International Journal of Africa Nursing Sciences 18 (2023) 100545

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International Journal of Africa Nursing Sciences

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

Knowledge, attitude and clinical practice regarding HIV/AIDS among

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

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

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

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

* Corresponding author.
E-mail address: abdulmanafmutaru@gamil.com (A.-M. Mutaru).

https://doi.org/10.1016/j.ijans.2023.100545
Received 4 May 2022; Received in revised form 23 December 2022; Accepted 29 January 2023
Available online 31 January 2023
2214-1391/© 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
A.-M. Mutaru et al.
reported to be 19.6 % (Teclessou et al., 2017). The estimated prevalence
in Ghana is 1.68 % (Ghana Aids Commission, 2020). That notwith­
standing, the burden of HIV/AIDS in Ghana has been reported to be
widespread across the country (Ghana Aids Commission, 2019). The
southern coastal seaports in Ghana, to the hinterland and landlocked
neighbors of northern Ghana, is the eastern corridor stretch, approxi­
mating 695 km. The area shares a close border with Togo eastwards,
with an estimated HIV prevalence of 13.0 % among MSM (Teclessou
et al., 2017). Also, travelers who pass the stretch and people from
neighboring countries patronize the health facilities dotted along the
stretch. This increases the chance of cross-country infections. The main
health training institutions within the northern part of the eastern
corridor stretch have their students constantly being on clinical training
at various hospitals within the corridor. In India, the risk of infection in
clinical practice among health workers has been noted to be high (four
times) compared to the general population (Singhal et al., 2009). Hence,
these inexperienced students, still undergoing training and are recog­
nized to have lesser regard for precautionary measures stand even
higher chances (Aniaku et al., 2019; Rathi et al., 2018). That notwith­
standing, no available empirical literature has been found to have
examined the situation in the setting, amidst the recommendation by
Mutaru et al. (2021) on the need for revitalization of the modes and
dimensions of the teaching of sexual and reproductive health. The study,
therefore, sought to determine the knowledge, attitude, and clinical
practice regarding HIV/AIDS among nursing students along the north-
eastern corridor of Ghana. Specifically, this current study sought to
Fig. 1. Conceptual Framework of the Study (Wan, 2014; Rav-Marathe et al., 2016).
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International Journal of Africa Nursing Sciences 18 (2023) 100545
examine;
1. The knowledge and attitude levels regarding HIV/AIDS among
trainee nurses in north-eastern corridor of Ghana.
2. The clinical practices regarding HIV/AIDS among trainee nurses in
north-eastern corridor of Ghana.
3. The association between sociodemographic characteristics, knowl­
edge, attitude and clinical practices regarding HIV/AIDS among
trainee nurses in north-eastern corridor of Ghana.
2. Materials and methods
2.1. Conceptual framework of the study (KAP-O Model)
The current study’s concept is in line with the Knowledge, Attitude,
and Practice Outcome (KAP-O) model propounded and enhanced by
Wan (2014) and Rav-Marathe et al (2016) respectively, where an as­
sociation has been established among knowledge, attitude, and practice
towards infection prevention. Thus, the model seeks to visualise a linear
relationship among health education, knowledge of and attitude to­
wards disease, where health education is expected to translate into
improved knowledge levels and attitude on the diseases, consequently
leading to improved practices towards the disease.
As presented in Fig. 1, we adapted the KAP-O model. As such,
knowledge level (Awareness, Knowledge of transmission, diagnosis, and
prevention) and attitudes (Perceived self at risk, Occupational attitudes,
A.-M. Mutaru et al.
Perceived severity, Preventive behaviours) towards HIV/AIDS infection,
relate to health education as well as socio-demographic features, which
impacts on their clinical practices (HIV screening, perceived threat,
clinical practices) towards HIV/AIDS infection. These interactions are
expected to ultimately result in satisfactory knowledge, a good attitude,
and good clinical practices. The choice of socio-demographic as well as
other variables in this study was based on an extensive literature review
of related works (Balegha et al., 2021; Qu et al., 2010; Shokoohi et al.,
2016; UNICEF, 2011).
3. Study design and setting
This study employed a cross-sectional analytical design with a
quantitative approach (Barratt et al., 2018).
This study was carried out in the eastern corridor area of Ghana,
specifically the northern territory. The Eastern Corridor is an approxi­
mately 695 km stretch and one of three north-southern corridors
(Eastern, Central, and Western corridors) of Ghana. It links the southern
coastal seaports to the hinterland and landlocked countries in the
northern part of Ghana. The northern territory of the eastern corridor
shares a boundary eastward with Togo. The north-eastern corridor
harbours nine Municipalities/Districts including; Nanumba North and
South, Yendi, Gushegu, Karaga, Saboba, Tatali, Kpandai, and Zabzugu
(GSS, 2021). Almost all these Municipals/Districts have referral hospi­
tals as well as primary health facilities. The area also has three
government-owned nurses’ training institutions; College of Health Sci­
ences – Yendi (CoHSY), Gushegu Nurses’ and Midwifery Training Col­
lege (NMTC), and College of Community Health Nursing, Nkanchina
(CoCHN), located in Yendi Municipality, Gushegu District and Kpandai
District respectively. CoHSY offers three programs; Registered General
Nursing (RGN), Registered Mental Nursing (RMN), and Registered Nurse
Assistant Clinical (RNAC). Gushegu NMTC offers RNAC, Post-basic
Nursing/Midwifery (PNM), and Registered Midwifery (RM) while
CoCHN being less than three years offers only Nurse Assistant Preventive
(NAP). The RGN, RMN, and PNM programmes are offered for three years
leading to the award of a diploma qualification in nursing whereas the
RNAC and NAP are pursued for two years leading to the award of a
certificate qualification in nursing.
4. Study population
This study’s population comprised all nursing students of CoHSY and
Gushegu NMTC in the Yendi and Gushegu Municipalities respectively.
Nursing students in this study included all participants who were
registered students of both institutions and are still undergoing both
theoretical and clinical training at various levels of their programs. The
overall aim was to determine the knowledge, attitude and clinical
practice regarding HIV/AIDS, which can be transmitted in the clinical
practice area. And as part of the training for all programs offered in these
schools, clinical training is mandatory. Hence the need to ascertain the
situation among these various programs. CoHSY and Gushegu NMTC
were purposively sampled based on the programs that are being offered
and the study design/sampling technique. As such, CoCHN being a
newly established school and not having students for various levels at
the time of this current study, could not have been included. CoHSY and
Gushegu NMTC have an estimated student population of 682 and 475
respectively.
5. Sampling and sample size determination
The sample size was estimated using Yamane’s formula (Yamane,
N
1967) of sample size estimation; n =..1+N(e)2
Where N = estimated population size (475 + 682) = 1,157 students.
Using a confidence level of 95 %, level of precision (e) = 5 % = 0.05, the
estimated sample size is 298. Considering the COVID – 19 pandemic,
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International Journal of Africa Nursing Sciences 18 (2023) 100545
hesitance, and the need to increase statistical power of analysis, a non-
response rate of 25 % was considered. The final sample size was,
therefore, determined to be 373.
A multistage stratified random sampling technique was employed in
this survey (Taherdoost, 2016). The study population was stratified
based on the name of the college (CoHSY: 682; Gushegu NMTC: 475),
programme of study (RGN: 317; RMN: 85; RNAC: 513; RM/PNM: 242),
and year of study (First Year: 285; Second Year: 625; Third Year: 247).
Proportionate sample size was then determined for each stratum, and a
sampling frame was designed. Using the manual lottery system and
index number-based class registers as the sampling frame, simple
random sampling was then used to select each participant until the
desired sample size was obtained. The details of the sampling strategy,
including the probability proportional to the strata size approach that
we applied, have been presented in Table 1.
Inclusion and Exclusion criteria: the inclusion criteria for this
study considered all student nurses who were registered members of
either CoHSY or Gushegu NMTC and were pursuing any of the programs
at any level of study. However, students who had completed their pro­
grams of study and are awaiting graduation were exempted from
participating.
6. Data collection
The method of data collection was a self-reporting questionnaire.
After an extensive literature review from already published related
works (Balegha et al., 2021; Mutaru et al., 2021; Qu et al., 2010; Sho­
koohi et al., 2016; UNICEF, 2011), questionnaire was adapted and
revised to suit the objective of the current study. A closed-ended type of
questionnaire was created, for which content validity was assessed and
internal consistency was measured. Data collection was executed from
1st to 30th March 2022 after obtaining written consent. All the paper-
based questionnaires were hand-delivered to each consented partici­
pant in their respective classrooms by all the authors in this study. Re­
spondents were given at least two (2) weeks to respond to and submit
their questionnaire anonymously back to the researchers through their
respective class representatives. As such, they were allowed to retire
back to their hostels with the questionnaire to allow them to adequately
respond. The questionnaire was structured into four main sections; A to
D. Section A was designed to collect the socio-demographic features of
participants. Section B was designed to examine participants’ knowl­
edge regarding HIV/AIDS. This was formulated to encompass aware­
ness, knowledge of transmission, diagnosis, and prevention. Section C;
attitude was constructed to measure perceived self at risk, occupational
attitudes, perceived severity, and preventive behaviour towards HIV/
AIDS. Attitude refers to examining individual behaviour, including
proactive measures toward HIV/AIDS. As such, occupational attitude
sought to measure the student nurses’ predisposition in the clinical
setting to respond favourably or unfavourably to HIV/AIDS, since the
clinical practice area has a risk of exposure to HIV/AIDS infection.
Table 1
Selection based on probability proportional to strata size approach.
Level of study Population per Percentage Proportional sample
level size
First Year (CoHSY) 180 15.6 59
Second Year 341 29.5 112
(CoHSY)
Third Year (CoHSY) 161 13.9 53
First Year (GNMTC) 105 9.1 33
Second Year 284 24.5 89
(GNMTC)
Third Year 86 7.4 27
(GNMTC)
Total 1,157 100 373
GNMTC: Gushegu Nursing and Midwifery Training College; CoHSY: College of
Health Sciences, Yendi.
A.-M. Mutaru et al. International Journal of Africa Nursing Sciences 18 (2023) 100545

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

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

Age ≤ 23 220 59.0

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

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

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

4
A.-M. Mutaru et al. International Journal of Africa Nursing Sciences 18 (2023) 100545

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

Awareness 361 12 (03.2) 00 (00)

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

5
A.-M. Mutaru et al. International Journal of Africa Nursing Sciences 18 (2023) 100545

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

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

Ever screen for HIV Yes 250 67.0

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

9.1. Attitude

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

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

6
A.-M. Mutaru et al. International Journal of Africa Nursing Sciences 18 (2023) 100545

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

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

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

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

7
A.-M. Mutaru et al.
relatively smaller number of participants, which could have limited the
possibility of receiving a larger variety of opinions. Consequently, this
makes the generalization of their findings more representative than the
current study. Nonetheless, this present finding generally supports Rav-
Marathe et al. (2016)’s Knowledge, Attitude, and Practice Outcome
(KAP-O) model.
Inferential analysis from this study established a relationship be­
tween trainee nurses’ level of study and their attitudes toward HIV/
AIDS. As student nurses progress in their level of study, their attitudes
toward HIV/AIDS become improved. The higher, students climb their
academic ladder, much is expected from them hence, it is not surprising
that final-year students demonstrate good attitude than first years, since
they have had several clinical experiences. Therefore, they are very
likely to be more meticulous in terms of their attitudes towards the
disease.
Additionally, this current study established a statistically significant
association between participants’ knowledge level and their attitudes
toward HIV/AIDS. Thus, trainee nurses with sufficient knowledge were
more likely to demonstrate a good attitude toward the infection. In
tandem with our finding is Andrew et al. (2020) among undergraduate
students in the United States, where a cross-sectional survey among
undergraduate students revealed a significant relationship between
their HIV/AIDS knowledge levels and attitudes. It however refutes Pal
Singh et al.’s (2017) finding among dental students in Malaysia. This
variation in finding may be due to the nature of the study design and
sampling. Pal Singh et al.’s (2017) study used a relatively lesser sample
size compared to the current study. Also, as their study was directed to
eliciting information regarding participants’ attitudes to HIV patients,
the present study examined attitudes towards the infection. In any case,
both studies were among health trainees, hence, the current finding was
much anticipated, especially in the global fight against the spread of the
infection. These students who are enlightened through the knowledge
they acquire, are expected to exhibit improved attitudes and further
sensitize people regarding the spread of the infection. Therefore, to
ensure good attitudes toward HIV/AIDS, there is a need for increased
access to knowledge on the infection.
Finally, none of the socio-demographic features in addition to par­
ticipants’ knowledge and attitude were determinants of clinical prac­
tices toward HIV/AIDS in this study. This finding does not support Rav-
Marthe et al. (2016)’s KAP-O model; proposing a linear relationship
between knowledge, attitude, and practice. This could be reasoned from
the perspective of possibly weak clinal supervision and inadequate lo­
gistics, considering the deplorable nature of the available health facil­
ities within the setting. With a well-equipped clinical environment,
trainee nurses are expected to have clinical preceptors who facilitate the
translation of their knowledge into improved practical outcomes. Hence,
in circumstances where there are inadequate logistics, human resources,
and other facilities that are required to enhance practical learning, there
would likely be poor practices, irrespective of the training received.
There is a need for appraisal of their clinical placement programs and
the availability of clinical preceptors required.
11. Strengths and limitations of the study
The design and methods for this study ensure its replicability. The
multistage stratified probability sampling technique improves the
external validity and representativeness of the study. However, this
study was purely quantitative, hence could not triangulate the data
collection process in the form of adopting a qualitative approach in
addition to the quantitative, for more contextual meaning to the find­
ings. Also, since the procedure for data collection was self-reporting by
participants where participants could send questionnaire back to their
hostels, we cannot completely vouch for the accuracy of responses, due
to social desirability bias and lack of control over who completed the
form or whether they sought additional information due to lack of
personal knowledge.
8
International Journal of Africa Nursing Sciences 18 (2023) 100545
12. Conclusion
There is sufficient knowledge, good attitude, and clinical practices
towards HIV/AIDS, with participants’ level of study and knowledge
level being the predictors of attitudes toward the infection. Since
knowledge and attitudes did not translate into actual clinical practices,
emphasis on practical training in nursing education is required. There is
the need therefore for principals of health training institutions to
intensify the clinical monitoring and identify preceptors to ensure
knowledge acquired by students is translated into improved practical
skills. Further research is recommended with varying settings to further
evaluate knowledge, attitude, and clinical practice outcome relationship
among trainee nurses, especially in infection prevention and control
measures.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
Acknowledgements
We are grateful to the principals of College of Health Sciences, Yendi
and Nursing and Midwifery Training College, Gushegu for granting us
permission during the data collection process. We appreciate the time of
all trainee nurses who granted consent and participated in the study.
Ethical Consideration
This study received ethical clearance from the Committee on Human
Research Publications and Ethics of the Kwame Nkrumah University of
Science and Technology (CHRPE/AP/121/22). Permission for use of the
study site was granted by both Principals of CoHSY and Gushegu NMTC.
Oral and written consent was obtained from all participants after
explaining the nature and purpose of the study. Granting consent
including the use of data was a prerequisite to participating in this study.
Confidentiality and privacy were guaranteed and information sheets
were provided to each participant.
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