Clinical Sciences and Clinical Research

Abstract

Introduction: Condom as an important family planning method. Condoms are playing a central role in the prevention of sexually transmitted infections, HIV, and unintended pregnancy particularly among young peoples. The transmission of STIs including HIV/AIDS can be prevented by almost 100% through correct and consistent condom use.  Despite the continuous effort from the public and private sectors at various levels, its use among adolescent remains low. Therefore, this study aimed to assess the knowledge of correct condom use and factors associated among adolescent in Yeka sub city Addis Ababa Ethiopia.

Objective: To assess consistency of condom use and associated factors among adolescent in Yeka sub-city, Addis Ababa, Ethiopia.

Methods: - community based cross sectional study design were employed. To obtain study subjects, the respondents were selected using a simple random sampling technique. Firstly, from11woredas in the Yeka sub-city, 4 woredas namely Yeka woreda 06, Yeka woreda 07, Yeka woreda 08, and Yeka woreda 05 selected simple randomly by lottery methods. Secondly, the number of adolescent that were included in the study determined proportionally in accordance with the total number of adolescent in the sampling frame of the selected woreda Self-administered questionnaires’ used to collect the data. Data were checked, and entered to Epi-data version 3.1, and then exported to SPSS (Statistical Package for Social science) version 25 for analysis.

Result: Out of 422Adolescent, only 406 had participated in the study yielding a response rate of 96.2%. The prevalence of consistency of condom use among respondents was 17%. Factors that were independently associated with consistency of condom use in multivariate analysis were having sex (AOR=5.83, 95% CI: 2.45-13.90), secondary educational level & diploma above (AOR=2.55, 95% CI: 1.86-3.67), (AOR=6.15,95% CI:1.60-23.77), Average family monthly income (AOR=0.17,95% CI:0.04-0.73), pocket money (AOR=0.34,95% CI: 0.15-0.77),and Alcohol drunk (AOR=0.07,95% CI:0.02-0.24).

Conclusion: In this study, consistent condom use among adolescent was low. Adolescent having educational status of secondary school and diploma &above, sex, family monthly income, pocket money had better consistent condom use.

Introduction

Condom use is critical for comprehensive and sustainable prevention of sexually transmitted infections (STIs), human immunodeficiency virus (1), and unintended pregnancies, in a comprehensive and long-term way(2). Sexually transmitted diseases (STD), including HIV, can be prevented through the use of condoms and unplanned pregnancy. Programs that promote condom use are essential to reduce the spread of HIV. STDs are a group of contagious diseases that can be spread "person to person" or vertically from the mother to the child. The majority of HIV transmission occurs through STDs(3).

Adolescence is a period of high-risk behavior, especially sexual activity. When used appropriately and regularly, condoms can reduce transmission rates by 80-95%. PLHIVs are encouraged to use condoms as part of their preventative efforts to minimize HIV transmission and the spread of STIs(4, 5).

The global AIDS epidemic has 33.3 million people living with HIV/AIDS, 22.5 million from Sub Saharan Africa, and 1.8 are newly infected(6). HIV prevalence in Kenya is 7.4% in the 15-49 and 7.1% in the 15-64 age groups(7).

The use of condoms is essential to a long-term strategy for avoiding HIV/AIDS, STDs, and unintended pregnancies(8). They serve as a barrier to prevent body fluids containing HIV from coming into contact with areas of the body that are susceptible to HIV infection. External and internal (female) condoms are the two primary types, with the internal being inserted into the vagina and the external being placed on the erect penis(9). The only HIV prevention measure that can also lower the risk of pregnancy and sexually transmitted infections is the use of condoms(3).

HIV/AIDS patients must use condoms consistently to prevent the spread of the virus and other diseases. Barriers to this include belief that condoms are of no importance, poor sexual satisfaction, the need to raise children, alcohol use, anxiety, depression, and insufficient counseling by healthcare professionals. The risk of HIV transmission is reduced from very low to insignificant when condoms are used properly and consistently(10).

This study aimed to fill an information gap by assessing knowledge and associated factors of correct condom use and consistence of condom use among adolescent in Yeka sub city Addis Ababa, Ethiopia.

Statement of Problem

Every year, an estimated 333 million new cases of STDs are reported worldwide, with the highest rate among people aged 15 to 24(11).New infections contribute to the increasing numbers of people living with HIV (PLWHIV), and annual global statistics recorded 1.7 million new infections with HIV by the end of 2018(1).

The burden of HIV varies across different regions of the world, with sub Saharan Africa experiencing the most severe burden, having one in every twenty-five  adults living with the disease(12). Adolescents and young people are becoming a larger proportion of HIV positive people, with 400,000 young individuals aged 10 to 24 newly infected with HIV in 2020 alone(13). Using a condom properly and consistently can reduce the risk of transmission of HIV and some other STDs(9).

STD can increase the risk of mother-to-child HIV transmission and lead to adverse birth outcomes among HIV-infected women. However, the level of barrier method utilization among HIV-positive people in the developing countries is low(14).

For women ages 15 to 19, complications of pregnancy, childbirth, and unsafe abortion are the major causes of death. Young people ages 15 to 24 have the highest rates of sexually transmitted infections (STIs), including HIV. Statistics on rape suggest that between one-third and two-third of rape victims worldwide are 15 years old or younger(15).

Ethiopia’s youth accounts for about 34 % of the total population of the country. They are exposed to various risks such as early marriage, early pregnancy, STDs including HIV, unemployment, drug abuse and crimes(16).

Unwanted pregnancy among youth and adolescents is a major sexual and reproductive health challenge in Africa and Ethiopia, with 54% of women under 15 and 37% of youth aged 20-24 having an unwanted pregnancy(17).

Unprotected sexual intercourse is the main route of HIV transmission among young people in Ethiopia, with 87,000 living with HIV and only 8700 new infections. Condoms have been a major factor in the fight against STIs, HIV/AIDS, and other sexually transmitted illnesses over the past decade(18).

Inconsistent condom use elevates teenagers’ risk of STDs. Each year, more than nine million U.S. youths acquire an STD. although many factors may influence adolescents’ decisions about condoms, such decisions occur within the dyadic context of their sexual relationships(19).

The use of condoms is essential for the complete and long-term prevention of STIs, HIV, and unplanned pregnancies. Despite having a high degree of sexuality, studies in sub-Saharan African nations have shown that young people do not frequently engage in protected sex(20). In various survey have been done to study sexuality and condom use among school adolescents in Ethiopia, most of these studies are conducted in major towns and there is also a great gap between knowledge and practice which needs detailed research. In addition, most of the studies did not specifically assess factors that contribute to low use of condom among school adolescents.

Despite these interventions, the issue continues to be a public health problem, and there is paucity of evidence that has assessed the prevalence and factors affecting correct condom use among adolescents in Yeka sub city Ethiopia. Therefore, this study aimed to assess the level of consistent condom use and associated factors among youth who attended Yeka sub city in Addis Ababa Ethiopia.

Significant of the Study

This study aims to generate information on the magnitude and contributing factors of correct condom use among adolescents, and it will provide an insight about factors contributing to inconsistent condom use in adolescent in Yeka sub city youth center.

Identifying the causes of knowledge of correct condom use and consistency of condom use in Adolescent can helps in the development of strategies for reducing the risk of unwanted pregnancy and it complication, STI including HIV. To improve a healthy and productive adolescent.

The results of this study will be helpful in giving information and highlights about the prevalence and associated factors of knowledge of correct condom use and consistency of condom useamong adolescent for the Yeka sub city Addis Ababa, Ethiopia.

Health care providers to give more focus on the issue and integrate the assessment and treatment of knowledge of correct condom use and consistency of condom usein the adolescent and youth friendly services (AYH).

Adolescent are the key beneficiaries of this study since their level of knowledge about correct condom use and consistency of condom use are assessed, and recommended to concerned agencies. The findings of this study will serve as baseline data for further study related to this topic.

Objectives

General Objective
To asses consistency of condom use and associated factors among Adolescent in Yeka sub-city, Addis Ababa, Ethiopia, 2023.
Specific Objectives
1.    To determine the magnitude consistency of condom use among Adolescent in Yeka sub-city, Addis Ababa, Ethiopia
2.    To identify factors associated with consistency of condom use among adolescent in Yeka Sub City, Addis Ababa, Ethiopia
 

Methods and Materials

Study Area and Period

Yeka Sub City was located at the north of the city Administration and was bounded by bole sub city to the south, by lemikura sub city to east, by Oromia region to the north and by Arada and Gulalle to the west. The total population of the sub city was about 355, 473 as projected for 2017 (38). Yeka sub city is divided in to eleven Woredas. In Yeka sub city, there are 02 Public hospitals, 11 health centers (HCs), one nongovernmental organization five private hospital and 71 private health facilities. One of the city administration's sub cities is Yeka and there are 106 kindergartens, 26 of which are public, 88 primary schools, 28 of which are public, and 17 secondary and preparatory schools, seven of which are public.

In 2022/3 G.C, there are a total of eleven woredas in the Yeka sub city. The study conducted in May 15-30, 2023.

Fig 1: Map of new updated yeka sub city with its woreda and bordering sub cities, 2023

Study Design

A community-based cross-sectional study were employed.

Population

Sources of population

The target populations for this study were all adolescent live in woredas at Yeka sub city Addis Ababa Ethiopia.

Study population

The study population adolescents found in randomly selected woredas in Yeka sub-city Addis Ababa Ethiopia.

Eligible Criteria

Inclusion criteria

All adolescents capable of being interviewed, lived more than six months in the selected woreda of Yeka sub-city.

Exclusion criteria

Adolescent who have not mentally capable for the interview

Adolescent in emergency conditions that affect the ability to give consent and respond to the questions.

Sample Size Determination

Sample size for the first objective was calculated using single population proportion formula;

n= Za22 *Pqd2

The assumptions used are: Z=standard normal distribution curve value for the 95% with a confidence interval (1.96)

d - Marginal error of 5%,

p – Proportion

 n - Sample size

The prevalence consistence condom use was taken (P) at 50%, as no studies have been conducted in this area. To calculate the sample size:-

n = 1.962*(o.5*.0.5)(0.05)2.   n=384 , =by adding 10% non-response rate then the final sample size of the study will be 422.

Sampling Procedures

The study was conducted in Yeka sub-city. To obtained study subjects, the respondents were selected using a simple random sampling technique. Firstly, from 11woredas in the Yeka sub-city, 4 woredas namely Yeka woreda 06, Yeka woreda 07, Yeka woreda 08, and Yeka woreda 05 selected by lottery methods. Secondly, the number of adolescent that were included in the study determined by proportionally in accordance with the total number of adolescent in the sampling frame of the selected woreda.  The sampling frames (list of all adolescents) obtained from family health folder from the primary health care unity in woreda health center. Finally, the respondents were selected by systematic random sampling from the frame list.

Figure 2: schematic presentation of sampling procedure among woreda at yeka sub city 2024.

Study Variables

Dependent variables

Consistence of condom use

Independent variables

1. Sex
2. Age
3. Religion 
4. Marital statue
5. Educational statues
6. Living arrangement
7. Household income
8. Pocket income
9. Drink alcohol
10. Chewing chat
11. Cigarette smoking
12. sexual intercourse
13. Peer pressure

Data Collection Tool and Technique

The data collection instrument was an interviewer-administered questionnaire& the questionnaire was adapted from previous similar studies (3, 5, 22).To guarantee the consistency, the firstly written in English, and then translated into Amharic and then back into English by a native speaker of both languages.

The questionnaire was address the objectives of the study, which touch on the following areas: Using structured questionnaires, researchers assessed 1) socio-demographic characteristics, 2) substances factors, 3) sexual factors, 4)knowledge of correct condom use.

Data was collected from each selected woreda &households. Four trained data collectors and two supervisors was participated in the data collection task. The principal investigator coordinate the overall process for data collection. The data was collected in May15-30, 2022.

Operational Definition

Adolescents: Those who are in the age group of 10-19 years (39).

Consistency of condom use: Who used condoms every time was considered consistency of condoms use. Sexually experienced participants were asked, “Did you use a condom at every sexual intercourse in the last six month?” Response options were “Yes” or “No”(40).

Knowledge of condom use: Knowledge index was built from the answers to seven questions on a condom use answers. Based on the answers to these knowledge questions, the index was classified as good knowledge (score  4) and poor knowledge (score <=3 )(5).

Sexual risk behavior: Any sexual behavior that does not fulfill the above statement

Alcohol: - Drinking material that contains alcohol (Tella, Teji, Areke, Beer, Wine, etc...)

Alcohol drinkers: - study participants who were taking alcohol drink sometimes or more

Data Analysis

The collected data was checked for completeness and consistency, then coded, and entered into Epi data version 3.1 and exported to SPSS version 25 statistical software for final analysis. Descriptive, bivariate and multivariate analyses was carried out. Simple descriptive analyses used to describe the study population correlated to relevant variables and presented using text, table, frequency, and percentage. Variables that have a p-value ≤of 0.25 on bivariate analyses entered in the multivariate logistic regression model to identify independent variables of consistency of condom use P < 0.05 was considered statistically significant. The strength of association and precision was examined using an adjusted odds ratio at a 95% confidence interval. The multivariate logistic regression analysis was conducted to examine the associated factors for consistency of condom use. The predictive value of the model was assessed using Hosmer–Leme show goodness-of-fit test statistics.

Data Quality Assurance

The investigator was offer data collectors one days of training to achieve the following goals: a complete review of questionnaire interview techniques, ensuring confidentiality and privacy of study respondents, and assistance on how to deliver the questionnaire. Pre-testing was done on the questionnaire, and the data was checked for accuracy and completeness.  The data was be kept in a secure location until it is necessary for a backup, in order to protect confidentiality to ensure the questionnaire's reliability. Pretest was done in Arada sub city at woreda 07 with a population that similar to study area. The study area of the study subjects was taken by taking 5% (19) participants, which was not included in the survey. Based on the finding from the pretest, two questions on socio-demographic were exclude (religion & ethnicity), which create vague among participants. Survey completion required 20-25 minutes.

Ethical considerations

Ethical clearance was obtained from an institutional review committee of Rift Valley University. A permission letter, and also secured from, Addis Ababa health bureau public health research, and emergency management directorate (AAPREM) and the official letter was written to Yeka sub-city health office and then Yeka sub-city health office to each health centers. Additionally, Oral or written consent was taken after aims and side effects were told and cleared. Information given was confidential and use only for the purpose of the research. The information obtain from the respondents was identified by their code numbers & conducted entirely. There no any risk and direct benefit to the participants for their participation. Full right to stop the study any time they want or refuse to respond to some of the questionnaires.

Result

Socio-Demographic Characteristics

Out of a total of 422 respondents, 406 respondents had participated in providing a response rate of 96%. Of these more than half of the study participants, 252 (62.1%) were found under female, and the remaining 164(40.4%) were categorized under male. The mean age of the study participants was 17.41 with ±SD 1.22. With regards to Educational level, the majority of study participants 120 (29.6%) were Diploma and above,107 (26.4%) were primary school and 91(22.4%) of the participants were secondary school. Concerning marital status three hundred twelve (76.8%) of the participants had single, and 42 (10.3%) were married. (46.6%) of study. Half of the respondent were living with their family and occupation of student 197(48.5%), 208(51.2%) of the study respondent respectively.

Substances use history of the respondent

From the total 406 respondents 162 (39.9%) consumed alcohol, 78(19.2%), chat chewing and 62(15.3%) cigarette smoking.   135(83.3%) of the respondent after consumed alcohol ever had Sexual intercourse and 97(71.9%) used condom.

Sexual behavior of the respondents

One hundred seventy six (43.3%) of the respondents had sexual intercourse and half of them 90 (51.1%) of them had sexual intercourse with a spouse partner for the first time followed by 51 (29% with permanent partner, and 35 (19.9%) had sex with casual partner. The mean age of first time sexual intercourse was 16.06 with (SD 1.024). Most of the respondents 176 (43.3%) were history of condom use sexually active during the past 6months. 87 (49.4%) of the respondents had condom use recommended by mutual decision. Regarding to frequency of condom usefrom176 respondents 69(39.2%), 57(32.4% and 50(28.4%) were always, sometimes and mostly used condom during sex respectively.

Knowledge of condom use

The condom continues to be the most widely used form of birth control among teenagers. 394 respondents (97%) knew about condoms. The main sources of information about condoms for 293 of the respondents (74.4%) came from friends, while 268 (68%), 220 (55.8%), and 50 (12.7%) came from the media, school clubs, and families, respectively. Of the respondents, 238 (56.2%) had been to a condom demonstration session. Correct condom use can prevent HIV/AIDS transmission in 392 (96.6%) respondents, minimize HIV risk in 374 (92.1%), and prevent pregnancy and sexually transmitted infections in 99.8% of respondents and respondents, respectively. The respondents' total knowledge of proper condom use was 374 (92.1%).

Prevalence of consistency condom use

Sixty-nine (17%) (CI: 95% 16.93, 17.07) of the sexually active respondents have used condoms consistently in the last 6 months (table 4). Regarding the overall frequency of condom use in the past six months, 56 (31.8%) adolescent claimed that they sometimes used condoms, 44 (25 %) mostly used condoms, and 76 (43.2 %) used condoms every time. The participants who used condoms every time were considered to be using condoms consistently. Fifty-one (23.8%) students reported that they had not used condoms the last time they had sex with a male sex partner.

Factors Associated with Consistent Condom Use

Bivariate analysis was conducted to identify associated factors of consistent condom use among adolescents: sex of respondents; age; educational level; pocket money; family monthly income; marital status income alcohol drinking; chat chewing, and cigarette smoking films was found to be p<0.25 and entered into multivariable analysis. Then multivariable binary logistic regression analysis was used to examine the effect of each predictor variable on the consistent condom use. The overall goodness of fit was checked using the Hosmer-Leme show test.

The predictive value of the model was assessed using the Hosmer–Leme show goodness-of-fit, which was found 0.954. Thus, the p-value for the Hosmer and Leme show was greater than 0.05, which indicated the fitness of the model. Sex of respondents, educational level, family monthly income, pocket money, and alcohol drinking significantly determine respondents’ consistent condom use.

According to the results, the odds of inconsistent condom use were 2.81 times higher among females than males (AOR: 2.81, 95% CI (3.43, 12.30) and p-value = 0.000.

This study showed that educational levels were associated with inconsistency of condom use. Adolescents whose attended secondary and diploma and above were 2.60 and 3.55 times higher to have inconsistent condom use than illiterate (AOR: 2.55; 95% CI (1.76, 3.67), p-value = 0.005) and AOR: 3.55; CI (1.60, 23.71), p-value = 0.005, respectively. The odds of using condom consistently were 83% less likely among adolescents whose family average monthly income were <5200 as compared to > 10901(AOR፡ 0.17; 95% CI (0.04, 0.73), p-value=0.017.

The odds of using condom consistently were 66% less likely among adolescents who have pocket money as compared to the counterpart (AOR: 0.34, 95% CI (0.15, 0.77), p-value = 0.009). 

The odds of using condom consistently were 93% less likely among adolescents who drunk alcohols compared to those did not drink alcohol (AOR: 0.07; 95%CI (0.02, 0.24)), p-value = 0.0001.)

Discussion

This cross-sectional study is one of the few studies that has explored the factors associated with consistency of condom use in the past six months among Adolescents in Yeka sub city Addis Ababa, Ethiopia. Risky sexual behaviors were commonly identified in this study.

Consistent condom use is a cornerstone in public health for the prevention of HIV and other sexually transmitted infections (STIs), especially among people with HIV/AIDS. This study revealed that the magnitude of consistent use of condom was 17 %. This finding is lower than a study conducted in savannakhet 85%(24), Changsha City 56%(25), democratic republic of Congo 40%, Burkina Faso 38%, Ghana 47%, Malawi20%, and Uganda 36%(26), in Jos Nigeria 26%(29) ,  in Sodo, Southern Ethiopia 70% (5), Hawassa City, Sidama, Ethiopia, 51.4%(3),and also this finding is higher than a study  conducted in Amhara region, Ethiopia 14.2%(16). This difference might be due difference in socio_ cultural of participants, study area, period, and sources of population.

In order to reduce the risk of HIV transmission (including reinfection and spread of resistant strains to sexual partners), Adolescent must consistently use condoms. The likelihood of an HIV-positive pregnant woman passing on the unprotected sex increases the risk of infection to her unborn child, even if she is taking ART. Combined with the simultaneous protection  given by regular condom use, which protects against HIV and other STIs that may also result in infections in newborns, the additional benefits of routine condom use in expectant mothers It cannot be overstated.

This study showed that educational levels were associated with inconsistency of condom use. Adolescents whose attended secondary and diploma and above were 2.6 and 3.55 times higher to have inconsistent condom use than illiterate respectively. This finding is supported by similar  study conducted in South Africa Soweto(34),Democratic Republic of Congo(14),and in Ethiopia such as Amhara regional state(16)and Hawassa city ,Sidama(3). This differences might be due to negligence of those who had higher educational level.

This study found that inconsistent condom use is affected by sex. Females were 2.81 times more likely to use condom inconsistently than male. This result was supported by a study conducted in Kenya also showed that female were three times more likely to report inconsistent condom use compared to males(7) , also study in UNAIDS 2011 report(32), in Angola (37).  in south Africa Soweto(34), and a similar study conducted in Hawassa city , Sidama, Ethiopia(3). in contract  to this a study conducted in male was more consistency use of condom than female(36). The unusual female preponderance in consistent condom utilization might be due to the fact that female might be forced to commit sex with males and female might use sex as income source & the shift of male’s need from a reduction of infection to seek satisfaction.

According to this study the odds of using condom consistently were 83% less likely among adolescents whose family average monthly income were <5200 as compared to > 10901. Similar study conducted in South-East Nigeria(29). This possible reason for this might be due to those have low income might not have right to decide to had sex with condom.

This study also showed that the odds of using condom consistently were 66% less likely among adolescents who have pocket money as compared to the counterpart.

Alcohol drinking has high effect on personal decision on using condom. According to this study the odds of using condom consistently were 93% less likely among adolescents who drink alcohol as compared to those didn’t drink alcohol. This finding is supported by a study conducted in four Southeast Asian(33) , Adama and Asella(28). This might due to the fact that alcohols affect each activities and decisions towards usage of condom.

However, occasional condom use cannot play its full protection role, especially when having sex with an HIV-positive partner. Therefore, developing an HIV prevention program for consistent condom use is important for Adolescents.

In the current study, the participants with overall knowledge of condom use high were likely to report condom use consistency in the past six months, this finding supported by study conducted in Kenya(7). The main sources of information about condom was Friends, mass media, school club, and family 74.4%, 68%, 55.8%, 12.7% respectively. This might be due to knowledgeable participant increase the use of consistent condom use.

Respondents who use condom to prevent from HIV/ADIS, (92.1%) unwanted pregnancy (99.8%), and STI (99.8%) respectively. This result was supported by study conducted in Savannakhet Stated reasons for consistent condom use was prevention of HIV (94 %), STIs (88 %) and pregnancy (87%)(24). This might be due to the better knowledge of condom use were more likely to use a condom.

Age category of respondents, marital status, chat chewing adolescent and cigarette smoking the current study has no significant association with consistence condom utilization the variables mentioned needing further study of ascertainment with big sample size.

Conclusion & Recommendation

Conclusion

Adolescents' consistent condom use is crucial for an HIV-free nation and reducing unwanted pregnancies. This study found that adolescents with higher education, sex, family income, and alcohol consumption statically significantly associated to consistent condom use. To improve women's educational status, it is essential to develop HIV prevention programs and emphasize the importance of consistent condom use in health education. Safe sex strategies should also be developed in exceptional circumstances, and parents should be involved in their children's sex education, especially before college.

Recommendation

The study recommends the following:-

1. Scaling up campaigns that will help to equip knowledge among male adolescent on the prevention of STI's including HIV and prevention of unwanted pregnancy through the use of a condom
2. Government and stakeholders more focus on adolescent education programs and AYH services.
3. Make Female condoms accessible and affordable to the general public
4. Promotion of sexual and reproductive health communication with the household, which can assist the adolescent in the prevention of STI’s, including HIV and unwanted pregnancies
5. Increases monthly average household income and to prevent adolescent for sexual intercourse for financial purpose for family and them
6. Family members scaling upon sexual and reproductive health information with adolescent.
7. For policy makers sexual consistency of condom use is still low in Ethiopia, policy makers should be give special attention to decrease the prevalence of HIV unwanted pregnancy & STI.

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