In this study, we examined the trends in the prevalence and predictors of STIs among female youths aged 15–24 years in Uganda (2006–2016). Findings indicate that the overall prevalence was high (26.0%); highest in 2011 and the lowest in 2006. The year of study (2011), having 2 or more life partners, sexual activity in the last 4 weeks, being a Muslim or belonging to other religions other than Christianity, were positively associated with reporting an STI, while being from Northern Uganda was negatively associated with reporting any STI among the female youths aged 15–24 years.
In this study, we found that the prevalence of STIs among youths was high, with the highest prevalence found among youths 20–24 years old. This is consistent with several studies (21–25) showing that the prevalence of STIs was higher among young people aged 20–24 years compared to those 15–19 years. Surprisingly, the prevalence of STIs in 2011 is strikingly higher than in other years. There was a notable increase in prevalence between 2006 and 2011 and the decline later in 2016. Considering the relationship between HIV and STIs, the high STI prevalence in 2011 may be due to the high prevalence of HIV (7.3%), and high rates of HIV enrolment and care between 2004 and 2015, with the highest prevalence in 2011 (26), while the decline in 2016 is probably due to increased uptake of sexual and reproductive health (SRH) among young people, leading to improved knowledge of HIV/STI, and promotion of safer sex following the SRH/HIV integration in Uganda in 2012. (27) It was also confirmed in a study in South Africa that STIs are a risk factor for HIV infection and likewise, HIV infection is a risk factor for STI acquisition. (28)
Both self-reported and laboratory-diagnosed STIs have been consistently high among young people with a history of having multiple lifetime partners, as seen in evidence from several studies over the years.(5, 7, 29, 30) The results from this study equally reveal that throughout all the survey years and in the pooled dataset, female youths aged 15–24 with a history of 2 or more lifetime sex partners reported higher cases of STIs than those who reported having only one sexual partner. A study using nested health and the demographic survey also corroborates our findings. (21) These findings are not surprising since female youths with multiple lifetime partners will most likely engage in frequent sexual activities with different partners.
In Uganda, a study using the 2016 UDHS data revealed that engagement in sexual activities in the last one month prior to the survey was significantly associated with self-reported STI status. (2) This corroborates findings from our analysis of the pooled dataset, including data from the 2006, 2011, and 2016 UDHSs that show an association between recent sexual activity in the last 4 weeks and self-reported STI status. This is also consistent with a study by Lewis (31) that revealed an association between STIs including bacterial vaginosis with recent unprotected sex.
Apart from sexual behaviours, some sociodemographic characteristics including religion and region of residence were associated with STI status among female youths aged 15–24 years. Findings from this study reveal that belonging to Islam and other religions was associated with higher odds of STIs. This supports a study by Nankinga in Uganda (10), which revealed that Muslim women had higher odds of STIs compared to Catholics. This may be attributed to several factors, including the fact that most Muslim unions are associated with polygamy in Uganda. Moreover, Muslim affiliation is associated with early engagement in sex among adolescents, as shown by a study in Ethiopia (32). Cultural beliefs, poor SRH knowledge, and negative attitudes towards SRH and contraception are also common among Muslim women. (33)
In corroboration with other studies conducted in Uganda (2, 7, 10), our study shows an inversely significant association between STI status and coming from the northern region of Uganda. The northern region is classified among the rural regions of Uganda, so our results are consistent with findings from other studies conducted in Uganda (34, 35), which revealed that living in rural regions, including northern Uganda, was protective against STI acquisition. This may be attributed to more access to STI information in urban regions such as central region and Kampala, which improves self-assessment and recognition of STIs among young people living in these regions. Misinde (7) in his study argues that the low prevalence of STIs in northern Uganda may be due to cultural reasons, including strong norms towards sexual relationships for young women, while the high prevalence in central and Kampala regions is due to high exposure, which predisposes young women to early sexual initiation and consequently increases their chances of contracting STIs.
Strengths and limitations of the study
The main strength of this study is that it uses data from the Uganda demographic and health surveys, which are nationally representative studies and have large datasets that increase the power. Data from three different survey years were used for analysis, which allows for a better comparison of prevalence outcome variables and risk factors across the different years. The study however had its limitations; in this study, cross-sectional data were used, which may have introduced recall bias due to participants failing to remember certain exposures, or falsely recalling events influenced by having experienced the outcome. Additionally, the cross-sectional data used only show associations but not causation. Another limitation is that the outcome variable of self-reported STIs among female youths may introduce bias due to over, or under-reporting of STIs. Moreover, reporting of symptoms to determine STI status as used in this study is more likely to miss out on asymptomatic STI cases. Despite these limitations, the results from this data provide insight into the prevalence and predictors of STIs among female youths aged 15–24 years in Uganda across the years. Additionally, syndromic management is the approved standard method for assessing STIs in Uganda. Finally, a complete case analysis of secondary data was used in this study, so we didn’t have information and control over data quality. However, some variables in the data sets were already imputed, and the sample was large enough to provide enough power to answer the research question.