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American Journal of  
Chemistry and Pharmacy (AJCP)

Magnitude and Associated Factors for Sexually Transmitted Infections Among Hawassa 
Industrial Park Workers, Southern Ethiopia

Solomon Tesfaye Doelaso1*

Volume 1 Issue 1, Year 2022
ISSN: 2834-0116 (Online)

DOI: https://doi.org/10.54536/ajcp.v1i1.431
https://journals.e-palli.com/home/index.php/ajcp

Article Information ABSTRACT

Received: July 11, 2022

Accepted: July 18, 2022

Published: July 20, 2022

Sexually Transmitted Infections (STI) are a group of  infectious diseases spread through 
unprotected sexual intercourses, resulting in curable and incurable diseases. The syndrome 
is a variety of  clinical signs and symptoms caused by pathogens that can be acquired and 
transmitted through sexual activity. Around the world estimated about 376 million people 
become infected each year with one of  four common curable STIs where about 86 million 
new cases of  curable STIs occurred in the African region. The objective of  this study to as-
sess the magnitude and associated factors for Sexually transmitted infections in 2020 among 
Hawassa industrial park workers, Southern Ethiopia. The multistage sampling technique 
was used to select a total of  663 study participants. The data were entered into the Epi-Data 
version 4.4 and analyzed by SPSS version 21. Both bivariate and multivariable logistic regres-
sion analyses were employ P-values of  <0.05 and AOR with 95%CI was used to determine 
the presence of  association between covariates and dependent variable.. The Self-reported 
STI magnitude in the last 12 months was 18.7% (18.54-18.91) among the Hawassa indus-
try park workers. Hometown residence [AOR=2.29; 95%CI: 1.34-3.92], drinking alcohol 
(AOR=3.26; 95%CI: 1.74-6.09), view/read pornography (AOR=4.38; 95%CI: 2.67-7.18) 
and poor knowledge (AOR=2.69; 95%CI: 1.65-4.420 were significantly associated with the 
magnitude of  STIs. The Self-reported magnitude of  STIs among Hawassa Industrial Park 
was found to be high. 

Keywords
Stis, Associated Factors, 
Syndromes, Risky Sexual 
Practices, HIP Workers

1 Sidama regional state health department, Ethiopia.
* Corresponding author’s e-mail: gersam2016@gmail.com

INTRODUCTION
Sexually transmitted infections (STIs) are a group of  
infectious diseases transmitted through unsafe sexual 
intercourse as the primary mode of  transmission.
(Workowski K, 2015). Please follow the referencing style 
of  the journal (APA 6/7th Edition). The organisms 
causing STIs can also be spread through other routes 
such as blood transfusion, tissue transfer, skin-to-skin 
sexual contact, mother-to-child, and blood or blood 
products (WHO, 2014) (FMOH, 2015). To date more 
than 30 pathogens; bacterial, viral, fungus, protozoa and 
ectoparasites have been identified that can be transmitted 
through sexual intercourse. Commonly known curable 
SIs is Syphilis, Gonorrhea, Chlamydia, Trichomoniasis, 
Chancroid, Lymph granuloma venereum and Donovan’s. 
The STIs that are preventable, but not curable are the 
viral STIs which includes HIV, Human papilloma virus, 
Hepatitis B virus and Herpes simplex virus (De Schryver 
A MA, 1990).
Conventionally, a supposed STIs has been diagnosed by 
either clinical appearance alone, which is often inaccurate 
and incomplete or a laboratory-based test, which is 
complex, very expensive, and commonly delay treatment 
(FMOH, 2015). Also, clinical diagnosis of  several STIs 
is problematic due to broad-based signs and symptoms. 
Etiologic-confirmed diagnosis is scientific, But the service 
is often unreachable in many developing countries or may 
be located in urban centers (Sahu L MP, 2005). Another 
strategy, the syndromic approach, offers an alternative 
approach, which depends on the ability to identify and 
treat the syndromes caused by an STI, with minimal 

or no requirement for laboratory diagnostic support 
(Tesfaye F et al., 2000) (Mehul T et al., 2013). Instead, 
it is based on the identification of  a group of  signs and 
symptoms associated with a number of  well-known 
etiologies approach that can be attained and spread 
through sexual intercourse. Treatment is provided for 
the majority of  the etiologies  locally responsible for the 
syndrome (De Schryver A MA, 1990). Commonly known 
STI syndromes are: Urethral discharge in men, Genital 
ulcer/sores, Vaginal discharge, Inguinal bubo, Scrotal 
swelling, Lower abdominal pain in women and Neonatal 
conjunctivitis (FMOH, 2015) (CSA, 2017).  Also, It is 
inclusive approach because in addition to the provision 
of  treatment, it includes: patient education, condom 
supply, counseling, partner notification and management, 
and HIV testing and counseling (FMOH, 2015).
According to the WHO 2019 estimate around the world, 
about 376 million people become ill each year with one 
of  four common STIs: Syphilis, Gonorrhoea, Chlamydia 
and Trichomoniasis. It is projected about 86 million new 
cases of  curable STIs occurred in Africa regions (WHO, 
2019). In developing countries prevalence and their 
complications are amongst the top five disease groups 
for which adults seek health care (Mehul T et al., 2013). 
Their burden in Sub-Saharan African countries is very 
high. It is estimated that 80-90% of  the global burden 
of  STIs found in the developing countries because there 
is inadequate or inaccessible diagnosis and treatment 
facilities (WHO, 2007). However, large scale up of  health 
care investments and strategies applied for the prevention 
and treatment of  STIs in Ethiopia the issue continues 

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to be a young adults’ health problem. The prevalence of  
STIs rises from 1.15% in 2005 to 4% in 2016 among 15-
49 years old (CSA, 2017). 
Its magnitude, health and socio-economic impacts are still 
not well known due to a combination of  social stigma, 
under-reporting, asymptomatic nature of  infections and 
lack of  diagnostic facilities (WHO, 2013). The reason for 
high prevalence is risky sexual practices (RSP) and low 
use of  preventive services among young age groupies. 
The health of  these group is a key element for social 
and economic development of  the country, overlooking 
the SRH of  these groupies can lead to high social and 
economic costs, both immediately and in the years ahead 
(WHO, 2007). Majority of  STIs are asymptomatic and only 
part of  the symptomatic population seeks health care and 
even a smaller number of  cases are reported. Which can 
lead to the development of  serious complications with 
severe consequences for the individuals and community 
(Mehul T et al., 2013). About 70-80% of  infected women 
are asymptomatic and so do not seek treatment. They 
are risky for complications and possibly infecting others 
(FMOH, 2015). 
It may increase the risk of  HIV acquisition, mother-
to-child transmission of  STIs can result in adverse 
pregnancy outcomes. also, late treatment or untreated 
infection can lead to pelvic inflammatory disease, 
ectopic pregnancy, infertility and cervical cancer (WHO, 
2014). The association between STIs and HIV has an 
epidemiologic interaction and share the same risk factors. 
So, it is very critical to strengthen STI prevention and 
control program not only to improve quality of  life and 
control their complications, but also to prevent the spread 
of  HIV infection (FMOH, 2015) (Mehul T et al., 2013). 
Counselling can improve people’s ability to recognize the 
syndromes of  STIs, and increase the likelihood they will 
seek care early. As well, people seeking treatment for STIs 
also face several challenges including limited resources, 
social stigma, poor quality  services, and No follow-
up of  sexual partners (WHO, 2014). Although sexual 
abstinence is the preferred method for STI prevention 
among young age group, it is not practical for many of  
the individuals. Therefore, consistent and correct condom 
use is a rational method of  preventing the transmission 
STIs (WHO, 2007).
In Hawassa city, urbanization and rural-urban migration 
is a growing phenomenon for a job opportunity that set 
for younger age groups to employ at the newly established 
Hawassa industrial park (HIP), that predisposes them to 
high risk for STIs. Report from symptomic presentation 
of  STIs among people living in rural areas of  Lucknow 
shows that about 11.18% were diagnosed STIs based on 
syndromic approaches (Mishra S et al., 2016). Another  
Community-based survey on STIs associated symptoms 
and health-seeking behaviors among Iranian adults shows 
that, 39.9% of  women and 17.6% of  men reported 
having at least one STI associated syndromes under 
consideration at the time of  study (Nasirian M et al., 
2015).

According to Ethiopian demographic and health survey 
2016, Overall 4% of  women and men age 15-49 reported 
having syndromes of  STI in the last 12 months (CSA, 
2017). Other studies conducted among Wolaita Sodo 
University and University of  Gonder students shows  that 
12 month period self-reported prevalence of  STIs to be 
19.5% and 18.2% respectively (Yohannes B et al., 2013) 
(Ayanaw B et al., 2019) . Similar studies conducted among 
high school students at Bahir-dar and HIV patients in 
Ayder referral hospital, Northern Ethiopia reported that 
the prevalence of  STIs is 13.1% and 8.5% reported to 
have syndromes of  STIs respectively (Gebremichael H et 
al., 2017) (Gebrelibanos A et al., 2015). 
Study conducted among young women in Northern 
Ethiopia shows that self-reported prevalence of  STIs 
in the last 12 months was 21.3% (Fisseha G AE, 2015). 
Surveillance conducted in Ethiopia in 8 health facilities 
located in Amhara, Oromia and Addis Ababa reported 
that commonest syndrome was vaginal discharge 50%, 
urethral discharge 31%, genital ulcer/sores 9%, lower 
abdominal pain 7.3%, and two syndrome were present in 
few patients 3% (FMOH, 2015).
National survey in New Caledonia among youths 
shows that hometown residence showed significant 
association with the prevalence of  the STIs (Corsenac P 
et al., 2012). Another study at Debre Birhan high school 
students shows that, residence being urban had positive 
association with knowledge of  syndromes of  STIs (Adera 
A, et al., 2015).  Similarly, living with families and relatives 
helps the parent/relatives to monitor their children and 
improve decision-making capacity on RSPs (Bettinger 
J et al., 2004). Another study conducted among young 
people in South Africa shows that, study subjects aged 
20-24 years and women had more than twice the odds of  
having a curable STI compared to study participants aged 
15-19 years and men, respectively (Francis S et al., 2018). 
Also, divorced individuals were about 5 times more likely 
to have had risky sexual activities than married individuals 
(Kassa M et al., 2013). 
One study among seasonal migrant workers in Metema, 
Northwest Ethiopia shows that study subjects who got 
a daily income above USD 5.00 were 2.2 times more 
likely to have RSPs during the prior 6 months than those 
having a daily income lower than USD 5.00 (Tiruneh K et 
al., 2015). Migrants were frequently forced into physically 
demanding works with poor living conditions and little 
benefits, while having to live apart from their partners and 
families, may develop new sexual partners and involve in 
high RSPs that may increase the chance of  STIs (Tiruneh 
K et al., 2015). 
Study among people living in rural area of  Lucknow 
shows that significant association between educational 
status and prevalence of  STIs (Mishra S et al., 2016). 
Respondents whose educational level less than fourth 
grade were 12 times more likely to be engaged in RSPs 
than whose educational level tenth grade or more (Kassa 
M et al., 2013). Similarly occupation and social classes 
were also marked as significant socio-economic factors 

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associated with the prevalence of  the STIs (Mishra S 
et al., 2016). Having good knowledge on modes of  
transmission, prevention methods and complications 
of  STIs helps to protect themselves from STIs and its 
complication (Ayanaw B et al., 2019). Also, many studies 
shows that  those who have poor knowledge of  STI 
were more likely to have STIs than students with good 
knowledge (Yohannes B et al., 2013) (Ayanaw B et al., 
2019) . Adverse impacts associated with substance use 
include, increase the chance of  unprotected sex, decrease 
the selection of  sexual partners, increase the number 
of  sexual partners and careless sexual activity. Such 
combinations significantly increase their vulnerability to 
the STIs (Winters K., 1999). 
Study shows that overall, 53.8% of  them used at least 
one substance in lifetime. Commonly used substances 
are: alcohol 41.7%, khat 30.3%, cigarette 11.3% and 
illicit substances 3.9% (Derese A et al., 2014). Alcohol 
use found significantly associated with RSPs including 
unprotected sex, multiple sexual partners (MSPs), paying 
for sex and selling sex that increases likelihoods of  STIs 
(Weiser S et al., 2006). Those using alcohol having about 
3 times higher chances of  RSPs compared to those not 
using it (Alemu A et al., 2015). khat chewer were 3.4 times 
more likely to have RSPs than those who didn’t chew 
khat. Moreover, those who smoke shisha were 3.44 times 
more likely to have risky sexual behaviour as compared 
to those who didn’t smoke shisha (Gizaw A et al., 2014). 
Different reasons were stated for the substance use such 
as, to get personal pleasure, increase work performance, 
peer pressure, to get relief  from tension, to be sociable 
and for other reasons (Alemu A et al., 2015).  View/read 
pornographic materials could change the normal sexual 
desire and care taking of  exposing to RSPs (Ayanaw B et 
al., 2019). Those who attend sex films, movies frequently 
were about 2 times more likely to be involved in RSPs 
than those who didn’t view/read pornographic materials 
(Henok A et al., 2015).  
Risky sexual practice is any human sexual practices which 
put individual’s physical, social and psychological health 
at the risk (Malhotra S et al., 2008). It also includes early 
sexual practices, unprotected sexual intercourse, and 
MSPs occur in a wider context. although RSPs doesn’t  
always shows a high-risk lifestyle, it often clusters with 
other risky behaviors such as substance use and violence 
participation (Blum R MK, 2005). Earl age sexual 
initiation was significantly associated with increased risk 
of  STIs (Upchurch D et al., 2004). Those who first sexual 
start from 15-19 years were about 3 times more likely to 
have had RSPs than from 20-24 years (Kassa M et al., 
2013). And those who have no sexual partner currently 
was riskier sexually practices than those who had current 
partner currently (Kassa M et al., 2013). 
Studies conducted among Wolaita Sodo and Madawulabu 
University students revealed that those who had MSPs in 
a lifetime were more likely to have STIs than those who 
had one sexual partner in the life time (Yohannes B et al., 
2013) (Setegn T et al., 2013). Similar studies conducted 

among school youth at Bahirdar and young women in 
Northern Ethiopia revealed that those who had MSPs in 
the last 12 months had higher chances of  experiencing 
STIs compared to those with one partner (Gebremichael 
H et al., 2017) (Fisseha G, 2015). One study conducted 
among migrant daily laborers in Metema district show that 
Isolated work sites lead to a lack of  social cohesion and 
social norms governing behavior of  workers, which may 
lead to engagement in RSPs, about 68% of  sexually active 
respondents reported non-marital sexual intercourse in 
the last 6 months (Tiruneh K et al., 2015). 
Studies conducted in Wolaita Sodo university students 
and young women in Northern Ethiopia, those who 
had never used condom during intercourse had higher 
odds of  experiencing STIs than those who had ever 
used condom in their lifetime (Yohannes B et al., 2013) 
(Fisseha G, 2015). The most common reasons stated 
for not using at all or inconsistently using condom are 
partners refusal, condom inaccessibility, trust of  partner, 
forgetfulness after alcohol intake, religious prohibition, 
hurry to have sex and additional reasons for not using 
condoms (Alemu A et al., 2015) (Abeje A AA, 2017). Also, 
those who reported themselves to have had extra-marital 
sexual contacts in the last year had  higher prevalence of  
STI (Rostami F et al., 2017). 
People who experienced a syndrome of  STI may delay to 
seek care timely or do not seek care despite the available 
service. Health-seeking behavior affects people’s actions 
when they suspect an infection (Voeten H et al., 2004). 
Perceived severity of  STI was also one of  the predictor 
factors for early health care-seeking behavior (Tsadik 
M et al., 2019). According to EDHS 2016 report only 
32% of   those  who had syndromes STI sought advice 
or treatment (CSA, 2017). The most important reasons 
for not receiving treatment by study subjects were feeling 
guilty of  telling problem to the health worker,  thinking 
symptom as incurable,  thinking symptom not serious, 
thinking symptom as curable without treatment,  lack of  
money, not knowing where to get treatment,  and others 
including lack of  time (Yohannes B et al., 2013).

METHODS AND MATERIALS
Study design and period
Institution based cross-sectional study was conducted 
among Hawassa industrial park workers from July 26 to 
August 26, 2020. 
Self-reported syndromic approach was used to assess 
magnitude and associated factors for STIs among HIP 
workers.

Source and study Population 
Source population was HIP workers and Workers in 
randomly selected factory sheds during the study period 
were Study population.

Inclusion and Exclusion criteria
All HIP workers were included, and HIP workers who are 
severely ill during study period and Recruitment time less 

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than 30 days were excluded.  

Operational definitions 
Early sexual initiation: Having sexual intercourse before 
the age of  18 years (CSA, 2017).
Risky sexual practices: Workers who have at least one of  
the following: inconsistent condom use with non-regular 
partner, having multiple sexual partners, starting sexual 
intercourse before age of  18 years and sexual intercourse 
with CSWs. 
Knowledge about STI: It was measured using a series of  
36 knowledge questions about STIs. Those who scored 
mean and above were taken as good knowledgeable.
STI cases for Male/Female: They were considered STIs 
cases if  he/she reported at least one of  history of  urethral 
discharge, genital ulcer/sores, scrotal swelling, inguinal 
bubo, abnormal vaginal discharge, or lower abdominal 
pain syndromes in the last 12 months. 
Sexually active: workers who had sexual intercourse at 
least once prior to the study.

Sample size determination
The sample size was determined using single population 
proportion formula by taking the prevalence of  STIs 
(50%) because absence of  similar studies among industry 
workers at national level.

n= Minimum sample size
Z = Standardized normal distribution value for the 

95%Cl, which is (1.96).
p= Prevalence of  STIs (50%).
d= Margin of  error 5% (0.05)
Design effect of  1.5
Non-response rate of  15% 
nf  = Final sample size

Using population proportion formula: n= z2
a/2 p(1-p)/d2

n= (1.96)2 (0.5) (0.5)/(0.05)2

n =3.84×0.25/0.0025 =384
n= 384, Multiplied by design effect of  1.5 and non-

response rate (15%) was added
Final sample size (nf) = [(384×1.5) + 15%] =663

Sampling technique and procedures
There are 52 sheds in HIP and about 30,000 regular 
workers within it. Multistage sampling technique was used 
to select representative study subjects. Simple random 
sampling technique (lottery method) was used to select 
the factory shed from the total of  52 sheds by taking 
29% (15 sheds) of  the total factory sheds. To assure 
the representativeness of  the data, the sample size was 
proportionally allocated to all (15 sheds) proportional to 
their number of  workers. Finally, the study participants 
were selected from factory sheds using a simple random 
sampling technique by using attendance sheet. 

Data Collection Procedures
Data was collected using structured self-administered 
questionnaires. The questionnaire was first prepared in 
English, and translated into Amharic then, translated 

back into English, to check the consistency. Data was 
collected using a structured questionnaire with open and 
closed end questions.

Data Quality Management
One week prior to data collection a pre-test was 
conducted on 5% (Setegn T et al., 2013) of  the sample 
size at MOHA soft drink factory in Hawassa. Depending 
on the result of  pretest, correction and modification 
were done on questionnaire before applying on the study 
population. 

Data Processing and Analysis 
Data was cleaned, coded and entered in SPSS version 
21.0 software for further analysis. Frequencies and 
cross tabulations were used to summarize descriptive 
statistics of  the data. Tables and texts were used for data 
presentation. Bivariable logistic regression analysis was 
used to identify candidate variables for multivariable 
logistic regression at P-value of  ≤0.25. The strength of  
association was determined using multivariable logistic 
regression at p-value <0.05, and 95% CI of  adjusted Odd 
Ratio (AOR). 

RESULTS AND DISCUSSION
Socio-demographic and Economic characteristics 
In this study, 657 study participants were involved in the 
study making a response rate of  (99 %). The mean age of  
study participants was 27 years (SD ± 3.2 years). Among 
study participants 117 (17.8%) were male and 540 (82.2%) 
were females, 530 (80.7%) were single in marital status, 
and 363 (55.3%) were Protestant. About 452 (68.8%) 
respondents stayed for more than one year at HIP. The 
mean income of  the respondents was 2350 ETB (SD 
±1183) and 405 (61.6%) were from rural residential. And 
about 298 (45.4%) of  the respondents have secondary 
educational attainment.

Knowledge of  respondents about STIs 
The overall Knowledge of  study participants shows that, 
about 323(49.2%) of  the study participants had good 
knowledge of  STIs. About 651(99.1%) respondents have 
heard about STIs. About 641 (97.6%) of  the respondents 
know at least one mode of  STI transmission. Among the 
total of  657 study participants 640 (97.4%) were known 
at least one preventive methods of  STI. Regarding the 
syndromes of  STIs, 640 (97.4%) of  the study participants 
know how STIs manifest. About 216 (32.9%) respondents 
know asymptomatic case transmits STIs. Among total 
respondents about 54 (90.4%) study subjects reported 
that early treatment has benefit, and 490 (74.6%) study 
participants know that STI have complication. 

Non sexual behavioral characteristics
Respondents were asked their experience of  non-sexual 
risky practices to assess their exposure to substances and 
pornographic materials; and the findings shows that, 
about 96 (14.6%) drink alcohol, 67 (10.2%) chew khat, 

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Table 1: Socio-Demographic characteristics of  HIP Workers, Southern Ethiopia, 2020.
Variables Frequency Percent
Sex Male 117 17.8

Female 540 82.2
Age 18-22 59 9.0

23-27 306 46.6
28-32 268 40.8
33-37 24 3.6

Length of  Stay at HIP Less than 6 months 37 5.6
6-12 months 168 25.6
Greater than 12 months 452 68.8

Religion Protestant 363 55.3
Orthodox 184 28.0
Muslim 67 10.2
Catholic 43 6.5

Ethnic groups Sidama 350 53.3
Oromo 96 14.6
Amhara 85 12.9
Wolayita 62 9.4
Kambata 35 5.3
Other* 29 4.5

Marital status Single 530 80.7
Married 112 17.0
Divorced 15 2.3

Living arrangement Living alone 234 35.6
Friends 199 30.3
Wife or husband 108 16.4
Family 76 11.6
Relatives 40 6.1

Income of  respondents 450-1000 25 3.8
1001-1500 208 31.7
1501-5000 379 57.7
5001-6500 45 6.8

Hometown residence Urban 252 38.4
Rural 405 61.6

Education status Read and write 20 3.0
Primary 92 14.0
Secondary 298 45.4

247 37.6
*others:  Hadiya, Silte, Gurage, Halaba

Table 2: Knowledge of  STI among HIP Workers, Southern Ethiopia, 2020 (n=657)
Frequency Percent 

Heard about STI Yes 651 99.1
No 6 0.9

Common curable STI Syphilis Yes 620 94.4
No 37 5.6

Gonorrhea Yes 536 81.6
No 121 18.4

Chlamydia Yes 155 23.6
No 502 76.4

Trichomoniasis Yes 105 16.0
No 552 84.0

Transmission routes of  STI Yes 641 97.6
No 16 2.4

Routes of  STI 
transmission

Sexual intercourse Yes 641 97.6
No 16 2.4

Blood/blood product Yes 343 52.2
No 314 47.8

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Sharp materials Yes 284 43.2
No 373 56.8

Mother to child Yes 396 60.3
No 261 39.7

STI prevention methods Yes 640 97.4
No 17 2.6

STI prevention 
methods

Abstinence Yes 631 96.0
No 26 4.0

Condom use Yes 487 74.1
No 170 25.9

Faithful partner Yes 380 57.8
NO 277 42.2

STI syndromes Yes 640 97.4
No 17 2.6

Common syndromes 
of  STI

Genital ulcer or sores Yes 460 70.0
No 197 30.0

Urethral discharge in male Yes 589 89.6
No 68 10.4

Vaginal discharge Yes 608 92.5
No 49 7.5

Lower abdominal pain in women Yes 357 54.3
No 300 45.7

Scrotal swelling Yes 317 48.2
 No 340 51.8

Inguinal bubo Yes 145 22.1
No 512 77.9

Neonatal conjunctivitis Yes 153 23.3
No 504 76.7

Asymptomatic case transmits STI Yes 216 32.9
No 441 67.1

Early treatment has benefit for STI Yes 594 90.4
No 63 9.6

STI has Complications Yes 490 74.6
No 167 25.4

Complications of  STI Still birth Yes 375 57.1
No 282 42.9

Abortion Yes 438 66.7
No 219 33.3

Infertility Yes 281 42.8
No 376 57.2

Ectopic pregnancy Yes 229 34.9
No 428 65.1

Increase HIV transmission Yes 240 36.5
No 417 63.5

Some kind of  cancer Yes 165 25.1
492 74.9

Absolute treatment for STI Yes 619 94.2
No 38 5.8

Place of  absolute 
treatment for STI 
available

Hospital Yes 556 84.6
No 101 15.4

Health center Yes 432 65.8
No 225 34.2

Family guidance association Yes 281 42.8
No 376 57.2

Private health centers Yes 233 35.5
424 64.5

Overall Knowledge of  STI Poor 334 50.8
Good 323 49.2

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Table 3: Non-sexual behavioral characteristics of  HIP Workers, Southern Ethiopia, 2020
Variables Frequency Percent 
Chew khat Yes 67 10.2

No 590 89.8
khat chewing frequency Daily 6 9.0

More than once in a week 23 34.3
Weekly 31 46.3
Monthly and above 7 10.4

Drink alcohol Yes 96 14.6
No 561 85.4

Alcohol drinking frequency Daily 25 26.0
More than once in a week 18 18.8
Weekly 21 21.9
Monthly and above 32 33.3

Shisha smoke Yes 16 2.4
No 641 97.6

Shisha smoking frequency More than once in a week 3 18.8
Weekly 3 18.8
Monthly and above 10 62.5

Over all substance use Yes 126 19.2
No 531 80.8

Reason for substance use (n=126) Satisfaction 76 60.3
Work hard 13 10.3
Peer pressure 20 15.9
Relief  tension 17 13.5

View/read Pornographic materials Yes 185 28.2
No 472 71.8

Pornography types Mobile video 99 53.5
Internet 51 27.6
Movies or television 31 16.8
Reading materials 4 2.2

and 16 (2.4%) smoke shisha in the last 12 months. Overall, 
126 (19.2%) of  them used at least one substance in the 
last 12 months. About 185 (28.2%) of  study participants 
view/read pornographic materials in the last 12 months.

Sexual behavior of  the Respondents
About 647 (98.5%) respondents had a history of  sexual 
intercourse in life time. The mean age reported at first 
sexual intercourse was 18.8 (± 2.7) years. About 577 
(89.2%) of  the study participants has MSPs in lifetime. 
Only 119 (28.4%) sexually active study participants used 
a condom for every sexual intercourse in lifetime. During 
the last 12 months, 453 (73.2%) of  study participants 
reported to have MSPs, and 398 (64.3%) didn’t used a 
condom during sexual intercourse. About 29 (4.7%) 
had sexual intercourse for the benefit/gift in the last 12 
months. 

Self-reported STI syndromes and health-seeking 
behavior 
The number of  respondents who have a syndrome of  
STI in a lifetime was 182 (28.1%) with (95%CI; 28.03-
28.72) and among them 121 (18.7%) with (95%CI; 18.54 
- 18.91) were within the last 12 months among sexually 
active study participants. Out of  these 15 (12.4%) were 
males and 106 (87.6%) were females.  

Factors associated with sexually transmitted infections 
Bivariate and Multivariable analysis were applied to 
identify the factors significantly associated with the 
magnitude of  STIs. The bivariate analysis shows that, 
sex of  respondents, marital status, hometown residence, 
monthly income, education status, drinking alcohol, 
view/read pornographic materials, age at first sex, didn’t 
use condom ever, MSPs in the last 12 months, didn’t 
use condom in the last 12 months, no current sexual 
partner, sex for the benefit/gift and poor knowledge of  
STIs found to have a statistically significant association 
with the magnitude of  STIs. Variables such as; sex 
of  respondents, marital status, hometown residence, 
monthly income, education status, drinking alcohol, 
view/read pornographic materials, current sexual partner 
and knowledge of  STIs were considered in multivariate 
logistic regression analysis.
This study shows that 121 (18.7%) with (95%CI; 18.54-
18.91) of  sexually active HIP workers had self-reported 
STIs syndromes in the last 12 months. The finding of  
this study is comparable with studies conducted among 
Wolaita sodo university and University of  Gondar 
students, 19.5% and  18.2% respectively  (Yohannes B et 
al., 2013) (Ayanaw B et al., 2019). However, it is somewhat 
lower than studies conducted among  young women 
in Northern Ethiopia 21.3% (Fisseha G, 2015). This 
difference could be due to the study subjects of  Northern 

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Table 4: Sexual practices among HIP Workers, Southern Ethiopia, 2020 (n=657)
Variables Frequency Percent
Ever had sexual intercourse(n=657) Yes 647 98.5

No 10 1.5
Extra-marital sex(n=112) Yes 5 4.5

No 107 95.5
Age at first sex(n=647) < 18 324 50.1

≥18 323 49.9
No. of  life time sexual partners(n=647) 1 70 10.8

≥2 577 89.2
Condom ever used(n=647) Yes 419 64.8

No 228 35.2
Condom use frequency(n=419) Always 119 28.4

Mostly 141 33.7
Sometimes 159 37.9

Reason for not use condom always (n=528) Trust partner 222 42.0
Partner refuse 127 24.1
I didn't get it 73 13.8
I dislike it  70 13.3
Ashamed to buy 36 6.8

Sexual intercourse in the last 12 months(n=647) Yes 619 95.7
No 28 4.3

No. of  sexual partners in the last 12months(n=619) 1 166 26.8
≥2 453 73.2

Condom use in the last 12 months(n=619) Yes 221 35.7
No 398 64.3

Having current sexual partners(n=657) Yes 254 38.7
No 403 61.3

Having sex for the benefit/Gift(n=619) Yes 29 4.7
No 590 95.3

Sex after substance use(n=619) Yes 13 2.1
No 606 97.9

Sex with CSWs(n=117) Yes 12 10.3
No 105 89.7

Condom use with CSWs(n=12) Yes 8 66.7
No 4 33.3

Ethiopia were only women and selection was from 
health facilities there is a high chance to find suspected 
cases.  While, the finding from this study is higher when 
compared with the EDHS 2016 national report 4% (CSA, 
2017) people living in rural areas of  Lucknow 11.18% 
(Mishra S et al., 2016), population based survey in the 
city of  São Paulo, Brazil 6.3% (Monteiro V et al., 2016) 
and School youths at Bahir-dar 13.1% (Gebremichael H 
et al., 2017). This could be due to EDHS survey, People 
living in rural areas of  Lucknow and population-based 
survey in brazil was community-based, in which most 
study subjects could be all age groups and also may be 
differences in data collection method. The difference 
from study conducted among school youth in Bahir dar 
may be due to differences in age group, living condition 
and work habit of  the HIP workers. 
This study shows that those workers with poor knowledge 
of  STIs were 2.7 times more likely to develop STIs than 
workers with good knowledge of  STIs. The finding 
consistent with other studies conducted at the Wolaita 
Sodo university  4.8 times and University of  Gondar 
students  3.3 times more risky than good knowledge of  

STI (Yohannes B et al., 2013) (Ayanaw B et al., 2019). 
Overall, 334 (50.8%) of  the study subjects have poor 
knowledge on STI. This finding was consistent with a 
studies conducted among University of  Gondar students 
55.3%, young women in Northern Ethiopia 40.4% 
and Madawalabu University students 57.5% have poor 
knowledge of  STI (Ayanaw B et al., 2019) (Fisseha G AE, 
2015) (Setegn T et al., 2013).
This study indicated that having drunk alcohol statistically 
significant association with risks of  STIs. Those workers 
who had drunk alcohol were about 3.2 times more likely 
to have risky for STIs when compared to those who didn’t 
drink alcohol. The finding of  this studies was consistent 
with study conducted among the female partners of  
inmates in Brazil, alcohol drinkers were 1.7 times more 
likely to have a STI than non-drinkers (Martins C et al., 
2018). 
Exposing to pornographic materials could alter the 
normal sexual desire and care taking of  exposure to STIs. 
This study shows that about 28.2% of  respondents were 
view/read pornography materials in the last 12 months. 
Those who view/read pornographic materials were 4.4 

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Table 5: STI syndromes in the Last 12 months among HIP Workers, Southern Ethiopia, 2020
Variables Frequency Percent
Self-reported STIs(n=121) Male 15 12.4

Female 106 87.6
STI Syndromes among Males(n=15) Genital ulcer or sore 4 26.6

Urethral Discharge 5 33.3
Inguinal bubo 2 13.3
Scrotal swelling 4 26.6

STI Syndromes among Females (n=106) Genital ulcer or sore 23 21.7
Vaginal discharge 63 59.4
Inguinal bubo 4 3.8
Lower abdominal pain 16 15.1

Treatment history(n=121) Yes 92 76.0
No 29 24.0

Place of  treatment(n=92) Hospital 27 29.3
Health center 33 35.9
Pharmacy 6 6.5
Family guidance  4 4.3
Private clinic 22 23.9

Reason for not taking treatment (n=29) Thought syndrome is incurable 4 13.8
Syndromes are not serious 5 17.2
Well without treatment 8 27.6
Don't know where it can be treated 8 27.6
Lack of  money 2 6.9
Ashamed of  health professionals 2 6.9

HIV status of  respondents (n=657) Negative 361 54.9
Unknown 282 42.9
Positive 14 2.1

times more likely to have STI than when compared with 
those who didn’t view/read pornographic materials. The 
finding was comparable with studies conducted among 
University of  Gondar students, 1.5 times more likely to 
have an STI than counterpart  (Ayanaw B et al., 2019).
This study shows that those who comes from rural areas 
where 2.3 times more likely to have the risks for STIs 
when compared to those who are urban areas. This 
finding was consistent with community based survey in 
Adami Tullu, which shows that rural residents where 2.3 
times more likely to have STIs than urban residents [6]. 
This difference may be poor knowledge on transmission 
and prevention methods of  STIs in rural areas.  Most of  
workers came from different rural areas having different 
cultures and values. They are vulnerable to RSPs in new 
environment, living away from the family, may limit 
workers to protect from peer pressure and could also be 
easily deceived with monetary incentives from persons 
who seek out sex because low monthly payment in HIP.

LIMITATIONS
Since sexual behavior and practice is a private, intimate 
and sensitive issue, respondents may feel embarrassed 
to report syndromes (May subject to bias). So, self-
administered questionnaires were used to keep privacy, 
and study participants were informed the purpose and 
confidentiality of  the study before data collection. In this 
study STI was assessed only through the self-report of  
the workers, no physical and laboratory examination was 
done and since we are using a syndromic approach, we 

may miss asymptomatic workers and we may misdiagnose 
signs and symptoms due to other health problems as 
similar manifestations with STI syndromes. So under/
over reporting of  STIs may be possible.

CONCLUSION
The self-reported prevalence of  STIs among Hawassa 
industry park workers was high. Hometown residence, 
drinking alcohol, view/read pornographic materials 
and poor knowledge of  STIs were factors significantly 
associated with the magnitude of  sexually transmitted 
infections. The findings in this study suggest that STI 
magnitude among HIP workers found to be higher than 
the general population, thus advances in STI prevention 
and control hard work targeting among HIP workers were 
required. Large scale studies including all other industry 
institutions and use of  better diagnostic modalities were 
recommended.

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