Knowledge on safe sex practices among undergraduate university students at Chuka University, Kenya

INTRODUCTION

Safe sex practices refer to sexual behaviour, particularly sexual intercourse, in which different precautions are taken to avoid diseases spread through sexual contact and undesired pregnancy.¹ The global incidence of Human Immunodeficiency Virus (HIV) is on a downtrend since 2000 but has remained high in Africa.² Adolescents and the youth constitute a quarter of the sexually active population but unfortunately globally, they represent almost half of all new STI cases.³ In Kenya, it is estimated that about 1.3 million adult citizens live with HIV and higher prevalence in women (5.8%) than in males (3.1%) (National AID and STI Control Programme.⁴ In addition, a higher prevalence was reported among the 15–49 age group (4.5%) as compared to 0.9% in the 10–19 years old. Moreover, young people accounted for 27% of HIV infections in 202.⁵

Unsafe sex practices also referred to as risky sexual behaviour (RSB) are practices that pose a great risk of contracting sexually transmitted diseases as well as having unwanted pregnancies.⁶ Having intercourse with several sexual partners, having sex while under the influence of alcohol or drugs, failure to or inconsistent use of a condom, having sex with an unknown partner, usage of pornographic materials, and sexual coercion are examples of these activities.^7,8 Unsafe sexual practices may be associated with individual demographic factors, psychological factors and sociocultural factors.⁹ Men are more likely to present with risky sexual behaviour than women. A study in Brazil established that 9% of undergraduate students are involved in risky sexual behaviour whereas men presented riskier sexual behaviour.¹⁰ Additionally, knowledge levels tend to differ according to gender.^11,12

Other individual factors that may be associated with knowledge on safe sex practices include the student’s area of specialization in academics, age, family composition, and parent’s level of education. In Nigeria, knowledge level on Sexually Transmitted Infections may be low among art students compared to those from science faculties.¹³ Besides younger students had poor knowledge on STIs. Good knowledge levels were more likely to be observed among undergraduate students living with both parents and those whose fathers had secondary education and above. A mixed-method study indicated that in Kenya, RSB among undergraduate students may be associated to socio-economic status, sexual norms and substance abuse.¹⁴

Medical records at the university medical department showed an increasing trend of STIs treated in the health facility; 214 cases in 2016, 236 cases in 2017, 248 cases in 2018 and 254 cases in 2019. Commonly treated STIs include candidiasis, vulvovaginitis, chlamydia, trichomoniasis, bacterial vaginosis, vulvovaginal warts and genital ulcer disease. Although most undergraduate students are often educated on safe sex practices during induction programs to the university, there is limited recent data on knowledge of safe sex practices among Kenyan university/college students and the associated factors. This study, therefore, set out to establish the level of knowledge on safe sex practices among undergraduate students of Chuka University and its associated factors.

METHODS

This was a cross-sectional study carried out at Chuka University; a public university in the Eastern region of Kenya among 352 participants. The study was conducted in March 2022–April, 2022). The sample size for the participants was determined using Yamane formula.¹⁵

Where: n=sample size; N=population size (undergraduate students); e=margin of error (0.05 at 95% confidence level).

Using a simple random sampling technique, 352 participants were selected to participate in the study. Quantitative data was obtained using a self-administered research questionnaire. The questionnaire assessed the demographic and socioeconomic data of the students and their knowledge of safe sex practices. A correct answer scored one point while a wrong answer scored a zero. Pretesting of study instruments was done at a neighbouring University of Embu. The results were coded and entered in a statistical package of social science (SPSS) v.24 for analysis. Bivariate and multivariate regression analysis were used to determine the association between the demographic and socioeconomic characteristics of the participants and their knowledge level of safe sex practices. A p value of <0.05 was considered statistically significant. Ethical clearance to carry out the study was obtained from Chuka University Ethical Review Committee (CUIERC/NACOSTI 291) and National Commission for Science, Technology and Innovation (NACOSTI) provided a research permit (NACOSTI/P/22/20623). Participants of the study were informed that the data obtained would solely be used for the study. They were also assured of the confidentiality of the information provided. Willing participants signed informed consent to indicate their willingness to participate in the study.

RESULTS

There were 352 participants with more male (56.5%) than female (43.5%) participants. The mean age of the participants was 21.37 (±1.747). The youngest participant was 17 years while the oldest was 29 years. The majority of the participants (61.4%) were in the 20–22 years’ age group. The majority studied primarily in the sciences (59.4%). More than three-quarters were single (83.8%). Most of the participants were from rural regions of Kenya (63.1%). There were more Christians (88.6%) than Muslim participants (11.4%).

More than half of the participants (71.9%) resided in private hostels outside the university and approximately half of the participants reported a monthly allowance of <5000 Ksh (49.7%). Participants cut across all years of training and the fourth year had the least number of participants (13.9%). Two-thirds of the participants (66.8%) were sexually active while the rest were not (Table 1).

Knowledge on sexual practices was assessed with 8 questions. Low scores were observed in questions regarding the effectiveness of female condoms as compared to male condoms (44.3%), the likelihood of conception midway menstrual cycle (56.8%) and except condoms, other FP methods do not protect against STIs and HIV/AIDs (55.7%) (Table 2).

Individual knowledge scores were transformed into percentages. Participants demonstrated a knowledge mean score of 68.15 (±21.59) %. Using Bloom’s cut-offs, knowledge was classified into poor knowledge (<60 %), moderate knowledge (60–79%) and high knowledge (80–100 %).¹⁶ The majority of the participants had moderate knowledge of safe sex practices (41.2%) (Figure 1).

*Majority

An independent student t-test was used to measure mean knowledge differences according to gender, place of birth, religion, major in studies, place of residence and sexuality. There exist significant differences in mean knowledge levels on safe sex practices about gender (t=-2.82 df=350, p=0.005), place of birth (t=-2.73, df=350, p=0.007), and place of residence (t=2.65, df=350, p=0.008) (Table 3).

Using binary logistic regression analysis, knowledge level was associated with the demographic and socioeconomic characteristics to assess the association between the variables.

There is a statistically significant relationship between participants’ knowledge level on safe sex practices and gender, age, place of birth and residence; p=0.018, COR=1.959 CI (95% 1.122–3.419); p=0.028, COR=0.334 CI (95% 0.126–0.886); p=0.004, COR=2.347 CI (95% 1.307–4.215) and p=0.004, COR=0.399 CI (95% 0.212–0.751) respectively.

Furthermore, moderate knowledge level was associated with gender; (p=0.048, COR=1.658 CI (95% 1.004–2.737). Male students were 1.96 and 1.66 more likely to have low and moderate knowledge levels of safe sex practices as compared to female students. Participants, 19 years and below were 0.33 less likely to have a low knowledge level than those 23 years and above. Participants from rural areas were 2.3 more likely to demonstrate low knowledge levels compare to their colleagues from urban areas (Table 4).

Variables that had an association; participants’ gender, age group, place of birth, and place of residence were run in a multivariate logistic regression model to assess their variability impact on knowledge level. Place of birth and place of residence are significant predictors of low knowledge level; p=0.027, AOR=1.975 CI (95% 1.081–3.608) and p=0.026, AOR=0.477 CI (95% 0.249–0.913) respectively.

Students from rural areas had 1.975 lower knowledge levels than their counterparts from urban areas. In addition, those who resided in the private hostels within the university neighbourhood were 0.477 less likely to have low knowledge levels than those who resided within the university hostels (Table 5).

*Statistically significant at 95%

*Statistically significant at 95%; 1-reference category; CI-confidence interval; COR – crude odds ratio

*Statistically significant at 95%; 1-reference category; CI-confidence interval; COR – crude odds ratio.

DISCUSSION

The majority of the study participants had high knowledge levels of safe sex practices which may be attributed to a university induction training on safe sex practices. The high knowledge levels are similar to a study conducted in Ethiopia among the youths in secondary and preparatory schools.⁶ This is probably because the studies have been conducted within the same regions and targeted similar participants; school-going youths. However, the results are higher than what was reported by some medical students in Mexico between 19–24 years.¹⁷ The differences may be attributed to the methods of assessment since in Ibarrola-Peña et al study, the participants did a self-evaluation of their knowledge of safe sex practices compared to the present study where the researchers assessed for the specific knowledge of the subject.¹⁷

There exist significant differences (t=-2.82 df=350, p=0.005) in mean knowledge levels between the female (71.81±21.34) and male (65.33±21.34) students. Besides, gender was associated with low knowledge level where males were more likely to have a low-moderate knowledge level compared to females. The results concur with the results of a previous study where male students had significantly lower knowledge of STIs than their female colleagues.¹¹ Similarly, there were significant differences in the knowledge level of safe sex practices among male and female university students in China.¹² The similarities in these study results may occur since the study targeted undergraduate university students whose experiences at that stage of life could be related.

The knowledge level of the study participants was significantly associated with their place of birth and place of residence. Students from the urban area and those residing within university hostels had better knowledge levels as compared to their colleagues from rural areas and those residing in private hostels. Similarly, in Nigeria, place of birth was a significant predictor of knowledge of contraceptive pills (AOR=0.66) and female condoms (AOR=0.66).¹⁸ Students from urban areas and living within the university hostels may have more opportunities in terms of knowledge available through health campaigns and posters as compared to those from rural areas and living alone in private hostels. Consistent with a previous study done in South Carolina, sexual activity was not a significant predictor of knowledge level in this study.¹⁹ Most universities have introduced some sexual education programmes for undergraduate students which may bring out the similarities in related subject areas.

Limitations

The study was conducted in a single institution of higher learning and therefore cannot be considered to represent all other universities in Kenya. Future studies should include more institutions including private and religion-affiliated universities. A self-administered questionnaire was used to obtain data in this study, so some respondents may not have answered correctly if they did not understand the question. The use of the cross-sectional study designs could not enable the researchers to explore the causes and effects comprehensively. Further studies should consider other designs such as longitudinal design while exploring this area further.

CONCLUSION

The students demonstrated high knowledge levels of safe sex practices associated with their place of birth and residence. There is a need therefore to assess if the high knowledge level of safe sex practices translates to practice. Institutions of higher learning should continue to give continuous sexual education to the students. The university management should ensure that safe sexual practices curriculum provides comprehensive age-appropriate and accurate information about sex and sexuality. This should include information about contraception including condoms, the menstrual cycle, sexually transmitted infections (STIs), and other topics related to sexual health.

ACKNOWLEDGEMENTS

The authors wish to acknowledge the participants of the study for spending their time to provide the responses of the questionnaire.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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