Knowledge, attitude and perception of uninitiated adolescents towards customary male initiation practices in selected schools in Buffalo City Municipality, Eastern Cape
- Authors: Igaba, Nelson Kibiribiri
- Date: 2022-07
- Subjects: Circumcision , HIV infections -- Prevention , Initiation rites
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/26896 , vital:66061
- Description: Background: Based on evidence that Voluntary Medical Male Circumcision (VMMC) significantly reduces the risk of human immunodeficiency virus- HIV transmission by 60percent, the World Health Organization (WHO) recommends implementing VMMC programs in countries with a high HIV prevalence, considering the unique sociocultural and economic dynamics of each setting. However, in South Africa (SA), multiple tribes including the AmaXhosa in the Eastern Cape (EC) province practice Customary Male Initiation (CMI) also known as Ulwaluko as a rite of passage of males from boyhood to manhood, and this involves circumcision. In recent years, this practice has been riddled with deaths of initiates, admissions to hospital, amputation of penis, assaults, drug and alcohol, and crime. Hence, this study aimed at understanding the knowledge, attitude, and perceptions of uninitiated adolescents towards the CMI practice in Buffalo City Municipality (BCM), EC to aid in developing strategies to solve current challenges. Methods: Between June and December 2021, this cross-sectional descriptive study was conducted in selected schools within BCM, in the EC, using a quantitative research approach. The study population included adolescent males aged 15 to 19 years who had not attended CMI. Applying a multistage random sampling technique, three (3)BCM towns (Bhisho, King William Town-KWT and East London-EL) and the Mdantsane township (MT) were selected and further the schools from which consenting pupils were enrolled into the study. Data was collected using a validated self-administered questionnaire which was captured on excel and analysed using STATA version 16.1. Categorical variables were summarized using percentages. Bivariate and multivariate regression was used to determine factors associated with a level of knowledge, attitude, and perception towards CMI and VMMC. The odds ratio with a 95percent confidence interval was calculated. A p–value of <0.05 was considered statistically significant. Results: Among 297 participants that responded 251 (84.51percent) were between the ages of 15-19 years and had not undergone circumcision or CMI. These were included in this analysis. Majority of participants 181 (72.11percent, 95percent CI 66.21-77.33) lacked knowledge on whether circumcision reduces risk of HIV acquisition. More than three quarters of participants 195 (77.69percent, 95percent CI 72.09-83.87) showed absence of knowledge on whether circumcision reduces risk of STIs. Close to all participants 244 (97.21percent, 95percent CI 94.25-98.67) indicated that they would choose CMI over VMMC due to cultural reason. More than three quarters of participants 193 (76.89percent, 95percent CI 71.24-81.72) agreed that CMI/Ulwaluko proves manhood. The presence of knowledge on the benefits of VMMC was positively dependent on the location where a participants lived (uOR 2.32, 95percent CI 1.09-4.97, p-value 0.029) and access to internet more than once a week (uOR 3.44, 95percent CI 1.14-10.43, p-value 0.029. The choice for CMI over VMMC was positively associated with participants living in Mdantsane Township than those living in urban areas (Coef. 1.55, 95percent CI 0.77-2.33, p-value 0.001). Conclusion: This study found lack of knowledge on benefits of VMMC, laws governing and on risks associated with CMI/Ulwaluko practices among uninitiated adolescents. The study further found that CMI/Ulwaluko was still highly regarded despite current challenges and most adolescents would choose CMI/Ulwaluko over VMMC. There is urgent need to integrate VMMC services into CMI/Ulwaluko to include health education on benefits of VMMC, infection prevention and control, male circumcision by trained medical personnel and education on laws governing CMI/Ulwaluko. These interventions should also target uninitiated adolescents. , Thesis (MPA) -- Faculty of Health Sciences, 2022
- Full Text:
- Authors: Igaba, Nelson Kibiribiri
- Date: 2022-07
- Subjects: Circumcision , HIV infections -- Prevention , Initiation rites
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/26896 , vital:66061
- Description: Background: Based on evidence that Voluntary Medical Male Circumcision (VMMC) significantly reduces the risk of human immunodeficiency virus- HIV transmission by 60percent, the World Health Organization (WHO) recommends implementing VMMC programs in countries with a high HIV prevalence, considering the unique sociocultural and economic dynamics of each setting. However, in South Africa (SA), multiple tribes including the AmaXhosa in the Eastern Cape (EC) province practice Customary Male Initiation (CMI) also known as Ulwaluko as a rite of passage of males from boyhood to manhood, and this involves circumcision. In recent years, this practice has been riddled with deaths of initiates, admissions to hospital, amputation of penis, assaults, drug and alcohol, and crime. Hence, this study aimed at understanding the knowledge, attitude, and perceptions of uninitiated adolescents towards the CMI practice in Buffalo City Municipality (BCM), EC to aid in developing strategies to solve current challenges. Methods: Between June and December 2021, this cross-sectional descriptive study was conducted in selected schools within BCM, in the EC, using a quantitative research approach. The study population included adolescent males aged 15 to 19 years who had not attended CMI. Applying a multistage random sampling technique, three (3)BCM towns (Bhisho, King William Town-KWT and East London-EL) and the Mdantsane township (MT) were selected and further the schools from which consenting pupils were enrolled into the study. Data was collected using a validated self-administered questionnaire which was captured on excel and analysed using STATA version 16.1. Categorical variables were summarized using percentages. Bivariate and multivariate regression was used to determine factors associated with a level of knowledge, attitude, and perception towards CMI and VMMC. The odds ratio with a 95percent confidence interval was calculated. A p–value of <0.05 was considered statistically significant. Results: Among 297 participants that responded 251 (84.51percent) were between the ages of 15-19 years and had not undergone circumcision or CMI. These were included in this analysis. Majority of participants 181 (72.11percent, 95percent CI 66.21-77.33) lacked knowledge on whether circumcision reduces risk of HIV acquisition. More than three quarters of participants 195 (77.69percent, 95percent CI 72.09-83.87) showed absence of knowledge on whether circumcision reduces risk of STIs. Close to all participants 244 (97.21percent, 95percent CI 94.25-98.67) indicated that they would choose CMI over VMMC due to cultural reason. More than three quarters of participants 193 (76.89percent, 95percent CI 71.24-81.72) agreed that CMI/Ulwaluko proves manhood. The presence of knowledge on the benefits of VMMC was positively dependent on the location where a participants lived (uOR 2.32, 95percent CI 1.09-4.97, p-value 0.029) and access to internet more than once a week (uOR 3.44, 95percent CI 1.14-10.43, p-value 0.029. The choice for CMI over VMMC was positively associated with participants living in Mdantsane Township than those living in urban areas (Coef. 1.55, 95percent CI 0.77-2.33, p-value 0.001). Conclusion: This study found lack of knowledge on benefits of VMMC, laws governing and on risks associated with CMI/Ulwaluko practices among uninitiated adolescents. The study further found that CMI/Ulwaluko was still highly regarded despite current challenges and most adolescents would choose CMI/Ulwaluko over VMMC. There is urgent need to integrate VMMC services into CMI/Ulwaluko to include health education on benefits of VMMC, infection prevention and control, male circumcision by trained medical personnel and education on laws governing CMI/Ulwaluko. These interventions should also target uninitiated adolescents. , Thesis (MPA) -- Faculty of Health Sciences, 2022
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Exploration of the factors influencing the upscaling of medical male circumcision targets in selected hospitals in eThekwini District, South Africa
- Authors: Tshabalala, Sandile Clement
- Date: 2022-03
- Subjects: Circumcision
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/22005 , vital:51930
- Description: Medical male circumcision has been shown to reduce female to male HIV transmission. This study was designed to examine the underlying factors responsible for, or influencing, the inability of the health care system to achieve the MMC targets in selected hospitals in KZN. The objective of this study to was explore the challenges that lead to failure of the government to meet set targets, regarding the implementation of the MMC programme in the province of KZN, as perceived by the health care workers. Methodology A mixed quantitative and qualitative study where 150 questionnaires were used and in-depth open-ended interviews were conducted. Participants were from Clairwood and Wentworth hospitals in the district of eThekwini, KwaZulu-Natal. Eighteen healthcare workers (nurse managers, doctors, nurses and counsellors) were purposively selected from the two hospitals. Results Findings showed that poor marketing of MMC, in line with the cultural and religious inclination of the catchment populations, had an effect on the targets. The fear of pain by the male clients came out as the biggest factor followed by the fear of having an HIV test done. The six weeks healing period before indulgence in sexual intercourse had a part to play in the reluctance of clients to do MMC. Some clients feared losing the ability to have an erection post MMC and would therefore not come for MMC. Other contributory factors for failure to reach targets included shortage of staff, poor mobilisation by the staff due to lack of training on how to mobilise and how to market MMC, lack of availability of mobilisation and marketing resources, inadequate and inequitable allocated of resources. Other factors include, lack of incentives for staff to stay in the programme or even within the Department, lack of training, cultural and religious beliefs in the community. The staff also felt that the MMC targets were too high. Notwithstanding, the staff members were willing to learn how to market MMC and to mobilise clients. Clients and community education on the importance of MMC and the combination of this process with good sexual behaviour would improve MMC uptake and reduce HIV prevalence and the incidence. Conclusions The fear of pain, fear to do HIV test and the fear to loose erection were the most prominent reasons why the males would not come for MMC procedure. , Thesis (MPH) -- Faculty of Health Sciences, Public Health, 2022
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- Authors: Tshabalala, Sandile Clement
- Date: 2022-03
- Subjects: Circumcision
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/22005 , vital:51930
- Description: Medical male circumcision has been shown to reduce female to male HIV transmission. This study was designed to examine the underlying factors responsible for, or influencing, the inability of the health care system to achieve the MMC targets in selected hospitals in KZN. The objective of this study to was explore the challenges that lead to failure of the government to meet set targets, regarding the implementation of the MMC programme in the province of KZN, as perceived by the health care workers. Methodology A mixed quantitative and qualitative study where 150 questionnaires were used and in-depth open-ended interviews were conducted. Participants were from Clairwood and Wentworth hospitals in the district of eThekwini, KwaZulu-Natal. Eighteen healthcare workers (nurse managers, doctors, nurses and counsellors) were purposively selected from the two hospitals. Results Findings showed that poor marketing of MMC, in line with the cultural and religious inclination of the catchment populations, had an effect on the targets. The fear of pain by the male clients came out as the biggest factor followed by the fear of having an HIV test done. The six weeks healing period before indulgence in sexual intercourse had a part to play in the reluctance of clients to do MMC. Some clients feared losing the ability to have an erection post MMC and would therefore not come for MMC. Other contributory factors for failure to reach targets included shortage of staff, poor mobilisation by the staff due to lack of training on how to mobilise and how to market MMC, lack of availability of mobilisation and marketing resources, inadequate and inequitable allocated of resources. Other factors include, lack of incentives for staff to stay in the programme or even within the Department, lack of training, cultural and religious beliefs in the community. The staff also felt that the MMC targets were too high. Notwithstanding, the staff members were willing to learn how to market MMC and to mobilise clients. Clients and community education on the importance of MMC and the combination of this process with good sexual behaviour would improve MMC uptake and reduce HIV prevalence and the incidence. Conclusions The fear of pain, fear to do HIV test and the fear to loose erection were the most prominent reasons why the males would not come for MMC procedure. , Thesis (MPH) -- Faculty of Health Sciences, Public Health, 2022
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