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Article

Research

Risky sexual behavior and associated factors among


high school adolescents in North Shewa zone, Oromia
Region, Ethiopia

Berhanu Teshome Woldeamanue

Corresponding author: Berhanu Teshome Woldeamanue, Salale University, Department of Statistics, Oromia, Ethiopia.
berteshome19@gmail.com

Received: 11 Jun 2020 - Accepted: 10 Jul 2020 - Published: 28 Jul 2020

Keywords: Risky sexual behavior, adolescents, high school, early initiation of sex

Copyright: Berhanu Teshome Woldeamanue et al. PAMJ - One Health (ISSN: 2707-2800). This is an Open Access article
distributed under the terms of the Creative Commons Attribution International 4.0 License
(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited.

Cite this article: Berhanu Teshome Woldeamanue et al. Risky sexual behavior and associated factors among high school
adolescents in North Shewa zone, Oromia Region, Ethiopia. PAMJ - One Health. 2020;2(18). 10.11604/pamj-
oh.2020.2.18.24237

Available online at: https://www.one-health.panafrican-med-journal.com/content/article/2/18/full

Risky sexual behavior and associated factors among Abstract


high school adolescents in North Shewa zone,
Oromia Region, Ethiopia Introduction: risky sexual behavior is one of the
major problems among adolescents in Ethiopia
Berhanu Teshome Woldeamanuel,& currently that results in adverse sexual and
1 reproductive health, such as undesirable
Salale University, Department of Statistics,
pregnancies, unsafe abortion and sexually
Oromia, Ethiopia
transmitted infections (STIs), like HIV/AIDS. This
&
Corresponding author study aimed to assess the risk factors associated
Berhanu Teshome Woldeamanue, Salale with risky sexual behavior among high school
University, Department of Statistics, Oromia, adolescents in the North Shewa zone, Oromia
Ethiopia region.

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Methods: a cross-sectional study was used. The HIV/AIDS [4]. Some studies also include that having
information collected from 386 high school multiple sexual partners, having sex without using
adolescents was considered. The study used a condom or inconsistent use of condom, initiation
descriptive statistics, and logistic regression model of sex before the age 18 years, sexual intercourse
to identify significant factors associated with risky under the pressure of alcohol and having sex with
sexual behavior. Results: the data showed that from commercial sex workers [5-8] in their definition of
total high school adolescents included in the study, risky sexual behavior. Globally, it is estimated that
13.2% were ever had sexual intercourse and the in 2019 about 1.2 billion (16%) of the total
mean age at first sexual intercourse was 16.05 ± population are adolescents aged 10-19 years,
2.57 years (95% CI 14.98-17.12). Overall the whereas about 23% of the population in sub
prevalence of risky sexual behavior was 11.4% in Saharan Africa are adolescents [9]. On the other
the study area. The logistic analysis revealed, hand, the UNAIDS in 2016 reported an estimated of
factors sex (being male) (AOR = 3.52; 95% CI: 1.479- 250, 000 new HIV infections among adolescents
8.382), drinking alcohol (AOR = 2.387; 95% CI: worldwide. Of these, 80% occurred in sub-Saharan
1.079-5.280), chewing khat (AOR = 3.850; 95% CI: Africa [10]. In Ethiopia according to population
2.729-5.188), watching pornographic movies (AOR projections for 2017, adolescents and youth aged
= 4.068; 95% CI: 1.70-9.735), using Shisha/hashish 10-24 account for one third of the total
(AOR = 1.649; 95% CI: 1.217-5.603) were population [11]. While adolescents aged 10-19
statistically significantly associated with the higher years consist of 25% of the total populations in
risk of practicing risky sexual behavior while Ethiopia [12]. Evidence indicated that in Ethiopia
discussion on sexual reproductive issues with the national prevalence of HIV/AIDS is 0.9%. The
parents was inversely associated with risky sexual high prevalence of HIV/AIDS is observed in the
behavior (AOR = (AOR = 0.339; 95% CI: 0.143- Addis Ababa city (3.4%) and Gambella region
0.806). Conclusion: the study identified sex, alcohol (4.8%) [13]. Overall, 0.2% of adolescent youth aged
use, chewing khat, using Shisha/hashish, watching 15-24 have been infected with HIV, whereas HIV
pornographic movies and discussion on sexual prevalence among adolescent girls and young
reproductive health issues with parents were the women is 0.3% and that of boys in the same age is
factors significantly associated with risky sexual 0.1% [13,14]. The recent Ethiopian Demographic
behavior. Even though the prevalence of engage in and Health Survey [15] reported nearly one in four
risky sexual behavior is lower than most studies in (24%) of women has first sexual intercourse before
Ethiopia, schools should give special cares for male age of 15 years old, whereas 2% of young men and
students, alcohol users, khat chewers, less than 1% of young women aged 15-24 years
Shisha/hashish users and students who watch were reported have had sexual intercourses with
pornographic movies, in order to decrease the more than one partner. On the other hand, about
prevalence of risky sexual behaviors among high 4.4% of Ethiopian adolescents and youth smoke
school adolescents. cigarettes, 45.6% consume alcohol 51% of
adolescents and youth consume alcohol [16].
Introduction Previous researches conducted in the Ethiopia
Adolescent period age 10-19 [1,2] is a transitional revealed that even though it differs from region to
stage of life; sexual behaviors that might negatively region the prevalence of risky sexual behavior was
affect the healthy development of young peoples´ relatively high. A study conducted on the risky
established [3]. Risky sexual behaviors are common sexual behavior practice and associated factors
sexual practices that results in adverse sexual and among secondary and preparatory school students
reproductive health, such as unintended of Aksum town, northern Ethiopia, showed that
pregnancies, unsafe abortion and STIs, like 19.6% of had practiced risky sexual behaviors [17].

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Another study done on risky sexual behaviors and contracting sexually transmitted infections,
associated factors among preparatory school currently many high school adolescents are
students in Arba Minch town, Southern Ethiopia engaged in risky sexual practice. Thus, this study
indicates 22.4% of students had risky sexual tries to assess the major risk factors associated with
behaviors [18]. A similar systematic review and risky sexual behavior among adolescents in the
meta-analysis of epidemiology of risky sexual north Shewa zone, Oromia region.
behaviors among college and university students in
Ethiopia showed that the prevalence of risky sexual Methods
behaviors among college and university students
was 41.62% [19] and a study done among Mizan Study setting and period: a cross sectional study
high school and preparatory school students´ was conducted between March 1 to May 1, 2019 in
revealed 51.3% prevalence of risky sexual eights secondary schools found in the north Shewa
behaviors [20]. On the other hand, a study zone with estimated residents of 1431305
conducted in the Wolayta zone, south Ethiopia, populations. North Shewa zone is located 114 km
revealed 17.9% of high school adolescents were away in the North West from, Addis Ababa.
engaged in risky sexual practice [21] whereas a
study in Bahir Dar and Mecha district indicated that Study design, population and eligibility criteria:
more than 13% of high school Adolescents had risky institutional based cross-sectional study design was
sexual behavior [3]. conducted. All systematically selected students
from registered for grade 9 - 10 and acquiesced
The determinants of practice of risky sexual were included in the study.
behaviors are significantly associated with
socioeconomic, cultural, geographic areas, Sample size calculation and sampling procedure:
environmental and demographic factors. Uses of the sample size was calculated using a single
alcohol were found strongly associated with high population proportion formula by considering 95%
risk sexual behaviors [18,19,22-24]. Substance use confidence level, the proportion of risky sexual
was also significant determinants of practice of practice as 51.3% [20] and a 5% margin of error. The
risky sexual behavior [18,25-27]. Other sample size of 386 was obtained. The sample size
determinants of the practices of risky sexual has been allocated to the eight schools based on
behaviors among students include watching proportional allocation to their size. The number of
pornographic movies [17-19,22], level of students between grades has varied. Assuming
knowledge and information about STIs [18,24,26], homogeneity in academic status among students in
peer influence [17,23, 26,27]. There is also a strong the same grade, a stratified proportionate sampling
and positive association between no parental was used to select study participants. List of
control and no parental discussion on sexual and students were obtained from registration books.
reproductive health issues [22, 23,26], high
income/pocket money [25] and with risky sexual Data collection and analysis process: the study
behaviors. Most studies also found that being male instrument was self-administered questionnaire
[19,23,25,26] is strongly positively associated with adapted from WHO sexual and Reproductive
risky sexual behaviors. Despite the fact that a Health. The questionnaire was designed to gather
number of studies have been done on the qualitative and quantitative data relating to
examination of factors associated with risky sexual demographic, socioeconomic and cultural factors,
behavior, in different parts of Ethiopia, the practice substance use, alcohol use, and practices of risky
of risky sexual behavior is still higher and more sexual behavior. Trained supervisors and data
effort is needed. Regardless of policies and efforts collectors were employed during data collection.
made to create communities´ awareness of The data collectors brief each question to the
respondents to help them understand the question

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well and complete the questionnaire. The participants. The majority of the participants (61%)
researchers had checked the completeness of each were male and 39% were females. The mean age of
questionnaire, followed and facilitated overall data the study participants was 17.40±1.535 years. The
collection process. Data were entered to SPSS vast majority (87.4%) of study participants was
version 21. Descriptive statistics such as, frequency followed Coptic Orthodox religion. Regarding the
and cross-tabulations were used to summarize the family education level, 62.1% of study participants
characteristics of study participants, whereas the were from a mother with no education at all and
multivariable logistic regression was used to whereas more than half (53.7%) were from
identify variables significantly associated variables illiterate father. On the other hand, when the
with risky sexual behavior with p-value < 0.05. The employment status of families was concerned,
goodness of fit test was done using the likelihood 77.7% and 86% of study participants were reported
ratio test (LRT) and Hosmer-Lemeshow tests. they were from unemployed mother and father
respectively. Nearly three-fourth of study
Measurement variables: adolescents were participants was living with their parents while
considered to have practiced risky sexual behavior 16.09% were living alone. Table 1reveals that 42.2%
when, they multiple sexual partners (having more of the study participants use alcohol and 17.8%
than one sexual partner until the survey), early chew khat. On the other hand, about 5% of study
initiation of sex (sexual debut at the age < 18 years participant smoke cigarette and 15.9% used illicit
old), erratic use of condom (inconsistent/fail to use drugs. It also indicates that 38% of study
condom at least ones during sexual intercourse participants were seen/read pornography (Table 1).
until the survey), sex with commercial sex workers
at least once until the survey. The variable, 'risky Prevalence of risky sexual behavior: about 13.2%
sexual behavior', was characterized as a binary of study participants were ever had sexual
response with 1 representing “yes” if the study intercourse and the mean age at first sexual
participants practiced any of the above behaviors intercourse was 16.05 ±2.57 years (95% CI 14.98-
and 0 representing “no” elsewhere. The 17.12). For those who ever had sexual intercourse
independent variables were socioeconomic, one-third of the study participant started sexual
cultural, environmental, parents and demographic intercourse below the age of 18 years. Only 43.8%
characteristics. of study participants used condom at the first
sexual intercourse and one-third (34.1%) had more
Ethical clearance: ethical clearance had been than two lifetime sexual partner. Concerning
obtained from the research and community service reason to start sexual intercourse nearly half
directorate office of Salale University. Permission (47.8%) of the study participants reported peer
to conduct the research was obtained from north pressure, 21.7% reported personal desire, 19.6%
Shewa zone education bureau and school directors. reported alcohol or drug influence while 15.7%
Full informed written consent/assent was obtained reported the started sexual intercourse for
from each study subject´s accordingly before the money/economic problem. The majority of the
data collection started and privacy was secured. study participants (65.6%) had started sexual
When age was under 16 years old, it obtained from intercourse with their boy/girlfriend, 31.1% started
parents/legal guardians. sexual intercourse with their teachers and 21.3%
started sexual intercourse with other than their
Results boy/girlfriend and teachers. Approximately three-
fourth of the study participant had information
Descriptive statistics of study participants: Table 1 about HIV/AIDS and only 25% reported they had a
presented the percentage distribution of the discussion on sexual reproductive health issues
selected sociodemographic characteristics of study

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with parents. Inclusive 11.4% of study participants with parents was found significantly associated
had practiced risky sexual behaviors (Table 2). with risky sexual behavior. Compared to
adolescents who didn´t discuss on the sexual
Factors associated with risk sexual behavior: reproductive health issues with parents, those
multivariable binary logistic regression analysis was children who had a discussion on the sexual
used to examine the effect of each predictor reproductive health issues with parents, had
variable on the practice of risky sexual behavior. significantly lower odds of risky sexual behavior
The overall goodness of fit was checked using the (AOR = 0.339; 95% CI: 0.143-0.806) (Table 3).
LRT and Hosmer -Lemeshow test. Consequently,
the likelihood ratio test, provided a chi-square Discussion
value of 46.938 (p-value < 0.001), which would
imply good fit for the model. Similarly, the Hosmer- The present study investigates the factors
Lemeshow test is found the observed data was associated with risky sexual behaviors among high
better fitted by the model (chi-square value = school adolescents in the north Shewa zone,
6.416, p-values = 0.601). The multivariable analysis Ethiopia. The prevalence of risky sexual behavior
of factors associated with risky sexual behavior was was 11.4%. This figure is lower than the previous
presented in Table 3. The result showed sex of a study conducted Aksum reported 19.6% prevalence
student, using alcohol, chewing khat, watching of risky sexual behavior [17]. A similar studies
pornographic movies, using Shisha/hashish, and conducted in Arba Minch reported 22.4% of
parental discussion of sexual and reproductive students had risky sexual behavior [18] and another
health were statistically significant factors study conducted in Jiga high school, the Amhara
associated with risky sexual behavior. According to region [24] reported 14.7% of the prevalence of
the results from Table 3, the odds of risky sexual risky sexual behavior. Whereas a study conducted
behavior were higher among males than females in Bahirdar and Mecha district reported nearly
(AOR = 3.52; 95% CI: 1.479-8.382). Study similar prevalence of risky sexual behavior (13%) [3]
participants who used alcohol were more likely to and a study conducted in Gondar reported 12.8% of
practice risky sexual practice than non-user keeping the prevalence of risky sexual behavior [22].
all other variables constant. The odds of risky sexual Similarly the mean at initial of sexual intercourse
practice were 2.387 times higher among alcohol was 16.05 ±2.57 years, which is lower than the
users than the non-users (AOR = 2.387; 95% CI: studies finding in Jiga, Amhara region [24],
1.079-5.280). Table 3 also shown that the odds of Shashemene, West Arsi zone [28], higher than the
risky sexual behavior were higher among studies finding in Aksum [17], Gondar [22] and
adolescents, who chew khat (AOR = 3.850; 95% CI: nearly consistent with the findings in Dire
2.729-5.188) compared to that of who didn´t chew Dawa [29], and Uganda [30] This inconsistent might
khat. Watching pornographic movies were found be due to the fact that the cultural, socioeconomic
significantly associated with risky sexual behavior. and environmental difference. In the multivariable
The odds of risky sexual behavior were about 4.068 logistic regression analysis, it was found that being
times higher among adolescents who had male was more likely associated with risky sexual
seen/read pornography (AOR = 4.068; 95% CI: 1.70- behavior as compared to female. This finding is
9.735). Using Shisha/hashish was another variable congruent with previous studies conducted in
significantly associated with risky sexual behavior, Bodit, south Ethiopia [21], Dire Dawa [31,29],
the odds of risky sexual behavior were 2.611 times Aksum [32], Ghana [33] and a meta-analysis done
higher among adolescents who used in developing countries [34]. The possible
Shisha/hashish than that of those who didn´t use explanation for this difference might be culturally
Shisha/hashish (AOR = 1.649; 95% CI: 1.217-5.603). males are more likely exposed to sexually explicit
Finally, discuss on sexual reproductive health issues materials than females in Ethiopia. Additionally,

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consuming alcohol was associated with the practice The major limitation was that misreporting or
of risky sexual behavior. The result is comparable under reporting of risky sexual practice and illicit
with previous studies from Haramaya, east drugs uses due to due to some cultures and
Ethiopia [35], Adama [27], Jimma [36], Gondar [22], traditions in the community. The other limitation
West Arsi zone [28], Sri Lanka [37], Dire Dawa [29], was that interaction effects were not used included
Southern Ethiopia [38], Jiga, Amhara region [24], in the analysis due to the large number of variables
Brazil [39], Mizan Aman [40], Arba Minch [18], and to compute.
a systematic review and meta-analysis in
Ethiopia [19]. This might be attributed to the fact Conclusion
that adolescents who drink alcohol could have a
better chance of getting sex with commercial sex The study has examined the prevalence and factors
workers and erratic use of during sexual associated with risky sexual behavior in North
intercourse. Shewa zone Oromia, Ethiopia. In the multivariable
logistic regression analysis, it was found that being
Adolescents who had ever seen/read pornography male sex, drinking alcohol, chewing khat, using
were more likely to practice risky sexual behavior. Shisha/hashish, watching pornography, and no
This finding is in agreement with previous studies discussion on sexual reproductive issues with
reported in Aksum [17,32], Gondar [22], Dire parents were factors significantly increase the risk
Dawa [29], Jimma [38], Arba Minch [18], and a of risky sexual behavior among adolescents. Even
systematic review and meta-analysis in though the prevalence of engage in risky sexual
Ethiopia [19]. Use of illicit drugs such as behavior is lower than most studies in Ethiopia, the
Shisha/hashish, were risk factors of risky sexual problem is still higher and policy makers and
behavior; i.e, adolescents who used Shisha/hashish schools should give special cares for male students,
were more likely to practice risky sexual behavior. alcohol users, khat chewers, Shisha/hashish users
Several studies recognized that uses of and students who watch pornographic movies, so
Shisha/hashish strongly correlated with risky sexual that to decrease the prevalence of risky sexual
behavior [18,27,30,32,39]. In this study, we found behaviors among high school adolescents.
that student who chewed khat had higher odds of
practicing risky sexual behavior. This finding is What is known about this topic
consistent with a study conducted in Dire  The practice of risky sexual behavior is
Dawa [29,31], West Arsi zone [28], Jimma [36] and higher;
Haramaya, east Ethiopia [35]. The possible  Most high school students use alcohol and
explanation of this might be that using substances substances;
might imitate adolescents watch pornographic  Most women have first sexual intercourse
movies and to practice what they seen with their before age of 15 years old and infected with
partners or other peoples. Discussion on sexual HIV/AIDS due to unprotected sexual
reproductive issues with parents was another intercourse is risky.
variable found statistically significantly associated
with risky sexual behavior. Adolescents who had a What this study adds
discussion on sexual reproductive health issues  The prevalence of risky sexual behavior was
with parents were less likely to practice risky sexual still high;
behavior. Similar findings were also reported lower  Discuss on sexual reproductive health issues
odds of risky sexual behavior among adolescents with parents is poor;
who had a discussion on sexual reproductive issues  Male students, are more likely uses alcohol,
with parents [17,22,28,32]. khat, Shisha/hashish and watch
pornographic movies.

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Table 1: socioeconomic and demographic characteristics of study participants
Variables Categories n %
Sex Male 230 61
Female 147 39
Age Below 17 91 28.9
17 and above 224 71.1
Religion Coptic Orthodox 332 87.4
Protestant 20 5.3
Muslim 16 4.2
Others 12 3.2
Mothers education No education 228 62.1
Primary 61 16.6
Secondary 37 10.1
College 41 11.2
Father education Illiterate 198 53.7
Primary 60 16.3
Secondary 39 10.6
College 72 19.5
Father’s employment status Employed 78 22.3
Unemployed 271 77.7
Mother’s employment status Employed 50 14
Unemployed 307 86
Current living condition With parents 256 71.1
Guardian/others 12 3.3
With relatives or friends 31 8.6
Alone 61 16.9
Ever drunk alcohol Yes 156 42.2
No 214 57.8
Ever chew khat Yes 64 17.8
No 295 82.2
Ever smoke cigarette Yes 18 4.8
No 311 95.2
Ever use illicit substances Yes 60 15.9
No 317 84.1
Ever seen/read pornography Yes 138 38
No 225 62
Parents control students Yes 180 48.6
No 190 51.4

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Table 2: sexual and reproductive history of study participants, North Shewa zone, Ethiopia
Variables Categories n %
Ever had sexual intercourse Yes 48 13.2
No 317 86.8
Reason to start sex Personal desire 10 21.7
Peer pressure 22 47.8
Influence of alcohol/drugs 9 19.6
Economic problem/for money 7 15.2
Age at first sexual intercourse <18 years old 16 33.3
≥18 years old 32 66.7
Mean±SD= 16.05 ± 2.57
Use condom at first sex Yes 53 43.8
No 68 66.2
Total number of sexual partners One 29 65.9
Two or more 15 34.1
Risky sexual behavior Yes 44 11.4
No 342 88.6
Knowledge of HIV/AIDS Yes 245 73.4
No 89 26.6
Discuss on sexual reproductive Yes 89 25.1
health issues with parents No 265 74.9
Relationship of first sexual partner Boy/girlfriend 40 65.6
Teachers 8 13.1
Others 13 21.3
Consistent condom use Yes
No

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Table 3: factors associated with risky sexual behavior among high school adolescents, North Shewa zone,
Ethiopia
Variable Risky sexual behaviors
COR 95% CI AOR 95% CI
Yes n (%) No n (%)
Sex
Male 34(14.8) 196(85.2) 2.377 1.136-4.972 3.52* 1.479-8.382
Female 10(6.8) 137(93.2) 1 1
Knowledge of HIV/AIDS
Yes 32(13.1) 213(86.9) 0.428 0.271-1.579 0.607 0.248-1.485
No 10(11.2) 79(88.8) 1
Alcohol use
Yes 27(17) 132(83) 2.582 1.340-4.977 2.387* 1.079-5.280
No 16(7.3) 202(92.7) 1 1
Currently live with
Parents 28(10.9) 228(89.1) 1.912 0.680-5.377 2.341 0.570-9.608
Guardians/relatives/others 4(9.3) 39(90.7) 1.197 0.475-3.017 0.519 0.146-1.842
Alone 10(16.4) 51(83.6) 1 1
Chew khat
Yes 19(30.6) 43(69.4) 5.302 2.681-10.486 3.850* 2.729-5.188
No 24(7.7) 288(92.3) 1 1
Ever seen/read pornography
Yes 21(15.2) 117(84.8) 1.656 0.873-3.140 4.068* 1.70-9.735
No 22(9.8) 203(90.2) 1 1
Peer pressure
Yes 10(16.9) 49(83.1) 1.709 0.789-3.701 0.879 0.347-2.229
No 32(10.7) 268(89.3) 1 1
Use of illicit drugs
Yes 14(22.6) 48(77.4) 2.858 1.414-5.779 2.611* 1.217-5.603
No 30(9.3) 294(90.7) 1 1
Use cigarette
Yes 4(25) 12(75) 2.658 0.817-8.647 1.488 0.392-5.643
No 39(11.1) 311(88.9) 1
Discuss on SRH issues with
parents
Yes 14(7.8) 166(92.2) 0.488 0.248-0.960 0.339* 0.143-0.806
No 28(14.7) 162(85.3) 1 1
*Significant at p < 0.05, Note: LRT = 46.938 (p-value < 0.001), Hosmer and Lemeshow Test = 6.416 (p-value =
0.601)

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