A total of seven hundred thirty-three (733) participants completed the online questionnaire. Nine (9) participants were excluded from the survey because they were above 30 years of age, thus only seven hundred twenty-four (724) were considered for analysis.
Socio-demographic characteristics of participants
Out of 724 participants, 56.4% were male and 78.0% were living single. The mean age of the participants was 24.4 (SD± 2.8) years. The majority (87.2%) had attained an educational level of university and 27.2% were salaried employees. Most participants were from central Uganda (37.8%) followed by western Ugandan (35.1%) and most of them were students (46.5 %) at the time of study followed by paid employment 27.2% (Table 1).
Table 1: Socio-demographic characteristics of participants during the COVID-19 lockdown
Variable
|
Frequency N (%)
|
Sample size
|
724 (100)
|
Sex
|
|
Female
|
316 (43.6)
|
Male
|
408 (56.4)
|
Age group in years
|
|
18 to 24
|
395 (54.6)
|
25 to 30
|
329 (45.4)
|
Marital status
|
|
Living single
|
555 (78.0)
|
Married
|
81 (11.2)
|
Cohabiting
|
78 (10.8)
|
Education level
|
|
University
|
631 (87.1)
|
Vocational or Technical Institution
|
46 (6.4)
|
Secondary School and below
|
47 (6.5)
|
Location/Region in Uganda
|
|
Central Uganda
|
274 (37.8)
|
Western Uganda
|
254 (35.1)
|
Eastern Uganda
|
122 (16.9)
|
Northern Uganda
|
74 (10.2)
|
Employment status
|
|
Students
|
337 (46.5)
|
Paid employment (employee on a salary)
|
197 (27.2)
|
Self-employed (Business/Income Generating Activity)
|
62 (8.6)
|
Unemployed: No structured activity
|
69 (9.5)
|
Unemployed: Volunteer or unpaid work
|
59 (8.1)
|
Access to sexual and reproductive health services of participants during the COVID-19 lockdown
Out of 724 participants, 203 (28.0%) reported not having information and/or education concerning SRH and 521 (72.0%) otherwise. One hundred ninety-five participants (26.9%) reported not having access to testing and treatment services for STIs, 43.5% had access to STIs testing and treatment services while 29.6% participants reported not having information about STIs testing and treatment services. The preferred modern contraceptive methods were not easily accessible to 27.2% (n=197) of the participants during the COVID-19 lockdown. . HIV testing and counselling services were accessible for 48.2% (n=349) participants, while 22 % (n=159) of participants were unable to access the services when they needed them. Out of 62 participants who were on HIV treatment, 50 (80%) had difficulty in accessing HIV drugs during the study period. Menstrual health products were accessible to 26.1% (n=189) of participants while 17.5% (n=127) reported inability to access the services. Pregnancy care was available to 81.8% of 44 participants who were pregnant that time. Post abortion care was not available to 20.8% of the 24 participants who had abortion during the study period as shown in Table 2.
Table 2. Access to sexual and reproductive health services among Ugandan youths during the COVID-19 lockdown
Variables
|
All (%)
n=724
|
Availability of information and/or education concerning sexuality
|
|
No
|
203 (28.0%)
|
Yes
|
521 (72.0%)
|
Availability of testing and treatment services of STIs
|
|
No
|
195 (26.9%)
|
Yes
|
315 (43.5%)
|
Don't know
|
214 (29.6%)
|
Access to the preferred modern contraceptive
|
|
Not Easily
|
197 (27.2%)
|
Easily
|
132 (18.2%)
|
Not Applicable
|
395 (54.6%)
|
Availability of HIV testing and counselling services
|
|
No
|
159 (22%)
|
Yes
|
349 (48.2%)
|
I Don't know
|
216 (29.8%)
|
Access to Antiretroviral therapy (medication)
|
|
Not Easily
|
50 (6.9%)
|
Easily
|
12 (1.7%)
|
Not Applicable
|
662 (91.4%)
|
Access to menstrual health products such as sanitary pads
|
|
Not Easily
|
127 (17.5%)
|
Easily
|
189 (26.1%)
|
Not Applicable
|
408 (56.4%)
|
Availability of pregnancy care
|
|
Yes
|
36 (81.8%)
|
No
|
8 (18.2%)
|
Access to post abortion care services
|
|
Yes
|
19 (79.2%)
|
No
|
5 (20.8%)
|
Nearly half of the participants (n=357; 49.3%) reported using family planning methods of which 320 (44.2%) and 37 (5.1%) were modern and traditional methods respectively (Figure 1). Out of the 320 participants who were using modern contraceptive during the lockdown, the majority (n=232; 72.5%) were using condoms followed by emergency pills (n=33; 10.3 %), IUD (n=22; 6.9%), injection (n=20; 6.3%). Only 4.1% (n=13) of the participants reported using implants.
The limiting factors to access sexual and reproductive health services and information were reported among 453 (62.6%) of the 724 participants. These factors included lack of transport as the most common (43%), followed by distance from home (34.5%), cost of services (26.4%) and curfew (24.4%). Other limiting factors were fear/negative provider attitude (22.5%), no service provider (21.3%), school closure (12.3%) and unknown place of SRHR services (Figure 2).
The Ugandan youths (n=136; 18.8%) reported having problems related to SRH. STIs (40.4%) were the commonest problem related to SRH during the COVID-19 lockdown, followed by unwanted pregnancy (32.4%) and sexual abuses (32.4%). Other SRH problems included unsafe abortions and pregnancy complications that constituted 17.7% each, lack of ARVs (13.2%), child death (5.9%), fistula (5.2%) as shown in Figure 3.
Having a limiting factor to access SRH among Ugandan youths with their social demographics during the COVID-19 lockdown
The bivariate and multivariate regression analyses in Table 3, show that the limiting factors were more prevalent among cohabiting participants [CPR: 1.3 (1.13-1.49) and APR:1.2 (1.06-1.41)] followed by unemployed [CPR: 1.3 (1.09 - 1.53) and APR:1.2 (1 - 1.42)] and non-salaried [APR:1.2 (1- 1.42)] than other participants.
Table 3: Bivariate and Multivariate regression analyses using Poisson Regression of having a limiting factor to access SRH among Ugandan youths with their social demographics during the COVID-19 lockdown
|
Bivariate
|
|
Multivariate
|
Variable
|
CPR (95%CI)
|
P-Value
|
APR (95%CI)
|
P-Value
|
Sex
|
|
0.965
|
0.997
|
Female
|
1
|
|
1
|
Male
|
1 (0.89 - 1.12)
|
|
1 (0.89 - 1.12)
|
Age group in years
|
|
0.740
|
0.424
|
18 to 24
|
1
|
|
1
|
25 to 30
|
1 (0.91 - 1.14)
|
|
0.9 (0.83 - 1.08)
|
Marital status
|
|
<0.001
|
0.016
|
Single
|
1
|
|
1
|
Married
|
1.2 (1.04 - 1.41)
|
|
1.1 (0.97 - 1.36)
|
Cohabiting
|
1.3 (1.13 - 1.49)
|
|
1.2 (1.06 - 1.41)
|
Education level
|
|
<0.001
|
0.001
|
University
|
1
|
|
1
|
Vocational or Technical Institution
|
1.4 (1.27 - 1.65)
|
|
0.9 (0.72 - 1.08)
|
Secondary School
|
1.2 (1 - 1.45)
|
|
1.2 (0.94 - 1.48)
|
Location/Region in Uganda
|
|
0.088
|
0.294
|
Central Uganda
|
1
|
|
1
|
Western Uganda
|
1 (0.91 - 1.2)
|
|
1 (0.9 - 1.2)
|
Eastern Uganda
|
1.2 (1.03 - 1.4)
|
|
1.2 (0.99 - 1.34)
|
Northern Uganda
|
1.1 (0.95 - 1.39)
|
|
1.1 (0.92 - 1.34)
|
Employment status
|
|
0.048
|
0.025
|
Student
|
1
|
|
1
|
Paid employment (employee on a salary)
|
1.1 (0.94 - 1.23)
|
|
1 (0.87 - 1.2)
|
Self-employed (Business/Income Generating Activity)
|
1.2 (1 - 1.44)
|
|
1.1 (0.94 - 1.41)
|
Unemployed: No structured activity
|
1 (0.79 - 1.22)
|
|
1 (0.79 - 1.21)
|
Unemployed: Volunteer/ non-salaried
|
1.3 (1.09 - 1.53)
|
|
1.2 (1 - 1.42)
|
APR: Adjusted Prevalence ratios
CI: Confident Interval
CPR: Crude prevalence ratio
Problems relating to sexual and reproductive health with socio-demographics
The bivariate and multivariate regression analyses show that the problems related to SHR were more prevalent among those cohabiting [CPR: 2.7 (1.88 - 3.74) and APR: 2.3 (1.6 - 3.29)] followed by unemployed (Volunteer or unpaid) [CPR: 2 (1.27 - 3.2) and APR: 1.6 (1.03 - 2.64)] than others participants.
Table 4: Bivariate and Multivariate regression analyses using Poisson Regression of problems related to sexual and reproductive health among Ugandan youth with their Socio-demographics during the COVID-19 lockdown
|
Bivariate
|
|
Multivariate
|
|
Variable
|
CPR (95%CI)
|
P-Value
|
APR (95%CI)
|
P-Value
|
Sex
|
|
0.902
|
|
0.994
|
Female
|
1
|
|
1
|
|
Male
|
1 (0.72 - 1.33)
|
|
1 (0.74 - 1.35)
|
|
Age group in years
|
|
0.080
|
|
0.661
|
18 to 24
|
1
|
|
1
|
|
25 to 30
|
1.3 (0.97 - 1.78)
|
|
1.1 (0.76 - 1.54)
|
|
Marital status
|
|
<0.001
|
|
<0.001
|
Single
|
1
|
|
1
|
|
Married
|
2 (1.38 - 3.02)
|
|
1.5 (0.99 - 2.32)
|
|
Cohabiting
|
2.7 (1.88 - 3.74)
|
|
2.3 (1.60 - 3.29)
|
|
Education level
|
|
<0.001
|
|
0.001
|
University
|
1
|
|
1
|
|
Vocational or Technical Institution
|
2.3 (1.51 - 3.47)
|
|
0.5 (0.31 - 0.74)
|
|
Secondary School
|
2.2 (1.47 - 3.4)
|
|
0.8 (0.45 - 1.33)
|
|
Location/Region in Uganda
|
|
0.306
|
|
0.748
|
Central Uganda
|
1
|
|
1
|
|
Western Uganda
|
1.1 (0.74 - 1.56)
|
|
1.1 (0.75 - 1.53)
|
|
Eastern Uganda
|
1.5 (0.97 - 2.2)
|
|
1.2 (0.82 - 1.79)
|
|
Northern Uganda
|
1.1 (0.66 - 1.94)
|
|
0.9 (0.55 - 1.59)
|
|
Employment status
|
|
0.034
|
|
0.198
|
Student
|
1
|
|
1
|
|
Paid employment (employee on a salary)
|
1.5 (1.03 - 2.12)
|
|
1.2 (0.76 - 1.76)
|
|
Self-employed (Business/Income Generating Activity)
|
1.7 (1.04 - 2.79)
|
|
1.2 (0.73 - 2.09)
|
|
Unemployed: No structured activity
|
0.7 (0.32 - 1.41)
|
|
0.7 (0.33 - 1.44)
|
|
Unemployed: Volunteer or unpaid work
|
2 (1.27 - 3.2)
|
|
1.6 (1.03 - 2.64)
|
|
|
|
|
|
|
|
|
|
|
APR: Adjusted Prevalence ratios; CI: Confident Interval; CPR: Crude prevalence ratio