Predictors of early sexual initiation among a nationally representative sample of Nigerian adolescents

Factors associated with attrition in a longitudinal study of health risk behaviours and conditions among adolescents in Ibadan, Nigeria

BACKGROUND

Use of longitudinal design in research improves understanding of adolescent health. In this paper, we present factors associated with attrition in a pilot longitudinal study among adolescents in Ibadan, Nigeria.

METHODS

Adolescents were recruited from private and government-owned junior secondary schools using multi-stage sampling and interviewed over three data collection waves (2017, 2018 and 2019).

RESULTS

A total of 1067 (99.4%) of the 1073 adolescents recruited were willing to participate and were interviewed in wave one. Mean age at baseline was 11.9 ± 1.2 years and 34.9% owned a personal mobile phone. Of the 1067 adolescents, 192 (18.0%) were not willing to be followed up while 875 (82.0%) were willing to be followed up by home visit (70.2%), phone call (21.3%), text message (14.3%) or online chat-based message (4.8%). Overall attrition rate (proportion of adolescents lost to follow-up during waves two and/or three compared with the baseline sample) was 66.5% with 396 (37.1%) and 315 (46.9%) respondents lost to follow-up during waves two and three respectively. Common reasons for attrition were use of pseudonyms instead of real names, which many adolescents could not remember during subsequent data collection waves, relocation to a different school or neighborhood, school drop-out and closure of two schools. Adolescents in private versus government-owned schools (AOR = 3.35; CI =  2.39 - 4.69), those who did not have personal mobile phones (AOR = 1.43, CI =  1.03 - 1.98) and those engaging in remunerated work (AOR =  2.04, CI =  1.19 - 3.49) were more likely to be lost to follow-up.

CONCLUSIONS

Attrition was high despite high willingness to participate in the study. Whereas technology has made follow-up of study participants in high-income countries easier, multiple, and cost intensive methods to minimize attrition may be required in low-resource settings.

Prevalence, predictors and selected outcomes of early sexual initiation among adolescents in secondary schools in Lugbe, Abuja, Nigeria: a mixed methods study

Background

Early sexual initiation is the onset of sexual intercourse below 15 years. Despite many negative effects of early sexual initiation, its prevalence has kept increasing globally over the past decades.

Objective

This study aims to determine the burden, identify risk factors and examine the selected outcomes of early sexual initiation among secondary school adolescents.

Design

The study was a school-based descriptive cross-sectional survey which employed quantitative and qualitative methods.

Method

A descriptive cross-sectional survey was conducted among 300 in-school adolescents aged 15-19 in Lugbe, Abuja. Data were collected using an interviewer-administered questionnaire. Focus group discussion was also conducted in six schools using a structured FGD Guide. The prevalence of early sexual initiation was determined. Descriptive and inferential statistical analysis was done including a binary logistic regression to determine the predictive factors and outcomes of early sexual initiation with statistical inference made at p value <0.05.

Results

The prevalence of early sexual initiation was 11%; 80% of the respondents who had initiated sex did so before age 15, while 20% had first sex at ages between 15 and 19. Gender, academic performance, communication with parents and peer pressure were significantly associated predictive factors. Pregnancy, abortion, sexually transmitted infections, loss of self-confidence, expulsion from school, poor academic performance and depression were associated outcomes. Four main themes were identified from the qualitative data: being in a romantic relationship, peer pressure, media and lack of parental communication and monitoring.

Conclusion

The study concluded that there is high prevalence of early sexual initiation among those who had initiated sex. Predictive factors such as peer pressure, parental communication and media influence can be addressed by the inclusion of sex education in school curriculum and training of peer educators, advocacy and health education for parents of adolescents.

Age at first sex and other determinants of multiple sexual partnerships among sexually active adolescent girls in Ghana: a regression analysis of the 2022 Ghana demographic and health survey

BACKGROUND

Early sexual debut is a widely recognized public health issue due to its influence on lifetime multiple sexual partners which can lead to complications such as teenage pregnancy, abortion, HIV/AIDS and other sexually transmitted infections. However, there is paucity of research evidence on sexual behaviour such as age at first sexual intercourse and the number of sexual partnerships among adolescent girls in Ghana. This study aims to examine the influence of age at first sexual intercourse and other determinants on multiple sexual partnerships among adolescent girls aged 15-19 years in Ghana.

METHODS

Data for this study were obtained from the 2022 Ghana Demographic and Health Survey (GDHS) conducted between October 17, 2022 and January 14, 2023. A total weighted sample of 719 sexually active adolescent girls who reported having sexual partners was extracted from the women's data file. Data were analyzed with SPSS version 27, employing multilevel logistics regression modelling. Statistical significance was set at p < 0.05.

RESULTS

The average age at sexual debut for adolescent girls aged 15-19 years in Ghana is 15.5 years. A little over half (51.6%) of adolescent girls reported having two or more lifetime sexual partners. Adolescent girls who initiated sex before reaching age 15 were more likely (aOR = 2.00; C.I 1.39-2.87) to have multiple partners compared to those who had their first sex before attaining age 20. After controlling for other factors, girls who had their sexual debut before age 15 had higher odds (aOR = 1.85; C.I:1.30-3.31) of engaging in multiple sexual partnerships. Girls living female headed households (aOR = 2.25; C.I:1.18-4.29] and consuming alcohol (aOR = 2.38; C.I 2.38-1.09-5.17) had higher odds of having multiple sexual partners.

CONCLUSION

The study findings show that early sexual debut, living in female headed household, and consuming alcohol are strong predictors of multiple sexual partnerships among adolescent girls in Ghana. It suggests the need for policies promoting delayed sexual debut and empowering adolescents to make informed decisions to improve sexual health outcomes.

Spatial distribution and determinants of Early sexual initiation in Ethiopia

INTRODUCTION

Early sexual initiation has negative health, social, and economic consequences for both women and future generations. The trend of early sexual initiation is increasing globally, leading to higher rates of sexually transmitted diseases and unplanned pregnancies. Ethiopia has been challenged various disasters that makes women vulnerable and position them at heightened risk of early sexual initiation in the last four years. The spatial patterns and factors of early sexual initiation in the post-conflict-post pandemic settings is not well understood. Hence this research aimed at mapping Spatial Patterns and identifying determinant factors in the Post-COVID-Post-Conflict Settings.

METHODS

The study was conducted on secondary data from the PMA 2021 cross-sectional survey which conducted nationally from November 2021 to January 2022 which is in the post pandemic and post-war period. Total weighted sample of 6,036 reproductive age women were included in the analysis. ArcGIS Pro and SaTScan software were used to handle spatial analysis. Multilevel logistic regression model was used to estimate the effects of independent variables on early sexual initiation at individual and community level factors. Adjusted odds ratio with the 95% confidence interval was reported to declare the strength and statistical significance of the association.

RESULT

The spatial distribution of early sexual initiation was clustered in Ethiopia with a global Moran's I index value of 0.09 and Z-score 6.01 (p-value < 0.001).Significant hotspots were detected in East Gojjam zone of Amhara region, Bale, Arsi, West Hararge, East Wellega and Horo Gudru Wellega zones of Oromia region. The odds of having early sexual initiation was higher in women with primary education (AOR = 1.23, 95%CI: 1.03, 1.47), secondary or above education (AOR = 4.36, 95%CI: 3.49, 5.44), Women aged 26 to 25 (AOR = 1.91, 95%CI: 1.61, 2.26), women aged 36 to 49(AOR = 1.51, 95%CI: 1.24, 1.84). However, there was a significant lower likelihood of early sexual initiation in rural resident women (AOR = 0.53, 95%CI: 0.35, 0.81) and women living in 5 to 7 family size (AOR = 0.79, 95%CI: 0.68, 0.92), and more than 7 members (AOR = 0.63, 95%CI: 0.49, 0.81).

CONCLUSIONS

The spatial distribution of early sexual initiation was clustered in Ethiopia. Interventions should be taken to eliminate the observed variation by mobilizing resources to high-risk areas. Policies and interventions targeted to this problem may also take the identified associated factors into account for better results.

Prevalence and associated factors of early initiation of sexual intercourse among youth in Ethiopia: systematic review and meta-analysis

BACKGROUND

Early sexual initiation refers to engaging in sexual activity at a young age, typically before the age of 18. Even though many studies have been conducted in Ethiopia, the result is inconsistent between studies. In the study area, the pooled prevalence and associated factors of early initiation of sexual intercourse among youth were not done before. Therefore, this study aimed to determine the pooled prevalence and associated factors of early initiation of sexual intercourse among Youth in Ethiopia.

METHODS

This study used a systematic review and meta-analysis of studies conducted from 2008 to 2022, in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Cochrane Library, Hinari, and Google Scholar electronic databases were searched. The analysis was performed using STATA 17 software. Heterogeneity and publication bias were assessed using forest plots, I2, Cochran's Q statistics and Funnel plots, Egger test, and Begg rank tests respectively. Duval and Tweedie's 'trim and fill' method was also performed to adjust the pooled estimate. Pooled analysis was conducted using the inverse-variance fixed-effects model.

RESULTS

A total of 10 articles were included in this systematic review and meta-analysis. The pooled prevalence of early initiation of sexual intercourse among youth in Ethiopia was 24.7% (95%CI: 10.4, 38.9). Being female (AOR = 3.57; 95% CI: 1.387, 5.743), having poor knowledge of HIV/AIDS prevention (AOR = 3.65; 95% CI: 1.981,5.309), alcohol use (AOR = 2.05; 95% CI: 1.415, 2.679), khat chewing (AOR = 3.03; 95% CI: 1.800, 4.254), Viewed pornographic film(AOR = 4.21, 95% CI: 2.135, 6.283), Cigarette smoking (AOR = 2.74; 95% CI: 2.102, 3.370) and Poor family controls (AOR = 4.39; 95% CI: 2.572, 6.199)were associated factors of early initiation of sexual intercourse.

CONCLUSIONS

The pooled prevalence of early initiation of sexual intercourse among Youth in Ethiopia was high. Being female, poor knowledge of HIV/AIDS prevention, alcohol use, khat chewing, Viewing pornographic films, Cigarette smoking, and poor family controls were associated factors of early initiation of sexual intercourse. It is recommended that targeted interventions be put in place to address the high prevalence of early initiation of sexual intercourse among youth in Ethiopia. These interventions should focus on addressing the associated factors such as poor knowledge of HIV/AIDS prevention, alcohol use, khat chewing, viewing pornographic films, cigarette smoking, and poor family controls. It is important that these interventions are gender-sensitive and take into consideration the unique challenges faced by females in accessing sexual and reproductive health services.

A meta-analytic exploration of associations between religious service attendance and sexual risk taking in adolescence and emerging adulthood

Findings since 2000 about the association between the frequency of religious service attendance (formal religiosity) and sexual risk taking in adolescents and emerging adults were explored. A systematic literature search (April 2020) focused on articles with data on religiosity and age at sexual debut, number of sexual partners, condom use at most recent sexual intercourse, and consistent condom use. A total of 27 studies with 37,430 participants (Mage = 18.4, range: 12-25, 43.5% male) were included. In random-effects meta-analysis, the link between formal religiosity and sexual risk taking was significant only for age at sexual debut (r = 0.09, 95% CI = 0.05, 0.13) and the number of sexual partners (r = -0.14, 95% CI = -0.19, -0.09). Weak associations between the constructs of interest indicate that formal religiosity is not sufficient to protect young people's sexual health.

Determinants of early sexual initiation among female adolescents in Bangladesh: evidence from a countrywide cross-sectional survey

OBJECTIVES

Early sexual initiation (ESI), defined as sexual activity that begins before 15 or 18 years of age, is one of the risky sexual behaviours that has been linked to increased likelihood of adverse consequences, such as sexually transmitted diseases, unintended pregnancies and unsafe abortions. However, to date, there are no studies investigating the prevalence and factors influencing ESI among adolescent females (aged 10-19 years) in Bangladesh. Thus, this study aimed to identify the potential determinants of ESI among adolescent females in Bangladesh based on data that are representative of the country.

STUDY DESIGN

This was a cross-sectional study.

METHODS

Based on the availability of the data, the analysis included a weighted sample of 2051 adolescent females aged 15-19 years from the Bangladesh Demographic and Health Survey 2017/18. Initial selection of predictor variables was based on the bivariate analysis using the Chi-squared test. Univariate and multivariable logistic regression modelling were performed to measure the crude and adjusted effect of the selected predictor variables on ESI using the odds ratio (OR). The elasticity of the effects was calculated by their 95% confidence intervals (CIs).

RESULTS

Approximately 22% and 85% of female adolescents experienced ESI before the age of 15 and 18 years, respectively. Findings revealed that illiteracy (adjusted OR [AOR]: 3.61, 95% CI: 1.82-7.18), primary education (AOR: 2.08, 95% CI: 1.60-2.69), working status (AOR: 1.25, 95% CI: 0.98-1.60), living in Chittagong (AOR: 0.46, 95% CI: 0.27-0.79), living in Sylhet (AOR: 0.21, 95% CI: 0.08-0.56), reading newspapers (AOR: 0.63, 95% CI: 0.40-1.01), earlier marriage preference (AOR: 3.30, 95% CI: 2.31-4.71) and later marriage preference (AOR: 4.10, 95% CI: 3.01-5.59) were significantly linked with ESI before the age of 15 years. ESI before the age of 18 years was significantly association with primary education (AOR: 1.47, 95% CI: 1.01-2.13), religion (AOR: 0.55, 95% CI: 0.32-0.94), female household head (AOR: 1.93, 95% CI: 1.17-3.19), living in Rajshahi (AOR: 1.97, 95% CI: 0.95-4.08), being in the 'poorest' wealth category (AOR: 2.43, 95% CI: 1.45-4.07), being in the 'poorer' wealth category (AOR: 1.70, 95% CI: 1.06-2.72), being in the 'middle' wealth category (AOR: 1.76, 95% CI: 1.12-2.77), being in the 'richer' wealth category (AOR: 1.58, 95% CI: 1.02-2.44), earlier marriage preference (AOR: 15.71, 95% CI: 9.09-27.14), later marriage preference (AOR: 12.62, 95% CI: 8.82-18.06) and heard about family planning (AOR: 0.70, 95% CI: 0.47-1.04).

CONCLUSIONS

In Bangladesh, the prevalence of ESI among female adolescents is a public health concern. Due to the detrimental impact of ESI on the well-being of adolescents, it is crucial that policymakers consider the factors influencing ESI that have been identified in this study when designing health strategies. The findings from this study will help the development of evidence-based effective initiatives by policymakers in collaboration with governmental and non-governmental organisations.

Early Sexual Debut and Its Associated Factors Among Young Women Aged 15-24 in Mali: A Multilevel Analysis

Early sexual debut is associated with increased risk of several sexual and reproductive health problems, including unwanted pregnancies and sexually transmitted infections. Hence, determining factors that promote early sexual initiation is significant to guide policy and inform interventions aimed to promote the health of young people through to adulthood. This study examined the prevalence of early sexual debut and its associated factors among young women in Mali. Using cross-sectional nationally representative data from the 2018 Mali Demographic and Health Survey, a total of 4063 young women aged 15-24 were included in the study. Multilevel binary logistic regression analysis was done to determine the factors associated with early sexual debut. The results were presented using adjusted odds ratios (aOR) and 95% confidence intervals (CIs). The prevalence of early sexual debut in Mali was 17.8% (95% CI; 16-19.7%). Young women who attended higher school had lower odds of early sexual debut (aOR = 0.10, 95% CI; 0.01-0.82) compared to young women who had no formal education. Young women from richest households had lower odds of early sexual debut compared to those from the poorest households (aOR = 0.48, 95% CI; 0.27-0.82). Young women from households with large family size also had lower odds of experiencing early sexual debut compared to those in small family size (aOR = 0.81, 95% CI; 0.66-0.99). Furthermore, the odds of early sexual debut were lower among young women in Koulikoro (aOR = 0.59, 95% CI; 0.39-0.90), Sikasso (aOR = 0.35, 95% CI; 0.21-0.56), Segou (aOR = 0.40, 95% CI; 0.25-0.64), and Mopti (aOR = 0.44, 95% CI; 0.23-0.82) regions compared to young women in Kayes region. Higher odds of early sexual debut were found among currently employed compared to not currently employed young women (aOR = 1.74, 95% CI; 1.42-2.12) and currently married compared to not currently married young women (aOR = 4.64, 95% CI; 3.64-5.92). Young women from the Peulh ethnic groups compared to those from the Bambara ethnic groups were at a higher odds of early sexual debut (aOR = 1.43, 95% CI; 1.03-1.99). The findings suggest the need for interventions aimed at addressing early sexual debut among young women. These can include emphasizing the promotion and importance of female education, addressing the cultural practices that promote negative sexual norms/practices such as child marriages, and ensuring social change through efforts such as creating employment or economic opportunities for families.

Socioeconomic inequality in early sexual initiation among female youths in sub-Saharan African countries: a decomposition analysis

INTRODUCTION

Youths are defined as individuals within the age group 15-24 years. It is the transitional stage from childhood to adulthood with biological, social, and psychological change, so it is a time of risk and opportunity for their future life. Early sexual initiation exposes young people to various social, economic, sexual, and reproductive health issues, such as unwanted adolescent pregnancies, sexually transmitted infections, unsafe abortion, cervical cancer, and early marriages. Therefore, this study aimed to assess the presence of socioeconomic inequality in early sexual initiation and contributing factors in sub-Saharan African countries.

METHODS

A total of 118,932 weighted female youths from SSA countries' DHS data were included in the study. Socioeconomic inequality of Early sexual initiation was evaluated using the Erreygers znormalized concentration index and associated concentration curve. Decomposition analysis was performed to determine those factors causing socioeconomic-related inequality.

RESULTS

The weighted Erreygers normalized concentration index of wealth-related inequality of early sexual initiation was - 0.157 with a Standard error = 0.0046 (P value < 0.0001); this indicated that early sexual initiation was disproportionately concentrated among the poor (pro-poor). Moreover, the weighted Erreygers normalized concentration index (ECI) of educational status-related inequality of early sexual initiation was - 0.205 with a Standard error = 0.0043 (P value < 0.0001). This indicated that early sexual initiation was disproportionately concentrated among youths with no formal education. The decomposition analysis revealed that mass media exposure, wealth index, place of residency, religion, marital status, educational status, and age were significant contributors to the pro-poor socioeconomic inequalities in early sexual initiation.

CONCLUSION AND RECOMMENDATION

This study has revealed pro-poor inequality in early sexual initiation. Therefore, priority must be given to modifiable factors such as promoting the accessibility of media exposure in the household, improving the educational opportunity of female youths, and improving their country's economy to a higher economic level to improve the wealth status of the population.

Measuring sexual behavior among in-school youth in Rwanda: a cross-sectional analysis of self-reported timing of first sex and correlates of early sexual debut

PURPOSE

Understanding the timing of sexual debut is critical for informing sexual and reproductive health interventions. We investigated sexual behavior and early sexual debut among Rwandan youth.

METHODS

We conducted a cross-sectional analysis of data from a cluster-randomized trial with 6079 students ages 12-19 years in Rwanda. We examined predictors of early sexual debut (<15 years) using logistic regression to estimate odds ratios and factors associated with the timing of first sex using Cox models to estimate hazard ratios. Interpretations of sex were also explored.

RESULTS

Participants were 15 years and 51.5% female on average; 1723 (28.3%) reported sexual activity. Among the 1320 participants who provided an age of sexual debut, 51.4% reported sex at ≤12 years and 75.7% at<15 years. Males had a higher odds of early sexual debut (adjusted odds ratio: 2.40; 95% CI: 1.99, 2.90) and a higher hazard of sex occuring at an earlier age than females (adjusted hazard ratio: 1.91; 95% CI: 1.67, 2.20). One-third of participants considered "sexual intercourse" to include kissing, touching, or masturbation.

CONCLUSIONS

Sex at ≤12 years was frequently reported, indicating that interventions facilitating access to youth-friendly sexual and reproductive health services are necessary before age 12. Validation studies are needed to evaluate how interpretations of sexual intercourse influence the assessment of sexual activity.

CLINICAL TRIAL

NCT04198272.

Prevalence and predictors of premarital sexual intercourse among young women in sub-Saharan Africa

INTRODUCTION

Premarital sexual intercourse (PSI) without adequate information and/or appropriate application of the relevant knowledge about sex before marriage, potentially has adverse effects on the sexual and reproductive health outcomes of vulnerable young women in sub-Saharan Africa (SSA). This study sought to examine the prevalence and predictors of PSI among young women aged 15-24 in SSA.

METHODS

Nationally representative cross-sectional data from 29 countries in SSA were extracted for the study. A weighted sample size of 87,924 never married young women was used to estimate the prevalence of PSI in each country. A multilevel binary logistic regression modelling approach was used to examine the predictors of PSI at p < 0.05.

RESULTS

The prevalence of PSI among young women in SSA was 39.4%. Young women aged 20-24 (aOR = 4.49, 95% CI = 4.34, 4.65) and those who had secondary/higher educational level (aOR = 1.63, 95% CI = 1.54, 1.72) were more likely to engage in PSI compared to those aged 15-19 and those with no formal education. However, young women who belonged to the Islamic religion (aOR = 0.66, 95% CI = 0.56, 0.78); those who were working (aOR = 0.75, 95% CI = 0.73, 0.78); belonged to the richest wealth index (aOR = 0.55, 95% CI = 0.52, 0.58); were not exposed to radio at all (aOR = 0.90, 95% CI = 0.81, 0.99); were not exposed to television at all (aOR = 0.50, 95% CI = 0.46, 0.53); resided in rural areas (aOR = 0.73, 95% CI = 0.70, 0.76); and those who were living in the East African sub-region (aOR = 0.32, 95% CI = 0.29, 0.35) were less likely to engage in PSI compared to those who were traditionalist, unemployed, belonged to the poorest wealth index, exposed to radio frequently, exposed to television frequently, resided in urban areas, and lived in the Southern Africa sub-region, respectively.

CONCLUSION

Sub-regional variations in the prevalence of PSI exist amidst multiple risk factors among young women in SSA. Concerted efforts are required to empower young women financially, including education on sexual and reproductive health behaviors such as the detrimental effects of sexual experimentation and encouraging abstinence and/or condom use through regular youth-risk communication advocacy.

Sexual knowledge, risk behavior, and access to reproductive health services among orphaned adolescents in Southwest Nigeria: implications for institutionalized care

Introduction

An orphan has been defined as a child under 18 years of age who has lost one or both parents to any cause. It has been reported that for every 10 Nigerian children, 1 is likely to be an orphan. Adolescents are faced with a serious challenge in meeting their reproductive health need, which oftentimes becomes overwhelming especially when they are orphaned.

Objectives

We compared institutionalized and non-institutionalized orphaned adolescents for their knowledge of sexuality, risky sexual practice, and access to reproductive health services.

Methods

The study adopted a cross-sectional descriptive study design conducted via structured, pretested, and interviewer-administered questionnaires among 205 orphaned adolescents (140 institutionalized and 65 non-institutionalized). Data were analyzed using the Statistical Product and Service Solution (SPSS version 25.0) and summarized using frequency, mean and percentages, and inferential statistics. All analyses were done at a 95% confidence interval and at a p < 0.05 level of significance.

Results

The knowledge levels of a majority of non-institutionalized respondents (73.8%) were good when compared with those in institutions (56.4%) (χ² = 5.713, p = 0.017). Institutionalized orphans displayed better sexual behavior (80.7%) than non-institutionalized respondents (64.6%) (χ² = 6.239, p = 0.011). Access to reproductive health services was found to be slightly higher among institutionalized respondents (66.4%) than among their non-institutionalized counterparts (64.6%).

Conclusion

Institutionalized and non-institutionalized orphans differed in terms of their knowledge of sexuality, sexual behavior, and risky practices, including access to reproductive health services. This study demonstrated the effectiveness of institutionalized care of orphans toward improved access to reproductive health services and good sexual practices. In the light of this, the government and relevant stakeholders should advocate the need for providing better sexuality education and understanding, make sure that access barriers for orphans are removed and orphans utilize the facilities for reproductive health that are available, and also make sure that adolescent health policies are implemented effectively.

Prevalence and associated factors of early sexual initiation among youth female in sub-Saharan Africa: a multilevel analysis of recent demographic and health surveys

Background

Early sexual initiation is a major public health concern globally, specifically in Sub-Saharan African (SSA) countries where reproductive health care services are limited. It is strongly related to increased risk of HIV/AIDS, sexually transmitted diseases, unwanted pregnancy, adverse birth outcomes, and psychosocial problems. However, there is limited evidence on the prevalence and associated factors of early sexual initiation among youth females in SSA.

Methods

A secondary data analysis was employed based on the recent DHSs of sub-Saharan African countries. A total weighted sample of 184,942 youth females was considered for analysis. Given the hierarchical nature of DHS data, a multilevel binary logistic regression model was fitted. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), and Likelihood Ratio (LR) test were used to assess the presence of clustering. Four nested models were fitted and the model with the lowest deviance (-2LLR0 was selected as the best-fitted model. Variables with p-value < 0.2 in the bivariable multilevel binary logistic regression analysis were considered for the multivariable analysis. In the multivariable multilevel binary logistic regression analysis, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) was reported to declare the strength and statistical significance of the association.

Results

The prevalence of early sexual initiation among youth females in sub-Saharan Africa was 46.39% [95%CI: 41.23%, 51.5%] ranging from 16.66% in Rwanda to 71.70% in Liberia. In the final model, having primary level education [AOR = 0.82, 95% CI; 0.79, 0.85], and [AOR = 0.50, 95%CI; 0.48, 0.52], being rural [AOR = 1.05, 95%CI: 1.03, 1.07], having media exposure [AOR = 0.91, 95%CI: 0.89, 0.94], and belonged to a community with high media exposure [AOR = 0.92, 95%CI: 0.89,0.96] were found significantly associated with early sexual initiation.

Conclusion

The prevalence of early sexual initiation among youth females in SSA was high. Educational status, wealth index, residence, media exposure, and community media exposure have a significant association with early sexual initiation. These findings highlight those policymakers and other stakeholders had better give prior attention to empowering women, enhancing household wealth status, and media exposure to increase early sexual in the region.

Are delay ages at marriage increasing? Pre-marital sexual relation among youth people in the place of residence in India

BACKGROUND

Adolescent sexual and reproductive health is a major public health issue throughout the world. At the same time shifting of marriage are undergoing discernible changes in country like India. This paper attempts to examine the effect of delay age at marriage on the risks of pre-marital sexual intercourse for the youth people in the place of residence.

METHODS

Data used in the present study is from various annual publications of Sample Registration System (SRS) and four round of National Family Health Survey, which was conducted in 2015-2016. The Kaplan-Meier life table technique and multivariate regression models are used to examine the premarital sex by the place of residence and marriage cohort.

RESULTS

Findings of the study indicate that the reasons underlying delayed marriage differs between blow 21 years age group and 22-30 years age group. Multinomial analysis clearly shows education, wealth quintile and mass media are major controlling factors of delayed age at marriage. Residing in urban adolescent women who belonged to better economic family background and exposed to mass media had a higher probability to experience premarital sexual intercourse than the rural adolescent in delay age group.

CONCLUSION

The study concludes that the restorative the empowerment of youth especially for women and health care provider should consider a multidimensional approach for higher education among youth people and safe sexual behaviour in pre-marital sexual intercourse.

Factors associated with pregnancy and induced abortion among street-involved female adolescents in two Nigerian urban cities: a mixed-method study

OBJECTIVES

This study determined the correlates of unwanted pregnancy and induced abortion among sexually active female street-involved adolescents (SIAs) aged 10-19 years in two urban cities in South-west, Nigeria.

METHODS

The data for this study were extracted from a larger mixed-method survey dataset on the sexual and reproductive health (SRH) of 1505 street-involved young people aged 10 to 24 years. For the quantitative data, the explanatory variables were age, history of school attendance, employment status, religion, living arrangement and city of residence. The study outcomes were a history of pregnancy and a history of induced abortion of last pregnancy. Binomial regression analysis was performed to determine the association between the explanatory and outcome variables. For the qualitative data generated through focus group discussions and in-depth-interviews, inductive and deductive approaches were used in conducting a thematic analysis to explore the perspectives and experiences of SIA on pregnancy and induced abortion.

RESULTS

Of the 424 female SIAs, 270 (63.7%) reported having had sex. Sixty-four (23.7%) respondents had a history of pregnancy, of which 38 (59.4%) gave a history of induced abortion of the last pregnancy. A history of school attendance significantly reduced the likelihood of being pregnant (AOR: 0.42, 95% C.I: 0.19-0.91), while 15-19-years-old SIAs who were pregnant were significantly less likely to abort (AOR: 0.13, 95% C.I: 0.02-0.77). Qualitative reports indicated that unintended pregnancy and induced abortion was a common experience among the sexually active SIAs. Many participants were aware of the methods of, and places to induce abortion.

CONCLUSION

A large proportion of SIAs are sexually active with a high incidence of unintended pregnancy and a high rate of unsafe abortion. Access of female SIAs to education can reduce the risk of unintended pregnancy. Attention needs to be paid to how SIAs can have access to contraception.

Prevalence and Factors Associated with Risky Sexual Behaviors Among Sexually Active Female Adolescents in Zambia

Despite decades long commitment to women's reproductive health rights, sexually transmitted diseases and unintended pregnancies continue to be major public health concerns in sub-Saharan Africa. In order to provide an evidence base for future policy and services, this study aims to explore the prevalence and factors associated with risky sexual behaviors (RSB) among sexually active Zambian female adolescents using a nationally representative sample. Data on females, aged 15-19 (n = 3000), were obtained from the 2018 Zambia Demographic and Health Survey, an interviewer-administered, nationally representative survey that used multistage sampling. The study conducted multiple logistic regression to explore the correlates of RSB. Of the 3000 respondents, 49.7% (1490) reported ever having sexual intercourse of which 71.1% reported engaging in RSB. Among sexually active female adolescents, the following RSB percentage were reported: intercourse before age 16 (50.6%), nonuse of condoms at last intercourse (37.8%), engaging in transactional sex (6.2%), alcohol use at last intercourse (4.6%), and multiple sexual partners (1.9%). Educational attainment and household wealth showed strong inverse trends with RSB risk and there were notably large geographic differences in RSB within Zambia (22.1% in Lusaka region vs. 62.4% in Western province). The multiple logistic regression results revealed that those who were younger, unmarried, with less than secondary education, without access to Internet, and residents of Western Zambia were significantly more likely to have engaged in RSB (AOR: 1.74-7.69, p < 0.05). Given the negative health outcomes associated with RSB, Zambian adolescent health care programs may strategically target limited resources to the identified risk groups.

Community structure and timing of sexual activity among adolescent girls in Nigeria

Studies have linked the timing of sexual debut to unplanned pregnancies and sexually transmissible infections, including HIV. Current understandings of sexual debut among Nigerian adolescents focused on the roles of individual and familial characteristics. We leveraged the 2018 Nigeria Demographic and Health Survey data to examine how community features like affluence, ethnic diversity, and women empowerment may be associated with the timing of sexual debut among adolescent girls. The sample comprised 7449 adolescent girls who were usual residents in 6,505 households and 1,352 clusters or communities. Statistical associations between community characteristics and the onset of sexual debut were assessed using a two-level mixed-effects parametric survival model with Weibull distribution. We found that community affluence [aHR:0.43, 95%CI: 0.30-0.62] and community ethnic diversity [aHR: 0.63, 95%CI: 0.42-0.94] are associated with a lower hazard of sexual debut among adolescent girls. We also observed that women that married within the observation period had an earlier sexual initiation than those who were unmarried. The results disaggregated by marital status further shows that higher community level of women's employment [aHR: 2.45, 95%CI: 1.38-4.38] and women's education [aHR:1.85, 95%CI: 1.03-3.33] were associated with a higher hazard of sexual debut among unmarried adolescent girls but not married adolescent girls. Higher community affluence [aHR:0.40, 95%CI: 0.27-0.60] was also associated with a lower hazard of sexual debut among unmarried adolescent girls but not married adolescent girls. Our results illuminate the associated factors of the timing of sexual debut among adolescent girls that moves beyond individual characteristics to community characteristics.

Sexual debut among college students in China: effects of family context

This study examines family context and sexual debut among young people in China. Using data from the 2018 Panel Study of Chinese University Students (PSCUS), it explores how the family is correlated with sexual debut among young people in China aged 18-24 years. The Kaplan-Meier method was adopted to detect a survival function for different family factors and related demographic variables. Cox proportional hazard regression analysis was adopted to calculate hazard ratios for the timing of sexual debut. The average age of sexual debut among the college students was 18.39 years. The Kaplan-Meier analysis showed that sexual intercourse initiation was earlier for female students who had no siblings, and those who had a mother with senior high school (including technical school) education or higher family income, but this correlation was insignificant among male students. The multivariate hazard regression analysis revealed that living in a family with a higher level of fathers' education, having a lower level of family income and having siblings had positive correlations with later sexual debut among the college students. Moreover, family factors showed gender differences in their associations with the timing of sexual debut, typically parent's education level, family income and left-behind experience. This study provides a comprehensive perspective on the role of family influences in timing of sexual debut among youth in China.

Religious faith and sexual risk taking among adolescents and emerging adults: A meta-analytic review

RATIONALE

Although there is some evidence that religious faith may offer protection against sexual risk taking in adolescence and emerging adulthood, no attempts have been made to systematically quantify the association.

OBJECTIVE

Using data from studies conducted in the 2000-2020 period, this meta-analysis aimed to estimate the link between religious faith and four sexual risk-taking behaviors in samples of adolescents and emerging adults.

METHODS

Five different search systems were used to conduct a systematic literature search in April 2020. Studies that contained quantitative data on religious faith and at least one indicator of sexual risk taking (age at sexual debut, number of sexual partners, condom use at most recent sexual intercourse, and consistent condom use) were searched for. In total, 35 articles published in peer-reviewed journals, in English, were identified. Random-effects meta-analytic approach was used to assess target associations among 41,758 adolescents and emerging adults (M_age = 18.9 years, 37% male). To estimate the effect across the four risk indicators, we employed robust variance estimation (RVE) method.

RESULTS

We found small associations between religious faith on the one hand and age at sexual debut (r = 0.08, 95% CI = 0.03, 0.12) and the number of sexual partners on the other hand (r = -0.15, 95% CI = -0.21, -0.09). No association with condom use was observed. With all studies included, the overall effect size was 0.11 (95% CI = 0.06, 0.16), indicating a small (protective) role of religious faith in young people's sexual risk taking.

CONCLUSIONS

Considering the limited role of religious faith in young people's sexual and reproductive health, comprehensive sexuality education remains essential for risk-reduction, even among more religious young people.

Sexual Debut Among Heterosexual Men of African and Caribbean Descent: Are the Youth Initiating Sex Earlier than the Older Generation?

Although age at first sex is considered a measure of sexual risk and vulnerability for HIV infection, there is a dearth of literature on age at sexual debut in the Canadian context. This study examined time variations to first sex among heterosexual African, Caribbean, and Black (ACB) men in four Ontarian cities. A population-based retrospective survey (n = 879) on timing to first sexual intercourse was conducted between 2018 and 2019 among self-identified heterosexual ACB men 16 years or older and residing in London, Ottawa, Toronto or Windsor. We used the lognormal survival analysis technique to examine variations in time to first sexual intercourse among age cohorts and between cities. The findings showed a generational shift in the pattern of sexual initiation, with younger heterosexual ACB men initiating sexual intercourse earlier compared with those currently older than 50 years. We observed those between 16 and 19 years, 20 and 29 years, and 30 and 39 years of age to have significantly higher risk ratios of TR = 0.852, TR = 0.869, and TR = 0.855, respectively. At city level, the results show marked spatial variations, with youth in cities of Toronto, Ottawa, and London at the highest risk of early sexual debut relative to those in Windsor. Early initiation of first sexual intercourse among heterosexual ACB youth was observed with those in the larger cities being at a relatively higher risk. There is the need for programs aimed at delaying sexual debut among youth in general. It is, however, important to recognize the relative risk of those in the larger cities.

What predicts the early sexual debut among unmarried adolescents (10-19 years)? Evidence from UDAYA survey, 2015-16

INTRODUCTION

The societal norm in India is such that adolescents are expected to respect and follow traditional values and view early sexual debut as undesirable and deviant from the social mores. However, a dramatic shift in attitudes towards sex before marriage has been observed in India. We in this study, aim to study the factors associated with early sexual debut among unmarried adolescents.

MATERIALS AND METHODS

The study used data from the Understanding the lives of adolescents and young adults (UDAYA) survey conducted in 2016 with 15,388 adolescents aged 10-19 years from two Indian states. Bivariate and logistic regression analyses were performed to determine the associated factors.

RESULTS

Adolescent boys (9%) were more prone to early sexual debut compared to girls (4%). Both boys (17.2%) and girls (6%) who were school dropouts had significantly higher chances of early sexual debut. Boys who had rare [OR: 2.28; CI: 1.12-4.64] or frequent media exposure [OR: 2.70; CI: 1.36-5.32] were significantly more likely to report early sexual debut than those who had no media exposure. Further, the likelihood of early sexual debut was significantly higher among boys [OR: 3.01; CI: 2.34-3.87] and girls [OR: 1.87; CI: 1.12-3.12] who had exposure to pornography compared to their counterparts. The odds of early sexual debut were higher among boys [OR: 1.89; CI: 1.19-3.01] and girls [OR: 1.77; CI: 1.30-2.41] who had moderately-severe/severe depressive symptoms compared to their counterparts.

CONCLUSIONS

The results highlight that Indian unmarried adolescents demand the appropriate knowledge to promote safer sexual behavior and lead a responsible and healthy lifestyle. The preventive efforts must be multifaceted with involvement at the individual and parental levels. Especially, interventions appear advantageous to be parents-focused emphasizing family life education that can prevent risky sexual behaviors among adolescent boys and girls. And the public programs should focus on sexual health promotion considering the physical and psychosocial changes during early ages of sex life.

Changes in contraceptive and sexual behaviours among unmarried young people in Nigeria: Evidence from nationally representative surveys

Context

Nigeria is a high-burden country in terms of young people’s health. Understanding changes in young people’s sexual and reproductive health (SRH) behaviours and the associated factors is important for framing appropriate interventions.

Objective

This study assessed changes in SRH behaviours of unmarried young people aged 15–24 and associated factors over a ten-year period in Nigeria.

Data and method

We analysed datasets from Nigeria Demographic and Health Surveys of 2008, 2013 and 2018 to assess changes in inconsistent condom use, non-use of modern contraceptives; multiple sexual partnership; and early sexual debut. Using binary logistic regression, we assessed the association of selected variables with the SRH behaviours.

Results

Over four-fifths of unmarried young people (15–24) in Nigeria engaged in at least one risky sexual behaviour in each survey year. The pattern of changes in the four risky SRH behaviours was consistent over the 10-year period, with the highest rates of each behaviour occurring in 2018 while the lowest rates were in 2013, thus indicating an increase in the proportion of respondents engaging in risky sexual behaviours over the study period. Comprehensive HIV/AIDS knowledge, male gender, older age category (20–24), residence in south-west Nigeria, urban residence, higher socio-economic status, secondary/higher education were mostly protective against the four SRH variables analysed across the different data waves.

Conclusion

Addressing the high and increasing level of risky SRH behaviours among young people in Nigeria is imperative to improve overall national health status and to ensure progress towards achieving SDG target 3.7 focusing on SRH.

Prevalence and Factors Associated with Early Sexual Initiation among College Students in Southwest Ethiopia

Background

Early age at first sexual practice is a public health issue and now common around the world especially in the developing countries. The development of effective strategies to reduce the adverse consequences of early sexual initiation becomes real when sufficient data is available. Therefore, this study is aimed at assessing the prevalence and factors associated to early sexual initiation among college students in southwest Ethiopia.

Methods

A cross-sectional study was conducted among 453 college students in southwest Ethiopia from April to May 2018. A two-stage stratified sampling technique was used to select the study participants. The data were collected using structured pretested self-administered questionnaire. The collected data were entered using Epi-Data version 4.2.0.0 and analyzed using SPSS version 20. Logistic regression models were fitted to assess the effect of independent variables on the outcome variable. Significance was declared at p < 0.05 in the multivariable logistic regression analysis.

Results

The proportion of early sexual initiation among college students was 17.9%, 95% CI (14.4%-24.4%). The mean age of sexual intercourse was 17.6 (±2 SD) years. Nearly three-fourths (73.4%) of the respondent's reason for early sexual intercourse was falling in love. More than half (62.2%) of the respondents used a condom for their first sexual intercourse. The factors associated with early sexual initiation were being female (AOR = 2.09and 95% CI [1.17-2.35]), chewing khat (AOR = 7.05 and 95% CI [3.81-13.1]), exposed to pornographic materials at age < 18 years (AOR = 3.57 and 95% CI [1.94-6.89]), and poor knowledge of sexually transmitted diseases (AOR = 8.69 and 95% CI [3.52-21.5]).

Conclusion

The prevalence of early sexual initiation among college students was alarmingly high. This may be associated with a huge burden of poor sexual and reproductive health. Therefore, creating awareness of the factors and related negative sexual and reproductive health effect of early sexual initiation for young peoples through the use of mass media (television and radio), school teachers, and parents plays a paramount importance.

An Epidemiology of Premarital Sexual Behaviour in India: Exploring Gender Differences

This article analyzes the social context of increasing premarital sex in India in a gender perspective, which affects the overall contexts, patterns and the characteristics of premarital sexual behaviour. The study has been conducted on data collected from 169,814 unmarried women and 40,003 unmarried men, a part of the Indian Demographic Health Survey (DHS), 2015–2016. Gender differences in premarital sex were pronounced, where unmarried men were five times more likely to have premarital sex (16%) as compared to unmarried women (3%). Cox regression portrays that both men and women at younger ages were significantly more likely to initiate premarital sex. Muslim men were significantly more likely (HR = 1.16 times) to have premarital sex at younger ages. Regional variations in the prevalence of premarital sex are pronounced. Findings reveal that unmarried women with higher education, residing in urban areas and who belong to richest wealth quintile and exposed to regular mass media were more likely to have multiple sexual partners in premarital sex. There is a striking regional variation in the low prevalence of condom use in the premarital sex reported by unmarried men as well as women. In fact, unmarried men were more likely to use condom in their first as well as last premarital sexual encounter than their women counterparts. Findings suggest strengthening the empowerment of youth, especially women, through enhancing their reproductive and sexual rights education and promoting safe sexual behaviour in premarital sexual encounters.

Early sexual debut and associated factors among students in Ethiopia: A systematic review and meta-analysis

Students with early sexual debut are exposed to risky sexual behaviours. For effective intervention on early sexual debut and its consequences, determination of its magnitude and identifications of associated factors is important. Therefore, this systematic review and meta-analysis aims to estimate the pooled prevalence and the associated factors of early sexual debut among students in Ethiopia. Relevant articles were identified through databases such as PubMed, Global Health, HINARI, Google advance search, Scopus, and EMBASE from March 10^th to April 3^rd. The data was extracted using a standardized data extraction form and exported to STATA 11 for analysis. The overall pooled prevalence of early sexual debut among students was estimated using a randomeffects meta-analysis. Presence of association was determined using an odds ratio with a corresponding 95% CI. A total of 9 studies with 4,217 participants were involved in this meta-analysis. The estimated pooled prevalence of early sexual debut among students in Ethiopia was 27.53% (95% CI: 20.52, 34.54). Being female (OR: 3.64, 95% CI: 1.67, 5.61), watching pornography (OR: 3.8, 95% CI: 2.10, 5.50) and having boyfriend or girlfriend (OR: 2.72, 95% CI: 1.24, 5.96) were found to be significantly associated with early sexual debut. More than one fourth of students practiced early sexual debut. The finding suggests the need of strengthening prevention strategies, effective intervention, and programs in educational institutions to reduce early sexual debut and its consequences. Furthermore, special attention should be given to female students and students who watch pornography.

Early Life Exposures and Risky Sexual Behaviors among Adolescents: A Cross-sectional Study in Ghana

BACKGROUND

Risky sexual behaviors (RSBs) are behaviors that could result in unwanted pregnancies and sexually transmitted infections. These behaviors are often initiated during adolescence, and the frequency of engagement in such behaviors rises with increasing age during the teenage years. It has been asserted that exposures to sexual materials early in life could lead to early sex debut among adolescents.

OBJECTIVE

The objective of this study was to determine the early life exposures contributing to RSBs among basic school pupils in the Twifo Praso District of Ghana.

MATERIALS AND METHODS

A descriptive cross-sectional study was conducted using a structured questionnaire. Three hundred and sixty basic school pupils were selected by simple random sampling technique. Data were analyzed using SPSS version 20.

RESULTS

The study found that 64.4% of the respondents have had sexual intercourse at a mean age of 13.7 years. Respondents from polygamous homes were more likely to engage in earlier sexual debut than those from monogamous home (r = 0.0343, P = 0.003). Furthermore, having a high number of friends who have had sex was associated with an early sexual debut (r = 0.720, P = 0.000).

CONCLUSION

Adolescents are initiating sexual intercourse very early in life and this calls for customized reproductive health promotion activities aimed at minimizing risky sexual behaviors. Further studies on how parent-child sexual communication could delay sexual debut are recommended.

Geographical variations of early age sexual initiation among reproductive-age women in Ethiopia: evidence from EDHS 2016

Background

The early age of sexual initiation contribute a lot for various risks such as mistimed pregnancy followed by insecure termination, developing fistula and contracting sexually transmitted infections which are currently the major public health concerns for low-income countries. Therefore, the purpose of this study was to detect spatial clusters and identify factors associated with an early age sexual initiation of women in the reproductive age group.

Methods

We used a population-based nationwide representative Ethiopian Demographic and Health Survey (EDHS) 2016 data.. A total of 12,033 respondents of reproductive age (15–49 years) women who had at least one event of sexual intercourse was retrieved and included for the analysis. Spatial cluster detection and autocorrelation analysis were also done to explore the patterns of early age sexual initiation.

Results

The median age at first sexual intercourse among respondents was 16 (±3.3) years and more than half (66.2%) had their first sexual intercourse before the age of 18 years. The spatial variations of the age of sexual initiation was nonrandom and clustered with a Moran’s I = 0.413 (P-value < 0.001). In addition, five significant spatial clusters were also identified. Moreover, the probability of starting sex at an earlier age was associated with the respondent’s residence, marital status, educational attainment and wealth index.

Conclusion

This study found a higher proportion of an early age sexual initiation of women. Respondent’s residence, marital status, educational attainment and wealth index were significantly associated with early sexual initiation. The SaTScan analysis identified five statistical significant spatial clusters which indicate that there were geographical variations. Therefore, integrated interventions focusing on the identified high spot clustered areas are recommended to reduce early age sexual initiation.

Alcohol Consumption, Risky Sexual Behaviors, and HIV in Nigeria: A Meta-Analytic Review

BACKGROUND

Alcohol consumption is associated with risky sex, which increases the risk of acquiring and transmitting HIV.

OBJECTIVE

To examine the prevalence of, and associations among alcohol, risky sex, and HIV, in Nigeria.

METHODS

We searched electronic databases and reviewed reference sections of relevant papers to locate studies that sampled people living in Nigeria and assessed both alcohol and sexual risk behavior. We calculated effect sizes to determine (a) prevalence of alcohol and sex behaviors and (b) associations between alcohol consumption and risky sex, and examined moderators to determine if sample characteristics predicted behavioral or biological outcomes.

RESULTS

Of the 696 unique records identified, 35 manuscripts reporting on 42 separate studies met the inclusion criteria. Participants in these studies (N = 83,350; M age = 26 years; 48% women; 10% HIV-infected) reported high rates of heavy drinking (63%) and low rates of consistent condom use (24%). One-third of participants (30%) also reported using alcohol before sexual activity. Participants who consumed alcohol were more likely to report sexual activity (OR = 3.66, 95% CI = 3.09, 4.33), multiple partners (OR = 3.22, 95% CI = 2.38, 4.36), and condomless sex or inconsistent use of condoms (OR = 2.30, 95% CI = 1.54, 3.43).

CONCLUSION

High rates of heavy drinking and low rates of condom use have been well-documented in Nigeria. Results from this meta-analysis can be used to inform critically needed alcohol-related HIV interventions.

Trends and gender differences in age at sex debut among adolescents and young adults in urban Cape Area, South Africa

BACKGROUND

Adolescents and young adults in South Africa are at increased risk of experiencing negative outcomes from early sex initiation due to the context they develop in. This study aimed at investigating trends and gender differences in early age at sexual debut.

METHODS

Data from the Cape Area Panel Study (CAPS) of young adults' conducted between 2002 and 2009 in urban Cape Town were used. Correlates of early sex using ecological risk factors were analysed.

RESULTS

Overall mean age at sexual debut at follow-up was 17.5 years (standard deviation (SD) =2.5), with males at 16.8 years (SD=2.5) and 18.1 years (SD=2.4) for females. Males consistently reported an earlier age at sex debut across the five waves of the survey. Significant risk factors for early sex appeared at all levels of the ecology to include individual, household, and community factors.

CONCLUSIONS

Integrated interventions for delaying early sex debut should consider factors within the ecology of the young adults' development context.

Vulnerabilities at First Sex and Their Association With Lifetime Gender-Based Violence and HIV Prevalence Among Adolescent Girls and Young Women Engaged in Sex Work, Transactional Sex, and Casual Sex in Kenya

BACKGROUND

Adolescent girls and young women (AGYW) experience high rates of HIV early in their sexual life course. We estimated the prevalence of HIV-associated vulnerabilities at first sex, and their association with lifetime gender-based violence (GBV) and HIV.

METHODS

We conducted a cross-sectional biobehavioral survey among AGYW (14-24 years) in Mombasa, Kenya in 2015. We compared the prevalence of first sex vulnerabilities across AGYW who self-identified as engaging in sex work (N = 408), transactional sex (N = 177), or casual sex (N = 714) and used logistic regression to identify age-adjusted associations between first sex vulnerabilities and outcomes (GBV after first sex; HIV).

RESULTS

The median age at first sex was 16 years (interquartile range 14-18). A total of 43.6% received gifts or money at first sex; 41.2% and 11.2% experienced a coerced and forced first sex, respectively. First sex vulnerabilities were generally more common among AGYW in sex work. GBV (prevalence 23.8%) and HIV (prevalence 5.6%) were associated with first sex before age 15 [GBV adjusted odds ratio (AOR) 1.4, 95% confidence interval (CI): 1.0 to 1.9; HIV AOR 1.9, 95% CI: 1.1 to 1.3]; before or within 1 year of menarche (GBV AOR 1.3, 95% CI: 1.0 to 1.7; HIV AOR 2.1, 95% CI: 1.3 to 3.6); and receipt of money (GBV AOR 1.9, 95% CI: 1.4 to 2.5; HIV AOR 2.0, 95% CI: 1.2 to 3.4).

CONCLUSIONS

HIV-associated vulnerabilities begin at first sex and potentially mediate an AGYW's trajectory of risk. HIV prevention programs should include structural interventions that reach AGYW early, and screening for a history of first sex vulnerabilities could help identify AGYW at risk of ongoing GBV and HIV.

Religiosity and sexual abstinence among Nigerian youths: does parent religion matter?

BACKGROUND

Religion plays an important role in youth behaviours, making it a significant factor in the discourse on youth sexuality in sub-Saharan Africa. Several studies have found that religion and religiosity play an important role in the sexual behaviours of young people. However, little research in Nigeria has examined the mechanisms through which religiosity influences youth sexual behaviour and if parents' religion moderates this relationship. Guided by the social control theory, this paper contributes to the existing literature by examining the relationship between religiosity and youth sexual behaviour.

METHODS

Data for the study came from 2399 male and female youth aged 16-24 years in four states purposively selected from four regions in Nigeria. Abstinence was the sexual behaviour of interest. Logistic regression was used to examine this relationship.

RESULTS

Results showed that 68% of the youth had never had sex. Religiosity was a protective factor for youth sexual behaviour and this positive association was still evident even after controlling for other covariates. Youth who were highly religious (OR - 1.81, CI- 1.13-2.88) had significantly higher odds of abstaining compared to their counterparts who were not religious.

CONCLUSION

Religiosity is a protective factor for sexual abstinence among youth in Nigeria. Policy makers can work around using religious institutions for behavioural change among youth in Nigeria.

Factors associated with early sexual initiation among preparatory and high school youths in Woldia town, northeast Ethiopia: a cross-sectional study

BACKGROUND

Early initiation of sexual activity affects the sexual and reproductive health of the young population. The youth are at a high risk of risky sexual behaviours, including multiple partners and inconsistent condom use. There has been limited research on the level and determinants of early sexual initiation in Woldia town. Thus, this study aimed to assess the prevalence of early sexual initiation and associated factors among preparatory and high school students in Woldia town, northeast Ethiopia.

METHODS

An institution based cross-sectional study was conducted on 723 students selected by the simple random sampling technique on March 7, 2016. A pre-tested and structured self-administered questionnaire was used for data collection. Descriptive statistics, bivariate and multivariable logistic regression were computed. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was calculated to examine the strength of association. In the multivariable analysis, a p-value < 0.05 was considered as statistically significant.

RESULT

The prevalence of early sexual initiation among preparatory and high school students in Woldia town was 18.4% (95% CI:15.50,21.30%). Not attending religious programs (AOR = 3.2, 95% CI:1.84,5.44), peer pressure (AOR = 1.9, 95% CI:1.14,3.25), cigarette smoking (AOR = 2.3, 95% CI:1.06,4.85), poor parental monitoring (AOR = 2.8, 95% CI:1.77,4.53), and exposure to pornographic materials (AOR = 2.7, 95% CI:1.68,4.40) were significantly associated with early sexual initiation.

CONCLUSION

A large number of students initiated sexual activity at an early age. The practiced is associated with sexual and reproductive health problems. Therefore, raising awareness of students about the risk factors for and implication of early sexual initiation through teachers, religious leaders, and parents is highly recommended.

Correlates of Early Sexual Debut Among Sexually Active Youth in Ghana

Using the 2014 Ghana Demographic and Health Survey, this study explores the correlates of early sexual debut among 2,746 (males = 670 and females = 2,076) sexually active youth aged 15 to 24 years in Ghana. The results indicate that males aged 15 to 19 years (odds ratio [ OR] = 8.84, p < .001) and who had basic education ( OR = 3.17, p < .001) were significantly more likely to initiate sexual debut early. Urban males who had used modern contraceptive ( OR = 0.35, p < .001) were significantly less likely to initiate early sexual debut. Meanwhile, females aged 15 to 19 years ( OR = 4.26, p < .001); who had used modern contraceptive ( OR = 1.99, p < .001); with no formal ( OR = 2.90, p < .001) or basic ( OR = 3.12, p < .001) education; with partial access to media ( OR = 1.58, p < .01); and from the Akans ( OR = 1.73, p < .001), Ewes ( OR = 1.92, p < .001), and other ethnic groups ( OR = 1.63, p < .001) were significantly more likely to initiate early sexual debut. However, employed females living in rural areas ( OR = 0.70, p < .01) and those with average ( OR = 0.54, p < .01) or rich ( OR = 0.51, p < .01) household living in urban areas were significantly less likely to initiate early sexual debut. Interventions and policies targeting those living in both rural and urban areas are therefore needed for adolescent males and females in their early teens before they start engaging in sexual intercourse.

Factors contributing to the duration of postpartum abstinence among Nigerian women: semi-parametric survival analysis

Background

The duration of postpartum abstinence is on the decrease but has not been met with increased uptake of contraceptive in Nigeria. This imbalanced transition could result in shorter birth intervals and worsen maternal and child health outcomes. There is a paucity of information on the duration and predictors of time to end of postpartum abstinence in Nigeria. This study was aimed at understanding the time to end of postpartum abstinence and factors predicting the duration in Nigeria.

Methods

The NDHS 2013 data was used. Data of all women who had ever given birth were included. The time to end of postpartum abstinence was censored among currently breastfeeding mothers. The Kaplan Meier Product Limit method was used to estimate the survival and hazard function while the Cox regression was used to fit a model for time to end of postpartum abstinence at 5% significance level. Data were weighed and provisions were made for multicollinearity.

Results

The overall average duration of postpartum abstinence in Nigeria is 3 month. In all, 58% ended postpartum abstinence within the first three months while 18%, 10%, and 14% ended it within 4–6 months, 7–12 months and after one year respectively. Postpartum abstinence did not last beyond 3 months among 83% of the women in the North-West region, compared with 23% in the North Central region, and 34% in the South East. The Muslims had the highest proportion of women who ended postpartum abstinence within the first three months after delivery at 72% compared with Catholic women (31%). The median time to end of postpartum abstinence was lowest (2 months) among women from North West, Muslims, in poorest wealth quintiles and those with no education. The “hazard” of earlier resumption of sexual activity after birth was over 3 times more likely among women in the North West than those in the North Central (aHR = 3.09, 95% CI: 2.95–3.24). Women using contraceptives had a 40% hazard of ending postpartum abstinence earlier. Rural women were 7.6% times less likely to end postpartum abstinence compared to their urban counterpart. Women from rich households have an excess risk of 14% to end postpartum abstinence early compared to women from poor households.

Conclusion

Women of reproductive age in the North West, who are Muslims and with no education are at higher risk of ending postpartum abstinence early. Hence, policymakers and reproductive health stakeholders should design effective intervention targeted at this group of women as a means of controlling fertility.

Factors associated with early sexual intercourse among teenagers and young adults in rural south of Benin

Early initiation to sexual intercourse increases the risk of sexually transmitted infections including HIV/AIDS and early or unwanted pregnancies. This study aimed identifying the factors associated with the early initiation to sexual intercourse among teenagers and young adults aged 10-24, in the south of Benin. A cross-sectional study was conducted in the south of Benin where 360 respondents were selected by random cluster sampling. Multiple logistic regressions was used to find related factors to early sexual intercourse. The significance level for the tests was of 5%. The average reported age of initiation to sexual intercourse was 14.75±2.18. Among the male teenagers and young adults, 41.11% had an early sexual intercourse against 20.24% for the female gender (P<10-3). The lack of communication between parents-teenagers (P=0.003), level of education of the father (P=0.021), exposure to pornographic movies (P=0.025), an adverse opinion on premarital sexual abstinence (P=0.026) were significantly associated with early sexual intercourse. Communication about health promotion for behavioural change may contribute to delay the age of sexual initiation.

International note: Analysis of risk and protective factors for risky sexual behaviours among school-aged adolescents

This study examined the prevalence and associated factors of risky sexual behaviours among 1648 school-going adolescents using the 2012 Ghana Global School-based Student Health Survey. Our findings showed 33.5% of the participants had ever had sex 32.5% had multiple sexual partners and only 26.2% reported using condom during their last sexual intercourse. Being male, older age, anxiety, loneliness, suicidal ideation, being bullied, food insecurity (hunger), current alcohol and marijuana use were significant risk factors for being sexually experienced, multiple partners, but not condom use. Parental knowledge of activity was a significant protective factor against adolescents' sexual experience. These findings underscore the need to develop school-based interventions that would help reduce risky sexual behaviours among school-going adolescents.

Age at First Sexual Intercourse and Multiple Sexual Partnerships Among Women in Nigeria: A Cross-Sectional Analysis

Background: Little is known about sexual behavior such as first sexual intercourse and number of sexual partnerships among women in Nigeria. Early sexual debut is a widely recognized public health issue due to its influence on higher lifetime sexual partners which in turn is associated with increased vulnerability to pregnancy complications, HIV/AIDS and other and sexually-transmitted diseases. In the present study, we attempted to explore the patterns of age of sexual debut and multiple sexual partnerships among women of reproductive age in Nigeria.

Methods: Women who responded to the questions about the age at first sex and number of lifetime sex partners were selected from two latest rounds Nigeria Demographic and Health Survey (DHS). In total 60,611 women aged between 15 and 49 years were selected for this analysis. Age at sexual debut was used as the predictor of multiple sexual partnerships which was assessed by multinomial regression models with logit link function in complex sample analysis mode.

Results: The median age at first sex was 16 years (Interquartile range 16–24). Age at first sexual intercourse below the age of 19 years was reported by 30.8% of the women. Respectively 45.4% (95%CI = 42.9–47.9) 49.8% (95%CI = 47.8–51.7) of the women reported experiencing first intercourse before reaching 15 and 17 years, whereas 46.9% (95%CI = 45.2–48.7) of the women reported being monogamous and 47.2% (95%CI = 45.6–48.8) and 47.6% (95%CI = 43.8–51.3) had 2–3 and >3 lifetime sexual partners. In multivariable analysis after adjusting for confounding factors, women having sexual debut below 18 years were found to be significantly more likely to have 2–3 and more than 3 lifetime sexual partner.

Conclusion: The study concludes that an increasing proportion of Nigerian women are experiencing sexual debut before reaching 15 years. The findings suggest that early sexual debut is associated with multiple sexual partnerships which may increase the risk of STIs. Stakeholders in health care system need to be aware that early sexual debut can be associated with successive unsafe sexual practices which can lead to adverse health outcomes including HIV infection and STIs, early marriage, unwanted pregnancy, and abortion. Therefore, it is important to design effective interventions to encourage women delay sexual debut to help prevent unintended pregnancies and decrease the disproportionate burden of adverse health outcomes.

Reaching Urban Female Adolescents at Key Points of Sexual and Reproductive Health Transitions: Evidence from a Longitudinal Study from Kenya

Urban areas include large numbers of adolescents (ages 15-19) and young adults (ages 20-24) who may have unmet sexual and reproductive health (SRH) needs. Worldwide, adolescents contribute 11% of births, many of which are in low and middle-income countries. This study uses recently collected longitudinal data from urban Kenyan women to examine the association between targeted intervention activities and adolescents' SRH transitions. The focus was on a female adolescent (15-19) sample and their transition to first sex and first pregnancy/birth. Multinomial logistic regression methods were used to examine whether exposure to program activities was associated with delays in transitions. Overall, a high percentage of adolescents were exposed to television activities with family planning messages. About a third were exposed to community events, program posters, or the Shujaaz comic book that included themes related to relationships and positive health outcomes using recognizable characters. Multivariate analyses found that exposure to the Shujaaz comic book was associated with remaining sexually inexperienced and never pregnant at end line. Future programs for urban adolescents should implement interventions that test novel media strategies, like the Shujaaz comic book, that may be more interesting for young people. Innovative strategies are needed to reach female adolescents in urban settings.

Perception and Practice of HIV/AIDS Counseling and Testing Among Secondary School Adolescents in Ogun Waterside Local Government Area, Ogun State, Southwest Nigeria

A large proportion of Nigerian adolescents are sexually active and the country has one of the highest HIV prevalence among youths globally. This study was done to assess the perception and practice of HIV/AIDS counseling and testing (HCT) among secondary school adolescents in a rural community in Southwest Nigeria. A cross-sectional descriptive study was carried out using multistage sampling method. The results showed that despite high level of HCT awareness, majority of the adolescents (62.9%) had negative attitude toward it. The practice of HCT was poor among majority of the respondents as less than 15% of the adolescents had ever done HCT. This study recommends that adolescents should be better informed on the locations of the health centers within the community and services rendered by them. Peer education on HCT should also be intensified in schools to promote positive healthy sexual lifestyles among adolescents.

Role of Religion in Preventing Youth Sexual Activity in Malaysia: A Mixed Methods Study

One of the popular approaches of preventing youth sexual activity in Malaysia is using religion to promote premarital sexual abstinence. Despite this intervention, youth continue to practise premarital sex. Thus, the purpose of this exploratory mixed methods study was to understand the role of religion on sexual activity among college students in Klang Valley, Malaysia. A self-administered questionnaire survey to determine the relationship between religiosity and youth sexual activity was carried out on 1026 students recruited from 12 randomly selected colleges. Concurrently, face-to-face interviews were conducted on 15 students to explore how religiosity had influenced their decision on sexual activity. The survey data were analysed using logistic regression, while the qualitative data from the interviews were examined using thematic analysis with separate analysis for each gender. Both quantitative and qualitative results were then compared and integrated. Religious activity significantly reduced the risk of continuing sexual activity among female students (AOR = 0.67, CI = 0.47, 0.95, p = 0.02) but not male students. There was no significant relationship of religious affiliation and intrinsic religiosity (inner faith) to sexual activity by gender. Having faith in religion and strong sexual desire were the main themes that explained participants' sexual behaviour. Engaging in religious activity might be effective at preventing female students from being sexually active. However, when sexual urges and desires are beyond control, religiosity might not be effective.

Residential Spaces and Timing of First Sexual Intercourse Among Never-Married Youths in Nigeria

Youths in sub-Saharan Africa who initiate sex at an early age tend to be more vulnerable to HIV/AIDS and other sexually transmitted diseases because of the lack of accurate knowledge of preventive behaviors. Although sociocultural and economic factors associated with sexual initiation among youths have been studied extensively in Nigeria, little is known about the effect of place-based factors. Rural and urban disparities remain high in Nigeria, and these disparities are reinforced by stark regional inequalities between the north and south. Considering these underlying inequalities, we examined the extent to which rural and urban youths in northern and southern Nigeria differ with regard to the timing of sexual initiation using the 2013 Nigerian Demographic and Health Survey. Results from our event history analyses suggest that never-married male and female youths who lived in the urban north delayed their first sexual intercourse compared with their counterparts in the rural north, but those who lived in the rural south had their first sex earlier. Young males who lived in the urban south also experienced their first sex earlier than their counterparts in the rural north. Surprisingly, educated youths and those who had accurate knowledge about HIV/AIDS transmission experienced their first sex early. Clearly, the timing of sexual initiation among youths varies across different spatial and cultural contexts. Therefore, interventions aimed at discouraging early sexual initiation among young people in Nigeria may need to go beyond merely providing health information and services to addressing the livelihood needs of youths, especially those in rural settings.

Early sexual debut: prevalence and risk factors among secondary school students in Ido-ekiti, Ekiti state, South-West Nigeria

Background

Early adolescent sexual activity remains a recurring problem with negative psychosocial and health outcomes. The age at sexual debut varies from place to place and among different individuals and is associated with varying factors. The aim was to determine the prevalence and risk factors of early sexual debut among secondary school students in Ido-Ekiti, South-West Nigeria.

Methodology

This was a cross-sectional study. The respondents were selected using multi-stage sampling technique. Pre-tested, semi-structured, self-administered questionnaire was used to collect data. Data was analyzed using SPSS version 15.

Results

More than two-thirds, 40(67.8%), had early sexual debut. The prevalence of early sexual debut was about 11%. The mean age of sexual debut was 13.10±2.82; the mean age for early sexual debutants was 11.68±1.98. The mean number of sexual partners was 2.44±1.99. Male gender, having friends who engaged in sexual activities had association with early sexual exposure (p<0.05). Alcohol intake had the strongest strength of association for early sexual debut among the students.

Conclusion

The high prevalence of early sexual exposure among the students calls for urgent interventions to stem the trend. This will help to reduce the devastating negative psycho-social and health sequels.

Family functionality and parental characteristics as determinants of sexual decision-making of in-school youths in a semi-urban area of Southwest Nigeria

BACKGROUND

Though research findings have indicated that family characteristics have a bearing on sexual behavior, there is a paucity of published literature on the role of family functionality and parental characteristics on adolescent sexual decision-making. This study was designed to assess the role of family function and parental influence on sexual behavior of in-school youths in secondary schools in a sub-urban area of Southwest Nigeria.

METHODS

A descriptive cross-sectional study was conducted among secondary school students using semi-structured interviewer-assisted questionnaire. Information was obtained on the sexual behavior and parent-child characteristics. Family functionality was assessed using family APGAR standardized instrument. Association was established using χ2-test for qualitative variables and t-test for quantitative variables at p=0.05.

RESULTS

Mean age of respondents was 14.8±2.2 years. Majority were from monogamous family setting (70.7%) and lived with their families (75.6%). About a quarter (26.8%) was from dysfunctional families and 9.2% had ever had sexual intercourse. Recent sexual engagement in the preceding 1 month was reported (47.4%). The mean score for parental monitoring, father-child communication, mother-child communication, and parental disapproval of sex were 10.4±2.2, 9.3±2.3, 9.8±2.4, and 10.4±2.3, respectively. There was a significant association between parental monitoring (t=3.9, p≤0.001), mother-child communication (t=3.03, p=0.003), and parental disapproval of sex (t=5, p≤0.001); and sexual experience.

CONCLUSION

This study showed that parental influence had a vital role in the sexual behavior of young persons. Advocacy and health education interventions are needed among parents regarding their role in the sexual behavior of in-school youths.

EFFECT OF EARLY SEXUAL DEBUT ON HIGH SCHOOL COMPLETION IN SOUTH AFRICA

Early sexual debut is of major concern because it is a correlate for health and economic shocks experienced in adulthood. In South Africa, this concern has provided impetus for research directed at the HIV and AIDS epidemic, teenage pregnancy and the effect of adolescent sexual behaviour on persistence in school. Of interest to the present study is high school completion, which is a well-established empirical barometer of adult socioeconomic opportunities. Using data from the five waves of the Cape Area Panel Study (CAPS), this paper examines the association between sexual behaviours initiated in pre- and early adolescence and high school completion rates. The CAPS study is a longitudinal survey that was designed to investigate young people's (aged 14-22 years) educational attainment and sexual behaviours in Cape Town, South Africa. The sample was constituted from 3213 individuals who had initiated sex during their teenage years and the analysis was undertaken when the youngest cohort was aged 21, an age at which they should have completed high school if they were on time. Logistic regression models were fitted separately for males and females. Overall, the results reveal that early sexual debut is correlated with long-term negative educational outcomes. Individuals who experience early sexual debut are less likely to complete high school than their counterparts who make their sexual debut later on in life. This effect is worse for Africans, who also disproportionately have an earlier sexual debut than other race groups. Apart from race however, the findings also reinforce the effect of other demographic factors on high school completion, namely, place of residence and family socioeconomic status as measured by parental education and household income. Hence, early sexual debut adds another layer of inequality and worsens the plight of Africans, females, those living in rural areas and those who come from low-income families.

TIMING OF SEXUAL DEBUT AMONG UNMARRIED YOUTHS AGED 15–24 YEARS IN SUB-SAHARAN AFRICA

This study aimed to contribute to the evidence on the timing of sexual debut in young people in sub-Saharan African countries. Data were extracted from 34 nationally representative surveys conducted in the region between 2006 and 2014. The study sample comprised unmarried women (n=167,932) and men (n=76,900) aged 15–24 years. Descriptive techniques and Cox proportional regression models were used to estimate the timing of sexual debut, and Kaplan–Meier hazard curves were used to describe the patterns of sexual debut in each country by sex. For the countries studied, sexual debut for both women and men occurred between the ages of 15 and 18 years, with median ages of 16 for women and 17 for men. Overall, education and household wealth provided significant protection against early sexual debut among women, but the reverse was found among men for wealth. Women in rural areas, in female-headed households and in Central, South and West Africa reported higher hazards of early commencement of sexual activity than their counterparts in urban, male-headed households and East Africa. However, the impact of these variables on male sexual debut did not follow a consistent pattern. Varied timing, as well as country-specific risk factors associated with sexual debut for young women and men across sub-Saharan Africa, were identified. Sexual health programmes and interventions for young people may require different approaches for young women and men.

Ethnicity, gender and risky sexual behaviour among Nigeria youth: an alternative explanation

BACKGROUND

While studies in demography and public health have acknowledged the role of ethnic differences, the influence of ethnicity on youth sexual behaviour in Nigeria has received little or no attention. It is important to know how cultural norms and gender roles, which vary by ethnicity, may promote or prevent risky behaviour. Such information could provide insights into previously undetected sexual behaviour in multi-ethnic situations.

METHODS

The Nigeria Demographic and Health Surveys (NDHS) for 2003, 2008 and 2013 were pooled to examine the relationship between ethnicity and youth sexual reproductive health, proxied by age at sexual debut, multiple sexual partners (MSP) and condom use at last sexual activity, among the 6304 females and 1549 males who reported being sexually active in the four weeks preceding the survey. Multivariate analysis using a Cox proportional hazard regression model was used to determine the risk factors for early sexual activity among young people (15-24). Logistic regression was used to predict condom use at last sexual activity and MSP.

RESULTS

The median age at first sexual activity was 16 for females and 17 for males. 43% of male youths used condoms in their last sexual activity, compared to only 16% among females and a higher number of males (81%) had multiple sexual partners compared to females (35%). For females, elevated risks of first sex was higher among Hausa/Fulanis aged 15-19 and elevated risk of first sex was higher among Yoruba males.

CONCLUSION

This study provides further evidence that in order to promote protective sexual behaviours among youth in Nigeria, social, cultural and gender-specific tactics should be put in place for the prevention of HIV and other STIs.

The Role of Condom Use Self-Efficacy on Intended and Actual Condom Use Among University Students in Ghana

Little attention has been paid to the dimensions that help to predict and understand condom use among university students within an African context. A cross-sectional study involving 518 university students in Accra, Ghana was conducted to determine how the Condom Use self-Efficacy Scale-Ghana (CUSES-G) can predict both actual condom use and future condom use. Of all the participants, 84% were sexually active but less than half of the sample (48%) reported to have used condom during their last sexual intercourse. A hierarchical regression analysis showed that components of the Condom Use Self-Efficacy Scale (CUESE-G) such as appropriation, assertiveness, pleasure and intoxication, and STDs predicted condom use and condom use intentions. Behavioural change campaigns targeting university students should encourage condom use self-efficacy, as this would strengthen condom use, which is economically cheap and practically effective means of preventing STIs including HIV.

The media as a critical determinant of the sexual and reproductive health of adolescents in Ibadan, Nigeria

PURPOSE

Findings on the influences of the media on the sexual health of adolescents in vulnerable communities in Ibadan are presented.

METHODS

Phase I of the WAVE study in Ibadan was conducted among participants purposively selected from disadvantaged communities in Ibadan North Local Government Area (LGA). Qualitative research methods (key informant interviews, in-depth interviews, community mapping and focus group discussions as well as photovoice sessions) were utilized.

RESULTS

A total of 132 key informants and adolescents (aged 15-19 years) participated. The key informants were teachers, youth workers, and religious leaders working with adolescents within the LGA. Respondents mentioned a number of media technologies (such as television, cellphones, computers, the Internet as well as online and hard copy novels) that adolescents are exposed to in contemporary times. They said these had positive and negative influences on them. Adolescents often looked up information on the Internet although it was mostly used as a means of meeting and communicating with friends. Respondents stated that the media had a strong influence on adolescents' sexual and reproductive health especially regarding dating, relationships, and sexual practices. It also exposed them to pornography and Internet fraud.

CONCLUSIONS

The study highlighted the important role the media plays in the sexual health of adolescents in Ibadan. Intervention programmes need to make use of this medium to reach out to more adolescents and measures should be instituted to prevent adolescents from misusing the media.

The influence of perceived behaviour control, attitude and empowerment on reported condom use and intention to use condoms among adolescents in rural Tanzania

BACKGROUND

Despite the declining trends of Human immunodeficiency virus (HIV) infection in Sub-Saharan Africa (SSA), unsafe sexual behaviours among adolescents still represent a public health challenge. It is important to understand factors acting at different levels to influence sexual behaviour among adolescents. This study examined the influence of perceived behaviour control, subjective norms, attitudes and empowerment on intention to use condoms and reported use of condoms among adolescents in rural Tanzania.

METHODS

We used a questionnaire to collect data from 403 adolescents aged 14 through 19 years from nine randomly selected secondary schools in the Newala district located in the Southern part of Tanzania. The self-administered questionnaire collected information on sexual practices and factors such as attitudes, subjective norms, perceived behaviour control and empowerment. Binary logistic regression was performed to identify factors associated with intention to use and reported use of condoms.

RESULTS

Sexually active adolescents constituted 40.6 % of the sample, among them 49.7 % did not use a condom at last sexual intercourse and 49.8 % had multiple sex partners. Many (85 %) of sexually active respondents had their sexual debut between the ages of 14 to 17 years. Girls became sexually active earlier than boys. Perceived behaviour control predicted intentions to use condoms (AOR = 3.059, 95 % CI 1.324-7.065), thus demonstrating its importance in the decision to use a condom. Empowerment (odds ratio = 3.694, 95 % CI 1.295-10.535) and a positive attitude (AOR = 3.484, 95 % CI 1.132-10.72) predicted reported condom use, thus turning the decision to actions. Subjective norms had only indirect effects on intention and reported use of condoms.

CONCLUSION

The findings suggest that unsafe sex practices are prevalent among school adolescents in rural areas of Tanzania. Perceived behaviour control and positive attitudes predict intensions to use condoms whereas empowerment predicts reported condom use. The findings may imply that safe sex promotion interventions that simultaneously address socio-cognitive and ecological determinants of sexual behaviours may improve adolescents' safe sex behaviours.

Pubertal Timing and Demographic Predictors of Adolescents in Southwest Nigeria

BACKGROUND

Changes in the timing of puberty have been an area of research interest in developed countries because of its associated health and psychosocial problems. Adolescents in Africa are no exception as they are reaching adulthood today much earlier than before. This changing trend may have a major influence on adolescents' sexual behaviour.

AIM

This study determined the timing of puberty and demographic predictors among the adolescents in southwest Nigeria.

MATERIALS AND METHODS

The study was a cross-sectional study. Using Modified Sexual Maturity Scale (MSMS) of pubertal assessment, data were collected from 1000 respondents from rural and urban areas of Osun state, Nigeria. Data were collected using pre-tested Assisted Self Completion Questionnaires (ASCQ). The rate of pubertal development was based on age group and current pubertal stage. Data were analysed using SPSS version 16. Chi-square and logistic regression analyses were done to identify significant demographic predictors. Statistical significance was at 5% level.

RESULTS

The overall mean age of the respondents was 14.22±2.47 years. The mean age for males was 14.19±2.38 years and 14.25±2.57 years for females. A total of 52.9% of the respondents were males and 47.1% were females. Higher proportions of the females, 41.6% were already in late puberty stages compared to their male counterparts where 21.9% were at this stage. With regards to this rate of pubertal development, more males, 14.2% significantly had late rate of pubertal development than the females 5.1%. The significant demographic predictors was socio-economic class in females only.

CONCLUSION

From this study, the timing of puberty was early for females and socio-economic class is an important demographic predictor for pubertal development. This study was however limited because intrinsic factors such as genetic makeup and nutritional status which could affect the finding were not be excluded.