Awareness of HIV, HPV, and Gonorrhea, and acceptance of vaccines against them, among displaced persons and their host communities in Bangladesh

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Rego, Ashok K. Barman, Abram Wagner, Bradley Carlson, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6051041/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction New vaccines are forthcoming for various diseases, including sexually transmitted infections (STIs). Acceptance by populations is critical for vaccine programs. Considering the ever-increasing number of displaced people globally, given conflict and climate change, displaced populations and their host communities are key but under-studied groups. We examined the acceptance of the current Human Papilloma Virus (HPV) vaccine and hypothetical Human Immunodeficiency Virus (HIV), and Gonorrhea vaccines, as well as awareness of these STIs among displaced populations and their host communities in Bangladesh. Methods The study, conducted between September 2022 and February 2023, examined four groups: forcibly displaced Myanmar nationals in Teknaf; the host community of Bangladeshi citizens living in Teknaf; climate internally displaced people in Dhaka; and the host community of permanent residents in Dhaka. We aimed to randomly recruit 400 households per group. Participants were asked for consent and screened for eligibility. Once consented, a survey was administered, which measured: 1) household composition, 2) demographics, 3) healthcare use, 4) perspectives on government policy and neighborhood dynamics, and 5) STI awareness and vaccine hesitancy. Data were analyzed using bivariate and multivariate analyses. Results Overall 1,617 respondents were included. Disease knowledge was low - 34[95%CI(31.7,36.3)]% had heard of HPV, 50[95%CI(47,53)]% had heard of HIV, and 5[95%CI(4,6)]% had heard of gonorrhea. Awareness varied by group - with the displaced populations generally having less awareness than their host communities; and those in Dhaka having higher awareness than those in Teknaf. Covariates associated with awareness include gender, with women more likely to be aware of STIs than men; education, with those with tertiary education more likely to be aware of HPV than those with below primary education; and watching TV - with watching TV increasing awareness of HIV and HPV. Almost all respondents reported willingness to be vaccinated against each STI. Conclusions Despite the low awareness of STIs, acceptance of STI was high. This presents a promising opportunity for reducing the burden of STIs, however it calls for increasing educational activities to increase deeper knowledge on various STIs. Introduction Infectious disease outbreaks of both endemic and epidemic pathogens are a major concern among displaced populations and their host communities. This is particularly important to consider in countries with high numbers of displaced people, such as Bangladesh, which hosts over 1 million displaced people from Myanmar, and a high number of internally displaced people (IDPs) due to climate change within Bangladesh (UNHCR, n.d.). Most of the displaced people from Myanmar are in Cox’s Bazar, and a large number of IDPs, many of whom were displaced due to climate change, are in Dhaka (IDMC, n.d.). Displaced populations may face a low underlying or impaired immunity for infectious diseases, especially due to low vaccination rates (Deola and Patel 2014; Lam, McCarthy, and Brennan 2015). Displaced populations are also likely to have other comorbidities, which makes them more susceptible to infection and associated morbidities and mortalities. This increased proclivity to disease affects not only the displaced population but also their host communities, calling for disease prevention methods among both the host and displaced populations. IDPs, refugees, and other migrants are at particularly high risk for sexually transmitted infections (STIs). A scoping review of the health needs of IDPs found several studies suggesting that this risk could be explained by low socioeconomic status, psychological stress from displacement, and poor living conditions (Cantor et al. 2021). Moreover, in contrast to other infectious diseases, STIs can be highly stigmatized, which could lead to individuals not seeking treatment (Lee and Cody 2020). Bangladesh also faces significant challenges with STIs, the most common bacterial STIs are non-gonococcal urethritis (31.37%), gonorrhea (27.81%), and syphilis (18.06%) (Mowla, Ara, and Rahman 2017). HPV infection affects 7.7% of women, and while HIV prevalence remains low at 0.1% in the general population, it is increasing among high-risk groups (Nahar et al. 2014; M. M. Islam and Conigrave 2008). Due to a number of social and structural factors, including forced migration, difficult travel conditions, and the aftermath of displacement, refugees are more likely to contract STIs than other populations (Orcutt et al. 2021). Among Rohingya refugee women in Cox's Bazar, approximately two-thirds lacked accurate knowledge about STI/HIV myths and misconceptions (Zakaria 2024). In addition, refugees may resort to risky sexual behaviors, such as transactional sex, in order to survive, and during humanitarian crises, there is an increase in sexual and gender-based violence, which further increases the risk of infection (Orcutt et al. 2021; Haffejee and Maksudi 2020). Vaccines are available for some viral sexually transmitted infections (STIs) like HPV, but not for bacterial STIs like gonorrhea or other viral infections like HIV (Raccagni et al. 2022). However, new STI vaccinations, including those for gonorrhea and HIV, are expected in the future. The only current vaccination against STIs, the HPV vaccination, has emerged as a critical intervention, as it can significantly reduce the incidence of cervical cancer and other HPV-related diseases. A drive to vaccinate girls between the ages of 10 and 14 against HPV has officially begun in Bangladesh's Dhaka division, however those in camps, including Cox’s Bazar, are not expected to be included in this initiative. It is crucial that contextual and behavioral factors in vaccination programs be studied to properly implement STI vaccination programs, both current and future, among displaced populations. Acceptance of STI vaccines could be impacted by stigma associated with STIs, concerns about sexual behaviors, lack of knowledge on vaccines, and other socio political changes, including fallout from the COVID-19 pandemic (Brouwer et al. 2019). However, information on acceptance of STI vaccines – outside of the currently available HPV vaccine – is limited even in high-income countries(Valleroy et al. 2023). For example, a survey in the United States of America in August 2022 found that about 60% of adults would get a gonorrhea vaccine for themselves, higher among those who became more trusting of science since the start of the COVID-19 pandemic (Wagner, Lacombe-Duncan, and Boulton 2023). As an indication of STI vaccination acceptance, childhood vaccine rates are low in Bangladesh - both for the Bangladeshi and displaced populations. A study conducted by Boulton et al. (2014) estimated that 17% of Bangladeshi children have not received basic routine childhood vaccinations, with poor and rural children even less likely to receive these vaccinations. The rate of non-vaccination is similar among the forcibly displaced Myanmar Nationals (FDMNs) in Cox’s Bazar (Khan et al. 2018). These rates are even higher for vaccines that are not on the basic immunization schedule, such as OPV and Rubella. Only 26.5% of Bangladeshi children aged 12–23 months have received these vaccines, with no information available for the FDMNs(“The DHS Program,” n.d.). In addition to the problems surrounding the uptake of these childhood vaccines, hesitancy to the COVID-19 vaccine is emerging as a key issue. Among Bangladeshi nationals, 32.5% are vaccine-hesitant (Ali and Hossain 2021), a number likely to be higher in Teknaf, the area around Cox’s Bazar. The authors are unaware of any studies that have looked at vaccine hesitancy among FDMNs, but 23% of those eligible to be vaccinated (55+) chose not to be. Overall, there is a lack of information on vaccine hesitancy in Bangladesh, even as we come to understand vaccination hesitancy in general can be a significant roadblock to vaccination programs in any country (de Figueiredo et al. 2020). The authors are unaware of any study to date specific to Bangladeshi nationals that has examined vaccine hesitancy or knowledge for STIs; nor studies that have examined vaccine hesitancy at all for any vaccine among FDMNs in Bangladesh. Baseline information about acceptance of these vaccines can help guide equitable implementation of vaccination programs in the future. This paper presents data on Bangladesh’s displaced populations and their host communities’ awareness and acceptance of vaccines for STIs. Methods Study Design The study, conducted between September 2022 and February 2023, utilized a cross-sectional study design in which a total of 1,600 households (400 from each community in each area) were targeted. The communities of interest were: 1) Forcibly Displaced Myanmar Nationals (FDMNs) in Teknaf (Cox’s Bazar); 2) the host community in Teknaf; 3) climate internally displaced people (IDPs) in Mirpur (Dhaka); and 4) the permanent population (host community) in Mirpur (Dhaka). These households were recruited through random household sampling using the Expanded Program for Immunization (EPI) sampling method, in which a series of random angles and distances from a predetermined central point (e.g. , a water tap) were generated, selecting household structure closest to the mapped location (Rego et al. 2021). This paper adheres to the STROBE checklist for cross-sectional studies(von Elm et al. 2007). Study Settings Teknaf We worked in the Leda area of Teknaf, approximately 15 kilometers from Teknaf Upazilla, near Bangladesh's border with Myanmar. The FDMN camp in Leda hosts 35,583 FDMN individuals, of whom 48% are male, 52% are female, and 24% are children under the age of 5 (Intersector Coordination Group, ISCG, 2018). The International Organization for Migration manages this camp. The camp is surrounded by residential villages, home to Bangladeshi citizens who live there permanently. Dhaka Dhaka is Bangladesh’s capital and largest city. We collected data in the Mirpur section, approximately 12 km away from the city center. This community houses 632,664 individuals within 187,626 households (BRAC, n.d.). Participants, Recruitment, and Sample Size Using the EPI sampling method, we randomly selected 400 households in each study area. Details on the sample size calculation are below. Each day, research assistants were provided with a list of households to visit. The research assistant approached the selected households and asked to speak to an adult over the age of 18 who was capable of consenting. Participants were informed that participation was voluntary and participants were free to withdraw at any time during the interview. After written consent was obtained, the research assistant administered the survey. The inclusion and exclusion criteria for each participant group are below (Table 1). Table 1: Inclusion and Exclusion criteria in all areas Mirpur Permanent Resident Inclusion Exclusion There is at least one adult over the age of eighteen capable of consenting Relocated to Mirpur due to climate change-related disaster All permanent household members have lived in Mirpur for at least 1 year (unless below one year of age, in which case since birth) Does not consent Mirpur Internally Displaced Person Inclusion Exclusion There is at least one adult over the age of eighteen capable of consenting Does not consent All permanent household members have lived in Mirpur for at least 1 year (unless below one year of age, in which case since birth) Relocated to Mirpur due to climate change Teknaf Host Community Inclusion Exclusion There is at least one adult over the age of eighteen capable of consenting Is not a Bangladeshi National All permanent household members have lived in Teknaf for at least 1 year (unless below one year of age, in which case since birth) Does not consent Teknaf FDMN Inclusion Exclusion There is at least one adult over the age of eighteen capable of consenting Does not consent All permanent household members have lived in Cox’s Bazar for at least 1 year (unless below one year of age, in which case since birth) Is a FDMN Sample Size The sample size of 1600 was calculated using standard methods. We calculated that a sample size of 300 per group would allow us to estimate a difference in vaccine hesitancy prevalence of 6.8 percentage points between groups, with a power of 80% at the 95% confidence interval. With a 15% attrition rate, 345 households would need to be approached (rounded to 400 per group - 1600). Participant Recruitment In Teknaf, 805 households were approached, all of whom contained an adult over 18; 801 of whom lived in the area for at least a year, and 800 consented to participate in the study. In Dhaka, similar proportions were approached and screened, with 781 consenting to take part. These were broken down into 409 FDMN in Cox’s Bazar, 401 members of the host community in Teknaf; 602 climate IDPs in Mirpur, Dhaka; and 205 permanent residents of Mirpur, Dhaka. The final samples included in the study are presented in Table 1. Variables and Measurement We administered a comprehensive survey to all participants. The survey consisted of five domains: 1) household characteristics, 2) individual demographics, 3) healthcare use, 4) perspectives on government policy and neighborhood dynamics, and 5) STI disease awareness; and STI vaccine acceptance. Household characteristics domain included questions such as household age composition, time in residence, asset ownership, and income. Individual demographics domain contained questions related to participant’s age, gender, religion, education, and marital status. The healthcare use domain consisted of where one would seek healthcare at the first instance, and if the respondent had health insurance. Perspectives on government policy and neighborhood dynamics domain questions assessed participant’s rating of trust on their neighbors, the government, and groups living around them (such as displaced and non-displaced populations). Lastly, vaccine awareness and hesitancy were assessed using a list of questions related to sources of information and media uptake, symptoms, awareness, and vaccination intent for several STIs, and vaccination preferences and responses to the adult Vaccination Hesitancy Scale (Akel et al. 2021). The primary outcomes of interest included awareness (measured by “Have you heard of X STI,” and vaccination intent (measured by “[Description of STI]. No vaccine is currently available, but if a safe, effective vaccine was found would you have the vaccine?” for gonorrhea and HIV and “HPV can cause most cervical cancer in women and some head and neck cancers in both men and women. HPV is spread through sexual activity. The vaccine has been used for several decades in high-income countries. If available at no cost, would you have the vaccine?” for HPV). Questions were drawn from a variety of sources , which can be found in Appendix 2 (Akel et al. 2021; Buckner 1988; “The DHS Program,” n.d.; World Bank Group, n.d.). Statistical Methods All analyses were conducted using Stata (17.0). We first estimated the proportions of all variables through a bivariate analysis, comparing means across the study groups. We then ran an adjusted logistic regression to estimate associations between predictor variables and awareness of the three STIs. The model was constructed using predictors found in past literature on vaccination hesitancy. We explored potential interactions among the predictor variables using a correlation matrix. Results Demographics In total, 1,617 participants were included. Table 2 presents the baseline characteristics of this sample. The entire sample’s average age was 31 years. The majority of the sample were women (79%). Education varied significantly by group, with 92% of FDMNs in Cox’s Bazar having education below the primary level compared to half of the Teknaf host community having primary level or higher education level; Dhaka IDPs also had lower education level compared to Dhaka permanent residents. FDMNs in Cox’s Bazar primarily visited NGO clinics (77%) for healthcare services, but their host community mostly visited pharmacies (47%) and private clinics (27%). Climate IDPs in Dhaka primarily accessed their healthcare from pharmacies, whereas the permanent population primarily visited private clinics (54%). Also of note, many respondents in all groups reported that their spouse was part of the decision-making process when making decisions related to their sexual health (79%). Table 3 reports knowledge of STI disease for the sample. Of the entire sample, only 34[95%CI(32,36)]% had heard of HPV, 50[95%CI(47,53)]% had heard of HIV, and 5[95%CI(4,6]% had heard of gonorrhea. However, knowledge varied substantially between groups - and should be interpreted separately. For FDMNs and the host community in Teknaf, fewer FDMNs knew about HPV than the host community (10% compared to 31%) - with similar trends for HIV and gonorrhea. Similarly, comparing climate IDPs and their host community in Dhaka, 27 percentage points fewer IDPs knew about HPV compared to the host community - with similar trends for HIV and gonorrhea. Further, comparing those in Teknaf and Dhaka, those in Dhaka generally had more awareness of the STIs than those in Teknaf. Table 2: Baseline Characteristics Total Cox's Bazar FDMN Teknaf Host Community Dhaka Climate IDP Dhaka Permanent Residents p-value N=1,617 N=409 N=401 N=602 N=205 Age years(SD) 31 (9) 29 (8) 31 (9) 31 (9) 32 (9) <0.001 Women (%) 79% 89% 82% 72% 78% <0.001 Education <0.001 Below Primary 54% 92% 50% 45% 8% Primary 30% 7% 41% 42% 23% Secondary 9% 0% 7% 9% 30% Tertiary 7% 0% 1% 4% 38% Household Income [1] <0.001 0-3000BDT 15% 56% 4% 0% 0% 3991-7500 15% 32% 23% 4% 0% 7501-14000 27% 10% 27% 45% 6% 14001+ 42% 1% 46% 50% 94% Respondent believes they are in good health 92% 88% 90% 94% 94% 0.004 Marital Status <0.001 1. Married/Co-Habitating 86% 84% 86% 90% 80% 2. Divorder/Separated 2% 4% 2% 1% 1% 3. Widowed 4% 7% 3% 2% 3% 5. Unmarried 8% 5% 9% 7% 17% Where health care is accessed <0.001 1. Traditional Healer 0% 0% 0% 0% 1% 2. Pharmacy 52% 21% 46% 82% 39% 3. Government Clinic 4% 1% 6% 5% 6% 4. Private Clinic 17% 1% 21% 12% 54% 5. NGO Clinic 26% 77% 27% 1% 0% Trust Scale 62 (11) 67 (9) 67 (8) 60 (9) 49 (13) <0.001 Reads the Newspaper at least once a week 4% 0% 4% 4% 11% <0.001 Listens to the radio at least once a week 1% 0% 0% 2% 3% 0.002 Watches TV at least once a week 38% 2% 16% 65% 75% <0.001 Uses Social Media at least once a week 42% 26% 43% 41% 75% <0.001 Uses Whatsapp a tleast once a week 25% 8% 27% 24% 61% <0.001 Reports that they make decisions related to their sexual health 19% 33% 19% 10% 17% <0.001 Reports that their spouse makes decisions related to their sexual health 79% 67% 78% 88% 79% <0.001 [1] During the data collection period, one USD equal ~93BDT3 Table 3: STI disease awareness and willingness to be vaccinated Has heard of HPV 34% 10% 31% 41% 68% <0.001 Has Heard of HIV 50% 12% 52% 63% 86% <0.001 Has Heard of Gonorrhea 5% 1% 5% 4% 13% <0.001 Would receive the HPV Vaccine 99% 98% 99% 99% 99% 0.49 Would receive the HIV Vaccine 99% 99% 99% 99% 99% 0.91 Would receive the Gonorrhea Vaccine 99% 100% 99% 99% 98% 0.4 Estimating Awareness of Common STIs Table 4 presents the adjusted odds ratios (AORs) and confidence intervals (CIs) estimating the relationship between demographics, media consumption, decision-making power, and knowledge of common STIs. The results provide evidence that when compared to the Teknaf FDMNs, the host community in Teknaf and both IDP and host communities in Dhaka had higher awareness of HPV and HIV. Non-significant higher levels of awareness with similar trends were also seen for gonorrhea. Other covariates significantly associated with STI awareness were: gender, with women 1.89 times as likely as men to have knowledge of HIV; education, with those with tertiary education 8.58 times more likely than those with below primary education to have knowledge of HPV; income, with those with higher levels of income more likely to know about HIV; and watching TV, with watching TV at least once a week increasing the chances of knowing about both HIV (AOR: 1.62 95%CI: 1.2-2.2) and HPV (AOR: 1.44 95%CI: 1.06,1.97). Of note, while reporting that their spouses were involved in decisions pertaining to their reproductive health did not significantly reduce awareness of STIs, it did trend in that direction for all STIs. Acceptance of STI Vaccines Almost all respondents reported that they would receive vaccinations against each STI: 99% for HPV, 99% for HIV, and 99% for gonorrhea. Given the very high acceptance rates, multivariate regressions were not performed on this outcome. Table 4: Adjusted Odds Ratios of Knowing about Various STIs Age (Ref: Under 25) HPV HIV Gonorrhea AOR (95%CI) AOR (95%CI) AOR (95%CI) 25-29 1.23(0.86,1.78) 1.25(0.86,1.81) 1.33(0.62,2.81) 30-34 1.17(0.78,1.73) 1.2(0.81,1.77) 1.21(0.51,2.86) 35-39 1.11(0.73,1.69) 1.16(0.77,1.77) 1.45(0.61,3.44) 40+ 1.08(0.71,1.66) 0.87(0.57,1.32) 1.05(0.41,2.66) Woman 1.89(1.33,2.7) 0.96(0.68,1.35) 0.43(0.23,0.78) Education (Ref: Less than Primary) Primary 1.14(0.83,1.56) 1.63(1.21,2.19) 1.58(0.75,3.32) Secondary 1.63(0.95,2.79) 5.85(2.93,11.68) 2.12(0.78,5.76) University or Above 1.4(0.72,2.74) 8.58(3.15,23.32) 2.8(0.94,8.33) Income (Ref: Under 3000) 3991-7500 3(1.5,6) 1.73(0.98,3.06) 0.87(0.19,4.05) 7501-14000 3.39(1.62,7.09) 1.93(1.06,3.52) 0.47(0.1,2.22) 14001+ 3.1(1.46,6.6) 1.53(0.82,2.85) 0.77(0.17,3.54) Believes they are in good health 0.46(0.3,0.71) 1.04(0.67,1.61) 0.67(0.25,1.84) Marital Status (Ref: Married) Divorced/Separated 1.13(0.41,3.12) 2.12(0.83,5.41) 1(0,0) Widower 0.68(0.28,1.67) 1.16(0.53,2.55) 0.74(0.08,6.86) Unmarried 0.92(0.46,1.84) 0.88(0.45,1.73) 0.69(0.22,2.12) Where Health Care is Received (Ref: Pharmacy) 1. Traditional Healer 0.64(0.07,5.61) 1(0,0) 3.99(0.22,73.25) 3. Government Clinic 1.91(1.09,3.33) 1.27(0.71,2.28) 1.11(0.4,3.08) 4. Private Clinic 1.37(0.93,2) 1.07(0.7,1.64) 0.61(0.29,1.28) 5. NGO Clinic 1.04(0.66,1.63) 1.14(0.76,1.73) 0.51(0.17,1.54) Social Cohesion Score Quintile (Ref: First Quintile) 2nd 0.61(0.41,0.92) 0.56(0.36,0.89) 0.8(0.32,2.03) 3rd 0.39(0.25,0.59) 0.51(0.32,0.81) 1.07(0.42,2.69) 4th 0.19(0.12,0.3) 0.28(0.18,0.45) 0.5(0.18,1.39) 5th 0.13(0.08,0.22) 0.31(0.19,0.5) 1.04(0.41,2.65) Reads the Newspaper atleast once a week 0.83(0.45,1.54) 1.91(0.82,4.45) 2.17(1.01,4.69) Listens to the radio atleast once a week 0.95(0.33,2.72) 0.71(0.22,2.35) 2.08(0.55,7.95) Watches TV at least once a week 1.62(1.2,2.2) 1.44(1.06,1.97) 1.38(0.74,2.55) Uses Social Media a tleast once a week 1.36(0.83,2.24) 1.06(0.64,1.77) 2.25(0.71,7.13) Uses Whatsapp at least once a week 1.07(0.72,1.61) 0.98(0.64,1.5) 1.18(0.55,2.53) Uses the internet at least once a week 0.93(0.56,1.57) 2.03(1.19,3.44) 0.88(0.29,2.68) Reports that they make decisions related to their sexual health 0.82(0.44,1.51) 0.85(0.46,1.57) 0.59(0.2,1.67) Reports that their spouse makes decisions related to their sexual health 0.63(0.31,1.29) 0.72(0.36,1.42) 0.43(0.13,1.49) STI Disease awareness (Ref: Cox's Bazar FDMN) Teknaf Host Community 3.28(1.85,5.81) 5.62(3.36,9.4) 2.76(0.6,12.74) Dhaka Climate IDP 2.52(1.32,4.83) 5.69(3.1,10.41) 1.75(0.32,9.66) Dhaka Permanent Population 3.61(1.69,7.73) 5.61(2.59,12.18) 3.01(0.5,18.09) Discussion Among displaced populations in Cox’s Bazar and Dhaka, as well as their host communities, we found that while awareness of HPV, HIV, and gonorrhea was low, acceptance of current vaccinations (for HPV) and potential future vaccinations (for HIV and gonorrhea) were high. These results indicate that vaccination programs should focus on actualizing demand rather than creating it, through methods such as mobile delivery of vaccinations, expanding clinics to more locations, and extending the hours of clinics. Further, these results illustrate that emphasis needs to be placed on improving health literacy, facilitating reduction in the spread of STIs through non-vaccination programs such as condom distribution, testing and treatment, and prophylaxis. There are a variety of methods for doing this, including designing person-centered approaches to reduce stigma and increase targeted knowledge; or using pre-made tools in the humanitarian sector such as the minimum initial service package (Garcia et al. 2021). The exact methods and approaches to use are critical to consider in light of specific contextual factors. Awareness of STIs in Bangladesh was low STIs are significantly determined by a range of socioeconomic and demographic characteristics in low- and middle-income countries, such as Bangladesh (Hossain et al. 2014). This study intended to assess the level of awareness and acceptability of STI vaccinations among vulnerable populations contextualized within the broader global threats, including climate change, juxtaposed against their immediate social milieu. Notably, Hossain et al. (2014) reported that 62% of rural women possessed rudimentary knowledge concerning STIs, with more educated women who watch television exhibiting higher levels of awareness compared to their counterparts (Hossain et al. 2014). Our investigation, which primarily included women with lower levels of education in a rural area, corroborated these findings, revealing a pervasive lack of awareness regarding STIs across diverse demographic groups. Moreover, our analysis identified a consistent trend of STI awareness among various demographic strata, with urban residents of Dhaka and host populations in Teknaf demonstrating higher awareness levels compared to FDMN or IDP within Dhaka. Noteworthy socioeconomic and urban-rural differentials in STI knowledge were corroborated by Gani and colleagues (2014), indicating that urban adolescents and individuals hailing from more affluent backgrounds exhibit heightened awareness levels (Gani, Chowdhury, and Nyström 2014). This discrepancy can be attributed to the enhanced access to diverse informational resources among educated urban dwellers, including printed materials (e.g., books, newspapers, posters, pamphlets) and electronic media (e.g., computers, internet). Consequently, individuals with such heightened exposure are better equipped to adopt healthier lifestyles than those with constrained access to informational avenues. However, these results were not fully reflected in our study. Our results indicated that newspaper readership increased awareness of gonorrhea, TV viewership increased awareness of HPV and HIV, and internet use increased knowledge of HIV – with otherwise insignificant results. A difference between our study and Gani and colleagues’ study may be related to location of the study. The aforementioned studies focused only on Dhaka city, where people have greater access to knowledge and formal education, or the study represents the privileged population of these countries. In these studies, nearly all of the interviewees stated that they were informed about STIs (Hossain et al. 2014; S. S. Islam, Mou, and Bhuiya 2015; Mahboob et al. 2022). However, young female university students in Dhaka had limited understanding of the transmission and prevention of STIs (S. S. Islam, Mou, and Bhuiya 2015). As such, analysis of how location interacts with health information sources is warranted in future investigations. Acceptance of vaccinations against STIs in Bangladesh was high Our research findings indicate that most participants are willing to receive vaccinations against STIs if they become available, particularly if provided free of charge. Vaccine acceptance rates in Bangladesh are increasing, influenced by socio-demographic factors such as age, gender, education level, and income, as well as perceptions of infection risk and severity, belief in vaccine effectiveness, and absence of health risks (Mahmud et al. 2022; Parvej et al. 2021). Chowdhury and colleagues (2022) found a high level of positive attitudes (75.88%) towards HPV vaccination, with females exhibiting more favorable attitudes than males, and a significant portion (96.81%) expressing willingness to recommend the vaccine to others Chowdhury et al. 2022). Ara and colleagues (2013) demonstrated strong support among professionals for female-controlled HIV/STI prevention methods (Ara, Begum, and Nweneka 2013). Bhuiyan and colleagues (2018) reported low levels of knowledge regarding cervical cancer/HPV but moderate intention for vaccination acceptance among women, contrasting with a higher willingness to vaccinate their children (Bhuiyan et al. 2018). Factors influencing complete immunization coverage of children under five years in rural Bangladesh include wealth, education, proximity to health facilities, parity, maternal age, exposure to mass media, and child's sex (Rahman and Obaida-Nasrin 2010). Regarding STIs, partner referral behaviors are influenced by attitudes, perceived social norms, marital status, and income (Alam et al. 2010). Despite progress, challenges remain, underscoring the necessity for a well-researched immunization strategy to address barriers and dispel misinformation and misconceptions (Mahmud et al. 2022). As such, similarly to the context around childhood vaccines in Bangladesh, the challenge lies in actualizing demand through delivery mechanisms rather than creating demand. Limitations Given the cross-sectional design of the study, it is critical to understand the limitations. As participants were recruited randomly, we anticipate minimal sampling bias. However, likely due to data being collected during the day, the sample skewed towards women. While we therefore hazard using these findings for women, women are a key group in STI prevention which this study provides important findings for. Further, social desirability bias may have led to respondents not always responding truthfully to questions despite assurances of confidentiality and privacy, particularly among the FDMN population in Cox’s Bazar who often fear sharing data with unknown or governmental parties. We expect however that trust in the data collectors, many of whom were part of the community (though not people whom the respondents know personally) may help dispel these concerns. Finally, the hypothetical nature of questions on vaccination acceptance may not directly transfer to actual vaccination uptake – however, we do not expect this to impact our other primary outcome of STI awareness. Conclusion The acceptance of STI vaccination among the population of Bangladesh presents a promising opportunity for mitigating the burden of sexually transmitted infections. Our study reveals a high willingness to accept vaccination, contingent upon factors such as awareness and affordability. However, challenges such as gender disparities, misinformation, and socioeconomic barriers persist and require targeted interventions to overcome. By implementing comprehensive education campaigns, accessible vaccination programs, and addressing underlying social determinants, Bangladesh can make significant strides in reducing the prevalence of STIs and improving public health outcomes. Moving forward, sustained efforts and investments in STI vaccination programs are crucial for realizing the full potential of vaccination in combating STIs and promoting overall health and well-being in Bangladesh. Declarations Ethics Ethical approval was granted by the Ethical Review Committee of the International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b) (PR-22042). Funding Research reported in this publication was supported by the University of Michigan Center for Global Health Equity; and the Office Of The Director, National Institutes Of Health (OD), the National Institute Of Biomedical Imaging And Bioengineering (NIBIB), the National Institute Of Mental Health (NIMH), and the Fogarty International Center (FIC) of the National Institutes of Health under award number U54TW012089 (Abubakar A and Waljee AK). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. References Akel, Kaitlyn B., Nina B. Masters, Shu-Fang Shih, Yihan Lu, and Abram L. Wagner. 2021. “Modification of a Vaccine Hesitancy Scale for Use in Adult Vaccinations in the United States and China.” Human Vaccines & Immunotherapeutics 17 (8): 2639–46. Alam, Nazmul, Peter Kim Streatfield, Sharful Islam Khan, Dalia Momtaz, Sibylle Kristensen, and Sten H. 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Lam, Eugene, Amanda McCarthy, and Muireann Brennan. 2015. “Vaccine-Preventable Diseases in Humanitarian Emergencies among Refugee and Internally-Displaced Populations.” Human Vaccines & Immunotherapeutics 11 (11): 2627–36. Lee, Amy S. D., and Shameka L. Cody. 2020. “The Stigma of Sexually Transmitted Infections.” The Nursing Clinics of North America 55 (3): 295–305. Mahboob, Iqbal, Afrin, Abedin F., and Ahmed. 2022. “Assessment of Knowledge and Attitude about Sexually Transmitted Infections among Medical Students of Dhaka City, Bangladesh.” Saudi Journal of Pathology and Microbiology 7 (7): 313–20. Mahmud, Sultan, Md Mohsin, Saddam Hossain Irfan, Abdul Muyeed, and Ariful Islam. 2022. “Knowledge, Attitude, Practices, and Determinants of Them toward Tuberculosis among Social Media Users in Bangladesh: A Cross-Sectional Study.” PloS One 17 (10): e0275344. Mowla, M. R., S. Ara, and Mizanur Rahman. 2017. “Current Trends in Sexually Transmitted Infections — Bangladesh Experience.” Forum Dermatologicum 2 (4): 144–49. Nahar, Quamrun, Farhana Sultana, Anadil Alam, Jessica Yasmine Islam, Mustafizur Rahman, Fatema Khatun, Nazmul Alam, et al. 2014. “Genital Human Papillomavirus Infection among Women in Bangladesh: Findings from a Population-Based Survey.” PloS One 9 (10): e107675. Orcutt, Miriam, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, and Ibrahim Abubakar. 2021. Handbook of Refugee Health: For Healthcare Professionals and Humanitarians Providing Care to Forced Migrants . Edited by Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, and Ibrahim Abubakar. London, England: CRC Press. https://doi.org/10.1201/9780429464874. Parvej, Md Iftakhar, Samina Sultana, Mimma Tabassum, Seefat E. Mannan, and Firoz Ahmed. 2021. “Determinants of COVID-19 Vaccine Acceptance and Encountered Side-Effects among the Vaccinated in Bangladesh.” Asian Pacific Journal of Tropical Medicine 14 (8): 341–49. Raccagni, Angelo Roberto, Francesca Alberton, Antonella Castagna, and Silvia Nozza. 2022. “Vaccines against Emerging Sexually Transmitted Infections: Current Preventive Tools and Future Perspectives.” The New Microbiologica 45 (1): 9–27. Rahman, Mosiur, and Sarker Obaida-Nasrin. 2010. “Factors Affecting Acceptance of Complete Immunization Coverage of Children under Five Years in Rural Bangladesh.” Salud Publica de Mexico 52 (2): 134–40. Rego, Ryan, Samuel Watson, Mohammad Atique Ul Alam, Syed Asif Abdullah, Mohammad Yunus, Imam Taskin Alam, A. S. M. Homuan Kabir Chowdhury, et al. 2021. “A Comparison of Traditional Diarrhoea Measurement Methods with Microbiological and Biochemical Indicators: A Cross-Sectional Observational Study in the Cox’s Bazar Displaced Persons Camp.” EClinicalMedicine 42 (101205): 101205. “The DHS Program.” n.d. Accessed February 17, 2025. https://dhsprogram.com/methodology/survey/survey-display-584.cfm. UNHCR. n.d. “Bangladesh.” UNHCR. Accessed February 17, 2025. https://reporting.unhcr.org/operational/operations/bangladesh. Valleroy, T., Colin Garon, Janamarie Perroud, and Abram L. Wagner. 2023. “Public Willingness to Receive Chlamydia, Gonorrhea, Syphilis, and Trichomoniasis Vaccines: A Scoping Review.” BMC Health Services Research 23 (1): 1290. Wagner, Abram L., Ashley Lacombe-Duncan, and Matthew L. Boulton. 2023. “Acceptance of a Future Gonorrhea Vaccine in a Post-Coronavirus Disease 2019 World: Impact of Type of Recommendation and Changing Levels of Trust in Health Institutions and Authorities.” The Medical Clinics of North America 107 (6S): e19–37. World Bank Group. n.d. “COVID-19 High Frequency Phone Survey Brief - Kenya.” World Bank. Accessed February 17, 2025. https://documents.worldbank.org/pt/publication/documents-reports/documentdetail/438361608031523236/covid-19-high-frequency-phone-survey-brief-kenya. Zakaria, Muhammad. 2024. “Exploring STI/HIV Knowledge and Effect of Communication Activities among Rohingya Refugee Women: A Camp-Based Cross-Sectional Study in Bangladesh.” Journal of Psychosexual Health 6 (1): 55–65. Additional Declarations The authors declare no competing interests. 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Sirajul Islam","email":"","orcid":"","institution":"International Center for Diarrheal Disease Research, Bangladesh","correspondingAuthor":false,"prefix":"","firstName":"Md.","middleName":"Sirajul","lastName":"Islam","suffix":""}],"badges":[],"createdAt":"2025-02-17 22:06:46","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6051041/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6051041/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76810801,"identity":"19eff730-284c-41fa-aa16-cff2b5911b9c","added_by":"auto","created_at":"2025-02-21 04:23:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1271713,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6051041/v1/530d7d5b-245a-4dcd-aa6b-05268ce11098.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eAwareness of HIV, HPV, and Gonorrhea, and acceptance of vaccines against them, among displaced persons and their host communities in Bangladesh\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInfectious disease outbreaks of both endemic and epidemic pathogens are a major concern among displaced populations and their host communities. This is particularly important to consider in countries with high numbers of displaced people, such as Bangladesh, which hosts over 1\u0026nbsp;million displaced people from Myanmar, and a high number of internally displaced people (IDPs) due to climate change within Bangladesh (UNHCR, n.d.). Most of the displaced people from Myanmar are in Cox\u0026rsquo;s Bazar, and a large number of IDPs, many of whom were displaced due to climate change, are in Dhaka (IDMC, n.d.). Displaced populations may face a low underlying or impaired immunity for infectious diseases, especially due to low vaccination rates (Deola and Patel 2014; Lam, McCarthy, and Brennan 2015). Displaced populations are also likely to have other comorbidities, which makes them more susceptible to infection and associated morbidities and mortalities. This increased proclivity to disease affects not only the displaced population but also their host communities, calling for disease prevention methods among both the host and displaced populations.\u003c/p\u003e \u003cp\u003eIDPs, refugees, and other migrants are at particularly high risk for sexually transmitted infections (STIs). A scoping review of the health needs of IDPs found several studies suggesting that this risk could be explained by low socioeconomic status, psychological stress from displacement, and poor living conditions (Cantor et al. 2021). Moreover, in contrast to other infectious diseases, STIs can be highly stigmatized, which could lead to individuals not seeking treatment (Lee and Cody 2020). Bangladesh also faces significant challenges with STIs, the most common bacterial STIs are non-gonococcal urethritis (31.37%), gonorrhea (27.81%), and syphilis (18.06%) (Mowla, Ara, and Rahman 2017). HPV infection affects 7.7% of women, and while HIV prevalence remains low at 0.1% in the general population, it is increasing among high-risk groups (Nahar et al. 2014; M. M. Islam and Conigrave 2008). Due to a number of social and structural factors, including forced migration, difficult travel conditions, and the aftermath of displacement, refugees are more likely to contract STIs than other populations (Orcutt et al. 2021). Among Rohingya refugee women in Cox's Bazar, approximately two-thirds lacked accurate knowledge about STI/HIV myths and misconceptions (Zakaria 2024). In addition, refugees may resort to risky sexual behaviors, such as transactional sex, in order to survive, and during humanitarian crises, there is an increase in sexual and gender-based violence, which further increases the risk of infection (Orcutt et al. 2021; Haffejee and Maksudi 2020). Vaccines are available for some viral sexually transmitted infections (STIs) like HPV, but not for bacterial STIs like gonorrhea or other viral infections like HIV (Raccagni et al. 2022). However, new STI vaccinations, including those for gonorrhea and HIV, are expected in the future. The only current vaccination against STIs, the HPV vaccination, has emerged as a critical intervention, as it can significantly reduce the incidence of cervical cancer and other HPV-related diseases. A drive to vaccinate girls between the ages of 10 and 14 against HPV has officially begun in Bangladesh's Dhaka division, however those in camps, including Cox\u0026rsquo;s Bazar, are not expected to be included in this initiative. It is crucial that contextual and behavioral factors in vaccination programs be studied to properly implement STI vaccination programs, both current and future, among displaced populations.\u003c/p\u003e \u003cp\u003eAcceptance of STI vaccines could be impacted by stigma associated with STIs, concerns about sexual behaviors, lack of knowledge on vaccines, and other socio political changes, including fallout from the COVID-19 pandemic (Brouwer et al. 2019). However, information on acceptance of STI vaccines \u0026ndash; outside of the currently available HPV vaccine \u0026ndash; is limited even in high-income countries(Valleroy et al. 2023). For example, a survey in the United States of America in August 2022 found that about 60% of adults would get a gonorrhea vaccine for themselves, higher among those who became more trusting of science since the start of the COVID-19 pandemic (Wagner, Lacombe-Duncan, and Boulton 2023).\u003c/p\u003e \u003cp\u003eAs an indication of STI vaccination acceptance, childhood vaccine rates are low in Bangladesh - both for the Bangladeshi and displaced populations. A study conducted by Boulton et al. (2014) estimated that 17% of Bangladeshi children have not received basic routine childhood vaccinations, with poor and rural children even less likely to receive these vaccinations. The rate of non-vaccination is similar among the forcibly displaced Myanmar Nationals (FDMNs) in Cox\u0026rsquo;s Bazar (Khan et al. 2018). These rates are even higher for vaccines that are not on the basic immunization schedule, such as OPV and Rubella. Only 26.5% of Bangladeshi children aged 12\u0026ndash;23 months have received these vaccines, with no information available for the FDMNs(\u0026ldquo;The DHS Program,\u0026rdquo; n.d.). In addition to the problems surrounding the uptake of these childhood vaccines, hesitancy to the COVID-19 vaccine is emerging as a key issue. Among Bangladeshi nationals, 32.5% are vaccine-hesitant (Ali and Hossain 2021), a number likely to be higher in Teknaf, the area around Cox\u0026rsquo;s Bazar. The authors are unaware of any studies that have looked at vaccine hesitancy among FDMNs, but 23% of those eligible to be vaccinated (55+) chose not to be.\u003c/p\u003e \u003cp\u003eOverall, there is a lack of information on vaccine hesitancy in Bangladesh, even as we come to understand vaccination hesitancy in general can be a significant roadblock to vaccination programs in any country (de Figueiredo et al. 2020). The authors are unaware of any study to date specific to Bangladeshi nationals that has examined vaccine hesitancy or knowledge for STIs; nor studies that have examined vaccine hesitancy at all for any vaccine among FDMNs in Bangladesh. Baseline information about acceptance of these vaccines can help guide equitable implementation of vaccination programs in the future. This paper presents data on Bangladesh\u0026rsquo;s displaced populations and their host communities\u0026rsquo; awareness and acceptance of vaccines for STIs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cu\u003eStudy Design\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe study, conducted between September 2022 and February 2023, utilized a cross-sectional study design in which a total of 1,600 households (400 from each community in each area) were targeted. The communities of interest were: 1) Forcibly Displaced Myanmar Nationals (FDMNs) in Teknaf (Cox\u0026rsquo;s Bazar); 2) the host community in Teknaf; 3) climate internally displaced people (IDPs) in Mirpur (Dhaka); and 4) the permanent population (host community) in Mirpur (Dhaka). These households were recruited through random household sampling using the Expanded Program for Immunization (EPI) sampling method, in which a series of random angles and distances from a predetermined central point (e.g.\u003cu\u003e,\u003c/u\u003e a water tap) were generated, selecting household structure closest to the mapped location (Rego et al. 2021). This paper adheres to the STROBE checklist for cross-sectional studies(von Elm et al. 2007).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eStudy Settings\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTeknaf\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe worked in the Leda area of Teknaf, approximately 15 kilometers from Teknaf Upazilla, near Bangladesh\u0026apos;s border with Myanmar. The FDMN camp in Leda hosts 35,583 FDMN individuals, of whom 48% are male, 52% are female, and 24% are children under the age of 5 (Intersector Coordination Group, ISCG, 2018). The International Organization for Migration manages this camp. The camp is surrounded by residential villages, home to Bangladeshi citizens who live there permanently.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDhaka\u0026nbsp;\u003c/em\u003e\u003cbr\u003eDhaka is Bangladesh\u0026rsquo;s capital and largest city. We collected data in the Mirpur section, approximately 12 km away from the city center. This community houses 632,664 individuals within 187,626 households (BRAC, n.d.).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eParticipants, Recruitment, and Sample Size\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eUsing the EPI sampling method, we randomly selected 400 households in each study area. Details on the sample size calculation are below. Each day, research assistants were provided with a list of households to visit. The research assistant approached the selected households and asked to speak to an adult over the age of 18 who was capable of consenting. Participants were informed that participation was voluntary and participants were free to withdraw at any time during the interview. After written consent was obtained, the research assistant administered the survey. The inclusion and exclusion criteria for each participant group are below (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 1: Inclusion and Exclusion criteria in all areas\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMirpur Permanent Resident\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInclusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExclusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eThere is at least one adult over the age of \u0026nbsp;eighteen capable of consenting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eRelocated to Mirpur due to climate change-related disaster\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eAll permanent household members have lived in Mirpur for at least 1 year (unless below one year of age, in which case since birth)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eDoes not consent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eMirpur Internally Displaced Person\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInclusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExclusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eThere is at least one adult over the age of \u0026nbsp;eighteen capable of consenting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eDoes not consent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eAll permanent household members have lived in Mirpur for at least 1 year (unless below one year of age, in which case since birth)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eRelocated to Mirpur due to climate change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTeknaf Host Community\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInclusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExclusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eThere is at least one adult over the age of eighteen capable of consenting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eIs not a Bangladeshi National\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eAll permanent household members have lived in Teknaf for at least 1 year (unless below one year of age, in which case since birth)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eDoes not consent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Teknaf FDMN\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInclusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExclusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eThere is at least one adult over the age of \u0026nbsp;eighteen capable of consenting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eDoes not consent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eAll permanent household members have lived in Cox\u0026rsquo;s Bazar for at least 1 year (unless below one year of age, in which case since birth)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003eIs a FDMN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 301px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eSample Size\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size of 1600 was calculated using standard methods. We calculated that a sample size of 300 per group would allow us to estimate a difference in vaccine hesitancy prevalence of 6.8 percentage points between groups, with a power of 80% at the 95% confidence interval.\u0026nbsp;With a 15% attrition rate, 345 households would need to be approached (rounded to 400 per group - 1600).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eParticipant Recruitment\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eIn Teknaf, 805 households were approached, all of whom contained an adult over 18; 801 of whom lived in the area for at least a year, and 800 consented to participate in the study. In Dhaka, similar proportions were approached and screened, with 781 consenting to take part. These were broken down into 409 FDMN in Cox\u0026rsquo;s Bazar, 401 members of the host community in Teknaf; 602 climate IDPs in Mirpur, Dhaka; and 205 permanent residents of Mirpur, Dhaka. The final samples included in the study are presented in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eVariables and Measurement\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eWe administered a comprehensive survey to all participants. The survey consisted of five domains: 1) household characteristics, 2) individual demographics, 3) healthcare use, 4) perspectives on government policy and neighborhood dynamics, and 5) STI disease awareness; and STI vaccine acceptance. Household characteristics domain included questions such as household age composition, time in residence, asset ownership, and income. Individual demographics domain contained questions related to participant\u0026rsquo;s age, gender, religion, education, and marital status. The healthcare use domain consisted of where one would seek healthcare at the first instance, and if the respondent had health insurance. Perspectives on government policy and neighborhood dynamics domain questions assessed participant\u0026rsquo;s rating of trust on their neighbors, the government, and groups living around them (such as displaced and non-displaced populations). Lastly, vaccine awareness and hesitancy were assessed using a list of questions related to sources of information and media uptake, symptoms, awareness, and vaccination intent for several STIs, and vaccination preferences and responses to the adult Vaccination Hesitancy Scale (Akel et al. 2021). The primary outcomes of interest included awareness (measured by \u0026ldquo;Have you heard of X STI,\u0026rdquo; and vaccination intent (measured by \u0026ldquo;[Description of STI]. No vaccine is currently available, but if a safe, effective vaccine was found would you have the vaccine?\u0026rdquo; for gonorrhea and HIV and \u0026ldquo;HPV can cause most cervical cancer in women and some head and neck cancers in both men and women. HPV is spread through sexual activity. The vaccine has been used for several decades in high-income countries. If available at no cost, would you have the vaccine?\u0026rdquo; for HPV). Questions were drawn from a variety of sources , which can be found in Appendix 2 (Akel et al. 2021; Buckner 1988; \u0026ldquo;The DHS Program,\u0026rdquo; n.d.; World Bank Group, n.d.).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eStatistical Methods\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAll analyses were conducted using Stata (17.0). We first estimated the proportions of all variables through a bivariate analysis, comparing means across the study groups. We then ran an adjusted logistic regression to estimate associations between predictor variables and awareness of the three STIs. The model was constructed using predictors found in past literature on vaccination hesitancy. We explored potential interactions among the predictor variables using a correlation matrix.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cu\u003eDemographics\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eIn total, 1,617 participants were included. Table 2 presents the baseline characteristics of this sample. The entire sample\u0026rsquo;s average age was 31 years. The majority of the sample were women (79%). Education varied significantly by group, with 92% of FDMNs in Cox\u0026rsquo;s Bazar having education below the primary level compared to half of the Teknaf host community having primary level or higher education level; Dhaka IDPs also had lower education level compared to Dhaka permanent residents. FDMNs in Cox\u0026rsquo;s Bazar primarily visited NGO clinics (77%) for healthcare services, but their host community mostly visited pharmacies (47%) and private clinics (27%). Climate IDPs in Dhaka primarily accessed their healthcare from pharmacies, whereas the permanent population primarily visited private clinics (54%). Also of note, many respondents in all groups reported that their spouse was part of the decision-making process when making decisions related to their sexual health (79%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3 reports knowledge of STI disease for the sample. Of the entire sample, only 34[95%CI(32,36)]% had heard of HPV, 50[95%CI(47,53)]% had heard of HIV, and 5[95%CI(4,6]% had heard of gonorrhea. However, knowledge varied substantially between groups - and should be interpreted separately. For FDMNs and the host community in Teknaf, fewer FDMNs knew about HPV than the host community (10% compared to 31%) - with similar trends for HIV and gonorrhea. Similarly, comparing climate IDPs and their host community in Dhaka, 27 percentage points fewer IDPs knew about HPV compared to the host community - with similar trends for HIV and gonorrhea. Further, comparing those in Teknaf and Dhaka, those in Dhaka generally had more awareness of the STIs than those in Teknaf.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eTable 2: Baseline Characteristics\u003c/u\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003eCox\u0026apos;s Bazar FDMN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003eTeknaf Host Community\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003eDhaka Climate IDP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003eDhaka Permanent Residents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eN=1,617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003eN=409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003eN=401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003eN=602\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003eN=205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge years(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e31 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e29 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e31 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e31 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e32 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWomen (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp; 79%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e89%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e82%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e72%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e78%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eEducation\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003eBelow Primary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e54%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e45%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e41%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e42%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e23%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e38%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eHousehold Income\u003cstrong\u003e\u003cu\u003e\u003csup\u003e[1]\u003c/sup\u003e\u003c/u\u003e\u003c/strong\u003e\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e0-3000BDT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e56%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e3991-7500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e32%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e23%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e7501-14000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e27%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e27%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e45%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e14001+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e42%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e46%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e94%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRespondent believes they are in good health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e88%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e94%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e94%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eMarital Status\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1. Married/Co-Habitating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e86%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e84%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e86%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2. Divorder/Separated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e3. Widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e5. Unmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e17%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eWhere health care is accessed\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1. Traditional Healer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2. Pharmacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e52%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e21%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e46%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e82%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e39%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e3. Government Clinic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e4. Private Clinic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e17%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e21%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e54%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e5. NGO Clinic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e26%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e77%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e27%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eTrust Scale\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e62 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e67 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e67 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e60 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e49 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReads the Newspaper at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eListens to the radio at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWatches TV at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e38%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e16%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e65%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUses Social Media at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e42%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e26%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e43%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e41%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUses Whatsapp a tleast once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e27%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e24%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e61%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReports that they make decisions related to their sexual health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e19%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e19%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e17%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReports that their spouse makes decisions related to their sexual health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e79%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e67%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e78%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e88%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e79%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e\u003csup\u003e[1]\u003c/sup\u003e\u003c/sup\u003e During the data collection period, one USD equal ~93BDT3\u003c/p\u003e\n\u003cp\u003eTable 3: STI disease awareness and willingness to be vaccinated\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHas heard of HPV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e34%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e31%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e41%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e68%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHas Heard of HIV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e52%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e63%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e86%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHas Heard of Gonorrhea\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWould receive the HPV Vaccine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e98%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWould receive the HIV Vaccine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWould receive the Gonorrhea Vaccine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 111px;\"\u003e\n \u003cp\u003e98%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cu\u003eEstimating Awareness of Common STIs\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eTable 4 presents the adjusted odds ratios (AORs) and confidence intervals (CIs) estimating the relationship between demographics, media consumption, decision-making power, and knowledge of common STIs. The results provide evidence that when compared to the Teknaf FDMNs, the host community in Teknaf and both IDP and host communities in Dhaka had higher awareness of HPV and HIV. Non-significant higher levels of awareness with similar trends were also seen for gonorrhea. Other covariates significantly associated with STI awareness were: gender, with women 1.89 times as likely as men to have knowledge of HIV; education, with those with tertiary education 8.58 times more likely than those with below primary education to have knowledge of HPV; income, with those with higher levels of income more likely to know about HIV; and watching TV, with watching TV at least once a week increasing the chances of knowing about both HIV (AOR: 1.62 95%CI: 1.2-2.2) and HPV (AOR: 1.44 95%CI: 1.06,1.97). Of note, while reporting that their spouses were involved in decisions pertaining to their reproductive health did not significantly reduce awareness of STIs, it did trend in that direction for all STIs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAcceptance of STI Vaccines\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAlmost all respondents reported that they would receive vaccinations against each STI: 99% for HPV, 99% for HIV, and 99% for gonorrhea. Given the very high acceptance rates, multivariate regressions were not performed on this outcome.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 624px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 4: Adjusted Odds Ratios of Knowing about Various STIs\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (Ref: Under 25)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eHPV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eGonorrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eAOR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eAOR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eAOR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e25-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.23(0.86,1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.25(0.86,1.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.33(0.62,2.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.17(0.78,1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.2(0.81,1.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.21(0.51,2.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e35-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.11(0.73,1.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.16(0.77,1.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.45(0.61,3.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e40+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.08(0.71,1.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.87(0.57,1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.05(0.41,2.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWoman\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.89(1.33,2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.96(0.68,1.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.43(0.23,0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation (Ref: Less than Primary)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.14(0.83,1.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.63(1.21,2.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.58(0.75,3.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.63(0.95,2.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e5.85(2.93,11.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2.12(0.78,5.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003eUniversity or Above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.4(0.72,2.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e8.58(3.15,23.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2.8(0.94,8.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome (Ref: Under 3000)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e3991-7500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3(1.5,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.73(0.98,3.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.87(0.19,4.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e7501-14000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.39(1.62,7.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.93(1.06,3.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.47(0.1,2.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e14001+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.1(1.46,6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.53(0.82,2.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.77(0.17,3.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBelieves they are in good health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.46(0.3,0.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.04(0.67,1.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.67(0.25,1.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status (Ref: Married)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003eDivorced/Separated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.13(0.41,3.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2.12(0.83,5.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1(0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003eWidower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.68(0.28,1.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.16(0.53,2.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.74(0.08,6.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.92(0.46,1.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.88(0.45,1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.69(0.22,2.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhere Health Care is Received (Ref: Pharmacy)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e1. Traditional Healer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.64(0.07,5.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1(0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.99(0.22,73.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e3. Government Clinic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.91(1.09,3.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.27(0.71,2.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.11(0.4,3.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e4. Private Clinic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.37(0.93,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.07(0.7,1.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.61(0.29,1.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e5. NGO Clinic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.04(0.66,1.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.14(0.76,1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.51(0.17,1.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial Cohesion Score Quintile (Ref: First Quintile)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e2nd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.61(0.41,0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.56(0.36,0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.8(0.32,2.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e3rd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.39(0.25,0.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.51(0.32,0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.07(0.42,2.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e4th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.19(0.12,0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.28(0.18,0.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.5(0.18,1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e5th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.13(0.08,0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.31(0.19,0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.04(0.41,2.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReads the Newspaper atleast once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.83(0.45,1.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.91(0.82,4.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2.17(1.01,4.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eListens to the radio atleast once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.95(0.33,2.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.71(0.22,2.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2.08(0.55,7.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWatches TV at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.62(1.2,2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.44(1.06,1.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.38(0.74,2.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUses Social Media a tleast once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.36(0.83,2.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.06(0.64,1.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2.25(0.71,7.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUses Whatsapp at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.07(0.72,1.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.98(0.64,1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.18(0.55,2.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUses the internet at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.93(0.56,1.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2.03(1.19,3.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.88(0.29,2.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReports that they make decisions related to their sexual health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.82(0.44,1.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.85(0.46,1.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.59(0.2,1.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReports that their spouse makes decisions related to their sexual health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.63(0.31,1.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.72(0.36,1.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e0.43(0.13,1.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSTI Disease awareness \u0026nbsp;(Ref: Cox\u0026apos;s Bazar FDMN)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003eTeknaf Host Community\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.28(1.85,5.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e5.62(3.36,9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2.76(0.6,12.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003eDhaka Climate IDP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e2.52(1.32,4.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e5.69(3.1,10.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1.75(0.32,9.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 326px;\"\u003e\n \u003cp\u003eDhaka Permanent Population\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.61(1.69,7.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e5.61(2.59,12.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e3.01(0.5,18.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eAmong displaced populations in Cox\u0026rsquo;s Bazar and Dhaka, as well as their host communities, we found that while awareness of HPV, HIV, and gonorrhea was low, acceptance of current vaccinations (for HPV) and potential future vaccinations (for HIV and gonorrhea) were high. These results indicate that vaccination programs should focus on actualizing demand rather than creating it, through methods such as mobile delivery of vaccinations, expanding clinics to more locations, and extending the hours of clinics. Further, these results illustrate that emphasis needs to be placed on improving health literacy, facilitating reduction in the spread of STIs through non-vaccination programs such as condom distribution, testing and treatment, and prophylaxis. There are a variety of methods for doing this, including designing person-centered approaches to reduce stigma and increase targeted knowledge; or using pre-made tools in the humanitarian sector such as the minimum initial service package (Garcia et al. 2021). The exact methods and approaches to use are critical to consider in light of specific contextual factors. \u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAwareness of STIs in Bangladesh was low\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eSTIs are significantly determined by a range of socioeconomic and demographic characteristics in low- and middle-income countries, such as Bangladesh (Hossain et al. 2014). This study intended to assess the level of awareness and acceptability of STI vaccinations among vulnerable populations contextualized within the broader global threats, including climate change, juxtaposed against their immediate social milieu. Notably, Hossain et al. (2014) reported that 62% of rural women possessed rudimentary knowledge concerning STIs, with more educated women who watch television exhibiting higher levels of awareness compared to their counterparts (Hossain et al. 2014). Our investigation, which primarily included women with lower levels of education in a rural area, corroborated these findings, revealing a pervasive lack of awareness regarding STIs across diverse demographic groups. Moreover, our analysis identified a consistent trend of STI awareness among various demographic strata, with urban residents of Dhaka and host populations in Teknaf demonstrating higher awareness levels compared to FDMN or IDP within Dhaka. Noteworthy socioeconomic and urban-rural differentials in STI knowledge were corroborated by Gani and colleagues (2014), indicating that urban adolescents and individuals hailing from more affluent backgrounds exhibit heightened awareness levels (Gani, Chowdhury, and Nystr\u0026ouml;m 2014). This discrepancy can be attributed to the enhanced access to diverse informational resources among educated urban dwellers, including printed materials (e.g., books, newspapers, posters, pamphlets) and electronic media (e.g., computers, internet). Consequently, individuals with such heightened exposure are better equipped to adopt healthier lifestyles than those with constrained access to informational avenues. However, these results were not fully reflected in our study. Our results indicated that newspaper readership increased awareness of gonorrhea, TV viewership increased awareness of HPV and HIV, and internet use increased knowledge of HIV \u0026ndash; with otherwise insignificant results. A difference between our study and Gani and colleagues\u0026rsquo; study may be related to location of the study. The aforementioned studies focused only on Dhaka city, where people have greater access to knowledge and formal education, or the study represents the privileged population of these countries. In these studies, nearly all of the interviewees stated that they were informed about STIs (Hossain et al. 2014; S. S. Islam, Mou, and Bhuiya 2015; Mahboob et al. 2022). However, young female university students in Dhaka had limited understanding of the transmission and prevention of STIs (S. S. Islam, Mou, and Bhuiya 2015). As such, analysis of how location interacts with health information sources is warranted in future investigations. \u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAcceptance of vaccinations against STIs in Bangladesh was high\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eOur research findings indicate that most participants are willing to receive vaccinations against STIs if they become available, particularly if provided free of charge. Vaccine acceptance rates in Bangladesh are increasing, influenced by socio-demographic factors such as age, gender, education level, and income, as well as perceptions of infection risk and severity, belief in vaccine effectiveness, and absence of health risks (Mahmud et al. 2022; Parvej et al. 2021). Chowdhury and colleagues (2022) found a high level of positive attitudes (75.88%) towards HPV vaccination, with females exhibiting more favorable attitudes than males, and a significant portion (96.81%) expressing willingness to recommend the vaccine to others Chowdhury et al. 2022). Ara and colleagues (2013) demonstrated strong support among professionals for female-controlled HIV/STI prevention methods (Ara, Begum, and Nweneka 2013). Bhuiyan and colleagues (2018) reported low levels of knowledge regarding cervical cancer/HPV but moderate intention for vaccination acceptance among women, contrasting with a higher willingness to vaccinate their children (Bhuiyan et al. 2018). Factors influencing complete immunization coverage of children under five years in rural Bangladesh include wealth, education, proximity to health facilities, parity, maternal age, exposure to mass media, and child\u0026apos;s sex (Rahman and Obaida-Nasrin 2010). Regarding STIs, partner referral behaviors are influenced by attitudes, perceived social norms, marital status, and income (Alam et al. 2010). Despite progress, challenges remain, underscoring the necessity for a well-researched immunization strategy to address barriers and dispel misinformation and misconceptions (Mahmud et al. 2022). As such, similarly to the context around childhood vaccines in Bangladesh, the challenge lies in actualizing demand through delivery mechanisms rather than creating demand.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eLimitations \u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eGiven the cross-sectional design of the study, it is critical to understand the limitations. As participants were recruited randomly, we anticipate minimal sampling bias. However, likely due to data being collected during the day, the sample skewed towards women. While we therefore hazard using these findings for women, women are a key group in STI prevention which this study provides important findings for. Further, social desirability bias may have led to respondents not always responding truthfully to questions despite assurances of confidentiality and privacy, particularly among the FDMN population in Cox\u0026rsquo;s Bazar who often fear sharing data with unknown or governmental parties. We expect however that trust in the data collectors, many of whom were part of the community (though not people whom the respondents know personally) may help dispel these concerns. Finally, the hypothetical nature of questions on vaccination acceptance may not directly transfer to actual vaccination uptake \u0026ndash; however, we do not expect this to impact our other primary outcome of STI awareness. \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe acceptance of STI vaccination among the population of Bangladesh presents a promising opportunity for mitigating the burden of sexually transmitted infections. Our study reveals a high willingness to accept vaccination, contingent upon factors such as awareness and affordability. However, challenges such as gender disparities, misinformation, and socioeconomic barriers persist and require targeted interventions to overcome. By implementing comprehensive education campaigns, accessible vaccination programs, and addressing underlying social determinants, Bangladesh can make significant strides in reducing the prevalence of STIs and improving public health outcomes. Moving forward, sustained efforts and investments in STI vaccination programs are crucial for realizing the full potential of vaccination in combating STIs and promoting overall health and well-being in Bangladesh.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eEthics\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was granted by the Ethical Review Committee of the International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b) (PR-22042).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eResearch reported in this publication was supported by the University of Michigan Center for Global Health Equity; and the Office Of The Director, National Institutes Of Health (OD), the National Institute Of Biomedical Imaging And Bioengineering (NIBIB), the National Institute Of Mental Health (NIMH), and the Fogarty International Center (FIC) of the National Institutes of Health under award number U54TW012089 (Abubakar A and Waljee AK). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.\u003c/p\u003e"},{"header":" References","content":"\u003col\u003e\n \u003cli\u003eAkel, Kaitlyn B., Nina B. Masters, Shu-Fang Shih, Yihan Lu, and Abram L. Wagner. 2021. \u0026ldquo;Modification of a Vaccine Hesitancy Scale for Use in Adult Vaccinations in the United States and China.\u0026rdquo; \u003cem\u003eHuman Vaccines \u0026amp; Immunotherapeutics\u003c/em\u003e 17 (8): 2639\u0026ndash;46.\u003c/li\u003e\n \u003cli\u003eAlam, Nazmul, Peter Kim Streatfield, Sharful Islam Khan, Dalia Momtaz, Sibylle Kristensen, and Sten H. Vermund. 2010. \u0026ldquo;Factors Associated with Partner Referral among Patients with Sexually Transmitted Infections in Bangladesh.\u0026rdquo; \u003cem\u003eSocial Science \u0026amp; Medicine (1982)\u003c/em\u003e 71 (11): 1921\u0026ndash;26.\u003c/li\u003e\n \u003cli\u003eAra, Zaman, Nilufar Begum, and Chidi V. 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S. M. Homuan Kabir Chowdhury, et al. 2021. \u0026ldquo;A Comparison of Traditional Diarrhoea Measurement Methods with Microbiological and Biochemical Indicators: A Cross-Sectional Observational Study in the Cox\u0026rsquo;s Bazar Displaced Persons Camp.\u0026rdquo; \u003cem\u003eEClinicalMedicine\u003c/em\u003e 42 (101205): 101205.\u003c/li\u003e\n \u003cli\u003e\u0026ldquo;The DHS Program.\u0026rdquo; n.d. Accessed February 17, 2025. https://dhsprogram.com/methodology/survey/survey-display-584.cfm.\u003c/li\u003e\n \u003cli\u003eUNHCR. n.d. \u0026ldquo;Bangladesh.\u0026rdquo; UNHCR. Accessed February 17, 2025. https://reporting.unhcr.org/operational/operations/bangladesh.\u003c/li\u003e\n \u003cli\u003eValleroy, T., Colin Garon, Janamarie Perroud, and Abram L. Wagner. 2023. \u0026ldquo;Public Willingness to Receive Chlamydia, Gonorrhea, Syphilis, and Trichomoniasis Vaccines: A Scoping Review.\u0026rdquo; \u003cem\u003eBMC Health Services Research\u003c/em\u003e 23 (1): 1290.\u003c/li\u003e\n \u003cli\u003eWagner, Abram L., Ashley Lacombe-Duncan, and Matthew L. Boulton. 2023. \u0026ldquo;Acceptance of a Future Gonorrhea Vaccine in a Post-Coronavirus Disease 2019 World: Impact of Type of Recommendation and Changing Levels of Trust in Health Institutions and Authorities.\u0026rdquo; \u003cem\u003eThe Medical Clinics of North America\u003c/em\u003e 107 (6S): e19\u0026ndash;37.\u003c/li\u003e\n \u003cli\u003eWorld Bank Group. n.d. \u0026ldquo;COVID-19 High Frequency Phone Survey Brief - Kenya.\u0026rdquo; World Bank. Accessed February 17, 2025. https://documents.worldbank.org/pt/publication/documents-reports/documentdetail/438361608031523236/covid-19-high-frequency-phone-survey-brief-kenya.\u003c/li\u003e\n \u003cli\u003eZakaria, Muhammad. 2024. \u0026ldquo;Exploring STI/HIV Knowledge and Effect of Communication Activities among Rohingya Refugee Women: A Camp-Based Cross-Sectional Study in Bangladesh.\u0026rdquo; \u003cem\u003eJournal of Psychosexual Health\u003c/em\u003e 6 (1): 55\u0026ndash;65.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"a1261728-b494-4f11-b3ef-195cfc8cad7a","identifier":"10.13039/100000002","name":"National Institutes of Health","awardNumber":"U54TW012089 ","order_by":0},{"identity":"eadbc66c-ddab-4b3e-82cd-f4891d283987","identifier":"10.13039/100007270","name":"University of Michigan","awardNumber":"NA","order_by":1}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Michigan–Ann Arbor","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6051041/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6051041/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cu\u003eIntroduction\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNew vaccines are forthcoming for various diseases, including sexually transmitted infections (STIs). Acceptance by populations is critical for vaccine programs. Considering the ever-increasing number of displaced people globally, given conflict and climate change, displaced populations and their host communities are key but under-studied groups. We examined the acceptance of the current Human Papilloma Virus (HPV) vaccine and hypothetical Human Immunodeficiency Virus (HIV), and Gonorrhea vaccines, as well as awareness of these STIs among displaced populations and their host communities in Bangladesh.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eMethods\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe study, conducted between September 2022 and February 2023, examined four groups: forcibly displaced Myanmar nationals in Teknaf; the host community of Bangladeshi citizens living in Teknaf; climate internally displaced people in Dhaka; and the host community of permanent residents in Dhaka. We aimed to randomly recruit 400 households per group. Participants were asked for consent and screened for eligibility. Once consented, a survey was administered, which measured: 1) household composition, 2) demographics, 3) healthcare use, 4) perspectives on government policy and neighborhood dynamics, and 5) STI awareness and vaccine hesitancy. Data were analyzed using bivariate and multivariate analyses.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eResults\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eOverall 1,617 respondents were included. Disease knowledge was low - 34[95%CI(31.7,36.3)]% had heard of HPV, 50[95%CI(47,53)]% had heard of HIV, and 5[95%CI(4,6)]% had heard of gonorrhea. Awareness varied by group - with the displaced populations generally having less awareness than their host communities; and those in Dhaka having higher awareness than those in Teknaf. Covariates associated with awareness include gender, with women more likely to be aware of STIs than men; education, with those with tertiary education more likely to be aware of HPV than those with below primary education; and watching TV - with watching TV increasing awareness of HIV and HPV. Almost all respondents reported willingness to be vaccinated against each STI.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConclusions\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eDespite the low awareness of STIs, acceptance of STI was high. This presents a promising opportunity for reducing the burden of STIs, however it calls for increasing educational activities to increase deeper knowledge on various STIs.\u003c/p\u003e","manuscriptTitle":"Awareness of HIV, HPV, and Gonorrhea, and acceptance of vaccines against them, among displaced persons and their host communities in Bangladesh","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-21 04:07:43","doi":"10.21203/rs.3.rs-6051041/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d07e0ed6-043d-4ce3-ae5a-fd91bad1d22b","owner":[],"postedDate":"February 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-21T04:07:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-21 04:07:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6051041","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6051041","identity":"rs-6051041","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}