The assessment of the magnitude of risky sexual behavior and its association with self-esteem and other covariates among in-school adolescents in Addis Ababa: an explanatory mixed-methods study.
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Date
2021-09
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Addis Abeba University
Abstract
Background: Most of the sexual initiation and sexual practice of adolescents begins at
secondary school which is very risky. Low self-esteem may predispose adolescents to sexual risk
through negative schemata and attributions. However, not enough was done to assess the effect
of self-esteem development in reduction of risky sexual behaviors among Ethiopian adolescents.
Objective: The study aims to assess the magnitude of risky sexual behavior and its association
with self-esteem and other covariates among in-school adolescents in Addis Ababa.
Methods: Facility-based explanatory sequential mixed methods design was employed during
December 2020- February 2021. Self-administered questionnaire was used to collect quantitative
data from 629 high school students selected using a multi-stage sampling method. Quantitative
data was entered to Epi-data version 3.1 and exported to STATA version-15 for analysis.
Frequency distributions of variables were tabulated. Bivariable and multivariable binary logistic
regression analyses were performed and p-values less than 0.05 were considered to calibrate
statistical significance. The views of 18 qualitative participants selected by maximum variation
sampling procedure were explored using an in-depth interview. The qualitative data were coded
and classified into themes and sub-themes and findings were represented by way of a narrative.
RESULTS: A total of 605 participated in the study (response rate of 96.2%). About 248(41%)
of students reported that they ever had sexual intercourse. About 546(90.3%) of the students had
high self-esteem. The overall prevalence of risky sexual behavior was 160(26.5%). Perception
about the risk of STIs and pregnancy (AOR=2.34; 95% CI, 1.51-3.63), self-esteem (AOR=3.48;
95% CI, 1.88-6.42), and school type (AOR=2.08; 95% CI, 1.14-3.79) were independent
predictors of risky sexual behaviors. The strong reasons for the practice of risky sexual behaviors
among these adolescents were perception about sexual and reproductive health, low self-esteem,
school type, peer influence, substance use, pornography viewing and social media activities.
CONCLUSIONS: Over one in four high-school students have risky sexual behavior. Risk
perception, self-esteem and school type are significantly associated with risky sexual behavior.
Sexual and reproductive health programs for in-school adolescents should be tailored to address
their specific needs by building friendly public policies; creating a supportive environment,
developing personal skills, and reorienting the health services that help develop self-esteem and
change poor perceptions about STIs and pregnancy.
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Keywords
Risky Sexual Behavior, Self-esteem, Adolescents, Students, School