Reproductive health needs of out-of-school adolescents: A cross-sectional comparative study of rural and urban areas in northwest Ethiopia

Abstract

Abstract Background: It is a globally acknowledged that adolescents, in general, and out-of-school adolescents, in particular often lack access to health information, counseling, legal protection, as well as health care and other social services. Objective: This study is intended to assess and compare reproductive health needs of rural and urban out-of-school adolescents. Methods: A cross-sectional, comparative study was conducted in East Gojjam zone, northwest Ethiopia, in May 2001. Twelve kebeles (smallest social administrative units) were randomly selected from four districts (one urban and three rural). A modified, random walk method was used to identify households in each cluster. Trained 12th grade students collected data using pretested questionnaires. The χ2 - test, the t- test, and the Odds Ratio (OR) with 95% Confidence Interval (CI) were used in data analysis. A multiple logistic regression analysis was performed using the SPSS version 10 statistical program to assess the relative impact of variables on sexual activity and contraceptive use. Results: Overall, 1001 adolescents responded to the interview. Knowledge on reproductive issues appeared good but several misconceptions were observed. Only 53% of the study participants knew that a healthy looking person can have HIV while 40% said that a person can get HIV the first time he/ she has sex. About 10% of the participants believed that they were at risk of getting HIV in the next 12 months, whereas more than 45% reported that they had sexual experience. The mean age at first sexual onset was found to be 13.6 years. Significantly higher proportions of rural adolescents were also found to be sexually active (OR =3.0; 95%CI = 1.9, 6.2). About 46% of the sexually active rural adolescents had 2-5 lifetime sexual partners compared to 35.4% of their urban counterparts. However, contraceptive use including condoms was ten times lower among rural adolescents (OR = 0.10; 95%CI =0.04 - 0.3). Only 2% of the rural compared to 35% of the urban sexually active adolescents had ever used condoms. A high divorce rate of 32% in rural and 27% in the urban adolescents was noted. Conclusions: Early and unprotected sexual activity and misconceptions about HIV/AIDS were found to be prevalent in the study population and rural out-of-school adolescents are at the greatest risk of sexual and reproductive health problems. In this era of the rapid spread of HIV/AIDS, high mobility and the ever increasing interaction between rural and urban populations, appropriate programs to prevent HIV/AIDS and promote reproductive health should be designed for out of school adolescents and rural out of school adolescents need the utmost attention. [Ethiop.J.Health Dev. 2006;20(1):10-17]