Prevalence and Associated Factors of Risky Sexual Behavior among Students of Teachers Education College, in Mettu Town, South West Ethiopia
Yomiyu Temesgen¹, Tsegaye Berkessa² and Zakir Abdu3
1Mettu Health Science College, Mettu, Ethiopia
2 Research, community service and collaboration vice president, Mettu University, Ethiopia.
3Department of Psychiatry, Faculty of Health Sciences, Mettu University, Ethiopia
Submission: April 27, 2018; Published: September 24, 2018
*Corresponding author: Zakir Abdu, Research, community service and collaboration vice president, Mettu University, Ethiopia.
How to cite this article: Yomiyu T, Tsegaye B, Zakir A. Prevalence and Associated Factors of Risky Sexual Behavior among Students of Teachers Education College, in Mettu Town, South West Ethiopia. Glob J Arch & Anthropol. 2018; 7(3): 555712. DOI: 10.19080/GJAA.2018.07.555712
Abstract
Background: Sexual behavior is the core of sexuality matters in adolescents and youths. Globally, young people aged 15-24 years are at the forefront of the epidemic and among the most vulnerable groups for risky sexual behavior that account for an estimated 45% of new HIV infection.
Objective:To assess the prevalence of risky sexual behavior and associated factors among students of Teachers Education Colleges, in Mettu Town, South West Ethiopia, 2018.
Methods: A cross-sectional study was conducted among 478 randomly selected students in Teachers Education College in mettu town, South waste Ethiopia from April to May 2018, using a Self-administered questionnaire for data collection. Simple random sampling technique was used to select study participant from each department. Data were entered Epi-data version 3.1 then exported to SPSS version 20. Binary logistic regression analysis was carried out. Variables with P-values< 0.25 in binary logistic regression was selected as a candidate for multiple logistic regressions to determine independent determinants of risky sexual behavior. Odds ratio was calculated with 95 % CI to show strength of association and P-value < 0.05 was used to declare statistical significance.
Result:A total 444 students participated in the study making the response rate 93%. Two hundred ninty four (66.6%) students reported to have ever had sexual activity. The overall prevalence of risky sexual behavior in this study was 46.6% with [95% CI, (41.9 -51.6)]. In this study ; sex (male) [AOR=2.578; 95% CI: (1.648, 4.033)], study year(year three) [AOR= 2.182; 95% CI: (1.214, 3.921)], Peer pressure [AOR= 3.616; 95% CI: (1.591, 8.484)], were the independent predictors for risky sexual behavior.
Conclusion and Recommendations: The study indicated that a significant segment of risky sexual behaviour and associated factors among Teachers Education college in mettu twon. which were being male, peer pressure and year of study were pridectors factors.Therefore, the needs of youth reproductive health in the college through Governmental and non-governmental organizations working on SRH services should work on better access to information, education and communication on SRH issues to the College students.
Keywords: Risky; Sexual behavior and Associated factors; Mettu Teachers Education College
Abbrevations: COR: Crude Odds Ratio; AOR: Adjusted Odds Ratio; CI: Confidence Interval; STIs: Sexually Transmitted Infections; RSB: Risky Sexual Behaviors; SPSS: Statistical Package for Social Sciences
Background
Sexual behavior is the core of sexuality matters in adolescents and youths. In adolescents and young people risky sexual behavior has been recognized as an important health, social and demographic concern in the developing world. It is a priority public health concern because of the high prevalence of HIV/AIDS and sexually transmitted infections (STIs) among this age group [1]. Risky sexual behavior is defined as an individual’s conduct that increases the susceptibility of the person to sexually transmitted infections (STIs), HIV, unwanted pregnancy and psychological distress. According to published research, risky sexual behaviors may present as having unprotected sex (without or inconsistently using a condom), having multiple sexual partners, having sex under the influence of stimulant substances, or having sex immediately after watching pornographic or early sexual debut before 18 years [2].
Globally, young people aged 15-24 years are at the forefront of the epidemic and among the most vulnerable groups for risky sexual behavior that account for an estimated 45% of new HIV infection [1]. Report from USA showed that 46% of in school youths had ever had sexual intercourse and 34% had sexual intercourse during the previous three months. From this, 39% did not use condom last time they had sex and 77% did not use any birth control to prevent pregnancy the last time they had sex with their opposite sex. About 14% had sex with four or more people during their life time [3].
Study conducted among University students of South Africa and Uganda also showed high rate of multiple sexual partners. It is assumed that university and college students are fully aware of HIV risks and preventive mechanisms; how-ever, evidence showed that they are usually engaged in higher in risky sexual behavior [4]. The majority of adolescent and youth sexual health problems can occur due to different environmental factors [5-7]. Practicing sex with multiple partners, inconsistent condom uses and commencing sex with female commercial sex workers, which were highly risky sexual behaviors for HIV infection transmission among study participants, were commonly practiced [8,9].
In Ethiopia, youth people (aged 15–24) represented one of the country’s largest groups, comprising about 35% of the population and college students are in this age category and are exposed to risky sexual behaviors such as unprotected sexual intercourse leading to HIV, other STIs and unwanted pregnancies [10]. They are more vulnerable to wider sexual and reproductive health problems due to new environment with poor protection, age and the need to explore life, peer pressure and absence of proactive programs and Living independently away from home was considered important factors because it facilitated students to have sex with many different partners without fear of social censure from peers or community members [10].
Youth are at high danger of risky sexual behaviors and reproductive health problems. But these problems are not considered health priorities because more often young people considered having lower morbidity and the youth have limited access to reproductive health services and exposed to risky sexual behavior [7]. Even though youth reproductive health initiatives programs are being implemented at the national level including in learning institutions [11].
However, risky sexual behaviors remain a significant problem predisposing for STIs and HIV infection. The Ethiopian government has developed and implemented various strategies to promote sexual and reproductive health. Despite these interventions, different studies in the country showed a high prevalence of risky sexual behavior [9]. However there are limited information on risky sexual behavior in the study area. Currently, Teachers education colleges do not have accommodations for their students unlike governmental universities. Most of the students come from rural areas and are living in the rented houses away from their supervising families and this could open a door for having risky sexual behavior among college students.
Among U.S. high school students surveyed in 2013, from among those who ever had sexual intercourse, 40.9 % did not use condom the last time they had sex. A study conducted on high school students of China among sexually active adolescents, 42.4 % had unprotected sexual intercourse [1,6]. Different findings in different area reports magnitude of risky sexual behavior in the range of 21.6% to 42.1% as measured by having multiple sexual experience [7,8]. According to EDHS 2011, among young men who had one or more partners in the past year, only 47 % reported using condom in their most recent sexual intercourse [6]. The prevalence of multiple sexual partners among Tanzanian college students was 42%; males were two times more likely to have multiple sexual partners compared to females [4].
In most sub-Saharan African countries, the age of first sex which happens before marriage is less than 18 years. For example, 19% of Rwandese, 37% of Senegalese, 41% of Ghanaian, 49% of Ethiopian, 62% of Democratic republic Congolaise,64% of Ugandan, 79% of Mozambique and 80%of Liberian women aged between 20-24 had sex before 18 years [12]. According to the 2013 UNAIDS report, the HIV prevalence among sex workers is 12 times greater than among the general population [6]. In a meta-analysis study conducted on 26 developing countries including Ethiopia, across countries, male youth under 20 years were about 8 times more likely than were male youth aged 20-24 years to have had higher-risk sex in the last 12 months (95% CI: 6.25-10.01) [13,14].
A study conducted on school adolescents in Addis Ababa confirmed that students who perceived their peers are involved in sexual relationships were eleven times more likely to risky sexual behavior compared to those who did not have this perception [AOR = 11.68 (95%CI: 8.76 - 15.58)] [7]. According to a study among middle and high school students of Colombia, 18.4 % reported sexual intercourse after alcohol consumption, 5.8 % after illegal drugs consumption [15]. A study conducted on exposure to sexually explicit websites and adolescent sexual attitudes and behaviors revealed that adolescent males indicated that their exposure to explicit sex material put their lives at risk of contracting sexually transmitted infections (STIs) including HIV/AIDS because they engaged in unsafe sexual practices as a result of impulsivity and conformity [16].
Methods and Materials
An Institutional based cross-sectional study was conducted from April1 to May. 2018. The study was conducted in Teachers Education College Students, in Mettu Town, Illu-Ababor Zone, and located to the south Waste Ethiopia. Mettu is located 600km in the south western of Addis Ababa, the capital city of Ethiopia the total population of college was 5,539 students which from the register office, 2018. From these 2,253 students are female and 3,287 are male. Total number of regular students are 1663, among these males are 943 and females are 721. Randomly selected regular students from each departments of Teachers Education College. The sample size was determined using single population proportion formula and determined using 95% level of significance and at 4% margin of error considering. The overall pooled prevalence of risky sexual behavior in Ethiopia was 42.8% (9) and 10% non-response was considered to determine the final sample size.
ni =588
Where,
ni = Initial sample size
p = the overall pooled prevalence of risky sexual practice in Ethiopia was 42.8%.
d = margin of error (0.04)
But the source population (N) is <10,000; the sample size was modified using the correction formula. = nf = 43
Where, nf: Final sample size
ni: Initial sample size
N: Total population
Add 10% for non-respondents=10% of sample size+ sample size
nf= 44+434=478
Data were collected through self-administered questionnaire by local language Afan Oromo. Standardized questionnaire adapted and modified from different literature reviews
Measurements
Concerning risky sexual behaviors (RSB), participants were asked [1] if they ever had sexual intercourse (yes/no), [2] how many sexual partners they have had in the last 12 months (1 or more than 1) [3] how frequent they used condom (always or irregularly/never), Those who have more than one sexual partner or those do not use condom regularly were taken to have risky sexual behaviors.
Operational Definitions
Risky Sexual Behaviors
In the context of this study, risky sexual behavior refers to if Adolescent/Youth are practicing at least one of the following problematic sexual behaviors: Having more than one sexual partner or inconsistently/incorrectly condom use.
Inconsistent condom use (Unsafe sex)
Not using condom all the time during every sex act, consistently and correctly for any length of time.
Sex with Commercial sex worker
According to this study, it is defined as ever making of intercourse with a person who performs sex with people in exchange for money or gift.
Multiple sexual partners
The practice of having more than one sexual intercourse at the same time, with the full knowledge and consent of all partners involved.
Data Analysis
The collected data was cleaned, edited, coded and entered Epi-Data version 3.1 then exported to Statistical package for social sciences (SPSS) version 20. The data was also explored again for inconsistencies and missing values. After categorizing and defining variables Frequencies and cross tabulations was used to summarize descriptive statistics. Adjusted odds Ratio was estimated with 95% CI to show strength of association and P-value < 0.05 was used to declare statistical significance. Goodness of fit of the final model was checked using Homer Lemeshow test of goodness of fit considering good fit at P-value ≥0.05(0.086), omnibus likelihood test <0.05(0.000). The results were presented in text, figures and tables.
Ethical Approval and Consent to Participant
Ethical clearance was obtained from the ethical review committee of Mettu University (MeU) School of Post-Graduate Studies. Official letter of cooperation was written to Mettu Teachers Education College. Consent was obtained from those who was meet the inclusion criteria and agreed to participate. Also, affirmation that they were free to withdraw consent and discontinue participation without any form of prejudices was made. Confidentiality of information and privacy of participants was assured for all the information provided, to preserve the confidentiality the data was not exposed to the third party except the principal investigator and advisor.
Result
Socio-demographic Characteristics of the Respondents
A total of 478 students participated, four hundred forty-four respondents completed questionnaires with full information and those questionnaires with inconsistent and incomplete response were excluded from the analysis which make response rate 93%. More than half (55.0%) of respondents were males. The mean (+SD) age of respondents was 20.25(±1.74) years. From the four hundred forty-four, two hundred eighty-four (64%) of them were in the age between (20-24) years, four hundred twenty-three (95.3%) were Oromo in ethnicity and two hundred fifteen (48.4%) were protestant in religion. From the study participants, three hundred one (67.8%) reported living with friends in rented house (Table1).
Sexual practice of study participants in Mettu Teachers Education College, South-West Ethiopia, 2018. (n=294)
Among the study participants 294 ((66.2%), two hundred twenty-six (76.8%) male and sixty-eight (23.2%) female)) students were sexually active. Majority of respondents two hundred seventy-five three (93.5%) reported to engage in sexual activity with their boy or girlfriend and eleven (3.7%) participants had reported to have sex with commercial sex workers. Regarding number sexual partners in the last 12 months of the respondents’ majority of respondents 189 (64.3%) of participants reported they have had one sexual partner (Table 2).
Associated Factors for Risky Sexual Behavior
In Bivariate analysis reveals
The factors that were significantly associated with risky sexual behaviors are includes: sex (male), Age between (20-24 and Age (>24), previous home residence, peer pressure, and drinking alcohol, year of study2 and year of study 3, night club, current living condition Were significantly associated with the risky sexual behavior (Table 3).
COR: Crude Odds Ratio; AOR: Adjusted Odds Ratio; CI: Confidence Interval; 1: Reference Category
In the multivariate logistic regression after adjusting for potential confounders
Sex (male), Year of study [3] and peer pressure were found to be significant associated factor for risky sexual behavior. male was more than two and half times more likely to ever Risky sexual behavior as compared to female [AOR=2.578; 95% CI: (1.648,4.033)]. Those respondents who were peer pressure were more than three times more likely to Risky sexual behavior as compared to non-peer pressure [AOR= 3.616; 95% CI: (1.591,8.484)]. Those respondents who were three years more than two times more likely to Risky sexual behavior as compared to year one [AOR= 2.182; 95% CI: (1.214, 3.921)].
Discussion
The purpose of this study was to assess the prevalence of risky sexual behavior and associated factors among Mettu Teachers Education College of students. The overall prevalence of risky sexual behavior in this study was 46.6% with [95% CI, (41.9 -51.6)]. This finding is in line with study among Debre Marko’s university students (44.7%) [1] and study among Bihar Dar private colleges (42.3%) [17]. But it is higher than studies conducted in other universities in Ethiopia; in Bahirdar 36.4 % [11], among Haramaya University (33.5%) [18] and in Gondar and Bahirdar Universities jointly (16.5%) [19]. This could be because of college students are not living in a campus rather most are living in a rented house away from their supervising families and which could lead students initiate substance use and engage in risky sexual behavior. The other reason for this high disparity could be difference in college-based risk education and information provision to students. In addition, there may be also social and cultural differences as well as the difference in the settings of the cities such as possessing recreational areas.
However; It is far less than other studies in Africa and other parts of the world; in Enugu Nigeria it was reported to be 76.8 %, [20]. Among undergraduates’ students of Muhimbili and Dares Salaam Universities in Tanzania it was reported to be 70.4 % [20] and among students of Ugandan University (60.3%) [21]. This difference may be attributable to the social and cultural differences and unpredictability behaviors of sexual behaviors of youth. In this study, peer pressure was associated with risky sexual behavior. Respondents who had experienced peer pressure to have sex were more than three times more likely to risky sexual behavior than their counterpart [AOR= 3.616; 95% CI: (1.591, 8.484)]. This finding is in line with studies conducted in school-youth of West Gojam zone [22], among high school in Bahir Dar town [23], and Studies in South Africa [14]. This could be due to youth spend most of their time with their peers so that peers are most influential socializing agent for sexuality among youth. Besides youth need attention, and recognition with peers so that they are liable to behave in a manner intimate friend practice.
In this study, year of study was independently associated with risky sexual behavior. Respondents who were year three were found to be more than two times more likely to engage in risky sexual behavior when compared with year one [AOR= 2.182; 95% CI: (1.214, 3.921)]. This finding is in line with study among Madawalabu University, Fourth- and third-year students were nearly three times and two times more likely to ever have risky sexual behavior as compared to first year students [5]. This justifies that as year of study increases the risk of having risky sexual behavior also increases; this might be because of alcohol use, peer pressure, and increased level of extroversion [17]. A qualitative study in Jimma University asserted that most students focus on their academic performance for first year and tend to engage in love, sexual activity and have risky sexual behavior after assuring their academic survival [7].
In this study sex of respondents was associated with risky sexual behavior. The findings of this study revealed that male respondents were more than two and half times more likely to have risky sexual behavior than females [AOR=2.578; 95% CI: (1.648, 4.033)]. This finding is in line with Tanzanian college students where males were two times more likely to have risky sexual behavior [24]. And this finding is consistent with finding from Haramaya University which revealed that being male students is significantly associated with risky sexual behavior. The odds of performing risky sex among males were two times higher than that of females [11]. This might be due to several factors like high level of personal freedom and romantic videos (pornography) which offers an opportunity for high level of sexual networking. The other reason could be substance use such as chat and alcohol were more common in males.
Limitations of the Study
The behavioral outcomes were based on self-reported information, which was subject to reporting errors and bias. The study is limited to college students so that the result cannot be generalized to the out of college youth in the town.
Conclusion and Recommendations
Conclusion
A considerable proportion of students in the college practice risk sexual behavior which endangers their future, which was 46.6% with [95% CI, (41.9-51.6)]. Among the associated factors, variables such as sex (male), having sex due to peer pressure, and year of study, among college students were found statistically significant with risky sexual behavior. This implies the need for concerted effort to alleviate the problem. When the practice of risk sexual behavior among college students is qualitatively explored, students perceived that having sex is a sign of modernization.
Recommendations
This study suggests that mettu Teachers Education College need to:
a. Peers have greater influence on the positive and negative behavior of their friends. In order to protect youth from risky sexual behavior, college focus on promoting peer educators and the way of peer discussion.
b. College should inform their students, especially third year students, about the risky sexual behavior and its consequences.
c. Intervention consider males because the problems of high-risk sexual activity were reported mostly among male participants.
d. Governmental and non-governmental organizations working on SRH services should work on better access to information, education and communication on SRH issues to the College students.
e. Researchers
f. Furthermore, this study suggests that there is a need of further investigation or researches using qualitative studies on longitudinal base or triangulated quantitative research to explore and identified the associated factors very well, and should address sociocultural, attitude of youth among college students.
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