobium Status Factor Subcategory No. negative No. Positive p value   Gender       Age           Level of education         Occupation       Sell/eating of snail     Drinking water     Swimming       Washing in river Male Female   5-15 16-26 27-37 38-48 49-59   None Primary Secondary Graduate   Farming Housewife Student Trading   Yes No     Sachet Stream Well   Yes No     Yes No   34 47   28 12 16 14 11   16 45 18 2   28 10 30 13   39 52     2 64 15   61 20     65 16 25 (42.4) 39(45.3)   52(65.0) 4(25.0) 4(20.0) 2(12.5) 2(15.4)   3(15.8) 54(54.5) 7(28.0) 0(0.0)   7(20.0) 1(9.1) 55(64.7) 1(7.1)   34(53.9) 30(36.6)     2(50.0) 62(49.2) 0(0.0)   59(49.1) 5(20.0)     60(48.0) 4(20.0) 0.723       0.000           0.002         0.000       0.037       0.001       0.008       0.019

 

count. Of the 145 persons examined for urinary Schistosomiasis in the study area, 61% (n=88) were found to be negative for the presence of Schistosoma haematobium egg, 2% (n=3) were excreting between 1-9eggs/10ml, 26% (n=38) were excreting between 10-49eggs/10ml urine, while 11.0% (n=16) were excreting above 50 eggs/10ml urine.

Discussion

The study showed a high prevalence of Schistosoma haematobium infection among resident of Apojola community, Nigeria. Previous studies in Nigeria^14-17 and other countries like Ghana¹⁸ and Cameroon¹⁹, reported a comparable prevalence of Schistosoma haematobium infection.

However, data from various parts of Nigeria^20-22, showed lower prevalence than that obtained in the present study. Factors including poverty, ignorance, poor living conditions, inadequate sanitation and water supplies as well as deplorable personal and environmental hygiene characteristic of many rural communities have been suggested as reasons for variation in prevalence of infection²³. The frequency of infection was higher among the female participants compared to the male counterpart, although there was no statistical significance in the association. A study carried out in Nigeria found similar results²⁴ while others reported the opposite^25,26. The fact that fetching water and washing clothes are seen as female responsibilities in Nigeria, suggests the likely reason for Schistosoma haematobium infection preponderance among females. In the present study, prevalence was higher among schoolaged participants and the association was statistically significant. Previous studies reported higher infections among younger age group in Nigeria²⁷, Malawi²⁸ Cameroon²⁹ and Cote d’Ivoire³⁰. The higher prevalence among younger age group is not surprising. This is because this same group are the most commonly found in persistent and unrestrained water contact activities such as bathing and swimming. In addition, participants’ levels of education and occupation showed a statistical association with urinary schistosomiasis. This is supported by the findings of some previous study that associated higher infections with different level of education and occupation^31,32. The higher prevalence may be suggestive of their frequency of going to the river. In addition, the high illiteracy and neglect levels of the parents, observed in the study area, can lead to the non-education of preventive measures to their children, therefore influencing transmission pattern

Eating/selling of snails, using the stream as a source of drinking water, swimming, and washing in a river were significantly associated with Schistosoma haematobium infection. In accordance with our findings, previous studies reported similar observations^9,33,28. Water contact activities and traditional agricultural practices such as washing, fishing, bathing, and farming may influence the transmission of the disease in many parts of Nigeria.

Furthermore, the prevalence of participants with light infection was significantly higher than those with heavy infection. The higher prevalence of light infection reported here was in accordance with findings of Uneke et al.,³⁴ an indication that the distribution of schistosomiasis in endemic communities fits a negative binomial curve, with most infected individuals harbouring low worm burdens and only a small proportion having heavy infections³⁵. However, according to Secor et al.,³⁶, the aggregation of worm load in a small percentage of infected individuals may have various explanations including genetic vulnerability and the implication of these epidemiologic results are important to our understanding of the dynamics of the Schistosoma haematobium infection and its control in the populations studied.

We acknowledge some limitations of our methodology. This study had to rely on sedimentation method instead of the ideal filtration technique. In addition, our study was conducted on a smaller scale instead of the ideal larger scale. Thus, the prevalence rates of schistosomiasis are likely to be underestimated

Conclusion

The prevalence of 62%³⁷ obtained 3 years ago compared with present 44.1% prevalence obtained in the study area shows that participants in Apojola community and its environ are still plagued with urinary Schistosomiasis. It seems that adequate control measures had not been deployed to this endemic zone of schistosomiasis. Therefore, there is an urgent need for Government to mount successful control interventions such as the provision of safe water supply, development of recreational water bodies to avoid contact with present infested water, control of snail vector, public awareness and education regarding urinary schistosomiasis in the area.

Also, the report from our study is an indication that the school age children and teenagers are the population at risk of schistosomiasis. Control measures should, therefore, be targeted more on this at-risk group in the study area.

Acknowledgments

The authors would like to express their appreciation to Apojola community for given consents prior to sample collection

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors

Competing interests

The authors declare that they have no competing interests.

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¹Ogbomade, Ronami S., *²Ephraim-Emmanuel, Benson C., ³Okorie, Uzoma C.

1. Department of Science Foundation, Bayelsa State College of Health Technology, Otuogidi, Ogbia town, Bayelsa, Nigeria.
2. Department of Dental Health Sciences, Bayelsa State College of Health Technology, Otuogidi, Ogbia town, Bayelsa, Nigeria.
3. Department of Community Health Sciences, Bayelsa State College of Health Technology, Otuogidi, Ogbia town, Bayelsa, Nigeria.

Corresponding author*: Ephraim-Emmanuel, Benson Chukwunweike.

Phone Number: +234-806-003-8135 Email: benchike2002@yahoo.com

Abstract

Background and Aim: Oral habits are complex patterns of learned behavior that is characterized by muscle contractions which are usually related with a number of factors occurring in the individual practicing the habit. They have the capacity of causing dental health problems. It is thus the aim of this study to determine the prevailing oral habits and related factors.

Materials and methods: A descriptive research design was used. This study was conducted among primary school children. Using an effect size of 0.5 and error probability of 0.05, a minimum sample size of 176 respondents was calculated for this study. The instrument for data collection was a structured self-administered questionnaire. The instrument was distributed to the children at school to take home to their parents or guardians with the instruction to complete and return them the following day. Ethical considerations, permission, consent and confidentiality were ensured for this study.

Results: 77.2% of children of study respondents were affirmed to have practiced oral habits in the past. Fingernail biting (24.8%) was the most reported habit to be practiced. However, the practice of oral habits had reduced with 15% of the study participants no longer practicing oral habits. The majority of the respondents practiced these oral habits when sleeping (30.4%) as well as when bored (20.3%). Major measures utilized to stop these habits included flogging the child as well as punishing the child (22.4%), advising and encouraging the children to desist from the oral habits (19.6%).

Conclusion: The practice of oral habits is a problem within the study area. The most reported habit was fingernail biting and the major initiators of these habits included sleeping as well as the feeling of boredom. Flogging and motivation to stop the habit were mostly used as measures to stop the habit. It is however recommended that oral health education programmes be provided to improve awareness of the deleterious effects of oral habits on oral health. Emphasis should also be placed on the use of positive rather than negative reinforcement as a measure to enhance cessation of the habit.

Keywords: Oral habits, Malocclusion, Primary School Children, Yenagoa, Nigeria

Introduction

Habits have been described as complex patterns of learned behavior characterized by repetitive actions which occur involuntarily. Within the context of the oral cavity, oral habits are complex patterns of learned behavior that is characterized by complex muscle contractions which are usually related with a number of factors occurring in the persons practicing the habit. These could include fear, anger, ease of tension, hunger, sleep etc. ^(1,2).

These habits are basically classified as being nutritive and non-nutritive. The nutritive habits include oral habits related with sucking action of a child including bottle feeding as well as breast sucking. However, for the purview of this study, the non-nutritive class of oral habits is more of interest. These oral habits include nail biting, finger sucking, lip sucking etc. They are those habits which occur in relation to the mouth and could be initiated by prevailing events and circumstances being experienced by the individual practicing the habit. These circumstances include boredom, fatigue, hunger, emotional stress etc. ^(2,3). They are prevalent among children especially in the infantile period of life but have also been reported among older individuals. It is however generally believed that the habit stops spontaneously. ^(1,3). Various manifestations of poor dental health including dental caries, periodontal disease, malocclusion, poor oral seal, speech defects etc; could occur depending on the nature of an oral habit, onset of the habit as well as its duration ^(4). Those who practice these habits for more than six hours in a day generally tend to develop more serious dental health problems than those who do so for lesser amounts of time in a day. ^(1,5-8). In order to stop the occurrence of these habits, a number of measures have been utilized. These include application of interceptive orthodontics, motivation of the child to stop the habit, placing distasteful liquids on the nails or fingers, oral health education, behavioral treatment as well as the use of anti-anxiety medications etc. Seeing that the severity of oral health problems that are likely to occur are directly proportional to the length of occurrence of the offending oral habits, it is essential that oral health education targeted at improving awareness of the adverse effects of these habits be encouraged ^(1,9). The problem of oral habits being one for which children are especially susceptible and which can be initiated by circumstances normal to every human could certainly be prevalent among children residing in Yenagoa, Bayelsa State, Nigeria. There is however no published reports to confirm this.

It is thus the aim of this study to determine prevailing oral habits within the study area as well as factors known to stimulate its occurrence and measures geared at arresting its occurrence.

Materials and Methods

A descriptive research design was used in the assessment of oral habits practiced among school children in Yenagoa. This was adequate as it effectively enabled description of the study variables in its natural setting. This study was conducted in primary schools located in Ekeki Yenagoa Local Government Area of Bayelsa State and the targeted population was the primary school children attending these schools. Using an effect size of 0.5 and error probability of 0.05, a minimum sample size of 176 respondents was calculated for this study. The spin-a-bottle random sampling technique was then used in selecting the required number of primary schools to make-up our sample size at Ekeki, Yenagoa. The instrument for data collection was a structured self-administered questionnaire. The instrument was divided into two sections. Section A to collect demographic data while section B to elicit information on the oral habits of the children. The questionnaires were distributed to the children at school to take home to their parents or guardians with the instruction to complete and return them the following day. The instrument was retrieved from the children one week later. For the purpose of this study, the research instrument was submitted to a dental professional who assessed it for both content and face validity. Upon collation using the Microsoft Excel software, data was presented on tables, charts and expressed as frequencies and percentages.

Ethics clearance to carry out this research was gotten from the Project Research and Ethics Committee of the Bayelsa State College of Health Technology. Permission to carry out this study was sought from the school authorities. Participation for the study was on a voluntary basis and informed consent was sought from the parents and guardians of the primary school children. Data collected from participants was treated as confidential.

Results

Altogether, 230 questionnaires were distributed and 184 were retrieved and completed properly. This gives a response rate of 80%. Majority of the respondents was female (51.6%) and 48.4% were male. 35.3% of the respondents were aged between 7 and 9 years, 32.1% aged between 4 and 6 years amongst other age groups. The demographic data of our study respondents’ is shown on Table 1.

Table 1: Demographic data of respondents

Demographics	Frequency	Percentage (%)
Gender Male Female Age (years) 4-6 7-9 10-14 15-18	89 95 59 65 52 8	48.4 51.6 32.1 35.3 28.3 4.3

Practice of Oral Habits

Regarding the practice of oral habits among the participants of this study, multiple responses were entertained regarding oral habits practiced and when the habits were practiced the most. Most of them (77.2%) were affirmed to have practiced oral habits in the past. Fingernail biting (24.8%) was the most reported habit to be practiced among the children. As at the time of this present study, the practice of oral habits had reduced with 15% of the study participants no longer practicing oral habits which they earlier manifested. The majority of the respondents practiced these oral habits when sleeping (30.4%) as well as when bored (20.3%). This information is shown on Tables 2, 3 and 4 as well as on Figure 1.

Table 2: Practice of oral habits

Practice of oral habits	Frequency	Percentage (%)
Yes No	142 42	77.2 22.8

Table 3: Oral habits practiced in the past (before this study)

Oral habits practised	Frequency	Percentage (%)
Finger biting	18	11.8
Finger sucking	30	19.6
Teeth grinding	23	15.0
Lip sucking	17	11.1
Lip biting	6	3.9
Fingernail biting	38	24.8
Cheek biting	2	1.3
Lip chewing	8	5.2
Tongue thrusting	11	7.2

Table 4: Oral habits being practiced presently

Oral habits practised	Frequency	Percentage (%)
Finger biting	5	3.4
Finger sucking	23	15.6
Teeth grinding	22	15.0
Lip sucking	17	11.6
Lip biting	5	3.4
Fingernail biting	34	23.0
Cheek biting	2	1.4
Lip chewing	6	4.1
Tongue thrusting	11	7.5
None	22	15.0

 

Figure 1: When the oral habits are practiced

Stopping the Oral Habit

Among the 142 participants that had practiced oral habits, 24.6% of the parents/guardians of the participants of this study did not do anything to stop the habits. However, among the 75.4% who did something to stop the habit; the major measures utilized to stop these habits included flogging/whipping the child as well as punishing the child (22.4%), advising and encouraging the children to desist from the practice of the oral habits (19.6%), creating distractions such as engaging the children in activities, shouting at the children etc; as well as placing bitter leaf on the hand or in the mouth of the child practicing the oral habit. This information is shown on Table 5.

Table 5: Measures carried out to stop the oral habits

Measures carried out to stop the oral habits	Frequency	Percentage (%)
Flogging and punishment	24	22.4
Advice and encouragement to stop habit	21	19.6
Giving food to solve root cause of hunger	3	2.8
Slapping the hand/mouth/cheek/finger	8	7.5
Removing finger from the mouth	7	6.5
Creating distractions	14	13.1
Placing an obstacle on the finger/tongue	2	1.9
Using bitter leaf on the hand/mouth	12	11.2
Positive reinforcement	4	3.7
Placing salt in mouth	1	0.9
Tying hand/finger	2	1.9
Waking child from sleep	6	5.6
Making the child happy	3	2.8

DISCUSSION

The occurrence of oral habits has been reported to be a common problem among paediatric patients which has the ability to affect the quality of life of the individual ^(7). Considering that oral health is an integral part of general health and that the general health plays a role in ensuring general quality of life, it is important that these kinds of problems be tackled as quickly as possible whenever they are noticed ^(10). Specific initiators of these habits including hunger, boredom, anxiety, anger, tiredness as well as fear should also be quickly addressed whenever implicated. The use of positive reinforcement in these cases is of utmost importance in order to relieve the emotional stress that is likely involved in the practice of the oral habit ^(5).

This study revealed that a majority of the respondents affirmed that their children practiced oral habits in the past and still continued practicing them. This is a finding that is corroborated by the findings of other authors who reported similar results regarding the practice of oral habits among children ^(11). The implication of this is that this condition is one that is of public health concern considering the age group it mostly affects as well as the problems it may pose to the quality of life of the affected individuals. This thus calls for a more globalized strategy to adequately prevent its occurrence as well as nip it in the bud in the shortest possible time whenever noticed ^(11). The findings of Pruthi et al, (2013); however do not support the present study findings as they reported a prevalence of deleterious oral habits of 25.9%. The reason for this could have been because of the ages of 12 and 15 years used in selecting their study population ^(12).

Fingernail biting, finger sucking and teeth grinding (bruxism) were the most reported habits practiced by the children in this study. This finding agrees with those of authors who reported similar findings in their studies especially regarding nail biting ^(3,8). There is however a significant implication of this finding in that the reported habits in this study have been reported to be directly related with psychological/emotional disturbances. The occurrence of these habits thus implies that measures need to be taken to relieve or treat the emotional/psychological disturbance which in turn helps in stopping the habit. ^(5,10,13). However as seen in this study, the most utilized method of stopping the habit was flogging the children or meting out punishments to them. These forms of negative reinforcement have been shown to be capable of further worsening the emotional or psychological disturbance affecting those manifesting the habit and thus strengthen the practice of the habit rather than stop it ^(5). It is however noteworthy to point out that some form of positive reinforcement through encouragement was also utilized in this study to stop the habits. It is recommended that positive reinforcement methods are utilized in these situations because if the emotional or psychological disturbance can be corrected, it makes it easier for the habit to be stopped as well as boost the self-confidence of the individual especially in children ^(1,14).

In our study, sleep, boredom, hunger and anger were found to be the most reported factors that occurred during the practice of the oral habits. These are similar to findings in other studies that reported similar circumstances to influence the occurrence of oral habits ^(13). It is necessary to point out that to any of the circumstances reported to influence the occurrence of oral habits, the specific remedy should be provided in order to aid the cessation of the habit. In the case of hunger, food is required; for emotional disturbances involving anger or anxiety, effort should be made to pacify the angry or anxious emotion. This could be in form of positive reinforcement. Engaging the child in productive activities or distraction with toys following a gentle withdrawal of the part of the body being used during the habit, could also be utilized as a remedy for boredom etc ^(1). Interceptive orthodontics, a branch of dentistry that provides treatments that effectively help in the cessation of oral habits should however be incorporated when the need arises especially in cases of compulsive oral habits ^(11,12).

Generally, it is more beneficial to prevent the occurrence of oral habits or to provide necessary information to encourage prompt cessation of the habit when noticed. Preventive measures could include provision of dental health education programmes to provide enlightenment on the issue of oral habits and how to prevent its occurrence. Education should also be provided on how to differentiate between acquired oral habits (which could be easily stopped as the child grows older) from compulsive oral habits which are more inclined towards emotional imbalance initiators ^(5).

CONCLUSION

The practice of oral habits is a problem in the area in which this study was conducted. The most reported habit was fingernail biting and the major initiators of these habits included sleeping as well as the feeling of boredom. Flogging and motivation to stop the habit were mostly used as measures to curb the habit. It was however recommended that less of negative reinforcement and more of positive reinforcement methods be utilized in helping to stop these habits considering that most of the habits were non-nutritive in nature and could have been precipitated by emotional or psychological imbalances which are best managed by adequate support and motivation of the child.

Authors’ contributions

Ephraim-Emmanuel, Benson C. and Okorie UC developed the manuscript protocol, were involved in literature search and review for this manuscript. They were also involved in conducting the study and development of the final manuscript. Ogbomade, Ronami S. was involved in the revision process of the manuscript as well as in development of the manuscript transcript. All authors have approved the write-up of the final manuscript for publication. There are no conflicts of interest regarding this manuscript.

REFERENCES

1. Shahraki N, Yassaei S, Moghadam MG. Abnormal oral habits: A Review. J Dent Oral Hyg,2012;4:12-5. DOI:10.5897/JDOH12.001. ISSN 2141-2472. Available online at http://www.academicjournals.org/JDOH
2. Kharat S, Kharat SS, Thakkar P, et al. Oral habits and its relationship to malocclusion: A Review. J Adv Med Dent Sci Res, 2014;2:123-6.
3. Almonaitienė R, Balčiūnienė I, Tutkuvienė J. Prevalence of oral habits and their impact on facial parameters in Lithuanian children 4 to 9 years of age. Medicinos,2013;19:31-8.
4. Joelijanto R. oral habits that cause malocclusion problems. Int Dent J,2012;1:86-8.
5. Jyoti S, Pavanalakshmi GP. Nutritive and non-nutritive sucking habits – effect on the developing oro-facial complex; a review. Dent, 2014;4:203. DOI:10.4172/2161-1122.1000203.
6. Chour RG, Pai SM, Chour GV, et al. Assessment of various deleterious oral habits and its effects on primary dentition among 3-5 years old children in Davangere city. J Ped Dent,2014;2:37-43. DOI: 10.4103/2321-6646.137676. Available online at: www.jpediatrdent.org
7. Suchita MT, Sheetal R. Tongue thrusting habit: A review. Int J Contemp Dent Med Rev, 2015. DOI: 10.15713/ins.ijcdmr.26.
8. Giugliano D, Apuzzo F, Jamilian A, Perillo L. Relationship between Malocclusion and oral habits. Cur Res Dent,2014;5:17-21. DOI: 10.3844/crdsp.2014.17.21
9. Gowri SS, Chetan K. Tongue thrust habit – A review. Ann Essences Dent,2009;1:14-23.
10. Leme MS, Barbosa TS, Gavião MBD. Relationship among oral habits, orofacial function and oral health-related quality of life in children. Braz Oral Res., (São Paulo), 2013;27:272-8.
11. Lagana G, Masucci C, Fabi F, et al. Prevalence of malocclusions, oral habits and orthodontic treatment need in a 7- to 15-year-old schoolchildren population in Tirana. Prog in Orthod,2013;14:12. Available online at: http://www.progressinorthodontics.com/content/14/1/12
12. Pruthi N, Sogi GM, Fotedar S. Malocclusion and deleterious oral habits in a north Indian adolescent population: A correlational study. Eur J Gen Dent,2013;2:257-63.
13. Seraj B, Shahrabi M, Ghadimi S, et al. The prevalence of bruxism and correlated factors in children referred to dental schools of Tehran, based on parents’ report. Iran J Ped,2010;20:174-80.
14. Aasim FS, Manu B, Sudeep CB, et al. Oral habits and their implications. Ann Medicus,2014;1:179-86.

 

Louis Odeigah¹, Shittu O Rasaki¹, Ajayi F Ajibola², Ameen A Hafsat³, Abdullateef G Sule⁴, Yusuf Musah⁵

1. Department of Family Medicine, University of Ilorin Teaching Hospital, Kwara State, Nigeria.
2. Department of Anatomy, Kwara State College of Nursing and Midwifery, Ilorin. Tel: +2347036999373. 3. Department of Epidemiology and Community Health, Faculty of Clinical Sciences, University of Ilorin.
3. Department of Family Medicine, Ahmadu Bello University, Teaching Hospital, Zaria, Nigeria.
4. Department of Medicine, Federal Teaching Hospital Ido-Ekiti, Nigeria.

Author details:

Shittu O Rasaki Tel: +2348035062687. Email: oorelopehospital@gmail.com, Ajayi F Ajibola,Tel: +2347036999373. Email: jimmyayayi30001@yahoo.com, Odeigah O Louis,. Email: lodeigah@yahoo.com, Ameen A Hafsat: Tel: +2348033937472. Email: hafkam2005@gmail.com, Abdullateef G Sule: Tel: +2348065535088. Email: gbensule@yahoo.com, Yusuf Musah: Tel: +2348033750480. Email: yusmusah@yahoo.com

Abstract

Background: The consequences of high risk sexual practices (HRSP) are enormous among adolescent senior secondary school students. They therefore need to have sufficient knowledge of HRSP.

Aim Objectives: The study gauged the level of knowledge and perceptions of high risk sexual behavior among senior secondary school students in Ilorin, Nigeria with a view to improving their understanding of the current trends in HRSP.

This was a quantitative, cross-sectional, descriptive study of adolescent secondary school students in Ilorin East Local Government Area. Multi – stage sampling method involving 3 stages was used. A semi-structured interviewer administered questionnaire was used to obtain data. Informed consent of respondents was obtained. The data was analyzed using SPSS windows software package version 17.

Results: Majority, 305 (69.5%) of the students were between 16 – 20 years. The major source of information was from movies, 42.5%, and the internet, 24.7%. Twenty-three percent (23.1%) had poor knowledge of HRSP. Thirty-eight percent (38.1%) did not consider indiscriminate sexual intercourse as HRSP while 27.9% still believed that unprotected sexual practice is safe. Thirty-four percent (34.2%) did not know that sex with multiple partners is a HRSP while 34.4% did not know that oral –genital sex is unsafe. Over thirty-two (32.9%) perceived that engaging in sex made them mature among peers. Twenty-four (24.7%) did not perceive any danger in keeping multiple sexual partners while 15.3% would still engage in unprotected sex.

Conclusion: The students had relatively poor knowledge and perceptions of HRSP. Quite a number did not consider indiscriminate sexual intercourse as HRSP. An appreciable number did not perceive any danger in keeping multiple sexual partners or being engaged in unprotected sex. Counselling on the dangers of HRSP should be a component of the school health services so as to curb the complications of HRSP in our secondary schools.

Keywords: Knowledge, attitude , perception , high risk sexual practices, Nigeria.

Corresponding author: Louis Odeigah, Department of Family Medicine, University of Ilorin Teaching Hospital, Kwara State, Nigeria. Tel: +2348069048555. Email: lodeigah@yahoo.com

DOI: https://dx.doi.org/10.4314/ahs.v19i1.20

Cite as: Odeigah L, Rasaki SO, Ajibola AF, Hafsat AA, Sule AG, Musah Y. High risk sexual behavior among adolescent senior secondary school students in Nigeria. Afri Health Sci. 2019;19(1). 1467-1477. https://dx.doi. org/10.4314/ahs. v19i1.20

Introduction

An adolescent is defined by the National Adolescent Health Policy in Nigeria as an individual between the ages of 10 and 24 years. This age group makes up one third of Nigeria’s total population of 180 million¹ whereas the World Health Organisation (WHO)² defines an adolescent as an individual between ages 10 to 19 years. It is

© 2019 Odeigah et al. Licensee African Health Sciences. This is an Open Access article distributed under the terms of the Creative commons Attribution License (https://creativecommons.org/licenses/BY/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

the most turbulent stage of human development and it is characterized by indiscriminate sexual escapades.³ The National Family Health Survey (NFHS)⁴ defines high risk sexual behavior as sexual intercourse with somebody who is neither a spouse nor a cohabitating partner. Factors that predispose to high risk sexual practices are: early sexual debut, cultural practices, drug abuse and illiteracy. The mean age of 15 years for sexual debut has been reported in Nigeria.⁵ Religion, government policies, socioeconomic status, place of residence, family, gender, constitute distant conceptual framework on adolescent sexual risk taking in Nigeria while the mass media, communication, peer influence, contraception, and early marriage constitute the proximal factors.

Adeyemo and colleagues’⁶ in their study indicated that female adolescents with higher religiosity scores were more likely to initiate sex at a later age.. Studies have documented the association between socio-economic status and sexual behavior.^7-8 High levels of family cohesion lead to bonding, and low levels of cohesion indicate poor family support, which could lead to a family dysfunction. Low family cohesion is associated with adolescent sexual risk behavior.⁹

The Bello et al in their study¹⁰ showed that the mean age of sexual initiation was 15±2.6years with more than a quarter (28.3%) of the respondents having sexual exposure and about 40 percent having more than one sexual partner and over a third had their first sexual exposure the same day they met the partner (37.6%).¹⁰

Multiple sex, is sexual intercourse with more than one partner. Homosexuality is romantic behaviour between members of the same sex. The most common terms for homosexual people are lesbian for women and gay for men.¹¹ Two percent (2%) to 13% of the world’s population are homosexual.12 Having multiple sex partners is a sexual risk taking behavior. Izugbara et al showed that respondents were aware that having multiple sex partners was a risk factor for several negative health outcomes, including contracting, sexually transmitted infections – STIs.¹³

Anal sex is sexual acts involving the anus. It involves, pegging, anilingus, fingering and object insertion. Pegging is the form of practice whereby the female wears a penis- like object and inserts it into the anus of the female partner. Anilingus is oral stimulation of a person’s anus. Fingering is the insertion of fingers into the sexual partner’s anus/vagina. The risks associated with these practices include trauma, ano-rectal fissures, rectal prolapse, infections and anal cancer.¹⁴

Oral sex is any sexual activity involving the stimulation of the genitalia by the use of the mouth and tongue.¹⁵ Terms identified in this form of sexual practice are: cumillingus which is oral sex performed by females, fellatio refers to oral sex performed by males while anilingus refers to oral stimulation of a person’s anus.

Transactional sexual relationship is a situation whereby gifts, (monetary/non-monetary) and services are given or collected in exchange for sex.¹⁶ This is common in sub-Saharan Africa due to the extreme poverty in this region.¹⁷ The threat of reproductive health hazards confronting the youth in Nigeria should be a focus of research and advocacy. The problem associated with youth sexuality, such as unprotected sexual activities and inability to negotiate safe sex become readily apparent.¹⁸ This study is therefore aimed at assessing the level of knowledge of HRSB aswell as the perception of HRSP of secondary school students in Ilorin, North Central Nigeria.

 

Methods

Ilorin is the state capital of Kwara State with an estimated population of 847,582 as at 2007. Ilorin metropolis consists of 3 local governments namely; Ilorin East, Ilorin West and Ilorin South which consist of 12, 12 and 11 wards respectively with numerous communities. IlorinEast local government area has an area of 486 km² and a population of 204,310 as at 2006. Ilorin East has her headquarters in Oke-Oyi and consist of communities such as Apado, Sango, Sabo-Oke, Oke-Ose, Sobi, Maraba and Okelele among others.

This research was approved by the Ethical Committee of the Kwara State, the Kwara State Ministry of Education and the school authority. Informed consent of respondents was obtained. This was done through a section of the questionnaire in which respondents indicated their willingness to participate in the study voluntarily. Respondents were also made to understand that they could voluntarily withdraw at any time of the study. There are 40 secondary schools in the local government area; 24 public and 16 private which have the population of senior secondary students of 8,952 and 1,170 respectively. These bring the total population of senior secondary school students in the local government area to 10,122. It is in this local government area that we have prominent secondary schools such as Government Secondary School (GSS) Ilorin, Saint Anthony’s Secondary School Ilorin, Cherubim and Seraphim (C&S) College Ilorin among others. The senior secondary school curriculum mandates biology as a compulsory subject for students and parts of the body and reproduction are areas covered in this subject. This gives the students a basic knowledge and understanding of the body and sexuality. The communication channels through which information is passed to the general public in Ilorin include newspapers, radio, television, billboards and postal. There are two major television stations in the city which are Nigerian Television Authority (NTA), Ilorin and Kwara Television. The prominent radio stations based in Ilorin include Radio Kwara, Midland FM, Royal FM and Unilorin FM.

The major social settings that influence sexual behaviour of adolescents in Ilorin include the presence of popular beer parlors all around the local government area. Also, female sex workers are found in identified hotels and some are also found on the streets where they receive patronage. There are also night clubs and relaxation centers that host parties and settings that create avenues for many high risk sexual practices. These places and activities influence the perception of adolescents to sexual practices since they are aware of such avenues and also sometimes they see what goes on in such places. Also, this will affect perception of lifestyle modification towards health promotion.

It is also important, to note that the Kwara state ministry of Health and Kwara State Agency for Control of AIDS (KWASACA) carry out activities on HIV/AIDS such as awareness programmes and public sensitization on the mass media among other activities. The role of the activities of non-governmental organizations (NGOs) on HIV/AIDS has also been important in the prevention and control of the disease in the local government areas and the state at large.

This was a cross-sectional, descriptive study of secondary school students in Ilorin-East local government area. Ten senior secondary students selected for the study were given interviewer administered questionnaire in order to acquire information on the knowledge, attitude and perception of high risk sexual practices.

The minimum sample size used was determined using the Andrew Fischer’s¹⁹ formula for studying population greater than 10,000, degree of accuracy desired, which is set at 0.05, standard normal deviation which is set at 1.96 which corresponds to the 95% confidence level. Prevalence of a factor within the study population (63% – percentage of adolescents found to be already sexually active in Ilorin by Araoye and Fakeye)²⁰. The calculated sample size was 400. However, 450 was used to increase the power. Multistage sampling method involving 3 stages was used.

Stage one – There are forty (40) secondary schools in Ilorin-East local government area. Simple random sampling was used to select 10 schools out of the 40 secondary schools. This was done through balloting. The population of the senior secondary students in each of the selected schools was gotten during the advocacy visit. Proportionate allocation of respondents sampled in each of the 10 schools selected was done using the population of the schools, to estimated total population and sample size for the study.

Stage two – The class of the schools exist as natural strata. Stratified random sampling was used to determine the number of students sampled in each of the classes and arms of the selected schools. The senior secondary is divided into levels (SSI, SSII and SSIII). Also, proportionate allocation of respondents from each level was used. Total Population of Senior Secondary School Students in the 10 Schools Sampled was 6348. The Sample Size was 450

SCHOOL   Number of SS1 Students   Number of SS2 Students   Number of SS3 Students Total number of Students School 1 372 329 98 799 School 2 111 142 90 343 School 3 345 340 200 885 School 4 57 54 31 142 School 5 283 374 279 936 School 6 111 129 90 320 School 7 248 274 122 644 School 8 417 306 196 919 School 9 307 269 93 669 School 10 307 277 97 681 Total 2558 2494 1296 6348   Total Population of Senior Secondary School Students = 6348. The Sample Size = 450 Total number of students in each school is shown in the table above Formula: Total number of students in each school × sample size Total Population of senior secondary school students

Total Population of senior secondary school students

Stage three– Simple random sampling was done to select the respondents from each of the schools and class levels. A semi-structured interviewer administered questionnaire was used as the instrument to obtain data from the respondents. The questionnaire was in three sections viz: Demographic data of the respondents, assessment of the knowledge of respondents of high risk sexual practices and assessing the perception of respondents to high risk sexual practices. Respondents were also made to understand that they could voluntarily withdraw at any time of the study. Data collected were strictly confidential. Quantitative data was collected through the use of semi- structured interviewer administered questionnaire. The data sheets were sorted, collated and coded. Data entry was carefully done. The analysis of data collected was done using SPSS windows software package version 17. The responses were coded after the collection of the raw data and were correctly analyzed based on the objectives of the study. Chi-square was used to test significance level.. Results obtained were presented as percentage and in the form of tables and charts. The total package of the analysis is a reflection of the broad objectives of the study as well as the socio-demographic data of the respondents at the level of significance at P = 0.05.

The specific objectives identified the socio-demographic variable of respondents, the level of knowledge of high risk sexual behavior as well as the perception towards high risk sexual behavior among secondary schools in

Ilorin.

Results

Table 1 shows the socio-demographic characteristics of respondents. Majority 305 (69.6%) of the respondents were between ages 16-20 years. The male among the respondents were 254 (58.0%) while the female accounted for 184 (42%) respondents. The predominant religious groups were found to be Christianity and Islam accounting for 50.0% and 49.3% of respondents respectively. The Yorubas were the predominant ethnic group accounting for 342 (78.1%). The other ethnic groups found among respondents classified under ‘Others’include Ebira, Isoko, Ishekiri, Nupe, Fulani and Baruba. The family sizes of majority (65.1%) of the respondents were found to be 6-10 people.

Table 1: frequency distribution of respondents showing socio-demographic data.   Socio-demographic Characterisitcs (n=438) Frequency Percentage (%) Age group in years 10-15   131   29.9 16-20 305 69.6 21-24   2   0.5   Class of Respondents SSI   175   40.0 SSII 172 39.3 SSIII   91   20.7   Gender MALE   254   58.0 FEMALE   184   42.0   Religion of Respondents CHRISTIANITY   219   50.0 ISLAM 216 49.3 OTHERS   3   0.7   Ethnic Distribution YORUBA   342   78.1 HAUSA 25 5.7 IGBO 20 4.6 OTHERS   51   11.6   Family Size 1-5   118   26.9 6-10 285 65.1 11-ABOVE 35 8.0   Mean Age ± S.D. = 16.23 ±4.75 Median = 16.31 Mode = 16

Table 2 shows that 167 (38.1%) did not consider indiscriminate sexual intercourse as HRSP while 61.9% were aware of condom use. Also, (117) 26.7% did not know that multiple sex partners is a HRSP. A proportion of 122 (27.9%) did not know that unprotected sex with a partner of unknown status was a HRSP. Respondents’ knowledge of anal sex as a HRSP showed that 150 (34.2%) did not

know that anal sex is a HRSP. Homosexuality was not known to be a HRSP by 156 (35.7%). The proportion of respondents that did not know that oral-genital sex is a HRSP was 151 (34.4%). A proportion of 305 (69.9%) and 308 (70.3%) knew that giving and receiving sex in exchange for money/gift/service are HRSP. Three hundred and five (69.6%) knew that sex for money was a HRSP.

Knowledge of respondents on high risk sexual practices

Table 2– frequency distribution of respondents’ knowledge on high risk sexual practices

High risk sexual practice (N = 438)	Frequency	Percentage (%)
Indiscriminate Sexual Intercourse Yes	271	61.9
No	167	38.1
Sex without using Condom Yes	328	61.9
No	167	38.1
Multiple Sex Partners Yes	321	73.3
No	117	26.7
Unprotected sex Yes	316	72.1
No	122	27.9
Anal Sex Yes	288	65.8
No	150	34.2
Homosexuality Yes	282	64.4
No	156	35.7
Genito-oral Sex Yes	287	65.5
No	151	34.4
Sex for Money/Gifts/Service Yes	305	69.6
No	133	30.4
Money/Gift/Services for Sex Yes	308	70.3
No	130	29.7

 

Knowledge of respondents on high risk sexual prac- Table 3 shows the proportion of respondents who cor-

tices rectly answered 7-10 questions on risky sexual practices.

Table 3 – frequency distribution of respondents’ knowledge score on high risk sexual practices

Score	Frequency (Percentage)	Cumulative Percentage
Poor Knowledge (0-3)	101(23.1)	23.1
Fair Knowledge (4-6)	52 (11.9)	34.9
Good Knowledge (7-10)	285 (65.1)	100.0
Total	438(100.0)

 

One hundred and one (23.1%) had poor knowledge.

Table 4 shows the frequency distribution of respondents’ perception toward HRSP. One hundred and forty four (32.9%) felt engaging in sex makes one to be considered as mature among peers while 208 (47.5%) felt there was no spiritual attachment to sex. There were 56 (12.8%) of respondents who could be friends with homosexual colleagues. Most of the respondents 333 (73.7%) considered it to be shameful to pay or collect money/service in exchange for sex while 108 (24.7%) did not perceive any danger in keeping multiple sexual partners. Also, 67 (15.3%) would still engage in unprotected sex if opportunity presented. Majority 387 (88.7) agreed that unbridled sex freedom should not be allowed while 353 (80.5%) believed that students caught in any form of sexual practice should be severely punished.

Table 4 – frequency distribution of respondents’ perception towards high risk sexual practices

Response Yes (%) No (%) Indifferent

(%)

Engaging in sex makes one to be considered matured among peers.	144 (32.9)	277 (63.4)	17 (3.9)
Can be friends with an homosexual	56 (12.8)	373 (85.2)	9 (2.1)
Spiritual attachment to sex	209 (47.7)	208 (47.5)	21 (4.8)
Sex is avoidable	302 (68.9)	126 (28.8)	10 (23)
It is a shameful thing to pay or collect money/service in exchange for sex	323 (73.7)	102 (23.3)	13 (3.0)
There is danger in multiple sex partners	319 (72.8)	108 (24.7)	11 (2.5)
Will engage in unprotected sex if opportunity presents	67 (15.3)	355 (81.1)	16 (3.6)
Any student caught in any form of sexual practice should be severely punished	353 (80.5)	76 (17.4)	9 (2.1)
Freedom to engage in sex should be	48 (11.0)	387 (88.4)	3 (0.7)

allowed in the school

 

The table 5 shows the Chi-Square tests of the relationship between age, sex, socio-demographic variables and level of knowledge on HRSP. The result of the test using a significance level of 0.05 shows that gender was found

to be in a statistically significant (P-value < 0.005) relationship with high risk sexual practices. The major sources of information on high risk sexual practices among respondents was movies which accounted for 42.5% of the respondents while 24.7% got the information from the internet.

Table 5 – frequency distribution and chi-square significance of respondents on knowledge level on high risk sexual practices and socio-demographic characteristics

Variables	Poor Knowledge (%)	Fair knowledge (%)	Good knowledge (%)	Chi-square value	P-value
Age 10-15	4 (3.1)	42 (32.1)	85 (64.8)	7.143	0.129
16-20	3 (1.0)	72 (23.6)	230 (75.4)
21-24	0 (0.0)	0 (0.0)	2 (100.0)
Gender Male	3 (1.2)	77 (30.3)	174 (68.5)	6.180	0.045
Female	4 (2.2)	37 (20.1)	143 (77.7)
Level of knowledge on HSRP Poor	2 (2.0)	33 (32.7)	66 (65.3)	4.731	0.316
Fair	0 (0.0)	15 (28.8)	37 (71.2)
Good	5 (1.8)	66 (23.2)	214 (75.0)

 

Discussion

This study assessed the knowledge and perception of high risk sexual practices among respondents sampled from 10 senior secondary schools in Ilorin-East Local Government of Kwara State. Out of the 450 respondents sampled 438 questionnaires were valid and completed. The response rate was 97.3%.

Majority of the students were between 16 – 20 years and with a mean age of 16.23 + 4.75. The expected age for the students in the senior secondary level of education was between 13 and 19 years. This is a reflection that they were relatively young and sexually active. This was confirmed by the National Demography Health Survey (NDHS) which revealed that nearly half (48.6%) of adolescents aged 15 – 19 were sexually active (NDHS, 2008).²¹

The study showed that males are more prone to high risk sexual behavior than females. This is because their libido is generally greater than that of females and continues even to old age while that of female diminishes as they get older. This made Hoffman,²² Kirby²³ and Dryfoss²⁴ state that interventions that use attitude change to change behavior may be more effective among females than among males. Osarenren²⁵ also stated that young men have a very strong passion about sex and they try to satisfy themselves quite indiscriminately.

The respondents were found to be mainly of the Yoruba extraction which is a reflection of the ethnic distribution of the Ilorin populace according to census and previous studies.²⁶

The family sizes of respondents were found to be predominantly 6-10 people (65.1%).There has been previous studies that conform to this finding.^27,28 The family as a unit of care can mitigate adolescent problems. High levels of family cohesion lead to bonding and low levels of cohesion indicate poor family support, which could lead to a family dysfunction. Family members also exert influence on adolescents through their own modeling of risk behavior and through shared core family processes.

The cumulative knowledge on high risk sexual practices was 65.1% which is consistence with previous studies.²⁹ About, 23.1% of respondents still have poor knowledge of high risk sexual practices which show that a proportion of secondary school students still need to be educated on high risk sexual practices. The relatively high knowledge about these high risk sexual practices should not be sufficient reason to stop discussing the perceived high level of unsafe sexuality behavior among secondary school students.^27,30 Therefore, there is need to review health education strategies towards ensuring not only knowledge but also practice of safe sexual behaviour.

One third of the respondents did not consider indiscriminate sexual intercourse as HRSP. This is lower than two thirds recorded by Akanle and co-workers.³¹ Majority of the respondents know that unprotected sex is unsafe hence the need to be protected during sex. In this study two thirds were aware of condom use. This is comparable to the study of Folayan et al,³² but a departure from the study by Asekun – Olarinmoye and colleagues²⁷ who reported that there was no much difference between those using condom and those who didnot.

The level of knowledge on sex for money, gifts and services being HRSP was higher than that in the study by Odu and colleagues³³ in South West Nigeria where one third of the respondents received gifts or services for sex. The study established that it is shameful to pay or collect money/services in exchange for sex. At the national level, about 10 percent of females and 26 percent of males aged 15-24 years engaged in transactional sex in 2005.³⁴ Wusu et al.,²⁹ found that factors influencing involvement in transactional sex include poverty, broken homes, peer influence and desire to make cheap money. The data from this study suggest that most students who engaged in transactional sex rarely used measures of protection such as condoms and most of the partners who engaged students in risky sexual behaviour were of higher social and economic status.³⁴ This inequality in social and economic status makes it very difficult for the students to negotiate safe sex, hence increasing their vulnerability to sexually transmitted infections (STIs) and HIV.³⁴

The knowledge on genito-oral sex as HRSP was higher, hence better off than that of the study of Morhason– Bello¹⁰ in Nigeria where half of the respondents practiced oral sex. Folayan et al,³² found out that oral sex was practiced by 15.1% male and 23.5% female adolescents. Male to male oral sex was reported by 7.6% adolescents while 12.0% adolescents reported female to female anal sex. Similarly, Folayan et al, also found out that anal sex was practiced by 5.6% males and 3.4% female. Male to male anal sex practice was reported by 2.2% adolescents; male to female anal sex was reported by 5.9% adolescents and female to female anal sex was reported by 0.8% adolescents. More than 11.6% males engaged in heterosexual anal sex.

Similar, multiple sex partners were recorded as HRSP by more than one third of the respondents. This is an improvement in knowledge over the two third of the respondents who practiced multiple sex in a study in South West Nigeria. The study shows that there is danger in multiple sexual partners.

Majority agreed that unbridled sex freedom should not be tolerated and those caught in any form of HRSP should be severely punished. This is in conformity with previous studies.¹⁶ This is an example of right perception that helps in preventing HRSP among secondary school students.

There are a number of sources through which information is received by the public. Higher proportion of respondents in this study identified that their major source of information on high risk sexual practices was movies and internet. Quite a considerable proportion also got information from friends and classmates. This finding is consistence with previous studies which found that movies, friends and internet are the major sources where information about high risks sexual practices were obtained.³⁵ In some studies, school mates were key sources of information about sexual practices across the classes: some respondents in the entry class (77.9%), 65.7% in the mid-class and 78% in the exit class reported that they got information about sexual practices from their school mates. More than half of the respondents in the exit class (58.3%) reported that their source of information about sexual practices was the Internet.¹³

Conclusion

The knowledge and perception of HRSP among adolescents in senior secondary school in Ilorin East Local Government is poor. There are still quite a number of students who could not identify some of the high risk sexual practices while others held wrong perceptions about these practices. Therefore, there is need for health education on high risk sexual practices among these students.

Conflict of interest None.

References

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