Demographic Characteristics
The median age of the study participants was 15 (IQR=2), in which 88.8% were between age of 14 to 16 years. Of all the study participants, 53% were females. Grade composition include 178(41.6%) grade nine, 142(33.2%) grade ten and 108(25.2%) grade eleven. The majority (91.8%) of the respondents were Christians and the rest 8.2% were Muslims. Regarding their family status, 71.5% live with both parents (father and mother), whereas 18.5% live with their mother only, and the rest 10% without any of the parents. The majority (91.8%) belong to Tigrigna ethnic group. With regard to the educational background of their parents, 81.5% fathers and 77.8% mothers of the students completed junior level or above, whereas illiterate parents were less than 9%. Students who discussed on important issues with their family were 396 (92.5%), but only 107 (25%) discussed about sexual issues and 225 (52.6%) discussed about pubertal changes during adolescence. The socio-demographic characters of the study participants is available as additional file 1.
Knowledge of participants on human reproductive system
The majority (n=219, 51.2%) of the respondents stated testes as an important reproductive organ, followed by ovary (47.2%), don’t know (24.8%); penis (19.4%); vagina (17.3%) and bladder (8.2%). Participants who knew the age of menarche were 227(53%) and those who correctly described the average days of menstrual cycle were 137 (32%). Participants were also asked the time of conception during menstrual cycle, and 69 (16.1%) replied correctly (Table 1).
Table 1.Study participants’ knowledge about human reproductive organs and function.
Variables
|
Number
|
Percent
|
Important male/female reproductive organ
|
|
|
|
Penis
|
83
|
19.4
|
|
Vagina
|
74
|
17.3
|
|
Bladder
|
35
|
8.2
|
|
Testes
|
219
|
51.2
|
|
Ovary
|
202
|
47.2
|
|
I don’t know
|
106
|
24.8
|
At what Age menarche starts
|
|
|
|
13 to 16
|
227
|
53
|
|
Other incorrect response
|
201
|
47
|
Average days of menstrual cycle
|
|
|
|
28
|
137
|
32
|
|
Incorrect response
|
291
|
68
|
Days a woman can conceive during menstrual cycle
|
|
|
|
Mid cycle
|
69
|
16.1
|
|
Other incorrect response
|
359
|
83.9
|
Knowledge of participants about STIs
As presented in table 2, the percentage distribution of responses of the students regarding sexually transmitted infections were HIV/AIDS (95.3%), syphilis (25%), gonorrhoea (21.3%), herpes simplex (9.8%), hepatitis B (4.4%), and I don’t know (3.3%). Most (44.6%) of the students responded that they don’t know the signs and symptoms of STI, those responded as high grade fever (31.8%), genital ulcer (31.6%), foul smelling discharge (26.2%), and no sign (7.9%). More than three fourth (77.3%) of the students responded unprotected sex as a mode of transmission of STIs. Others responses include contaminated blood (53.5%), MTCT (52.3%), and unsterilized sharps (49.3%). Very few (6.8%) were found to have no knowledge of the modes of transmission.
Table 2. Percentage distribution of study participants on knowledge of STI.
Variables
|
Number
|
Percent
|
Most common sexually transmitted infections
|
|
|
|
Gonorrhea
|
91
|
21.3
|
|
Hepatitis B
|
19
|
4.4
|
|
Syphilis
|
107
|
25
|
|
Herpes simplex
|
42
|
9.8
|
|
HIV/AIDS
|
408
|
95.3
|
|
I don’t know
|
14
|
3.3
|
Common signs and symptoms of STI
|
|
|
|
Foul smelling discharge
|
112
|
26.2
|
|
Genital ulcer
|
133
|
31.1
|
|
High grade fever
|
136
|
31.8
|
|
No sign
|
34
|
7.9
|
|
I don't know
|
191
|
44.6
|
Modes of transmission of STDs.
|
|
|
|
Unprotected sex
|
331
|
77.3
|
|
Unsterilized sharps
|
211
|
49.3
|
|
MTCT
|
224
|
52.3
|
|
Contaminated blood
|
229
|
53.5
|
|
I don't know
|
29
|
6.8
|
Prevention methods of STDs.
|
|
|
|
Abstinence
|
250
|
58.4
|
|
Condom
|
312
|
72.9
|
|
One to one
|
237
|
55.4
|
|
Oral contraceptive pills
|
128
|
29.9
|
|
Injectable
|
99
|
23.1
|
|
I don't know
|
31
|
7.2
|
Participants were also asked on the prevention methods of STIs, with responses condom (72.9%), abstinence (58.4%), one to one (55.4%), oral contraceptive pills (29.9%) and injectable (23.1%). Less than one tenth (7.2%) of the students were not able to identify any of the prevention methods.
Knowledge of participants on contraceptives
As described in table 3, most of the students (93.7%) knew about the availability of contraceptives. When asked where contraceptive can be found, 57.7%of them responded from pharmacy, 57.2%from hospital 39.7% from clinic, 35% from regular shops, 12.6% from hotels and 11.9% were not able to identify where contraceptives can be found. The knowledge on any of the contraceptive methods was also assessed, in which the majority 65.7% responded condom followed by oral contraceptive pills (50.7%), injectable (38.1%), abstinence (32.5%), withdrawal (7%), IUD (4.4%), Norplant (2.6%) and 13.1% said that they don’t know. Participants were asked the best method of contraceptive they think and 53.3% replied that the best method they think is abstinence. Concerning to the best method of contraceptive in general, 53.5% of the participants answered abstinence followed by condom (20.6%). They were also assessed for their knowledge of the best method of contraceptive during rape or unprotected sex and the majority (54%) of the participants responded that they don’t know, 28.5% said injection, 28.3% oral contraceptive pills, 3% Norplant and very few (1.9%) said IUD.
Table 3. Study participants’ knowledge about contraceptives.
Variables
|
Number
|
Percent
|
Do you know the availability of contraceptives?
|
|
|
|
Yes
|
401
|
93.7
|
|
No
|
27
|
6.3
|
Where can you find contraceptives?
|
|
|
|
Pharmacy
|
248
|
57.9
|
|
Shop
|
150
|
35
|
|
Clinic
|
170
|
39.7
|
|
Hospital
|
245
|
57.2
|
|
Hotel
|
54
|
12.6
|
|
I don't know
|
51
|
11.9
|
Methods of contraception you know?
|
|
|
|
Pills
|
217
|
50.7
|
|
Injectable
|
163
|
38.1
|
|
Norplant
|
11
|
2.6
|
|
Condom
|
281
|
65.7
|
|
Withdrawal
|
30
|
7
|
|
Abstinence
|
139
|
32.5
|
|
Loop
|
19
|
4.4
|
|
I don't know
|
56
|
13.1
|
What is the best contraceptive method?
|
|
|
|
Abstinence
|
228
|
53.3
|
|
Condom
|
88
|
20.6
|
|
Pills
|
28
|
6.5
|
|
Injection
|
15
|
3.5
|
|
One to one
|
39
|
9.1
|
|
I don't know
|
30
|
7
|
Best contraceptive during rape or unprotected sexual act
|
|
|
Injectable
|
122
|
28.5
|
|
Pills
|
121
|
28.3
|
|
Loop
|
8
|
1.9
|
|
Norplant
|
13
|
3
|
|
I don't know
|
231
|
54
|
Attitude of participants on reproductive health
Regarding to the attitude of the participants on whether adolescents should get a regular reproductive health service and advice, 408(95.3%) respondents had positive attitude. The result also showed that 333(77.8%) respondents had the perception that any adolescent can be infected with STIs. Moreover, 242(56.5%) of the respondents agreed that an adolescent need not to have a boyfriend or a girlfriend and 286(66.8%) had positive attitude towards continuing friendship with a friend who is infected with STI. The study also found that, 302(70.6%) had the attitude that unmarried couple can use any types of contraceptive during sexual intercourse. Furthermore, 363(84.8%) disagreed with sexual intercourse before marriage and 311 (72.7%) reported pregnancy before marriage is not acceptable. Among the study subjects, 311 (72.7%) stated utilizing sexually explicit material is not helpful (Table 4).
Table 4. Mean (SD) and percentage distribution of the participant’s attitude on RH.
Attitude
|
M (SD)
|
Agree n (%)
|
Disagree n (%)
|
An adolescent boy or girl should get regular reproductive health service and advice?
|
1.65 (0.92)
|
408 (95.3)
|
20 (4.7)
|
Any adolescent can be infected with sexually transmitted diseases?
|
2.34 (1.27)
|
333 (77.8)
|
95 (22.2)
|
An adolescent student needs not to have a boyfriend/girlfriend?
|
3.14 (1.30)
|
242 (56.5)
|
186 (43.5)
|
Continuing friendship with your friend who is infected with sexual transmitted disease has no problem?
|
2.73 (1.42
|
286 (66.8)
|
142 (33.2)
|
Unmarried girl or boy can use any type of contraceptive during sexual intercourse?
|
2.75 (1.31)
|
302 (70.6)
|
126 (29.4)
|
Sexual intercourse before marriage is not acceptable?
|
1.96 (1.31)
|
363 (84.8)
|
65 (15.2)
|
Pregnancy before marriage is not acceptable?
|
2.00 (1.26)
|
363 (84.8)
|
65 (15.2)
|
Utilizing sexually explicit material is not helpful?
|
2.48 (1.50)
|
311 (72.7)
|
117 (27.3)
|
Practice of participants on reproductive health
Most (77.8%) of the students stated that they did not have boy or girlfriend. Of those who had boy or girl friend, 3.5%were already engaged in sexual intercourse. The age of the respondents with regard to their engagement in sexual intercourse in descending order is that at age of 18(6.7%), 17(26.7%), 16 (33.3%), 15(20%), and 14(13.3%). Respondents who practiced sexual intercourse were at the mean age of 15.93 years (Table 5).
Table 5. Study participants practice on reproductive health.
.Variables
|
Frequency
|
Percent
|
Having boy or girl friend
|
|
|
|
Yes
|
95
|
22.2
|
|
No
|
333
|
77.8
|
Engage in Sexual Intercourse
|
|
|
|
Yes
|
15
|
3.5
|
|
No
|
413
|
96.5
|
Age at first intercourse
|
|
|
|
14
|
2
|
13.3
|
|
15
|
3
|
20
|
|
16
|
5
|
33.3
|
|
17
|
4
|
26.7
|
|
18
|
1
|
6.7
|
Using contraceptives during Sexual Intercourse
|
|
|
|
Yes
|
13
|
86.7
|
|
No
|
2
|
13.3
|
Action to be taken when there is a sign of STI
|
|
|
|
Tell father
|
179
|
41.8
|
|
Tell Mother
|
244
|
57
|
|
Tell siblings
|
119
|
27.8
|
|
Go to hospital
|
339
|
79.2
|
|
Tell friends
|
100
|
23.4
|
|
I keep quite
|
20
|
4.7
|
Utilizing sexually explicit materials
More than half (53%) of the respondents said that they utilize sexually explicit materials and the majority (63.9%) of them reported they use mobile phones, followed by video (35.7%), internet (24.7%), magazine (18.5%) and sexual books (14.5%). Most (53.3%) of them started utilizing at the ages between 13 to 15 years, 42.3% at the ages between 16 to 18 years and a few (4%) at the ages less than 12 years (Fig. 1).
Association of student variables with knowledge, attitude and practice
Students in the age range 14 to 16 (mean + SD value of 19.45 + 6.12) were found to have significantly higher level of knowledge than students in the age range 17 to 19 (mean + value of 17.60 + 5.81) (p-value=0.048). Moreover, the level of knowledge was significantly different among the three grades (p=0.001). ANOVA (LSD post hoc) has revealed that grade eleven students had significantly higher level of knowledge than both ninth (MD=2.72, 95% CI: 1.28-4.17, p<0.001) and tenth grades (MD=2.08, 95% CI: 0.57-3.59, p=0.007). Categories of gender (p=0.876), religion (p=0.942), ethnicity (p=0.492), parent with whom did they grew up (p=0.600), and with parent whom do they currently live (p=0.692) did not show any statistically significant difference in the level of knowledge (Additional file 2).
As presented in additional file 3, there is no statistically significant relationship the attitude of the students and their corresponding categories of demographic characteristics including age (p=0.134), gender (p=0.136), grade (p=0.09), religion (p=0.268), ethnicity (p=0.494), with whom grew up (p=0.604) and currently with whom they are living (p=1).
The items of questions used to assess the practice of the respondents toward reproductive health were made in such a way where the ideal minimum and maximum scores are taken to be 0 and 10. The distribution of the scores was not normally distributed and hence non-parametric statistics were used to assess the difference in the score of practice among the student categories. Mann-Whitney U test revealed that those students who communicate with their parents on important issues were found to have higher level of practice (p=0.039). However the rest of the variables such as age (p=0.063), sex (p=0.059), grade (p=0.931), religion (p=0.98), ethnicity (p=0.327), with whom grew up (p=0.362), currently with whom living (p=0.703) and communication on important issues and pubertal changes were not found to be significantly related with the practice of the participants from a statistical point of view (additional file 4).