Parental care status and sexual risk behavior in five nationally-representative surveys of sub-Saharan African nations

Background About 10% of children worldwide do not live with either of their biological parents, and although some of these children are orphans, many have living parents. While research shows that orphaned children in Sub-Saharan Africa tend to engage in more sexual risk behaviors than their peers, possibly due to decreased parental oversight and support, it is unclear if these effects also apply to children separated from their living parents. Exploring the question of whether living without parents, regardless of whether they are deceased, is linked to greater sexual risk-taking, this study is the first, to our knowledge, to examine correlates of parental care status in a multi-country, nationally-representative analysis. Methods This study was a secondary analysis of the Centers for Disease Control and Prevention’s Violence Against Children Surveys from Kenya, Malawi, Tanzania, Nigeria, and Zambia. We conducted logistic regressions on N = 6770 surveys of youth aged 13 to 17 years to determine if living with their biological parents predicted the odds of engaging in risky sexual behavior, controlling for demographic factors including orphanhood. Post-hoc regressions examined specific risk behaviors. Results Compared to those living with both parents, youth not living with either parent had heightened odds of engaging in any sexual risk behavior, even when controlling for orphanhood (OR = 2.56, 95% CI: [1.96, 3.33]). Non-parental care predicted heightened odds of non-condom use (OR = 3.35, 95% CI: [2.38, 4.72]), early sexual debut (OR = 1.80, 95% CI: [1.31, 2.46]), and more sexual partners (β = .60, p < .001). Conclusions This study extends prior research linking orphanhood and sexual risk behavior, lending credence to the idea that it is not parental death, but rather parental absence, that leads to sexual risk in youth. Public health programming in Sub-Saharan Africa should consider targeting not only “orphaned youth,” but all children separated from their parents.

Prevalence and factors associated with unplanned pregnancy in The Gambia: findings from 2018 population-based survey

Background Unplanned pregnancy is a public health issue that has detrimental implications for the mother and baby alike. However, few studies have been conducted in The Gambia on this subject. As a result, the prevalence of unplanned pregnancy among women of reproductive age in The Gambia was investigated, as well as the factors associated with it. Methods The Gambia's Multiple Indicators Cluster Survey (MICS) was used to evaluate the 2018 results. Data was obtained from 3790 women aged 15 to 49 who had also given birth. The univariate analysis was conducted using percentage. The adjusted odds ratios (AOR) were determined using a multivariable logistic regression model (with corresponding 95% confidence interval (CI)). The degree of statistical significance was set at 5%. Results Approximately 25.3% (95% CI: 23.1%-27.6%) of the women reported unplanned pregnancy. Women aged 30–34 years had 45% reduction in unplanned pregnancy, when compared with those aged 15–19 years (AOR = 0.55; 95% CI: 0.32–0.94). The Fula and non-Gambian women had 30% and 45% reduction in unplanned pregnancy respectively, when compared with Mandinka women. Those who had no functional difficulties had 47% reduction in unplanned pregnancy, when compared with women who had functional difficulties (AOR = 0.53; 95% CI: 0.30, 0.91). Respondents who had given births to 3–4 and 5 + children were 1.79 and 3.02 times as likely to have unplanned pregnancy, when compared with women who had given birth to 1–2 children. Single/unmarried women were 11.38 times as likely to have unplanned pregnancy, when compared with women currently married/in union (AOR = 11.38; 95% CI: 6.38, 20.29). Local Government Area of residence was significantly associated with unplanned pregnancy. Furthermore, women who were neither happy nor unhappy and 18 + at sexual debut were 1.39 and 1.34 times as likely to have unplanned pregnancy, when compared with the very happy women and those < 18 at sexual debut respectively. Conclusion The rate of unintended pregnancies was large (25.3%). Several causes have been linked to unplanned pregnancies. These results suggest that further efforts are required to enhance women's sex education, expand access to family planning services, and provide affordable health care to high-risk women in order to minimize unintended pregnancies.

A Multilevel Analysis of Trends and Predictors Associated with Teenage Pregnancy and Early Motherhood in Zambia (2001 - 2018)

IntroductionTeenage pregnancy remains a major social and public health challenge in developing countries especially sub-Saharan Africa (SSA) where prevalence rates are still increasing. Even if considerable effort has been made over the years to study determining factors of teenage pregnancy in SSA, few studies have looked at the trends and associated factors over a longer period. Furthermore, no known study has focussed on both individual and contextual factors influencing teenage pregnancy in Zambia. This study, thus sought to fill this gap in knowledge by simultaneously investigating trends of teenage pregnancy and early motherhood as well as its individual and contextual determining factors. MethodsA total pooled weighted sample of 10,010 teenagers (in the age group 15 to 19) from four waves of the Zambia Demographic and Health Surveys (ZDHS) were extracted. Using bivariate analysis, we investigated the trends of teenage pregnancy between 2001 and 2018. Separate multilevel logistic regression models were fitted on pooled teenage pregnancy data in relation to several individual and contextual level factors. Both fixed and random effects were produced. Parameter estimates were produced using Bayesian Markov chain Monte Carlo (MCMC) Methods in BRMS.ResultsResults show that the trends of teenage pregnancy in Zambia have shown an overall decrease of 2% between 2001 and 2018. Almost all the socioeconomic and demographic variables were consistently associated with teenage pregnancy (p < 0.001) in a bivariate analysis across the four ZDHS waves. In multilevel analysis, the odds of being pregnant were higher for teenagers who were aged between 18 and 19 years (AOR = 2.57, 95% CI: 2.20-2.98), employed (AOR= 1.24, 95% CI: 1.06-1.46) married (AOR =8.33, 95% CI: 6.84-10.26) and those with knowledge of fertile period (AOR=1.69, 95% CI: 1.43-2.00). On the other hand, being in higher wealth quintile, 15-17 years of age, exposure to family planning messages and delayed sexual debut were associated with decreased odds of early teenage pregnancy. ConclusionThe study shows that early pregnancy remains a social and public health challenge in Zambia as the country has seen little decrease in the prevalence over the years under consideration. Factors associated with teenage pregnancy and early motherhood include age, marital status, and employment, knowledge of fertility period, wealth quintile, sexual debut and exposure to mass-media family planning messaging. Concerted effort must be made to improve literacy levels, reduce poverty and enhance sexual health promotion through the mass media in view of cultural norms, which may prevent parents and children from discussion sexual education topics thus exacerbate the vice.

Young key populations left behind: The necessity for a targeted response in Mozambique

Introduction The first exposure to high-risk sexual and drug use behaviors often occurs during the period of youth (15–24 years old). These behaviors increase the risk of HIV infection, especially among young key populations (KP)–men how have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID). We describe the characteristics of young KP participants in the first Biobehavioral Surveillance (BBS) surveys conducted in Mozambique and examine their risk behaviors compared to adult KP. Methods Respondent-driven sampling (RDS) methodology was used to recruit KP in three major urban areas in Mozambique. RDS-weighted pooled estimates were calculated to estimate the proportion of young KP residing in each survey city. Unweighted pooled estimates of risk behaviors were calculated for each key population group and chi-square analysis assessed differences in proportions between youth (aged less than 24 years old) and older adult KP for each population group. Results The majority of MSM and FSW participants were young 80.7% (95% CI: 71.5–89.9%) and 71.9% (95% CI: 71.9–79.5%), respectively, although not among PWID (18.2%, 95% CI: 13.2–23.2%). Young KP were single or never married, had a secondary education level or higher, and low employment rates. They reported lower perception of HIV risk (MSM: 72.3% vs 56.7%, p<0.001, FSW: 45.3% vs 24.4%, p<0.001), lower HIV testing uptake (MSM: 67.5% vs 72.3%, p<0.001; FSW: 63.2% vs 80.6%; p<0.001, PWID: 53.3% vs 31.2%; p = 0.001), greater underage sexual debut (MSM: 9.6% vs 4.8%, p<0.001; FSW: 35.2% vs 22.9%, p<0.001), and greater underage initiation of injection drug use (PWID: 31.9% vs 7.0%, p<0.001). Young KP also had lower HIV prevalence compared to older KP: MSM: 3.3% vs 27.0%, p<0.001; FSW: 17.2% vs 53.7%, p<0.001; and PWID: 6.0% vs 55.0%, p<0.001. There was no significant difference in condom use across the populations. Conclusion There is an immediate need for a targeted HIV response for young KP in Mozambique so that they are not left behind. Youth must be engaged in the design and implementation of interventions to ensure that low risk behaviors are sustained as they get older to prevent HIV infection.

Trends and country-level variation in age at first sex in sub-Saharan Africa among birth cohorts entering adulthood between 1985 and 2020

Background: Debuting sexual intercourse is a life course event marking exposure to pregnancy or fatherhood, and sexually transmitted infections (STIs), including HIV. We systematically analysed the timing, distribution, and trends in age at first sex (AFS) in 42 sub-Saharan Africa (SSA) countries. Methods: We collated individual-level AFS data from nationally representative household surveys across SSA. We used a log-skew-logistic distribution to model the distribution of AFS in a Bayesian spatio-temporal hierarchical random-effect model to estimate national trends of AFS over time and space, adjusting for age at report biases. Findings: Small changes in AFS are observed between the birth cohorts entering adulthood between 1985 and 2020, ranging 0.79 years [-0.01-1.51] and 0.48 [-0.03-1.92] for female and male, respectively. Northern SSA countries show appreciable increase in AFS but its gender gap remains the widest compared with minimal gender gap in the southern countries. The gender gap shows little evidence of change over time in most of the countries. Female's AFS approach to a similar age across SSA while male's AFS varies between regions. Proportion ever had sex under fifteen and eighteen are as high 34% and 83%, respectively. AFS distribution is typically asymmetric with most of sexual debut events occur in a span of 3.9 [3.4-5.0] years. Female teen often reports higher AFS compare to their late twenties while male teen report lower AFS; both sexes tend to recall a higher AFS in older ages compared to their thirties. Interpretation: Women debut sexually earlier and in a shorter span of age than men. Northern and southern SSA gender gap are distinctively different. Since the ratifying of HIV/AIDS intervention programs in SSA, a stagnant trend in AFS had remained in the countries most affected by the epidemic.

Sexual Risk Behaviors of Adolescents with Type 1 Diabetes in Comparison with Their Peers

Background: Adolescents with type 1 diabetes mellitus (T1D) may differ from peers regarding sexual risk behaviors. Objectives: To explore sexual risk behaviors of adolescents with T1D in comparison with peers. Materials and methods: The subjects were 174 adolescents, 58 adolescents with T1D (mean ± SD age 16.3 ± 2.0 yrs, disease duration 6.7 ± 3.5 yrs and HbA1c:8.0 ± 1.3%) and 116 without (matched 1:2). Anonymous, self-reported questionnaires were used to evaluate sexual education and behaviors. Results: Fewer adolescents with T1D than those without had a sexual experience (74.1% vs. 87.4%, p = 0.033), with similar age of sexual debut. Among adolescents with T1D, ≥2 risky behaviors were observed less frequently than adolescents without T1D (8.62% vs. 23.27%, p = NS respectively) and in fewer girls than boys in both adolescents with T1D (0% vs. 18.5%, p = NS) and adolescents without T1D (11% vs. 44%, p = 0.022). Adolescents with T1D with ≥2 risky behaviors were older (p = 0.031), younger at first sexual intercourse (p = 0.031), with higher maternal education (p = 0.039). Early sexual debut was associated with higher maternal education (p = 0.014) and HbA1c (p = 0.049). Most adolescents without T1D with ≥2 risky behaviors were boys and older than peers. Conclusions: Adolescents with T1D and females were more cautious than adolescents without T1D regarding sex. The associations of increased risky behaviors with male gender, older age, younger age at sexual debut and higher maternal education in adolescents with T1D merit further investigation.