Premarital sexual practices and associated factors among high school students in Hawassa city in Ethiopia, 2018: institutional-based cross sectional study design

INTRODUCTION

Adolescent is a period of dynamic change representing the transition from child hood to adult hood and is marked by emotional, physical and sexual maturation. Currently one-fifth of the world's population is adolescents (10-19 years of age), with more than four fifths in developing countries.^1,2 Sexual activity among adolescent has been reported to be on the increasing worldwide.

Most young people throughout world will engage in sexual intercourse by age 20, whether married or un married.^3,4 Several studies in sub Saharan Africa have also documented high and increasing premarital sexual activities amongst adolescents. Data from the DHS from the Africa region show that, in 7 out of 9 countries surveyed, more than half of unmarried woman in their reproductive years (15-49) have had sexual intercourse at least once.⁵

The sexual behavior and reproductive health of young people in developing countries constitute a large proportion of the population in these countries and are disproportionately affected by HIV/AIDS and others negative reproductive health out come. The existing literatures document that adolescents engage in premarital sex with in sufficient knowledge of reproductive health and familyplanning, and the small proportion use contraceptive, especially condom. Adolescent sexual behavior is important because of the possible reproductive outcomes and risky sexua lbehavior is associated with sexually transmitted infections suchas HIV/AIDS.⁶

As long as there is unprotected sexual intercourse there will be un wanted pregnancy. Early initiation of sex poses health risks for both young women and men following unplanned and unintended pregnancy which come up with life threaten conditions, for instances; unsafe abortion, unplanned pregnancy related negative health outcome, HIV/AIDS, Syphilis and other sexual transmitted infections, as result of these there is high chance for premature death.⁷

In a survey conducted among high school students in Addis Ababa reported 38% reported that they were sexually active and of them 71% experienced first sex between the age of 14 and 16 years, and they had peer pressure (35.2%), forced sex (21.6%), alcohol use (11.5%) and drug (10.3%).⁸ Also one study revealed in Zeway, nearly half of study participants have unable to discuss sexual issues due to cultural barrier they faced.⁹

Furthermore, in other studies reported, six in ten of students in Gondar Medical School, seven in ten and two in ten: males and females as study done in Harar, had experience of premarital sexual intercourse.^10,11 According to the study in Jimma University students, 35% of male and 23.1% female students had sexual intercourse before.¹²

A cross-sectional study in Ambo city revealed 66.7% of study participants have had sexual intercourse and female sex, mother education, no pocket money, watching video were found to be positive association.¹³ Moreover, one study have showed in Aleta wondo town, the prevalence of premarital sexual intercourse among female students was 18.3% and a significant associated factors are age, having boyfriend, from rural resident, and going to night club.¹⁴ Also study revealed in Arsi Zone 53.7% of study participants had early sexual debut; and age, alcohol drinking, peer pressure, watching pornography video, and marital status have significant association.¹⁵ Similarly, study done in Alkan University Addis Ababa pointed out that six in ten students had premarital sexual intercourse and being male, alcohol user, age, Khat chewer are predictors.¹⁶ In addition 39.7% was reported as study done in Jimma teacher College for prevalence of premarital sexual intercourse and, pocket money, watching pornography video, batch, accessing information, and mother private employer have significant association.¹⁷

Therefore, up to date information on adolescent sexual practices and factors related to it was needed to in order to develop and strategy to implement the problem because availability of new ideas through videos, music and books which could enforce students to premarital sexual intercourses. Therefore, the aim of this study was to determine adolescent premarital sexual practices and factors related to it in Hawassa city, Ethiopia, 2018.

METHODS

This research was conducted in Hawassa city, southern Ethiopia, which located 270 km of Addis Ababa the capital of Ethiopia. The city has an area of 47.66 Sq. km and divided into eight sub city and 32 kebeles based on population projection of year 2017, the total population of the city is 232,115. School based cross-sectional study was conducted among high school students who were attending grade 9th, 10th, 11th and 12th in Hawassa city, October 12-22, 2018. Students who are attending classes for more than six months were included; and those who unable to respond and seriously ill were excluded from the study. Sample size was calculated using the single population proportion formula with assumptions of 5% of margin of error, 95% CI, 10% non-response rate and 52.8% of proportion of premarital sexual practice (PMSP) adapted from similar study on other highschool northern Ethiopia, final calculated total sample size was become 843.¹⁸ A cluster multi stage sampling technique was employed in order to select the study unit probability proportionate to sample size (PPS) was used to determine the sample proportion for each grade (grades 9-12). Data was collected through self-administered structured questionnaires which was adopted from sexual and reproductive health. The data collectors were teachers from other high school. Training was given for them by the investigator for two days. The English version of the questionnaire was translated first to Amharic & back to English to assure its consistency. Pretest of the questionnaire was carried out on the non-selected school using 5% of 843. The result of the pretest was discussed &some corrections and changes were made on the questionnaires.

After data was collected, the response was coded and entered in to the computer using EPIinfo software and then exported to SPSS version 21 for analysis. Descriptive statistics was computed to describe basic socioeconomic and demographic characteristics of the participants. Bivariate logistic analysis was computed to know the candidate variables for multivariate logistic regression analysis in which p value less than 0.25 variables, and where p value less than 0.05 in multivariate logistic regression found to be statistical association with dependent variable of the study. Finally, all necessary information is reported through text and table forms.

RESULTS

From a total of 853 students who were identified for the study, 813 were participated in the study while 40 refused to participate in the study, yielding the response rate of 96.4%. The majority of the participants were from grade 9 (43.2%), 10 (32.1%), 11 (13.2%) and 12 (11.2%) respectively. More than three fourth of the respondents, 360 (44.3%) were found between the age group of 20-24 year. About 605 (74.4%) of respondents were males and 208 (25.6%) were females. About two third of the respondents, 381 (45.2%) were followers of the orthodox followed by 251 (29.8%) were protestants. Majority of the respondents 795 (94.4%) were never married and 52% have never received any pocket money from their families. About 403 (47.9%) of the study participants were living with both parents, 298 (35.4%) of the participants had illiterate mother and 62 (7.4%) of the respondents fathers were illiterate. In related to substance uses and behaviors; 36.7% of respondents reported drunk alcohol most of the time, 45.8% were ever chew Khat but only 10.7% of participants smoke all types of cigarette once in life time, and 19.2% were see pornography video (Table 1).

Fifty (6.1%) of the respondents often discuss sex related issues with their fathers, 100 (12.3%) discuss occasionally and the rest 663 (81.4%) never discuss sex related issues with their fathers. Four hundred (49.1%) of the respondents also often discuss sex related issues with the relatives and friends, 251 (30.8%) discuss occasionally and the rest 162 (19.9%) never discuss sex related issues with their relatives, friends and others else. Similarly, 120 (14.7%) of the high school adolescent respondents often discuss sex and related issues with their mothers, 210 (25.8%) discuss occasionally and 483 (59.3%) never discuss sex related issues with their mothers (Table 1).

From the total respondents 610 (74.9%) had boy or girl friends; however, only 100 (12.3%) had experienced sexual intercourse, of these 61 are males and the rest 39 are females. 298 (35.4%) of the respondents who had premarital sexual intercourse belong to illiterate mother and 62 (7.4%) of the sexually active students belong to illiterate fathers. Knowledge of students towards the reasons for premarital sexual intercourse was: romantic love 442 (54.0%), sexual desire 3 (0.4%) peer pressure 84 (10.3%), rape 41 (5.0%), to target money 195 (23.8) and others 49 (6.0%) (Table 1).

In order to determine factors associated with premarital sexual intercourse, first scrutinizing of variables were made where variables theirs p value less than or equals to 0.25 in bivariate analysis could be candidate for multivariate logistic analysis, thus were educational status of mother, monthly pocket money, khat chewing, drinking alcohol, smoking cigarette, watching pornography video, and sex of student. And finally, of them, the following variables are statistical significant at multivariate level like being male sex [AOR: 0.48; 95% CI (0.31, 0.75)], illiterate educational status of mother [AOR: 7.35 (4.56, 11.89)], drinking alcohol [AOR: 8.43, 95% CI (5.12, 13.94)], and watching pornography video [AOR: 5.96, 95% CI (3.80, 9.37)] (Table 2).

*P value less than or equal to 0.05, statistical significant.

DISCUSSION

One in-ten respondents had premarital sexual intercourse at the time of the survey, of which females had two-times chance to practice premarital sexual intercourse as compared to the proportion rate of males. On the other hand, this finding is relatively consistent with the study done in high school adolescents in Aleta wondo town with the prevalence of premarital sexual intercourse of 18.3% and another study among in school youths of Shendi town Gojam was 19%.^14,19 These findings were in lower than a result obtained among Agaro high school students where 25% of study participants had premarital sex.¹⁷ This discrepancy might be due to the time duration and current accessibility of information concerning different data sources related to risky behaviors.

Among the socio-demographic factors that show significant association with premarital sexual practice was maternal educational status. In students from those mothers who have no formal educations were 7.35 times higher to practice premarital sex [AOR=7.35, 95 % C.I (4.56, 11.89). this is inter related from finding from Oromia Region Robe town and West Shoa Zone.^17,20

Several case reports and population studies have shown that there is a clear association between consumption of alcohol and premarital sexual initiation this is consistent with the finding from this survey with other finding from Bale, West Shoa.^20,21 According to the result of this study students who drink alcohol were higher to practice premarital sex than that of those who did not drink alcohol according to this study. The possible reason might be, drinking alcohol decrease self-control and predispose to risky behavior such as early initiation of sexual intercourse and rape.

Another socio-demographic characteristic of study participants which was significantly associated with premarital sex was sex. In students from those being female were 5.2 times higher to practice premarital sex [AOR=0.48 95 % C.I (0.31, 0.75). This is inter related from finding from west Shoa Zone, Oromia Region.¹⁷ On the other hand, students pornography were 5.95 times more likely to have odds of premarital sexual practice than the counter parts [AOR=5.96, 95% C.I (3.80, 9.37)]. This finding is in line with study done in Arsi, Addis Ababa, ambo and Shendi town of East Gojam.^13,15,16,19

In short, this study showed that a significant proportion of students that had engaged in premarital sex. Personal desire, peer pressure and to maintain relationship with partner were the most frequently mentioned reasons for students to begin premarital sex. Therefore, regional health bureau, private school administrative, Hawassa town Zonal Health Department and NGOs should work on comprehensive sexual and reproductive health education program in response to the pressing needs of Students must be promoted assertively in the study setting. Sex and adolescent reproductive health education should be included in the school curriculum at all levels so as to equip students with adequate knowledge about healthy sexual practice.

CONCLUSION

One in-ten respondents had premarital sexual intercourse at the time of the survey, of which females had two-times chance to practice premarital sexual intercourse as compared to the proportion rate of males. The study also revealed that mother education, alcohol drinking, and pornography video watching are the only predictor of premarital sexual intercourse among high school students. Thus, strengthen school based reproductive health program, and limiting the accessibility and utilization of unnecessary video is mandatory in collaboration and integration of different stakeholders for sustainable behavioral change.

ACKNOWLEDGEMENTS

We would like to thank those people helped us throughout this research work like my wife Liyuwork Melese, and also special thank goes to study participants for their endeavor participation. Finally, we would like to thank data collectors and supervisors for their unreserved effort.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the institutional ethics committee

REFERENCES

1. 1. CIE P. Adolescent sexual and Reproductive Health Report of the workshop. 1991;8-11.
2. 2. EPA. Annual public Health conference, the health service extension program in Ethiopia, experiences and prospects, Addis Ababa, 2005.
3. 3. ME. Study of sexual behavior and level of awareness about HIV/AIDS/STI Among high school teachers, their attitude towards VCT, DCH FM, and AAU 2004.
4. 4. TG. Barriers to use contraceptive among adolescents in the city of Addis Ababa, Studies in Family planning. 2005;36.
5. 5. GE. Assessment of level of knowledge of reproductive health and sexual behavior among adolescents in Nekemte town, DCH, FM, AAU, 2003.
6. 6. International strategies that work for youth, summary of focus on young adults, end of program report, 2002.
7. 7. WUWB. Special Program of Research Development and Research Training in Human Reproduction. News58.htm.
8. 8. Eshetu F, Zakus D, Kebede. The attitude of students, parents and teachers towards the promotion and provision of condoms for adolescents in Addis Ababa. Ethiopian J. 1997.
9. 9. Taffa N, Desalegn S, Tesfaye A, Mohamed K. Do parents and young people communicate on sexual matters? The situation of family life education (FLE) in rural town in Ethiopia. Ethiop J. 1999;13(3):207.
10. 10. Asefaw. Survey of sexual behavior of the students in relation to HIV/AIDS in Harar town, Eastern Ethiopia. 2003.
11. 11. AD. perception of risks of sexual activities among out-of-school Adolescents in South Gondar Administrative Zone, Amhara Region. 2003.
12. 12. ZK. Sexual Experiences and their correlated among Jimma University students, Jimma University. 2002.
13. 13. Bayisa Abdissa MA, Wubareg Seifu. Premarital Sexual Practices, Consequences and Associated Factors among Regular Undergraduate Female Students in Ambo University, Oromia Regional State, Central Ethiopia. Health Sci J. 2017:7.
14. 14. Emebet Techeletsadik Ds, Deresse Deka. Prevalence, assicated risk factors and consequences premarital sexual intercourse among female student in Aleta Wondo Sidama Zone. J Public Health Epidiomol. 2014:7.
15. 15. DTN. Determinants of Sexual Debut among High School Girl Students in Arsi Zone, Huruta Town, Ethiopia: School based Cross Sectional Study. J Gynecol Women’s Health. 2017:7.
16. 16. Sendo EG. Health premarital sexual practice among unmarried first year undergraduate students in Alkan University College in Addis Ababa, Ethiopia. Global J Med Public. 2014:10.
17. 17. Bekana F Hurissa BT, Hirut Megersa. Prevalence of Pre-marital Sexual Practices and Associated Factors among Jimma Teacher Training College Students in Jimma Town, South West Shoa Zone, Oromiya Region, Ethiopia-2013. J Women's Health Care. 2014:10.
18. 18. Habtamu M DM, Hailu F. Assessment of time of sexual initiation and its associated factors among students in Northwest Ethiopia. Science Journal of Public Health. 2015;3(1):10-8.
19. 19. AK. Sexuality, perception of risk of HIV/ADIS and condom use among high school Adolescents in South Gonder zone, Amhara Region, DCH, FM, AAU. 2004.
20. 20. NI. Factor that influences school adolescent exposure to HIV/AIDS in Bale, Oromia Region, DCH, FM, AAU. 2004.
21. 21. Sexual Health Exchange, Addressing young women, and girl’s unique vulnerability to HIV/AIDS/ 2004/3-4. Data from Ambo Secondary School, Ambo. 2005.