|Year : 2019 | Volume
| Issue : 1 | Page : 70-75
Knowledge, attitude, and practice toward human immunodeficiency virus/acquired immune deficiency syndrome: A questionnaire study among students, teachers, and parents in Mangalore, India
Neil J De Souza, Rohit P Kolipaka, Jithendra Kumar, Amitha M Hegde
Department of Pedodontics and Preventive Dentistry, A.B Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, Karnataka, India
|Date of Submission||10-Oct-2017|
|Date of Acceptance||14-Jan-2019|
|Date of Web Publication||15-Mar-2019|
Dr. Neil J De Souza
Department of Pedodontics and Preventive Dentistry, Government Dental College, Bambolim, Goa
Source of Support: None, Conflict of Interest: None
Background: The human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) epidemic probably represents the greatest public health problem in India and the world today. Education and awareness of the society forms an integral part of the global effort to prevent and control the spread of AIDS. Aim: The aim of this study was to evaluate the levels of knowledge, attitude, and practice toward HIV/AIDS among various schoolgoing children, teachers, and parents in urban and rural areas of Mangalore, Karnataka. Materials and Methods: The cross-sectional study was conducted among a sample of 1535 respondents comprising students, teachers, and parents associated with three rural and two urban schools, by means of a structured questionnaire encompassing knowledge, opinion/attitudes, and practices related to HIV/AIDS. Descriptive and inferential statistics have been applied. Inferential statistics included independent sample t-tests, one-way ANOVA, and Chi-square test. Results: The results suggest a considerable difference in the levels of awareness among the urban and rural population. Furthermore, teachers display significantly greater knowledge about HIV/AIDS, followed by parents and then students. Based on the knowledge scores, the sample population was divided into three categories as follows: high, medium, and low. Nearly 90% of the teachers have high level of knowledge whereas only 40% of parents and 14% of students display high-level knowledge. The results also suggest that urban and rural respondents have acquired knowledge from different sources regarding HIV/AIDS. While friends are the main source of information for the urban respondents, the rural sample draws their knowledge from newspapers and TV. Conclusion: The study suggests that despite the various government-aided programs for HIV/AIDS awareness among schoolgoing children, there still exists a significant difference in the knowledge and awareness between rural and urban populations. The study notes that a sizeable number of children attending rural government schools still lack adequate knowledge about HIV/AIDS.
Keywords: Awareness, human immunodeficiency virus/acquired immune deficiency syndrome, knowledge, parents, schoolchildren, teachers
|How to cite this article:|
De Souza NJ, Kolipaka RP, Kumar J, Hegde AM. Knowledge, attitude, and practice toward human immunodeficiency virus/acquired immune deficiency syndrome: A questionnaire study among students, teachers, and parents in Mangalore, India. J Indian Assoc Public Health Dent 2019;17:70-5
|How to cite this URL:|
De Souza NJ, Kolipaka RP, Kumar J, Hegde AM. Knowledge, attitude, and practice toward human immunodeficiency virus/acquired immune deficiency syndrome: A questionnaire study among students, teachers, and parents in Mangalore, India. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2019 Mar 18];17:70-5. Available from: http://www.jiaphd.org/text.asp?2019/17/1/70/254323
| Introduction|| |
The acquired immune deficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV) remains the most serious of infectious disease challenges to public health. The severity of the challenge is evident by the fact that the United Nations prioritized the control and spread of HIV/AIDS as one of its millennium development goals. Almost 70 million people have been infected with HIV since it was first discovered, and about 35 million people have died since then. A study estimated that the number of people living with HIV at the end of 2011 globally was approximately 34 million (31.4–35.9 million). An estimated 0.8% of adults between the age group of 15–49 years worldwide are living with HIV.
Situation in India
The AIDS is a major emerging public health problem in India. The regional office of the World Health Organization for Southeast Asia estimated that India accounts for over two-thirds of all HIV-infected individuals in the region. This amounts to an annual economic loss of roughly rupees 3447 billion due to HIV/AIDS in India.
As per NACO 2013 data, the prevalence of HIV in India is 0.3%, with an estimated number of 2.4 million people living with HIV/AIDS. Children make up about 7% of those infected, while 86% are in the most productive age group of 15–49 years. Of all the HIV-infected people, 39% of them happen to be women.
Human immunodeficiency virus/acquired immune deficiency syndrome and children
Of all the various age groups affected by this pandemic, the adolescent age group is identified as the group that is most at risk of contracting HIV/AIDS and other sexually transmitted diseases (STDs). It was estimated that there were 5 million young people (15–24 years of age) and 3.4 million children (under 15 years of age) living with HIV in 2010 and that one-third of all new HIV infections are among people aged 15–24 years. Globally, AIDS has been recognized as the second most common cause of death among 20–24 years of age.
Globally, every minute, a baby is born with HIV, either passed on by their mother during pregnancy or delivery. Of the 2.1 million people who died of AIDS during 2007, more than one in seven were children. Furthermore, it is estimated that around 40 children die every hour as a result of AIDS.
Studies done in India documented mother-to-infant HIV transmission rates between 36% and 48%. It has been reported that 63% of the multitransposed thalassemic HIV-positive children displayed symptoms in infancy with a 9% fatality rate within 14 months of age., Another study reported median survival of 8.5 months (range: 0.3–2 years) in 26.3% perinatally infected children. Studies have reported that young people form a significant segment of those attending sexually transmitted infection clinics and those infected by HIV.
To stop the spread of HIV/AIDS in India, the Tenth Five-Year Plan (2002–2007) was developed with targets set to achieve 90% coverage of schools and colleges through education programs and 80% awareness among the general population in rural areas.
Proper education and development of awareness among women can play an equally significant role in controlling the mother-to-infant transmission rate of HIV/AIDS. Studies done to estimate the level of awareness of HIV/AIDS among pregnant women in India revealed that over 75% of women displayed knowledge of primary transmission routes and nearly 70% of women demonstrated knowledge of maternal-to-child transmission; however, only 8% knew of any methods of prevention.
With the high level of HIV infection and poor sexual and reproductive health outcomes among young people, it is crucial to understand the level of awareness about HIV/AIDS among the youth/young students to inform policies and programs that protect them. In general, males demonstrated higher levels of awareness as compared to their female counterparts.
In spite of all the efforts both by the government and the NGO sector, young people often report inadequate knowledge and information, particularly in the rural areas. It is in this context that the present study has been taken up to estimate the level of awareness among schoolgoing students and compare the same among the urban and rural children. Since teachers and parents are considered as the main service providers, mentors, and educators of young children, they have also been included in the study. The aim of this study was to evaluate the levels of knowledge, attitude, and practice toward HIV/AIDS among various schoolgoing children, teachers, and parents in the urban and rural areas of Mangalore, Karnataka.
| Materials and Methods|| |
A cross-sectional study was approved by the Institutional Review Board of Nitte University, Mangalore and was conducted between June and August 2015. An initial pilot study conducted on 100 children and parents reporting to the Department of Pedodontics, A. B Shetty Memorial Institute of Dental Sciences, Mangalore, revealed low levels of awareness regarding HIV/AIDS. The study population comprised the teachers, parents, and students in urban and rural Karnataka, drawing a sample from Mangalore city and the neighboring rural area Maddur. The students selected for the study belonged to the higher secondary section of all the schools, between the age group of 8–14 years. The sample comprised both male and female respondents in all the three categories of respondents. Three rural and two urban schools were selected purposively based on their willingness to participate in the study. The disparity in the number of schools can be attributed to the larger number of students per class in the urban schools. All the teachers and students in these five schools who agreed to respond have formed the sample, and then, the parents of the students who have responded were contacted for their inclusion. The number of teachers is significantly lower than the other groups owing to the high number of students/teachers in the participating schools. Furthermore, few parents did not find the time to respond both in the urban and rural areas, as a result of number of parents compared to the students is marginally fewer in both the urban and rural samples. The teachers, students, and parents have been taken as individuals while comprising the sample. Any teachers, students, and their parents who refused to participate in the study for unspecified reasons were excluded from the sample population. Furthermore, students below the age of 8 years were excluded from the study group, as the aim of this study was to target a preadolescent and adolescent age group.
Data were collected using a pretested self-designed structured questionnaire. The questionnaire was sent to four subject experts to check for the content validity, and the 25-item questionnaire was found to be internally reliable (Cronbach's alpha 0.746). The questions gave the respondents the freedom to express their view without reservation. The 25-item questionnaire covers three major areas as follows: knowledge, opinion/attitudes, and practices related to HIV/AIDS. Most of them relate to assessing the level of knowledge, while a few relate to opinions and practices.
To measure the levels of various aspects of knowledge, attitudes, and practices (KAP), the questionnaire was divided into three distinct modules. In each module, relevant questions were asked from the respondents such as in knowledge module, the emphasis was given to assess the level of knowledge of respondents for HIV/AIDS. To assess knowledge, attitude, and practices, 10, 9, and 6 questions were asked, respectively. Each question was given one point for correct response and zero point for wrong or uncertain response.
Overall, there were 25 questions in the questionnaire. If a person answered all questions correctly, 25 scoring points were awarded. Those respondents who obtained KAP score above 20 were considered as high level, while the scores between <20 and 10 were considered as medium level. The score below 10 was considered as low level.
A total number of 1535 questionnaires were personally administered in the five schools. Approval from school authorities to conduct the study was obtained from each of the schools, and informed consent was obtained from the teachers and parents of all the students included in the sample. The researchers individually administered the questionnaires and collected back immediately which ensured that no willing sample was lost. This enabled the researchers to have a high rate of return.
Statistical analysis was done using the SPSS (version 23 for Windows, Armonk, NY, USA). Responses for the questions related to knowledge levels were scored, and mean knowledge scores were calculated. Independent sample t-tests are carried out to know whether rural and urban areas differ significantly with regard to the level of knowledge on HIV/AIDS. The one-way ANOVA was carried out to ascertain the difference in levels of knowledge among students, teachers, and parents. The level of statistical significance was considered at P < 0.05.
| Results|| |
A total of 1535 respondents participated in the study and included students, teachers, and parents from rural and urban Mangalore. All the 25 queries constructed to assess the level of knowledge have been scored taking into consideration the responses, and then, the levels of awareness have been categorized as high, medium, and low based on the scores obtained. These were then compared for the urban and rural samples, not only as a whole but also for the three categories of sample separately.
Responses for the questions related to knowledge levels were properly scored, and total knowledge scores were calculated. Independent sample t-tests are carried out to determine whether rural and urban populations differ significantly with regard to the level of knowledge on HIV/AIDS. From the results, it is evident that there is a significant difference between urban and rural respondents with respect to the knowledge on HIV/AIDS. Urban respondents have more knowledge than that of the rural sample [Table 1].
However, comparing the level of awareness between the different sample groups in terms of the location, i.e., urban and rural, the analysis shows that in case of teachers and parents, there is no impact of locality on the level of knowledge, whereas students from urban and rural localities differ significantly. Urban students have higher knowledge (13.89 ± 2.96) than their counterparts in the rural areas (12.52 ± 2.26) [Table 1].
The one-way ANOVA was carried out to know whether teachers, parents, and students differ significantly with regard to the level of knowledge on HIV/AIDS. From the results, one can understand that teachers differ significantly from parents and students with considerably higher knowledge (17.45 ± 2.35), followed by parents with mean knowledge score of 13.76 ± 3.40 and students with mean knowledge score of 13.19 ± 2.71 [Table 2].
A Tukey's honestly significant difference post hoc test was also performed to reveal whether comparisons between knowledge scores of different groups were significant. The comparisons of teachers versus parents and teachers versus students were found to be highly significant, whereas that of parents versus students was found to be nonsignificant [Table 2].
Depending on the knowledge scores, respondents were divided into three categories: low, moderate, and high. Nearly 90% of the teachers have high level of knowledge whereas only 40% of parents and 14% of students display high levels of knowledge [Table 3] and [Table 4]. Hence, one can understand that there is a significant impact of group on the level of knowledge (P < 0.001).
|Table 3: Association between locality and levels of knowledge of human immunodeficiency virus/acquired immune deficiency syndrome|
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Source of information
Results of the Chi-square test depict that there is a significant impact of locality on the source of information. Friends were the main source of information for the urban respondents; the rural sample draws their knowledge from newspapers and TV [Table 5].
|Table 5: Sources of information for human immunodeficiency virus awareness among the various study group|
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Perceived level of risk
Similarly, again urban and rural respondents differed significantly in their opinion at the risk of contracting HIV/AIDS. Most of the rural people opined that they have high risk than that of urban persons [Table 6]. Low level of knowledge among the rural students and parents, particularly in terms of the preventive measures could cause respondents to feel that they are at high risk.
|Table 6: Opinion on the perceived risk of contracting human immunodeficiency virus/acquired immune deficiency syndrome among the study groups|
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Human immunodeficiency virus testing mandatory
For the question “is HIV testing mandatory,” rural people differ significantly from urban people by stating that it is mandatory. Nearly 34% of rural respondents have stated that it is not mandatory whereas this percentage is very low in case of urban people. A good percentage of the urban respondents feel that it should be left to the individual to decide.
Treatment toward human immunodeficiency virus positive
With respect to the attitude of respondents toward HIV-positive person, 67% of rural people and 59% of urban people have agreed that they would treat HIV-positive person differently.
Information to be kept private
Same percentages of urban and rural respondents have opined that “HIV patient has to keep the fact private.” Nearly 55% of rural people seem to be of the opinion that “the HIV person should tell the fact to others” whereas 47% of urban people have this opinion. Hence, there is an insignificant impact of locality of respondents on this opinion.
| Discussion|| |
The William J. Clinton Foundation is training private practitioners on managing HIV and opportunistic infections. The Foundation has pledged to help NACO train up to 150, 000 doctors over the next few years as well as strengthening the treatment agenda with major stakeholders. The Canadian International Development Agency funds the states of Rajasthan and Karnataka through the India-Canada Collaborative HIV/AIDS Project in targeted and prevention interventions and health systems' strengthening, especially care, support, and treatment. Several other programs are being implemented by many actors committed to arrest the further spread of HIV/AIDS as this is more of a social issue today rather than a health issue. However, in spite of these innumerable measures and the active role of media in the present context, it is disheartening to know that a sizeable number of children attending rural government schools still do not have adequate knowledge about HIV/AIDS so that they could protect themselves from this dreadful virus. It is high time that suitable strategies are developed and implemented to ensure universal coverage of the rural population. All the actors, including the corporate sector, should join hands to protect the future generations.
Previous studies have reported that a majority of the population had a limited degree of awareness of HIV/AIDS but had incorrect perceptions about the mode of transmission or prevention. Despite the vigorous outreach programs, which the government and other organizations had carried out, many people had several misconceptions about HIV or about people living with HIV/AIDS.
There is a clear indication on how rural students are deprived of access to knowledge in spite of the many programs that are taken up by the government and the NGOs and active role of media in disseminating information about HIV/AIDS. This could also be explained in terms of the sample where the urban sample was drawn from the private schools and the rural from the government schools.
There is adequate evidence in research literature that it is generally the poor children who attend the government-run school, who in turn might have limited access to media such as the newspapers and television, which has been quoted as the main source of information by the rural sample of this study [Table 5].
Teachers followed by parents are the main source of transmitters of information for students given that they spend most part of their active time period with them. As part of the AIDS education program, teachers were first trained so that they could, in turn, educate the students. However, this does not seem to be happening in rural areas in view of the low level of knowledge among students in the rural sample. Responses for the questions related to knowledge levels are properly ranked, and total knowledge scores are calculated.
The study targeted one of the most important measures to prevent HIV/AIDS, i.e., awareness of the disease. The study comprised a large sample size, transcending economic disparities, localities, and age. Numerous studies have assessed the levels of awareness among schoolchildren, but very few, if any, focus on the information givers (teachers and parents). The study also sought to compare the levels of awareness between urban and rural populations, which judging by the findings of the study is significantly different. The relatively small teachers' sample, however, is insufficient to estimate the levels of awareness and its effect on the information given to the students. A larger sample to better evaluate the awareness among teachers, both rural and urban, and its effect on the levels of knowledge among students also can be conducted. Furthermore, considering Mangalore is a small, semi-urban area, the study may not be an accurate estimate for HIV/AIDS awareness among the population of India as a whole.
In India, during the recent years, the central government has become more involved in raising awareness of AIDS and taking steps to prevent and contain it. The school AIDS awareness program titled “AIDS Prevention Education Program” was taken up in all the states to educate young people about virus, its impact, and how young people need to protect themselves as they are at a high risk of contracting it.
A multidisciplinary approach comprising targeted interventions such as early identification and treatment of STDs, condom promotion, blood safety, drug deaddiction programs, and long-term strategies such as awareness oriented to behavioral change, especially among vulnerable populations, young people and women, steps toward the improvement of literacy, status of women and overall development, reduction in poverty, and development of primary prevention interventions such as vaccines will have to be considered for effective prevention and control of AIDS in India.
| Conclusion|| |
It was noticed that despite numerous government-aided programs for HIV/AIDS awareness among schoolgoing children, a sizeable number of children, especially those attending rural government schools still lack adequate knowledge about HIV/AIDS. Hence, it is imperative that the school authorities and the others concerned should help design specifically created awareness campaigns for the benefit of the students so as to help them develop an adequate understanding of HIV/AIDS, its risk, spread, treatment, and prevention. An effort should be made to develop relevant curricula every semester depending on the knowledge structures and the perception abilities of the students.
- This document has benefited throughout from contributions and comments from friends and colleagues. Special thanks to our respective guides Dr. Manju Gopakumar, Dr. Kavita Rai, and Dr. Vabitha Shetty for all the timely help rendered in the completion of the study
- We would also like to acknowledge Prof. Mrs. Uma Vennam, SPMVV, Tirupati, for all the help rendered in the completion of this study. We also sincerely thank the teachers, parents, and especially the children involved in this study for their patience and wholehearted response toward the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]