Research Article
Sexual and Reproductive Health Service Utilization and Associated Factors among Adolescent and Youth in Dire Dawa City, Eastern Ethiopia
1Department of public health, College of medicine and health sciences, Dire Dawa University, Ethiopia.
2Department of Midwifery, College of medicine and health sciences, Dire Dawa University, Ethiopia.
3School of Medicine, College of medicine and health sciences, Dire Dawa University, Ethiopia.
*Corresponding Author: Legesse Abera, Department of public health, College of medicine and health sciences, Dire Dawa University, Ethiopia.
Citation: Abera L., Guta A., Fentie D. (2023). Sexual and Reproductive Health Service Utilization and Associated Factors among Adolescent and Youth in Dire Dawa City, Eastern Ethiopia. Journal of Women Health Care and Gynaecology, BRS Publishers. 2(1); DOI: 10.59657/2993-0871.brs.23.007
Copyright: © 2023 Legesse Abera, this is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: April 24, 2023 | Accepted: May 11, 2023 | Published: May 17, 2023
Abstract
Background: adolescents and youth characterized by significant physiological, psychological, and social changes; these were put them at high risk for several sexual and reproductive health problems. Insufficient studies have addressed the burden and risk factors of young people’s sexual and reproductive health services utilization in Ethiopia.
Objective: This study aimed to investigate the adolescents and youth sexual and reproductive health service utilization and associated factors in Dire Dawa City Administration, Eastern Ethiopia.
Methods: For the quantitative data, community-based cross-sectional study was carried out using multistage sampling technique. Data was collected using pretested interview-administered questionnaires and analyzed using SPSS version 24.0. Binary and multiple logistic regression analysis were done to determine the association between the dependent and independent variables. For the qualitative data, phenomenological study was conducted and thematic analysis was employed.
Results: This study revealed that the overall sexual and reproductive health service utilization was found to be 39.5%. Youths’ preference regarding the services majority preferred special service hours designated for adolescents (55.6%), (46.9) preferred a discounted price (43.2%) preferred free service, (37% %) preferred young health providers of the same sex. Having discussion on sexual and reproductive health issues with family, living with partner/friend, convenient service hour, short distance from health facility, having sexual activity within the last 12 months were among the factors associated with sexual and reproductive health services utilization.
Conclusion and recommendation: This study revealed that the overall sexual and reproductive health service utilization was found to be low. Considering the physical and psychological changes of adolescents’ the discussion on sexual and reproductive health matters is highly important and expected from every family.
Keywords: adolescent; youth; sexual and reproductive health; service utilization; dire dawa
Introduction
According to the World Health Organization, adolescents are defined as persons between 10 -19 years of age, youth are those age between 15-24 years old and they are characterized by significant physiological, psychological, and social changes; these put them at high risk for sexual and reproductive health problems. Adolescent and youth period is an important period in a person's life at which new behaviours are learned easier than adulthood. This period is again characterized by immature, exploration and experimentation behaviours of adolescents and youth and subjection to peer influences [1, 2,3, 4].
The world population is composed of 18% of adolescents and 26% of young people (10–24 years) which are about 1.2 billion in which almost 90% live in low-income countries [5, 6]. Adolescent and youth populations in Ethiopia have been increasing during the last few decades. Currently, adolescents constitute about 24% while young adults constitute about 30% of the total population [7]. Adolescent and youth sexual and reproductive health (AYSRH) refers to the physical and emotional well-being of adolescents and youth; includes their ability to remain free from sexual and reproductive health problems. Adolescent and youth sexual and reproductive health is one vital component of adolescent health [8].
The major AYSRH services; including information and counselling on sexual and reproductive health issues, promotion of healthy sexual behaviours through peer education, family planning information, counselling and provision, condom promotion and provision, pregnancy test, human immune virus (HIV) testing and counselling, management of sexually transmitted infections (STIs), antenatal care, delivery services, postnatal care and prevention of mother to child transmission (PMTCT) of HIV, abortion and post abortion care, and appropriate referral linkage between facilities [9-11]. These services must safeguard adolescents’ rights to privacy, respect, and informed consent, while respecting cultural and religious values and the rights and responsibilities of parents [12].
Globally adolescents and youth are facing different sexual and reproductive health problems such as unwanted pregnancy, unsafe abortion, sexual transmitted diseases (STDs) including HIV, however, they are usually mistakenly perceived as healthy and as if they are not in need of special health services [19, 20].
Adolescents and youth having survived all childhood health problems, have been enjoying a relatively low morbidity and mortality period in the past. At present, due to changing conditions such as civilization, urbanization and life style, the health of adolescents and youth is increasingly at stake [23]. Despite the growing needs, there is no adequate health service or counselling specifically suitable for this specific age group unlike children, mothers or adults. This indicates that the SRH needs of adolescents and youth as a group have been largely ignored to date by existing services [24].
In Ethiopia, more than one third of the population is found between the ages of 10-24, in which they are the most vulnerable to a range of reproductive health problems as a result of premarital sexual activities. According to Ethiopian demographic health survey (EDHS) showed that 23% of women aged 15-19 started child-bearing, while 40% were either mothers or pregnant with their first child by their 19 years of age [25 ,30, 34].
Still there is huge gap in accessing adolescents and youth with sexual and reproductive health services in our country. Knowledge about adolescents and youth sexual and reproductive health service preferences to different attributes of health services, identifying reasons for low utilization of SRH services and ensuring supportive environment from parents, teachers, health workers and other relevant would maximize the available sexual and reproductive health service utilization rate [35]. Therefore, the main purpose of this study was to assess adolescent and youth sexual and reproductive health service utilization, and associated factors in Eastern Ethiopia.
Methods and materials
Study area and period
The study was conducted from January 1- 30/2022 in Dire Dawa City Administration in Eastern Ethiopia. Dire Dawa is one of the known and ancient cities in Ethiopia which is found around 515 km far from Addis Ababa in the East of Ethiopia. Dire Dawa has a total population of 453,000 in 2016 consisting of 227,000 males, 226,000 females, and 99,660 young people’s (10-24 years) living in the administration. The total fertility rate (TFR) for the administration is 3.4 child/ woman and annual population growth rate of 2.9.
Study design and population
A community-based cross-sectional study design (using both quantitative and qualitative methods) were employed among adolescent and youth in Dire Dawa city administration, Eastern Ethiopia, 2021/2022. The source population for the study was all adolescents and youth living in Dire Dawa city administration in 2021/2022. For qualitative study the study subjects were key informants (health workers, teachers, and youth) in Dire Dawa City Administration. The study population was all adolescents and youth living in Dire Dawa city administration in 2021/2022 and included in the sample. For qualitative study the study subjects were purposively selected key informants (health workers, teachers, religious leaders, and youth) in Dire Dawa City Administration.
Eligibility criteria
All adolescents and youth living for more than six months in Dire Dawa city administration in 2021/2022 were included. Those adolescents and youth seriously sick at the time of data collection were excluded from the study.
Sample size determination
For quantitative study, the required sample size for the study was determined by using the single population proportion formula.
P= proportion of adolescent & youth utilized at least one SRH services 41% [45], D= margin of error 5%, 95% confidence level and non-response rate of 10%, n=z alpha /2)2 p(1−p)/ D2= (1.96*1.96) 0.41(1-0.41) / 0.05*0.05=372, n= 372, by using design effect which is 2, n=2*372, n=744 and 10% non-response rate gives =818. For qualitative study 6 FGD and 16 in-depth interviews were conducted on purposively selected participants in the study area.
Sampling techniques and procedures
A multistage sampling method was employed. First six administrative kebeles were selected randomly from the total ten kebeles, then the number of households having adolescent and youth with their parents/care-takers were identified in each selected kebele from health extension worker registration logbook. Moreover, the calculated sample size was proportionally allocated to each selected kebeles based on the number of households having adolescent and youth. Finally, the study subjects were selected within each selected kebele’s by simple random method. If two or more adolescents found in selected household the one who was available at the time of data collection was considered for interview but if two or more adolescent/youth available during data collection only one adolescent/youth was selected by lottery method. For qualitative study purposive sampling technique was used. Participants were taken based on their relation with adolescents and youth in their experiences.
Study Variables
Dependent variables
- SRH service utilization
Independent variables
- Socio-demographic and Individual factors,
- Family and household r/t factors,
- Peer and partners related factors,
- Health facility and community related factors.
Data collection instruments
Data collection tools were a pretested structured questionnaire which was adapted by reviewing different literatures and guidelines in line with the objectives of the study (42-54). The tool has four different parts; socio-demographic variables, family and household related factors, peer and partners related factors, community’s and institution related factors. For qualitative data, interview guide was developed based on the focus group discussion (FGD) and in-depth interview guide and tape recorder was used
Data collection procedure and data collectors
Data were collected using the prepared interview-administered questionnaires after orientation given to the study participants by 10 data collectors and facilitators. Since the topic is sensitive issue and our participants were young, the health workers were facilitated the consent by wearing gown and gave to the participants a detail description mainly on the aim of the study, on each part of questionnaires, about consents, the right to participate or not, the right to withdraw at any time, and confidentiality issues and they secure the oral consent and then again obtained the written consent. Qualitative data was collected by the researchers.
Data quality control
The questionnaire was translated to Amharic, Oromic and Sumali languages and back translated to English. Pre-testing of the questionnaire was undertaken in 5% of adolescents and youth in kebeles that not included in the sample before the actual data collection take place and corrections on the instruments were made accordingly. An intensive training was given for all supervisors and data collectors (facilitators). Data collection process was supervised and checked for completeness, clarity and consistency by the facilitators and the principal investigator as soon as submitted.
Operational or Standard definitions
Adolescent and youth SRH Services includes access to information and services on prevention, diagnosis, counselling, treatment and care on STDs/HIV, abortion, unwanted pregnancy, modern contraceptive, sexual activities, and requires that all people can safely reach services without travelling a long distance or wasting time [9-11]. Adolescent and youth sexual and reproductive health services utilization is considered if adolescent and youth having sought or received at least one of the four SRH services that the study focuses on (modern contraceptive service, abortion care/safe abortion service, HIV testing and counselling service, STI diagnosis and treatment service) in the last 12 months [48]. AYSRH service accessibility: The term accessibility in this study was applied to geographical accessibility based on adolescents’ and youth own perception. Adolescents and youth who lived within 1.6-km (1 mile) radius distance from the nearest SRH service centre and from their home less than 30-min walking distance were classified as having high geographical accessibility and low otherwise [45].
Data analysis methods
Data were cleaned, edited, coded and entered to Epi data version 3.1; software then exported to SPSS version 24.0 for analysis. Descriptive statistics frequencies, proportions and summary statistics were used to describe the study population in relation to relevant variables. Binary Logistic regression was used to assess the presence of association between predictors & outcome variable and variables having p-value <0>
Results
Socio-demographic characteristics of the study participants, A total of 810 adolescents and youths were participated in the study with a response rate of 99%. Majority (74%) of the participants were in the age between 15-19 years. The mean age of the study participants was 17.5±3.5 years. Majority of the respondents 445(55%) were males. More than ninety percent of the study subjects (92.6%) had formal education. Most, 660 (81.5%) of the participants were single and 550 (67.9%) of them were living with their both parents, the rest were either with relatives or alone (table 1).
Table 1: Socio-demographic characteristics of respondents on the study SRH service utilization and services preferences among adolescents and youth in DD City, Eastern Ethiopia, (n=810).
| Variables | No. | % | |
| Respondent’s age | <15> | 50 | 6.2 |
| 15-19 | 600 | 74.0 | |
| 20–24 | 160 | 19.8 | |
| Respondents’ Religion | Orthodox | 293 | 36.2 |
| Muslim | 332 | 41.0 | |
| Protestant | 118 | 14.6 | |
| Catholic | 67 | 8.3 | |
| Respondents’ Ethnicity | Oromo | 320 | 39.5 |
| Somali | 280 | 34.6 | |
| Amhara | 188 | 23.2 | |
| others | 22 | 2.7 | |
| Have you had formal education | Yes | 750 | 92.6 |
| No | 60 | 7.4 | |
| Respondents’ educational status | Primary school | 322 | 42.9 |
| Secondary school | 233 | 31.1 | |
| Certificate and above | 195 | 26.0 | |
| Respondents’ occupation | Student | 480 | 59.3 |
| Employee | 90 | 11.1 | |
| No jobs | 110 | 13.6 | |
| Merchant | 94 | 11.6 | |
| Daily labourer | 36 | 4.4 | |
| What is your current source of income, if you are unemployed? | Parents (family) | 480 | 81.64 |
| Relative/Friends | 100 | 16.9 | |
| humanitarian organization | 10 | 1.7 |
Family characteristics of participants
Concerning to the participants’ family characteristics more than half (62.3%) of the participants have had both mothers and fathers alive and living together with them. Furthermore, 331(40.9%) of respondent’s fathers and 290 (35.8%) of respondent’s mothers’ educational status were grade 1-8 and grade 12 and above respectively. Out of the total respondents, 470 (58.0%) reported that they have discussion habit on sexual and reproductive issues with in their family. About 26% of the participants’ family support early marriage and early childbearing. On the other hand, 63.2% of the participants were reported their average monthly family income was less than 5000 ETB and only 98 (12.1%) of participants reported their average monthly family income was greater or equal to 10,000 ETB (table 2).
Table 2: Respondents’ family characteristics on the study SRH service utilization and services preferences among adolescents and youth in Dire Dawa City Administration, Eastern Ethiopia, 2021/2022 (n=810).
| Variables | No. | % | |
| Living status of respondent’s parent | Yes, both alive | 550 | 67.9 |
| No father only alive | 75 | 9.2 | |
| No mother only alive | 130 | 16.1 | |
| No both died | 55 | 6.8 | |
| Occupation of your father | Marchant | 395 | 48.8 |
| Employer | 340 | 42 | |
| Others | 75 | 9.2 | |
| Educational status of your father? | Only read and write | 55 | 6.8 |
| Grade 1-8 | 96 | 11.9 | |
| Grade 9-12 | 328 | 40.5 | |
| 12 and above | 331 | 40.9 | |
| Educational status of your mother? | Only read and write | 100 | 12.3 |
| Grade 1-8 | 195 | 24 | |
| Grade 9-12 | 225 | 27.8 | |
| 12 and above | 290 | 35.8 | |
| Are you living with your father and mother? | Yes | 505 | 62.3 |
| No | 305 | 37.7 | |
| Do you have any SRH discussion with your family? | Yes | 470 | 58 |
| No | 340 | 42 | |
| Do you think your parent control and guide you? | Yes | 700 | 86.4 |
| No | 110 | 13.6 | |
| Do you think your parent discourage you to be access to SRH information & services? | Yes | 340 | 42 |
| No | 470 | 58 |
Respondents and peer characteristics
Among all the study participants 340 (42%) of them had sexually active partners and 26% of them had peer/partner pressure in their daily activities. Regarding to the participants’ last 12- months experience of substance use: almost half 400 (49.4%) of the participants were reported that they have been used any one or more of the addictive substances. Nearly half, (49.4%) and 47.0% of participants were used alcohol and khat respectively. Majority, (28.3%) of the ‘alcohol users’ less frequent once in a monthly & 58.4% chewing less frequently once in a month. Majority (55.5% & 44.8%) of the participants had a peer who were drinking and chewing khat respectively (Table 3).
Table 3: Respondents’ and peer substance utilization in Dire Dawa City Administration, Eastern Ethiopia, 2021 /2022.
| Variables | No. | % | |
| Do you have sexually active peer/partner? | Yes | 340 | 42 |
| No | 470 | 58 | |
| Do you have partner/peer pressure in your daily activity | Yes | 210 | 26 |
| No | 600 | 74 | |
| Have you taken any addictive substances in the last 12 months | Yes | 400 | 49.4 |
| No | 410 | 50.6 | |
| How do you feel about your sexual desire, after you drink Alcohols? | Increase than the usual | 150 | 37.5 |
| I do have les feeling | 130 | 32.5 | |
| No difference than usual | 120 | 30 | |
| Are you chewing khat? | Yes | 380 | 47 |
| No | 430 | 53 | |
| Frequency of chew khat (n=380) | Chewing once in a month | 222 | 58.4 |
| Chewing weekly | 40 | 10.5 | |
| Chewing daily | 80 | 21 | |
| Only on holy days | 38 | 10 | |
| Do you have a peer/partner drinking alcohol? | Yes | 450 | 55.5 |
| No | 360 | 44.5 | |
| Do you have a peer/partner chewing khat? | Yes | 480 | 59.3 |
| No | 330 | 40.7 | |
| Frequency of chew khat? | Chewing once in month | 215 | 44.8 |
| Chewing weekly | 160 | 33.3 | |
| Chewing daily | 105 | 21.9 |
Sexual and reproductive health service utilization of study participants
More than half 530 (65.4%) of the study participants were experienced some sort of sexual and reproductive health problems in their life. Moreover, 320 (39.5%) of the study participants were used at least one sexual and reproductive health services in the last 12 months. Among sexual and reproductive health service utilized, the most frequently utilized were, (30%) family planning services followed by (28%) safe abortion, (22%) HIV counselling services, (20%) STI diagnosis & treatment. Furthermore, more than half of the study participants use Condom (60.2%) and (20.4%) were use oral emergency contraceptive pills by male and female youth respectively (table 4).
Qualitative results
A total of 6 focus group discussion and 16 In-depth interviews were conducted with key informants and adolescents. The qualitative result indicated that, most participants in this study suggested that cultural barriers are a crucial factor contributing to the concealment of sexual and reproductive health problems by adolescents. Lack of positive interaction between mothers and daughters for various reasons such as embarrassment, negative attitudes, and fear of shame, and lack of adequate information on these issues were among major factors for not utilizing SRH services.
A 22-year-old female participant described her experience as follows: “I’d like to get more information on sexual transmitted diseases and about risky sexual behaviour; however, we are not comfortable to ask about these things at home”. The above scenario was agreed by focus group discussion participants, a 25-year-old male teacher said “It is not comfortable in the society and if adolescents have a question about sex, they do not know where to go, so, their knowledge of sex is poor”. Another 20-year-old female participants stated, “I'm really wanted to ask questions about sex from my mother. But I am not simply comfortable asking such questions”.
A 30 years old female teacher said, “In some cultures, parents are the influential sources of knowledge, beliefs, attitudes, and values for children and the youth. If young people do not get information from their families, they will seek answers elsewhere and try to find answers through peers, the media or their observations of adult actions”, so, family has had great responsibility. Research revealed that with an increase in the parent-adolescent communication and conversation the level of sexual risk decreases. One of the most important experiences reported by adolescent and youth in in-depth interview in this study was the modesty shown about the sexual reproductive health issues. The youth are ashamed to ask for information from adults who reluctant to discuss these issues. Hence, taboos, beliefs and traditions may prevent the youth from accessing the necessary information. In many cultures, parents do not talk about sex with their children and therefore they are useful sources of information.
Many of adolescents and youth were complaining about the lack of coverage of sexual and reproductive health issues by the media. Most participants stated that the role of the media in the field of sexual and reproductive health was very insignificant. Most adolescents in the in-depth interview participated in this study believed that reproductive health information obtained through friends is not reliable and cannot be considered as a reliable source. Therefore, the media can eliminate these sources of non-academic information through proper training.
A 20 years old female youth in the in-depth interview said “in our current community there is no as such many sources of information for young people regarding to SRH services, only few advertisers and advertisement take place through the mass media in this regard”.
A 28 years old male health professional in the focus group participants agreed with adolescents and youth and said “the media has a significant impact on educating of youth on sexual and reproductive health issues but the coverage in this topic was limited, but expected to provide accurate information on sexual and reproductive issues to youth”.
Nearly all of adolescents and youth participants wanted sexual health education to be offered formally in their curriculum as a formal course similar to other courses. They were interested in taking a formal course on reproductive health starting from primary school. 17-year-old female youth participants said “we do not have medical books on reproductive health care in the schools…I wish we had a specific book for such things”.
Concerning to the sexual and reproductive health service preference majority of focus group discussants agreed that youths preferred special service hours designated for adolescents, serves with a discounted price, free service, young health providers of the same sex with adolescents, service time on weekend basis and service location where other users don’t see them.
Table 4: Sexual and reproductive health characteristics and service utilization study participants on the study SRH service utilization and preferences among adolescents and youth in Dire Dawa City Administration, Eastern Ethiopia, 2021/2022 (n=810).
| Variables | No. | % | |
| Are you sexually active currently? | Yes | 380 | 46.9 |
| No | 430 | 53.1 | |
| Do you have sexual partner? | Yes | 380 | 46.9 |
| No | 430 | 53.1 | |
| Have you ever experienced sexual intercourse? | Yes | 340 | 42 |
| No | 470 | 58 | |
| How many sexual partners do have (n=380) | One | 301 | 79.2 |
| Two or more | 79 | 20.8 | |
| Ever discussed SRH issues with your partners/peers. | Yes | 320 | 39.5 |
| No | 490 | 60.5 | |
| Which topic you were discussed | Sexual issues | 85 | 26.6 |
| Condom use | 63 | 19.7 | |
| STI/HIV/AIDS | 58 | 18.1 | |
| Unwanted pregnancy | 54 | 16.9 | |
| Contraception | 60 | 18.7 | |
| Did you encounter any medical problems or illness in the last 12 months? | Yes | 650 | 80.2 |
| No | 160 | 19.8 | |
| Have you ever experienced SRH problems? | Yes | 340 | 42.0 |
| No | 470 | 58.0 | |
| Have you utilized SRH services in the last 12 months? | Yes | 320 | 39.5 |
| No | 490 | 60.5 | |
| Which SRH services you have been utilized | Family planning services | 96 | 30.0 |
| HIV counselling services | 70 | 22.0 | |
| STI diagnosis & treatment | 64 | 20.0 | |
| Safe abortion services | 90 | 28.0 | |
Factors associated with RH service utilization
After controlling confounding effect, variables that were statistically significant with sexual and reproductive health service utilization on bivariate analysis were entered in to multivariable logistic regressions. Based on this analysis, having discussion on SRH issues with their family, living with partner/friends, convenience service hour, distance from health facility, having sexual activity within 12 months. Adolescents and youth who were living with partner/friends were about two times more likely to utilize SRH service than those who were living with their parents (AOR = 2.40, 95% CI= 1.55–4.82). In these study adolescents who were perceived SRH service delivery hour is convenient 4.42 times more likely utilize SRH services than those who perceived the service hour is inconvenient (AOR: 4.42, 95% CI=2.22 - 6.63). A shorter distance to a healthcare facility was also found to be significantly associated with SRH service utilization. Adolescents and youth who have had health facility located at nearby were about 1.5 times more likely to utilize reproductive health services as compared to those who come from distance (AOR = 1.54, 95% CI: 1.05, 2.25). Adolescent and youth who had a discussion with family on sexual and reproductive health issues were about 3.8 times more likely to use sexual and reproductive health services than those who had no discussion (AOR = 3.8, 95% CI: 3.11- 5.42). Adolescents and youth who have had sexual activity within 12 months were nearly 2 times more likely to use the services than their counterparts (AOR = 1.95, 95% CI: 1.10, 3.44) (Table 5).
Table 5: Factors associated with adolescent and youth sexual and reproductive health service utilization in Dire Dawa City administration, Eastern Ethiopia, 2022 (n=818).
| Variables | SRHSutilization | COR (95%CI) | AOR (95%CI) | ||
| Yes | No | ||||
| Age of respondents | |||||
| <15> | 7 | 43 | 1 | 1 | |
| 15-19 years | 240 | 360 | 0.40(0.92.95) | 1.86(0.52-.05) | |
| 20-24 years | 73 | 87 | 1.80(1.19-.52) | 1.20(0.19-.54) | |
| Sex of respondents | |||||
| Male | 150 | 295 | 1 | 1 | |
| Female | 170 | 195 | 2.42(1.92-.98) | 1.50(0.28-.87) | |
| Marital status of respondents | |||||
| Married | 69 | 81 | 1 | 1 | |
| Single | 251 | 409 | (1.135-3.726) | 2.56(0.674.89) | |
| With whom are you living with | |||||
| Parents | 140 | 365 | 1 | 1 | |
| Relatives | 45 | 65 | 3.01(1.14-.41) | 5.02(0.24-8.04) | |
| Alone | 43 | 47 | 3.24(1.21-8.21) | 1.20(0.19-5.54) | |
| Partner/friend/husband | 92 | 13 | 2.44(1.21–.11) | 2.40(1.55–4.82) * | |
| Do you think SRH services delivery time convenient for youth? | |||||
| Yes | 130 | 230 | 2.51(1.22-.08) | 4.42(2.22-.63)* | |
| No | 190 | 260 | 1 | 1 | |
| Have you open discussion on SRH? | |||||
| Yes | 210 | 260 | 3.17(1.53 - 6.58) | 3.81(3.11 – 5.42) * | |
| No | 110 | 230 | 1 | 1 | |
| Perceived waiting time for service. | |||||
| Short | 182 | 190 | 2.08(2.44-4.25) | 1.2(0.09-4.51) | |
| Medium | 115 | 215 | 1.79(1.49-4.58) | 1.18(0.54-7.55) | |
| Long | 23 | 85 | 1 | 1 | |
| Health facility located or found | |||||
| Nearby | 216 | 190 | 1.95(1.22-3.19) | 1.54(1.05-2.25)* | |
| Distant/far | 104 | 300 | 1 | 1 | |
| Have you had sexual activity in the last 12 months? | |||||
| Yes | 180 | 160 | 1.32(1.12-3.79) | 1.95(1.10-3.44)* | |
| No | 140 | 330 | 1 | 1 | |
Discussion
This study revealed that the overall sexual and reproductive health service utilization was found to be 39.5%, which was much smaller than study conducted in Mandalay city, Myanmar (67%), and Gondar town, Ethiopia (79.5%) (58, 54). This variation was possibly due to economical, and socio demographical variations, for example, the study in Myanmar was conducted in the age group of 15–24, and maternal care also included in the service package which may inflate the figure in Mandalay city. In contrast, the study done in Gondar town specifically focused on those adolescent and youth who had sexual exposure, this could be potentially increased the likelihood of service utilization. However, adolescents’ and youth service utilization in this study was slightly closer to similar study conducted in Jimma town, Ethiopia 41.1% and in Addis Ababa, 40%, and Awabel district northwest Ethiopia 41% [59-60, 46]. But this study finding was greater than study conducted Machakal district 21.5%, Northwest Ethiopia, Debre Berhan town, Ethiopia, 33.8%, and Woreta town, South Gondar, North West Ethiopia 24.6% [60, 45, 48].
The finding of this study showed that considerable proportion of the adolescents and youth reported that, adolescent’s and youths’ preference regarding the service place and person serving varies widely; but the majority prefers special service hours designated for adolescents (55.6%), and a discounted price (46.9%), free service (43.2 %), and young health providers of the same sex (37%). This finding was agreed with the study conducted in Addis Ababa, Ethiopia [26]. In this study, the result found that living arrangement were played an important role in young people’s utilization of SRH services. Adolescents and youth who were living with their partner/friend were about two times more likely utilized SRH services than those who were living with their parents (AOR = 2.40, 95% CI = 1.55–4.82). This study result was consistent with the study conducted in Debre Berhan town, Ethiopia (45).
However, this finding was contradicting the study conducted in Gondar town where adolescents living with their parents utilized SRH services more likely than their counter parts (54). This could be due to relatively high parental monitoring (86.4%) in our setting. In addition to this, even though majority of the respondents in this study were living with both their parents, the families’ habit of communication on sexual and reproductive issues were quite low (58%). Communication of sexual and reproductive health issues within the family allows the adolescent to enhance their knowledge, build their confidence and in turn scale up their tendency to use those services in demand. Several studies revealed that discussion on sexual and reproductive health issues with sexual partner and peers increase the chance of service utilization [59, 61].
Similarly, this study showed that adolescent and youth who had discussions on SRH issues with their family were found to be about four times more likely to use SRH services than those who didn’t have the opportunity to discuss the matter. This finding was in line with the study conducted in Debre Berhan town, Central Ethiopia [45]. A study done in Bahir Dar; Ethiopia indicated that the barriers in utilizing reproductive health services were inconvenient health facility operating hours [53]. Similarly, this study revealed that adolescent and youth who were perceived SRH service delivery hour is convenient 4.42 times more likely utilize SRH services than those who perceived the service hour is inconvenient (AOR: 4.42, 95% CI=2.22 - 6.63). This could be because of the fact that if the SRH service delivery facility opening hour is convenient for youth they can utilized better.
This study revealed that, shorter distance to a healthcare facility was also found to be significantly associated with SRH service utilization. Adolescents and youth who have had health facility located at nearby were about 1.5 times more likely to utilize reproductive health services as compared to those who come from distance (AOR = 1.54, 95% CI: 1.05, 2.25). This finding was supported by the study conducted in Woreta town, South Gondar, North West Ethiopia, Awabel district northwest Ethiopia and study conducted in Nepal [48,46, 40]. Adolescents and youth who have had sexual activity within 12 months were nearly 2 times more likely to use the services than their counterparts (AOR = 1.95, 95% CI: 1.10, 3.44). Nearly similar finding was obtained with study conducted in East Gojjam area, Goba town, Ethiopia and study conducted in Nepal [55, 61, 40].
Conclusion
The findings of this study indicated that sexual and reproductive health services among young people in the study area were low. Among sexual and reproductive health service utilized, the most frequently utilized were, family planning services followed by safe abortion services, HIV counselling services, and STI diagnosis & treatment were from higher to lower proportion. Having discussion on sexual and reproductive health issues with family, living with partner/friend, convenient service hour, short distance from health facility, having sexual activity within the last 12 months were among the factors associated with sexual and reproductive health services utilization.
Abbreviations
AIDS: Acquired Immune Deficiency Syndrome, AYSRH: Adolescent and Youth Sexual and Reproductive Health, FGD: Focus Group Discussion, SRH: Sexual and Reproductive Health, YRH: Youth reproductive health, YSRH: Youth Sexual and Reproductive Health, EDHS/DHS: Ethiopian Demographic and Health Survey, F/P: Family Planning, MDG: Millennium Development Goal, STI: Sexually Transmitted Infections.
Data Sharing Statement: We confirm that all the data underlying the findings are within the manuscript.
Ethics and Consent Statement
The study was carried out after ethical approval was obtained from Dire Dawa University, Institutional review board (IRB). Information was given to the study participants about the purpose, procedures, and potential risks. Furthermore, data were collected after getting informed written consent from all study participants. For those study subjects age less than 18 years, assent was obtained from their family.
Author Contributions
L.A. analyzed the data and led the report writing, contributed to the study design, data collection and revision of the draft; A.G. data analysis and report writing; D.F. research conceptualization, data curation, contributed to the study design. All authors have read and agreed to the summited version of the manuscript.
Acknowledgments
The authors forward a special salute to study participants, data collectors, and Dire Dawa regional health managers. We also acknowledge Dire Dawa University for providing ethical clearance and material support.
Funding: Author(s) didn’t receive any fund for this study.
Authors Disclosure: The authors declare that they have no conflicts of interest.
References
- World Health Organization. (1999). Programming for Adolescent Health and Development: Report of WHO/UNFPA/UNICEF Study Group on Programming for Adolescents Health. Geneva: WHO.
Publisher | Google Scholor - Friedman LH, Edstron GK. (1993). Adolescent Reproductive Health: an approach to planning health services research. WHO, Geneva.
Publisher | Google Scholor - Ryan SA, Millstein SG, Greene B, Irwin Jr. (1996). CE: Utilization of ambulatory health services by urban adolescents. Journal of Adolescent Health. 18(3):192-202.
Publisher | Google Scholor - KleinJD, Slap GB, Elster AB, CohnSE. (1993). Adolescents and access to health care. Bulletin of the New York Academy of Medicine. 70(3):219.
Publisher | Google Scholor - UNFPA. (2011). Sexual and Reproductive Health of Adolescents: a review of UNFPA assistance. Technical Report. 48.
Publisher | Google Scholor - WHO. (2009). Programming for adolescent health and development report of WHO/ UNFPA/ UNICEF study group on programming for adolescent health, technical report series 886, Geneva.
Publisher | Google Scholor - Central Statistics Authority. (1994). Population and Housing Census of Ethiopia-Results at country level, Addis Ababa.
Publisher | Google Scholor - McIntyre P et al. (2002). Adolescent Friendly Health Services – An Agenda for Change. WHO.
Publisher | Google Scholor - Reproductive Health Outlook. (2010). Adolescent Reproductive Health Program Examples.
Publisher | Google Scholor - WHO: Adolescent friendly health services in South East Asia region: Report of Regional consultation, 9-14 February 2004, Bali, Indonesia.
Publisher | Google Scholor - Roudi-Fahimi F, Ashford L. (2008). Sexual and reproductive health in the Middle East and North Africa: a guide for reporters. Washington DC: Population Reference Bureau.
Publisher | Google Scholor - WHO. (2003). Adolescent-friendly health services: An agenda for change. Geneva, Switzerland.
Publisher | Google Scholor - Senderowitz J. (2015). Adolescent Health reassuring the passage to adulthood, World Bank discussion paper, World Bank Washington DC No: 272.
Publisher | Google Scholor - Hofmann AM, Greydanus DE. (2009). Adolescent Medicine. Second Edition, USA.
Publisher | Google Scholor - Senderowitz J. (2009). Making Reproductive health service youth friendly. Focus on Young Adults.
Publisher | Google Scholor - Marie Stops International. (2005). “A cross Cultural Study of Adolescents” Access to Family Planning and Reproductive Health Education and Service.
Publisher | Google Scholor - Wood K, Aggleton P. Promoting young people’s sexual and reproductive health: stigma, discrimination and human rights. London: Department for International Development.
Publisher | Google Scholor - WHO. (2008). Promoting Adolescent sexual and reproductive health through schools in low income countries; an information brief Department of child and adolescent health, Geneva: WHO.
Publisher | Google Scholor - Fonds C. (2015). Training in Sexual Health Research. GFMER /WHO, Geneva.
Publisher | Google Scholor - Mesganaw F. (2011). Notes on maternal and child health-reproductive health for master of public health students.
Publisher | Google Scholor - Rosen JE. (2014). Adolescent Health and Development: A Resource Guide for World Bank Operations Staff and Government Counterparts. Washington, DC: The International Bank for Reconstruction and Development/The World Bank.
Publisher | Google Scholor - Ringheim K, Gribble J. (2010). Improving the Reproductive Health of sub-Saharan African Youths: A route to achieve the Millenium Development Goals. Washington, USA: Population Reference Bureau. Ref Type: Report
Publisher | Google Scholor - Berhane F. (2009). Assessment of Reproductive Health Service in Front Line Health Institution, under Addis Ababa Health Bureau.
Publisher | Google Scholor - Pathfinder International African Regional Office. (2009). Adolescent Reproductive Health in Africa: Path into the next century.
Publisher | Google Scholor - Central Statistical Agency [Ethiopia] and ICF International. Ethiopia Demographic and Health Survey. (2016). Addis Ababa, Ethiopia and Calverton, Maryland, USA.
Publisher | Google Scholor - FHI/USAID. (2011). Assessment of Youth Reproductive Health Programs in Ethiopia, Youth Net Institute of Development Research,Addis Ababa, Ethiopia.
Publisher | Google Scholor - World Health Organization. (2011). Youth and Health Risk. In Sixty-Fourth World Health Assembly. 1-4.
Publisher | Google Scholor - The World Bank Group. (2011). Why invest in Children and Youth. New York: World Bank.
Publisher | Google Scholor - Hughes J, McCauley AP. (2008). Improving the fit: adolescents’ needs and future programs for sexual and reproductive health in developing countries studies in family planning. Stud Fam Plan. 29(2):233-245.
Publisher | Google Scholor - Federal Democratic Republic of Ethiopia Ministry of Health, National Adolescent and Youth Reproductive Health Strategy (2007–2015).
Publisher | Google Scholor - The federal democratic republic of Ethiopia ministry of health. Health sector transformation plan (2015) 2015/16–2019/20 (2008–2012 EFY).
Publisher | Google Scholor - WHO. (2009). Strengthening health sector response to adolescent health and development. Geneva: World Health Organisation.
Publisher | Google Scholor - WHO. (2012). Making health services adolescent friendly: Developing national quality standards for adolescent-friendly health services. Geneva: World Health Organization.
Publisher | Google Scholor - Ministry of Health [Ethiopia]. (2008). Standards on Youth Friendly Reproductive Health on YFRH Services. Addis Ababa.
Publisher | Google Scholor - FHI/Youth Net. (2008). Assessment of youth reproductive health programs in Ethiopia. Addis Ababa, Ethiopia: Family Health International.
Publisher | Google Scholor - Moya C. (2016). Creating youth-friendly sexual health services in sub-Africa. 1-4.
Publisher | Google Scholor - Ashford L, Makinson C. (2009). Reproductive Health in Policy and Practice: Case Studies from Morocco and Uganda. Washington (DC): Ref Bur.
Publisher | Google Scholor - Dingeta T, Oljira L, Alemayehu T, Akililu A. (2011). First sexual intercourse and risky sexual behaviors among undergraduate students at haramaya university, Ethiopia. Ethiop J Reprod Health. 5:22-30.
Publisher | Google Scholor - Abiodun O, Olu Abiodun O. (2016). Sexual and reproductive health knowledge and service utilization among in-school rural adolescents in Nigeria. J AIDS Clin Res. 7:6.
Publisher | Google Scholor - Kiran Bam1, Fariha Haseen, Rajendra Kumar, M. Sophia Newman, Asiful Haider, Rajshree Thapa, Ismat Bhuyia: Perceived Sexual and Reproductive Health Needs and Service Utilization among Higher Secondary School Students in Urban Nepal: American
Publisher | Google Scholor - Tegegn A, Gelaw Y. (2012). reproductive health services and intimate response shaping partner violence in Sub-Saharan Africa a pragmatic. Reprod Health. 30:4.
Publisher | Google Scholor - Zone H, Nations’ S, Region P. (2017). Public health & and factors affecting adolescents and youth friendly reproductive health services among secondary school students in Hadiya Zone, Southern Nations, Nationalities and People Region, Ethiopia. J Pub Health Safe 2:4.
Publisher | Google Scholor - A, Fantahun M, Worku A. (2006). Original article reproductive health needs of out-of-school adolescents A cross-sectional comparative study of rural and urban areas in northwest Ethiopia. J Health Dev. 20(1):17.
Publisher | Google Scholor - A, Syre T, Egata G, Kenay A. (2016). Utilization of youth friendly services and associated factors among youth in Harar town, east Ethiopia: A mixed method study. BMC Health Serv Res. 16(1):1-10.
Publisher | Google Scholor - Kenean Getaneh Tlaye, Mesfin Abebe Belete, Feleke Hailemichael Astawesegn. (2016). Reproductive health services utilization and its associated factors among adolescents in Debre Berhan town, Central Ethiopia: a community-based cross-sectional study.
Publisher | Google Scholor - A, Kassaw T, Hailu G. (2016). Level of young people sexual and reproductive health service utilization and its associated factors among young people in Awabel District, Northwest Ethiopia. 11(3):1-11
Publisher | Google Scholor - Zewdie Birhanu, Kora Tushune, Mulusew G. Jebena. (2018). Sexual and Reproductive Health Services Use, Perceptions, and Barriers among Young People in Southwest Oromia, Ethiopia.
Publisher | Google Scholor - Addisu Taye, Aynalem Adu and Tesfamichael G/Mariam. (2019). Reproductive health services utilization and its associated factors among secondary school youths in Woreta town, South Gondar, North West Ethiopia, BMC Res Notes. 12:90.
Publisher | Google Scholor - Ministry of Education and UNESCO. (2012). Education sector response to HIV and AIDS: learning from good practices in Ethiopia.
Publisher | Google Scholor - Shivaram K, Nandini C, Malleshappal K. (2011). Knowledge and attitude about reproductive health among rural adolescent girls in Kuppammandal: an intervention study. Biomed Res. 22(3):305-310.
Publisher | Google Scholor - Ifa M. (2019). Risky sexual practice and associated factors among university students, Ambo, Ethiopia.
Publisher | Google Scholor - Abiodun O, Olu Abiodun O. (2016). Sexual and reproductive health knowledge and service utilization among in-school rural adolescents in Nigeria. J AIDS Clin Res. 7:6.
Publisher | Google Scholor - Abebe M, Awoke W. (2014). Utilization of Youth Reproductive Health Services and Associated Factors among High School Students in Bahir Dar, Amhara Regional State, Ethiopia Open Journal of Epidemiology. 4:69-75.
Publisher | Google Scholor - Feleke SA, Koye DN, Demssie AF, Mengesha ZB. (2013). Reproductive health service utilization and associated factors among adolescents in Gondar town, Northwest Ethiopia. BMC Health Services Research.
Publisher | Google Scholor - Abajobir AA, Seme A. (2014). Reproductive health knowledge and services utilization among rural adolescents in east Gojjam zone, Ethiopia: a community-based cross-sectional study. BMC Health Services Research. 14:138.
Publisher | Google Scholor - Abenezer Yared, Zekariyas Sahile, Mulugeta Mekuria. (2014). Sexual and reproductive health experience, knowledge and problems among university students in Ambo, Ethiopia.
Publisher | Google Scholor - Dire Dawa region annual report of. (2020).
Publisher | Google Scholor - Phyu P, Zaw T, Liabsuetrakul T, Htay TT, Mcneil E. (2011). Equity of access to reproductive health services among youths in resource-limited suburban communities of Mandalay City. Myanmar BMC Health Serv Res. 12(1472-6963):1-12.
Publisher | Google Scholor - Ayalew T, Tegegn A, Gelaw Y. (2004). Adolesce t reproductive health services in Jimma city: accessibility and utilization. Ethiop J Heal Sci. 19(2,4):91-102.
Publisher | Google Scholor - Berhane, F., Berhane, Y. and Fantahun, M. (2005) Adolescents’ Health Service Utilization Pattern and Preferences: Consultation for Reproductive Health Problems and Ethiopian Journal of Health Development, 19:29-36.
Publisher | Google Scholor - Gebreselassie B, Takele A, Bililign N, Adera A. Yonas Yimam Ayene AW. (2014). Assessmen of reproductive health service utilization and associated factors among adolescents (15-19 years old) in Goba town, Southeast Ethiopia. Am J Heal Res. 3(4):203-212.
Publisher | Google Scholor
