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\title{The Prevalence of Consistent Condom use among Western Command Force in Bahir Dar City, North West Ethiopia}
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             \author[1]{Zelalem  Alamrew}

             \author[2]{Nega  Adamtie}

             \affil[1]{  Bahir Dar University}

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\date{\small \em Received: 15 December 2013 Accepted: 5 January 2014 Published: 15 January 2014}

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\begin{abstract}
        


Background: Despite recent declines in global HIV/AIDS mortality, HIV/AIDS was still the fifth leading cause of global DALYs in 2010. The distribution of HIV/AIDS burden is not equal across regions and different population segments. Sub Saharan countries are disproportionately affected from the disease despite. In 2012; roughly 25 million people were living with HIV in the region, accounting for nearly 70 percent of the global total. People in the military are part of a social group with particular risk factors of isolation, often being far from home, working in extremely stressful environments, so that are at higher risk of sexual transmitted diseases including the non curable disease, AIDS.Objectives: To assess consistent condom use and associated factors among military personnel in Western Command in Bahir Dar City, in 2013.Methods and Materials: A cross-sectional study was conducted in November 2013 among 898 military personnel in Western command in Bahir Dar City, North west Ethiopia. Self-administered questionnaire was used to collect the data. The data were analyzed using univariate, bivariate, and multivariate analyses with SPSS version 16 software package.

\end{abstract}


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\let\tabcellsep& 	 	 		 
\section[{Introduction}]{Introduction}\par
espite recent declines in global HIV/AIDS mortality, HIV/AIDS was still the fifth leading cause of global DALYs in 2010. The distribution of HIV/AIDS burden is not equal across regions and different population segments. Sub Saharan countries are disproportionately affected from the disease despite accounting for just 13 percent of the world's population; in 2012; roughly 25 million people were living with HIV in the region, accounting for nearly 70 percent of the global total. In the same year, there were an estimated 1.6 million new HIV infections and 1.2 million AIDSrelated deaths as a result; the epidemic has had widespread social and economic consequences, not only in the health sector but also in education, industry and the wider economy \hyperref[b0]{(1,}\hyperref[b1]{2)}.\par
People in the military are part of a social group with particular risk factors-isolation, often being far from home, working in extremely stressful environments, and lacking independent decision making power. So that they are at higher risk of sexual transmitted diseases including the non curable disease, AIDS \hyperref[b2]{(3)}.\par
Even though limitation on information regarding military forces of any country, evidences indicated that military personnel are a population group at special risk of exposure to sexually transmitted diseases including HIV/AIDS. In peacetime, STD infection rates among service members are generally 2 to 5 times higher than among civilian population. In time of conflict, the differences can be 50 or more times greater \hyperref[b3]{(4)}.\par
The armed forces in many high risks for conflict countries are vulnerable to STIs including HIV and factor including age of soldiers, their related high level of sexual activity, a military culture that promotes risk taking behaviors, and the usual availability of commercial sex workers near army camps, and the length periods of soldiers are away from home \hyperref[b4]{(5,}\hyperref[b5]{6)}.\par
Despite armed forces is among high risk group of sexual transmitted disease including HIV, evidences indicated that about 20\% of military personnel use condom sometimes and 8.8\% never used condom in their sexual intercourse. The study further indicated that 8\% of soldiers reported sexual contacts with partners with high risk of sexual behavior, whilst 0.37\% of them reported homosexual and bisexual contacts \hyperref[b6]{(7)}.\par
According to the suggestions of WHO, a combination of approaches are very important to prevent the sexual transmission of HIV, including correct and consistent condom use, reduction in the number of sexual partners, HIV testing and counseling, delaying sexual debut, treatment for STIs and male circumcision \hyperref[b7]{(8)}.\par
Condom is a barrier method put on erect penis and physically blocks ejaculated semen from entering the body of a sexual partner during sexual interaction. Condoms, when used correctly and consistently, are highly effective in preventing HIV and other sexually transmitted infections (STIs). A large body of scientific evidence shows that male latex condoms have an 80\% or greater protective effect against the sexual transmission of HIV and other STIs \hyperref[b8]{(9)}. 
\section[{II.}]{II.} 
\section[{Objectives a) General objective}]{Objectives a) General objective}\par
To assess magnitude consistent condom use and its associated factors among military personnel of Western Command in Ethiopia. b) Specific objectives 1. To determine the prevalence of consistent condom use. 2. To identify factors associated with consistent condom use. 
\section[{III.}]{III.} 
\section[{Methods and materials}]{Methods and materials}\par
The study was conducted in one of the Federal Democratic Republic of Ethiopia (FDRE), Ministry of Defense, Western Command, in Northern Ethiopia, in Amhara National Regional States. Bahir Dar, the capital city of Region, is about 565 kms away from Addis Ababa.\par
The Western Command has one large hospital equipped with different health professionals; the hospital gives both preventive and curative activities for the soldiers. In the western command, there are one primary school and institute in which solders are taking training Cross sectional quantitative study was used among military personnel of Western command or Kifle Tore 43 in November 2013. 
\section[{a) Source population}]{a) Source population}\par
The eligibility criteria for the study were all members of the FDRE Western Command Ethiopian Army and working in the compound as soldiers, officers and non officers b) Sample size determination\par
The sample size was determined using single population proportion formula. The proportion of consistent condom use among study subjects was estimated to be 50\%.\par
The following assumptions were used: level of confidence 95\%, a 5\% marginal error. So based on these assumptions, the sample size was calculated as: n = (Za/2)2p (1-p)/d2. Where; n = the minimum sample size needed, P= proportion of consistent condom use (50\%), d= absolute precision = 0.05 and Za/2 = 1.96 at confidence level 95\%. Then, n = (1.96)2 (0.5 x 0.5)/ (0.05)2 = n = 385. The final sample size with multistage design effect of 2.2 and 10\% allowance for data incompleteness, the number of study subjects included in the study were [385 x 2.2] +10\% [385x2.2] = 932 c) Sampling procedure Multi-stage sampling technique was used, the Western Command contain four Kifle Tore and one the four Kifle Tore was selected randomly. Regiments also selected from the selected Kifle Tore and the respondents were selected using a simple random sampling technique. d) Data collection procedure Data was collected using a self administered structured questionnaire which was adopted and modified from reviewed literatures  {\ref (10 -12)}. Four data collection facilitators and one supervisor, who were working at the Western Command compound, were recruited.\par
Data collector facilitators and the supervisor were trained for one and half days on procedures, techniques and ways of collecting the data. The questionnaires were initially prepared in English and then translated in to Amharic and also back translation to English was done by other translator to check for the accuracy of the questionnaire.\par
The questionnaires were pre-tested prior to the actual data collection in the study area among units not included in the main survey. The result of the pre-test was discussed and some corrections and changes were made on the questionnaires before the actual data collection. During the actual data collection, the data collection facilitators distributed the questionnaires to the respondents, under the supervision the respondents were filled the questionnaires returned to the data collection facilitators. The gathered questionnaires in the same day of completion returned to their supervisor thereby the supervisor and the principal investigator check the numbers and completeness of the questionnaires e) Data processing and Analysis Data were double-entered onto the EPI-data Version 3.1 software by defining legal values for each variable and setting skip patterns. The double-entered data were validated and exported to SPSS version 16 software package. Univarate and bivarate analysis were computed to see the frequency distribution and to test whether there is association/ difference/ between consistent condom use and and selected independent variables. Factors associated with consistent condom use at bivariate were identified and the variables with pvalue of 0.20 and less were taken to multivariable Volume XIV Issue III Version I Year ( ) analysis and the model was built with backward elimination. Finally, the p-values less than 0.05 were considered statistically significant. 
\section[{f) Ethical Consideration}]{f) Ethical Consideration}\par
Ethical clearance was obtained from the Ethical Committee of University of Gondar and Addis Continental Institute of Public Health. Official permission was obtained from Amhara National Regional Health Bureau different experts and Department Head of the Western Command. The respondents were informed about the objective and purpose of the study and oral consent was obtained from each respondent. Confidentiality was assured by not writing the name of the respondents' on the questionnaire and information was recorded anonymously.\par
IV. 
\section[{Results}]{Results}\par
a) Socio-Demographic Characteristics of Western command force Bahir Dar, Ethiopia, November 2013.\par
According to the current study, out of the total 932 respondents filed the questionnaire, 35 responses were excluded because of gross incompleteness and resulted a response rate of 96.2\%. About half of the study subjects 463 (51.6\%) had soldiers rank followed by other non-officer rank and 65 (7.2\%) were officers in rank. Majority of the military personnel 842 (93.9\%) were male, with a mean age of 27 and standard deviation of 6.9 years. Regarding the age of the respondents 41.6\%, 26.6\%, and 31.7\% were in the age group of 18 -24 years, 25-30 years and above 31 years of age respectively.\par
Concerning the educational status of the respondents, 243 (27.1\%) have attained primary \hyperref[b0]{1} The study revealed that all respondents have had alcohol in their life time. Of these respondents 632 (70.8\%) of them took from time to time. Regarding frequency of alcohol intake in the last four weeks, 3.5\%, 32.9\%, 34.7\%, and 28.8\% were taking every day, once a week, less than once a week, and occasionally respectively.\par
Out of respondents, who took alcohol 426 (50.1\%) were never drank until intoxication and 323 (36.0\%) were drinking until being intoxicated.\par
Respondents further reported that 325 (36.2\%) chew Khat, 50 (5.6\%) had taken Shisha/Gaya, 4 (0.4\%) had taken Hashish, 3 (0.3\%) had taken Benzene, 6 (0.7\%) and taken Cocaine for the last 12months (table \hyperref[tab_1]{2}). About 892 (99.4\%) soldiers had ever sexual intercourse in their life time, of these 785 (87.5\%) started their first sex below the age of 20 years, and 112 (12.5\%).\par
The mean and standard deviation of at which respondents sexually debuted was 18.67 ± 2.236. About 67.7\% of the respondents have had more than one sexual partner in their life time. Moreover, this study revealed that 37.7\% of the respondents had more than one sexual partner in the last twelve months (table \hyperref[tab_2]{3}). The prevalence of consistent condom use among the western command force of Ethiopia was found to be 59.4\% in the last twelve month.\par
Consistent condom use was depicted by 495 (55.2\%) of the respondents who had intercourse with prostitutes, by 438 (48.8\%) of these who had intercourse with non-regular partners, by 101 (11.3\%) of these who have intercourse with unmarried regular partners and by 50 (5.6\%) of these having intercourse with their married regular partners.\par
Among the military personnel who had used condom, majority 543 (60.5\%) mentioned that it was by their own suggestion, 169 (18.8\%) reported that their partners suggested, and 321 (35.8\%) said that it was a joint decision of the partners.\par
The reasons for not using condoms were asked and it was due to lack of satisfaction, due to its embracing nature to ask and buy condom, some also mentioned due to their love towards their partner. Some also mentioned their religion restricts them, some do not think about condom, condom is not necessary to use, and condom bursts (table \hyperref[tab_3]{4}). In a multivariate logistic regression analysis, variables which were having significant association in the crude analysis were fitted to the multivariate model to determine independent predictors of consistent condom use. Hence the odds of consistent condom use were about two fold more likely in males than females. (AOR = 2.05, 95\%, CI = (1.16, 3.63) and being secondary school and tertiary school level were less likely use condom consistently than primary school education with (AOR = 0.63, 95\%, CI = (0.45, 0.89)) and (AOR = 0.55, 95\%, CI = (0.34, 0.91) respectively.\par
Marital status was the other significantly associated with consistent condom use among the respondents, accordingly the odds of being unmarried and divorced, separated and widowed were more likely to use condom consistently compared to those who were married.\par
Moreover, individuals who were single in marital status were more likely to use condom consistently compared to those were married (AOR= 1.51, 95\%CI= (1.07, 2.15) (table  {\ref 5})  
\section[{Discussion}]{Discussion}\par
The overall prevalence rate of consistent condom use among soldiers 59.4\% in this study. This magnitude was lower than study conducted in Northern Command front, where it was 71.0\% \hyperref[b12]{(13)}. The major explanation for such discrepancy may be difference in the variation of sampling techniques of the two studies and may be due to time difference of research.\par
The current study was also not in accordance with a finding of BSS 2005 from the Ground Forces, where the prevalence of consistent condom use with non-regular partners was 71.8\% \hyperref[b13]{(14)}. The discrepancy might be due to different reasons including variation in sampling technique. However, the prevalence of consistent condom use in this study was higher than a study done in Lao People´s Democratic Republic military personnel where the prevalence of 51\% reported \hyperref[b15]{(15)}. Besides, the current prevalence is different from a study done among Cameroonian soldiers and consistent condom use was reported by 21.6\% \hyperref[b16]{(16)}.\par
Consistent condom use was uncommon in Nigerian Soldiers and found only 16-20\%, with no difference between genders (17) and it was less than the prevalence of the study area, this might due to the availability of condoms by the government and other stockholders and might be the creation of awareness through IEC with enough and appropriate information on Accordingly the odds of consistent condom use was twofold more likely in males than females (AOR = 2.05, 95\% CI = (1.  {\ref 16, 3.63}). This study was in line with other studies where the prevalence of consistent condom use was higher among males compared to females among Cameroonian armed forces and same for civil population too where women females were less likely to report condoms with their sex partners than men \hyperref[b18]{(18,}\hyperref[b19]{19)}. Besides, our finding was in line with a study done in Nigeria where male gender was significantly associated with consistent condom use among armed force Personnel \hyperref[b20]{(20)}.\par
Moreover, the findings of this study indicated that only 41.8\% of female soldiers were consistently using condom, which was much less than their counter parts in Nigeria \hyperref[b21]{(21)}. Different socio cultural reasons might contributed for the difference in using condom consistently.\par
According this study educational status of the armed forces was also significantly affecting consistent condom use among western command; accordingly the odds of consistent condom use among soldiers with secondary school was 0.63 times less likely and (AOR= 0.63, 95\%, CI = (0.45, 0.89), with tertiary school level was 0.55 times less likely (AOR = 0.55, 95\%, CI = (0.34, 0.91) than soldiers with primary school education. However, a study in Swaziland Defense Force had revealed that, militaries with secondary school education were more likely to use a condom with a regular partner \hyperref[b22]{(22)}. The probable reason that soldiers with secondary and tertiary education were less likely to use condom consistently compared to those with primary education might be due to armed forces with secondary and above were mostly older and may be resistant to change and failed to use condom than individuals with primary education where most of them were younger, who are may be friendly to accept ideas and advices to prevent sexual transmitted diseases and HIV/AIDS. This study further indicated that marital status was significantly associated with consistent condom use among armed forces, the odds of consistent condom use was higher among single, divorced and windowed personnel compared to those married. Accordingly, consistent condom use by unmarried military personnel in this study was found to be 65\%, whereas it was 87.66\% among unmarried military personnel of Cameroon \hyperref[b18]{(18)}.\par
Evidences indicated that most of the time military personnel were not using condoms during sexual interaction with their partners and vulnerable to HIV, because of unfaithfulness, dishonest creating mistrust between the partners \hyperref[b23]{(23)}, however; respondents from this study revealed that reasons for not using condoms were due to decrement in satisfaction while using condom, its embracing nature to ask and buy condom, others also mentioned that their love towards their partners. Besides others mentioned that they failed to use condom in their sexual intercourse because of religious reasons, evidences from other studies also supports that religion is one of factors that affect the sexual behaviors of individuals \hyperref[b24]{(24)}.\par
VI. 
\section[{Conclusions}]{Conclusions}\par
The study demonstrated the presence of considerable gaps in the consistent condom use by respondents. The overall prevalence of consistent condom use by the respondents was 59.4\%. The important factors that were significantly associated with consistent condom use among western command force were sex, educational and marital status the odds of non-regular partners were less likely use consistent condom than married regular one.\par
However; consistent condom use was not associated with age, monthly income, military ranks, military services, and alcohol and drug use. 
\section[{a) Recommendation}]{a) Recommendation}\par
Based on the findings of the study and understanding the nature of the militaries personnel:  \begin{figure}[htbp]
\noindent\textbf{5}\includegraphics[]{image-2.png}
\caption{\label{fig_0}FTable 5 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.85\textwidth}}
-8\end{longtable} \par
  {\small\itshape [Note: © 2014 Global Journals Inc. (US)]} 
\caption{\label{tab_0}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.6739171374764594\textwidth}P{0.07683615819209039\textwidth}P{0.0992467043314501\textwidth}}
Variable\tabcellsep Frequency\tabcellsep Percent (\%)\\
Ever drunk alcoholic beverage (like Tela, Teje, Beer, Arkie?)\tabcellsep \tabcellsep \\
Never drink\tabcellsep \tabcellsep \\
Once or twice\tabcellsep \tabcellsep \\
From time to time\tabcellsep 48\tabcellsep 5.4\\
Drink daily\tabcellsep 178\tabcellsep 19.8\\
Total\tabcellsep 632\tabcellsep 70.8\\
\tabcellsep 39\tabcellsep 4.3\\
\tabcellsep 897\tabcellsep 100\\
Frequency of taking alcohol in the last four weeks\tabcellsep \tabcellsep \\
Every day\tabcellsep \tabcellsep \\
Once a week\tabcellsep 30\tabcellsep 3.5\\
Less than once a week\tabcellsep 280\tabcellsep 32.9\\
Occasionally\tabcellsep 295\tabcellsep 34.7\\
Total\tabcellsep 245\tabcellsep 28.8\\
\tabcellsep 850\tabcellsep 100\\
Ever had drank heavily until intoxication\tabcellsep \tabcellsep \\
Never drank\tabcellsep 426\tabcellsep 50.1\\
Once to twice\tabcellsep 323\tabcellsep 38.0\\
Many times\tabcellsep 101\tabcellsep 11.9\\
Total\tabcellsep 850\tabcellsep 100\\
c) Sexual History and Number of Partners among\tabcellsep \tabcellsep \\
Western command armed force, Bahir Dar Ethiopia,\tabcellsep \tabcellsep \\
November 2013\tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_1}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.6488958990536278\textwidth}P{0.10457413249211356\textwidth}P{0.09652996845425868\textwidth}}
2014\tabcellsep \tabcellsep \\
Year\tabcellsep \tabcellsep \\
Volume XIV Issue III Version I\tabcellsep \tabcellsep \\
( ) F\tabcellsep \tabcellsep \\
November, 2013\tabcellsep \tabcellsep \\
Variables\tabcellsep Frequency\tabcellsep Percent (\%)\\
Age at first sexual intercourse\tabcellsep \tabcellsep \\
Below 20\tabcellsep 785\tabcellsep 87.5\\
20 -29\tabcellsep 11.2\tabcellsep 12.5\\
Mean + SD\tabcellsep 18.67+2.236\tabcellsep \\
Number of sexual partners in your life time\tabcellsep \tabcellsep \\
One\tabcellsep 287\tabcellsep 32.3\\
Two and above\tabcellsep 602\tabcellsep 67.7\\
Number of sexual partners in the last 12 months\tabcellsep \tabcellsep \\
One\tabcellsep 554\tabcellsep 62.3\\
Two and above\tabcellsep 335\tabcellsep 37.7\end{longtable} \par
 
\caption{\label{tab_2}Table 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{4} \par 
\begin{longtable}{P{0.6860236220472441\textwidth}P{0.07362204724409449\textwidth}P{0.09035433070866142\textwidth}}
Ethiopia, November, 2013\tabcellsep \tabcellsep \\
Variables\tabcellsep Frequency\tabcellsep Percent\\
\tabcellsep \tabcellsep (\%)\\
Condom use in the first sex\tabcellsep \tabcellsep \\
Yes\tabcellsep 548\tabcellsep 61.1\\
No\tabcellsep 349\tabcellsep 38.9\\
Ever use condom\tabcellsep \tabcellsep \\
Yes\tabcellsep 874\tabcellsep 97.4\\
No\tabcellsep 23\tabcellsep 2.6\\
Condom use in the last 12 months\tabcellsep \tabcellsep \\
Yes\tabcellsep 758\tabcellsep 84.5\\
No\tabcellsep 139\tabcellsep 15.5\\
Condom in the last month?\tabcellsep \tabcellsep \\
Yes\tabcellsep 622\tabcellsep 69.3\\
No\tabcellsep 275\tabcellsep 30.7\\
Condom use in the last sexual intercourse\tabcellsep \tabcellsep \\
Yes\tabcellsep 565\tabcellsep 63\\
No\tabcellsep 332\tabcellsep 37\\
Frequency of condom use in the last twelve months\tabcellsep \tabcellsep \\
Not consistent\tabcellsep 364\tabcellsep 40.6\\
Consistent condom use\tabcellsep 533\tabcellsep 59.4\\
e) The association between predictor variables and\tabcellsep \tabcellsep \\
consistent condom use among Western Command,\tabcellsep \tabcellsep \\
Bahir Dar, Ethiopia, November 2013\tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_3}Table 4 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.8151282051282052\textwidth}P{0.017435897435897435\textwidth}P{0.013076923076923078\textwidth}P{0.004358974358974359\textwidth}}
\multicolumn{4}{l}{2. Western Command health department should}\\
\multicolumn{4}{l}{introduce condoms in the compound and}\\
Strengthening\tabcellsep information,\tabcellsep education\tabcellsep and\\
\multicolumn{4}{l}{communication activities through Medias, news}\\
\multicolumn{4}{l}{papers and peer group discussions collaborating}\\
\multicolumn{2}{l}{with DKT-Ethiopia.}\tabcellsep \tabcellsep \\
\multicolumn{4}{l}{3. Concerned bodies better focus on interventions that}\\
\multicolumn{4}{l}{deal with sex, educational level, and marital status}\\
\multicolumn{2}{l}{need to be focused}\tabcellsep \tabcellsep \\
\multicolumn{2}{l}{b) Competing interest}\tabcellsep \tabcellsep \\
\multicolumn{2}{l}{We don't have any competing interest.}\tabcellsep \tabcellsep \\
c) Contributors\tabcellsep \tabcellsep \tabcellsep \\
\multicolumn{4}{l}{ZA was revised the research proposal, report,}\\
\multicolumn{4}{l}{and prepared the manuscript and NA was}\\
\multicolumn{4}{l}{conceptualized the research problem, report writing and}\\
\multicolumn{2}{l}{manuscript preparation.}\tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_5}}\end{figure}
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