Socio-demographic characteristics
A total of 426 participants (213 from YFS-implemented and 213 from non-implemented areas) were participated in the study yielding response rate of 93.0 %. The mean age of the respondents was 16.48 (SD± 1.23). More than one-third of the study participants were grade nine students. About 58% of adolescents living in YFS implemented areas and 49% of adolescents living in YFS not implemented areas were residing in rural areas and majority of them were Ari by ethnicity. Regarding the educational background of the adolescents’ mothers, 190 (44.6%) of them were having no formal education in both YFS-implemented and non-implemented areas (Table 1).
Table 1: Socio-demographic characteristics of study participants in YFS-implemented and non-implemented areas in South Ari district, March 2019 (n=426).
Variables
|
Category
|
YFS-implemented
(n=213)
|
YFS non- implemented
(n=213)
|
Total
(n=426)
|
Sex
|
Male
Female
|
136(63.8)
77(36.2)
|
133(62.4)
80(37.6)
|
269(63.1)
157(73.7)
|
Age
|
15-17
18-19
|
166(77.9)
47(22.1)
|
173(81.2)
40(18.8)
|
339(79.6)
87(20.4)
|
Marital status
|
Single
Married
Has boy/girlfriend
Others a
|
143(67.1)
18(8.5)
45(21.1)
45(21.1)
|
168(78.9)
13(6.1)
30(14.1)
2(0.9)
|
311(73.0)
31(7.3)
75(17.6)
9(2.1)
|
Grade of education
|
Grade 9
Grade 10
Grade 11
Grade 12
|
69(45.7%)
70(49.6%)
41(56.2)%
33(54.1%
|
82 (54.3%)
71(50.4%)
32 (43.8%)
28(45.9%)
|
151(35.4%)
141(33.1%)
73(17.1%)
61 (14.3%)
|
Religion
|
Orthodox
Protestant
Muslim
Others b
|
52(24.4)
144(76.6)
15(7.0)
2(0.9)
|
67(31.5)
127(59.6)
15(7.0)
4(1.9)
|
119(27.9)
271(63.6)
30(7.0)
6(1.4)
|
Place of
residence
|
Rural
Urban
|
123(57.7)
90(42.3)
|
104(48.8)
109(51.2)
|
227(53.2)
199(46.7)
|
Ethnicity
|
Ari
Amhara
Goffa
Malle
Othersc
|
146(68.5)
28(13.1)
18(8.5)
5(2.3)
16(7.5)
|
132(62)
33(15.5)
24(11.3)
9(4.2)
15(7)
|
278(65.3)
61(14.3)
42(9.9)
14(3.3)
31
|
Living
arrangement
|
Living with single parents
Living with both parents
Living alone
Living with boy/girlfriend
Living with husband/wife
Living with brothers/sisters
Living with grandparents
|
51(23.9)
88(41.3)
4(1.9)
5(2.3)
15(7.0)
23(10.8)
27(12.7)
|
70(32.9)
78(36.6)
7(3.3)
3(1.4)
13(6.1)
21(9.9)
21(9.9%)
|
121(28.4)
166(38.9)
11(2.6)
8(1.9)
28(6.6)
44(10.3)
48(11.3)
|
Father’s
Educational
Status
|
No formal education
Primary education
Secondary education and above
|
65(48.9%)
81(44.0%)
67 (61.5%)
|
68 (51.1%)
103(56.0%)
42 (38.5%)
|
133(31.2%)
184(43.2%)
109 (25.6%)
|
Mother’s educational status
|
No formal education
Primary education
Secondary education
|
94(49.5%)
66 (45.8%)
53 (57.6%)
|
96 (50.5%)
78 (54.2%)
39 (42.4%)
|
190 (44.6%)
144 (33.8%)
92(21.6%)
|
Others a: separated, divorced; others b: Catholic, Adventist; Others c : Wolayta, Oromo,Konso
Sexual and reproductive health services utilization
Sexual and reproductive health services utilization in YFS-implemented and non-implemented areas were 33.8% [95% CI (28.2-40.4)] and 9.9% [95% CI (6, 14)] respectively. The magnitude of utilization of SRH services has significant difference between YFS-implemented and non-implemented areas (χ2= 37.49, p-value < 0.001). The most common service utilized by adolescents was Information, Education and Communication (80.6%) followed by condom provision (57%) and voluntary counseling and testing for HIV (33.3%). The reasons forwarded by the participants not to utilize SRH services were lack of privacy in health facilities, unfavorable health professional attitude, embarrassment and perceived inadequate medical equipment (Figure 1).
Knowledge and attitude of participants about SRH services
Out of the study participants 53.35% had not been aware of at least one of the SRH services provided in the YFSs. A total of 275 (64.6%) of the adolescents had poor knowledge about SRH services (Table 2).
Table 2: Knowledge of the study participants related to SRH service in YFS-implemented and non-implemented areas in South Ari district, March 2019 (n=426).
Variables
Respondent’ knew about:
|
Yes
Frequency (%)
|
No
Frequency (%)
|
At least one SRH service
|
199 (46.7%)
|
227 (53.3%)
|
Information, education and communication related to SRH issues
|
162 (38.0%)
|
264 (62.0%)
|
Family Planning services
|
181(42.5%)
|
245(57.5%)
|
Pregnancy testing and care
|
26(6.1%)
|
400(93.9%)
|
Treatment of Sexually transmitted Infections
|
21(4.9%)
|
405(95.1%)
|
VCT for HIV
|
150(35.2%)
|
276(64.8%)
|
Condom provision service
|
164 (38.5%)
|
262(61.5%)
|
Cervical cancer screening
|
36 (8.5%)
|
390 (01.5%)
|
Teenage pregnancy can lead to maternal and infant death
|
240 (56.3%)
|
186(43.7%)
|
Unwanted pregnancy can be prevented by using condoms
|
334 (78.4%)
|
92(21.6%)
|
Reproductive tract infections can be caused by unprotected sex
|
63 (14.8%)
|
363 (85.2%)
|
Sexually transmitted diseases can be acquired by unprotected sexual intercourse
|
359 (84.3%)
|
67 (15.7%)
|
HIV/AIDS can be prevented by avoiding unprotected sexual contact.
|
347 (81.5%)
|
79 (18.5%)
|
Among 426 participants, 83.3 % (355/426) agreed that using condom is a sign of not trusting your partner. Eleven percent (71/426) of the participants agreed that a boy/girl should have sex before he/she gets married and 31.2% (133/426) of the participants agreed that discussing condom or other contraceptive methods with young people promotes Promiscuity. Sixty one percent (260/426) of the participants believed that risk of AIDS can be reduced by VCT services. Fifty two percent (223/426) of the participants preferred to visit health facilities to get SRH services. Fifty three (227/426) of the participants agreed that there is no problem if service provider of SRH services is either young or adult and 49.1 % (209/426) of the participants agreed that there is no problem if service provider of SRH services can be male or female. The computed overall attitude of adolescent towards SRH services showed that 295 (69.2%) of them had positive attitude whereas the remaining had negative attitude. A bout 19% of adolescents reported that their culture prohibits them from the utilization of SRH services.
The enabling factors of participants
Among adolescents participated in this study, 20 % and 59.4% of them had experienced open discussion with their families and with their peers on matters related to SRH issues respectively. From the total participants, 33.3%, 59.4% and 7.3 % of them reported their family economic status as poor, average and rich respectively.
The need factors of participants
Out of the respondents, 26.8%, 54.2%, 17.4% and 1.6% perceived their health condition as very good, good, fair and ill respectively. . Concerning worry about their own current health status (previous 12 months), 12%, 79.3%, and 8.7% were not concerned, having some degree of concern and extremely concerned respectively.
Factors associated with utilization of the SRH services
In multivariable binary logistic regression final model, living in YFS implemented areas, mother's educational status, discussion of SRH issues with family, knowledge and attitude remained significantly associated with utilization of SRH services.
The odds of utilizing SRH service among adolescents who lived in YFS implemented areas was four times higher than their counterparts (AOR =4.076, 95%CI: 2.150, 7.727). A part from this, the odds of utilizing SRH services among adolescents whose mother’s educational status was secondary education and above was 2.58 times higher than those whose mothers were having no formal education (AOR=2.588, 95 % CI: 1.220, 5.491). The odds of utilizing SRH service among adolescents who discussed SRH issue with their families was three times higher than that of their counterparts (AOR=3.175, 95%CI: 1.624, 6.206). The odds of utilizing SRH services among adolescents who had good knowledge was 4.5 times higher than those who had poor knowledge (AOR= 4.511, 95% CI: 2.458, 8.278). Similarly, the odds of utilizing SRH services among adolescents who had positive attitude was five times higher than those who had negative attitude (AOR= 5.084, 95% CI:2.764, 9.352) (Table 3).
Table 3: Multivariable logistic regression analysis to identify associated factor of SRH service utilization in South Ari district, March 2019 (n=426).
Variables
|
Category
|
utilization of SRH services
|
COR [95% C.I]
|
AOR [95% C.I]
|
P-value
|
Not utilized
|
Utilized
|
YFS implementation status
|
YFS non- implemented
|
192(90.1%)
|
21(9.9%)
|
1
|
1
|
|
YFS implemented
|
141(66.2%)
|
72(33.8%)
|
4.66[2.74,7.95]
|
4.076 [ 2.150, 7.727]
|
.001
|
Grade of education
|
Grade 9
|
125(82.8%)
|
26(17.2%)
|
1
|
1
|
|
Grade 10
|
101(71.6%)
|
40(28.4%)
|
1.94[1.089,3.33]
|
2.217 [1.070,4.591]
|
0.032
|
Grade 11
|
55(75.3%)
|
18(24.7%)
|
1.57[0.79,3.10]
|
1.807[.737,4.428]
|
0.196
|
Grade 12
|
52(85.2%)
|
9(14.8%)
|
0.83[0.365,1.89]
|
.918 [.329, 2.565]
|
0.870
|
Mother's educational status
|
No formal education
|
166(87.4%)
|
24(12.6%)
|
1
|
1
|
0.028
|
Primary education
|
109(75.7%)
|
35(24.3%)
|
2.22[1.25,3.93]
|
2.069 [1.021,4.191]
|
0.044
|
secondary education and above
|
58(63.0%)
|
34(37.0%)
|
4.05[2.22,7.40]
|
2.588 [1.220, 5.491]
|
0.013
|
Discussion on SRH issue with family members
|
Yes
|
42(48.8%)
|
44(51.2%)
|
6.22[3.69,10.46]
|
3.175 [1.624, 6.206]
|
0.001
|
No
|
291(85.6%)
|
49(14.4%)
|
1
|
1
|
|
Perceived health status
|
Very good
|
84(73.7%)
|
30(26.3%
|
1
|
1
|
0.093
|
Good
|
177(76.6%
|
54(23.4%)
|
2.14[0.24,18.53]
|
1.223 [.102, 14.643]
|
0.874
|
poor
|
66(89.2%)
|
8(10.8%)
|
1.83[0.21,15.54]
|
1.179 [.102, 13.585]
|
0.895
|
Ill health
|
6(85.7%)
|
1(14.3%
|
0.72[0.77,6.83]
|
.363 [.028, 4.640]
|
0.436
|
knowledge
|
Good
|
87(57.6%)
|
64(42.4%)
|
6.24[3.77,10.31]
|
4.511 [2.458, 8.278]
|
.001
|
Poor
|
246(89.5%)
|
29(10.5%)
|
1
|
1
|
|
Attitude
|
Positive
|
73(55.7%)
|
58(44.3%)
|
5.90[3.60,9.66]
|
5.084 [2.764, 9.352]
|
.001
|
Negative
|
260(88.1%)
|
35(11.9%)
|
1
|
1
|
|