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CHAPTER ONE
1.1 INTRODUCTION
Sexually Transmitted Infections (STIs) refers to a set of clinical infections in which the mode of transmission is through sexual contact, and in which at least, one partner is infected. There are more than 30 different sexually transmissible bacteria, viruses and parasites (WHO,2004).The most common STIs include gonorrhea, chlamydia infection, syphilis, trichomoniasis , chancroid,genital herpes,genital wart, human immunodeficiency virus (HIV) infection and hepatitis B infection. Many of these infections spread predominantly through sexual intercourse, but in some others, sexual contact may play a less predominant or uncertain role. Most STIs are not, however spread through casual contact, vectors or formites.
Sexually transmitted Infections (STIs) are recognized as a major public health problem in most of the industrialized world. In developing countries, STIs and their complications rank in the top five disease categories for which adult seek health care (WHO 1998a). The World Health Organization (WHO) estimates that, in the mid-1990s, 30 million curable sexually transmitted infections (syphilis, gonorrhea, Chlamydia and trichomoniasis) occurred every year in North America and Western Europe with an additional 18 million cases in Eastern Europe and Central Asia. These counts do not include incurable sexually transmitted Infections (STIs) such as genital herpes and Human Papilloma Virus (HPV) infections, for which no up-to-date estimates have been derived by the WHO. Approximately 74, 000 new HIV infections are estimated to have occurred in (1997) in North America and Western Europe. Centre for disease Control and prevention (Sexually transmitted Infection Surveillance, 2011). More than 1 million sexual transmitted infections are acquired every day. Each year, there are an estimated 357 million new infections with one of four STIs: Chlamydia, gonorrhea, syphilis and trichonomiasis (WHO, 2018). Although some increases in incidence are documented, it is unclear, how much of this upward trend is due to improvements in case ascertainment and surveillance or to actual increase in STI incidence. Most developed countries have seen dramatic declines in the incidence of Syphilis and gonorrhea since World War II. Some eastern European countries nevertheless have recently experienced increase in these two STIs.
In the developing countries, STDs and their complications rank in the top five disease categories for which adult seek health care (WHO, 2011). Some of these STDs when not controlled can lead to severe complications. In men, gonorrhoea and Chlamydia trachomatis can lead to epididymitis. Inflammatory urethral stricture may arise later from poorly treated gonococcal urethritis, which in turn may lead to urinary retention and possibly chronic renal failure if not properly managed. Some of the diseases may result to genital ulcers, with few cases developing severe sacral dysfunction resulting in urinary retention (Richard et al, 2002; Gerald and Steven, 2002). Consequences of these STD include AIDS, spontaneous abortions, stillbirths, perinatal and neonatal morbidities, chronic pelvic pains, dyspareunia, infertility, increased risk of ectopic pregnancy and even death (De Schryver and Meheus, 1990; Rice, 1991; Chamberlain, 1995; Robinson and Ridgeway, 1996; Otolorin, 1999).
STIs deserves attention, not only because of the high prevalence, but also because they frequently go undetected and untreated and can result in serious reproductive morbidity and mortality. Compared with the extensive efforts devoted to research and intervention on HIV and AIDS, very little attention has been paid to other STIs. Hence there is a need to increase awareness of, at least, one central aspect of most common curable STIs – their incidence. Recent findings shows that some STIs acts as a cofactor or facilitator for HIV transmission, arguing that research on STIs other than HIV and AIDS can also contribute to better insights into HIV infections. Sexually transmitted infections are responsible for a variety of health problems and can have especially serious consequences for adolescents and young adults. CDC-STI Surveillance (2011).
Prevalence estimates suggests that young people aged 15-24 years acquire half of all new STIs and that 1 in 4 sexually active adolescent females have an STI, such as Chlamydia or HPV. Compared with other adults, sexually active adolescent aged 15-19 years and young adults aged 20-24 are at higher risk of acquiring STIs for a combination of behavioral, biological and cultural reasons. For some STIs, such as Chlamydia, adolescent females may have increased susceptibility to infection because of increased cervical ectopy. The higher prevalence of STIs among adolescents also may reflect multiple barriers to accessing quality STI prevention services, including lack of health insurance or ability to pay, lack of transportation, discomfort with facilities and services designed for adults and concerns about confidentiality. CDC (2011).
According to Ayo et.al., (2013), Nigeria has a fast growing population and is confronted with numerous health challenges. With a population of more than 150 million, the country’s population is young; therefore, the future of the country rests to a greater extent, on how successful, its youth have a transition to a healthy and productive adulthood.
Adebowale (2013) et al., in a research work on statistical modeling of social risk factors for sexually transmitted infections among female youths in Nigeria argues that, STIs remain a major public health challenge because of their health consequences, several complications especially among women who excessively bear long term consequences. It was also stated that the prevalence of STIs among Nigerian female youths is 17 percent, arguing that STIs causes infertility in women and increases the risk of transmission of HIV/AIDS. Moreover youths are likely to be at greater risk for STIs than the older adults because they are yet to be married and more likely to have multiple sex partners.
1.2 STATEMENT OF THE RESEARCH PROBLEM
The World Health Organization (WHO) estimates that more than half of the people infected with HIV are less than 25 years with majority being women (Meekers and Carees, 1999) hence the need for HIV/STIs control. Apart from contracting HIV/STIs, youths are faced with problem of unwanted or unplanned pregnancies leading to the procurement of abortion which is usually unsafe or criminal with its attendant complications (Ekweoapu, 1999). There is a trend towards onset of sexual activity among youths. The changing youth life style caused by changing values, globalization of communication, peer influence, rural-urban migration, tourism and breakdown of traditional system of sexual control are major challenges confronting youths (EMOH, 2003). This has led to declining age debut, increased activity characterized by unstable short term unions. Opportunistic sexual encounters and multiple sexual partners (Niclicholas et al., 1986, Fawole et al., 1999).
The consequences of such practices among youth have disproportionately higher prevalence rates. Several reports have shown that sexual activity is on the increase among youths in Nigeria (Blane and Way, 1998). A major factor associated with STIs states in Nigeria is lack of awareness and knowledge of relevant STIs issues among young people due to lack of access to credible information and careless attitude. Sex education is not taught in most secondary schools despite the fact that the relevant curriculum have been designed and approved for use in Nigerian Secondary Schools, The negative attitude of various stake holders to the provision of health information to young people is mainly as a result of traditional and sexuality issues with young people (United Nations System in Nigeria, 2001).
STIs deserve attention because they frequently go undetected and untreated and can result in serious reproductive morbidity and mortality. Compared with the extensive efforts devoted to research and intervention on HIV and AIDS, very little attention has been paid to other STIs. Hence there is a need to increase awareness of, at least, one central aspect of most common curable STIs – their incidence.
1.3 AIM AND OBJECTIVES:
The aim of this study is to analyze sexually transmitted infections (STIs) among in-school and out of school youths in Chikun Local Government Area. This will be achieved through the following objectives:
i. To characterize the types of STIs in Chikun Local Government Area
ii. To assess the factors responsible for the prevalence of STIs in Chikun Local Government Area.
iii. To examine the factors responsible for the variation or non-variation in the prevalence of STIs in Chikun Local Government Area.
iv. To compare the prevalence of STIs among in school and out of school youths in Chikun Local Government Area.
1.4 SCOPE OF THE STUDY
The scope of the study is focused on the analysis of STIs among in-school and out of school youth in Chikun Local Government Area. About 400 youths were interviewed with standard questionnaires containing information such as their age at first sexual intercourse knowledge of STIs, experience on STIs and so on.
1.5 RESEARCH QUESTION
i. What are the types of STIs among youths in Chikun Local Government Area?
ii. What are the factors responsible for the prevalence of STIs?
iii. What are the impacts of STIs in Chikun Local Government?
iv. What are the factors responsible for the variation or non-variation in the prevalence of STIs in Chikun?
1.6 JUSTIFICATION OF THE STUDY
STIs have been a serious setback not only to health of individual but also to the economic growth and development of a community as a whole. To a very large extent in Africa the ignorance and careless attitude of the causes and consequence of these infections has given rise to rapid spread of diseases which has prompted this research.
The study was carried out to examine the factors responsible for the variation or non variation in prevalence of STIs in Chikun Local Government Area and also to assess the factors responsible for the prevalence of STIs. This research can be relevant in solving the problems of the prevalence of STIs among in-school and out of school youths by the government/non-governmental organization (NGOs), schools and community health service.
1.7 DEFINITION OF CONCEPTS
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