Background characteristics
Table 1 shows significant differences in background characteristics between migrant and non-migrant street children and young adults. Overall, 55.36% (n=284) were migrant street children and young adults while 44.64% (n= 229) were non migrant street children and young adults. The median age was 18 years (interquartile range 16 - 21 years) with the majority (35%) in the 18 - 20 age group. More migrant street children and young adults (76.50%) than non-migrant street children and young adults (58.57%) had attained pre-school or primary school education. More than three quarters (89.67%) of the street children and young adults were not in school. Most (79.53%) of the street children and young adults were not married and only 16.76% were either married or living with a partner. More than half (54.97%) of the street children stayed with a friend or partner while 10% stayed alone. Migrant street children and young adults earned more than the threshold value of 1USD daily compared to the non-migrant street children and young adults.
Prevalence of use of SRH services
Table 1 findings show that 61.99% (n=318) of the street children and young adults received at least one component of the SRH services in the last twelve months while 11.50% (n=29) received all the three SRH services (STI screening, HIV testing & FP use). Across all the SRH services components, use of services was generally lower among migrant compared to the non-migrant street children and young adults, with 51.76% migrants having ever tested for HIV in the past 12 months compared to 67.25% of the lifelong native street children and young adults; 14.14% of migrant street children compared to 22.71% of non-migrant street children and young adults had ever used family planning to delay or avoid pregnancy. Similarly, the prevalence of STI screening in the past 12 months was low, with 26.41% of migrant street children and young adults compared to 44.98% of non-migrant street children and young adults. The differences in SRH services use are significant at the 5% p-value. The commonly used FP method was a condom (77.03%). The majority (68.39%) of the participants accessed SRH services from public health facilities while 31.61% of the street children and young adults sought SRH services from non-governmental organisations (NGO)/private health facilities
Factors associated with use of SRH services
Table 2 shows findings from the bivariate analysis of socio-demographic and migration variables on use of SRH services among street children shows significant differences in service utilisation. Use of SRH services was associated with increasing age, with those aged above 18 years being 5.8 times more likely to use SRH services than the younger age group (cOR=5.84, 95%CI 3.95-8.64). In regards to marital status, street young adults in conjugal relationships were 2.5 times more likely to use SRH services than those in non-conjugal relationships (cOR=2.47, 95%CI 1.43-4.26). Street children who perceived themselves as permanent residents of the city were twice likely to use SRH services than the mobile/seasonal street children (cOR=1.93, 95%CI 1.32 - 2.81). Use of SRH services more than doubled with attainment of post primary education (cOR=2.71, 95% 1.69 - 4.34). Intra-urban residential mobility (movement between urban spaces) was associated with SRH services use among street children (cOR=2.13, 95%CI 1.43 - 3.15). However, the odds of using SRH services decreased with migration status (cOR=0.52, 95%CI 0.36 - 0.74), duration of stay (cOR=0.64, 95%CI 0.42 - 0.97) and tribe/ethnicity (cOR=0.56, 95%CI 0.37 - 0.82). The reduced odds of using SRH services further supports our hypothesis that migration inhibits use SRH services among migrant street children and young adults in urban spaces.
Migration as the main predictor of use of SRH services
Table 3 shows findings from the three multivariate binary logistic regression models with SRH use (model 1), STI screening (model 2) HIV testing (model 3) and ever used family planning (model 4) as the main outcome variables. The final models included ten predictors of SRH services use including age, sex, daily income, schooling status, rural-urban migration status and other known predictors of SRH services utilisation. The findings reveal that migrant street children and young adults had reduced odds of using SRH services compared to their non-migrant counterparts (aOR=0.59, 95%CI 0.36 - 0.97), implying that migrant street children and young adults were 41% less likely to use the SRH services than the non-migrants. However, we did not find a significant relationship between rural-urban circular and non-circular migrants (street children and young adults who had more than one repeat movement between the city and place/district of origin) and use of SRH services.
Other predictors of SRH services use
Other factors that predicted use of SRH services among the street children and young adults include age, knowledge of place of care for SRH services and access to SRH education information. Street children aged 18-24 years were four times more likely to use SRH services than those aged 12-17 years (aOR=4.51; 95%CI 2.78 - 7.33); In-school street children and young adults were 66% less likely to use SRH services compared to their out-of-school counterparts (aOR=0.34; 95%CI 0.15 - 0.76). Street children and young adults with knowledge of place of SRH care were three times more likely to use SRH services compared to those without knowledge of a place of SRH care (aOR=3.37, 95%CI 2.04 - 5.34). Street children and young adults who reported having received SRH education in the past 6 months were three times more likely to use SRH services than those did not have access to information (aOR=2.7, 95%CI 1.67 - 4.53).
Results from the multivariate regression models 2, 3 and 4 revealed findings similar to those of the pooled outcome (SRH services use) with some slight variations in the strength of the association. For instance, the relationship between migration status and use of FP was insignificant while religion was found to produce a 70% protective effect on FP use among Christians compared to non-Christians (aOR=0.30, 95%CI 0.15 - 0.62). Street young adults were five times more likely to use FP services than the street children aged below 18 years (aOR=5.29, 95%CI 2.28 - 12.293).
Multivariate regression analysis based on sample stratification by rural-urban migration status revealed significant differences in the use of SRH services among street children and young adults with regards to age, gender, schooling status, SRH education and place of SRH care. Among migrants alone, increased SRH services use was associated with age (aOR=6.319,95%CI 3.28 - 12.17), SRH education in past 6 months (aOR=2.47, 95%CI 1.32 - 4.65) and knowing a place of SRH care (aOR= 2.68, 95%CI 1.44 - 4.99). Similarly, among the non-migrants, the odds of SRH services utilisation were increased with age (aOR= 3.50, 95%CI 1.54 - 7.97), SRH education in past 6 months (aOR=3.24, 95%CI 1.34 - 7.86) and knowing a place of SRH care (aOR= 4.33, 95%CI 1.92 - 9.74) but reduced among in-school street children and young adults (aOR=0.24, 95%CI 0.084 - 0.68), which implies that being both a street youth and being in school precludes the street children and youth from using SRH services. We did not observe any significant gender differences in use of the individual SRH services and migration status.