Distribution of socio-demographic characteristics
We analyzed data for sexually active young women aged 15-24 years from all three surveys. The total sample size was 10,303 female youths: 2,414 in 2016, 2,418 in 2011, and 5,471 in 2016 (Table 1). More than half (64%) of the respondents were aged 20-24 years and had a mean age of 20.4 (SD=0.03). Over 70% of the women in each survey were from rural residences (80% in 2006, 76.6% in 2011, and 73.6% in 2016). The majority of respondents were Christians 8691(84.4%), were married or living with partner 6328 (61.4%), and employed 7095(68.7%). Regarding education, 3679 (35.7%) had received secondary education or higher (Table 1).
Table 1:Distribution of Selected Socio-demographic characteristics; pooled and by year of the survey.
Demographic Characteristics
|
Frequencies (Percentages)
|
2006
(n = 2,414)
|
2011
(n = 2,418)
|
2016
(n = 5,471)
|
Pooled
(N = 10,303)
|
Age group
|
|
|
|
|
15-19
|
833(34.5)
|
923(38.2)
|
1948(35.6)
|
3704(36.0)
|
20-24
|
1581(65.5)
|
1495(61.8)
|
3523(64.4)
|
6599(64.0)
|
Marital status
|
|
|
|
|
Not married
|
886(36.7)
|
918(37.8)
|
2176(39.8)
|
3975(38.6)
|
Married/livingtogether
|
1528(63.3)
|
1505(62.2)
|
3294(60.2)
|
6328(61.4)
|
Residence
|
|
|
|
|
Urban
|
482(20.0)
|
565(23.4)
|
1444(26.4)
|
2491(24.2)
|
Rural
|
1932(80.0)
|
1854(76.6)
|
4026(73.6)
|
7811(75.8)
|
Region
|
|
|
|
|
Kampala
|
263(10.9)
|
291(12.0)
|
312(5.7)
|
865(8.4)
|
Central
|
467(19.3)
|
507(21.0)
|
1354(24.8)
|
2328(22.6)
|
East
|
590(24.4)
|
650(26.9)
|
1543(28)
|
2783(27.0)
|
North
|
477(19.7)
|
410(17.0)
|
1025(18.7)
|
1912(18.6)
|
West
|
618(25.6)
|
560(23.2)
|
1237(22.6)
|
2415(23.4)
|
Religion
|
|
|
|
|
Christian
|
2068(85.7)
|
2035(84.2)
|
4587(83.9)
|
8691(84.4)
|
Muslim
|
308(12.8)
|
360(14.9)
|
826(15.1)
|
1494(14.5)
|
Other religions
|
36(1.5)
|
22.6(0.9)
|
57(1.0)
|
116(1.1)
|
Education
|
|
|
|
|
No education
|
229(9.5)
|
110(4.5)
|
157(2.9)
|
496(4.8)
|
Primary education
|
1522(63.1)
|
1457(60.2)
|
3149(57.6)
|
6127(59.5)
|
Secondary education
|
562(23.3)
|
741(30.6)
|
1766(32.3)
|
3069(29.8)
|
Higher
|
101(4.2)
|
111(4.6)
|
398(7.3)
|
610(5.9)
|
Literacy
|
|
|
|
|
Cannot read at all
|
814(33.7)
|
684(28.3)
|
1351(24.7)
|
2850(27.7)
|
Able to read
|
1483(61.5)
|
1695(70.1)
|
4091(74.8)
|
7269(70.6)
|
Other (blind or visually impaired)
|
116(4.8)
|
39(1.6)
|
27.8(0.5)
|
183(1.8)
|
Wealth index
|
|
|
|
|
Poor
|
943(39.1)
|
863(35.7)
|
2101(38.4)
|
3907(37.9)
|
Middle
|
398(16.5)
|
463(19.2)
|
924(16.9)
|
1785(17.3)
|
Rich
|
1073(44.4)
|
1092(45.1)
|
2446(44.7)
|
4610(44.7)
|
Employment
|
|
|
|
|
No
|
551(22.9)
|
921(38.1)
|
1724(31.5)
|
3196(31.1)
|
Yes
|
1853(77.1)
|
1496(61.9)
|
3747(68.5)
|
7095(68.9)
|
Source: Uganda Demographic Health and Health surveys (UDHS) 2006,2011,2016
|
Trends in Sexual behaviours and STIs
Half of the respondents in all three separate and pooled datasets (50.1% pooled, and 47.0, 47,8 and 52.5 in 2006, 2011, and 2016, respectively) reported more than one lifetime sexual partner, and only 10.43% used condoms consistently (always) with their most recent partner. Likewise, in the pooled data, more than half (55.6%) of the respondents reported having been sexually active in the last 4 weeks before the interview, consistent with 56.7%, 54.5%, and 55.6% reported in 2006, 2011, and 2016, respectively. The majority (72.9%) of the sexually active female youths in the pooled dataset had their first sexual intercourse between the ages between 15 and 19. Approximately 71.0%, 68.1, and 74.0 had their first sexual encounters in 2006, 2011, and 2016, respectively (Table 2).
Table 2: Trends in sexual behaviors and STIs among Ugandan women age 15-24 years, UDHS 2006-2016
Characteristics
|
Frequencies (Percentages)
|
|
2006
(n =2,414)
|
2011
(n=2,418)
|
2016
(n = 5471)
|
Pooled
(N=10,303)
|
Age at first sex
|
|
|
|
|
< 15
|
566(23.5)
|
512(21.2)
|
962(17.6)
|
2040(19.8)
|
15-19
|
1713(71.0)
|
1644(68.1)
|
4046(74.0)
|
7402(71.9)
|
20-24
|
134(5.6)
|
259(10.7)
|
460(8.4)
|
854(8.3)
|
Recent sexual activity
|
|
|
|
|
Not active
|
1044(43.3)
|
1098(45.5)
|
2431(44.4)
|
4573(44.4)
|
Active in last 4 weeks
|
1366(56.7)
|
1318(54.5)
|
3038(55.6)
|
5722(55.6)
|
Number of sex partners
|
Dont have
|
280(11.6)
|
319(13.2)
|
603(11.0)
|
1203(11.7)
|
Only one
|
2070(85.8)
|
2021(83.7)
|
4648(85.0)
|
8739(84.8)
|
2 or more
|
63(2.6)
|
76(3.1)
|
220(4.0)
|
358(3.5)
|
Total number of Lifetime partners
|
only one
|
1276(53.0)
|
1262(52.2)
|
2598(47.5)
|
5136(49.9)
|
2 or more
|
1134(47.0)
|
1155(47.8)
|
2872(52.5)
|
5161(50.1)
|
Number of lifetime marriages/unions
|
Only one
|
1593(90.0)
|
1533(90.0)
|
3470(90.8)
|
6596(90.4)
|
2 or more
|
177(10.0)
|
171(10.0)
|
350(9.2)
|
698(9.6)
|
Contraceptive knowledge
|
knows no method
|
38(1.6)
|
29(1.2)
|
20(0.4)
|
87(0.8)
|
knows other method
|
8(0.3)
|
1(0.0)
|
3(0.1)
|
5456(53.0)
|
knows modern method
|
2368(98.1)
|
2389(98.8)
|
5448(99.6)
|
4760(46.2)
|
Consistent condom use
|
No
|
2204(91.3)
|
2158(89.2)
|
4866(89.0)
|
9228(89.6)
|
Yes
|
210(8.7)
|
260(10.8)
|
604(11.0)
|
1074(10.4)
|
Heard about STIs
|
|
|
|
|
No
|
11(0.4)
|
1(0.1)
|
9(0.2)
|
21(0.2)
|
Yes
|
2403(99.6)
|
2416(99.9)
|
5461(99.8)
|
10280(99.8)
|
Do not know
|
|
1(0.1)
|
|
1(0.0)
|
Had genital sore
|
No
|
2072(86.1)
|
2034(84.2)
|
4844(88.6)
|
8950(87.0)
|
Yes
|
336(13.9)
|
381(15.8)
|
625(11.4)
|
1342(13.0)
|
Had genital discharge
|
|
|
|
|
No
|
2121(88.4)
|
2079(86.2)
|
4710(86.2)
|
8911(86.7)
|
Yes
|
279(11.6)
|
334(13.8)
|
757(13.8)
|
1370(13.3)
|
Has had any STIs in the last 12 months
|
|
|
|
No
|
1882(78.0)
|
1541(63.7)
|
4205(76.9)
|
7628(74.0)
|
Yes
|
532(22.0)
|
878(36.3)
|
1265(23.1)
|
2675 (26.0)
|
Source: Uganda Demographic Health and Health surveys (UDHS) 2006,2011,2016
|
Trends in the weighed prevalence of STIs among female youths aged 15-24 years old
The weighted prevalence of the STIs showing their distribution by year, age group, and region and sexual behaviours are reported in Table 3. The table shows a weighted pooled STI prevalence of 26%, 95%CI (24.8-27.1). Among the curable STIs assessed, a prevalence of 13.0%, 95%CI (12.2-13.9), and 13.3%, 95%CI (12.5-14.2) were reported for genital ulcers and genital discharge, respectively. As shown in Table 3 and figure 2, about 22.0%, % of youth women reported an STI in 2006. This increased to 36.3% in 2011, before declining to and 23.1% reported a sexually transmitted infection in 2006, 2011, and 2016 respectively. Between 2006 and 2011, there was evidence of change (+14.3%, p < 0.001) in STI prevalence before a significant reduction (-12.0%, p<0.001).
In general, the prevalence of STIs) among youths 20-24 years (27.3, 95%CI (25.9-28.8) was significantly higher than that for young adolescents, 23.6, 95%CI (21.8-25.4). Additionally, youths in the central region, 32.3%, 95%CI (29.4-35.3), and Kampala 28.4%, 95%CI (24.4-32.7) reported a higher prevalence of STIs compared to other regions, while the northern region had the lowest prevalence of STIs 16.0, 95%CI (14.2-17.8) (Figure 3).
Table 3: Prevalence of sexually transmitted infections among female youths aged 15-24 years, UDHS 2006 - 2016
|
Weighted Prevalences/percent(95 % CI)
|
Characteristics
|
Any STI
|
Genital sores
|
Genital Discharge
|
Year of interview
|
|
|
|
2006
|
22.0(19.7-24.6)
|
13.9(12.1-16.0)
|
11.6(10.0-13.4)
|
2011
|
36.3(33.7-38.9)
|
15.8(13.8-18.0)
|
13.8(12.1-15.7)
|
2016
|
23.1(21.7-24.7)
|
11.4(10.4-12.5)
|
13.8(12.7-15.1)
|
Pooled
|
26.0(24.8-27.1)
|
13.0(12.2-13.9)
|
13.3(12.5-14.2)
|
Age group
|
|
|
|
15-19
|
23.6(21.8-25.4)
|
10.9(9.7-12.2)
|
10.8(9.6-12.1)
|
20-24
|
27.3(25.9-28.8)
|
14.2(13.1-15.4)
|
14.7(13.7-15.9)
|
Region
|
|
|
|
Kampala
|
28.4(24.4-32.7)
|
15.1(12.0-18.8)
|
16.8(14.2-19.7)
|
Central
|
32.3(29.4-35.3)
|
16.4(14.4-18.8)
|
18.3(16.3-20.4)
|
East
|
26.8(24.7-29.1)
|
13.5(12.0-15.1)
|
11.2(9.9-12.7)
|
North
|
16.0(14.2-17.8)
|
7.2(6.0-8.5)
|
7.9(6.7-9.4)
|
West
|
25.9(23.7-28.3)
|
13.2(11.4-15.1)
|
14.0(12.4-15.9)
|
Residence
|
|
|
|
Urban
|
26.8(24.5-29.3)
|
12.5(10.9-14.4)
|
16.4(14.4-18.6)
|
Rural
|
25.7(24.4-27.0)
|
13.2(12.2-14.2)
|
12.3(11.5-13.2)
|
Marital status
|
|
|
|
Not married
|
23.6(21.9-25.4)
|
11.6(10.3-12.7)
|
12.6(11.4-13.9)
|
Married
|
27.4(26.0-28.9)
|
14.0(13.0-15.2)
|
13.8(12.8-14.8)
|
Total number of sexual partners
|
|
|
Only one
|
19.5(18.2-20.9)
|
9.6(8.6-10.^)
|
9.0(8.2-10.0)
|
2 or more
|
32.4(30.7-34.2)
|
16.5(15.2-17.9)
|
17.6(16.3-19.0)
|
Recent sexual activity
|
|
|
Not active
|
22.2(20.7-23.8)
|
10.3(9.2-11.4)
|
10.8(9.7-11.9)
|
Active in the last 4 weeks
|
28.9(27.4-30.5)
|
15.3(14.2-16.5)
|
15.3(14.2-16.5)
|
Religion
|
|
|
|
Christian
|
25.0(23.8-26.3)
|
12.5(11.6-13.5)
|
12.9(12.0-13.7)
|
Muslim
|
31.0(27.8-34.4)
|
15.7(13.7-18.0)
|
15.5(13.2-18.2)
|
Other
|
33.7(24.1-44.9)
|
17.8(11.2-27.0)
|
19.8(12.0-30.8)
|
Source: Uganda Demographic Health and Health surveys (UDHS) 2006,2011,2016
|
Relationship between STIs and different correlates and among Ugandan female youths
In the bivariate analysis, recent sexual activity in the last 4 weeks prior to the interview, lifetime number of marriages, and the total lifetime number of sex partners were significant in all surveys while age group, region, marital status, religion, education, age at 1st sex, and employment were significant in either one or two of the survey datasets. Condom use was not significant in the bivariate analysis across all datasets. (Table 4)
In multivariable analysis, the year of the interview (2011), being sexually active in the last 4 weeks, having 2 or more lifetime sexual partners, being from the northern region of Uganda, and being affiliated with the Muslim faith and other religions were significantly associated with STI status among youths aged 15-24 years. Notably, in the year 2011, participants were more likely to report an STI across all models (OR: 1.9, 95% CI (1.5-2.3)) compared to 2011 and 2016, both had a similar but non-significant odds ratio. Compared with female youths who reported having one lifetime sexual partner, the odds of having an STI was higher among those who reported having 2 or more lifetime partners (OR:1.6, 95%CI (1.4-1.9). Likewise, the odds of reporting an STI were slightly higher among female youths who were sexually active in the last 4 weeks prior to the respective survey (OR:1.3, 95% CI (1.1-1.6)). Besides the sexual behaviours, the youths affiliated with the Muslim faith (OR: 1.3, 95% CI (1.1-1.6)) and other religions (OR: 1.8, 95% CI (1.1-2.9) had higher odds of reporting an STI compared to those affiliated to Christianity. On the other hand, the northern region was found to be inversely associated with reporting any STI among female youths aged 15-24 years with youths from Northern Uganda having 0.5 times lower odds of reporting an STI compared to other regions(OR 0.5, 95%(0.3-0.7). Although statistically significant (p<0.05) in the different survey years in the bivariate analysis, marital status, age at first sex, age group, and having more than one lifetime partner, showed no statistical significance in the adjusted models. (Table 5).
Table 4: Bivariate analysis showing Relationship between reporting of STIs and selected correlates
|
2006
|
2011
|
2016
|
Variables
|
OR(95% CI)
|
P-value
|
OR(95% CI)
|
P-value
|
OR(95% CI)
|
P-value
|
Age group
|
|
|
|
|
|
|
15-19
|
1
|
|
1
|
|
1
|
|
20-24
|
1.2(1.0-1.5)
|
0.104
|
1.0(0.8-1.3)
|
0.847
|
1.4(1.2-1.7)
|
< 0.001
|
Residence
|
|
|
|
|
|
|
Urban
|
1
|
|
1
|
|
1
|
|
Rural
|
1.1(0.8-1.6)
|
0.644
|
1.0(0.7-1.3)
|
0.822
|
0.9(0.7-1.1)
|
0.153
|
Region
|
|
|
|
|
|
|
Kampala
|
1
|
|
1
|
|
1
|
|
Central
|
1.6(1.0-2.7)
|
0.047
|
1.2(0.8-1.8)
|
0.347
|
1.3(0.9-1.8)
|
0.103
|
East
|
0.8(0.5-1.4)
|
0.457
|
1.1(0.7-1.5)
|
0.744
|
1.1(0.8-1.4)
|
0.698
|
North
|
0.3(0.2-0.6)
|
< 0.001
|
0.4(0.3-0.7)
|
0.001
|
0.7(0.5-0.9)
|
0.015
|
West
|
0.9(0.5-1.5)
|
0.680
|
0.9(0.6-1.3)
|
0.604
|
1.0(0.8-1.4)
|
0.843
|
Religion
|
|
|
|
|
|
|
Christian
|
1
|
|
1
|
|
1
|
|
Muslim
|
1.8(1.3-2.5)
|
0.001
|
1.4(1.1-1.9)
|
0.013
|
1.2(0.9-1.5)
|
0.203
|
Other
|
2.3(0.9-5.6)
|
0.069
|
1.4(0.6-3.2)
|
0.413
|
1.3(0.6-2.7)
|
0.462
|
Education
|
|
|
|
|
|
|
No education
|
1
|
|
1
|
|
1
|
|
Primary
|
1.2(0.8-1.8)
|
0.476
|
1.6(1.0-2.5)
|
0.067
|
1.6(1.0-2.7)
|
0.051
|
Secondary
|
1.1(0.7-1.7)
|
0.816
|
1.0(0.6-1.6)
|
0.994
|
1.9(1.2-3.2)
|
0.010
|
Higher
|
0.9(0.5-1.7)
|
0.695
|
1.1(0.5-2.3)
|
0.802
|
1.3(0.7-2.2)
|
0.450
|
Employment
|
|
|
|
|
|
|
No
|
1
|
|
1
|
|
1
|
|
Yes
|
0.9(0.7-1.3)
|
0.730
|
0.8(0.7-1.1)
|
0.139
|
1.2(1.0-1.5)
|
0.024
|
Marital Status
|
|
|
|
|
|
|
Not married
|
1
|
|
1
|
|
1
|
|
Married/living
|
1.5(1.2-2.0)
|
< 0.001
|
1.1(0.9-1.5)
|
0.336
|
1.4(1.2-1.7)
|
0.001
|
Age at 1st sex
|
|
|
|
|
|
|
<15
|
1
|
|
1
|
|
1
|
|
15-19
|
0.8(0.6-1.0)
|
0.106
|
0.8(0.6-1.1)
|
0.184
|
0.8(0.6-0.9)
|
0.004
|
20-24
|
0.5(0.3-0.9)
|
0.031
|
0.8(0.5-1.1)
|
0.210
|
0.7(0.5-0.9)
|
0.016
|
Recent sexual activity in the last 4 weeks
|
Not active
|
1
|
|
1
|
|
1
|
|
Active
|
0.6(0.5-0.8)
|
< 0.001
|
0.8(0.6-0.9)
|
0.007
|
0.7(0.6-0.8)
|
< 0.001
|
Lifetime number of marriages/unions
|
Once
|
1
|
|
1
|
|
1
|
|
> once
|
1.6(1.1-2.5)
|
0.019
|
1.7(1.2-2.5)
|
0.005
|
1.3(1.0-1.7)
|
0.049
|
Total lifetime sexual partners
|
Only one
|
1
|
|
1
|
|
1
|
|
2 or more
|
2.5(2.0-3.2)
|
<0.001
|
1.9(1.6-2.4)
|
< 0.001
|
1.9(1.6-2.2)
|
< 0.001
|
Condom use
|
|
|
|
|
|
|
No
|
1
|
|
1
|
|
1
|
|
yes
|
1.0(0.7-1.5)
|
0.896
|
0.9(0.6-1.3)
|
0.605
|
0.8(0.6-1.0)
|
0.071
|
Source: Uganda Demographic Health and Health surveys (UDHS) 2006,2011,2016
ref = reference
|
Table 5: Logistic regression analysis showing the relationship between reporting of STIs and selected correlates of STIs among female youths aged 15-24 years in Uganda using pooled data (Model building)
|
Model 1
|
Model 2
|
Model 3 (fully adjusted model)
|
Selected factors
|
OR(95% CI)
|
P-value
|
OR(95% CI)
|
P-value
|
OR(95% CI)
|
P-value
|
Year of interview
|
|
|
|
|
|
|
2006 (ref)
|
1.0
|
|
1.0
|
|
1.0
|
|
2011
|
2.0(1.7-2.4)
|
< 0.001
|
1.9(1.5-2.3)
|
< 0.001
|
1.9(1.5-2.3)
|
< 0.001
|
2016
|
1.1(0.9-1.3)
|
0.462
|
1.0(0.9-1.2)
|
0.791
|
1.0(0.8-1.2)
|
0.836
|
Age at first sex
|
|
|
|
|
|
|
<15(ref)
|
|
|
1.0
|
|
1.0
|
|
15-19
|
|
|
0.9(0.8-1.0)
|
0.153
|
1.0(0.8-1.2)
|
0.739
|
20-24
|
|
|
0.9(0.7-1.2)
|
0.585
|
1.1(0.8-1.4)
|
0.731
|
Recent sexual activity in the last 4 weeks
|
Not active (ref)
|
|
|
1.0
|
|
1.0
|
|
Active
|
|
|
1.3(1.1-1.5)
|
< 0.001
|
1.3(1.1-1.6)
|
0.002
|
Lifetime Number of marriages/unions
|
Once (ref)
|
|
|
1.0
|
|
1.0
|
|
more than once
|
|
|
1.1(0.9-1.3)
|
0.348
|
1.1(0.9-1.3)
|
0.522
|
Total number of life partners
|
Only one (ref)
|
|
|
1.0
|
|
1.0
|
|
2 or more
|
|
|
1.9(1.6-2.1)
|
< 0.001
|
1.6(1.4-1.9)
|
< 0.001
|
Residence
|
|
|
|
|
|
|
Urban(ref)
|
|
|
|
|
1.0
|
|
Rural
|
|
|
|
|
1.0(0.8-1.2)
|
0.644
|
Region
|
|
|
|
|
|
|
Kampala(ref)
|
|
|
|
|
1.0
|
|
Central
|
|
|
|
|
1.2(0.9-1.7)
|
0.246
|
East
|
|
|
|
|
0.9(0.6-1.3)
|
0.615
|
North
|
|
|
|
|
0.5(0.3-0.7)
|
< 0.001
|
West
|
|
|
|
|
1.0(0.7-1.4)
|
0.791
|
Age group
|
|
|
|
|
|
|
15-19 (ref)
|
|
|
|
|
1.0
|
|
20-24
|
|
|
|
|
1.0(0.8-1.2)
|
0.846
|
Education
|
|
|
|
|
|
|
No education(ref)
|
|
|
|
|
1.0
|
|
Primary
|
|
|
|
|
1.2(0.9-1.6)
|
0.168
|
Secondary
|
|
|
|
|
0.9(0.7-1.3)
|
0.697
|
Higher
|
|
|
|
|
0.8(0.5-1.3)
|
0.319
|
Marital status
|
|
|
|
|
|
|
Not married(ref)
|
|
|
|
|
1.0
|
|
Married
|
|
|
|
|
0.9(0.7-1.1)
|
0.175
|
Religion
|
|
|
|
|
|
|
Christian(ref)
|
|
|
|
|
1.0
|
|
Muslims
|
|
|
|
|
1.3(1.1-1.6)
|
0.009
|
Other
|
|
|
|
|
1.8(1.1-2.9)
|
0.031
|
Source: Uganda Demographic Health and Health surveys (UDHS) 2006,2011,2016
ref = reference
|