Faculty of Medicine, Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda.
Department of Reproductive Health, Ministry of Health, Kampala, Uganda.
PLoS One. 2022 Aug 10;17(8):e0272692. doi: 10.1371/journal.pone.0272692. eCollection 2022.
There is inconsistent data about condom use at the last sexual intercourse (LSI) among university students in sub-Saharan Africa (SSA) and its association with sex, age, and condom negotiation efficacy. The primary objective of this study was to summarize the proportion of condom use at the LSI among university students in SSA. The secondary objective was to determine the association between condom use at the LSI with sex, age, and condom negotiation efficacy among university students in SSA.
In this systematic review and meta-analysis, two reviewers independently searched electronic databases and grey literature for eligible studies published until July 30, 2020, extracted data, and assessed the risk of bias in the included studies. We used the Dersimonian-Liard random-effects model to pool the proportion of condom use at the LSI and the association between condom use at the LSI with sex, age, and condom negotiation efficacy, reported using risk ratio (RR). We assessed publication bias using funnel plot and Egger's test, and explored sources of heterogeneity using sub-group and meta-regression analyses.
We meta-analyzed 44 studies with a combined sample size of 27,948 participants.Of 14,778 sexually active participants, 8,744 (pooled proportion, 52.9%; 95% CI, 45.0-60.7; 95% prediction interval, 2.8-98.9; I-squared = 99.0%, p< 0.0001) reported condom use at the LSI and the proportion of condom use at the LSI remained stagnant between 2000 and 2019 (p = 0.512). Condom use at the LSI was not associated with being a female compared to a male (pooled RR, 1.08; 95% CI, 0.68-1.71), being of a younger age (≤24 years old) compared to older age (25 years and more) (pooled RR, 1.16; 95% CI, 0-85-1.57), and having a higher condom negotiation efficacy compared to a lower condom negotiation efficacy (pooled RR, 1.54; 95% CI, 0-81-2.94).
We found a low and heterogenous use of a condom at the LSI among university students in SSA which was not associated with sex, age, or condom negotiation efficacy. Accordingly, context-relevant interventions are needed to improve condom use at the LSI among university students in SSA.
在撒哈拉以南非洲（SSA）的大学生中，关于最后一次性交时使用避孕套的情况存在不一致的数据，而且其与性、年龄和避孕套协商效果有关。本研究的主要目的是总结 SSA 大学生最后一次性交时使用避孕套的比例。次要目的是确定 SSA 大学生最后一次性交时使用避孕套与性、年龄和避孕套协商效果之间的关系。
在这项系统评价和荟萃分析中，两位审查员独立检索了截至 2020 年 7 月 30 日发表的合格研究的电子数据库和灰色文献，提取数据，并评估纳入研究的偏倚风险。我们使用 Dersimonian-Liard 随机效应模型来汇总最后一次性交时使用避孕套的比例，以及最后一次性交时使用避孕套与性、年龄和避孕套协商效果之间的关系，使用风险比（RR）报告。我们使用漏斗图和 Egger 检验评估发表偏倚，并使用亚组和荟萃回归分析探索异质性的来源。
我们对 44 项研究进行了荟萃分析，总样本量为 27948 名参与者。在 14778 名有性行为的参与者中，有 8744 名（合并比例为 52.9%；95%CI，45.0-60.7；95%预测区间，2.8-98.9；I 平方=99.0%，p<0.0001）报告了最后一次性交时使用避孕套，并且 2000 年至 2019 年期间最后一次性交时使用避孕套的比例保持稳定（p=0.512）。与男性相比，女性（合并 RR，1.08；95%CI，0.68-1.71）、年龄较小（≤24 岁）与年龄较大（25 岁及以上）（合并 RR，1.16；95%CI，0-85-1.57）以及避孕套协商效果较高与较低（合并 RR，1.54；95%CI，0-81-2.94）相比，最后一次性交时使用避孕套的比例没有差异。
我们发现，在 SSA 的大学生中，最后一次性交时使用避孕套的比例较低且存在异质性，而且与性、年龄或避孕套协商效果无关。因此，需要采取与具体情况相关的干预措施来提高 SSA 大学生最后一次性交时使用避孕套的比例。
