International Journal of Africa Nursing Sciences 18 (2023) 100545

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International Journal of Africa Nursing Sciences

journal homepage: www.elsevier.com/locate/ijans

Knowledge, attitude and clinical practice regarding HIV/AIDS among

trainee nurses in north-eastern corridor, Ghana
Abdul-Manaf Mutaru a, *, Aminu Ibrahim a, Abdul-Nuru Wumpini Osuman a,
Timothy Atanga Agana a, Ahmad Sukerazu Alhassan b
a
Department of General Nursing, College of Health Sciences - Yendi, P. O. Box 173, Yendi, Northern Region, Ghana
b
Department of Population and Reproductive Health, School of Public Health, University for Development Studies, P. O. Box 1883, Tamale, Northern Region, Ghana

A R T I C L E I N F O A B S T R A C T

Keywords: Background: HIV/AIDS remains a modern-day global burden, killing almost 650,000 people with over 38 million
Knowledge living with the disease, and one and a half million new cases. The risk of infection in clinical practice among
HIV/AIDS health workers has been noted to be high, compared to the general population.
Student nurses
Purpose: The study, therefore, sought to determine the knowledge, attitude, and clinical practice regarding HIV/
North-eastern corridor
AIDS among nursing students along the north-eastern corridor of Ghana.
Ghana
Methods: A cross-sectional analytical design with a quantitative approach was employed. A multistage stratified
random sampling technique was used to select 373 trainee nurses. A Pearson’s chi-square analysis was performed
at a 0.20 precision level. association between sociodemographic features, knowledge, attitude, and clinical
practice were established with a multivariate logistic regression at a 95% confidence level.
Results: The majority of participants representing 88.0%, 87.9%, and 57.6% demonstrated satisfactory knowl­
edge, good attitude, and good practices respectively towards HIV/AIDS. Students in their final years of study
were 2.3 times more likely to demonstrate good attitudes towards HIV/AIDS than first years (aOR: 2.28; CI: 1.10
– 4.72). Those with sufficient knowledge of HIV/AIDS were 3.5 times more likely to have good attitudes towards
its prevention than those with insufficient knowledge levels (aOR: 3.46; 1.76 – 6.77).
Conclusion: There are satisfactory knowledge, attitude, and clinical practices among trainee nurses regarding
HIV/AIDS in the study setting. Increasing access to knowledge can improve attitudes toward HIV/AIDS. How­
ever, there is a need for appraisal of the clinical placement programs of trainee nurses to ensure improved clinical
practices. Further studies are needed to ascertain the role of knowledge and attitude in enhanced clinical
practices against HIV/AIDS.

1. Introduction national conflicts, and poor access to reproductive health services have
been highlighted as the underpinnings for the high incidence among
Human Immune Virus (HIV)/Acquired Immune Deficiency Syn­ young adults (Nubed & Akoachere, 2016). Moreover, the United Nations
drome (AIDS) has continuously remained a modern-day global burden, Children and Emergency Fund (UNICEF) reports that these young adults
with global average adult and child deaths of about 650, 000, over 38 continue to lag in worldwide measures toward HIV/AIDS eradication.
million people living with the disease, and approximately-one and a half Thus, new cases still occur with the majority not having access to
million new cases (UNAIDS & AIDSinfo, 2021). The adult population has screening and treatment (UNICEF, 2020).
been suggested to constitute 310 per 1,000 of all new cases reported HIV in the World Health Organisation (WHO) African region is
(UNAIDS & AIDSinfo, 2021). This has been attributed to lots of social greatly affected, with over 1 million new cases and about 25.7 million
interactions as part of developmental process. It is therefore relevant people living with the disease (WHO, 2021). Nonetheless, the trend of
that they exhibit proactive healthy lifestyles to protect themselves from incidence within the region had shown a reduction by 33 %: from 2.2 to
the disease (Shokoohi et al., 2016). Inadequate health information, 1.5 million (Kharsany & Karim, 2016). The prevalence of HIV among
engagement in risky behaviours, economic exploitation, regional and men having sexual intercourse with other men (MSM) in Togo has been

* Corresponding author.
E-mail address: [email protected] (A.-M. Mutaru).

https://doi.org/10.1016/j.ijans.2023.100545
Received 4 May 2022; Received in revised form 23 December 2022; Accepted 29 January 2023
Available online 31 January 2023
2214-1391/© 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
A.-M. Mutaru et al. International Journal of Africa Nursing Sciences 18 (2023) 100545

reported to be 19.6 % (Teclessou et al., 2017). The estimated prevalence examine;

in Ghana is 1.68 % (Ghana Aids Commission, 2020). That notwith­
standing, the burden of HIV/AIDS in Ghana has been reported to be 1. The knowledge and attitude levels regarding HIV/AIDS among
widespread across the country (Ghana Aids Commission, 2019). The trainee nurses in north-eastern corridor of Ghana.
southern coastal seaports in Ghana, to the hinterland and landlocked 2. The clinical practices regarding HIV/AIDS among trainee nurses in
neighbors of northern Ghana, is the eastern corridor stretch, approxi­ north-eastern corridor of Ghana.
mating 695 km. The area shares a close border with Togo eastwards, 3. The association between sociodemographic characteristics, knowl­
with an estimated HIV prevalence of 13.0 % among MSM (Teclessou edge, attitude and clinical practices regarding HIV/AIDS among
et al., 2017). Also, travelers who pass the stretch and people from trainee nurses in north-eastern corridor of Ghana.
neighboring countries patronize the health facilities dotted along the
stretch. This increases the chance of cross-country infections. The main 2. Materials and methods
health training institutions within the northern part of the eastern
corridor stretch have their students constantly being on clinical training 2.1. Conceptual framework of the study (KAP-O Model)
at various hospitals within the corridor. In India, the risk of infection in
clinical practice among health workers has been noted to be high (four The current study’s concept is in line with the Knowledge, Attitude,
times) compared to the general population (Singhal et al., 2009). Hence, and Practice Outcome (KAP-O) model propounded and enhanced by
these inexperienced students, still undergoing training and are recog­ Wan (2014) and Rav-Marathe et al (2016) respectively, where an as­
nized to have lesser regard for precautionary measures stand even sociation has been established among knowledge, attitude, and practice
higher chances (Aniaku et al., 2019; Rathi et al., 2018). That notwith­ towards infection prevention. Thus, the model seeks to visualise a linear
standing, no available empirical literature has been found to have relationship among health education, knowledge of and attitude to­
examined the situation in the setting, amidst the recommendation by wards disease, where health education is expected to translate into
Mutaru et al. (2021) on the need for revitalization of the modes and improved knowledge levels and attitude on the diseases, consequently
dimensions of the teaching of sexual and reproductive health. The study, leading to improved practices towards the disease.
therefore, sought to determine the knowledge, attitude, and clinical As presented in Fig. 1, we adapted the KAP-O model. As such,
practice regarding HIV/AIDS among nursing students along the north- knowledge level (Awareness, Knowledge of transmission, diagnosis, and
eastern corridor of Ghana. Specifically, this current study sought to prevention) and attitudes (Perceived self at risk, Occupational attitudes,

Fig. 1. Conceptual Framework of the Study (Wan, 2014; Rav-Marathe et al., 2016).

2
A.-M. Mutaru et al. International Journal of Africa Nursing Sciences 18 (2023) 100545

Perceived severity, Preventive behaviours) towards HIV/AIDS infection, hesitance, and the need to increase statistical power of analysis, a non-
relate to health education as well as socio-demographic features, which response rate of 25 % was considered. The final sample size was,
impacts on their clinical practices (HIV screening, perceived threat, therefore, determined to be 373.
clinical practices) towards HIV/AIDS infection. These interactions are A multistage stratified random sampling technique was employed in
expected to ultimately result in satisfactory knowledge, a good attitude, this survey (Taherdoost, 2016). The study population was stratified
and good clinical practices. The choice of socio-demographic as well as based on the name of the college (CoHSY: 682; Gushegu NMTC: 475),
other variables in this study was based on an extensive literature review programme of study (RGN: 317; RMN: 85; RNAC: 513; RM/PNM: 242),
of related works (Balegha et al., 2021; Qu et al., 2010; Shokoohi et al., and year of study (First Year: 285; Second Year: 625; Third Year: 247).
2016; UNICEF, 2011). Proportionate sample size was then determined for each stratum, and a
sampling frame was designed. Using the manual lottery system and
3. Study design and setting index number-based class registers as the sampling frame, simple
random sampling was then used to select each participant until the
This study employed a cross-sectional analytical design with a desired sample size was obtained. The details of the sampling strategy,
quantitative approach (Barratt et al., 2018). including the probability proportional to the strata size approach that
This study was carried out in the eastern corridor area of Ghana, we applied, have been presented in Table 1.
specifically the northern territory. The Eastern Corridor is an approxi­ Inclusion and Exclusion criteria: the inclusion criteria for this
mately 695 km stretch and one of three north-southern corridors study considered all student nurses who were registered members of
(Eastern, Central, and Western corridors) of Ghana. It links the southern either CoHSY or Gushegu NMTC and were pursuing any of the programs
coastal seaports to the hinterland and landlocked countries in the at any level of study. However, students who had completed their pro­
northern part of Ghana. The northern territory of the eastern corridor grams of study and are awaiting graduation were exempted from
shares a boundary eastward with Togo. The north-eastern corridor participating.
harbours nine Municipalities/Districts including; Nanumba North and
South, Yendi, Gushegu, Karaga, Saboba, Tatali, Kpandai, and Zabzugu 6. Data collection
(GSS, 2021). Almost all these Municipals/Districts have referral hospi­
tals as well as primary health facilities. The area also has three The method of data collection was a self-reporting questionnaire.
government-owned nurses’ training institutions; College of Health Sci­ After an extensive literature review from already published related
ences – Yendi (CoHSY), Gushegu Nurses’ and Midwifery Training Col­ works (Balegha et al., 2021; Mutaru et al., 2021; Qu et al., 2010; Sho­
lege (NMTC), and College of Community Health Nursing, Nkanchina koohi et al., 2016; UNICEF, 2011), questionnaire was adapted and
(CoCHN), located in Yendi Municipality, Gushegu District and Kpandai revised to suit the objective of the current study. A closed-ended type of
District respectively. CoHSY offers three programs; Registered General questionnaire was created, for which content validity was assessed and
Nursing (RGN), Registered Mental Nursing (RMN), and Registered Nurse internal consistency was measured. Data collection was executed from
Assistant Clinical (RNAC). Gushegu NMTC offers RNAC, Post-basic 1st to 30th March 2022 after obtaining written consent. All the paper-
Nursing/Midwifery (PNM), and Registered Midwifery (RM) while based questionnaires were hand-delivered to each consented partici­
CoCHN being less than three years offers only Nurse Assistant Preventive pant in their respective classrooms by all the authors in this study. Re­
(NAP). The RGN, RMN, and PNM programmes are offered for three years spondents were given at least two (2) weeks to respond to and submit
leading to the award of a diploma qualification in nursing whereas the their questionnaire anonymously back to the researchers through their
RNAC and NAP are pursued for two years leading to the award of a respective class representatives. As such, they were allowed to retire
certificate qualification in nursing. back to their hostels with the questionnaire to allow them to adequately
respond. The questionnaire was structured into four main sections; A to
D. Section A was designed to collect the socio-demographic features of
4. Study population
participants. Section B was designed to examine participants’ knowl­
edge regarding HIV/AIDS. This was formulated to encompass aware­
This study’s population comprised all nursing students of CoHSY and
ness, knowledge of transmission, diagnosis, and prevention. Section C;
Gushegu NMTC in the Yendi and Gushegu Municipalities respectively.
attitude was constructed to measure perceived self at risk, occupational
Nursing students in this study included all participants who were
attitudes, perceived severity, and preventive behaviour towards HIV/
registered students of both institutions and are still undergoing both
AIDS. Attitude refers to examining individual behaviour, including
theoretical and clinical training at various levels of their programs. The
proactive measures toward HIV/AIDS. As such, occupational attitude
overall aim was to determine the knowledge, attitude and clinical
sought to measure the student nurses’ predisposition in the clinical
practice regarding HIV/AIDS, which can be transmitted in the clinical
setting to respond favourably or unfavourably to HIV/AIDS, since the
practice area. And as part of the training for all programs offered in these
clinical practice area has a risk of exposure to HIV/AIDS infection.
schools, clinical training is mandatory. Hence the need to ascertain the
situation among these various programs. CoHSY and Gushegu NMTC
Table 1
were purposively sampled based on the programs that are being offered
Selection based on probability proportional to strata size approach.
and the study design/sampling technique. As such, CoCHN being a
newly established school and not having students for various levels at Level of study Population per Percentage Proportional sample
level size
the time of this current study, could not have been included. CoHSY and
Gushegu NMTC have an estimated student population of 682 and 475 First Year (CoHSY) 180 15.6 59
respectively. Second Year 341 29.5 112
(CoHSY)
Third Year (CoHSY) 161 13.9 53
5. Sampling and sample size determination First Year (GNMTC) 105 9.1 33
Second Year 284 24.5 89
(GNMTC)
The sample size was estimated using Yamane’s formula (Yamane, Third Year 86 7.4 27
N
1967) of sample size estimation; n =..1+N(e)2 (GNMTC)
Where N = estimated population size (475 + 682) = 1,157 students. Total 1,157 100 373

Using a confidence level of 95 %, level of precision (e) = 5 % = 0.05, the GNMTC: Gushegu Nursing and Midwifery Training College; CoHSY: College of
estimated sample size is 298. Considering the COVID – 19 pandemic, Health Sciences, Yendi.

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A.-M. Mutaru et al. International Journal of Africa Nursing Sciences 18 (2023) 100545

Section D assessed participants’ clinical practices toward HIV/AIDS. Table 2

This included screening practices for HIV, perceived threats, and clinical Sociodemographic Characteristics (N = 373).
practices. Variable Category Frequency Percent

Age ≤ 23 220 59.0

6.1. Data analysis 24–29 143 38.3
30+ 10 2.7
Responded questionnaires were assessed periodically as and when Mean age (±2SD) 23.4 ± 2.5
they submit it for completeness and clarity. Data were sorted, coded, Gender Male 126 33.8
Female 247 66.2
entered into SPSS version 26, and cleaned. Socio-demographic features, Religion Islam 164 44.0
knowledge, attitude, and practice items are presented using frequencies Christianity 206 55.2
and percentages. Based on composite scores generated for overall Traditionalist 2 0.6
knowledge, attitude, and clinical practice, the overall proportions for No Religion 1 0.3
Hometown Rural 194 52.0
knowledge, attitudes, and clinical practice levels among respondents
Urban 179 48.0
have been presented using pie and bar charts. The minimum and College CoHSY 224 60.1
maximum scores for knowledge, attitude, and practice were; 0 – 21, 0 – Gushegu NMTC 149 39.9
8, and 0 – 10 respectively. In line with Andrew et al (2020), and the Program RNAC 165 44.2
statistical distribution (approximately normal distribution) of the RGN 104 27.9
RMN 28 07.5
overall scores on knowledge, attitude, and clinical practice, a 50 % RM/PNM 76 20.4
obtainable score on overall knowledge was categorized into ‘satisfac­ Level of study 1st Year 92 24.7
tory’ and ‘unsatisfactory’, while overall attitude and clinical practice 2nd Year 201 53.9
scores were as well categorized into ‘Good’ and ‘Poor’. 3rd Year 80 21.4
Parental Education No formal education 141 37.8
At 0.20 precision level, a Pearson’s chi-square analysis was per­
Primary 20 5.4
formed to determine the association between socio-demographic fea­ Middle school 67 18.0
tures and participants’ overall attitude and practice. The statistical SSS 48 12.9
association between overall knowledge, attitude, and clinical practice Tertiary 97 26.0
were as well examined. Further, to control for confounders and deter­ SD: Standard Deviation.
mine the independent predictive power of variables at p < 0.20, a
multivariate binary logistic regression analysis was executed, at a 95 %
(96.0 %) affirmed that sharing toiletries and haircut kits with PLHIV can
confidence level and 0.05 % precision.
cause transmission. About 53.9 % confirmed mosquitoes are not vectors
while an overwhelming 98.4 % reported sharing needles from a patient –
7. Validity and reliability
to – a patient being a mode of transmission. Most of the participants
identified kissing (59.0 %) as a possible means of HIV transmission
Face and content validity of the questions were done by three
whereas a majority (60.9 %) denied the possibility of identifying PLHIV
different experts in HIV/AIDS. The questionnaire was pretested among
by appearance. With regards to treatment, about 58.4 % reported that
30 students, who had completed their programs and awaiting their
treatment reduces chances of transmission and more than three quarters
graduation. They were randomly selected from both schools. As such,
(86.3 %) indicated that early diagnosis increases life expectancy. A
they were exempted from the main study. The internal consistency and
blood test was confirmed (79.1 %) as a definite diagnosis of HIV with
validity of the various scales were measured. A Cronbach’s alpha of
almost all participants (96.0 %) reporting condom use to reduce the
0.725, 0.741, and 0.766 was recorded for knowledge, attitude, and
transmission. About 94.4 % indicated that following treatment with a
clinical practice item scales respectively.
healthy diet makes PLHIV have normal lives. More than half (65.7 %)
denied the availability of the HIV vaccine while 75.9 % indicated mul­
8. Results
tiple sex increased chances of getting infected. About three quarters
confirmed that STIs increase the chances of transmission and 75.9 %
8.1. Sociodemographic characteristics of respondents
agreed there is no currently available cure for HIV.

In this study, 373 respondents were enrolled with a 100 % response

rate. Of this, the majority (59.0 %) were < 23 years with a mean age of 8.3. Overall knowledge level of respondents
23.4 ± 2.5. More than half (66.2 %) were females and about 55.2 %
were Muslims. Fifty-two percent (52.0 %) of participants were from As indicated in Fig. 2, an overwhelming majority (88.0 %) of par­
rural communities and about 60.1 % of students represented CoHSY. ticipants’ overall knowledge level on HIV/AIDS in this study was
The majority (44.2 %) were those offering the RNAC program with satisfactory.
about half (53.9 %) being in the second year of study. About 37.8 %
reported that their parents had no formal education. further details are 8.4. Respondents’ attitude towards HIV/AIDS
presented in Table 2.
As shown in Table 4, almost half (49.6 %) of the respondents
8.2. Knowledge of respondents regarding HIV/AIDS perceived themselves at risk of HIV/AIDS with a vast majority (85.8 %)
having to know that occasional contact with blood increases the risk of
As indicated in Table 3, the awareness level of HIV/AIDS in the HIV. About 77.2 % of the students disagreed that wearing PPE is not
current study was overwhelmingly high (96.8 %), with about 89.8 % necessary for surgical procedures and a little over half (52.5 %) of the
being able to differentiate between HIV and AIDS. 97.6 % of the students participants disagreed with HIV being perceived as not potentially
agreed to the fact that HIV is an STI and 96.2 % indicated HIV trans­ serious. Approximately 59.8 % affirmed that HIV is no longer serious
mission can be through contaminated syringes. Three-quarters (74.3 %) because of antiretrovirals. Also, 79.6 % of the respondents disagreed
of the students knew that pregnant mothers can pass the virus to the that occasional needle pricks don’t require reporting. With regards to
foetus. The majority (83.6 %) affirmed breastfeeding mother-to-child the use of condoms not necessary in every sexual activity, about 64.4 %
transmission is possible. Most (55.0 %) of the participants accepted of the participants disagreed with that as well as 82.3 % of respondents
the possibility of getting infected through sharing belongings. Almost all were not in support of the item blood/body fluid splash do not require

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A.-M. Mutaru et al. International Journal of Africa Nursing Sciences 18 (2023) 100545

Table 3
Item analysis for knowledge variables (N = 373).
Variable
Frequency (%)
Yes No Not sure

Awareness 361 12 (03.2) 00 (00)

(96.8)
Difference between HIV and AIDs 333 33 (08.8) 07 (1.9)
(89.3)
HIV as being an STI 364 8 (02.1) 01 (0.3)
(97.6)
HIV transmission through contaminated 359 13 (03.5) 01 (0.3)
syringes (96.2)
Pregnant mother to foetal transmission 277 80 (21.4) 16 (4.3)
(74.3)
Breastfeeding mother to child transmission 312 37 (09.9) 24 (6.4)
(83.6)
Sharing belongings of PLHIV as a 205 146 22 (5.9)
transmission (55.0) (39.1)
Sharing haircut kit as a means of 358 11 (02.9) 04 (1.1)
transmission (96.0)
Mosquito as a vector 134 201 38
(35.9) (53.9) (10.2)
Sharing needle patient to patient 367 5 (01.3) 01 (0.3)
(98.4)
Possibility of kissing PLHIV causing HIV 220 120 33 (8.8)
(59.0) (32.2)
Possibility of identifying PLHIV by 101 227 45
appearance (27.1) (60.9) (12.1)
Treatment reduces chances of transmission 218 128 27 (7.2)
(58.4) (34.3)
Early diagnosis increases life expectancy 322 24 (6.4) 27 (7.2)
(86.3)
Blood test as definite diagnosis 295 50 (13.4) 28 (7.5)
(79.1)
Condom use reduces transmission 358 13 (03.5) 02 (0.5)
(96.0) Fig. 2. Overall Knowledge level of respondents.
PLHIV live normal live with healthy diet 352 10 (02.7) 11 (2.9)
(94.4)
Availability of HIV vaccine 79 (21.2) 245 49
Table 4
(65.7) (13.1)
Item analysis for Attitude variables (N = 373).
Multiple sex-partner increase chance of 365 6 (01.6) 02 (0.5)
infection (97.9) Variable Category Frequency Percent
STI increases chance of infection 283 61 (16.4) 29 (7.8) (%)
(75.9)
Perceive self at risk Yes 167 44.8
Availability of HIV cure 55 (14.7) 283 35 (9.4)
No 185 49.6
(75.9)
Not sure 21 5.6
PLHIV: People Living with HIV. Occasional contact with blood increase Yes 320 85.8
risk of HIV
No 33 8.8
reporting. Not sure 20 5.4
Wearing PPEs not necessary in surgical Yes 82 22.0
procedures
8.5. The overall attitude toward HIV/AIDS No 288 77.2
Not sure 3 0.8
As indicated in Fig. 3, more than three quarters (87.9 %) of partici­ HIV perceive not potentially serious Yes 141 37.8
pants’ overall attitude level towards HIV/AIDS in this study was Good. No 196 52.5
Not sure 36 9.7
HIV no longer serious because of Yes 223 59.8
8.6. Respondents’ clinical practices toward HIV/AIDS antiretrovirals
No 120 32.2
Not sure 30 8.0
As indicated in Table 5, the number of participants who reported Occasional needle pricks don’t require Yes 54 14.5
ever being screened for HIV was appreciable (67.0 %), and about 3.5 % reporting
reported positive for their HIV status. Almost all (96.5 %) agreed to the No 297 79.6
Not sure 22 5.9
fact that it is necessary to screen for HIV by all health workers. More
Use of condom not necessary in every Yes 116 31.1
than half (56.3 %) of the participants affirmed that every client must be sexual activity
seen as potentially infectious and more than three-quarters (76.1 %) No 241 64.6
indicated that it is always necessary to take post-exposure prophylaxes Not sure 16 4.3
for HIV after experiencing needle stick of a suspected patient. An Blood/body fluid splash do not require Yes 43 11.5
reporting
overwhelming majority (93.0 %) of the participants accepted that gloves
No 307 82.3
should be changed always during blood collection. Only 17.2 % of the Not sure 23 6.2
participants never recapped needles after use and 64.1 % reported never
experiencing needle stick injury to the best of their knowledge. Most
(53.1 %) of the students reported never experiencing any splashed
blood/body fluids on their bodies and a more than half (64.1 %)

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A.-M. Mutaru et al. International Journal of Africa Nursing Sciences 18 (2023) 100545

Fig. 3. Participants’ overall attitude towards HIV/AIDS.

Table 5
Item analysis for clinical practice variables (N = 373).
Variable Category Frequency Percent
(%)

Ever screen for HIV Yes 250 67.0

No 121 32.4
Not sure 2 0.5
Self – reported HIV status Negative 237 63.5
Positive 13 3.5
Necessary to screen for HIV by all Yes 360 96.5
health workers
No 9 2.4
Not sure 4 1.1
Every client must be seen as potentially Always 210 56.3
infectious
Sometimes 137 36.7
Never 26 7.0
Necessary for post-exposure after Always 284 76.1
needle stick
Sometimes 78 20.9
Never 11 2.9
Frequency of gloves change during Always 347 93.0 Fig. 4. Participants’ practices towards HIV/AIDS.
blood collection
Sometimes 22 5.9
Never 4 1.1
sometimes reported needle stick injury or blood/fluids splash to the
Frequency of needles recap Always 274 73.5 authorities.
Sometimes 35 9.4
Never 64 17.2
Experience of needle stick injury Always 30 8.0 8.7. Overall practices towards HIV/AIDS prevention
Sometimes 104 27.9
Never 239 64.1 As indicated in Fig. 4, a little over half (57.6 %) of the participants’
Experience of body splash with blood/ Always 24 6.4 overall practices level towards HIV/AIDS in this study was Good.
fluid
Sometimes 151 40.5
Never 198 53.1 9. Association between sociodemographic characteristics,
Ever reporting needle stick injury/body Always 97 26.0 knowledge, attitude and clinical practice regarding HIV/AIDS
splash from bivariate (chi-square) and multivariate binary logistic
Sometimes 239 64.1
Never 37 9.9
regression analysis

9.1. Attitude

A Pearson’s chi-square analysis indicated age (Ch-stat = 3.52, p <

0.20), gender (Chi-stat = 1.70, p < 0.20), hometown (Chi-stat = 1.65, p
< 0.20), level of study (Chi-stat = 7.33, p < 0.05) and knowledge level
(Chi-stat = 17.86, p < 0.001) to be statistically significantly associated

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A.-M. Mutaru et al. International Journal of Africa Nursing Sciences 18 (2023) 100545

with attitude towards HIV/AIDS. After adjusting for confounding vari­ average level of knowledge was observed. Similarly, Wongkongdech
ables, a multivariate binary logistic regression analysis showed the level et al. (2020) in Lao People’s Democratic Republic and Oljira et al. (2013)
of study and overall knowledge level to be significant predictors of at­ reported poor knowledge levels of HIV/AIDS among college students
titudes toward HIV/AIDS. Students in their final years of study were 2.3 and in-school adolescents respectively. These differences in findings
times more likely to demonstrate good attitudes towards HIV/AIDS than could be attributed to variations in study populations. The aforemen­
first years (aOR: 2.28; CI: 1.10 – 4.72). Those with sufficient knowledge tioned studies were conducted among undergraduate, in-school ado­
of HIV/AIDS were 3.5 times more likely to have good attitudes towards lescents, and vocational college students respectively. Since the current
HIV/AIDS than those with insufficient knowledge levels (aOR: 3.46; study has been conducted among trainee nurses, it is only obvious that
1.76 – 6.77). Further details are presented in Table 6. their knowledge levels appear appreciable. Unlike vocational training
and secondary school students, where topics on Sexual and Reproduc­
tive Health (SRH) may not be detailed, trainee nurses have as part of
9.2. Practice their curriculum, programs that incorporate detailed course content
alongside clinical training of SRH. Therefore, the tendency for them to
Bivariate analysis with a Pearson’s chi-square analysis showed only provide intellectual responses to issues of HIV/AIDS is relatively higher.
hometown (Chi-stat = 2.05, p < 0.20) to be statistically significantly Moreover, since it was not all trainee nurses who possessed good
associated with clinical practice towards HIV/AIDS, Table 6. knowledge, we reiterate, as proposed by Mutaru et al. (2021), the need
for revitalization of the modes and dimensions of the teaching of sexual
10. Discussion and reproductive health in colleges of health.
Also, the overall attitude and clinical practice levels of participants in
The main objective of this current study was to determine the this study were found to be good. This was as well reported in Jordan
knowledge, attitude, and clinical practices of trainee nurses regarding (Ryalat et al., 2011), Addis Ababa University (Regassa & Kedir, 2011),
HIV/AIDS in the northeastern corridor of Ghana. This study presents an and among teacher trainees in north-western Ethiopia (Tsegaye, 2021).
overall, satisfactory knowledge level regarding HIV/AIDS among trainee The finding is however inconsistent with Haroun et al. (2016) in Dubai
nurses. These findings on overall knowledge correlate with Dzah et al. and Thanavanh et al. (2013) in the Lao people’s Democratic Republic.
(2019) among senior high students, Boakye and Mavhandu-Mudzusi The variation in findings may be plausibly associated with disparities in
(2019) among practicing nurses, Kenu et al. (2014) among adolescents study settings, populations, and sample size. The current study setting
in Ghana and Talwar (Talwar, 2015) in Malaysia. In all these studies, the was mainly health training institutions with student nurses as the study
majority of participants demonstrated satisfactory knowledge levels population. Student nurses appreciate the infectiousness and compli­
regarding HIV/AIDS infection. Also, just as employed in this current cations of HIV/AIDS. In this regard, they are more likely to exhibit
study, Dzah et al (2019), Boakye and Mavhandu-Mudzusi (2019), and proactive attitudes toward infection prevention and may essentially give
Talwar (2015) also used a cross-sectional design, which enhances the positive responses. However, unlike Haroun et al. (2016), where over
compatibility of the findings. The current finding however differs from 2,000 participants were enrolled, this current study recruited a
another cross-sectional study reported in Dubai (2016), where an overall

Table 6
Association between sociodemographic characteristics, knowledge, attitude and clinical practices of HIV/AIDS (N = 373).
Variable Attitude Practice
Poor Good Chi-stat aOR (95 %) Poor Good Chi-stat

Age
≤ 231 61 (53.5) 159 (61.4) – 90 (57.0) 130 (60.5)
24 – 29 53 (46.5) 90 (34.7) 3.52* 0.65 (0.40, 1.05) 63 (39.9) 80 (37.2) 0.60
30+ 3 (2.6) 7 (2.7) 0.82 (0.20, 3.35) 5 (3.2) 5 (2.3)
Gender
Male 1 44 (38.6) 82 (31.7) – 58 (36.7) 68 (31.6)
Female 70 (61.4) 177 (68.3) 1.70* 1.25 (0.77, 2.03) 100 (63.3) 147 (68.4) 1.05
Hometown
Rural 1 65 (57.0) 129 (49.8) – 89 (56.3) 105 (48.8)
Urban 49 (43.0) 130 (50.2) 1.65* 1.00 (0.63, 1.62) 69 (43.7) 110 (51.2) 2.05*
College
CoHSY1 68 (59.6) 156 (60.2) 95 (60.1) 129 (60.0)
Gushegu NMTC 46 (40.4) 103 (39.8) 0.01 63 (39.9) 86 (40.0) 0.001
Program
RNAC1 58 (50.9) 107 (41.3) 63 (39.9) 102 (47.4)
RGN 28 (24.6) 76 (29.3) 3.00 48 (30.4) 56 (26.0) 4.38
RMN 7 (6.1) 21 (8.1) 16 (10.1) 12 (5.6)
RM 21 (18.4) 55 (21.2) 31 (19.6) 45 (20.9)
Level of study
1st Year 1 34 (29.8) 58 (22.4) – 33 (20.9) 59 (27.4)
2nd Year 65 (57.0) 136 (52.5) 7.33** 1.12 (0.64, 1.96) 86 (54.4) 115 (53.5) 2.94
3rd year 15 (13.2) 65 (25.1) 2.28 (1.10, 4.72) ** 39 (24.7) 41 (19.1)
Parental Education
No formal education1 39 (34.2) 85 (32.8) 55 (34.8) 69 (32.1)
Secondary 31 (27.2) 84 (32.4) 1.08 42 (26.6) 73 (34.0) 2.36
Tertiary 44 (38.6) 90 (34.7) 61 (38.6) 73 (34.0)
Knowledge level
Insufficient 1 26 (22.8) 19 (7.3) – 22 (13.9) 23 (10.7)
Sufficient 88 (77.2) 240 (92.7) 17.86*** 3.46 (1.76, 6.77) *** 136 (86.1) 192 (89.3) 0.89
Attitude
Poor 1 48 (30.4) 66 (30.7)
Good 110 (69.6) 149 (69.3) 0.004

*p < 0.20; **p < 0.05; ***p < 0.001; 1_reference category.

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A.-M. Mutaru et al. International Journal of Africa Nursing Sciences 18 (2023) 100545

relatively smaller number of participants, which could have limited the 12. Conclusion
possibility of receiving a larger variety of opinions. Consequently, this
makes the generalization of their findings more representative than the There is sufficient knowledge, good attitude, and clinical practices
current study. Nonetheless, this present finding generally supports Rav- towards HIV/AIDS, with participants’ level of study and knowledge
Marathe et al. (2016)’s Knowledge, Attitude, and Practice Outcome level being the predictors of attitudes toward the infection. Since
(KAP-O) model. knowledge and attitudes did not translate into actual clinical practices,
Inferential analysis from this study established a relationship be­ emphasis on practical training in nursing education is required. There is
tween trainee nurses’ level of study and their attitudes toward HIV/ the need therefore for principals of health training institutions to
AIDS. As student nurses progress in their level of study, their attitudes intensify the clinical monitoring and identify preceptors to ensure
toward HIV/AIDS become improved. The higher, students climb their knowledge acquired by students is translated into improved practical
academic ladder, much is expected from them hence, it is not surprising skills. Further research is recommended with varying settings to further
that final-year students demonstrate good attitude than first years, since evaluate knowledge, attitude, and clinical practice outcome relationship
they have had several clinical experiences. Therefore, they are very among trainee nurses, especially in infection prevention and control
likely to be more meticulous in terms of their attitudes towards the measures.
disease.
Additionally, this current study established a statistically significant
Declaration of Competing Interest
association between participants’ knowledge level and their attitudes
toward HIV/AIDS. Thus, trainee nurses with sufficient knowledge were
The authors declare that they have no known competing financial
more likely to demonstrate a good attitude toward the infection. In
interests or personal relationships that could have appeared to influence
tandem with our finding is Andrew et al. (2020) among undergraduate
the work reported in this paper.
students in the United States, where a cross-sectional survey among
undergraduate students revealed a significant relationship between
their HIV/AIDS knowledge levels and attitudes. It however refutes Pal Acknowledgements
Singh et al.’s (2017) finding among dental students in Malaysia. This
variation in finding may be due to the nature of the study design and We are grateful to the principals of College of Health Sciences, Yendi
sampling. Pal Singh et al.’s (2017) study used a relatively lesser sample and Nursing and Midwifery Training College, Gushegu for granting us
size compared to the current study. Also, as their study was directed to permission during the data collection process. We appreciate the time of
eliciting information regarding participants’ attitudes to HIV patients, all trainee nurses who granted consent and participated in the study.
the present study examined attitudes towards the infection. In any case,
both studies were among health trainees, hence, the current finding was
much anticipated, especially in the global fight against the spread of the Ethical Consideration
infection. These students who are enlightened through the knowledge
they acquire, are expected to exhibit improved attitudes and further This study received ethical clearance from the Committee on Human
sensitize people regarding the spread of the infection. Therefore, to Research Publications and Ethics of the Kwame Nkrumah University of
ensure good attitudes toward HIV/AIDS, there is a need for increased Science and Technology (CHRPE/AP/121/22). Permission for use of the
access to knowledge on the infection. study site was granted by both Principals of CoHSY and Gushegu NMTC.
Finally, none of the socio-demographic features in addition to par­ Oral and written consent was obtained from all participants after
ticipants’ knowledge and attitude were determinants of clinical prac­ explaining the nature and purpose of the study. Granting consent
tices toward HIV/AIDS in this study. This finding does not support Rav- including the use of data was a prerequisite to participating in this study.
Marthe et al. (2016)’s KAP-O model; proposing a linear relationship Confidentiality and privacy were guaranteed and information sheets
between knowledge, attitude, and practice. This could be reasoned from were provided to each participant.
the perspective of possibly weak clinal supervision and inadequate lo­
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