Background characteristics of the study participants
A total of 839 female adolescents were consecutively enrolled into this study. The age range was 15 to 19 years, and the mean age was 18.3 years (SD = 0.83). As shown in table 1, seven hundred and twenty-seven (86.7%) of the participants were adolescents aged 18 years and above and 544 (64.8%) were either married or cohabiting. Considering the sexual and reproductive history, 169 participants (20.1%) had their first sexual intercourse below 16 years and 591 (70.4%) had ever been pregnant, 319 (54%) of whom had 2 or more children.
Table 1: Background characteristics of study participants
Variable
|
Number (N = 839)
|
Percentage (%)
|
Age
|
|
|
15 – 17
|
116
|
13.8
|
18 – 19
|
723
|
86.2
|
Religion
|
|
|
Catholic
|
440
|
52.4
|
Anglican
|
193
|
23.0
|
Moslem
|
1
|
0.1
|
Adventist
|
66
|
7.9
|
Other (Pentecostal, Lutheran, EFC, AIC)
|
139
|
16.6
|
Ethnicity
|
|
|
Acholi
|
659
|
78.6
|
Dinka
|
19
|
2.2
|
Nuer
|
18
|
2.1
|
Lotuho
|
46
|
5.5
|
Other (Bari, Shilluk, Luo)
|
97
|
11.6
|
Education
|
|
|
None
|
81
|
9.7
|
Primary
|
595
|
70.9
|
Secondary
|
148
|
17.6
|
Tertiary
|
15
|
1.8
|
Occupation
|
|
|
Self-employed / Employed
|
33
|
3.9
|
Unemployed
|
335
|
39.9
|
Peasant farmer
|
305
|
36.4
|
Student
|
166
|
19.8
|
Marital status
|
|
|
Single
|
233
|
27.8
|
Cohabiting
|
381
|
44.4
|
Married
|
163
|
19.4
|
Separated/Divorced/Widowed
|
62
|
7.4
|
Duration in the camp
|
|
|
≤ 12 months
|
135
|
16.1
|
> 12 months
Age at first sex (mean=16, SD = 1.09)
|
704
|
83.9
|
12 to 15
|
169
|
20.1
|
16 to 17
|
537
|
64.0
|
18 to 19
|
133
|
15.9
|
Ever been pregnant
|
|
|
Yes
|
591
|
70.4
|
No
|
248
|
29.6
|
Number of children alive (n-591)
|
|
|
0
|
31
|
5.3
|
1
|
275
|
46.5
|
2 – 4
|
285
|
48.2
|
Partner’s age* (Median= 26, Range=16 to 60)
|
|
|
16 to 25
|
281
|
43.5
|
26 to 35
|
331
|
51.3
|
36 – 60
|
30
|
4.6
|
Partner’s Education
|
|
|
None
|
13
|
2.0
|
Primary
|
190
|
29.4
|
Secondary
|
423
|
65.5
|
Tertiary
|
20
|
3.1
|
Partner’s Occupation
|
|
|
Self-employed / Employed
|
193
|
29.9
|
Unemployed
|
267
|
41.3
|
Peasant farmer
|
129
|
20.0
|
Student
|
57
|
8.8
|
Knowledge and accessibility of modern contraceptives among the study participants
A total of 758 participants (90.3%) had ever heard about modern contraceptives, 513 (67.7%) had heard about modern contraceptives from a health worker, 124 (16.4%) from family and friends, 83 (10.9%) from school and 38 (5%) from media (newspaper, television, radio, drama and posters). A good number of participants (82.1%) knew at least two modern contraceptives and the commonly known type was the condom (70.3%).
Regarding accessibility of the modern contraceptives, almost all the participants (99.6%) mentioned that the health facility was the only source of modern contraceptives they knew. A total of 589 (70.2%) of the participants did not know a contraceptive source within 10 minutes’ walk from their homes.
Modern contraceptive use among the study participants
The prevalence of modern contraceptive use among the 839 participants was 8.7% (95% CI: 7.0 – 10.8). Amongst the users, 31 (42.5%) were using injectable contraceptives and 40 (59.7%) had used the contraceptives for six months or less. The main reasons for not using modern contraceptives given by 301 (39.3%) of the non-users was fear of side effects (table 2).
Table 2: Modern contraceptive use among refugee adolescents in Northern Uganda
Variable
|
Number
|
Percentage
|
Use of modern contraceptives (n = 839)
|
|
|
Yes
|
73
|
8.7
|
No
|
766
|
91.3
|
Method of modern contraceptive used (n=73)
|
|
|
Condom
|
12
|
16.4
|
Oral contraceptive (pill)
|
4
|
5.5
|
Injectable contraceptive
|
31
|
42.5
|
Implant
|
26
|
35.6
|
Intra-Uterine Device (IUD)
|
0
|
0.0
|
Duration of use (n = 67)
|
|
|
6 months or less
|
40
|
59.7
|
7 to 12 months
|
18
|
26.9
|
More than 12 months
|
9
|
13.4
|
Reasons for non – use (n = 766)
|
|
|
Infrequent sex
|
83
|
10.8
|
Cultural / Religious prohibitions
|
85
|
11.2
|
Partner prohibitions
|
126
|
16.4
|
Fear of side effects
|
301
|
39.3
|
Lack of knowledge
|
105
|
13.7
|
Use of traditional methods
|
12
|
1.6
|
Want to become pregnant
|
54
|
7.0
|
Prevalence of modern contraceptive use by participants’ background characteristics
According to the participants’ background characteristics, participants who had attained up to secondary education had a higher modern contraceptive prevalence (10.1%) compared to their counterparts. Contraceptive use was slightly more common among those who had lived in the camp for more than 12 months (8.9%) compared to those who had lived in the camp for a shorter period of time (7.4%). Participants who had ever been pregnant had almost the same prevalence of modern contraceptive use (8.8%) as those who had never been pregnant (8.4%). Furthermore, participants whose partners were students had a higher modern contraceptive prevalence rate (19.3%) compared to those whose partners had other occupations, as shown in table 3.
Table 3: Prevalence of modern contraceptive use by participants’ background characteristics
Variable
|
Contraceptive use
No. (%)
|
Contraceptive Non-use
No. (%)
|
95%
Confidence Interval
|
Age
|
|
|
|
15 to 17
|
10 (8.6)
|
106 (91.4)
|
4.7 to 15.3
|
18 to 19
|
63 (8.7)
|
660 (91.3)
|
6.9 to 11.0
|
Religion
|
|
|
|
Catholic
|
38 (8.6)
|
402 (91.4)
|
6.3 to 11.7
|
Anglican
|
15 (7.8)
|
178 (92.2)
|
4.7 to 12.5
|
Adventist
|
6 (9.1)
|
60 (90.9)
|
4.1 to 18.9
|
Other (Pentecostal, Lutheran, EFC, AIC)
|
13 (8.0)
|
108 (90.0)
|
6.0 to 16.2
|
Ethnicity
|
|
|
|
Acholi
|
65 (9.9)
|
594 (90.1)
|
7.8 to 12.4
|
Dinka
|
1 (5.6)
|
17 (94.4)
|
0.7 to 32.0
|
Nuer
|
1 (5.3)
|
18 (94.7)
|
0.7 to 30.6
|
Lotuho
|
3 (6.5)
|
43 (93.5)
|
2.1 to 18.6
|
Other (Bari, Shulluk, Luo)
|
3 (3.1)
|
95 (96.9)
|
1.0 to 9.2
|
Education
|
|
|
|
None
|
4 (4.9)
|
77 (95.1)
|
1.9 to 12.5
|
Primary
|
53 (8.9)
|
542 (91.1)
|
6.9 to 11.5
|
Secondary
|
15 (10.1)
|
133 (89.9)
|
6.2 to 16.2
|
Tertiary
|
1 (6.7)
|
14 (93.3)
|
0.9 to 36.9
|
Occupation
|
|
|
|
Self-employed/Employed
|
3 (9.1)
|
30 (90.9)
|
2.9 to 25.1
|
Unemployed
|
29 (8.7)
|
306 (91.3)
|
6.1 to 12.2
|
Peasant farmer
|
23 (7.5)
|
282 (92.5)
|
5.1 to 11.1
|
Student
|
18 (10.8)
|
148 (89.2)
|
6.1 to 16.6
|
Marital status
|
|
|
|
Single
|
19 (8.2)
|
214 (91.8)
|
5.3 to 12.4
|
Cohabiting
|
42 (11.0)
|
339 (88.0)
|
8.2 to 14.6
|
Married
|
6 (3.7)
|
157 (96.3)
|
1.7 to 8.0
|
Separated/Divorced/Widowed
|
6 (9.7)
|
56 (90.3)
|
4.4 to 20.0
|
Age at first sex
|
|
|
|
12 to 15
|
13 (7.7)
|
156 (92.3)
|
4.5 to 12.8
|
16 to 17
|
52 (9.7)
|
485 (90.3)
|
7.4 to 12.5
|
18 to 19
|
8 (6.0)
|
125 (94.0)
|
3.0 to 11.6
|
Number of children alive
|
|
|
|
0
|
1 (3.2)
|
30 (96.8)
|
0.4 to 20.2
|
1
|
33 (12.0)
|
342 (88.0)
|
8.6 to 16.4
|
2
|
17 (7.2)
|
219 (92.8)
|
4.5 to 11.3
|
3 – 4
|
1 (2.0)
|
48 (98.0)
|
0.2 to 13.4
|
Partner’s Education
|
|
|
|
None
|
1 (7.7)
|
12 (92.3)
|
1.0 to 41.2
|
Primary
|
17 (8.9)
|
173 (91.1)
|
5.6 to 13.9
|
Secondary
|
45 (10.6)
|
378 (89.4)
|
8.0 to 14.0
|
Tertiary
|
1 (5.0)
|
19 (95.0)
|
0.6 to 29.4
|
Partner’s Occupation
|
|
|
|
Self-employed/Employed
|
22 (11.4)
|
171 (88.6)
|
7.6 to 16.7
|
Unemployed
|
24 (9.0)
|
243 (91.0)
|
6.1 to 13.1
|
Peasant farmer
|
7 (5.4)
|
122 (94.6)
|
2.6 to 11.0
|
Student
|
11 (19.3)
|
46 (80.7)
|
11.0 to 31.7
|
Factors associated with modern contraceptive use among the study participants
Using logistic regression, variables which had a p-value less than 0.2 were considered significant at bivariate analysis. They were age (p=0.153), marital status (p=0.079), number of children alive (p=0.081), partner’s age (p=0.007), and partner’s occupation (p=0.073). These variables were considered for the multivariate analysis. Statistical significance at multivariate analysis was considered at a p-value of 0.05. The significant variables at this level were being married (aOR=0.11, 95% CI: 0.04 to 0.35, p<0.001) or cohabiting (aOR=0.43, 95% CI: 0.20 to 0.93, p=0.032) and having an older partner (aOR=0.93, 95% CI: 0.86 to 0.99, p=0.046). The significant variables were further assessed for interaction between each other and for confounding with all the other independent variables that were significant at bivariate. However, there was neither interaction nor confounding. Therefore, marital status and partner’s age were the only variables associated with modern contraceptive use (table 4).
Table 4: Factors associated with modern contraceptive use among refugee adolescents
Variable
|
Crude OR
(95% CI)
|
P-Value
|
Adjusted OR (95% CI)
|
P-Value
|
Age in years
Median(IQR): 19(18-19)
|
0.83 (0.64 to 1.07)
|
0.153
|
0.75 (0.48 to 1.16)
|
0.194
|
Marital status
|
|
|
|
|
Single
|
1.00
|
|
1.00
|
|
Cohabiting
|
1.40 (0.79 to 2.46)
|
0.250
|
0.43 (0.20 to 0.93)
|
0.032
|
Married
|
0.43 (0.17 to 1.10)
|
0.079
|
0.11 (0.04 to 0.35)
|
<0.001
|
Separated/Divorced/Widowed
|
1.21 (0.46 to 3.16)
|
0.702
|
0.29 (0.08 to 1.00)
|
0.050
|
Number of children alive
Mean (SD): 1.5 (0.727)
|
0.70 (0.46 to 1.05)
|
0.081
|
0.83 (0.51 to 1.33)
|
0.431
|
Partner’s age
Median (IQR): 26 (24 – 30)
|
0.91 (0.86 – 0.98)
|
0.007
|
0.93 (0.86 to 0.99)
|
0.046
|
Partner’s Occupation
|
|
|
|
|
Self-employed/Employed
|
1.00
|
|
|
|
Unemployed
|
0.77 (0.42 to 1.41)
|
0.396
|
0.82 (0.43 to 1.58)
|
0.553
|
Peasant farmer
|
0.45 (0.18 to 1.08)
|
0.073
|
0.49 (0.20 to 1.24)
|
0.134
|
Student
|
1.86 (0.84 to 4.11)
|
0.126
|
|
0.152
|