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University of Ghana http://ugspace.ug.edu.gh












JULY 2013 University of Ghana http://ugspace.ug.edu.gh


I, Gifty Ayoma Blay declare that apart from references to other people’s works which have been duly acknowledged, this dissertation is as a result of my own independent work, and that this dissertation has not been submitted for the award of any degree in this or any other university elsewhere.

Gifty Ayoma Blay (Student)

Dr Mercy Ackumey (Academic supervisor)

i University of Ghana http://ugspace.ug.edu.gh


This dissertation is dedicated to the Lord God who counsels me, my husband, Mr Ketiboa Blay, my children Ewulay Blay, Arhizah Blay Abiti, Gifty Alima Blay, Kessie Kabenlah Blay and my grandchildren Betrand and Ketiboa Abiti for their kind blessings, support and encouragement throughout the study period.

ii University of Ghana http://ugspace.ug.edu.gh


I bless the name of the Lord God who protected and counselled me throughout this study. I wish to acknowledge and appreciate some individuals for their special efforts and assistance during the study period.

I am very grateful to Dr. Mercy Ackumey, my supervisor, for her guidance, encouragement and support throughout this work.

To Dr Philip Baba Adongo, Head of Department, and staff of the Department of Social and Behavioural Sciences of the School of Public Health, University of Ghana, I say thank you for the knowledge and skills you imparted to me.

And to my wonderful respondents, the female porters of Madina, I say a big thank you.

I am thankful to everyone who was of assistance to me in any way.

Thank you, all.

iii University of Ghana http://ugspace.ug.edu.gh


Sexually Transmitted Infections (STIs) are infections or diseases thatare passed on from person to person through sexual contact. The presence of an untreated ulcerative STI increases the risk of both acquisition and transmission of HIV. Low or lack of education of has been shown to be associated with low STI awareness and knowledge.

In Ghana clients with STIs are mainly young people of age 19-24 years, and female porters fall within this age group. In order to protect these young adults it is important to assess what they know about STIs. Therefore the aim of this study is to assess awareness and knowledge of STIs among this group of females. But due to very limited time of six weeks and material resources, the research (study) area has been necessarily limited to Madina township in the La-Nkwatanana Madina Municipality of Greater Accra Region.

The study design was a cross sectional explorative and qualitative research using focus group discussions. The target population for the study were female porters within Madina. A purposive sampling was employed to carry out five focus group discussions in three languages. The sample of participants (50) was selected for who they were.

The study found that level of education, media, workplace, health facilities, friends and families and colleague workers were important factors that influenced awareness and knowledge of STIs among the female porters in Madina.

There is need to organise a national capacity building programme in the identification and prevention of other STIs so that vulnerable women such as the Madina porters in this study can upgrade their knowledge and awareness of such infections.

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1.0 Introduction

1.1 Statement of the Problem

1.2 Research Question

1.3 Conceptual Framework

1.4 Objectives of the Study

1.5 Significance of the Study

1.6 Operational Definitions

1.7 Definition of Terms

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3.0 Method

3.1 Study Design

3.2 Study Area

3.3 Study Population

3.4 Sampling Method

3.5 Data Collection Procedure

3.6 Data and Analysis

3.7 Ethical Consideration

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6.1 Conclusion

6.2 Recommendations



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1. Table 1: Demographic characteristics of respondents……………………… 29


1. Figure 1: Conceptual framework the social ecological model……………… 9

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AIDS - Acquired Immune Disease Syndrome CDC - Centre for Disease Control and Prevention CRHCS - Commonwealth Regional Health Community Secretariat FGD - Focus Group Discussion GSS - Ghana Statistical Service

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1.0 INTRODUCTION Sexually transmitted infections (STIs) other than the human immune virus (HIV) are a major health problem affecting mostly young people, not only in the developing countries, but also in the developed countries. Studies have shown that diagnoses of STIs, especially syphilis, gonorrhoea and Chlamydia have been reported in several western countries especially among teenagers 16-19 years old (Samkange-Zeeb, Spallek, & Zeeb, 2011). STIs are infections that are spread primarily from person to person through unprotected sexual contact with an infected person (WHO, 2011). This sexual contact goes beyond vaginal intercourse it also includes anal genital and oral genital contact as well. There are more than 30 different sexually transmissible bacteria, viruses and parasites (WHO, 2011). Many of these infections, particularly the human immune virus (HIV) and syphilis, can be transmitted from mother to child during pregnancy and childbirth, and through blood products and tissue transfer.

STIs and their complications rank in the top five disease categories for which adults seek health care (WHO, 2011). The problem with most STIs is that they are asymptomatic (WHO, 2011). About 70% of women with gonococcal and chlamydia infections experience no symptoms at all and therefore STIs can thus be passed on unawares during unprotected sexual intercourse (WHO, 2011). The consequences of untreated STIs have adverse implications for reproductive and maternal health such as ectopic pregnancy, infertility, pelvic inflammatory disease and cervical cancer (WHO, 2011). According to estimates of WHO, 448 new cases of

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curable STIs (syphilis, gonorrhoea, Chlamydia and trichomoniasis) occur annually throughout the world mostly in people aged 15-49 years. This does not include HIV and other STIs which continue to adversely affect the lives of individuals and communities worldwide.

Majority of these infections occur in low and middle income countries in Latin America, Sub-Saharan Africa and Southeast Asia.

Nearly 19 million new cases of STIs are diagnosed each year in the United States, and more than 65 million Americans live with incurable STIs such as herpes and human papillomavirus (HPV). It is estimated that young people in particular are at a heightened risk of acquiring an STI and that those between the ages of 15 and 24 account for about one-half of the new STIs diagnosed every year, although this age group represents only one-quarter of the sexually active population (CDC, 2008).

In Zimbabwe STIs accounts for 6-10% of outpatient attendance and in Zvishavane a rural area in Zimbabwe, STIs were among the top five causes of outpatient consultations.

Meanwhile statistics showed a continual increase in STI cases, from 66 per 1,000 in 2002 to 97 per 1,000 in 2005, a 31% increase in STI cases. The magnitude of the problem was likely to be higher as STI patients often sought care from private providers, from which there is no available data (Chadambuka, Chimusoro, Maradzika, Tshimanga, Gombe,&Shambira, 2011).

It is estimated that in Sub-Sahara Africa 69 million new cases of STIs are recorded annually and these infections play a major role in contributing to poor reproductive health, especially

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in women.(WHO,2007) The disturbing feature seen in most developing countries is that since the emergence of HIV/AIDS so much attention has been placed on it leading to a situation where knowledge of HIV/AIDS within the population is high due to increased information and education through several media including mass communication media. This has, however, not been very well extended to other traditional STIs of which there is still a great deal of ignorance. (Adler, Cowan, French, Mitchel, & Richers, 2004).

It is estimated that among females aged 15-44 years STIs (excluding HIV) were the second commonest cause of loss healthy life after maternal morbidity, other studies have estimated that 5% of the total healthy life years lost in Sub- Saharan Africa are caused by STIs excluding HIV, and that HIV alone accounts for 10% of healthy life years lost (Adler, et al 2004). The lack of proper awareness and knowledge regarding other STIs may leave a large population of women (including female porters) vulnerable to contract infections. Awareness and knowledge regarding STIs are a general prerequisite for the prevention of STI infections.

), although knowledge and awareness have been reported to have a limited It has now been recognized that there is a synergy between most STIs and HIV infection, particularly ulcerative and inflammatory conditions such as genital ulcer and syphilis.

Research studies in both the developed and developing world have shown that HIV transmission and acquisition are enhanced by the presence of STIs probably because of inflammatory effects of STIs in the genital mucosa. HIV acquisition increases by two fold in the presence of STIs, and ulcers disrupt mucosa integrity and increase the presence or activity

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of both HIV and non-ulcerative STIs such as gonorrhoea, Chlamydia, trichomonasis vaginalis and bacterial vaginosis (Adler, et al 2004).

The Ghana Statistical Service stated in its 2008 Ghana Demographic Health Survey that 20.6% of females aged 15-49 years had some form of STI 12 months prior to the study.

Majority were aged 12-24 years, and 40% of women with STIs did not seek medical attention The Ghana 2011 HIV Sentinel survey reported that 513 new cases of syphilis were recorded during the year among women who attended antennal clinic (National AIDS/STI Control Programme, 2012). The issue that arises here is what happens to those who do not attend antenatal clinics? What information can be obtained on them, and how can they know their own status, since most STIs are asymptomatic?

1.1 Statement of the problem Sexually transmitted infections are public health problems with no easy solutions because they are rooted in human behaviour and are fundamental societal problems. In this researcher’s own experience as public health practitioner, it has been realised that many women (including female porters) have poor understanding of their own bodies and poor knowledge of the mechanism of STIs transmission and their levels of risk in unprotected sex with an infected person. This situation, it would seem, makes it necessary to investigate the awareness and knowledge in female porters, especially as their needy status seems to render them extremely vulnerable and exposed to unprotected sex.

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As can be readily observed in the markets and car stations, female porters are mostly young girls (adolescents) with a few adult women who migrate from rural areas all over the country (but mainly from the northern part) to cities, especially Accra and Kumasi, in search of all sorts of jobs for a living. But largely due to lack or low levels of employable knowledge and skills, they end up in markets and commercial streets where carrying of head-loads (headporting) is the only menial job they are readily able to do for money. Not all these porters leave home primarily in search of jobs. Some may flock to the cities to have a feel of city life no matter the hardship and consequences, or to escape forced early marriages traditionally common in their communities (Oral communication from some porters in Accra central and Madina, 2012). This is corroborated by Wilson (2012) and Opare (2003). These porters, majority of them being adolescents, have no homes in the city and so live on streets and in obscure corners. They are exposed to varied social influences including, indulgence in alcohol, drugs and promiscuous and convenience sex out of peer pressure and sheer financial need. As a result they become vulnerable and may be taken advantage of by males and forced into unprotected sexual activities.

In addition to being highly multi-ethnic but with the northern extraction being significantly high (Opare, 2003), many female porters arriving in Accra tend to head for Madina as a residential base (albeit on streets) or as operational area for their porter services. Like their colleagues elsewhere, female porters in Madina are faced with the fortunes of indulgence in alcohol, drugs and promiscuous and convenience sex that confront female porters out of peer pressure and sheer financial need.

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In view of the potential high risks of teenage pregnancy, abortion and its complications, HIV/AIDS and other STI infections associated with unprotected sex, there is need to assess the awareness and knowledge of these Madina female porters to know their sources of information about STIs and how they protect themselves from them. This is the rationale for this study.

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