Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-19T23:21:05.464Z Has data issue: false hasContentIssue false
  • English
  • Français

Sexual and reproductive health knowledge and behaviour of adolescent boys and girls aged 10–19 years in western Kenya: evidence from a cross-sectional pilot survey

Published online by Cambridge University Press:  28 July 2021

Monica Magadi Open the ORCID record for Monica Magadi [Opens in a new window] ,
Dan Kaseje ,
Charles Wafula ,
Margaret Kaseje ,
Pennina Ochola-Odhiambo ,
Salmon Ogutu-Owii ,
Bev Orton ,
Franklin Onukwugha ,
Mark Hayter  and
Lesley Smith
Monica Magadi*
Affiliation:
Faculty of Arts, Cultures and Education, University of Hull, UK
Dan Kaseje
Affiliation:
Tropical Institute of Community Health and Development for Africa (TICH), Kenya
Charles Wafula
Affiliation:
Tropical Institute of Community Health and Development for Africa (TICH), Kenya
Margaret Kaseje
Affiliation:
Tropical Institute of Community Health and Development for Africa (TICH), Kenya
Pennina Ochola-Odhiambo
Affiliation:
Tropical Institute of Community Health and Development for Africa (TICH), Kenya
Salmon Ogutu-Owii
Affiliation:
Tropical Institute of Community Health and Development for Africa (TICH), Kenya
Bev Orton
Affiliation:
Faculty of Arts, Cultures and Education, University of Hull, UK
Franklin Onukwugha
Affiliation:
Faculty of Health Sciences, University of Hull, UK
Mark Hayter
Affiliation:
Faculty of Health Sciences, University of Hull, UK
Lesley Smith
Affiliation:
Faculty of Health Sciences, University of Hull, UK
*
*Corresponding author. Email: M.Magadi@Hull.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

This paper reports findings of a pilot survey of adolescent sexual and reproductive health (ASRH) knowledge and behaviour in Homabay County of western Kenya. The study was based on a cross-sectional survey of 523 male and female adolescents aged 10–19 years from 32 Community Health Units (CHUs). Bivariate analysis of gender differences and associations between ASRH knowledge and behaviour was followed with two-level logistic regression analysis of predictors of ASRH behaviour (sexual activity, unprotected sex, HIV testing), taking individual adolescents as level-1 and CHUs as level-2. The findings reveal important gender differences in ASRH knowledge and behaviour. While male adolescents reported higher sexual activity (ever had sex, unprotected last sex), female adolescents reported higher HIV testing. Despite having lower HIV/AIDS knowledge, female adolescents were more likely to translate their SRH knowledge into appropriate behaviour. Education emerged as an important predictor of ASRH behaviour. Out-of-school adolescents had significantly higher odds of having ever had sex (aOR=3.3) or unprotected last sex (aOR=3.2) than their in-school counterparts of the same age, gender and ASRH knowledge, while those with at least secondary education had lower odds of unprotected sex (aOR=0.52) and higher odds of HIV testing (aOR=5.49) than their counterparts of the same age, gender and SRH knowledge who had primary education or lower. However, being out of school was associated with higher HIV testing (aOR=2.3); and there was no evidence of significant differences between younger (aged 10–14) and older (aged 15–19) adolescents in SRH knowledge and behaviour. Besides individual-level predictors, there were significant community variations in ASRH knowledge and behaviour, with relatively more-deprived CHUs being associated with poorer indicators. The overall findings have important policy/programme implications. There is a need for a comprehensive approach that engages schools, health providers, peers, parents/adults and the wider community in developing age-appropriate ASRH interventions for both in-school and out-of-school adolescents in western Kenya.

Keywords

Adolescent sexual and reproductive healthKnowledge and behaviourGender differences
Type
Research Article
Information
Journal of Biosocial Science , Volume 54 , Issue 5 , September 2022 , pp. 792 - 811
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agyemang, J, Newton, S, Nkrumah, I, Tsoka-Gwegweni, JM and Cumber, SN (2019) Contraceptive use and associated factors among sexually active female adolescents in Atwima Kwanwoma District, Ashanti region-Ghana. Pan African Medical Journal 32(182), doi: 10.11604/pamj.2019.32.182.15344 CrossRefGoogle ScholarPubMed
Awusabo-Asare, K, Kumi-Kyereme, A, Biddlecom, A and Patterson, K (2006) Adolescent Sexual and Reproductive Health in Ghana: Results from the 2004 National Survey of Adolescents. Occasional Report No. 22, Guttmacher Institute, New York. URL: https://www.guttmacher.org/sites/default/files/pdfs/pubs/2006/06/08/or22.pdf (accessed 6th November 2020).Google Scholar
Bello, BM, Fatusi, AO, Adepoju, OE, Maina, BW, Kabiru, CW, Sommer, M and Mmari, K (2017) Adolescent and parental reactions to puberty in Nigeria and Kenya: a cross-cultural and intergenerational comparison. Journal of Adolescent Health 61(4S), S35–S41.CrossRefGoogle ScholarPubMed
Blanc, AK, Tsui, AO, Croft, TN and Trevitt, JL (2009). Patterns and trends in adolescents’ contraceptive use and discontinuation in developing countries and comparisons with adult women. International Perspectives on Sexual and Reproductive Health 35(2), 63–71.CrossRefGoogle ScholarPubMed
Bukenya, JN, Nakafeero, M, Ssekamatte, T, Isabirye, N, Guwatudde, D and Fawzi, WW (2020). Sexual behaviours among adolescents in a rural setting in eastern Uganda: a cross-sectional study. Tropical Medicine and International Health 25(1), 81–88.CrossRefGoogle Scholar
Chandra-Mouli, V, McCarraher, DR, Phillips, SJ, Williamson, NE and Hainsworth, G (2014) Contraception for adolescents in low and middle income countries: needs, barriers, and access. Reproductive Health 11(1), doi: 10.1186/1742-4755-11-1.CrossRefGoogle Scholar
Clark, S and Mathur, R (2012) Dating, sex, and schooling in urban Kenya. Studies in Family Planning 43(3), 161–174.CrossRefGoogle ScholarPubMed
Dimagi (2015) The CommCare Evidence Base for Frontline Workers URL: https://healthmarketinnovations.org/sites/default/files/CommCare_Impact%20Evaluation%20_0.pdf (accessed 5th July 2021).Google Scholar
Doyle, AM, Mavedzenge, SN, Plummer, ML and Ross, DA (2012) The sexual behaviour of adolescents in sub-Saharan Africa: patterns and trends from national surveys. Tropical Medicine & International Health 17(7), 796–807.CrossRefGoogle ScholarPubMed
Every Woman Every Child (2015) The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030): Survive, Thrive, Transform. URL: https://www.who.int/life-course/partners/global-strategy/globalstrategyreport2016-2030-lowres.pdf (accessed 6th November 2020).Google Scholar
Fatusi, AO (2016) Young people’s sexual and reproductive health interventions in developing countries: making the investments count. Journal of Adolescent Health 59(3), S1–S3.CrossRefGoogle ScholarPubMed
Frost, JJ, Lindberg, LD and Finer, LB (2012) Young adults’ contraceptive knowledge, norms and attitudes: associations with risk of unintended pregnancy. Perspectives on Sexual and Reproductive Health 44(2), 107–116.CrossRefGoogle ScholarPubMed
Gallant, M and Maticka-Tyndale, E (2004) School-based HIV prevention programmes for African youth. Social Science & Medicine 58(7), 1337–1351.CrossRefGoogle ScholarPubMed
Gazimbi, MM and Magadi, MA (2019) Individual and community-level determinants of antenatal HIV testing in Zimbabwe. Journal of Biosocial Science 51(2), 203–224.CrossRefGoogle ScholarPubMed
Goldstein, H (2003) Multilevel Statistical Models (3rd Edition). Arnold, London.Google Scholar
Goldstein, H and Healey, MJR (1995) The graphical presentation of a collection of means. Journal of Royal Statistical Society A, 158, 175–157.CrossRefGoogle Scholar
Gupta, N and Mahy, M (2003) Sexual initiation among adolescent girls and boys: trends and differentials in sub-Saharan Africa. Archives of Sexual Behavior 32, 41–53.CrossRefGoogle ScholarPubMed
Haider, TL and Sharma, M. (2012) Barriers to family planning and contraception uptake in sub-Saharan Africa: a systematic review. International Quarterly of Community Health Education 33(4), 403–413.CrossRefGoogle ScholarPubMed
Halpern, CT, Udry, JR, Campbell, B and Suchindran, C (1993) Testosterone and pubertal development as predictors of sexual activity: a panel analysis of adolescent males. Psychosomatic Medicine 55(5), 436–447.CrossRefGoogle ScholarPubMed
Hedeker, D and Gibbons, RD (1994) A random-effects ordinal regression model for multilevel analysis. Biometrics. 50(4), 933–944.CrossRefGoogle ScholarPubMed
Hewett, PC, Mensch, BS and Erulkar, AS (2004) Consistency in the reporting of sexual behaviour by adolescent girls in Kenya: a comparison of interviewing methods. Sexually Transmitted Infections (Supplement 2), ii43–ii48.Google ScholarPubMed
Hindin, MJ and Fatusi, AO (2009) Adolescent sexual and reproductive health in developing countries: an overview of trends and interventions. International Perspectives on Sexual and Reproductive Health 35(2), 58–62.CrossRefGoogle ScholarPubMed
Hulton, LA, Cullen, R and Khalokho, SW (2000) Perceptions of the risks of sexual activity and their consequences among Ugandan adolescents. Studies in Family Planning 31(1), 35–46.CrossRefGoogle ScholarPubMed
KNBS (2010) The 2009 Kenya Population and Housing Census. Kenya National Bureau of Statistics (KNBS), Nairobi, Kenya.Google Scholar
KNBS and ICF Macro (2010) Kenya Demographic and Health Survey 2008–09. National Bureau of Statistics (KNBS), Nairobi, Kenya and ICF Macro, Calverton, MD, USA.Google Scholar
KNBS and ICF Macro (2015) Kenya Demographic and Health Survey 2014. National Bureau of Statistics (KNBS), Nairobi, Kenya and ICF Macro, Calverton, MD, USA.Google Scholar
Khan, S and Mishra, V (2008) Youth Reproductive and Sexual Health. DHS Comparative Reports No.19. Macro International Inc., Calverton, MD, USA.Google Scholar
Knopf, AS, McNealy, KR, Al-Khattab, H, Carter-Harris, L, Oruche, UM, Naanyu, V and Draucker, CB (2017) Sexual learning among East African adolescents in the context of generalized HIV epidemics: a systematic qualitative meta-synthesis. PloS One 12(3), e0173225.Google ScholarPubMed
Kwigizile, E, Shao, E, Mtango, G, Sonda, T, Moshi, J and Chilongola, J (2013) The gap between knowledge and practice of risky sexual behaviors for HIV among university students and staff in Moshi Town in Tanzania. Journal of Public Health in Africa 4(1), e8:38–43.CrossRefGoogle ScholarPubMed
Mburano, RJ-R, Djourdebbe, FB and Ekambi, EE (2020) Social and Individual Factors Associated with Condom Use Among Single Youths: An Analysis of the 2018 Cameroon Demographic and Health Survey. DHS Working Paper No. 170. ICF, Rockville, MD, USA.Google Scholar
Mee, P, Fearon, E, Hassan, S, Hensen, B, Acharya, X, Rice, BD and Hargreaves, JR (2018) The association between being currently in school and HIV prevalence among young women in nine eastern and southern African countries. PLoS One 13(6), e0198898.CrossRefGoogle ScholarPubMed
Meekers, D and Klein, M (2002) Determinants of condom use among young people in urban Cameroon. Studies in Family Planning 33(4), 335–346.CrossRefGoogle ScholarPubMed
Mensch, BS, Hewett, PC and Erulkar, AS (2003) The reporting of sensitive behavior by adolescents: a methodological experiment in Kenya. Demography 40(2), 247–268.CrossRefGoogle ScholarPubMed
Ministry of Health [Kenya] (2015) Kenya Adolescent Sexual and Reproductive Health Policy 2015. URL: https://www.popcouncil.org/uploads/pdfs/2015STEPUP_KenyaNationalAdolSRHPolicy.pdf (accessed 6th November 2020).Google Scholar
Ministry of Health [Kenya] (2016) Kenya HIV County Profiles 2016. National AIDS and STI Control Programme (NASCOP). URL: http://nacc.or.ke/wp-content/uploads/2016/12/Kenya-HIVCounty-Profiles-2016.pdf (accessed 6th November 2020).Google Scholar
Morris, JL and Rushwan, H. (2015) Adolescent sexual and reproductive health: the global challenges. International Journal of Gynaecology & Obstetrics 131 (Supplement 1), S40–S42.CrossRefGoogle ScholarPubMed
Muganda-Onyando, R and Omondi, M (2008) Down the Drain: Counting the Cost of Teenage Pregnancy and School Dropout in Kenya. Center for the Study of Adolescents (CSA), Nairobi, Kenya.Google Scholar
Nalwadda, G, Mirembe, F, Byamugisha, J and Faxelid, E (2010) Persistent high fertility in Uganda: young people recount obstacles and enabling factors to use of contraceptives. BMC Public Health 10, doi: 10.1186/1471-2458-10-530.CrossRefGoogle ScholarPubMed
Ngome, E (2016) Demographic, socio-economic and psychosocial determinants of current and consistent condom use among adolescents in Botswana. World Journal of AIDS 6, 137–156.CrossRefGoogle Scholar
Obare, F, Birungi, H, Undie, C, Wanjiru, M, Liambila, W and Askew, I (2011) Levels, trends and determinants of contraceptive use among adolescent girls in Kenya. APHIA II OR Project in Kenya. Population Council, Nairobi, Kenya. URL: https://knowledgecommons.popcouncil.org/cgi/viewcontent.cgi?article=1171&context=departments_sbsr-rh (accessed 5h July 2021).Google Scholar
Odimegwu, C and Somefun, OD (2017) Ethnicity, gender and risky sexual behaviour among Nigeria youth: an alternative explanation. Reproductive Health 14(1), doi: 10.1186/s12978-017-0284-7.CrossRefGoogle ScholarPubMed
Palomino, GR, Kadengye, DT and Mayega, RW (2019) The knowledge-risk-behaviour continuum among young Ugandans: what it tells us about SRH/HIV integration. BMC Public Health (Supplement 1), doi: 10.1186/s12889-019-6809-y Google Scholar
Paul-Ebhohimhen, VA, Poobalan, A and van Teijlingen, ER (2008) A systematic review of school-based sexual health interventions to prevent STI/HIV in sub-Saharan Africa. BMC Public Health 8, doi.org/10.1186/1471-2458-8-4 CrossRefGoogle ScholarPubMed
Rasbash, J, Steele, F, Browne, W and Goldstein, H (2020) A User’s Guide to MLwiN, Version 3.05. Centre for Multilevel Modeling, University of Bristol, UK.Google Scholar
Romero-Estudillo, E, González-Jiménez, E, Mesa-Franco, MC et al. (2014) Gender-based differences in the high-risk sexual behaviours of young people aged 15–29 in Melilla (Spain): a cross-sectional study. BMC Public Health 14, doi.org/10.1186/1471-2458-14-745.CrossRefGoogle ScholarPubMed
Sam-Agudu, N, Folayan, M and Ezeanolue, E (2016) Seeking wider access to HIV testing for adolescents in sub-Saharan Africa. Pediatric Research 79, 838–845.CrossRefGoogle ScholarPubMed
Seth, P, Lang, DL, Diclemente, RJ, Braxton, ND, Crosby, RA, Brown, LK, Hadley, W and Donenberg, GR (2012) Gender differences in sexual risk behaviours and sexually transmissible infections among adolescents in mental health treatment. Sexual Health 9(3), 240–246.CrossRefGoogle ScholarPubMed
Sheppard, Z, Madise, N and Hennink, M (2004) Gender and Risk of HIV in Ghana and Uganda. University of Southampton, UK. URL: https://www.academia.edu/21261808/Gender (accessed 1st November 2020).Google Scholar
Sommer, M (2011) An overlooked priority: puberty in sub-Saharan Africa. American Journal of Public Health 101, 979–981.CrossRefGoogle ScholarPubMed
Ssebunya, RN, Matovu, JKB, Makumbi, FE et al. (2019) Factors associated with prior engagement in high-risk sexual behaviours among adolescents (10–19 years) in a pastoralist post-conflict community, Karamoja sub-region, North eastern Uganda. BMC Public Health 19, doi.org/10.1186/s12889-019-7352-6 CrossRefGoogle Scholar
Thato, R, Jenkins, RA and Dusitsin, N (2008) Effects of the culturally sensitive comprehensive sex education programme among Thai secondary school students. Journal of Advanced Nursing 62(4), 457–469.CrossRefGoogle ScholarPubMed
UNFPA (2014) Counties with the Highest Burden of Maternal Mortality. Dispatch, United Nations Population Fund, Kenya. URL: http://kenya.unfpa.org/news/counties-highest-burden-maternal-mortality (accessed 21st August 2017).Google Scholar
UNFPA and Population Council (2006) Investing When It Counts: Generating the Evidence Base for Policies and Programs for Very Young Adolescents; Guide and Tool Kit. United Nations Population Fund, New York, USA. URL:https://www.popcouncil.org/uploads/pdfs/InvestingWhenItCounts_2006.pdf (accessed 1st November 2020).Google Scholar
Wood, E, Li, K, Miller, L, Hogg, SR, Montaner, JSG, Schechter, MT and Kerr, T (2005) Baseline self perceived risk of HIV infection independently predicts the rate of HIV seroconversion in a prospective cohort of injection drug users. International Journal of Epidemiology 34(1), 152–158.CrossRefGoogle Scholar