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Name of the Journal :Â Science, Technology and Arts Research Journal
Abbreviation :Â Sci. Technol. Arts Res. J.
ISSN :Â 2305-3372 (Online)
ISSN :Â 2226-7522 (Print)

April-June 2012, Volume 1, Issue 2: 01-116

Science

Participatory Barley Variety Selection and Farmersâ€™ Selection Criteria in the Bale Highlands of Southeastern Ethiopia

Zerihun J, Amsalu A, and Grando S.......................................................................................
DOI: http://dx.doi.org/10.4314%2Fstar.v1i2.98778

Abstract

Full Text

Sci. Technol. Arts Res. J. April-June 2012, 1(2):01-11

Participatory Barley Variety Selection and Farmersâ€™ Selection Criteria in the Bale Highlands of Southeastern Ethiopia

Zerihun J1*, Amsalu A2, and Grando S3

1Department of Plant Science, College of Agriculture and Natural Resources, Wollega University, Post Box No: 692, Nekemte, Ethiopia
2Department of Crop Research, Oromia Agricultural Research Institute, Addis Ababa, Ethiopia
3The International Center for Agricultural Research in the Dry Areas (ICARDA), Global Barley Improvement Program. Post Box No: 5466, Aleppo, SyriaArticle History: Received: 06-02-2012; Revised: 20-06-2012; Accepted: 25-06-2012
DOI: http://dx.doi.org/10.4314%2Fstar.v1i2.98778

*Corresponding Author:
Zerihun Jalata
E-mail: jaluu_z@yahoo.com

Abstract
The aim of the study was to identify farmersâ€™ selection criteria, preferences and generate baseline information on the importance of participatory barley breeding in Southeastern part of Ethiopia. The experiment was conducted in non-replicated plots at each location on plot size of 16m2 in 2007 Bona and on 25m2 in 2008 Ganna and Bona cropping seasons. Yield data was taken in kg plot-1 and converted in to t ha-1 .Selection criteria was set together with farmers; and ranked by farmers and breeders. Farmers and breeders made visual score of each plot on 1-5 scale beside variety selection. Some farmers were supported by the staff in case of data recording problem. The result showed that grain yield, disease resistance, effective tillers, early maturity and kernel size (plumpness) were among the most important selection criteria commonly used farmers. While, breeders preferred high yielding variety with insect and disease resistant and early maturing types. And farmers were able to identify the higher yielding barley varieties as breeders. Varieties such as Guta, Dinsho, Biftu and Abdane were selected as the best varieties preferred by most of the local farmers across locations except at Hora Soba (Upper Dinsho) site. Shage, Dimtu varieties and 27th IBON 73/99 (semi-dwarf advanced line) were preferred by the Hora Soba local farmers. Thus, attention should be given to seed multiplication and dissemination of barley varieties which have been highly preferred by the local farmers. It is important to consider farmers preferences in crop improvement to improve the adoption of agricultural technologies which ultimately have significant contribution in production and productivity.Keywords: Barley; Participatory; Variety Selection; Criteria; Preferences

INTRODUCTION
Barley (Hordeum vulgare L.) is one of the most important staple food crops in the highlands of Ethiopia (CSA, 2005) and its grain accounts for over 60% of the food of the people in the high lands of Ethiopia, for whom barley is one of the main sources of calories (ICARDA, 2002). It ranks fourth among the cereals in worldwide production (Kling and Hayes, 2004) and fifth in Ethiopia with national average of about 12 quintal per hectare (CSA, 2005). It is used as human food, livestock feed and for malting purposes (Harlan, 1976; Onwueme and Singh, 1991; Kling and Hayes, 2004). In Ethiopia, barley production is mainly constrained by lack of improved varieties, disease and insect pest problem, weed competition and poor soil fertility (Berhane et al., 1996).

Even though many improved barley varieties have been released nationally and regionally from different agricultural research centers in Ethiopia, the national productivity of barley crop did not exceed an average of 12 quintals per hectare for long time. One of the reasons could be adoption rate of improved varieties is very low among small scale farmers including Bale farmers. Because many breeding strategies follow conventional methods to develop cultivars. And farmersâ€™ preferences and criteria would differ from breedersâ€™ assumptions. As a result, farmers are reluctant in adopting the new technologies. Less adoption of the varieties may be also due to varieties were not adapted to the cropping systems, the biotic and abiotic stress in the area, the color, taste of produce did not match to the requirement of the consumers or other forms of uses (Voss, 1996). Thus, there should be some mechanisms in which farmers can be involved in crop improvement programs known as participatory approach. Participatory variety selection (PVS) involves the selection of released cultivars and varieties in advanced stages of testing from plant breeding programs and is used to differentiate materials that can be adopted rapidly (Witcombe and Joshi, 1996). Participatory breeding combined with decentralized selection has advantages of meeting their diverse needs by diversified varieties in order to manage risk and satisfy different end uses (Voss, 1996). Decentralized selection enable breeder to utilize farmers knowledge of the crop and the environment to fit crops to the specific needs and uses of farmers (Ceccarrelli et al., 2000). Participatory barley breeding (PBB) has been conducted in Eritrea (ICARDA, 1999), in Morocco (ICARDA, 1998), in Syria (Ceccarrelli et al., 2000) and in Egypt (ICARDA, 2000).

Bale highlands in the South-Eastern part of Ethiopia is a major barley producing areas in Ethiopia and barley is the second most important staple crop next to wheat in area coverage and production (EASE, 2002). Most of improved varieties released nationally did not perform well to these specific areas because of severe shoot fly damage and the late maturity of these varieties has not been preferred by the local farmers. The recently released varieties from Sinana agricultural research center barley breeding program have shown specific adaptation to these environments. However, farmersâ€™ preference of the varieties has not been identified well for scaling up and/or out program. Therefore, the present study was designed to identifying farmersâ€™ selection criteria, preferences and perceptions of barley crop in Bale highlands; identifying improved varieties which can be easily adopted by the local farmers and indicate better strategies to promote barley technologies in the area. On top of this, the purpose of this study was to generate baseline information about the importance of participatory barley breeding in Bale highlands for future barley breeding programs.

MATERIALS AND METHODS
The experiment was conducted in 2007 in Bona and in 2008 in Ganna by dividing in to two phases: Phase I: Study was Conducted in 2007 in Bona (July to December) growing season at five representative sites in two districts, namely Sinana (Salka Oda, Salka Urane, Jafara) and Agarfa (Ilani and Rataba) (Table 1). During 1st phase, a total of 12 food and malting barley varieties (Figure 1) were planted on 16 m2 non-replicated plots with seed and fertilizer rate of 125 kg ha-1 and 50 kg per hectare (ha-1) of DAP (Diammonium phosphate), respectively, at all sites.

Phase II: Study was conducted during 2008 Ganna (March to July) and cropping seasons at ten representative sites in four districts. These districts (Table 1) includes Sinana (Sinana (on station), Salka Oda, Hisu, Jafara and Robe sites), Lower Dinsho ?Homa and Waltaâ€™i sites?, Upper Dinsho (Hora Sobae site? and Adaba (Adaba (at on station) and Ejersa Chumulugo sites) covering most of representative barley growing areas. Except the Hora Soba (typical cool highland), Homa and Waltaâ€™i sites and the other sites represent mid highlands (2300-2500 meter above sea level) with relatively similar topography (Table 1). And except Upper Dinsho and Adaba districts, at all sites varieties were planted during Ganna 2008 cropping season. During phase-II, sixteen barley varieties (Figure 2) including one local and one new food barley candidate variety have been planted at each site on plot size of 25m2 and with similar seed and fertilizer rate to phase I. Most of the barley varieties used for evaluation was brought from different Agricultural research centers in Ethiopia.

Area Description and Cropping Seasons
Highlands of Bale is found in the South-East of Addis Ababa in the Bale zone. The experiment was conducted at sites/locations where most of barley research experiments have been conducted by Sinana barley breeding program. These experimental sites cover an altitudinal range of about 2300-3200 m.a.s.l (Table 1). The districts are characterized by bimodal (Sinana, Agarfa, Lower Dinsho) and monomodial (Upper Dinsho and Adaba) rainfall. Accordingly, there are two cropping seasons in the area: Ganna (March to July) and Bona (July to December) seasons. The average rainfall is about 590 mm in the Ganna and 560 mm in Bona season (Hailu et al., 1996).

Table 1: Some physical and biological characteristics of the growing environments in Bale.

District	Site	Altitude (m.a.s.l)	Rain Fall Type	Shoot Fly Incidence	Cropping Season Planted
Sinana	Sinana (on station)	2400	Bimodal	Present	2008 Ganna
Sinana	Salka-Oda	2400	Bimodal	Present	2007 Bona & 2008 Ganna
Sinana	Salka-Urane	2400	Bimodal	Present	2007 Bona
Sinana	Jafara	2400	Bimodal	Present	2007 Bona & 2008 Ganna
Sinana	Hisu	2400	Bimodal	Present	2008 Ganna
Sinana	Robe	2400	Bimodal	Present	2008 Ganna
Agarfa	Ilani	2300	Bimodal	Present	2007 Bona
Agarfa	Rataba	2400	Bimodal	Present	2007 Bona
Lower Dinsho	Homa	2640	Bimodal	Less	2008 Ganna
Lower Dinsho	Waltaâ€™i	2500	Bimodal	Less	2008 Ganna
Upper Dinsho	Hora Soba	3200	Monomodal	Very minimum	2008 Ganna
Adaba	Ejersa Chumulugo	2500	Monomodal	Very minimum	2008 Ganna
Adaba	Adaba (on station)	2500	Monomodal	Very minimum	2008 Ganna

Cultural Practices, Data Collection and Statistical Analysis
The local farmers and breeders were participated in the selection process. Selection criteria were set jointly with farmers. Farmers and breeders made selection separately and/or in group. In addition to breedersâ€™, agronomists, pathologists, entomologists and extensionists have been also involved in evaluation. Visual scoring of the plots or varieties was taken based on the (1-5) scale by the farmers and breeders. Where, 1=very good, 2=good, 3=average, 4=poor and 5=indicating very poor. Farmers were supported by our technical staff in recording the data during scoring or ranking. Grain yield data was recorded for each plot. Other recommended agronomic and cultural practices have been applied uniformly. Evaluation and variety selection was done at maturity period. Statistical analysis was done by using statistical package for social science (SPSS) version 12.0, 2003 software program.

RESULTS AND DISCUSSION
Technology transfer is a very problematic in developing countries and sometimes new technologies developed by researchers may not be adopted by the farmers. This is due to the limitations of formal plant breeding which is related to their inability to address the enormous diversity of environmental conditions and end-usersâ€™ needs (Morris and Bellon, 2004; Ceccarrelli and Grando, 2005). It concentrate on increasing yield potential in favorable environments through application of high inputs and give less attention to the importance of adaptation to variable and risky low input rain fed conditions, secondary crop uses and cultural preferences (de Boef and Ogliari, 2008). Hence, participatory approach ensures the involvement of farmers in crop improvement programs to alleviate problems related to technology transfer or adoption and integrate farmersâ€™ indigenous knowledge in crop improvement.

Hence, participatory barley variety selection which was conducted during phase I was at five sites in two districts (Sinana and Agarfa) during 2007. Bona cropping season; whereas during experimental phase II (Ganna and Bona during 2008), the research was carried out at ten representative sites in four districts (Sinana, Lower Dinsho, Upper Dinsho and Adaba) of Bale highlands. The overall research report of this research work has been presented as follows:

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Figure 1: Grain yield in tons per hectare of barley varieties at five sites in Bale highlands during 2007 (Phase I) Bona season.

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Figure 2: Grain yield tons per hectare of barley varieties tested at ten sites in Bale highlands during 2008 (Phase II) Ganna and Bona season.

Phase I: Participatory Research

Selection Criteria

Farmers and breeders rankings of selection criteria, visual scoring and variety ranking is presented in Table (2, 3, 4 and 5), respectively. A range of 7 to 10 farmers have been participated at individual site. Selection criteria ranked by individual farmers varied depending on their priority and preference. Grain yield was the first selection criteria of farmers at all sites except Salka Urane site in which drought and insect resistance was the top priority of selection. Disease resistance, early maturity and drought resistance were the most important selection criteria used by the farmers next to grain yield (Table 2). It was observed that during selection, farmers were observed opening apart the plants in order to see visually some important traits, for instance productive tillers and disease resistance. Thus, grain yield, disease resistance, early maturity and drought resistance were among the most important selection criteria used by farmers at most of the sites. On the other hand, breeders also participated in the rankings of selection criteria. Accordingly, almost at all sites grain yield was ranked first followed by biotic stresses such as insect resistance and disease resistance which are prevalent in the areas as a yield reducing factors (Table 2). Beside this, farmers and breeders have also ranked selection criteria jointly together at all sites so that early maturity, grain yield, disease resistance, insect resistance and utilization were selected by the group as important criteria at all sites (data not shown).

Visual Score

Visual score of the plots or varieties have been carried out before variety selection by farmers and breeders separately at all sites to score overall performance of the varieties (Table 3). Except at Rataba site, most of the farmers gave very good score for Guta variety at all sites. During scoring, farmers gave better value or performance for early maturing with productive tillers and disease resistant varieties. Whereas, majority of the farmers gave poor to very poor scores for late types regardless of their better performance in the field. Breeders gave very good score to Guta except at Salka Urane.

Variety Selection

In the ranking of best varieties, most farmers selected Guta as first choice in individual and/or in team at all sites except at Jafara in which the group selected as second (Table 4).This variety was early maturing, relatively free of diseases, with productive tillers and have plump seed as described by the local farmers during selection. At Ilani site, Guta variety was preferred by some farmers for injera (thin leavened bread), Beso (moistened flour) and tella (local drink). The second and third ranking variety varied among individual farmers and/or in group at different sites. For instance, one farmer at Salka Oda selected Beso variety differently for Beso (moistened flour). Meserach variety was also preferred for injera by some Salka Oda farmers, and as lodging resistant by Salka Oda, Jafara and Ilani farmers as a result of its medium height and uniformity. Though Biftu variety has uniform, good stand, large straw, looking weed competent and good spike, some farmers were suggesting it to give less grain weight as compared to similar volume of the first selected variety Guta. That means, it yield less flour amount and has large husk content. In addition, it has medium maturity and less productive tillers as suggested by the farmers. Most of the farmers considered Mezezo and Beso variety as new variety because the varieties have black seed color which is different from their local variety or not commonly produced in the area.

Breeders selected Guta, Biftu, and Meserach as first, second and third ranking varieties, respectively at most of the sites in Bale mid highlands (Table 5). The variety called Biftu was selected by breeders individually and/or in group next to Guta at Jafara, Salka Urane and Salka Oda sites. Concerning yielding potential of the varieties, varieties such as Dinsho, Dafo, Guta and Biftu have shown relatively better grain yield performance at most of the locations or sites. All the selected varieties were developed from landraces. Generally, the overall mean grain yield indicates that Biftu (2.2 tons per hectare), Guta (2.2 tons per hectare), Dinsho (2.0 tons per hectare) and Dafo (2.0 tons per hectare) were better yielding varieties over locations (Figure 1).

Phase II: Participatory Research

Selection Criteria

A total of 89 farmers have been participated in participatory variety selection at ten sites ranging from 4-14 farmers per site during 2008 Ganna and Bona cropping seasons. Farmers and breeders have ranked their selection criteria at each site (data not shown). The top priority of farmers' selection criteria varied from site to site. Hence, grain yield was ranked as the first selection criteria by Sinana (on station) and Hisu farmers. Similarly, early maturity was the top ranking criteria by Waltai and Chumulugo farmers.

Salka Oda and Jafara farmers considered disease resistance as the first important criteria than yield. Grain yield, disease resistance and early maturity were selected as second important criteria at least at two locations or sites. On the other hand, effective tillering was the top priority of selection among Upper Dinsho farmers. Generally, grain yield, disease resistance, early maturity and effective tillers were the most important farmers' selection criteria at these sites. While, breeders selected grain yield as the first top ranking criteria at all sites or locations. While, disease resistance and early maturity was selected as second priority at most of the evaluation sites.

Visual Scoring of Varieties : Visual scoring of the varieties was done by farmers and breeders separately to see the general performance of the varieties (Table 6). Accordingly, farmers generally scored good to very good performance for Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21' candidate variety whereas breeders scoring of varieties differed from sites to site. The local variety has not shown visually better performance at most of the sites. Homa site was an area where most of the varieties have shown good performances than any site may be because of its location which is about in between the other locations.

Variety Selection: Farmers and breeders made selection of varieties in the field based on their criteria (Table 7) at each site during 2008 Ganna and Bona cropping season. In individual farmers' ranking of best varieties, farmers' selected Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21, new candidate variety as a 1^st top ranking variety at Salka Oda, Hisu, Jafara and Adaba (On station) and this variety was also selected as 2 ^nd and 3^rd ranking variety at least at one site. According to farmers' opinion, this variety has additional merits such as earliness, better adapted to the environment, lodging tolerant and effective tillering. Generally, Biftu, Dafo, Guta, Meserach varieties and 27 ^th IBON 73/99 advanced line have been selected as the first priority at least at one site. Other varieties such as Beso, Mezezo, Dimtu, Shage and Harbu have been the choice of farmers at some sites as a second and/or third ranking. On the other hand, though selection varied from site to site, breeders also ranked best performing varieties. Thus, Harbu, Aruso/EH956/F₂-8H-6-4-SNRFBC99G003 -21, Biftu, 27^th IBON 73/99 (advanced line) and Meserach have been their first choices at least at one site. In addition, these varieties have been also frequently selected as second and/or third rank at most sites. In general, there is an overlap of choice between farmers and breeders variety selection at most sites.

Table 2: Mean of selection criteria ranked by individual farmers and breeders at five sites in Bale highlands during 2007 Bona season.

District	Site	Participant	Selection Criteria
District	Site	Participant	Grain Yield	Straw	spike	Utilization	Maturity	Disease Resistance	Drought resistance	Insect resistance
Sinana	Jafara	Farmers	1.6	6.8	7.3	6.0	3.6	4.4	2.6	3.8
	Jafara	Breeders	1.3	7.8	6.8	4.3	4.3	4.3	4.8	3.3
	Salka Urane	Farmers	4.0	7.0	7.0	5.0	4.0	5.0	2.0	2.0
	Salka Urane	Breeders	1.0	8.0	6.5	4.8	4.5	3.8	4.5	3.0
	Salka Oda	Farmers	2.1	6.6	6.4	5.6	3.7	2.7	4.7	3.9
	Salka Oda	Breeders	1.0	8.0	6.5	4.5	4.8	3.3	5.0	3.0
Agarfa	Ilani	Farmers	1.6	8.0	7.1	4.6	5.0	5.0	5.7	4.0
	Ilani	Breeders	1.0	8.0	6.5	4.5	4.8	3.3	5.0	3.0
	Rataba	Farmers	1.1	7.9	7.0	5.3	5.0	3.7	5.3	5.9
	Rataba	Breeders	1.0	8.8	8.3	5.3	5.0	4.0	6.3	2.3

Table 3: Visual score of varieties by farmers and breeders at five sites in Bale highlands during 2007 Bona season.

Site	Participant	Varieties
Site	Participant	HB 1533	Holker	Beka	Dinsho	Dimtu	Harbu	Dafo	Biftu	Guta	Mese-rach	Mezezo	Beso
Jafara	Farmers	5	4	4	2	4	2	3	3	1	3	4	3
Jafara	Breeders	4	3	3	3	3	2	3	1	1	2	4	3
Salka- Urane	Farmers	3	3	4	2	3	2	3	2	1	1	3	4
Salka- Urane	Breeders	2	2	4	3	3	2	3	1	2	2	3	2
Salka- Oda	Farmers	5	4	4	3	3	2	3	3	1	3	3	3
Salka- Oda	Breeders	5	3	3	3	3	3	3	1	1	2	4	3
Ilani	Farmers	4	4	5	2	5	2	3	2	1	3	4	4
Ilani	Breeders	5	3	3	3	3	3	3	3	1	1	2	4
Rataba	Farmers	4	3	4	3	3	3	3	1	2	2	3	4
Rataba	Breeders	3	3	5	3	2	3	4	1	2	1	3	3

Table 4: Farmers' rankings of better barley varieties at five sites in Bale high lands during 2007 Bona season.

No.	Variety	Evaluation Sites
No.	Variety	Jafara	Salka Urane	Salka Oda	Ilani	Rataba
1	Guta	1(2*)	1(1*)	1(1*)	1(1*)	1
2	Dinsho	2(1*)	3(2*)	-	3(2*)	4
3	Biftu	3	4	4	2(3*)	2
4	Harbu	4	2	2(2*)	4(4*)	3
5	Dafo	(3*)	5(3*)	3	-	-
6	Meserach	-	-	- (3*)	-	4
*Indicate the rank given by farmers in group

Table 5: Breeders' ranking of better barley varieties at five sites in Bale high lands during 2007 Bona season.

No	Variety	Evaluation Sites
No	Variety	Jafara	Salka-Urane	Salka-Oda	Ilani	Rataba
1	Guta	1 (1*)	1	1 (1*)	2 (2*)	3
2	Biftu	2 (2*)	2	2 (2*)	1 (1*)	1
3	Meserach	3 (3*)	3	3 (3*)	3 (3* )	2

Table 6: Visual scoring (1-5) of barley varieties by the farmers and breeders at different sites in Bale highlands during 2008 Ganna and Bona cropping season.

Site/ Variety	Participant	HB 1533^Â®	Holker^Â®	Beka^Â®	Dinsho	Dimtu	Harbu	Dafo	Biftu	Guta	Meserach	Mezezo	Beso	27 ^th IBON 73/99	Shage	Aruso /EH956 /F₂ -8H-6-4- SNRFBC 99 G003 -21	Aruso (Local)
Sinana (on Station)	Farmers	2.8	3.2	3.8	2.8	2.5	2.3	3.2	2.0	3.0	3.3	4.0	3.8	2.8	2.5	2.7	4.3
Salka Oda	Farmers	1.7	2.9	2.9	2.6	3.7	3.1	3.3	3.7	3.0	2.0	3.0	2.7	2.9	3.3	1.3	2.4
Salka Oda	Breeder	3.0	3.0	3.0	3.0	3.0	3.0	3.0	3.0	3.0	2.0	3.0	3.0	3.0	3.0	1.0	3.0
Hisu	Farmers	3.7	2.9	2.3	1.5	3.8	2.3	2.8	3.4	2.6	2.4	3.4	2.9	3.3	2.4	1.8	2.0
Hisu	Breeder	4.0	3.0	3.0	3.0	3.0	2.0	3.0	4.0	4.0	3.0	3.0	3.0	3.0	2.0	2.0	3.0
Jafara	Farmers	2.5	2.1	2.5	2.3	2.0	2.0	2.8	2.4	1.0	2.3	2.4	2.8	2.4	2.4	1.6	1.9
Jafara	Breeder	3.0	3.0	3.0	4.0	2.0	1.0	3.0	1.0	3.0	2.0	3.0	3.0	2.0	2.0	2.0	3.0
Homa	Breeder	1.0	2.0	2.0	4.0	2.0	1.0	3.0	1.0	1.0	1.0	2.0	2.0	2.0	3.0	1.0	2.0
Walta'i	Farmers	3.0	1.0	4.0	4.0	1.0	4.0	4.0	1.0	4.0	1.0	1.0	1.0	1.0	3.0	2.0	4.0
Walta'i	Breeder	1.0	2.0	2.0	3.0	1.0	1.0	2.0	1.0	2.0	1.0	1.0	2.0	2.0	2.0	1.0	3.0
Hora Soba	Farmers	4.0	4.0	4.0	4.0	1.0	3.0	5.0	3.0	4.0	1.0	3.0	3.0	1.0	1.0	3.0	4.0
Hora Soba	Breeder	3.0	2.0	4.0	4.0	1.0	3.0	5.0	3.0	3.0	1.0	3.0	3.0	1.0	2.0	3.0	4.0
Ejersa Chumulugo	Farmers	2.2	2	3.6	2	2.4	3	3.4	2.2	2.8	1.8	2.4	3.0	3.0	2.6	1.8	3.2
Ejersa Chumulugo	Breeder	3.0	3.0	4.0	3.0	1.0	3.0	4.0	3.0	4.0	1.0	2.0	3.0	3.0	3.0	3.0	5.0

In group selection, except at Ejersa Chumulugo, Sinana (on station) and Hora Soba sites, all farmers ranked Aruso/EH956/F₂ -8H-6-4-SNRFBC99G003-21 candidate variety as the first best preferred variety. Guta, Harbu and Biftu were the second and/or third farmers' choice at least at two sites. On the other hand, the late maturing varieties such as Shage, Dimtu and 27^th IBON 73/99 have been selected only at Hora Soba site (Upper Dinsho) during farmers' individual and/or group selection where they are well adapted and have shown superior performance than other sites. Meserach variety was also farmers' choice because of it is relatively early maturing, good stand, lodging tolerant (short), bending its spike (sprout resistant) as explained by farmers. At some sites farmers considered also variety selection based on some specific traits which are not commonly used by others and even difficult to confirm their reasoning. For instance, some farmers preferred Aruso/EH956/F₂ -8H-6-4-SNRFBC99G003-21 due to "the nature of shading its awns at maturity (at Jafara site) which is good during pilling up or storing in the field temporarily which makes easy during threshing and cleaning", as farmers explained. At Upper Dinsho (Hora Soba) and Jafara, the local farmers prefer varieties with plump seeds and less husk cover or content (they stated as "hansara baay'e kan hinkabne" in Afan Oromo language, literally meaning 'seeds which does not have large husk content'. Beside this, at Upper Dinsho, some farmers described the variety shage as resistant to bird damage but show resistance to threshing when trampling over by horses or cows. This variety has been distributed to the local farmers some years ago. The number of kernels per spike has been also used as main selection criteria in the selection of varieties at Homa site.

When the varieties selected by farmers' and breeders' are compared with the yield performance data of different sites during 2008 Ganna and Bona cropping season (Figure 2), the varieties selected at most sites by the farmers' and/or breeders have shown good grain yield performance. Even though the grain yield performances of malting barley varieties were good, farmers did not select them except at Walta'i site and the local variety (Aruso) was not selected at any of the sites. During phase I of this research work, the varieties such as Guta, Dinsho, Biftu, Harbu and Dafo were ranked from 1 to 3 by farmers at least at one site indicating similarity in farmers' preference for these varieties (Table 4). Whereas during phase II (Table 7), at all sites except Hora Soba, all these listed varieties except Dinsho variety were still farmers' choice in addition to the new candidate variety developed through crossing at Sinana, Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21.

Aruso-21=Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21,^Â®=malting barley variety, Â© At Ejersa Chumulugo site, malting barley varieties HB 1533, Holker and Beka were replaced by F₂ (SxS) 237/99, F₂ (SxS) 222/99 and 8^th EMBSN 3/99 food barley varieties, respectively.

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Figure 2: Grain yield tons per hectare (t ha^-1) of barley varieties tested at ten sites in Bale highlands during 2008 Ganna and Bona season, 2 ^nd phase.

In the present study, grain yield, disease resistance, productive or effective tillers, early maturity and kernel plumpness were the most important selection criteria frequently used by the farmers during the two phases. This result agrees with farmers' selection criteria in Morocco at Merchouch area and Jemma Shahim area in terms of grain yield and earliness, at respective areas. In Tigray Northern part of Ethiopia, farmers were able to select and develop barley variety known as Himblil and Dembay varieties.

Table 7: Individual farmers and breeders' ranking (1-3) of better barley varieties at ten evaluation sites in Bale high lands during 2008 Ganna and Bona seasons.

Site	Participant	1^st Ranking	2^nd Ranking	3^rd Ranking
Sinana (on station)	Farmers	Biftu	Harbu	Dimtu
Sinana (on station)	Breeder	Harbu	Biftu	Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21
Salka Oda	Farmers	Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21	Beso	Meserach
Salka Oda	Breeder	Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21	Meserach	Guta
Hisu	Farmers	Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21	Meserach, 27^th IBON 73/99^@	Biftu
Hisu	Breeder	Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21	27^th IBON 73/99	Shage
Robe	Farmers	Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21	Mezezo	Biftu
Jafara	Farmers	Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21^@	Meserach	Shage
Jafara	Breeder	Harbu	Biftu	Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21
Homa	Farmers	Dafo	Guta	Biftu
Homa	Breeder	Biftu	Harbu	Meserach
Walta'i	Farmers	Holker*	Mezezo	HB1533*
Walta'i	Breeder	Biftu	Meserach	Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21
Hora Soba	Farmers	27^th IBON 73/99	Meserach	Dimtu
Hora Soba	Breeder	27^th IBON 73/99	Meserach	Dimtu
Ejersa Chumulugo	Farmers	Meserach	Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21	Guta
Ejersa Chumulugo	Breeder	Meserach	Biftu	Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21
Adaba (on station)	Farmers	Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21	Dimtu	Harbu
Adaba (on station)	Breeder	Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21	Harbu	Dimtu

Especially Himblil showed superior performances under low input conditions. It is more stable than the improved varieties under low input and low rainfall conditions of Tigray (Fetien and BjÃ¸rnstad, 2008). During selection of varieties, Bale farmers have used disease resistance as a major factor in their selection which contradicts with farmers' selection criteria in Morocco (ICARDA, 1998) and Eritrea (ICARDA, 1999). But, insect damage (shoot fly damage) is little known to most of the farmers in the area and they consider it as generally adaptation problem of the variety to the climate. Straw yield was given less priority by the local farmers in all sites, may be because of the presence of alternative feed sources mainly from wheat, linseed and maize as opposed to the ICARDA (1998) report in Morocco. Selections in Egypt at El Karamis, El Shawaier, Ghout Rabbah, El Magroun and East Barrani sites showed that farmers' scores were positively and significantly correlated with biomass and grain yield, but breeders gave high (good) scores to tall plants; and in Syria farmers showed strong preferences for barley seed color and row type in such a way that farmers in Tel Brack, Byloun and Melabya areas preferred only two row types with black seeded in contrast farmers in Mardabsi and Suran sites that wanted only two row types with white seed colored (ICARDA, 2000), in contrast to this, in this study seed color and row types were not obligatory.

Participatory barley variety selection in Eritrea showed farmers' preferences for grain filling, spike length and in some cases tall plants and in Bale it is similar for grain filling; whereas, grain yield and biomass was highly correlated with breeders' selection (ICARDA, 1999) in Eritrea.

This study reveals that breeders' selection criteria were mainly grain yield, early maturity and disease resistance during the two phases of this research work. Insect resistance was one of an important criterion during 2007 Bona season. This is in agreement with ICARDA report (1998) on barley which was carried out in Morocco at Merchouch and Jemma Shahim area except for insect resistance. On top of this, another PBB which was conducted in Syria indicate farmers and breeders' preference for large kernels and higher grain yield (Ceccarrelli et al., 2000), which was similar to this findings. Some specific selection criteria such as thresh ability, less husk content, number of kernels per spike and bending nature of the spike have been also considered by some farmers at some sites as important criteria during this study which makes different from other findings. The reason of coincidence of farmers and breeders selection criteria in this study could be most of the barley experiments have been conducted on farmers' fields in Bale and the presence of large state farms in these areas also could have increased farmers' interaction with researchers or experts so that they had better concept on variety selection and selection of important traits like disease resistance. Most of the above mentioned varieties (Figure 2) were developed by Sinana Agricultural Research Center barley breeding program from local landrace collections and recommended for commercial production in Bale highlands. And, these varieties showed specific adaptation to these areas. In general, some of good characteristics of these varieties include early maturity, highly shoot fly resistant or tolerant, better disease resistance, high yielder and stable. At Upper Dinsho (Hora Soba site), late maturing varieties such as Shage, Dimtu, 27^th IBON 73/99 (advanced line) and Meserach were selected by farmers in group as well as individually as top performing varieties and their performance revealed specifically well adapted to this environment. These varieties give high yield at higher altitudes (cool environments) where there is relatively no or very minimum shoot fly incidence. On the other hand, breeders' selection of varieties was also similar to farmers. Therefore, farmers as well as breeders were able to select high yielding varieties. Similar result was reported by Ceccarrelli et al. (2000) and Ceccarrelli et al. (2003) in their study in Syria. In this study, farmers variety selection tended to vary more from site to site which indicates that farmers are trying to diverse their choices of varieties may be based on their specific needs and environmental conditions. This is one benefit of PPB in increasing crop biodiversity as described by Ceccarrelli and Grando (2007). Participatory variety selection enhances farmers' access to varieties (improved or local). The best and most suitable materials can be disseminated quickly through the informal seed system (Witcombe and Joshi, 1996; de Boef and Ogliari, 2008).

Upper Dinsho is a very cool specific environment in which biophysical factors differ significantly as compared to the rest selection sites. We have observed that the performance of barley varieties as well as farmers' selection of varieties at Upper Dinsho (Hora Soba site) is completely different from the other sites during evaluation. Barleys which performed well and selected repeatedly by the farmers at other evaluation sites showed poor performance at Hora Soba, none of them have been selected. However, late maturing varieties such as Shage, Dimtu, 27^th IBON 73/99 (advanced line) and Meserach variety have shown superior performance and well adapted to this environment. Therefore, these varieties are selected by the local farmers individually and/or in group because of their important merits. During selection, at Hora Soba farmers strictly compared varieties with their local cultivars such as Falibaye, Kasale, Limat & Senefkolo. Senefkolo (semi-hulled), two rowed, local variety commonly grown for kolo (roasted barley). Hence, the condition at Upper Dinsho reveals the importance of specific breeding program for barley. Similarly, Fetien and BjÃ¸rnstad, (2008) indicated that farmer developed variety Himblil adapted to specifically adapted to low input and low rain fall areas of Tigray.

CONCLUSIONS

Farmers were effective in identifying most of the higher yielding varieties as breeders. Productive tillers and kernel size were selection criteria not frequently used by breeders, but used by farmers. Shoot fly insect resistance was specifically breeders' criteria during Bona cropping season due to the prevalence of this biological pest is severe during this season. Guta, Dinsho, Biftu and Harbu varieties were selected as the best variety preferred by most of the local farmers across sites except at Hora Soba (Upper Dinsho) so that attention should be given to scaling up/out of these varieties in these areas. Beside this, new candidate variety known as Aruso/EH956/F₂-8H-6-4-SNRFBC99G003-21, which was developed through crossing, was recently released from Sinana Agricultural research center after approval by the national variety releasing committee in 2011 with a common name Abdane due to its superior agronomic performances and acceptance by the local farmers in Bale mid highlands. On the other hand, specifically at Upper Dinsho area, Shage, Dimtu, and 27^th IBON 73/99 (semidwarf advanced line) varieties showed excellent performance in this area showing varietal specific adaptation which signifies breeding for specific adaptation. Generally, encouraging results have been obtained from this research activity with ICARDA in the highlands of Bale which helps to integrate farmers' indigenous knowledge in barley improvement, create experience sharing between breeders and farmers with potentials and the limitations of barley technologies in the eyes of users. The study indicates the need of modification of formal breeding program system at Sinana to develop varieties that suits farmers' needs to avoid adoption problems.

ACKNOWLEDGMENT

The authors would like to thank ICARDA for their financial support to conduct the research & Oromia Agricultural Research Institute, Sinana Agricultural Research Center, for their provision of logistic support to carry out the experiment.

REFERENCES

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Ceccarrelli, S., Grando, S., Tutwiler, R., Baha, J., Martini, A.M., Salahich, H., Goochild, A., Michael, M. (2000). A methodological study on participatory barley breeding I. Selection phase. Euphytica 111: 91-104.

Ceccarrelli, S., Grando, S., Sing, M., Michael, M., Shikho, A., Al Issa, M., Al Salch, A., Kalconjy, G., Al Ghanem, S.M., Al Hassan, A.L., Dalla, H., Bahsa, S., Basha, T. (2003). A methodological study on participatory barley breeding II. Response to selection. Euphytica 133:185-200.

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Fetien, A., BjÃ¸rnstad, A. (2008). Participatory varieties selection of barley in the highlands of Tigray in Northern Ethiopia. In: Thijssen, M.H., Bishaw, Z., Beshir, A. de Boef, W.S. (Eds.), Farmers, seeds and varieties: supporting informal seed supply in Ethiopia. Wageningen International. Pp.198-206.

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Medicinal Plants Used by Herbal Healers in Narasipura and Manchale Villages of Sagara Taluk, Karnataka, India

Poornima G, Manasa M, Rudrappa D, Prashith Kekuda TR â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦
DOI: http://dx.doi.org/10.4314%2Fstar.v1i2.98779

Abstract

Full Text

Sci. Technol. Arts Res. J. April-June 2012, 1(2):01-11

Medicinal Plants Used by Herbal Healers in Narasipura and Manchale Villages of Sagara Taluk, Karnataka, India

Poornima G ^1*, Manasa M ¹, Rudrappa D ¹, Prashith Kekuda TR ²

¹ Department of Botany, SRNMN College of Applied Sciences, Balraj Urs Road, Shivamogga-577201, Karnataka, India

² Department of Microbiology, SRNMN College of Applied Sciences, Balraj Urs Road, Shivamogga-577201, Karnataka, India

Article History: Received: 26-04-2012; Revised: 22-06-2012; Accepted: 27-06-2012

DOI: http://dx.doi.org/10.4314%2Fstar.v1i2.98779

*Corresponding Author

Poornima G

E-mail: poo.an30@gmail.com

Abstract

The present study was designed to study the Medicinal plants used by herbal healers in Narasipura and Manchale villages of Sagara Taluk, Karnataka, India. The people, particularly from rural places, depend on herbs for primary health care where ethnomedicinal use of plants has been practiced since time immemorial. Sagara taluk is located in the midst of the Western Ghats region of Shivamogga District, Karnataka State, India. Ethnobotanical field surveys were conducted from January to March 2012 to document the uses of medicinal plants by herbal healers in villages Narasipura and Manchale of Sagarataluk, Karnataka state, India. A total of 21 plants in Narasipura and 14 plants in Manchale were documented. The information about local name, partsused, type of formulation and disorders for which they were used are documented.

Keywords : Ethnobotanical; Medicinal plants; Folk medicine; Sagara; Karnataka

INTRODUCTION

India's traditional system of medicine is related to richness of plant and cultural diversity. The indigenous knowledge on medicinal plant utilization not exceeding the resilience of surrounding environment is regarded as an important measure of plant biodiversity conservation. Apart from modern systems of medicines, even today people rely on herbal plants for primary healthcare. This dependency is even more in rural areas where ethnobotanical use of plants has been known since time immemorial. This is because of lack of primary healthcare centers, besides, medicinal plants are easily available natural products, easily formulatable and cost-effective with no side-effects. Tribal people depend on forest for their survival and are aware of the medicinal uses of plants in their surroundings. The traditional folk medicine is mostly unscripted, has been handed down orally from generation to generation (Kingston et al., 2009; Gupta et al., 2010; Rajakumar and Shivanna, 2010).

Sagara taluk is located in the midst of the Western Ghats region (one of the 'hot-spots of biodiversity' in India) of Shivamogga District, Karnataka State, India. The taluk is situated between 13⁰51' and 14⁰20'N latitude and between 74⁰37' and 75⁰17'E longitude in about the mid-south western part of Karnataka State, India at an altitude of 595m above the mean sea level. The areas selected in this study are the villages Manchale and Narasipura of Sagara Taluk, Karnataka, India. The study area has evergreen, semi-evergreen, moist and dry deciduous forests and is rich in diversity of plants with medicinal value. The area receives an average rainfall of 950 to 2130mm. Agriculture is the main occupation in this area and areca, banana, cotton, ginger, maize, paddy, pepper and sugarcane are the main crops (Rajakumar and Shivanna, 2010). In this study, an ethnobotanical field survey was conducted to document the uses of medicinal plants by herbal healers in villages Narasipura and Manchale.

MATERIALS AND METHODS

Regular field visits to the study areas were made for observation and documentation of herbs for a period of three months from first week of January 2012 till last week of March 2012. The places of collection and observation are shown in Figure 1.

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Figure 1: Study Area.

During field trips, ethnomedicinal information about the plants was recorded through interaction and discussion with herbal healers of study area along with field observation. Medicinal plants were documented and detailed field notes were taken along with voucher number, locality, habit, floral characteristics, nature of the fruit, colour of the ripe fruit, local name, local medicinal uses, etc. The identification of plants was made by referring flora (Gamble, 1995; Ramaswamy et al., 2001). Herbaria were prepared for selected plants.

RESULTS AND DISCUSSION

Plants Documented in Narasipura

In the study area Narasipura, a total of 21 plant species belonging to 18 genera and 15 families were documented and these plants were being used to treat 21 human ailments (Table 1).

Table 1: Plants used by herbal healer in Narasipura.

Plant name	Family	Local Name	Part Used	Preparation	Medicinal Uses
Achyranthus aspera Linn.	Amaranthaceae	Uttrani	Leaves	Paste	Brain disorders
Plumbago zylanica Linn.	Plumbaginaceae	Bili Chitramoola	Root	Paste	Jaundice, Hepatitis B, Hepatitis C
Plumbago indica Linn.	Plumbaginaceae	Kempu chitramoola	Root	Paste	Hepatitis A
Dipteracanthus prostrates	Acanthaceae	Kalighavani	Leaves	Decoction	Ear diseases and cancer
Rauwolfia serpentina Benth.	Apocyanaceae	Sarpaghandi	Root	Paste or decoction	Very effective to control high Blood Pressure
Zinziber officinalis Rosc.	Zinziberaceae	Shunti	Rhizome	Decoction with tea	Analgesic
Bacopa monniera Pennel.	Scrophulariaceae	Neeru brahmi	Leaves	Juice	Bronchitis and diarrhoea in children
Sauropus andragynus	Euphorbiaceae	Chakramuni	Leaves	Decoction	Vitamin deficiency
Croton roxburghii	Euphorbiaceae	Somare	Root	Paste with Myristica fragrans fruit	Tumors
Aristolochia indica Linn.	Aristolochiaceae	Eshwari balli	Root	Root extract with pepper	Applied on spot of snake bite and also taken to cure high fever
Ficus racemosa Linn.	Moraceae	Atti mara	Root	Paste with water	Diabetes mellitus
Ficus krishnae	Moraceae	Krishna aala	Root	Paste	Liver disorders
Dodonaea viscose N,jaeq.	Sapindaceae	Angaraka	Bark	Strong decoction	To balance Hb count in women
Mangifera indica Linn.	Anacardiaceae	Maavu	Bark	Powdered and boiled with water	To treat mental diseases
Sapindus laurifolia Vahl.	Sapindaceae	Antavaala	Raw Fruit	Extract of it	Lungs blockage
Ocimum kilimandscharicum	Lamiaceae	Karpura tulasi	Leaves	Paste and juice	Paste for acne treatment and juice for cough
Ocimum tenuiflorum	Lamiaceae	Shri tualsi	Leaves	Powder with ghee or decoction	To relieve stress and also to cure respiratory disorders
Tectona grandis Linn.	Verbenaceae	Sagvani	Leaves	Paste	Dermatitis
Nerium indicum Mill.	Apocyanaceae	Kanagale	Bark and root	Paste with Calatropis leaves.	Cancer tumors of stomach
Tinospora cardifolia Miers.	Menispermaceae	Amrutha balli	Leaves	Paste	Diabetes mellitus & heart weakness
Tylophora indica W&A.	Asclepiadeceae	Aadu muttada soppu	Leaves, bark and roots	Paste or powder	Asthma and lung inflammation

Maximum plant species documented were from the families Plumbaginaceae, Apocyanaceae, Euphorbiaceae, Morceae, etc. The number of plants from each family is shown in Figure 2. Various plant parts were used, among which leaves and roots were more commonly used followed by bark and stem (Figure 3). The most preferred type of drug formulation in Narasipura is paste and decoction followed by powder, latex and juice (Figure 4).

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Figure 2: Total number of plants in each family.


Figure 3: Plant parts used.		Figure 4: Types of formulation.

Plants Documented in Manchale

In the study area Manchale, a total of 15 plants belonging to 12 families were used to treat 18 human ailments (Table 2). Maximum plant species used were from the families Apocyanaceae and Verbenaceae. Number of plants used from each family is shown in Figure 5. The frequently used plant parts were leaves followed by root, bark and stem (Figure 6). Decoction formulation was more commonly used than paste, powder and juice (Figure 7).

Most of the plants documented were herbs followed by shrubs, trees and climbers. The plants were given as herbal medicines to cure various kinds of ailments ranging from skin to brain disorders. Majority of the plants in Narasipura were used for treating diabetes, liver and lung disorders and in Manchale menstrual disorders and arthritis. In both Narasipura and Manchale, the healers preferred use of a single plant for a particular disease rather than preparing medicines by combination of plants.

Some plants are widely distributed throughout the state and same plants are used to treat different ailments by different herbal healers. Rauwolfia serpentina is best known for its medicinal properties. In Narasipura, the decoction of root is used for controlling high blood pressure, whereas same is used as paste for snake bites in region of Bhadra Wild Life Scantuary (Parinitha et al., 2004). In coastal Karnataka, the root paste of the plant is used by a herbal healer to treat herpes and this has proven to be very effective (Bhandary and Chandrashekar, 2011).

Table 2: Plants used by herbal healer in Manchale.

Plant name	Family	Local Name	Part Used	Preparation	Medicinal Uses
Mimosa pudica Linn.	Mimosae	Nachike mullu	Root	Paste	Menorrhagia control and control of high BP
Plumbago auriculata	Plumbaginaceae	Neeli chitramoola	Root	Paste with water	Piles
Tabernaemontana divaricata	Apocyanaceae	Nandi batlu	Bark	Decoction	For Healthy pregnancy
Vitex negundo Linn.	Verbenaceae	Kari lakki	Leaves	Powder in water	Curing of arthritis
Lawsonia inermis	Lythraceae	Madrangi	Leaves	Fresh leaves are directly taken	Amenorrhoea and dysmenorrhoea, balance of Hb count, ulcers.
Pomenta officinalis	Myrtaceae	All-spice	Leaves	Decoction	As a stimulant
Polyalthia longifolia	Annonaceae	-	Bark	-	To prevent abortion in pregnant women
Gymnema sylvestre Retz.	Asclepiadaceae	Madhunashini	Leaves	Extract as tonic	Diabetes and also to lose weight
Diospyros montana Roxb.	Ebenaceae	Jagalaganti mara	Bark	Decoction	Liver disorders, Jaundice, Kidney stones & Hepatitis B.
Asparagus racemosa Wild.	Liliaceae	Shatavari	Fasciculated roots	Decoction or paste with water	Dysentery, Diarrhea and menstrual problems.
Areca catechu Linn.	Arecaceae	Adike	Root	Boiled with water	Insect bites and skin allergies
Canscora decurrens	Gentianaceae	Shanka pushpa	Leaves	Decoction or tonic	Urinary tract infections
Gmelina arborea	Verbenaceae	Shivane	Leaves	Paste mixed with dosa batter	Arthritis
Ervatamia heyneana Stapf.	Apocyanaceae	Maddarasa	Stem	Latex is used	Applied to throat to treat tonsils

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Figure 5: Number of plants from each family.

Tinospora cardifolia is another such well known medicinal plant which is popularly called as 'Amrutha Balli'. In our study, the leaf paste is used to treat diabetes and heart weakness in Narasipura, while the ground stem of the climber is taken orally for 5 days to cure malaria in Kargal region (Rajakumar and Shivanna, 2010). In Bhadravathi taluk, the leaf paste with turmeric powder is applied externally on boils and for itchy skin (Shivanna and Rajakumar, 2010).


Figure 6: Plant parts used.		Figure 7: Types of formulation.

In our study, Vitex negundo leaf powder was used in Manchale to treat arthritis, whereas leaf paste with lime juice was applied externally to treat ring worm in Bhadra Scantuary area (Parinitha et al., 2004) and leaf juice is used to treat poisonous bites in cattle in Uttar Kannada district by a herbal healer (Harsha et al., 2005).

Ervatamia heyniana stem latex was applied to throat to treat tonsils in Manchale, crushed bark with water was used for treating dysentery and diarrhea in Uttar Kannada (Harsha et al., 2005). Lawsonia inermis leaves are used in treatment of all kinds of menstrual disorders in Manchale, whereas same is used in treatment of acne in Bhadra Sanctuary (Parinitha et al., 2004).

CONCLUSIONS

The entnomedicinal knowledge about plants is vital in primary healthcare system. High costs coupled with side effects of synthetic drugs are driving people towards herbal medicines. These plants are to be scientifically evaluated and conserved for well being of mankind. These herbal formulations need further pharmacological investigations to prove their efficacy and for their use as effective drugs in treatment of many human diseases.

ACKNOWLEDGEMENTS

The authors express their sincere thanks to HOD, Department of Botany and Principal, SRNMN College of Applied Sciences, Shivamogga for providing all facilities to conduct this work.

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Assessment of Sexual Behaviour, Attitude and Risk Perception about HIV/AIDS among Out-of School youths, Ilu-Abba-Bora Zone, Western Ethiopia

Elias Legesse Negeriâ€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦
DOI: http://dx.doi.org/10.4314%2Fstar.v1i2.98780

Abstract

Full Text

Sci. Technol. Arts Res. J. April-June 2012, 1(2):18-30

Assessment of Sexual Behaviour, Attitude and Risk Perception about HIV/AIDS among Out-of School youths, Ilu-Abba-Bora Zone,

Western Ethiopia

Elias Legesse Negeri

Faculty of Health Sciences, Post Box No: 395, Wollega University, Nekemte, Ethiopia

Article History: Received: 21-02-2012; Revised: 18-06-2012; Accepted: 21-06-2012

DOI: http://dx.doi.org/10.4314%2Fstar.v1i2.98780

*Corresponding Author:

Elias Legesse Negeri

E-mail: tsegishelias@yahoo.com

Abstract

To assess sexual behaviour, attitudes and risk perception about HIV/AIDS among out-of-school anti-AIDS club member and non-member youths in Mettu and Bedelle towns. The study applied a case control study design. The cases are club members those registered in the out-of-school anti-AIDS clubs and actively participated for at least one year. Controls are non-club member who have never been registered and never became active member of any anti-AIDS clubs anywhere in the towns. A pre-tested self administered questionnaire was used to collect data. Focus Group Discussions were also conducted in the two groups to complement the quantitative findings. From a total of 786 youths, 386 club members and 400 non-club members participated in the study. In this survey two third of the club members, (66.6%) and one third of the non-club members (33.2%) reported to have practiced sexual intercourse in the past. Among cases 31.3% reported that they had two and more than two sexual partners and 29.2% controls reported that they had more than two sexual partners. 45.9% of club members and 33.3% of non-club members had used condoms during the first time they had sexual intercourse. The majority (99.1%) of the study populations were aware of HIV/AIDS. 72.5% of club member and 54.7% of non-club members perceived that they are at risk or may be at risk of acquiring the HIV/AIDS. The prevalence of multiple sexual partnerships over past year among both groups was 30.3% in the selected towns. The finding of the survey concluded both club member and non-club member out-of-school youths in this study area were exercising high risky sexual activities like early sex, multiple sexual partnerships, and inconsistent use of condom. But, the percentage among club members was lower than non-club members. Being a club member is protective for HIV/AIDS related risky sexual behaviors, perception.

Keywords : Sexual Risk Behaviours; HIV/AIDS; Ilu-Abba-Bora; Risk Perception; Out-Of School Youths

INTRODUCTION

Globally, the HIV/AIDS epidemic remains a major public health, social, economic and development challenge. It poses significant threats in the world with impacts that will be felt for many decades in the future. In the most affected countries the pandemic is eroding decades of development gains, undermining economies, threatening security and destabilizing societies (UNAIDS, 2008; ILO, 2004).

Young adulthood is a stage in which human beings brought about many developments; (biological, physical, psychological, social) and these developments are accompanied by positive or negative behaviours depending on the environment in which the person grow. Sexual risk behaviours, including early sexual debut, unprotected sexual intercourse, and multiple sexual partners, occur in a broader context (Degaga, 2007; Youth Net, 2004).

Young people today are at high risk of unintended pregnancies and STIs, including HIV/AIDS, and those between 15 and 24 are both the most threatened and the greatest hopes for turning the spread of the HIV/AIDS epidemic since they are sexually active at younger ages than previous generations or delay in marriage until they are older, and do not use condoms regularly enough to ensure protection (Meseret, 2003).

The finding of this study is expected to contribute in filling the gap in understanding risky sexual practices related with the knowledge, attitudes and the risk perception of HIV/AIDS among youths in the study area. It is hoped that the out-come of this study will also shade some light as to the effectiveness of organizing anti-AIDS clubs as one of the strategies of HIV/AIDS prevention and control programs and will be used by local or regional planners for further expansion and strengthening the method.

Therefore, this study will have an immense useful to the policy makers and program managers and those who are involved in reproductive health risk and sexual behaviour or any related issues in both towns.

MATERIALS AND METHODS

Study Area and Period

The study was conducted in Mettu and Bedelle towns which are located in Ilu-Abba-Bora zone, Oromia Regional state from January to June 2010G.C.

Study Design

The study applied a case control study design supplemented by qualitative studies (Focus Group Discussions and In-depth Interviews) The cases were club members those registered in the out-of-school anti-AIDS clubs and actively involved for at least one year. Controls were non-club members who had never been registered and became active member of any anti-AIDS clubs anywhere in the two towns.

Study Population

The source populations for the study were all youths in the two towns, while the study populations were selected randomly from out-of-school anti-AIDS club member and non-club member youths residing in Mettu and Bedelle towns.

Sample Size

The sample size for the quantitative survey was determined using a formula for comparison of two population proportions. 80% power and 5% type I error to approximate an acceptable population parameter was taken. Number of sexual partners, which is assumed to be the most important risk factor in Ethiopia, was taken as a high risk behaviour indicator (Meseret, 2003).

The finding of a recent study carried out in Jimma and Agaro towns in the south west of Ethiopia was taken to represent the proportion. Out of sexually active respondents, 31% of club members and 17% of the non-club members reported to have had two or more life time sexual partners (Meseret, 2003). One control was taken for each case and 20% allowance for missing or non-response rate. Total sample size was 800 (400 cases (club members) and 400 for controls (non-club members)).

Sampling Techniques

For the club members, first list of youths who were active members for at least one year was prepared from the registration book of each town and kebele and used as a sampling frame. The members were listed in an ascending order. Following this a random numbers list of 400 youths were selected from both towns. The names of youths corresponding to the selected random numbers were included in the study. From all kebeles of the two towns, representative sample of control groups were selected.

The study subjects from 6 kebeles were recruited using systematic sampling which is proportionate to the number of households, which corresponds to the study unit. Every k^thof the pre-numbered households were selected and approached accordingly until the representative sample size was obtained. Interviewers of the quantitative survey have identified eligible discussants from the respective kebeles for the controls, and youth leaders for the club members or cases.

Data Collection Procedure

A quantitative data was collected using a questionnaire adapted from the BSS-Ethiopia 2001.The questionnaire was prepared originally in English and then was translated to Afan Oromo language. Pre-test of the questionnaire for clarity and consistency of the questions was conducted on some selected club member and non-club member youths of Gore and Algie towns (woredas from Ilu-Abba-Bora zone) one week prior to the actual data collection. Then, necessary amendment was made based on the feedback.

Two days training was given to data collectors and supervisors focusing on the objective of the study and value of collecting the actual data. For the club members, data collection was done at the respective youth centres in all kebeles in both towns, while house-to-house data collection was taken place for non-club members. Focus Group Discussions were made in quite class rooms and female youths Focus Group Discussions were moderated by female moderator while, that of malesâ€™ group will be moderated by the principal investigator.

Data Processing and Analysis

Data obtained from the questionnaire was entered, cleaned and prepared for tabulation plan using statistical data analysis (using SPSS software version 17 and Epi info version 3.5 for windows) techniques. Frequencies for all variables were counted and cross tabulated by using percentage/proportions.

Uni-variate analysis was done for the selected variables. Then bi-variate analysis with crude odds ratio was used to test possible association of the independent variables with the dependent one. Furthermore, multivariate logistic regression analysis was used to see the net effects of each of the independent variables in explaining variation in the outcome variables. Proportions and percentages were calculated to show the distribution of the respondents by socio-economic, demographic variables.

Ethical Clearance

This study was done in conformity with the ethical guidelines approved by the Institutional Review Board (IRB) of Addis Ababa University, Medical Faculty, Department of Community Health. Zonal Health Bureau and other concerned bodies were approached for collaboration and permission. Informed verbal consent was obtained from participants. Participants assured that privacy and confidentiality was maintained. At individual level after explaining the purpose of the study verbal and written consent was obtained from all participants prior to their participation in this study. They were also told to withdraw from the study at any time they want.

RESULTS

Socio-Demographic Characteristics of the Study Participants

A total of 786 youths participated in the study, with 100% response rate for non-club members and 96.5%, response rate for the club members making 386 participants to which self administered questionnaire was administered.

Among the club member 164 (42.5%) of the respondents were between the age range of 15 to 19 years, 222 (57.5%) of them were between 20 to 24 years old and among the non-club member 186(46.5%) and 214(53.5%) of the respondents were between the age range of 15 to 19 years and between 20 to 24 years old respectively. The mean ages were 19.1Â±2.1 and 18.2Â±2.2 years for club members and for the non-club members respectively.

Most of the club members, 300(77.7%) were attending their education at different government and private institutions, 56(14.5%) do not have job and 30(7.7%) had job with average monthly income of 357 Ethiopian birr, of which 43.4% earning less than 200 birr per month, whereas from the non-club members 282(70.5%) were attending their education at different government and private institutions, 64(16%) do not have job and 54(13.5%) had job with the average monthly income of 420 birr. Most of the respondents among club member, 286(74.1%) were living with their parents, while 100(25.9%) were living alone and from non-club member, 246(61.5%) and 154(38.5%) were living with their parents and alone respectively.

Regarding the religion, greater than half of club members, 204(52.8%) were Christian orthodox and followed by protestant, 142(36.8%), while the majority of non-club members, 218(54.5%) & 154(38.5%) were Orthodox and protestant respectively. Most of respondents, 284(73.8%) and 303(75.8%) of club members and non-club members were Oromo by ethnicity respectively.

Sexual Experience of Survey Respondents

This survey was found out that more than two third of the club members, 257(66.6%) & about one third of the non-club members, 133(33.2%) claimed to have practiced sexual activity in the past; this result shows statistically significant proportion of out-of-school youths were sexually experienced in both groups (P<0.05).

Age at first sexual intercourse varies by sex and age group among cases and controls. Among cases almost two third of who practiced sexual intercourse, 173(67.3%) experienced the first sexual act in the age range of 15-19 years, while other age groups, 23.3% and 9.3% experienced the first sexual act in the age of less than 15 years and in the age range of 20-24years respectively. In the controls, more than half of those who practiced sexual intercourse, 76(57.1%) experienced the first sexual acts in the age range 15-19 years, and 30.8% and 14.2% experienced the first sexual act in the age range less than 15 years and in the age range of 20-24 respectively.

Having had sexual intercourse for both sexes rises with age from 32(18.2%) in the age group less than 15 years to 128(72.7%) in the age group 15-19 years among club members, whereas among non-club member youths having had sexual intercourse for both sexes also rises with age from 26(29.9%) in the age group less than 15 years to 51(58.6%) in the age group of 15-19 years.

The study result indicated that, the minimum and maximum age of sexual initiation for males was 12 and 22 years and for females was 10 and 18 years respectively. Amongst cases the mean age of sexual initiation for males and females was 16.9(Â±1.8) and 16.6(Â±2.2) years respectively. The mean age of sexual debut among controls for males and females was 17.3(Â±1.9) and 15.1(Â±2.6) respectively. This shows that females had more likely started sexual activity earlier than males in both groups which was statistically significant (P<0.05).

Out of 257(66.5%) club member respondents who had sex, 195(75.8%) of them had sexual intercourse during the previous 12 months. Among these, 68.6% and 31.4% were males and females respectively. While, out of 133(33.3%) non-club member respondents who had sex, 77(57.8%) of them had sexual intercourse during the previous 12 months. Among these, 55.8% and 44.2% were males and females respectively. More number of male, 68.8% than female, 31.2% youths among the club members were engaged in sexual activity in the last 12 months. The same difference was also observed among male and female of non-club member youths.

The majority 265(68.7%) of the club members reported that they had one sexual partner and of which, 182(68.7%) and 83(31.3%) were males and females respectively. The remaining 121(31.3%) respondents reported that they had two and more than two sexual partners and of which, 82(67.7%) and 39(32.3%) males and females respectively. Besides this, 283(70.8%) of non-club members reported that they had one sexual partner and of which 194(68.6%) and 89(31.4%) were males and females respectively. The remaining 117(29.2%) respondents reported that they had greater than two sexual partners and of which 88(75.2%) and 29(24.8%) males and females respectively.

This study revealed that the relationship between age and number of lifetime sexual partners, so the trend of having two and more than two sexual partners shows an increment as youthâ€™s age level increase. That is among 15-19 age group (44.5%) have more than one life time sexual partner whereas, among 20-24 age groups are (55.4%) in both groups. From this, we can observe that males had more likely high number of sexual partners than their female counter parts.

Among club members sexually initiated males reported to have an average of 2.5 life time partners, whereas females reported 1.9 life time partners. From non-club members sexually active males said that an average of 2.1 life time partners, while females reported that 1.5 life time partner. With respect to the number of sexual partners they had in the last 12 months, higher proportion (25.9%) of the sexually active club members had more than one partners as compared to that of non-club members (12.8%).

About 35(9.8%) and 22(5.5%) of the sexually active club member and non-club member adolescents reported history of signs and /or symptoms of STIs. The proportion of reported STIs was higher in males (19.5%) than in females (13.1%) among club members.

Unprotected Sexual Practice

Amongst 257(66.5%) club members who ever had sex, 118(45.9%) had used condoms during the first time they had sexual intercourse and of which, 72(56.7%) and 46(40.9%) were males and females respectively. Out of 133(33.3%) non-club members who ever had sex, 46(34.5%) had used condoms during the first time they had sexual intercourse and of which, 27(41.3%) and 19(31.0%) were males and females respectively.

Among 195(75.8%) club member youths who were sexually active in the previous 12 months, 138(70.7%) youths of which, 94(68.1%) males and 44(31.9%) females reported condom use during their most recent sexual encounter. From (55.1%) of respondents of which, 63.1% males and 36.9% said that condom use was suggested by joint decision. Thirty point four percent (61.9% males & 38.1% females) and 14.5 %( 60% males and 40% females) reported that it was suggested by themselves and their partner respectively.

However, 57(29.3%) club members of which, 37(64.9%) males and 20(35.1%) females reported that they had not used condoms in their most sexual encounter. The commonest reasons for non-use of condoms reported were partner trust (54%) and do not enjoy sex when using condoms (it decreases sexual pleasure) (26%).

When we compare the two groups as to the types of partners with whom they practiced sex revealed that, more proportion (7.5%) of non-club members had visited commercial sex workers than club members (2.7%). While, none of seven club members admitted to have sexual contact with commercial partners without condom, but three of the ten (30%) non-club members having sexual contact with commercial sex workers without using condoms.

Knowledge, Attitude and Stigma about HIV/AIDS and Other STIs

The majority (99.1%) of both groups of the study populations were aware of HIV/AIDS. The proportion of those who have ever heard about the HIV/AIDS epidemic is higher in club members 386(100%) than in non-club members 393(98.2%) youths.

About 95.2% of non-club members and 99.5% club members correctly identified unprotected sexual intercourse as mode of transmission for HIV, but only 51% of non-club members and 74.3% of club members correctly identified MTCT as mode of transmission for HIV. More than 80.3% of club members and 75.7% non-club members correctly identified contaminated blades and sharp materials as mode of transmission for HIV. Mosquito bite was misconceived and mentioned as a risk factor of HIV infection by 8% of non-club member and 4.7% of club member respondents.

Blood transfusions, 306(79.2%); breast feeding of infected mothers, 128(33.1%); deep kissing, 24(6.2%); unsafe injection, 295(76.4%) were the most commonly mentioned modes of transmission by the club members. While, blood transfusions, 298(74.5%); unsafe injection, 264(66.0%); breast feeding of infected mothers, 142(35.5%); followed by deep kissing, 41(10.2%); were the once most frequently replied responses by the non-club members.

As far as STIs are concerned, 96.6% and 92% of club member and non-club member respondents were familiar with at least one type of STIs other than HIV/AIDS respectively. Gonorrhoea (79.7%); syphilis (75.3%) and cancroid (57.5%) were the commonly stated STIs among club member youths. In the case of non-club members gonorrhoea (74%); syphilis (75.5%) and cancroid (61%) were the usually known STIs. 77.8% and 88.3% of the respondents did not know the LGV from club members and non-members respectively.

Contraceptive Use

More than half (52.5%) of club members and (26%) non-members reported that they used the contraceptive methods during their last sexual intercourse respectively. Among the club members the types of contraceptives used were condom (72.5%), pills (42.5%) and calendar (5.7%) methods. While, the types of contraceptives used by non-club members were condom, pills and calendar, 20%, 16.2% and 7.5% respectively. The major reasons for using contraceptive methods for club members and non-members as they reported were to prevent unintended pregnancy 118(58.1%) and 46(44.2%), while others said that to prevent HIV/AIDS and other STIs 79(38.9%) and 50(48.1%) respectively.

The data shows that more females (54.5%) than males (51.5%) used the contraceptive methods during their last sexual intercourse among club members. The same thing was happened in the non-club members except the percentage difference i.e. (30.5%) and (24.1%) of females and males respectively.

Attitudes towards Risks of Sexual Activities and HIV/AIDS among Youths

About 243(62.9%) and 187(46.7%) of the participants perceive that a person could get HIV the first time he/she had sex amongst club members and non-members. The odds ratio result points out that non-club members do not have good attitude towards PLWHA than club member youths (AOR=1.38 (1.39, 2.54)).

In addition, club members are more or less agree with the opinion that a boy/girl should have sex before he/she gets married as non-club members (AOR=1.29,(0.95, 1.90)). With regard to AIDS patientsâ€™ treatment and care, almost all of both groups had affirmative feelings even if the proportion of club members still outweighs the non-club members.

Risk Perception

Participantsâ€™ attitude towards perceiving themselves as susceptible to HIV infection was asked and the result indicated that, 112(29%) respondents replied that they had no chance of acquiring HIV, 187(48.4%) claimed to have low, 58(15.1%) medium and 29(7.5%) high chance of acquiring the virus.

Almost three fourth, 280(72.5%) of club members perceived that they are at risk or may be at risk of acquiring the disease than the non-club members 219(54.7%).The differences are statistically significant (AOR=3.32, (1.28, 7.29)).The most frequently mentioned reason by youths who did not perceive themselves as at risk of acquiring HIV were, 106(27.5%) that they did not have any sexual contact; 14(13.2%) were that they regularly use condom and 22(20.8%) because of praying regularly. The proportions that perceive themselves at risk of contracting HIV are highest among females, 345(69.1%) than males, 154(30.9%).

A number of factors including the number of lifetime sexual partners, knowledge on HIV transmission, willingness to get tested (VCT), condom use during first sexual intercourse and alcohol intake have shown significant association with self-risk perception.

Youths who were reported to have two or more sexual partners perceived themselves as at high risk of getting HIV than those with single sexual partner (AOR=2.79(1.24, 4.43). Risk perception of HIV significantly increases with the number of sexual partners. Those who have knowledge on HIV transmission feel that they are at high risk than those who were not knowledgeable (AOR=2.93, (1.45, 4.35). Those who use condom perceive that they are at lower risk of HIV than those who didnâ€™t use condom (AOR=2.3(0.14, 0.67) and youths who drank alcohol feel that they are at higher risk than those who were not (AOR=0.99, (1.54, 1.86)).

Having Ever Had Sex among the Respondents with Different Variables

Age of the respondents showed statistically significant association with their sexual behavior. Accordingly, the odds of having had sexual intercourse among youths in the age group 15-19 were 1.96 times higher than in the age group 20-24 years, (AOR=1.96(1.21, 3.04)).

Living arrangement of youthsâ€™ appears to have statistically significant relationship with their sexual behavior (AOR=2.75(1.26, 4.74)). This survey result revealed that, youths those currently living alone were 2.75 times more likely sexually experienced than youths who were currently living with both parents.

Parent-youths communication on sexual matter was another important variable to influence youthsâ€™ sexual experience. In this study, youths who reported to have had the chance of discussion with their parents had low engagement to sexual practice than their counter parts, (AOR=1.53(1.29, 3.96)).

Alcohol drinking and watching pornographic films are also found to be significant with their involvement in sexual practice. The data revealed that youths who ever drunk alcohol were 1.41 times more likely to have had sex(AOR=1.41(0.24, 0.61)) and youths those watching pornographic films were 1.87times more likely ever had sex than their counterparts.(AOR=1.87(1.53, 3.25))

Number of Lifetime Sexual Partners of the Respondents with Different Variables

Based on the study result, age groups, average monthly income of respondents and chat chewing shows a significant association with the number of life time sexual partners.

The odds of having multiple sexual partners among adolescents who have had an income more than 500 birr is 1.63 times more likely to have multiple sexual partners than the opposite groups (AOR=1.63(0.92, 3.41)).

This study revealed that, as the age of the youthâ€™s increase the probability of the youths to have more than one life time sexual partnersâ€™ increases. Among sexually active respondents 30.3% and 30.2% of 15-19 and 20-24 age groups respectively, have had multiple sexual partners before the study.

The odds of having multiple sexual partners among youths who were chewing khat is 1.52 times more likely to have multiple sexual partners than their counter parts. (AOR=1.52(0.23, 0.93)).

Consistence Use of Condom in the Last 12 Months with Selected Background Characteristics

This study result revealed that variables like sex, age categories; the number of lifetime sexual partners and educational levels shows a significant association with the pattern of condom use in the last 12 months.

Those with secondary educational level, (AOR= 2.33(1.82, 6.24)) and those who reported to have single sexual partner, (AOR=2.34(1.27, 5.68)) use condom less frequently than those who had elementary education and those who had two or more sex partners, respectively.

Respondentâ€™s sex was one of important predictors, which has influence on consistence use of condom in the last 12 months. The odds ratios for female respondents were found to be 2.65. That is the likelihood of not using condoms consistently among female students in the last 12 months is 2.65 times more likely that of male students.

Table 1: Comparison of selected variables and own risk perception among youths in Mettu and Bedelle towns, 2010.

Characteristics		Risk perception		OR (95% CI)
Characteristics		Yes	No	Crude	Adjusted
Study group	Club member	280	106	2.60(1.13, 6.12)	3.32(1.28, 7.29)**
Study group	Non-club member	219	181	1.00	1.00
Sex	Male	155	199	0.79(0.57, 2.43)	1.11(0.49, 2.03)
Sex	Female	345	88	1.00	1.00
Age group	15-19	220	129	1.64(1.17, 2.34)	0.82(0.38, 1.79)
Age group	20-24	279	158	1.00	1.00
Educational status	Elementary	30	19	1.00	1.00
	Secondary	83	43	1.24(0.16, 9.33)	0.67(0.10, 4.52)
	College and above	386	225	3.86(2.86, 6.45)	5.72(1.93, 5.17)
Marital status	Never married	436	242	1.00	1.00
Marital status	Married	63	45	1.44(0.88, 2.36)	0.90(0.44, 1.86)
Knowledge of HIV prevention	Knowledgeable	439	242	1.3(1.06, 2.22)	2.93(1.45, 4.35)**
Knowledge of HIV prevention	Not knowledgeable	60	45	1.00	1.00
No of life time sexual partner	>two	153	87	0.93(0.89, 3.54)	2.79(1.24, 4.43)**
No of life time sexual partner	One	346	200	1.00	1.00
Condom use during first sexual intercourse	Yes	204	110	1.12(0.36, 1.22)	2.30(0.14, 0.67)**
Condom use during first sexual intercourse	No	295	177	1.00	1.00
Willingness to get VCT	Yes	322	173	0.85(0.50, 1.43)	0.67(0.30, 1.49)
Willingness to get VCT	No	177	114	1.00	1.00
Drink alcohol	Yes	277	163	0.95(0.57, 1.98)	0.99(1.54, 1.86)**
Drink alcohol	No	222	124	1.00	1.00
Khat chewing	Yes	302	175	1.80(0.70, 5.94)	1.39(0.30, 4.28)
Khat chewing	No	197	112	1.00	1.00

The estimates of the age suggest variation in the odds of consistent use of condom in the last 12 months during sexual intercourse for the age group of 15-19 and 20-24. The odds ratios of condom use in the last 12 months who have age 15-19 were found to be 1.78. This means that respondents in the age group 15-19, 1.78 times less likely used condom consistently in the last 12 months during sexual intercourse than the reference category (20-24).

Table 2: Relationship between selected socio-demographic variables and sexual behaviour of out-of-school youths, Mettu and Bedelle towns, 2010.

Characteristics		Ever had sex		OR (95% CI)
Characteristics		Yes	No	Crude	Adjusted
Study group	Club member	257	129	3.99 (0.81, 2.47)	1.96 (0.293, 1.21)
Study group	Non-club member	133	267	1.00	1.00
Sex	Male	263	283	0.82 (1.01, 1.99)	1.45 (0.84, 3.88)
Sex	Female	127	113	1.00	1.00
Age group	15-19	251	244	1.12 (0.88, 2.51)	1.96 (1.21, 3.04)**
Age group	20-24	139	152	1.00	1.00
Educational status	Elementary	35	27	1.00	1.00
	Secondary	138	138	0.77 (0.17, 1.43)	0.95 (0.23, 0.96)
	College &above	217	231	0.72 (0.19, 3.64)	1.72 (0.52, 2.54)
Family economic status	Rich	61	55	1.00	1.00
	Medium	255	258	0.89 (0.43, 1.37)	1.48 (0.43, 2.52)
	Poor	74	83	0.81 (0.48, 2.63)	1.77 (0.32, 3.23)
Parent youths discussion about sexual matters	Yes	260	246	1.21 (1.08, 3.31)	1.53 (1.29, 3.96) **
Parent youths discussion about sexual matters	No	130	150	1.00	1.00
Religiosity	Regularly attending	334	343	0.92 (2.60, 3.52)	1.66 (0.93, 3.31)
Religiosity	Never attend	56	53	1.00	1.00
Alcohol consumption	Yes	214	222	1.95 (0.44, 2.42)	1.41 (0.24, 0.61) **
Alcohol consumption	No	176	174	1.00	1.00
Pornographic films	Yes	235	243	1.06 (0.54, 2.56)	1.87 (1.53, 3.25) **
Pornographic films	No	155	153	1.00	1.00

DISCUSSION

The results of the survey indicates that, more than two third of the club members, 66.6% (58.1% males, 31.5% females) and about one third of the non-club members, 33.2% (65.4% males and 34.6% females) claimed to have practiced sexual intercourse in the past.

The results of similar studies conducted among out-of-school adolescents in Ethiopia showed that, in Addis Ababa 52% for males and 47.8% for girls (Kidanu et al., 2002); in Bahir Dar 53% for males and 24% for females (Abate, 2001), in southern Ethiopia 49% for both sexes (Wosen, 2005), in Gondar the figure ranged from 42% to 56.1% for both sexes claimed to have practiced sexual intercourse in the past (Silieshi, 2005). In this survey the figure is relatively higher when compared to these studies, and shows there is high engagement in sexual intercourse which may be due to being out-of-school stimulates sexual activity, and the risk taking behavior concerning premarital sex may increase among the out-of-school youths.

This study identified that, amongst cases the mean age of first sexual inter course for males and females was 16.9Â±1.8 and 16.6Â±2.2 years respectively. The mean age of first sexual intercourse among controls for males and females was 17.3Â±1.9 and 15.1Â±2.6 respectively. This study had also revealed females began sex earlier than males. From the total of the study subjects the minimum and maximum age of sexual initiation for males was 12 and 22 years and for females 10 and 18 years respectively.

Similar study conducted in Jimma and Agaro towns identified the mean age of first sexual practice was16.8Â±1.9 and 16.8Â±2.1 years respectively for the two study groups. The minimum age reported was 10 years for both sites. In this study the mean age of first sexual intercourse is almost similar with a study conducted in Jimma and Agaro towns and in eastern part of Ethiopia.

Age at first sexual intercourse varies by sex and age group among cases and controls. In the cases almost two third of who practiced sexual intercourse, (67.3%) experienced the first sexual intercourse in the age range of 15-19years, while (23.3%) and (9.3%) experienced the first sexual act in the age range less than 15years and 20-24years respectively. In the controls, more than half of those who practiced sexual intercourse, (57.1%) experienced the first sexual acts in the age range of 15-19 years, whereas (30.8%) and (14.2%) experienced the first sexual act in the age range less than 15 years and 20-24 respectively. Similar study conducted in Bishoftu town reported that, youths in the age group 20-24 years old were 1.987 times more likely to have had sexual intercourse compared with youths in the age group of 15-19 years old.

The result of this study also indicates that sexual experience increase with age and the age of the respondent has a profound effect on sexual behavior of the youths. This association between age and sexual initiation coincides with the usual trend that the higher the age, the higher the risk of being sexually experienced. The reason reported in FGD is that, as age increases parental control decreases, and then they are exposed to sex films, substances like alcohol and chat, which leads them to experience risky sexual behaviors. In the present study most of the youths experienced the first sexual activity between ages of 15-19.

This study explain that there were different reasons for starting of sexual intercourse like having had personal desire, peer pressure, fall in love and to maintain relationship with partner were the most common reasons to start the first sexual intercourse among cases and reported by 40.9%, 32.9%, 31.8% and 21.1% respondents respectively. While, having had personal desire, peer pressure, fall in love and to maintain relationship with partner were the most common reasons to start the first sexual intercourse among controls and reported by 39.8%, 22.5%, 22.5% and15.2% respondents respectively.

This trend is consistent with the study conducted in Nekemte and Addis Ababa high school students; and found out that adolescents engaged in the practice of sexual intercourse for the first time due to love affairs, having had personal desire, peer pressure, to maintain relationship with partner and by force (Eggleston, 2000; Hibret, 2004). A study conducted in Jamaica also revealed that motives and reasons for engaging in sexual intercourse were curiosity and love, gift obtained from friends and being forced into it (Ahimbisibwe et al., 2000).

In the present study, regarding the number of lifetime sexual partners, respondents who are sexually active (31.3%, 29.2% among cases and controls respectively) have ever had two or more sexual partners and this agrees with the other studies conducted elsewhere in the country.

In terms of age, the trend of having two and more sexual partners show an increment as youthâ€™s age level increase i.e. among 15-19 age group (44.5%) and among 20-24 age groups (55.4%) have more than one life time sexual partner (AOR=1.72(1.42, 2.79)).In the present study, sexually initiated males and females reported an average of 2.5 and 1.9 life time partners from the club members respectively. From non-club members sexually active males and females reported to have an average of 2.1 and 1.5 life time partners.

FGD result substantiates that, it is usual among the youths to have sexual intercourse with more than one sexual partner. In this study, males had more likely high number of sexual partners than their female counter parts, but there was no statistically significant difference between the twogroups. The mean number of lifetime sexual partners among cases and controls were relatively higher than the aforementioned study conducted in Jimma and Agaro towns.

In this survey, out of (66.5%) club members who ever had sex, (45.9%) had used condoms during the first time they had sexual intercourse. Out of (33.3%) non-club members who ever had sex, (34.5%) had used condoms during the first time they had sexual intercourse.

The reported low utilization rate of condom in this study area may indicate that high-risk behaviors are widely practiced in the area. This calls for a well organized information, education and communication through peer educators to bring about behavioral change. Although, there was low utilization of condom in these study areas condom use is significantly increased in two fold among cases than controls.

In Ethiopia, EDHS 2006 indicated that condom use among adolescents is low, only (1%) of young women and (17%) of young men used condom during their first sexual intercourse. Condoms remain the integral part of HIV prevention programs. However; the prevalence of condom use is low despite all efforts made to improve the use of it (Melisew, 2008).

This study revealed that, out of (75.8%) club members who have had sex during the previous 12 months, (58.3%) reported that they were using condoms every time. Thirty three point four percent (33.4%) reported that they were using condoms some times and (12.8%) reported that they had never used condoms during sex in the past 12 months.

From (57.8%) non-club members who have had sex during the previous 12 months, (55.8%) reported that they were using condoms every time, 31.1% reported that they were using condoms some times and (12.9%) reported that they had never used condoms during sex in the past 12 months.

In a study conducted in Jimma and Agaro towns, south west Ethiopia, among sexually active respondents during the last one year, (46%) of the club members and (39.3%) of the non-club members reported to use condom every time and more males reported to use condom compared to the female youths (Meseret, 2003).

In other study conducted in Uganda, older youths (20-24 years) reported to use condom more than the younger once (15-19 years) (Hibret, 2004). In a study conducted in Bahir Dar town, (37.3%) and (36.8%) of out-of-school youths reported that they used condom every time when they have sexual intercourse with commercial sex partners and with non-regular sexual partners respectively (Lema and Hassen, 1994).The result obtained from this study was much higher than that of Jimma, Agaro and Bahir Dar towns and more males reported to use condom compared to the female youths.

FGD result also showed that, females are less likely to use condom. This may be due to cultural and other reasons such as the decision power and asking her sexual partner to use condom. In the same way, this study also confirms that older youths (20-24 years) reported to use condom more than the younger once (15-19 years).

The proportion of club member youths who had unprotected sexual intercourse at least once were higher than those non-club member counter parts (46.1% Versus 44.1%) and this was statistically significant (P<0.05). From this, we can observe that many youths had been engaged in a risky sexual behaviour that could make them vulnerable to STIs including HIV/AIDS, unwanted pregnancy, abortion, termination from school.

A study conducted in Injibara town, Awi zone, revealed that (22.6%) of young people used condom during their first sexual encounter and (77.4%) of young people did not use condom during their first sexual encounter. In addition, the proportion of condom users at the first sex were considerably higher among males than females (67% versus 33%) (Silieshi, 2005).

Young people in the study areas protect themselves from HIV/AIDS, other STIs and unwanted pregnancy. But, the required level of using condom was not reached yet. The proportion of condom users at the first sex was considerably higher among males than females (41.3% versus 31%). Higher educational attainment, greater wealth, and urban residence are related to a greater likelihood that condoms were used at the first time (Silieshi, 2005).

A recent survey in Afar region reported that consistent condom use during experiencing sex with commercial sex workers among out-of-school youths were (58%) and (36%) reported experiencing commercial sex using condom occasionally and none of them reported consistent condom use (Abate, 2001).

In this study, when we compare the two groups as to the types of partners with whom they practiced sex revealed that, though statistically not significant, more proportion (7.5%) of non-club members had visited commercial sex workers than club members (2.7%).

The alarming finding of this study is that, a significant percentage (28.5%) club members admitted to have sexual contact with commercial partners without using protective measure (condom), (30%) non-club members having similar contact and didn't use condom consistently.

From FGD, no condom dispensary is found in the study areas. Many kiosks carry condoms, but youths are reluctant to purchase them in their own neighborhoods' for fear of being labeled promiscuous.

The present findings indicates that majority of out-of-school youths were at increased risk of HIV/AIDS, because they were neither using condom consistently nor abstain from sex and this figure was much less than a study conducted in Afar region which indicates that there is a better usage of condom in the present study areas.

Result from the study indicated that, almost the majority (99.1%) of the study populations were aware of HIV/AIDS. The proportions of those who have ever heard about the HIV/AIDS were higher in club member (100%) than in non-club member (98.2%) youths. This finding does go with the research conducted in Jimma and Agaro towns, in which (99.8%) of the two groups were aware of HIV/AIDS (Meseret, 2003).

From this survey, greater proportions of club member (96.6%) and (92%) of non-club member respondents were able to mention at least one type of STIs other than HIV/AIDS respectively. Gonorrhoea (79.7%); syphilis (75.3%) and cancroid (57.5%) were the commonly stated STIs among club member youths. Among non-club members gonorrhoea (74%); syphilis (75.5%) and cancroid (61%) were the usually known STIs. 77.8% and 88.3% of the respondents did not know the Lymphogranuloma Venerium from club members and non-members respectively.

Studies conducted in some parts of the country among out-of-school youths revealed that the prevalence of self-reported STIs were (6.5 %), (4%) and (6%) in Bahirdar, Awassa, and Addis Ababa respectively (11, 19, 20). In our study self-repotted signs and symptoms of STIs among sexually active youths were (4.9%) among both groups. Half of those who reported history of STIs first consulted peers and a considerable proportion (44%) got treatment either from local injectors or from private pharmacy, but still they could have been better treated in fair cost in government health institutions.

The FGD discussants said that, youths prefer to go to private clinics, but getting the money to do so from their parents is a problem, especially as they feel they cannot openly discuss their infections. Effectiveness of the treatment and obtaining confidential service were the two main concerns for preferring the visited service areas.

In this survey more than half (52.5%) and (26%) of club members and non-members reported that they used the contraceptive methods during their last sexual intercourse respectively. The result from this study is with EDHS 2005 report in which (52%) of unmarried sexually active respondents of the 15-24 age group used contraceptive (Melisew, 2008). However, there is better usage of contraceptive methods among club members than non-club members in the study area, this indicates that most of non-club members involved in high risk sexual practice that endanger their life and their partner life.

Due to low use of contraceptive and condom, adolescents might encounter problems like unwanted pregnancy and abortion, STIs, HIV/AIDS and others.FGD result shows the possible barriers for low utilization of contraceptives may be absence of adolescent friendly services, lack of knowledge, and negative attitude to modern contraception.

This study reports that (52.5%) and (26%) among cases and controls respectively. This is much greater and also there was great discrepancy between their knowledge and practice (95.8% and 89% versus. 52.5% and 26%). Selassie also reported similar pattern of discrepancy between knowledge and practice of modern contraceptive use.

The odds ratio points out those non-club members do have bad attitudes and thoughts towards HIV/AIDS victims than club member youths. From this survey, club members are more or less agree with the opinion that a boy/girl should have sex before he/she gets married as non-club members. With regard to AIDS patientsâ€™ treatment and care, almost all of both groups had affirmative feelings with no statistically significant difference, even if the proportion of club members still outweighs the non-club members.

From FGD result, there are many misconceptions which wide spread among out-of-school adolescents about HIV/AIDS. The stigma related with HIV/AIDS causes discrimination and this has posed serious obstacles to tackle the epidemic. Stigma and discrimination are a result of ignorance about the disease was traditional and religious attachment about sex, sexuality and STIs.

Almost three fourth (72.5%) of club members perceived that they are at risk or may be at risk of acquiring the disease than the non-club members (54.7%). This figure was greater than a study conducted in Jimma and Agaro towns that two-thirds of the club members admitted that they are at risk or might be at risk of acquiring HIV and two-third of the non-club members reported that they are at risk (Meseret, 2003). In this study club member youths perceived that they are at risk of acquiring HIV/AIDS than the non-club members.

In this survey the figures in risk perception were relatively higher when compared with other studies. Our finding was even more encouraging compared to findings of south Gondar in which (5.8%) of the respondents perceived to have a high chance of acquiring HIV (Lema and Hassen, 1994). In South Africa (30%) of respondents perceive that they are at risk of HIV. This can have a positive influence on reducing high-risk behaviors, thus, reduces a major risk factor of HIV acquisition (Adugna, 2005).

In the present study it was tried to assess the most frequently mentioned reason, by those who did not perceive themselves as at risk, (27.5%) was that they did not have any sexual contact; (13.2%) was that they regularly use condom; followed by because of praying regularly, (20.8%). The proportions that perceive themselves as at risk of contracting HIV are highest among females (69.1%) than males (30.9%).

In this survey a number of factors including total number of reported sexual partners, knowledge on HIV transmission, willingness to get tested (VCT), condom use during first sexual intercourse and alcohol intake have shown significant association with self-risk perception. Similar finding was obtained from Debre Birhan town on HIV risk perception was found to be associated with condom use, knowledge on HIV transmission, number of sexual partners and khat chewing (Abdu Dawud, 2003).

Generally, this study revealed that knowledge, perception and attitude of the club members are better off. This is probably the result of repetitive and multiple information sources they had compared to the non-club members. Because of increased knowledge and heightened practices lead youths to recognize that new behaviors can meet a personal need, to decide to take action and eventually to adopt new practices (Hibret, 2004).

In this survey, 61.5% of the students heard about voluntary counseling and testing for HIV. Five point nine percent (5.9%) reported history of previous VCT, and (82.2%) agreed to undergo voluntary counseling and testing for HIV.

In FGD also, most of the youths know that taking VCT has multi-advantages, but a very small proportion of the people used this service. Among those who took the service the majority took pre-marriage VCT, but pre-sexual VCT is very minimal.

Study groups, sex of respondents and number of lifetime sexual partners were significantly associated with willingness to VCT. Those who reported single sexual partner were almost more willing to undergo VCT (AOR=1.89(1.22, 3.32)) than those who reported to have two or more sexual partner. Males were almost more willing to undergo VCT (AOR=2.84(1.58, 5.52)) than females, and similarly in the present study, the club members are more likely to show an attention for voluntary HIV testing and counselling, whereas club members were more voluntary to disclose or reveal the test result to others (AOR=1.87(1.53, 3.25)than the non-club member respondents.

Similarly in the present study, knowledge of HIV status is found to be a strong predictor variable to influence the level of risk perception of HIV infection among the respondents. Those respondents who had never been tested for HIV are 2.56 times more likely to perceive higher risk of HIV infection than respondents who took VCT. The result of this study was analogous with the study conducted in Dessie town in which the respondents who had never been tested for HIV were 2.779 times more likely perceive higher risks for HIV.

CONCLUSIONS

The majority of the respondents in the present study perceived themselves as being at little or no risk of HIV infection. Their reported sexual behavior indicate that a significant proportion of the respondents involve in risky sexual activities that could expose them to HIV infection. They had unfavorable attitude towards HIV/AIDS patients manifested, and the perception of risk acquisition is weak. A considerable number of out-of-school youths reported that they have involved in non-sexual risk behaviour such as chewing khat, drinking alcohol and watching pornographic films which are found to play significant role in predisposing the youths to risky sexual practices.

Though, parent youth discussion about sexual matters have found to be significantly associated with out-of-school youths sexual experience, they didnâ€™t discuss openly the information on issues of sexuality to their children, but there is open discussion with their peers about sexuality, condom use and other related issues. Peer pressure was also found to be another driving force that predispose youth for risky sexual practices.

Even in the face of existing perception and knowledge of self-risk, risk taking behaviors (first sex at early age, multiple sexual partnership, sex with high risk partners such as CSW, non-use of condom for every act of sexual intercourse, low HIV test service uptake, etc.) is still high.

ACKNOWLEDGEMENTS

I would like to offer my deepest appreciation and thanks to Dr. Alemayehu Worku for his constructive advice, support, valuable comments and suggestions. I would like to acknowledge the help provided by the staff of Ilu-Abba-Bora Zone Health Bureau, Mettu and Bedelle woreda Health Bureau and Bedelle town Capacity Building Bureau for their full cooperation and facilitation of the actual data collection procedure. I would also like to sincerely thank to supervisors and to all the participants of the study for their participation.

REFERENCES

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Ahimbisibwe, E. (1998). Risk Perception and Condom Use in Uganda. African Population Studies 18 (1): 68-80.

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Determinants of HIV Testing Among Tuberculosis Patients on DOTS in East Wollega Zone, Ethiopia

Gebi A and Alemayehu W â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦â€¦
DOI: http://dx.doi.org/10.4314%2Fstar.v1i2.98781

Abstract

Full Text

Sci. Technol. Arts Res. J. April-June 2012, 1(2):31-42

Determinants of HIV Testing Among Tuberculosis Patients on DOTS in East Wollega Zone, Ethiopia

Gebi A¹* and Alemayehu W²

¹ Faculty of Health Sciences, Post Box No: 395, Wollega University, Nekemte, Ethiopia

² School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia

Article History: Received: 09-02-2012; Revised: 25-05-2012; Accepted: 17-06-2012

DOI: http://dx.doi.org/10.4314%2Fstar.v1i2.98781

*Corresponding Author:

Gebi A

E-mail: gebi.agero@yahoo.com

Abstract

The main aim of the study was to assess determinants of HIV testing among Tuberculosis patients on DOTS in East Wollega zone, Ethiopia. Institution based case control study was conducted from January â€“ March 2011. Cases were tuberculosis patients who have not accepted HIV testing while the controls were those who have accepted HIV testing. A sample of 270 (90 cases and 180 controls) tuberculosis patients, with a ratio of two controls to one case, was used. Simple random sampling technique was used to recruit study subjects. Tuberculosis patients who was tested for HIV showed, 23(12.8%) of them were HIV positive and 157(87.2%) of them were HIV negative. The proportion of HIV infected individual was 10(13.2%) among males and 13(12.5%) among females. Among 23 patients, 19(16.4%) TB patients from urban and 4(6.2%) patients were from rural area. Tuberculosis patients having low knowledge about HIV and were more likely to reject HIV testing AOR 3.697 (CI 2.135, 6.402) compared to those who are knowledgeable about HIV. Higher level of stigmatized attitude toward HIV and being from urban were also associated with rejecting HIV testing AOR 3.421(CI 1.870, 6.257) and AOR 5.692(CI 1.930, 16.783) respectively. Efforts to promote HIV testing utilization require effective strategies to reduce stigmatizing beliefs towards HIV and PLWHA among TB patients. Health information dissemination regarding HIV testing and risky sexual behavior reduction should have to be targeted most at risk population like tuberculosis patients.

Keywords : Tuberculosis; HIV; Urban; Rural; Perception

INTRODUCTION

Tuberculosis (TB) is the most common cause of death among people living with HIV/AIDS (PLWHA). The World Health Organization (WHO) recommends that in countries where HIV prevalence is at least 1% among adults and 5% among TB patients, all TB patients should be offered HIV testing and all PLWHA should be screened for TB and to increase uptake of HIV testing, WHO also recommends provider-initiated HIV testing and counseling (PITC) (WHO, 2004). HIV related Tuberculosis remains serious challenge for health sector response to HIV. All countries with a generalized HIV epidemic state should aim to ensure that HIV testing is actively promoted and offered to all TB patients. The data available from these initiatives can form the basis of a reliable surveillance system that achieves high coverage (>80%) of testing among TB patients(WHO, 2004). Thus, the high rate of HIV infection and poorly functioning tuberculosis control programs in many parts of Africa are likely to contribute to the emergence of extreme drug resistant (XDR) tuberculosis, which could destabilize the control of tuberculosis in these areas (Dheda Shean et al., 2010). Sub-Saharan Africa continues to account for the majority of people living with HIV and TB in the world. In 2007, about 79% of the estimated total people living with HIV and TB were in this region posing other burden like risk of drug resistant forms of TB due to difficulty and delays in diagnosis, increased mortality and greatly reduced survival time(WHO UNAIDS Unicef Progress Report, 2009).

Tuberculosis (TB) is the initial clinical manifestation of human immunodeficiency virus (HIV) disease for many people in sub-Saharan Africa, and a very high proportion of TB patients in this region are co-infected with HIV. HIV counseling and testing of TB patients is therefore an important method for identifying HIV-infected individuals, all of whom require HIV care and many of whom are indicated for antiretroviral therapy (Zachariah Spielmann et al., 2003). A test done among TB suspects revealed a 42% HIV seropositive of these, 37% received a non-TB diagnosis. Patients who received a non-TB diagnosis were significantly more likely to be HIV-seropositive than those who were diagnosed with TB (49% vs 39%; odds ratio or 1.6, 95% confidence interval (1.1â€“2.2, P = 0.02) (Srikantiah Lin et al., 2007). WHO estimates that in Ethiopia 40% of TB patients tested for HIV are HIV positive, (WHO UNAIDS Unicef Progress Report 2009). While a study done in Arbaminch demonstrated that the prevalence of HIV among tuberculosis patients was high among individuals from urban areas and TB-HIV co-infection was high among womenâ€™s (32.3% versus 10.8% among men) and there is no significant difference between urban and rural in TB-HIV co-infection, but study done in Cameroon demonstrated a 68.5% HIV seropositive prevalence among TB patients (Jerene Endale et al., 2007; Njozing Migue et al., 2010) Factors like individuals self perceived risk of HIV infection were associated with initial willingness but are not associated with actually accepting the result, concerns about confidentiality, convenient timing of the service, level of spoken English and place of the testing site have been described as determinants of acceptability of HIV testing services (Pignatelli Simpore et al., 2006; Angotti Bula et al., 2009; Rodger Story et al., 2010; Mpairwe, Muhangi et al., 2005; Knut and Seter, 2004).

Operational factors like not understanding the process during group education session/pre test counseling, disagreement of the partner, wanting the partner to be tasted before hand, having salesman partner and the perception that the community would have negative attitude are explained as determinant factor for participation in HIV counseling and tasting. Distance to HIV testing site (presence of onsite HIV tasting) was associated with clientâ€™s uptake of HIV testing among TB patients (Pignatelli Simpore et al., 2006; Sarker, Sanou et al., 2007; Kanara Cain et al., 2009). To realize the right to health, states need to identify groups at risk of HIV in order to develop effective HIV prevention and control programs(Kouyoumdjian Seisay et al., 2010). VCT services may provide a means for States to fulfill the right to health as a way to prevent HIV and as the gateway for people with HIV to access health care. However, States must ensure that VCT is accessible and acceptable to the whole population at risk of HIV (Kanara Cain et al., 2009; Kouyoumdjian Seisay et al., 2010). Testing practices are highly dependent on the local culture of the clinics and the individual practices of healthcare workers (Rodger Story et al., 2010).

MATERIALS AND METHODS

Study Area and Period

The study was conducted in East Wollega zone, Oromia regional state, Western Ethiopia. East Wollega Zone is one of the zones of Oromia Regional state with a population of 1,230,402 among which 614,761 are males and 615,641 are females. Majority of the population live in rural areas 86% (1,061,120) (FDRE, 2008). Nekemte is the capital city of the zone which is located 331km west of Addis Ababa with a population of 76,817 (male 39,167 and female 37,650). The study was conducted from January to March, 2011.

Study Design

Institution based unmatched case control study design was used to assess determinants of HIV testing among tuberculosis patients on DOTS. Determinants were assessed among TB patients those who had taken HIV testing (controls) and those refused to accept HIV testing (cases).

Inclusion and Exclusion Criteria

TB patients aged less than 18 years and those for whom HIV had been diagnosed before TB were not included in the study. Whereas newly diagnosed, previously registered and those under treatment including all forms of TB in Nekemte Hospital and selected health centers during the study period were selected for the study.

Sample Size

The sample size was determined by using a formula for estimating two population proportions, 80% power and 5% type I error to approximate an acceptable population parameter and a 10% non response rate was used. The formula used for calculating the required sample size was computed by using, ever heard about HIV testing as exposure variable and taking 1:2 ratio (for one case two controls), since it yields maximum sample size (Ayenew Leykun et al., 2010). Where the proportion of exposure among cases (27.2) and the proportion of exposure among controls (11.7). A significance level of alpha (1.96 for a two-sided test at the 0.05 alpha level) and Z1-Î²/2 value of standard normal distribution corresponding to the desired level of power (0.84 for a power of 80%). Total sample size required for the study was 270 tuberculosis patients on DOTS (90 cases and 180 controls).

Sampling Procedure

List of all tuberculosis patients on DOTS was obtained from six health centers selected randomly from Nekemte hospital registration book. Before generating random number subjects were screened for inclusion and exclusion criteria, then simple random sampling technique was employed to select individual study participant.

Logo

Figure 1: Sampling procedure for assessment of determinants of HIV testing among tuberculosis patients on DOTS in East Wollega zone, Ethiopia 2011.

Data Collection

Questionnaires that were prepared in English language were translated to Afan Oromo language for data collection. The questionnaires contain socio-demographic characteristics, marital status, educational level, type of TB, place of residence, income, distance from health service, HIV related knowledge and intention to use VCT services. Pre-test of the questionnaire for clarity and consistency of the questions was conducted on 24 tuberculosis patients from Jimma Arjo health center that was not included in selected health centers for final data collection (from similar woredas in East Wollega zone) one week prior to actual data collection. Finally, necessary amendment was made based on the feedback.

Seven data collectors were recruited, three females and four males. Two days training was given to them focusing on the objective of the study and value of collecting the actual data. Data was collected by nurses trained in data collection; they were selected from their respective TB units. Structured questionnaire were used for data collection by interviewing TB patients after they have received their treatment.

Data Processing and Analysis

Quantitative data was entered and cleaned using Epi Info soft ware, and after clearance data was exported to SPSS version 17 for analysis. Thirteen questionnaires were used to assess knowledge regarding tuberculosis and HIV, the questionnaires were then given a mark of one, if the respondent answered the question correctly and given zero, if the answer was wrong, finally a summary score of all the questions were calculated. The mean of correct answer were used as a cutoff point, respondent who have answered greater than the mean were categorized as knowledgeable and those whose scores were less than the mean were categorized as non-knowledgeable. Similarly seven question were used to assess perceived stigma and discrimination related to HIV, those respondents whose scores were less the mean were categorized as having high perceive stigma and discrimination and those whose scores were greater than the mean were categorized as having low perceived stigma and discrimination. Binary logistic regression was used for both bivariate and multivariate analysis. A final model was developed using stepwise forward logistic to see the joint effect of socio-demographic and knowledge, attitude and perceived stigma towards HIV testing. Statistical significance was taken at p<0.05.

Data Quality Control

Pre-test was conducted out of study subjects to detect any problem in the questionnaire and data collection method. All filled questionnaires were checked daily for completeness, accuracy, clarity and consistency by the supervisor and the principal investigator and necessary corrections and changes was made. Completeness and consistency of variables during data entry was checked using frequency distributions. Appropriate statistics was used for describing the variables and their associations.

Ethical Consideration

Permission was taken from Ethical review committee of the SPH of Addis Ababa University, East Wollega zonal health office and from study units. At individual level after explaining the purpose of the study verbal and written consent was obtained from all participants prior to their participation in the study. HIV testing that was done prior to data collection by the respective health centers was used and HIV test result were retrieved from TB patient log book during data collection in selected health center in TB clinic, the study subjects were informed that their name or special ID will not be included in the report than HIV status that doesnâ€™t contain any information related to individual study subject.

RESULTS

Socio-demographic Characteristics

The socio-demographic characteristics of respondents are shown in Table 1. Two hundred seventy tuberculosis patients (100% both HIV tested and not tested for HIV) responded to the questionnaire completely. Of these 111(41.1%) of them were males and 159(59.9%) were females. The mean age of respondents was 33.52Â±10.29 for cases and 31.71Â±11.94 years for controls (Table 1).

Table 1 : Socio-demographic characteristics of Tuberculosis patients on DOTS in East Wollega Zone, Ethiopia, January to February 2011.

Variables

Cases(n=90)

Controls (n=180)

Total (n=270)

Sex

Male

Female

35(38.9%)

55(61.1%)

76(42.2%)

104(57.8%)

111(41.1%)

159(59.9 %)

Age in years

<25

25-34

35-44

>=45

19(21.1%)

32(35.6%)

23(25.6%)

16(17.8%)

64(35.6%)

51(28.3%)

36(20%)

29(16.1%)

83(30.7%)

59(21.9%)

45(16.7%)

Place of residence

Urban

Rural

71(78.9%)

19(21.1%)

116(64.4%)

64(35.6%)

187(69.3%)

83(30.7%)

Marital status

Single/Never married

Married

Divorced

Widowed

40(44.4%)

4(4.4%)

6(6.7%)

73(40.6%)

86(47.8%)

5(2.8%)

16(8.9%)

113(41.9%)

126(46.7%)

9(3.3%)

22(8.1%)

Ethnicity

Oromo

Amhara

Tigre

Others

63(70%)

17(18.9%)

3(3.3%)

7(7.7%)

120(66.7%)

53(29.4%)

2(1.1%)

5(2.8%)

183(67.8%)

70(25.9%)

5(1.9%)

12(4.4%)

Religion

Orthodox

Muslim

Protestant

Catholic

27(30%)

55(61.1%)

5(5.6%)

3(3.3%)

69(38.3%)

68(37.8%)

38(21.1%)

5(2.8%)

96(35.6%)

123(45.6%)

43(15.9%)

8(3%)

Highest level of education

Unable to read and write

Primary

Secondary

High school and above

42(46.7%)

7(7.8%)

18(20%)

23(25.6%)

55(30.6%)

36(20%)

40(22.2%)

49(27.2%)

97(35.9%)

43(15.9%)

58(21.5%)

72(26.7%)

Employment status

Employed

Unemployed

16(17.8%)

74(82.2%)

22(12.2%)

158(87.8%)

38(14.1%)

232(85.9%)

Distance from health institution

<=10km

>10km

84(93.3%)

6(6.7%)

161(89.4%)

19(10.6%)

245(90.7%)

25(9.3%)

Average monthly income(ETB)

<500

500-1000

>1000

No income

47(52.2%)

12(13.3%)

7(7.8%)

24(26.7)

104(57.8%)

18(10%)

10(5.6%)

48(26.7)

151(57.9%)

30(11.1%)

17(6.3%)

72(26.7%)

Knowledge, Attitude and Perceived Stigma towards TB/HIV

Thirteen questions were asked to assess knowledge and seven questions were also used to assess perceived stigmatized attitude towards TB/HIV, then for respondents who answered the question correctly a mark of one was given and zero was given for wrong answers. Accordingly mean value of correct answer was calculated and respondents scoring less than mean value were categorized as having low knowledge and high stigmatizing attitude. Regarding type of TB, stage of treatment and previous history of TB, more than one third (35.6%) of the respondents are smear positive pulmonary TB while 114(42.2%) and 60(22.2%) are smear negative and extra pulmonary TB respectively. One hundred twenty four (45.9%) of them are on intensive phase while 146(54.1%) of them are on continuous phase of treatment, from these 11(4.1%) of them had previous history of TB (Table 2).

Table 2 : Percentage distribution of knowledge, attitude and perceived stigma towards TB/HIV among Tuberculosis patients on DOTS in East Wollega Zone, Ethiopia, January to February 2011.

Variables

Cases(n=90)

Controls(n=180)

Total(n=270)

Heard about TB(ever/before sickness)

Yes

87(96.7%)

3(3.3%)

160(88.9%)

20(11.1%)

247(91.5%)

23(8.5%)

Source of Information

Radio/Television

News paper/Magazines

Parent/relatives

Health institution

Others

76(87.36%)

4(4.6%)

5(5.75%)

5(5.755)

112(70%)

28(17.5%)

11(6.87%)

28(17.5%)

1(0.625%)

188(76.11%)

32(12.95%)

16(6.48%)

33(13.36%)

1(0.4%)

Afraid of being infected with TB

Yes

4(4.4%)

86(95.6%)

30(16.7%)

150(83.3%)

34(12.6%)

236(87.4%)

Who is at risk of getting TB

The poor

Rural people

Those who live with TB

Smokers/Alcolics

Others

14(15.5%)

5(5.6%)

64(71.1%)

7(7.8%)

34(18.9%)

12(6.7%)

83(46.1%)

27(15%)

24(13.3%)

48(17.8%)

17(6.35)

147(54.4%)

34(12.6%)

24(8.8%)

As a TB patient reveal it to others

Yes

44(48.9%)

46(51.1%)

122(67.8%)

58(32.2%)

166(61.5%)

104(38.5%)

Type of TB

Smear positive PTB

Smear negative PTB

Extra pulmonary TB

40(44.4%)

44(48.9%)

6(6.7%)

56(31.1%)

70(38.9%)

54(30%)

96(35.6%)

114(42.2%)

60(22.2%)

Heard about HIV/AIDS

Yes

90(100%)

171(95%)

9(5%)

261(96.7%)

9(3.3%)

Healthy looking person can be infected with HIV

Yes

74(82.2%)

16(17.8%)

124(68.9%)

56(31.1%)

198(73.3%)

72(26.7%)

There is relationship between TB and HIV

Yes

24(26.7%)

66(73.3%)

95(52.8%)

85(47.2%)

119(44.1%)

151(55.9%)

TB increase after era of HIV

Yes

22(24.4%)

68(75.6%)

99(55%)

81(45%)

121(44.8%)

149(55.2%)

Control of HIV/AIDS prevent spread of TB

Yes

21(23.3%)

69(76.7%)

91(50.6%)

89(49.4%)