Relationship Between Knowledge, Attitude & Practice of Condom Use

ABSTRACT
Effectiveness of condoms in preventing pregnancy or STIs depends on the user. Risk of
pregnancy or STIS is greater when condoms are not correctly and consistently used with every
sexual act. When used every time and in an approved manner, it highly prevents STIs and HIV
transmission. Choma District where the study will be conducted is recorded as one of the
districts with high STIs/HIV prevalence and high pregnancy rate among the youths. This
indicates that use of preventive measures is low or preventive measures are not correctly used.
This has prompted the researcher to conduct a study in an area.
The objectives of the study was to determine the relationship between knowledge and practice
on secondary school pupils on condoms use in relation to STIs/HIV prevention. The research
further determined the relationship between knowledge and attitude in secondary school pupils
on condom use. It also determined the relationship between attitude and practice in secondary
school pupils on condom use. Furthermore the research was to determine if there is a
relationship between attitude and social, religious including traditional factors on secondary
School pupils in relation to STIs/HIV prevention. At the end of everything the research came
up with recommendations which can be implemented to improve behaviour change towards
condom use on the high school pupils.
The study was conducted in Choma district particularly Secondary Schools within the District.
It was an analytical cross sectional study that targeted both male and female pupils who are in
the High schools within Choma District. Multistage random sampling was used to come up
with the sample size. Data was collected by the researcher using simplified structured
administered questionnaire that were completed by pupils. Pupils were graded according to
their scoring on questionnaire. Data analysis was done by IBM SPSS version 20.0 and the chi-
squared was be performed to test for relationship between variables of interest.
STIs/ HIV still remain a global challenge. This indicates that preventive measures are not used
or not correctly used. Hence this still calls for joint efforts by policy makers, governments and
Non-Governmental Organizations to make available awareness on the importance of the use of
preventive measures in correct way. Hence the information obtained from this study is of great
importance to different stakeholders to determine the level of knowledge, attitude and practices
on condom use in relation to STIs/HIV prevention.

The study clearly indicated that there was a significant relationship between knowledge and
attitude of the High School pupils on Condom Use, it further indicated that there was a
significant relationship between knowledge and practice. It also clearly indicated that there was
a significant relationship between Attitude and Practice of Secondary School pupils. However
on the other hand the study indicated that there is no significant relationship between Attitude
and traditional factors of the respondents and it further indicated that there is no significant
relationship between Attitude and Religious factors of the respondents.
Following the findings of the study the following recommendations were stipulated, The
government through the ministry of Health must produce literature, come up with radio
programmes, Television Programs and Drama groups to provide education on the importance
of condoms use in prevention of STIs/AIDS. Furthermore the government through ministry of
health should call for seminars to the youths to teach them about proper condom use and its
importance in the prevention of STIs/AIDS. Institutions were youths are found such as schools
and youth recreation centres must have counsellors to freely educate youths on proper condom
use and discuss with them on matter of condom use in order to improve their attitude and they
must be provided with billboards were messages pertaining condom use can be displayed.
These billboards must be put also in youth centres and public places where everyone can freely
read the message about condom use. Families must also take primary steps in the education of
their children on proper condom use and its importance in the prevention of STIs/AIDS.

CHAPTER ONE
1.0 INTRODUCTION
1.1 Background of the study
Sexually transmitted infections (STIs), human immunodeficiency virus (HIV) and acquired
immune deficiency syndrome (AIDS) continue to be a major health problem worldwide,
particularly in young adults and in Africa. There is an increasing number of HIV infected
patients in Zambia (2010-2012 severance record). This implies that the use of preventative
measures, such as condoms, is low.
The condom, of which exist both a male and a female type, has a dual function. It is a barrier
method of contraception; it is also the most efficacious available means for reducing the risk
of transmission of agents of sexually transmitted infections (STIs), including HIV. Male
condoms are made of latex, polyurethane, or synthetic elastomers. On the contrary, the female
condom, which is available under various trade names, is made only of polyurethane. Condoms
have gained more importance for preventing the spread of AIDS. Yet, a large section of the
population, ignoring the risk of STI-transmission, still has unprotected sexual intercourse
(Kumar GA, Dandona R, Gutierrez JP, et al.)
Globally, sexual behaviour change remains a primary goal of HIV prevention efforts. It is a
complex issue influenced by numerous variables such as individual desires, social and cultural
relationships, environmental and economic dynamics (Njau et al., 2006). Protecting oneself
and others from STIs is important because many of these diseases have serious complications
or can lead to death. Young people are vulnerable to HIV probably because of risky sexual
behaviour and their poor access to HIV information and prevention services.
Many young people do not believe that HIV is a threat to them, and others do not know how
to protect themselves from infection (WHO, 2004). Sexual relations typically occur before
adolescents have gained experience and skills in self-protection, acquired adequate information
about STIs or have had access to health services and supplies (such as condoms). Young
people’s sexual relations are often unplanned, sporadic and, sometimes, the result of pressure
or force.
The HIV/AIDS pandemic has helped raise public awareness on the importance of adolescents’
health since they are at the centre of the pandemic in terms of transmission,

impact, and potential for changing the attitude and behaviour that underlie this disease (WHO,
2004). Basic knowledge about HIV/AIDS does not always lead to less risky behaviour. It is
very difficult to change any behaviour, and especially sexual behaviour, once it has become a
habit (UNICEF, 2006). Around the world, successful prevention programmes among young
people are those that equip adolescents with the knowledge, skills and attitudes that will keep
them safe from infection before they become sexually active.
It is evident that several factors work together to influence adolescent sexual behaviour and
condom use. Their socio-demographic characteristics, perception of peer behaviour and their
attitude towards their sexual and reproductive health may impact greatly on whether or not they
have sex, the number and types of sexual relationships they form and their condom use.
Pending the discovery of an effective vaccine or therapy, reduction of risk taking behaviour is
the only way in which the spread of the AIDS pandemic will be arrested (Toroitich-Ruto,
2004).
In many developing countries, male condoms are freely available from public health facilities.
More than 30% of groceries and kiosks outlets commonly found in low income residential
areas are stocked with free condoms in Zambia. Users’ access to condoms was greater for
poorer compared to wealthier respondents because of their residential areas within a ten
minutes’ walk of a condom outlet, thus eliminating socio economic inequality in condom
access (2010-2012 severance record).
Youths are recorded to have higher percentage of the STIs/HIV positive in Zambia. These are
usually youths of schooling age. Sexual contact accounts for the most of the cases (WHO,
2004). Choma District where the study was conducted is recorded as being one of the districts
with high HIV/AIDS prevalence rates within Zambia, (HIV/AIDS record 2010 Choma). Since
sexual contact accounts for the majority of the cases, this may put the youths on the risk of
contracting STIs including HIV, the purpose of this study was to determine knowledge, attitude
and practice of secondary school students on condom us. The information obtained is to be
used by the adolescents so that they develop positive attitudes, values and skills needed to
achieve behavioural changes necessary to protect themselves from HIV infection.

1.2 Problem statement
Condom use is one of the most popular forms of mechanical barriers against STIs/HIV as it
provides protection for the genital tract. It also prevents pregnancy by acting as a barrier
stopping semen from passing into the vagina (Jain et al., 2009).
It is estimated that 44 million couples use condom for family planning while as many as 60%
of all condoms are used outside marriage worldwide (Gardner et al., 2001).
The effectiveness of condoms in preventing pregnancy or STIs depends on the user.
Previous studies showed that pregnancy rate among correct condom users is about 2% per year.
The risk of pregnancy or STI is greater when condoms are not used correctly and consistently
with every sexual act. When it’s used every time and in the approved manner it could prevent
up to 80 to 95% of HIV transmission (USAIDS, WHO, 2007).
However an estimated 10.3 million young people aged 15-24 years are living with HIV/AIDS
worldwide (WHO, 2004). ). Choma District where the study was conducted is recorded as
being one of the Districts with high HIV/AIDS prevalence rates among the youths in Zambia,
(HIV/AIDS record 2010 Choma). ). Since sexual contact accounts for the majority of the cases,
this implies that the use of preventative measures, such as condoms, is low or preventive
measures are not used correctly. Condom use being one of the protective measures for the
transmission of HIV/AIDS, this research was conducted to determine the knowledge, attitude
and practice of condom among secondary school young adults.
1.3 Justification
The virus that causes AIDS has infected and is infecting many Zambians. According to the
2001/2002 Zambian demographic and health Survey about 16 percent of the adult population
(15-49 years for females and 15-59 years for males) in Zambia was HIV positive. Of which the
highest proposition of young adults showed being HIV positive. These are generally youths of
schooling age. To date there is little information pertaining the knowledge, attitude and
practices of condoms among secondary school young adults. It is for this reason that there is a
need to carry out this study.
The results of the study will help the health sector to know what must be done on the secondary
school youths in relation to use of barrier methods (condoms) in prevention of STIs and HIV.
The results will further help determine how effective the promotion on condom use has been

effective among secondary school young adults by determine their knowledge, attitude and
practice on barrier prevention methods.
1.4 Objectives:
1.4.1 General objectives:
To determine the knowledge, attitude and practices regarding condom use by secondary school
pupils in relation to prevention of STIs/HIV
1.4.2 Specific objectives:
i. To determine the relationship between knowledge and practice on secondary school
pupils on condoms use in relation to STIs/HIV prevention.
ii. To determine the relationship between knowledge and attitude in secondary school
pupils on condom use in relation to STIs/HIV prevention.
iii. To determine the relationship between attitude and practice in secondary school pupils
on condom use in relation to STIs/HIV prevention.
iv. To determine if there is a relationship between attitude with
A) religious factors
B) And traditional factors on secondary School pupils in relation to STIs/HIV
prevention.
1.5 Research Questions
The study embodied to answer the following research questions:
i. Is there any relationship between knowledge and practice on secondary school pupils’
condom use in relation to STIs/HIV prevention?
ii. Is there a relationship between knowledge and attitude on secondary school pupils’
condom use in relation to STIs/HIV prevention?
iii. Is there any relationship between attitude and practice in secondary pupils condom use
in relation to STIs/HIV prevention?
iv. Is there any relationship between attitude and, religious including traditional factors
with on secondary school pupils’ condom use in relation to STIS/HIV prevention?

1.6 Conceptual Framework
Various factors influences practices or condom use in relation to prevention of STI/ HIV. These
factors includes knowledge, attitude, social factors, traditional factors and religious factors.
Figure 1 shows the conceptual frame work on the factors influencing practice/ condom use.
Figure 1
1.7 Significance of the study
The issue of STIs/ HIV is a pandemic problem especially among the youths. The present focus
is on preventing new infections. Large-scale information campaigns and condom distribution
programmes are being done in Zambia.
The researcher is of the opinion that more has to be done on educating the youths on condoms
use and change their attitudes. Hence the results of this research are of great benefit to the
health sector, Nongovernmental organisations (NGOs), and other stakeholders that are fighting
the pandemic.
Condom use
Attitude
Knowledge
 Traditional
factors
 Religious factors

1.8 Operational definition of terms
1.8.1 Knowledge: For the purpose of this study, knowledge is an awareness that the
respondents have on condom use in relation to prevention of STIs/ HIV.
1.8.2 Attitude: In this study, attitude refers to the respondents’ feelings, thoughts or beliefs
about condom use in relation to STIs/HIV.
1.8.3 Practices: practices in this study refer to the habit, custom or tradition surrounding
condoms use in relation to prevention of STIs and HIV.
1.8.4 STIs (Sexual Transmitted Infections): in this study, Sexual transmitted infection
refers to any direct contact infection that can be transmitted through sexual intercourse
in exception of HIV/AIDS.
1.9 Operational definition of variables
Variables Parameter Indicator
Knowledge i. Knowledgeable
ii. Not knowledgeable
75% and above
Below 75%
Practice i. Excellent
ii. Good
iii. Poor
75% above
50-75%
Below 50%
Attitude i. Good
ii. Bad
75% above
Below 75%

CHAPTER TWO
2.0 LITERATURE REVIEW
2.1 History of condom in the world
The use of the condoms is traced back to several thousand years ago. Condoms were invented
in the fifteenth century in response to syphilis epidemic in Europe. Since then, the texture of
condoms was developed from different kinds of materials such as leather and animal gut.
During eighteenth century, the technological development improved the quality of condoms.
Rubber was developed as material because of its strength and elasticity. The role of male
condom for both contraception and prevention of STIs was established in Europe during this
century (Lewis, 2000).
2.2 Knowledge on condom use
Knowledge on condom use varies from one place to another. Therefore knowledge on condom
use is going to be discussed and global level, Africa level and knowledge in Zambia.
2.2.1 Knowledge on condom globally
According to the Joint United Nations Programme on HIV and AIDS (UNAIDS), knowledge
of the effectiveness of condoms in preventing HIV transmission is high in most countries,
however many people still fail to use them consistently especially those who engage in high
risk sexual practices. A survey commissioned by the united nations general assembly in 2007
and done in 64 countries, found high levels of knowledge related to condoms on average.
However on a differential analysis the level of knowledge in females was lower at 55%
compared with the males at 70% (UNAIDS 2008).
A study was conducted in Rajshahi district of Bangladesh which showed that knowledge and
use of contraception were low. Condoms were only use in 17% of the cases (Moisur et al.,
2009). Another study conducted in Pakistan, showed low knowledge regarding the appropriate
use of condoms even among contraceptive users (Fikree et al., 2005).
Likewise, A study which was conducted on family planning in Baghdad capital of Iraq in 2003
showed that knowledge about condoms were patchy and although males knew that there are
some benefits in using condoms for family planning 84% only 4.2% considered using this
means of contraception (Fikree et al., 2005).

2.2.2 Knowledge about condoms in Africa
Mufune (2005) reports that despite an intensified program to promote condom knowledge and
use in Namibia, their acceptance and use remained low. According to UNAIDS (2008)
knowledge of condoms is high in Namibia with rates over 60%. Bankole et al (2007) in a study
of consistent and correct condom use among adolescents in four African countries (Malawi,
Ghana, Burkina Faso and Uganda) found that those respondents who gave correct responses to
questionnaire items were 50% and less in all the countries with a range from 26% to 50%.
Questionnaires included items to test respondents‟ (adolescents‟) knowledge on how condoms
should be worn, when they should be put on in relation to the sexual act and whether they could
be used again. Knowledge on condoms depended on prior witnessing of demonstrations of their
use and sex education sessions. In Somalia levels of knowledge related to condoms were quite
low. Only 4% of women in the ages 15-24 years and only 11% of adults knew the effectiveness
of condoms in preventing HIV (UNAIDS 2008).
In a survey conducted on adolescent sexual and reproductive health in Uganda, it was revealed
that knowledge of condoms was high among the surveyed youths under the age of 24 years and
from rural areas. However only half of the respondents reported of having ever used a condom.
Morris, etal (2000) report from Rakai District, a rural area in Uganda, that people who travelled
regularly had a high level of knowledge and acceptance of condom use. This paper focused
more on regular travellers and therefore little if any information was reported about the non
regular travelling public. It was reported in the 2001 demographic and health survey that there
was a high level of knowledge among the respondents (over 80%), that condoms are a
contraceptive device (UBOS and Macro 2001).
2.2.3 Knowledge of condoms in Zambia
According to the study done by Sohail Agha on sexual activity and condom use in Lusaka it
indicates that the median age at first penetrative sex among young people aged 15-24 was 19.5
years for males and 17.5 years for females an increase since 2000 of two years among males
and one year among females. Among respondents aged 20-24, 86% have ever had sex, a decline
of about 5% since 2000.
The study further stipulates that 70% of the youths had knowledge on condom use. About 42%
of male respondents mentioned that they used condoms during their last sexual encounter with
a non regular partner, while the proportion among females was 35%. Condom use was more

prevalent in urban (54%) than in rural (28%) areas. Only 53% of adults expressed support for
education on condom use for prevention of HIV/AIDS among young people.
Zambia Sexual Behaviour Survey (ZSBS 2009) records that Condom use was significantly
higher among women aged 15-24 than among those aged 25 and older. Among men, condom
use was significantly higher for men 15-29 than for those 30 and older. There were no
significant differences in condom use between men and women aged 15-19 and those older
than 30. Condom use at ages 20-24 and 25-29, however, was significantly higher for men than
for women.
The result of the survey further showed that Condom use varied significantly by relationship
with last partner. For both women and men, condom use was almost three times as high for sex
with a regular or a casual partner as for sex with a marital partner. (Of the five men in the
survey who reported having had sex with a commercial sex worker, three used condoms.) It
also showed that there was no significant association between schooling and condom use at
last intercourse for women or men. The absence of a significant association with schooling is
surprising, and suggests that factors other than education may have a more important role in
determining condom use in Lusaka. Nevertheless, it is possible that some effect of schooling
on condom use is captured by the respondent's age or his or her relationship with the last
partner.
2.3 Condom use and STIs/ HIV
Condom is one of the most popular forms of mechanical barriers as it provides protection for
the genital tract from sexually transmitted infections (STIs). It also prevents pregnancy by
acting as a barrier stopping semen from passing into the vagina Jain et al., (2009).
Condoms were shown to be over 90% effective in preventing pregnancy, the transmission of
HIV and other sexually transmitted diseases (Stammers 2005). Several studies done among
discordant couples who engaged in regular sexual activity support this finding. Weller & Davis
(2003)
2.3.1 Condom use and STIs/ HIV globally
Worldwide condom use during sexual intercourse, an estimated 44 million couples use condom
for family planning while as many as 60% of all condoms are used outside marriage (Gardner
et al., 2001).The effectiveness of condoms in preventing pregnancy or STIs depends on the

user. Previous studies showed that pregnancy rate among correct condom users is about 2%
per year. The risk of pregnancy or STI is greater when condoms are not used correctly and
consistently with every sexual act. However, when it’s used every time and in the approved
manner it could prevent up to 80 to 95% of HIV transmission (USAIDS 2007). Condoms also
reduce the risk of STIs spread by skin to skin contact, such as herpes and Human Papilloma
virus.
Condoms have been and are an integral part of STIs/ HIV preventive measures worldwide and
many countries have designed programs that encourage people to use them Versteeg and
Murray (2008). Despite this concerted effort, many people don’t use condoms consistently
(UNAIDS 2008). Lubek, D.Y, etal (2003) in an investigative study in Cambodia found a low
level (58.7%) of condom use by sex workers in comparison to the neighbouring countries of
Thailand and Singapore; this was despite an almost 100% knowledge of the incurability of HIV
infection and presence of programs on condoms established by authorities for these sex
workers. The low level of condom use was partly due to paying clients refusing to use condoms
and emotional attachment to their non-paying clients.
Maet etal (2002) in a prospective cohort study on STD and condom use in Guangzhou, China,
found that there was an increase in consistent condom use among female sex workers from
30% to 82% over a period of 18 months. This was because the program provided them with
knowledge about the transmission of HIV and the role condoms play in reducing that
transmission. This increase in consistent condom use led to a decreased incidence of sexually
transmitted diseases by an average of 78% over the same period of time. Hence the above
information indicates that condom use in relation to STIs/ HIV prevention is globally
distributed.
2.3.2 Condom use and STIs/ HIV in Africa
While researching the use of condoms and related STIs/ HIV knowledge in Côte d’Ivoire, it
was reported that condom use among men was low and this decreased further with age from
about 35 years onwards; married men were least likely to use them. The problem is that it is
men who control sexual matters in relationships in most African settings. The level of
knowledge a person had about STIs/HIV was in tandem to the level of condom use. It was also
found that living in an urban area and having a low education were associated with decreased
level of condom use (Zellner 2003). Bunnell etal (2005) quoting Allen et al 2003 and Kamenga
et al 1991) reports a fold rise in condom use among discordant couples in both Congo and
Zambia. This was the result of sustained efforts in voluntary counselling and testing (VCT) and

therefore a reduction in HIV transmission and conversion rates. Despite this, HIV incidence
and pregnancy still occur among such couples probably due to a desire for children or a low
quality of VCT services offered to them. There has also been a noticeable increase in the use
of condoms by those who reported having multiple sexual partners in selected countries across
the sub Saharan region. That said though, there is a new trend developing where decline in
condom use in some countries is being noticed (UNAIDS 2008).
In Cameroon, many young men change sexual partners often. Condom use is low in regular
relationships, even though many young people have multiple regular partners.
Accessibility and knowledge about condoms have not translated into condom use in Cameroon
and South Africa Cleland .J & Mahara. P (2006). However, at a Nigerian University, 55% of
the students were sexually active. 70% of the men used condoms during sex. Simbayi S.C,
Kalichman S.J, Vuyisile M, et al (2004).
In Rwanda, of the students who had sex, 71% of the women reported condom use during their
last sexual act with a regular partner. These students used condoms more often with regular
partners than they did with casual ones Olley B.O & Rotimi O.J (2003). Condom promotion
campaigns in sub-Saharan Africa have resulted in increased condom use in young single
women and married couples. In Gabon, individual adherence to condom usage progressed from
64% to 95%. In Nicaragua, 85% of young adults believed that consistent condom use could
prevent STIs/ HIV infection, but only 21% of them used condoms regularly (UNICEF; 2001).
In Egypt, results of a study on the knowledge, attitude of condom use in 2007 showed that
although condoms was considered effective method of contraception and prevention of STIs
by 60%, only 23% had ever used condoms solely for contraception (Kabbash, 2007). Therefore
generally the level of condom use in Africa is average.
2.3.3 Condom use and STIs/ HIV-the Zambian context
(ZSBS 2009) records that HIV/AIDS knowledge is almost universal among adult males and
females in Zambia. Almost everyone interviewed (99%) mentioned that they have heard of
HIV/AIDS. About 95% of respondents in both rural and urban areas reported knowing that
HIV/AIDS can be avoided an increase from 81% in 2000.

It further records that Over 80% of respondents recognized that consistent condom use is a
way to prevent HIV/ AIDS transmission, however, only about 45% of female respondents and
about 53% of male respondents indicated that condoms are “very effective” in preventing the
infection. Between 64% and 79% of respondents rejected the common misconceptions about
HIV transmission: that mosquito bites (64% of respondents), witchcraft (64% of respondents),
or sharing food (79% of respondents) can transmit HIV/AIDS. Among youths aged 15-24,
abstinence was the most recognized way to prevent HIV transmission (74%), followed by
condom use (62%), and having only one faithful partner (34%). However, only 18% of youths
aged 15-24 spontaneously named all three ABCs of prevention (Abstinence, Be faithful,
Condom use). About 80% of youths mentioned that they know an acceptable place to purchase
a condom.
2.4 Attitude to condom use
There is a difference on the global perception on attitude to condom use. Therefore attitude to
condom use will be discussed at a global perception, African and Zambian view.
2.4.1 Attitudes to condom use globally
In Sao Paulo, Brazil, most HIV positive, heterosexual men used no condom when having sex
because they were unaware of their HIV positive status until they were tested due to illness. In
New Zealand, one out of four sexually active teenagers reported non-use of a condom because
they did not think either they or their partner had an infection, and a similar proportion did not
use a condom because they applied other contraceptive measures. Common reasons for non-
use of a condom among drug users in Rhode Island, USA, included a lower perceived risk of
contracting STIs, and a negative attitude towards the effect of a condom on pleasure, European
Journal of Contraception and Reproductive Health Care June (2008 ).
2.4.2 Attitudes to condom use in Africa
Zellner (2003) reports that attitudes to condoms (and consequent use) in Côte d’Ivoire Men
indicated condom use as important only for extra marital sex while, for women, condoms
served a contraceptive purpose. Maharaj and Cleland (2005) reported that among couples with
a high education level there was an associated positive attitude towards condom use. Women
who were less educated, or who were from a rural area had lower positive attitudes to condoms
(31%) than their urban and well educated counterparts (76%). The urban women were more
likely to discuss condom use with their partners than were rural women. Men had a negative

attitude towards condom use within a marriage. Agha, Kusanthan, Longfield, Klein and
Berman (2002) quoting several authors in their literature review about non condom use in
African countries, reported reasons for not using condoms such as: emotional distance;
reducing naturalness of sexual intercourse; and lack of lubrication and consequent dryness and
pain.
The European Journal of Contraception and Reproductive Health Care (EJCRHC 2008) reports
that in sub Saharan Africa, perceived lack of efficacy and condom related problems were
barriers to condom use. In South Africa, the negative attitude towards condoms and other
contraceptives was consistently associated with the probability of decreased free condom
procurement from public health facilities. In Nigeria, the major barriers to condom use
experienced by truck drivers were that the condom reduced their sexual satisfaction and
hindered their sexual interest. In Kenya, men who had coitus with sex workers refused to use
a condom under the pretence that the condom was unpleasant, defective, harmful, unnecessary,
and too hard to use. The most common reasons adduced for non-use of a condom by South
African university students were ‘I do not have the AIDS virus’ and ‘I thought I was safe’,
apparently indicating their low perceived susceptibility behind avoidance of condom use.
2.4.3 Attitude to condom use in Zambia
Attitudes towards condoms, with regard to Zambia, are discussed in terms of personal attitudes,
culture and religion.
2.4.3.1 Condom use and personal attitude
In Zambia, having a sexual partner from the same community was associated with non-use of
a condom. It is further considered that condom use reduces sexual pressure (EJCRHC 2008).
2.4.3.2 Condom use and Culture
Pool et al (2006) report that using a condom in a stable relationship is considered a “taboo” in
most of African countries including Zambia and this reason accounted for about 39% of non
use of condoms. This was corroborated by the findings of Ntozi et al (2003) among high risk
groups. According to UNAIDS (2008) culture plays a major role in who will use the condom
and when it will be used with women being in a disadvantaged position when it comes to
negotiating condom use. Culture often relegates women to passive roles on sexual matters
while male masculinity roles result in risk taking, aggressiveness and excessive alcohol

consumption, often defined by society and culture, leading men to engage in unprotected sexual
escapades.
According UNICEF (2004) reports that, women reported that the relationship with their
partners had been difficult because of the absence of dialogue about sexual matters and men
always had the final word. Despite being informed about AIDS, women did not use preventive
measures in their steady relationship because they did not wield decision making power.
Furthermore WHO (2003) report on condom use starches that the social dimensions of
masculine sexuality, pleasure, eroticism and emotional aspect of men’s lives influence condom
use. Men’s emotional fulfilment with attainment of satisfaction through direct penile-vaginal
contact and ejaculation during natural intercourse is an obstacle to condom use. Some men
perceive prolonged sexual intercourse without a condom as a sexual prowess in the domain of
masculinity and seek to preserve this manly skill by avoiding condom use.
2.4.3.3 Condoms and religion in Zambia
Religious ideology influences condom use. The measure of religiosity (group affiliation,
attendance at religious services, attitudes, perceptions of negative sanctions and adherence to
sanctions) was found to be associated with sexuality. Religious behaviour is a strong predictor
of sexual behaviour. Many aspects of religiosity are associated with general sexual attitude
(EJCRHC 2008).
Since its very inception, some churches like the Roman Catholic Church has forbidden the
application of contraceptive measures because it considers that such interference is a
transgression of divine law and a sin against nature. In the encyclical of Pius XI Casti Connubii
(1930) and in that of Paul VI Humanae Vitae (1968) birth control was again categorically
rejected. In spite of their difficult application and poor efficacy, only the so called ‘natural
methods’ (e.g., rhythm method, Billings method) are allowed. The use of contraceptives is
prohibited whatever the circumstances. This also applies to the condom even when one intends
to use it, not to prevent pregnancy, but to avoid a fatal infection such as HIV/AIDS. For
instance, the use of a condom within the marital relationship when one of the spouses is HIV
positive is considered sinful.
An obvious different interpretation developed within Christianity as, with few exceptions, the
Protestant churches emphasised birth control, basing their views on their Puritan tradition and
responsibility founded on a Christian social ethic (EJCRHC 2008).

According to the information discussed in the literature review, knowledge, attitude and
practice on condom use varies from region to region and different variables influences condom
use. These include cultural, spiritual, social, availability of condoms and the level of condom
use awareness in STIs/HIV prevention.

CHAPTER THREE
3.0 MATERIALS AND METHODS
3.1 Study design and type
The research was an analytical cross sectional study. Data about variables was collected in the
form of number and then analysed by statistical calculation. A cross sectional study was
adopted to allow data collected only at once from the sample group within a brief span of time.
This made the study easy and relatively cheap.
3.2 Study area
The research was conducted in Choma district particularly Secondary Schools within the
district. Choma is situated at 16.82° South latitude, 26.98° East longitude and 1325 meters
elevation above the sea level. Choma is a small city in Zambia, having about 46746 inhabitants.
The average temperature of 22 degrees centigrade is recorded during the cold season and 39
degrees centigrade during the hot season and the area experiences an average rainfall of
620mm-800 mm. Common soil types includes sand, sandy loam and red clay soil (CSO, 2010).
Choma District has a total of 95 basic schools, 10 secondary schools and the Choma Trades
Training Centre.
3.3 Study population
The study targeted both male and female youths who are in senior secondary schools (grades
10-12). These were therefore pupils from within the district, pupils who are from outside the
district were not be included.
3.4 Sampling
Since it is more expensive and time consuming and sometimes not possible to study the whole
target population a sample was determined.
3.4.1 Sampling Method
A multistage random sampling method was used in this research. Choma district has a total
number of 10 Secondary Schools. 4 of the secondary schools are based within the town centre
of the district. The remaining 6 secondary schools are located with varying distance from the
town centre. Two Secondary Schools were randomly sampled from those located within the

town centre and those outside making the total number of four secondary schools which were
randomly sampled.
The pupils were stratified according to their grades (Grade 10-12) resulting into formation of
3 stratums at each school sampled. From each stratum pupils were randomly picked using the
lottery method. This ensured that each pupil in the 3 stratums has an equal and independent
chance of being included in the sample thus avoiding selection bias. The number of the pupils
selected from each of the four sampled school depended on the sample size. Since the sample
size added up to 320, 80 pupils were systematically selected from each school.
The randomly selected pupils from the stratums were then be individually selected using
systematic random sampling. To obtain a truly random sample a list of all the pupils who were
picked from the stratums was made to act as sampling frame. Once this sampling frame was
obtained randomized the researcher then decided the sampling interval.
To decide on the sampling interval the researcher calculated 0.5% of the total number of the
sampling frame from the stratums. The first pupil was selected blindly using a table of random
numbers after which the remaining pupils were selected at regular intervals from the obtained
sampling frame. This process was continued until the required school sample size was
achieved.
3.4.2 Sample size
As stated above Choma district has a total number of 10 schools of which 4 schools were
sampled. These schools have approximately 400 in their Senior Grades (10-12). District
Education Board Information (2014). Bearing this fact would mean 4 sampled School added
up to 1600 pupils as the population from which the representative sample was driven. Therefore
the sample size was obtained by n=N/1+N(e)2 using 95% confidence level:
n=
𝑁
1+𝑁( 𝑒)2
n=
1600
1+1600(0.05)2
n=
1600
1+1600 (0.0025 )
𝑛 =
1600
1 + 4
𝑛 =
1600
5

n= 320
Therefore the sample size was 320
3.4.3 Sample determination
Sample size was determined using the formula 𝑛 =
𝑁
1+𝑁( 𝑒)2
Where:
n= Sample Size
N= Population size
e = error margin (95 confidence level)
3.5 Research tools
Data was collected by the researcher using a simplified, structured, self-administered
questionnaire completed by pupils at their institute. It was thought that a self administered
questionnaire would offer participants greater freedom to express their attitudes when
compared with the personal interview approach. . The questionnaire was based on the World
Health Organization AIDS programme knowledge, attitudes, beliefs and practices survey in
1988 and on other available literature
3.6 Validity
Validity was achieved in this study by proper development, review and perfection of the
question of the questionnaire basing on the literature review and objectives of the study.
Furthermore the content in the questionnaire was judged and perfected with the guidance of
supervisors based on their expertise in the research.
3.7 Reliability
To ensure that reliable data is obtained pupils were instructed not to discuss the questions with
their colleagues. If they have any queries, they were encouraged to ask the researcher and be
guided on what to do.

3.8 Data collection and technique
Data was collected using simplified questionnaires administered to pupils. Two weeks was
given to the pupils to answer the questionnaires. After two weeks the questionnaires were
collected by the researcher and they were marked. On each question, 1 point was awarded for
a correct answer and 0 point for an incorrect choice or no response. The questionnaire had five
parts, part one demographic information, part two (questions on knowledge), part three
(questions on attitude) and part four (questions on practice), part five (questions on religious
factor) and part six (questions on traditional factors).
3.9 Pilot study
To ensure reliability and validity, and determine clarity of the questionnaire and consistency of
responses, the researcher conducted a pilot study. A pilot study was conducted at choma
secondary school on limited number of pupils in all the grades from grade 10-12. It was
assumed that since this is also secondary school pupils have same level of understanding with
the target population. Corrections were made after pilot studies on areas were need arose.
3.10 Ethical consideration
Prior to conducting this research, permission was sought from Choma District Medical Office
(MDO).
Researchers also informed the study participants about the general objectives of the study and
that the questionnaires were anonymous in order to ensure the confidentiality of the information
provided.
3.11 Data analysis
Quantitative data was obtained from the study and Statistical Package for Social Scientists
SPSS, version 20.0, was used to enter and analyse the data. The total for each section was
calculated as the average of the percentage correct responses. The chi-squared test was
performed to test for differences in proportions, when appropriate.
3.12 Findings dissemination
Study findings will be printed and made available on soft copy. Printed copies will be
disseminated to the school were the study will be conducted, Choma district medical offices,
Rusangu university and all interested stakeholders. Presentation on the findings will be
conducted at Rusangu University by the researcher.

CHAPTER FOUR
RESULTS AND DISCUSSION
4.0 Introduction
This chapter presents results findings on the research undertaken and gives comprehensive
discussion in relation to the research objectives.
4.1 Respondent Frequencies Presentation
4.1.1 Schools Frequency Presentation of the Participants
Table 4.1.1 below shows the cumulative frequency of participants according to the sampled
schools. It is indicated that 25.6% were participants from Choma Secondary, 25.3% from
Chuundu Day School, 25.0% from Choma Day High School and 24.1% from Masuku
Secondary.
4.1.1 School of Participants
Frequency Percent Valid Percent Cumulative
Percent
Valid
Choma Secondary 82 25.6 25.6 25.6
Chuundu Day School 81 25.3 25.3 50.9
Choma Day High School 80 25.0 25.0 75.9
Masuku Secondary 77 24.1 24.1 100.0
Total 320 100.0 100.0
4.1.2 Gender Frequency of the Participants
Table 4.1.2 below presents the cumulative frequency table for the participants. The table
clearly indicates that 50.3% of the participants were males were as 49.7% of the participants
were females making a total of 100%.
Table 4.1.2 Gender of Participant
Percent
Valid
Male 161 50.3 50.3 50.3
Female 159 49.7 49.7 100.0
Total 320 100.0 100.0

4.1.3 Age Frequency of the Participant
Table 4.1.3 below presents a cumulative frequency table for the Age of the participants. The
table shows that the age range of 17-19 recorded the highest participant percentage of 53.1%
4.1.3 Age of Participant
Percent
Valid
14-16 Years 120 37.5 37.5 37.5
17-19 Years 170 53.1 53.1 90.6
20-22 Years 30 9.4 9.4 100.0
Total 320 100.0 100.0
4.1.4 Grade of Participant Presentation
Table 4.1.4 below is a cumulative frequency presentation for the Grades of the participants.
30.6% of participants were Grade 10, 33.4 Grade 11 and 35.9 participants were Grade 12.
4.1.2 Grade of Participant
Percent
Valid
Grade 10 98 30.6 30.6 30.6
Grade 11 107 33.4 33.4 64.1
Grade 12 115 35.9 35.9 100.0
Total 320 100.0 100.0

4.1.5 Religious Affiliation of Participant
Table 4.1.5 is the cumulative frequency table presenting the participants’ religious affiliation.
Majority of the respondents were Seventh Day Adventist were as the minority were Anglican.
4.1.5 Religious Affiliation of Participant
Percent
Valid
Roman Catholic 59 18.4 18.4 18.4
Seventh Day Adventist 161 50.3 50.3 68.8
Pentecostal 50 15.6 15.6 84.4
Brethren in Christ 20 6.3 6.3 90.6
New Apostolic 15 4.7 4.7 95.3
Religious Affiliation 7 2.2 2.2 97.5
United Church of Zambia 7 2.2 2.2 99.7
Anglican 1 .3 .3 100.0
Total 320 100.0 100.0
4.1.6 Tribe of Participant
Table 4.1.6 below presents the cumulative frequency of the participants. The highest
presentation of the participant’s tribe was Tonga with the percentage of 63.1 were as Luvale
recorded the lowest with the percentage of 0.3%. Generally 10 tribes were represented.
Tribe of Participant
Percent
Valid
Tonga 202 63.1 63.1 63.1
Ngoni 28 8.8 8.8 71.9
Namwanga 12 3.8 3.8 75.6
Lozi 39 12.2 12.2 87.8
Chewa 11 3.4 3.4 91.3
Bemba 18 5.6 5.6 96.9
Nsenga 4 1.3 1.3 98.1
Luvale 1 .3 .3 98.4
Lunda 3 .9 .9 99.4
Kaonde 2 .6 .6 100.0
Total 320 100.0 100.0

4.1.7 Knowledge Level of the Participant.
Table 4.1.7 below presents the Cumulative frequency of the knowledge level of the
participants. The frequency table below indicates that out of 320 samples population 180 were
knowledgeable indicating a percentage of 56.3 were as 140 were not knowledgeable indicating
a percentage of 43.8 of the sampled population.
4.1.7 Knowledge Level of Participant
Percent
Valid
Knowledgeable 180 56.3 56.3 56.3
Not Knowledgeable 140 43.8 43.8 100.0
Total 320 100.0 100.0
Table 4.1.7.1 below shows the statistical mean and standard deviation of the participants’
knowledge level. Participants had a knowledge level mean of 1.4375.
4.1.7.1 Statistics
Knowledge Level of Participant
N
Valid 320
Missing 0
Mean 1.4375
Std. Deviation .49686
4.1.8 Practice Level of Participant
Table 4.1.8 below shows the statistical mean and standard deviation of the participants’
practice level. Participants had a practice level mean of 1.7909.
4.1.8 Statistics
Practice Level of Participant
N
Valid 320
Missing 0
Mean 1.7906

Table 4.1.8.1 below shows the cumulative frequency of the practice level of the participants.
20.9% of the participants’ practice was Excellent were as 79.1% had poor practice.
4.1.8.1 Practice Level of Participant
Percent
Valid
Excellent 67 20.9 20.9 20.9
Poor 253 79.1 79.1 100.0
Total 320 100.0 100.0
4.1.9 Attitude Level of Participants
Table 4.1.9 below presents the statistical mean and standard deviation of the attitude’s level
of participants.
4.1.9 Statistics
Attitude Level of Participant
N
Valid 320
Missing 0
Mean 1.8469
Table 4.1.9.1 below is a cumulative frequency presentation of the attitude level of the
participants. The table indicates that out of 320 participants sampled only 49 (15.3) had “Good”
attitude on condom use.
4.1.9.1 Attitude Level of Participant
Percent
Valid
Good 49 15.3 15.3 15.3
Bad 271 84.7 84.7 100.0
Total 320 100.0 100.0

4.1.10 Participant Religion Factors
Table 4.1.10 below shows the statistical mean and standard deviation of the participants’
affected or not affected by Religious Factors. Religious factors had a mean of 1.7375.
4.1.10Statistics
ParticipantAffected or Not
Affected by Religious Factors
N
Valid 320
Missing 0
Mean 1.7375
Table 4.1.10.1 below presents the cumulative Frequency for participants affected and not
affected by religious. The table clearly indicates that only 26.3% of the participants were
affected by religious factors on condom use were as 73.8% were not affected.
4.1.10.1 Participant Affected or Not Affected by Religious Factors
Percent
Valid
Affected 84 26.3 26.3 26.3
Not Affected 236 73.8 73.8 100.0
Total 320 100.0 100.0
4.1.11 Participants Traditional Factors
Table 4.1.11 below shows the statistical mean and standard deviation for the participant
influenced and not influenced by traditional factors on condom use. Participant traditional
factor had a mean of 1.8281.
4.1.11 Statistics
ParticipantInfluenced or Not
Influenced by Traditional
Factors
N
Valid 320
Missing 0
Mean 1.8281

Table 4.1.11.1 is the cumulative frequency table showing participants influenced and not
influenced by traditional factors. The table indicates that 17.2 % were influenced by traditional
factors on Condom use.
4.1.11.1 Participant Influenced or Not Influenced by Traditional Factors
Percent
Valid
Influenced 55 17.2 17.2 17.2
Not Influenced 265 82.8 82.8 100.0
Total 320 100.0 100.0
4.2 Statistical Tests of Research Questions
4.2.1 Statistical Test for Research question 1.
This section presents an account of the outcomes of the statistical tests performed on the
research question 1. The data was analysed at 95% confidence level or p = 0.05. Chi sqare Test
for hypothesis H01: Is there any relationship between knowledge and practice on secondary
school pupils’ condom use in relation to STIs/HIV prevention?
Tables 4.2.1 below shows the cross tabulation and Chi-Square Test on Association between
Knowledge and practice on secondary school pupils’ condom use in relation to STIs/HIV
prevention.
4.2.1 Knowledge Level of Participant * Practice Level of Participant Cross tabulation
Practice Level of
Participant
Total
Excellent Poor
Knowledge Level of
Participant
Knowledgeable
Count 49 131 180
% within Knowledge
Level of Participant
27.2% 72.8% 100.0%
% of Total 15.3% 40.9% 56.2%
Not
Knowledgeable
Count 18 122 140
% within Knowledge
12.9% 87.1% 100.0%
% of Total 5.6% 38.1% 43.8%
Total
Count 67 253 320
% within Knowledge
20.9% 79.1% 100.0%
% of Total 20.9% 79.1% 100.0%

Chi-Square Tests
Value df Asymp. Sig.
(2-sided)
Exact Sig. (2-
sided)
Exact Sig. (1-
sided)
Point
Probability
Pearson Chi-Square 9.817a
1 .002 .002 .001
Continuity Correctionb
8.968 1 .003
Likelihood Ratio 10.212 1 .001 .002 .001
Fisher's Exact Test .002 .001
Linear-by-Linear
Association
9.786c
1 .002 .002 .001 .001
N of Valid Cases 320
a. 0 cells (0.0%) have expected count less than 5. The minimum expected countis 29.31.
b. Computed onlyfor a 2x2 table
c. The standardized statistic is 3.128.
Statistical Decision: The statistics showed that the Pearson Chi-Square test result was at P
(.001) ˂ P (0.05) measured with assumed α = 0.05 (at 95% level of significance). The calculated
probability is less than α = 0.05 hence the null hypothesis is rejected.
Conclusion: There is a significant association between knowledge levels and practice level of
high school pupils on condom use in Choma District.
research question 2. The data was analysed at 95% confidence level or p = 0.05. Pearson Chi-
Square test for hypothesis H02: Is there a relationship between knowledge and attitude level of
secondary school pupils’ condom use in relation to STIs/HIV prevention?

Knowledge and attitude level of high school pupils’ condom use in relation to STIs/HIV
prevention.
4.2.2 Knowledge Level of Participant * Attitude Level of Participant Cross tabulation
Attitude Level of Participant Total
Good Bad
Knowledge Level of
Participant
Knowledgeable
Count 35 145 180
% within Knowledge Level
of Participant
19.4% 80.6% 100.0%
% of Total 10.9% 45.3% 56.2%
Not Knowledgeable
Count 14 126 140
of Participant
10.0% 90.0% 100.0%
% of Total 4.4% 39.4% 43.8%
Total
Count 49 271 320
of Participant
15.3% 84.7% 100.0%
% of Total 15.3% 84.7% 100.0%
Chi-Square Tests
(2-sided)
Exact Sig. (2-
sided)
Exact Sig. (1-
sided)
Point
Probability
1 .020 .028 .014
4.713 1 .030
Linear-by-Linear
Association
5.400c 1 .020 .028 .014 .008
a. 0 cells (0.0%) have expected count less than 5.The minimum expected countis 21.44.
Statistical Decision: The statistics showed that the Pearson Chi-Square test result was at P
(.014) ˂ P (0.05) measured with assumed α = 0.05 (at 95% level of significance). The calculated
probability is less than α = 0.05 hence the null hypothesis is rejected.

Conclusion: There is a significant association between knowledge levels and Attitude level of
high school pupils on condom use in Choma District
Square Test for hypothesis H03: Is there any relationship between attitude and practice in
secondary pupils condom use in relation to STIs/HIV prevention?
attitude and practice in high school pupils’ condom use in relation to STIs/HIV prevention?
4.2.3 Attitude Level of Participant * Practice Level of Participant Crosstabulation
Practice Level of Participant Total
Excellent Poor
Good
Count 17 32 49
% within Attitude Level of
Participant
34.7% 65.3% 100.0%
% of Total 5.3% 10.0% 15.3%
Bad
Count 50 221 271
Participant
18.5% 81.5% 100.0%
% of Total 15.6% 69.1% 84.7%
Total
Count 67 253 320
Participant
20.9% 79.1% 100.0%
% of Total 20.9% 79.1% 100.0%

Chi-Square Tests
(2-sided)
Exact Sig. (2-
sided)
Exact Sig. (1-
sided)
Point
Probability
1 .010 .013 .011
5.670 1 .017
Linear-by-Linear
Association
6.594c
1 .010 .013 .011 .007
Statistical Decision: The statistics showed that the Pearson Chi-Square Test result was at P
(.011) ˂ P (0.05 ) measured with assumed α = 0.05 (at 95% level of significance). The
calculated probability is less than α = 0.05 hence the null hypothesis is rejected.
Conclusion: There is a significant association between attitude and practice in secondary
pupils’ condom use in relation to STIs/HIV in Choma District.
Square Test for hypothesis H04: Is there any relationship between attitude and Religious
Factors in high school pupils’ condom use in relation to STIs/HIV prevention?

attitude and religious factors in high school pupils’ condom use in relation to STIs/HIV
prevention.
4.2.4 Attitude Level of Participant * Participant Affected or Not Affected by Religious Factors
Crosstabulation
Participant Affected or Not
Affected by Religious Factors
Total
Affected Not Affected
Attitude Level of
Participant
Good
Count 9 40 49
Participant
18.4% 81.6% 100.0%
% of Total 2.8% 12.5% 15.3%
Bad
Count 75 196 271
Participant
27.7% 72.3% 100.0%
% of Total 23.4% 61.2% 84.7%
Total
Count 84 236 320
Participant
26.2% 73.8% 100.0%
% of Total 26.2% 73.8% 100.0%
Chi-Square Tests
(2-sided)
Exact Sig. (2-
sided)
Exact Sig. (1-
sided)
Point
Probability
1 .173 .217 .116
1.407 1 .235
Linear-by-Linear
Association
1.851c
1 .174 .217 .116 .058
c. The standardized statistic is -1.361.

Statistical Decision: The statistics showed that the Pearson Chi-Square Test result was at P
(.116) ˃ P (0.05) measured with assumed α = 0.05 (at 95% level of significance). The calculated
probability is greater than α = 0.05 hence the null hypothesis is not rejected.
Conclusion: There is no significant association between attitude and Religious factors effect
in High School pupils’ condom use in relation to STIs/HIV in Choma District
research question 3. The data was analysed at 95% confidence level or p = 0.05. Pearson Chi
square Test for hypothesis H05: Is there any relationship between attitude and traditional
factors in high school pupils’ condom use in relation to STIs/HIV prevention?
attitude and traditional factors in high school pupils’ condom use in relation to STIs/HIV
prevention.
4.2.4 Attitude Level of Participant * Participant Influenced or Not Influenced by Traditional Factors
Crosstabulation
Participant Influenced or Not
Influenced by Traditional Factors
Total
Influenced Not Influenced
Good
Count 7 42 49
Participant
14.3% 85.7% 100.0%
% of Total 2.2% 13.1% 15.3%
Bad
Count 48 223 271
Participant
17.7% 82.3% 100.0%
% of Total 15.0% 69.7% 84.7%
Total
Count 55 265 320
Participant
17.2% 82.8% 100.0%
% of Total 17.2% 82.8% 100.0%

Chi-Square Tests
(2-sided)
Exact Sig. (2-
sided)
Exact Sig. (1-
sided)
Point
Probability
Pearson Chi-Square .342a
1 .559 .683 .363
.144 1 .704
Likelihood Ratio .356 1 .551 .683 .363
Linear-by-Linear
Association
.341c
1 .559 .683 .363 .145
a. 0 cells (0.0%) have expected count less than 5. The minimum expected countis 8.42.
c. The standardized statistic is -.584.
Statistical Decision: The statistics showed that the Chi-Square Test result was at P (.363) ˃ P
(0.05) measured with assumed α = 0.05 (at 95% level of significance). The calculated
probability is greater than α = 0.05 hence the null hypothesis is not rejected.
Conclusion: There is no significant association between attitude and traditional factors
influence in High School pupils’ condom use in relation to STIs/HIV in Choma District
4.4 Discussion
4.4.1 Demographic characteristics of the sampled populations
From a study sample of 320 participants 82 (25.6%) were participants from Choma Secondary,
81(25.3%) from Chuundu Day School, (80)25.0% from Choma Day High School and
(77)24.1% from Masuku Secondary.
161 respondents giving a percentage of 50.3% were males were as 159 (49.7%) of the
participants were females making a total of 100%. Gender balance was maintained to avoid
biasness in the results.
120 participants were aged 14-16 indicating a percentage of 37.5, the majority of the
participants were aged 17-19 indicating a percentage of 53.1 and the minority were aged 20-
22 with a percentage of 9.4%.
Three Grades were sampled from the four sampled school. 30.6% of participants were Grade
10, 33.4% Grade 11 and 35.9% participants were Grade 12. These participants had different
religious affiliations of which out of the total sample size 8 denominations were represented
with varying percentages as indicated in table 5. These denominations are Roman Catholic,

Seventh Day Adventist, and Pentecostal, Brethren in Christ, New Apostolic, End Time
Message, United Church of Zambia and Anglican. The majority of the Participants were
Seventh Day Adventist were as the Minority were Anglican. These participants were of
different tribes as indicated in table 6.
4.4.2 Knowledge Level of Participants
Out of the 320 participants samples 180 were knowledgeable indicating a percentage of 56.3
were as 140 were not knowledgeable indicating a percentage of 43.8 of the sampled population.
This clearly indicates that the knowledge level of the High School pupils on condom use is
very low. The participant statistical mean also indicated to be at 1.4375 with a standard
deviation 0.49686 indicating that most of the knowledge level of the participants were below
average. Since excellent knowledge on condom use is cardinal in the protection again
STIs/AIDS, lack of knowledge can be attributed to increase in STIs/AIDS level in the District.
Similar study conducted in Kenya by Maharaj. P & Cleland. J (2005) indicated the similar
results that knowledge of the participants towards condom use was discovered to be low. He
further attributed to it being one of the contributing factors to non-reduction of STIs/AIDS.
4.4.3 Practice Level of Participants
The practice level of participants on Condom use was worse than the knowledge level. Out of
the total sample size 67 indicating a percentage of 20.9% of the participants’ practice was
Excellent were as 253 (79.1%) had poor practice. Computed to statistical measures the practice
level mean of the participants was at 1.7906 with a standard deviation of 0.40750. This clearly
indicates that the practice level of the participants were worse than their knowledge level.
Hence despite the little knowledge they had on condom use, their poorer practice increased
their chance of acquiring STIs/AIDS. In the year (2005) a study on condom use was done by
Stammers, T and it as well clearly indicated that the practice on condom use was worse than
participants’ knowledge. This hence clearly indicates the importance of the relationship
between Knowledge and practice in behaviour change.
4.4.4 Attitude Level of Participant
More worse than knowledge and practice of participants was attitude, out of 320 participants
sampled only 49 (15.3) had “Good” attitude on condom use were as 271 (84.7) indicated to
have bad attitude. This generally explains the great link that is there between knowledge and
attitude in order to have improved practice (use) of condoms. It further explains the causative
factor to poor practice attributed to bad attitude. The statistical measures further indicated level
of attitude of participants of which the mean indicated to be 1.8469 with standard deviation
0.36067. In the Journal Sexual Activityand Condom Use in Lusaka published in 2006 by Sohail

Agha, the journal clearly indicated similar findings. It indicated that attitude was the major
poor factor among most condom users. Despite the little knowledge they may have, attitude
towards use still remains poor as some people feel sexual excitement is reduced if a condom is
used.
4.4.5 Participant Religion Factors
84 of the participants representing 26.3% were affected by religious factors on condom use
were as 236 (73.8%) were not affected. This further indicated a statistical mean of 1.7375 and
a standard deviation of 0.44068. This clearly indicates that religious factors have no or limited
influence on the attitude and use of condoms in the prevention of STIs and AIDS. However a
study Weller, S & Davis, K. (2003) in Uganda indicated that Religious factors had great
influence on the attitude of condom use.
4.4.6 Participant Traditional Factors
17.2 % of the participants indicated to be influenced by traditional factors on Condom use were
as 82.8 % were not influenced by traditional factors in their condom use. The statistical mean
for traditional factor influence was at 1.8281 with a standard deviation of 0.37786, this indicates
that traditional factor had no or little influence on condom use. Contrary to the findings of the
study, a study conducted by Zambia Sexual Behaviour Survey ZSBS (2009) indicated that
traditional factors had great influence on the attitude toward condom use.

CHAPTER FIVE
CONCLUSION AND RECOMMENDATIONS
5.0 Introduction
This chapter gives conclusion of the study undertaken in Choma district among high school
pupils to determine their knowledge, attitude and practice (use) of condoms in prevention of
STIs and AIDS.
5.1 Conclusion
The outcome of the research clearly indicated that most of participants’ were not
knowledgeable on proper condom use. It further indicated that the attitude of the participants
was worse than their knowledge as the majority of the participants had bad attitude on condom
use. This generally contributed to poor use as dependent variable of the knowledge and attitude
factor. More strange of all, the practice level of the participants indicated to be higher than the
practice level, this clearly indicated that attitude towards condom use was the major factor
affecting the variable. Despite the little knowledge that pupils have on proper condom use, due
to the in between factor which is attitude the practice tends to be bad hence this can be attributed
to be the major factor affecting condom use.
Since the protection of condom again STIs/AIDS depends on the user’s collect use, and
excellent attitude, poor attitude and less knowledge on condom use stands as the major factor
contributing to raise in the reported cases of STIs/AIDS in the district.
The research further found out that attitude on condom use is independent of traditional and
religious factor as it indicated that the participants were not influenced or affected by traditional
and religious factors. These two factors had no influence on the attitude of the participant,
hence attitude was independent of religious and traditional factors.
The test statistics of the variables of interest indicated that there is a significant relationship
between the knowledge and practice level of participants on condom use, it further indicated
that there was also a significant relationship between the knowledge and attitude of the
participants. It further more indicated there is a significant relationship between attitude and
practice of participants on condom use. However the study outwardly indicated that there was
no significant relationship between attitude and traditional factors and religious factors of the
participant. This clearly indicates that poor use of condoms in prevention of STIS/AIDS is
attributed to knowledge and attitude. There is a strong relationships between these three
variables.

5.2 Recommendations
i. The government through the ministry of Zambia must produce literature, come up with
radio programmes, Television Programs and Drama groups to provide education on the
importance of condoms use in prevention of STIs/AIDS.
ii. The government through ministry of health should call for seminars to the youths to
teach them about proper condom use and its importance in the prevention of STIs/AIDS
iii. Institutions were youths are found such as schools and youth recreation centres must
have counsellors to freely educate youths on proper condom use and discuss with them
on matter of condom use in order to improve their attitude.
iv. Institutions must be provided with billboards were messages pertaining condom use can
be displayed. These billboards must be put also in youth centres and public places where
everyone can freely read the message about condom use.
v. Families must take primary steps in the education of their children on proper condom
use and its importance in the prevention of STIs/AIDS.

6.0 BIBLIOGRAPHY
Bankole. A, Ahmed F.H, Neema. S, Ouedraogo, C & Konyani, S. (2007): knowledge of correct
condom use and consistency of use amongadolescents in four countries in sub-Saharan Africa.
African Journal of Reproductive Health
Bunnell. R, Nassozi. J & Marum. E (2005): Living with discordance: knowledge, challenges,
and prevention strategies of HIV-discordant couples in Uganda. AIDS care journal.
Gardner. R (1999): Closing the condom gap, Baltimore, Johns Hopkins school of Public Health
population information Program.
http://www.aidsmark.org/resources/pdfs/sub-saharanafrica.pdf (retrieved on 14th April, 2014).
https://tspace.library.utoronto.ca/bitstream/1807/1257/1/ep03005.pdf. (Retrieved on 21st
March, 2014)
Http: data.unaids.org/Publications/IRC-pub03/Lusaka 99_en.html, (retrieved on 6th May,
2014).
http:data.unaids.org/Publications/IRC-pub01/jc010 impactyoungpeople_en.pdf, (retrieved on
17th April 2014).
http:www.www.nied.edu.na/publications/aids/UNICEF%20Nam_2006_HIV (retrieved on
17th April 2014)
http://www.who.int/child-adolescent-health/ HIV/HIV_adolescents.htm, (retrieved on 6th May
2014).
Kumar, R(2005): Research methodology A step by step guide for beginners. Sage Publications;
New Delhi.
Konde L, SewankamboJ.K, & Morris, M. (1997): Adolescent sexual networking and HIV
transmission in rural Uganda. Health transition review supplement.
Lewis, M. A. (2000): Brief history of condoms, in London.
Mufune, P. (2005): Myths about condoms and HIV/AIDS in rural northern Namibia;
International Social Science Journal
Macaluso. M, etal (2003): Efficacy of the female condom as a barrier to semen during
Intercourse, American Journal of Epidemiology
Maharaj. P & Cleland. J (2005): Risk perception and condom use among married or cohabiting
couples in KwaZulu-Natal, South Africa. International Family Planning Perspectives journal

Pool, R, (2000): Men’s attitudesto condoms and female controlled means of protection against
HIV and STIs in south-western Uganda. Culture, Health and Sexuality journal
Stammers, T (2005): Primary prevention of sexually transmitted infections, Postgraduate
Medical Journal
Sohail Agha (2005) Sexual Activity and Condom Use in Lusaka, Zambia.
Uganda Bureau of Statistics (UBOS) and ORC Macro (2001): Uganda Demographic and
Health Survey .Calverton, Maryland, USA
Versteeg, M & Murray M. (2008): Condom use as part of the wider HIV prevention strategy:
Experiences from communities in the North West Province, South Africa. Journal of Social
Aspects of HIV/AIDS
Weller, S & Davis, K. (2003) Condom effectiveness in reducing heterosexual HIV
transmission, Oxford.
Wong M.L,etal (2003): Social and behavioural factors associated with condom use among
direct sex workers in Siem Reap, Cambodia, Sexually Transmitted Infections, journal.
Zambia central stastistics office (2010): census on Choma District
Zellner S.L (2003): Condom use and the accuracy of AIDS knowledge in Côte d’Ivoire,
International Family Planning Perspectives journal
Zambia Sexual Behaviour Survey ZSBS (2009): survey on the sexual conducts in Zambia,
condom use journal.

7.0 APPENDICES
7.1 Appendix A: Budget
Item Qty Unit cost Total
Transportation 4 trips K50.00 K200.00
Ream of Paper 03 K30.00 K90.00
Typing and Printing
and photocopying
320 copies
questionnaires
K1.00 K320
Accommodation 4 nights K70.00 K280.00
Lunches 12 Meals K10.00 K120.00
Grand Total K 1275.00

7.2 Appendix B: Work Plan
Months
Aug Sept Oct Nov Dec Jan Feb March April
Activity
Problem
Identification
Literature Review
Proposal Writing
Proposing
Data Collection
Data Entry
Data Analysis
ThesisDefence

7.3 Appendix C: Questionnaire
QUESTIONNAIRE
The full name for the researcher is Siamondole Wachata Mike, a full time student at Rusangu
University pursuing a Bachelor’s degree in Environmental Health (BSc Environmental
Health). This research is strictly for academic purposes, therefore all the responses to this
questionnaire will be treated with utmost confidentiality and protection of study participants.
Participants:
This questionnaire will be administered to the Choma District Secondary School pupils
(strictly those from within the district).
Purpose of the Research:
The purpose of the research is to assess knowledge, attitude and practices regarding
condom use by secondary school pupils in relation to prevention of STD/HIV.
Your responses are of great value and will help to keep young people in this country healthy.
Please help us by filling in this questionnaire.
Instructions:
i. Do not write your name or unasked details; limit yourself to the questions asked.
ii. Do not write any individually identifiable information, such as name, NRC number or
any form of identification.
iii. Answer all the questions in this questionnaire by ticking in the boxes provided at the
end of each question or
iv. Explain in the spaces provided at each question.
NOTE: This is not a test and there are no right or wrong answers. PLEASE BE HONEST
IN YOUR ANSWERS. Any clarity on the questions must be referred to the researcher.
School -------------------------------------------------------------------------
Date ----------------------------------------------------------------------------

SECTION A
Demographic
(tick in the box that apply)
For official use only
1 What is your Sex/ Gender?
Male
Female
2 State your age in years?
…………………years
3 What Grade are you?
Grade 10
Grade 11
Grade 12
4 What isyour religiousaffiliation?
Roman
catholic
S.D.A
Pentecostal
……
...
Others
specify
5 State your tribe? …………………………
………………..

SECTION B
Knowledge On Condom
1 What are condoms?
(Please fill in your response)
1 Correct
answer
2 Wrong
answer
3 Correct but
incomplete
answer
4 No answer
Indicate the extent to which you agree or disagree to the following statements
A= agree; D= Disagree; DK; Don’t know
A
3
D
2
DK
1
1. Have you attended any condom demonstration
session?
2. Correct use of condom will prevent HIV/AIDS
transmission?
3. Correct use of condom will prevent STIs?
4 Correct use of condom will prevent pregnancy?
5 Can condoms be stored and used even after 10 years?
6 Do condoms have expiry date?
7 Can the HIV virus pass through the condom?
8 Do condoms have worms in them that result into rashes?
9 Can condoms disappear in a woman’s vagina?

10 Correct use of condom will prevent STIs?
SECTION C
CONDOM USE
Indicate the extent to which you agree or disagree to the following statements
A= agree; D= Disagree; NA; Not Applicable
A
1
D
2
NA
3
1 Have you ever used a condom?
2 Do you always use a condom during sex?
3 Are you able to get a condom when you need one?
4 Are you able to demonstrate to a friend on proper condom
use?
5 Should Condoms be put on when the penis is not erect?
6 Should a condom be put on before any contact with the
vagina?
7 Can condoms be used more than once?
8 Should a condom be unrolled before being put on the
penis?
9 Is it essential for a person using condom to withdraw his
penis immediately after ejaculation?
10 Can an oil based lubricant ( e.g Vaseline, cold cream,oil )
be used with condoms?
SECTION D
ATTITUDE ON CONDOM USE

Indicate the extent to which you agree or disagree to the following
statements by ticking in the box below.
A= agree; D= Disagree; DK; Don’t know
A
3
D
2
DK
1
1 Do u think sexual intercourse with a condom feels as good
as without a condom?
2 Because of condoms people are unfaithful to their
partners/spouses?
3 Do u think sexual pleasure is reduced when using a
condom?
4 Do you think you would feel guilty if you would infect
someone else with HIV due to non-use of condom?
5 Do you think you are confident that you can talk to your
sexual partner(s) about using condoms?
6 Do you think Condoms should be openly displayed in
places where persons can obtain them when they need
them?
7 Do you think children age 12-14 should be taught about
using a condom?
8 People in this school talk freely about condom use?
Section E
Religion and condom use
For officialuse
Indicate the extent to which you agree or disagree to the following
statements by ticking in the box below.
A= agree; D= Disagree
A D

1 3
1 The reason for not using a condom is because it’s a sin to
use it during sex.
2 Our church does not allow the use of condoms during sex.
3 Condom use is a pagan practice.
1 It’s a taboo to use a condom during sex.
2 Condom can just be used to a partner of different
background.
3 The use of a condom proves the weakness of a partner.

Relationship Between Knowledge, Attitude & Practice of Condom Use

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