The aim of the present study was to assess the knowledge, attitude and practice of ECP and to elucidate the associations of ECP use with condom utilization among female students pursuing their education in private universities.
The finding of the present study indicates that almost half of the students (48.8%) had heard about ECP prior to this study. This figure is lower than the reports of studies conducted in the Northwest Ethiopia 67.1% , Mizan-Tepi University 67.8% , Jima technical college 80.1%  and Addis Ababa University 84.2% . However, it is higher than the findings reported from studies conducted in Addis Ababa 43.5%  and Jima 41.9% . These discrepancies might be associated with socio-cultural differences, availability and accessibility of sources of information and level of urbanization within towns where studies were conducted. However, the finding is consistent with reports of a study conducted in South Africa, which was 49.8% .
The finding also revealed that more than half of the students know correct time of taking ECP after unprotected sexual intercourse. This figure is higher than the findings reported in studies from Addis Ababa, Jima and South west part of Ethiopia [5, 18, 19]. Also, we found that the respondents had positive attitudes toward ECP use as the majority (61.7%) showed willingness to and about 59.8% pledged to recommend to friends. Similar findings were reported by Wassie et al.,  and Naidoo et al., .
The present study indicated that almost half (48.8%) of the students have had sexual intercourse before. This figure is higher than reports of similar studies conducted in Addis Ababa 19.5% , Northwest part of Ethiopia 16.5%  and Ghana 38% . This may be associated with the extent of convincing the respondents to disclose the sensitive issues. However, the result is consistent with findings of studies conducted in Kenya and South Africa, which reported 47.7% and 53.2% among university students respectively [3, 21]. Among those who ever had sex, the majority (61.3%) had sexual intercourse with ≥ 2 partners. This finding is higher than Ethiopian demographic health survey report  and study conducted in the Northwest part of Ethiopia . This discrepancy may be due to the residence of students as they were living with large communities in the present study.
The study indicated that one hundred fifteen respondents had used ECP before giving 30.2% overall prevalence of ECP use among young female students. This figure is higher than that of a study by Meskerem et al.  which reported 9.7% in Dire Dawa. But, higher than the study conducted by Ahmed et al.  in Addis Ababa University which was 75%. This discrepancy might be due to difference in the socioeconomic characteristics of study populations and the extent of town modernization and availability of ECP in the towns.
Moreover, our findings suggested that ECP utilization has negative impact on condom use. This supports the previous findings which showed consistent ECP users do not necessarily consider using condoms for STIs prevention [7, 11, 24]. On the other hand, the respondents who believed that ECP does not prevent STIs were 2 times more likely to use condoms than those who believed ECP can prevent STIs. In fact, one fourth of the students believed that ECP can prevent STI. This misbelief on ECP use lead to commit unprotected sexual intercourses. In this case, the students do not consistently take the necessary precautions to protect STIs; instead they focus primarily on preventing pregnancy [8, 25, 26]. To contain escalating STIs including HIV/AIDS and unwanted pregnancy, dual protections (condoms with other contraceptives) should be used [5, 8, 14, 27].
This study is not free of limitations. First, it was conducted only in three private universities found in Nekemte town, Western Ethiopia. Thus the findings cannot be generalized to ECP users in the country. Second, the study might not be free of bias during data collection as it involves a sensitive issue (sexual intercourse). A cross-sectional design was also limited in evaluating cause-effect relationships. Nonetheless, this study is the first of its kind to look at effect of ECP on condom use among female students in Western Ethiopia.