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Risky sexual behavior and associated factors among high school adolescents in North Shewa zone, Oromia Region, Ethiopia

Risky sexual behavior and associated factors among high school adolescents in North Shewa zone, Oromia Region, Ethiopia

Berhanu Teshome Woldeamanuel,&

 

1Salale University, Department of Statistics, Oromia, Ethiopia

 

 

&Corresponding author
Berhanu Teshome Woldeamanue, Salale University, Department of Statistics, Oromia, Ethiopia

 

 

Abstract

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

 

Methods: a cross-sectional study was used. The information collected from 386 high school adolescents was considered. The study used descriptive statistics, and logistic regression model to identify significant factors associated with risky sexual behavior.

 

Results: the data showed that from total high school adolescents included in the study, 13.2% were ever had sexual intercourse and the mean age at first sexual intercourse was 16.05 ± 2.57 years (95% CI 14.98-17.12). Overall the prevalence of risky sexual behavior was 11.4% in the study area. The logistic analysis revealed, factors sex (being male) (AOR = 3.52; 95% CI: 1.479-8.382), drinking alcohol (AOR = 2.387; 95% CI: 1.079-5.280), chewing khat (AOR = 3.850; 95% CI: 2.729-5.188), watching pornographic movies (AOR = 4.068; 95% CI: 1.70-9.735), using Shisha/hashish (AOR = 1.649; 95% CI: 1.217-5.603) were statistically significantly associated with the higher risk of practicing risky sexual behavior while discussion on sexual reproductive issues with parents was inversely associated with risky sexual behavior (AOR = (AOR = 0.339; 95% CI: 0.143-0.806).

 

Conclusion: the study identified sex, alcohol use, chewing khat, using Shisha/hashish, watching pornographic movies and discussion on sexual reproductive health issues with parents were the factors significantly associated with risky sexual behavior. Even though the prevalence of engage in risky sexual behavior is lower than most studies in Ethiopia, schools should give special cares for male students, alcohol users, khat chewers, Shisha/hashish users and students who watch pornographic movies, in order to decrease the prevalence of risky sexual behaviors among high school adolescents.

 

 

Introduction    Down

Adolescent period age 10-19 [1,2] is a transitional stage of life; sexual behaviors that might negatively affect the healthy development of young peoples´ established [3]. Risky sexual behaviors are common sexual practices that results in adverse sexual and reproductive health, such as unintended pregnancies, unsafe abortion and STIs, like HIV/AIDS [4]. Some studies also include that having multiple sexual partners, having sex without using a condom or inconsistent use of condom, initiation of sex before the age 18 years, sexual intercourse under the pressure of alcohol and having sex with commercial sex workers [5-8] in their definition of risky sexual behavior. Globally, it is estimated that in 2019 about 1.2 billion (16%) of the total population are adolescents aged 10-19 years, whereas about 23% of the population in sub Saharan Africa are adolescents [9]. On the other hand, the UNAIDS in 2016 reported an estimated of 250, 000 new HIV infections among adolescents worldwide. Of these, 80% occurred in sub-Saharan Africa [10]. In Ethiopia according to population projections for 2017, adolescents and youth aged 10-24 account for one third of the total population [11]. While adolescents aged 10-19 years consist of 25% of the total populations in Ethiopia [12]. Evidence indicated that in Ethiopia the national prevalence of HIV/AIDS is 0.9%. The high prevalence of HIV/AIDS is observed in the Addis Ababa city (3.4%) and Gambella region (4.8%) [13]. Overall, 0.2% of adolescent youth aged 15-24 have been infected with HIV, whereas HIV prevalence among adolescent girls and young women is 0.3% and that of boys in the same age is 0.1% [13,14]. The recent Ethiopian Demographic and Health Survey [15] reported nearly one in four (24%) of women has first sexual intercourse before age of 15 years old, whereas 2% of young men and less than 1% of young women aged 15-24 years were reported have had sexual intercourses with more than one partner. On the other hand, about 4.4% of Ethiopian adolescents and youth smoke cigarettes, 45.6% consume alcohol 51% of adolescents and youth consume alcohol [16].

Previous researches conducted in the Ethiopia revealed that even though it differs from region to region the prevalence of risky sexual behavior was relatively high. A study conducted on the risky sexual behavior practice and associated factors among secondary and preparatory school students of Aksum town, northern Ethiopia, showed that 19.6% of had practiced risky sexual behaviors [17]. Another study done on risky sexual behaviors and associated factors among preparatory school students in Arba Minch town, Southern Ethiopia indicates 22.4% of students had risky sexual behaviors [18]. A similar systematic review and meta-analysis of epidemiology of risky sexual behaviors among college and university students in Ethiopia showed that the prevalence of risky sexual behaviors among college and university students was 41.62% [19] and a study done among Mizan high school and preparatory school students´ revealed 51.3% prevalence of risky sexual behaviors [20]. On the other hand, a study conducted in the Wolayta zone, south Ethiopia, revealed 17.9% of high school adolescents were engaged in risky sexual practice [21] whereas a study in Bahir Dar and Mecha district indicated that more than 13% of high school Adolescents had risky sexual behavior [3].

The determinants of practice of risky sexual behaviors are significantly associated with socioeconomic, cultural, geographic areas, environmental and demographic factors. Uses of alcohol were found strongly associated with high risk sexual behaviors [18,19,22-24]. Substance use was also significant determinants of practice of risky sexual behavior [18,25-27]. Other determinants of the practices of risky sexual behaviors among students include watching pornographic movies [17-19, 22], level of knowledge and information about STIs [18,24,26], peer influence [17,23, 26,27]. There is also a strong and positive association between no parental control and no parental discussion on sexual and reproductive health issues [22, 23,26], high income/pocket money [25] and with risky sexual behaviors. Most studies also found that being male [19,23,25,26] is strongly positively associated with risky sexual behaviors. Despite the fact that a number of studies have been done on the examination of factors associated with risky sexual behavior, in different parts of Ethiopia, the practice of risky sexual behavior is still higher and more effort is needed. Regardless of policies and efforts made to create communities´ awareness of contracting sexually transmitted infections, currently many high school adolescents are engaged in risky sexual practice. Thus, this study tries to assess the major risk factors associated with risky sexual behavior among adolescents in the north Shewa zone, Oromia region.

 

 

Methods Up    Down

Study setting and period: a cross sectional study was conducted between March 1 to May 1, 2019 in eights secondary schools found in the north Shewa zone with estimated residents of 1431305 populations. North Shewa zone is located 114 km away in the North West from, Addis Ababa.

Study design, population and eligibility criteria: institutional based cross-sectional study design was conducted. All systematically selected students from registered for grade 9 - 10 and acquiesced were included in the study.

Sample size calculation and sampling procedure: the sample size was calculated using a single population proportion formula by considering 95% confidence level, the proportion of risky sexual practice as 51.3% [20] and a 5% margin of error. The sample size of 386 was obtained. The sample size has been allocated to the eight schools based on proportional allocation to their size. The number of students between grades has varied. Assuming homogeneity in academic status among students in the same grade, a stratified proportionate sampling was used to select study participants. List of students were obtained from registration books.

Data collection and analysis process: the study instrument was self-administered questionnaire adapted from WHO sexual and Reproductive Health. The questionnaire was designed to gather qualitative and quantitative data relating to demographic, socioeconomic and cultural factors, substance use, alcohol use, and practices of risky sexual behavior. Trained supervisors and data collectors were employed during data collection. The data collectors brief each question to the respondents to help them understand the question well and complete the questionnaire. The researchers had checked the completeness of each questionnaire, followed and facilitated overall data collection process. Data were entered to SPSS version 21. Descriptive statistics such as, frequency and cross-tabulations were used to summarize the characteristics of study participants, whereas the multivariable logistic regression was used to identify variables significantly associated variables with risky sexual behavior with p-value < 0.05. The goodness of fit test was done using the likelihood ratio test (LRT) and Hosmer-Lemeshow tests.

Measurement variables: adolescents were considered to have practiced risky sexual behavior when, they multiple sexual partners (having more than one sexual partner until the survey), early initiation of sex (sexual debut at the age < 18 years old), erratic use of condom (inconsistent/fail to use condom at least ones during sexual intercourse until the survey), sex with commercial sex workers at least once until the survey. The variable, 'risky sexual behavior', was characterized as a binary response with 1 representing “yes” if the study participants practiced any of the above behaviors and 0 representing “no” elsewhere. The independent variables were socioeconomic, cultural, environmental, parents and demographic characteristics.

Ethical clearance: Ethical clearance had been obtained from the research and community service directorate office of Salale University. Permission to conduct the research was obtained from north Shewa zone education bureau and school directors. Full informed written consent/assent was obtained from each study subject´s accordingly before the data collection started and privacy was secured. When age was under 16 years old, it obtained from parents/legal guardians.

 

 

Results Up    Down

Descriptive statistics of study participants: Table 1 presented the percentage distribution of the selected sociodemographic characteristics of study participants. The majority of the participants (61%) were male and 39% were females. The mean age of the study participants was 17.40±1.535 years. The vast majority (87.4%) of study participants was followed Coptic Orthodox religion. Regarding the family education level, 62.1% of study participants were from a mother with no education at all and whereas more than half (53.7%) were from illiterate father. On the other hand, when the employment status of families was concerned, 77.7% and 86% of study participants were reported they were from unemployed mother and father respectively. Nearly three-fourth of study participants was living with their parents while 16.09% were living alone. Table 1 reveals that 42.2% of the study participants use alcohol and 17.8% chew khat. On the other hand, about 5% of study participant smoke cigarette and 15.9% used illicit drugs. It also indicates that 38% of study participants were seen/read pornography (Table 1).

Prevalence of risky sexual behavior: about 13.2% of study participants were ever had sexual intercourse and the mean age at first sexual intercourse was 16.05 ±2.57 years (95% CI 14.98-17.12). For those who ever had sexual intercourse one-third of the study participant started sexual intercourse below the age of 18 years. Only 43.8% of study participants used condom at the first sexual intercourse and one-third (34.1%) had more than two lifetime sexual partner. Concerning reason to start sexual intercourse nearly half (47.8%) of the study participants reported peer pressure, 21.7% reported personal desire, 19.6% reported alcohol or drug influence while 15.7% reported the started sexual intercourse for money/economic problem. The majority of the study participants (65.6%) had started sexual intercourse with their boy/girlfriend, 31.1% started sexual intercourse with their teachers and 21.3% started sexual intercourse with other than their boy/girlfriend and teachers. Approximately three-fourth of the study participant had information about HIV/AIDS and only 25% reported they had a discussion on sexual reproductive health issues with parents. Inclusive 11.4% of study participants had practiced risky sexual behaviors (Table 2).

Factors associated with risk sexual behavior: multivariable binary logistic regression analysis was used to examine the effect of each predictor variable on the practice of risky sexual behavior. The overall goodness of fit was checked using the LRT and Hosmer -Lemeshow test. Consequently, the likelihood ratio test, provided a chi-square value of 46.938 (p-value < 0.001), which would imply good fit for the model. Similarly, the Hosmer-Lemeshow test is found the observed data was better fitted by the model (chi-square value = 6.416, p-values = 0.601). The multivariable analysis of factors associated with risky sexual behavior was presented in Table 3. The result showed sex of a student, using alcohol, chewing khat, watching pornographic movies, using Shisha/hashish, and parental discussion of sexual and reproductive health were statistically significant factors associated with risky sexual behavior. According to the results from Table 3, the odds of risky sexual behavior were higher among males than females (AOR = 3.52; 95% CI: 1.479-8.382). Study participants who used alcohol were more likely to practice risky sexual practice than non-user keeping all other variables constant. The odds of risky sexual practice were 2.387 times higher among alcohol users than the non-users (AOR = 2.387; 95% CI: 1.079-5.280). Table 3 also shown that the odds of risky sexual behavior were higher among adolescents, who chew khat (AOR = 3.850; 95% CI: 2.729-5.188) compared to that of who didn´t chew khat. Watching pornographic movies were found significantly associated with risky sexual behavior. The odds of risky sexual behavior were about 4.068 times higher among adolescents who had seen/read pornography (AOR = 4.068; 95% CI: 1.70-9.735). Using Shisha/hashish was another variable significantly associated with risky sexual behavior, the odds of risky sexual behavior were 2.611 times higher among adolescents who used Shisha/hashish than that of those who didn´t use Shisha/hashish (AOR = 1.649; 95% CI: 1.217-5.603). Finally, discuss on sexual reproductive health issues with parents was found significantly associated with risky sexual behavior. Compared to adolescents who didn´t discuss on the sexual reproductive health issues with parents, those children who had a discussion on the sexual reproductive health issues with parents, had significantly lower odds of risky sexual behavior (AOR = 0.339; 95% CI: 0.143-0.806) (Table 3).

 

 

Discussion Up    Down

The present study investigates the factors associated with risky sexual behaviors among high school adolescents in the north Shewa zone, Ethiopia. The prevalence of risky sexual behavior was 11.4%. This figure is lower than the previous study conducted Aksum reported 19.6% prevalence of risky sexual behavior [17]. A similar studies conducted in Arba Minch reported 22.4% of students had risky sexual behavior [18] and another study conducted in Jiga high school, the Amhara region [24] reported 14.7% of the prevalence of risky sexual behavior. Whereas a study conducted in Bahirdar and Mecha district reported nearly similar prevalence of risky sexual behavior (13%) [3] and a study conducted in Gondar reported 12.8% of the prevalence of risky sexual behavior [22]. Similarly the mean at initial of sexual intercourse was 16.05 ±2.57 years, which is lower than the studies finding in Jiga, Amhara region [24], Shashemene, West Arsi zone [28], higher than the studies finding in Aksum [17], Gondar [22] and nearly consistent with the findings in Dire Dawa [29], and Uganda [30] This inconsistent might be due to the fact that the cultural, socioeconomic and environmental difference. In the multivariable logistic regression analysis, it was found that being male was more likely associated with risky sexual behavior as compared to female. This finding is congruent with previous studies conducted in Bodit, south Ethiopia [21], Dire Dawa [31,29], Aksum [32], Ghana [33] and a meta-analysis done in developing countries [34]. The possible explanation for this difference might be culturally males are more likely exposed to sexually explicit materials than females in Ethiopia. Additionally, consuming alcohol was associated with the practice of risky sexual behavior. The result is comparable with previous studies from Haramaya, east Ethiopia [35], Adama [27], Jimma [36], Gondar [22], West Arsi zone [28], Sri Lanka [37], Dire Dawa [29], Southern Ethiopia [38], Jiga, Amhara region [24], Brazil [39], Mizan Aman [40], Arba Minch [18], and a systematic review and meta-analysis in Ethiopia [19]. This might be attributed to the fact that adolescents who drink alcohol could have a better chance of getting sex with commercial sex workers and erratic use of during sexual intercourse.

Adolescents who had ever seen/read pornography were more likely to practice risky sexual behavior. This finding is in agreement with previous studies reported in Aksum [17,32], Gondar [22], Dire Dawa [29], Jimma [38], Arba Minch [18], and a systematic review and meta-analysis in Ethiopia [19]. Use of illicit drugs such as Shisha/hashish, were risk factors of risky sexual behavior; i.e, adolescents who used Shisha/hashish were more likely to practice risky sexual behavior. Several studies recognized that uses of Shisha/hashish strongly correlated with risky sexual behavior [18,27,30,32,39]. In this study, we found that student who chewed khat had higher odds of practicing risky sexual behavior. This finding is consistent with a study conducted in Dire Dawa [29,31], West Arsi zone [28], Jimma [36] and Haramaya, east Ethiopia [35]. The possible explanation of this might be that using substances might imitate adolescents watch pornographic movies and to practice what they seen with their partners or other peoples. Discussion on sexual reproductive issues with parents was another variable found statistically significantly associated with risky sexual behavior. Adolescents who had a discussion on sexual reproductive health issues with parents were less likely to practice risky sexual behavior. Similar findings were also reported lower odds of risky sexual behavior among adolescents who had a discussion on sexual reproductive issues with parents [17,22,28,32].

The major limitation was that misreporting or under reporting of risky sexual practice and illicit drugs uses due to due to some cultures and traditions in the community. The other limitation was that interaction effects were not used included in the analysis due to the large number of variables to compute.

 

 

Conclusion Up    Down

The study has examined the prevalence and factors associated with risky sexual behavior in North Shewa zone Oromia, Ethiopia. In the multivariable logistic regression analysis, it was found that being male sex, drinking alcohol, chewing khat, using Shisha/hashish, watching pornography, and no discussion on sexual reproductive issues with parents were factors significantly increase the risk of risky sexual behavior among adolescents. Even though the prevalence of engage in risky sexual behavior is lower than most studies in Ethiopia, the problem is still higher and policy makers and schools should give special cares for male students, alcohol users, khat chewers, Shisha/hashish users and students who watch pornographic movies, so that to decrease the prevalence of risky sexual behaviors among high school adolescents.

What is known about this topic

  • The practice of risky sexual behavior is higher;
  • Most high school students use alcohol and substances;
  • Most women have first sexual intercourse before age of 15 years old and infected with HIV/AIDS due to unprotected sexual intercourse is risky.

What this study adds

  • The prevalence of risky sexual behavior was still high;
  • Discuss on sexual reproductive health issues with parents is poor;
  • Male students, are more likely uses alcohol, khat, Shisha/hashish and watch pornographic movies.

 

 

Competing interests Up    Down

The authors declares no competing interests.

 

 

Authors' contributions Up    Down

The author have read and agreed to the final manuscript.

 

 

Acknowledgments Up    Down

The Author would like to acknowledge Salale University. I thank also North Shewa zone education bureau and high school administrators, the supervisors, data collectors and respondents.

 

 

Tables Up    Down

Table 1: socioeconomic and demographic characteristics of study participants

Table 2: sexual and reproductive history of study participants, North Shewa zone, Ethiopia

Table 3: factors associated with risky sexual behavior among high school adolescents, North Shewa zone, Ethiopia

 

 

References Up    Down

  1. United Nations. Adolescent reproductive behaviour, vol II, Evidence from developing countries. United Nations Publications. 1997; E89 XIII:10.

  2. WHO. The Second decade: Improving adolescent health and development. Geneva: WHO. 2001. Accessed June 11 2020.

  3. Kerebih Asrese, Alemtsehay Mekonnen. Social network correlates of risky sexual behavior among adolescents in Bahir Dar and Mecha Districts, North West Ethiopia: an institution-based study. Reproductive Health. 2018 Apr 11;15(1):61. PubMed | Google Scholar

  4. WHO. Information series on school health Geneva switzerland. WHO document production service. 2003.

  5. Madise N, Zulu E, Ciera J. Is poverty a driver for risky sexual behavior? Evidence from National Surveys of adolescents in four African countries. African Journal of Reproductive Health. 2007;11(3): 83-98. PubMed | Google Scholar

  6. Abels MD, Blignaut RJ. Sexual risk behavior among sexually active first year students at the University of the Western Cape, South Africa. African Journal of AIDS Research. 2011;10(3): 255-61. PubMed | Google Scholar

  7. Averett S, Corman H, Reichman NE. Effects of Overweight on Risky Sexual Behavior of Adolescent Girls. Economic Inquiry. 2013;51(1):605-619. Google Scholar

  8. Silas J. Poverty and Risky Sexual Behaviors: Evidence from Tanzania. ICF International Calverton, Maryland, USA. 2013.

  9. UNICEF. Adolescent demographics. 2019. Accessed June 11 2020.

  10. UNAIDS. Ending the AIDS epidemic for adolescents, with adolescents: a practical guide to meaningfully engage adolescents in the AIDS response. UNAIDS Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland. 2016.

  11. Central Statistical Agency (2013). Population Projections for Ethiopia 2007-2037. Central Statistical Agency. 2013.

  12. PMA 2020/Ethiopia. Adolescents and young women health brief. Accessed June 11 2020.

  13. HAPCO. HIV prevention in Ethiopia National Road map. Accessed June 11 2020.

  14. Central Statistical Agency (CSA) [Ethiopia] and ICF. Ethiopia Demographic and Health Survey 2016: HIV Report. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF. 2018.

  15. Central Statistics Agency (CSA) [Ethiopia] and ICF International. Ethiopia demographic and health survey 2016. Addis Ababa and Rockville: Central Statistical Agency (CSA) and ICF International. 2016.

  16. FDRE MOH. National adolescent and youth health strategy (2016-2020). MOH. 2016.

  17. Alem Girmay, Teklewoini Mariye. Risky sexual behavior practice and associated factors among secondary and preparatory school students of Aksum town, northern Ethiopia, 2018. BMC Research Notes. 2019 Oct 26;12(1):698. PubMed | Google Scholar

  18. Abera Mersha, Kedir Teji, Rasha Darghawth, Woiynshet Gebretsadik, Shitaye Shibiru, Agegnehu Bante et al. Risky sexual behaviors and associated factors among preparatory school students in Arba Minch town, Southern Ethiopia. Journal of Public Health and Epidemiology. 2018;10(12): 429-442. Google Scholar

  19. Tadele Amare, Tebikew Yeneabat, Yohannes Amare. A systematic review and meta-analysis of epidemiology of risky sexual behaviors in college and university students in Ethiopia, 2018. Journal of Environmental and Public Health. 2019 Mar 20;2019:4852130. PubMed | Google Scholar

  20. Alemayehu Sayih Belay, Yohannes Worku, Tsion Addisu, Addis Alemneh. Assessment of magnitude of risk sexual behavior among Mizan high school and preparatory school students, South West, Ethiopia, 2016: descriptive cross-sectional study. ournal of Environmental and Public Health. 2018;4(3):68-74. Google Scholar

  21. Derese Daka, Debebe Shewano. Magnitude of risky sexual behavior among high school adolescents in Ethiopia: a cross-sectional study. Journal of Public Health and Epidemiology. 2014;6(7):211-215. Google Scholar

  22. Abebaw Wasie Kasahun, Mezgebu Yitayal, Tadele Girum, Bekri Mohammed. Risky Sexual Behavior and Associated Factors among High School Students in Gondar City, Northwest Ethiopia. International Journal of Public Health Science (IJPHS). 2017;6(3):257-265. Google Scholar

  23. Getahun Mekonin, Abulie Takele, Daniel Atlaw, Batu Lema, Sisay Degno, Kebon Seyoum et al. Risky Sexual Behaviour and Associated Factors among Students in Robe Technical Vocational Educational Training College, Oromia Regional State, South East Ethiopia. Journal of Basic and Clinical Reproductive Sciences. 2019;8(3):1-9. Google Scholar

  24. Getachew Mullu Kassa, Genet Degu, Meseret Yitayew, WorkuMisganaw, MikiyasMuche, Tiguaded Demelash, Meless Mesele, andMelat Ayehu. Risky Sexual Behaviors and Associated Factors among Jiga High School and Preparatory School Students, Amhara Region, Ethiopia. International Scholarly Research Notices. 2016 Jun 15;2016:4315729. Google Scholar

  25. Desalegn B Sendekie, Netsanet Worku. A Case Study on Risky Sexual Behaviour of Undergraduate Students in Ethiopia. Journal of Tropical Diseases. 2019;7(3):1-12. Google Scholar

  26. Young Lee RN, Adanisse Cintron MS, Surinder Kocher RN. Factors Related to Risky Sexual Behaviors and Effective STI/HIV and Pregnancy Intervention Programs for African American Adolescents. Public Health Nursing. 2014; 31(5): 414-427. PubMed | Google Scholar

  27. Geremew Werkeshe Wana, Oyedunni Arulogun, Adebola Roberts, Abraham Sahilemichael Kebede. Predictors of risky sexual behaviour among pre-college students in Adama Town, Ethiopia. Pan African Medical Journal. 2019 Jun 24;33:135. PubMed | Google Scholar

  28. Hana Seyfu,Tadele Yohannes. Risky Sexual Behavior and Associated Factors among Reproductive Age Group High School Students: Institution Based Cross Sectional Study. Epidemiology (Sunnyvale). 2018;8(2):1-6. Google Scholar

  29. Dawit Daniel, Zinabe Seyoum, Alemusa Gipo. Risk Factors of HIV/AIDS Among Secondary and Preparatory School Students in Dire Dawa City. Ethiopia. American Journal of Health Research. 2017;5(3):83-92. Google Scholar

  30. Rogers N Ssebunya, Joseph KB Matovu, Fredrick E Makumbi, Grace P Kisitu, Albert Maganda, Adeodata Kekitiinwa. Factors associated with prior engagement in high-risk sexual behaviours among adolescents (10-19 years) in a pastoralist post-conflict community, Karamoja subregion, North eastern Uganda. BMC Public Health. 2019;19:1027. PubMed | Google Scholar

  31. Tariku Derese Asfaw, Alemshet Getachew Bekele, Tadele Woldie Sitota, Adane Tareke Getu. Risky Sexual Behavior and Associated Factors Among Dire Dawa Comprehensive Secondary and Preparatory School Students, East Ethiopia in 2018. Current Trends in Translational and Research. 2018;2018(1). Google Scholar

  32. Hiwet Zelalem Fisseha, Wondwossen Lerebo, Kidan Abreha Teferi. Substance Abuse and Predictors of Risky Sexual Behavior among Students in Axum University, Ethiopia. Journal of Addiction Research & Therapy. 2015;6(1):1-6.

  33. Jeffrey B Bingenheimer, Elizabeth Asante, Clement Ahiadeke. Peer Influences on Sexual Activity among Adolescents in Ghana. Studies in Family Planning. 2015;46(1):1-19. PubMed | Google Scholar

  34. Yifru Berhan, Asres Berhan. A Meta-Analysis of Risky Sexual Behaviour among Male Youth in Developing Countries. AIDS Research and Treatment. 2015;2015:580961. PubMed | Google Scholar

  35. Andualem Derese, Assefa Seme, Chalachew Misganaw. Assessment of substance use and risky sexual behavior among Haramaya University Students, Ethiopia. Science Journal of Public Health. 2014;2(2):02-110. Google Scholar

  36. Yonas Tesfaye, Alemayehu Negash, Tsegaye Tewelde Gebrehiwot, Worknesh Tessema, Susan Anand, Gutema Ahmed et al. Is there association between risky sexual behaviors and depression symptoms among youth? A case of Jimma University students, Ethiopia. Psychiatry Journal. 2019 Jul 1;2019:3757656. PubMed | Google Scholar

  37. Upuli Amaranganie Pushpakumari Perera, Chrishantha Abeysena. Prevalence and associated factors of risky sexual behaviors among undergraduate students in state universities of Western Province in Sri Lanka: a descriptive cross sectional study. Reproductive Health. 2018 Jun 4;15(1):105. PubMed | Google Scholar

  38. Likawunt Samuel, Mulugeta Tarekegn Angamo. Substance use and sexual risk behavior and factors associated with HIV transmission in Southern Ethiopia. International Journal of Pharmaceutical Sciences and Research. 2012; 3(4):1080-1086. Google Scholar

  39. Lima AS, Pitangui AC, Gomes MR, Mola R, Araújo RC. Risky sexual behaviors and their association with overweight and obesity among adolescent students: a cross-sectional study. Einstein Journal. 2019;17(3):1-15. PubMed | Google Scholar

  40. Yarinbab TE, Tawi NY, Darkiab I, Debele F, Ambo WA. Determinants of Risky Sexual Behaviors among Students of Mizan Aman College of Health Science, Southwest Ethiopia: Cross- Sectional Study. International Journal of Womens Health Wellness. 2018;4(2):1-6. Google Scholar