Analysing the socio-demographic determinants of comprehensive HIV/AIDS knowledge among school-going children in Botwana: a multi-level analysis

Kgosi, Shatho

Analysing the socio-demographic determinants of comprehensive HIV/AIDS knowledge among school-going children in Botwana: a multi-level analysis

Thesis / Dissertation

2024

Publisher

University of Cape Town

Department

Health Economics Unit

Faculty

Faculty of Health Sciences

Abstract

Background: Despite international efforts to contain transmission, the spread of HIV/AIDS remains a problem in some communities. Botswana is one of the countries in sub-Saharan Africa that is most affected by the pandemic and, similar to other countries, Botswana has a higher proportion of HIVinfected young people in comparison to other age groups. Various factors such as wealth disparity, treatment systems, gross domestic product per capita, corruption, religion, education, contraceptive use, and availability of antiretroviral drugs, have been identified as drivers of new HIV infections. Additionally, lack of comprehensive knowledge regarding HIV/AIDS has been cited as a factor in HIV/AIDS transmission. Therefore, tailored HIV prevention and educational interventions are advocated for reasons of efficiency and sustainability. To address knowledge gaps and promote positive and safe sexual behaviour, emphasis has also been placed on behaviour change programs, highlighting the importance of understanding key populations. Objectives: This study sought to investigate the level of comprehensive HIV/AIDS knowledge among school-age children in Botswana as well as the determinants of this cohort's comprehensive knowledge of HIV/AIDS. Methods Setting The data used in this analysis is from a survey that was conducted in 135 private and public schools in Botswana in the ten districts overseen by the Ministry of Basic Education. Data was collected between February and April 2015 (Ministry of Basic Education, 2016). Study Design The data used in this study is from the 2015 Botswana Youth Risk Behavioural and Biological Surveillance Survey (BYRBBSS-II). Stratified multistage sampling was used to select schools and classrooms for participation in the study (Ministry of Basic Education, 2016). The school was the primary sampling unit (first stage), while the classroom was the secondary sampling unit (second stage) (Ministry of Basic Education, 2016). First, the student population was stratified by school district, while schools were selected based on their enrolment size and a list of classes of each sampled school was organised by grade level (grade 8,9,10,11 and 12) (Ministry of Basic Education, 2016). Schools were selected using a sampling frame derived from the 2014 master list of school enrolment data provided by the Ministry of Basic Education (MBE) (Ministry of Basic Education, 2016). Study Population Students were eligible to participate in the study if they regularly attended secondary school, were in grade 8 to 12, had permission from their parents or legal guardians to participate, and gave informed consent and assent (Ministry of Basic Education, 2016). Of a total of 9,590 students eligible to be included in the study, 7,564 (78.9%) provided informed consent or assent and agreed to participate in the survey (Ministry of Basic Education, 2016). The ages of survey participants ranged from 13 to 19 years for both males and females (Ministry of Basic Education, 2016) Inclusion Criteria Students who provide informed consent and assent were included in the study. Exclusion Criteria Those who did not provide informed consent or assent were not included in the study (Ministry of Basic Education, 2016). Schools where there were fewer than 20 students surveyed were also excluded. Data Analysis A multilevel mixed-effects logistic regression was used to identify predictors of comprehensive HIV/AIDS knowledge at individual, school, and regional levels. Results: The overall prevalence of comprehensive HIV/AIDS knowledge was estimated at 58.6%, 95% CI: (57.4% - 59.7%). Female students had higher levels of HIV/AIDS knowledge than their male counterparts. Comprehensive HIV/AIDS knowledge was also positively associated with school grade level completion. Surprisingly, it was found that 13-14-year-olds had higher odds of comprehensive knowledge compared to 15-19-year-olds. In contrast, students in grades 9 to 12 had a higher likelihood of comprehensive knowledge than those in grade 8. The odds of possessing comprehensive knowledge about HIV/AIDS were higher among private school students than among those attending public schools, while students identifying as Christian, demonstrated higher odds than those identifying as belonging to other religions or non-religious. Students who experienced hunger (as a proxy of socioeconomic status) were typically less informed than those who did not experience hunger, and those who resided with their parents during school holidays were more likely to be well-informed compared to those who did not reside with their parents. Conclusion: This study highlights that comprehensive knowledge of HIV/AIDS among students is still quite limited. It also highlights the role of school type, age, grade, and religion as key determinants of comprehensive knowledge of HIV/AIDS. Therefore, any meaningful policy to improve adolescents' knowledge of HIV/AIDS should consider the gaps associated with these determinants. The developed guidelines should aim to disseminate the latest and most relevant HIV/AIDS promotional messages in both private and public schools. In addition, while not neglecting Christians, extra efforts should be made to disseminate HIV/AIDS messages to young people who are non-Christian. What this study adds: this study highlights the importance of comprehensive HIV/AIDS knowledge as an avenue for fighting the pandemic over and above biomedical interventions. Thus, the results of this study should guide programme development on topics that influence young people's understanding of HIV/AIDS to change behaviour. In addition, compared to the previous studies conducted on this topic, by using a multi-level analysis, this study was able to account for intra-cluster correlations in ascertaining the determinants of comprehensive HIV/AIDS knowledge, an innovation that was hitherto lacking in the literature on Botswana.

Keywords

Public Health

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