Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Health Informatics, College of Health Sciences, Mettu University, Mettu, Ethiopia.
BMC Womens Health. 2023 Mar 30;23(1):147. doi: 10.1186/s12905-023-02298-z.
Early sexual initiation is a major public health concern globally, specifically in Sub-Saharan African (SSA) countries where reproductive health care services are limited. It is strongly related to increased risk of HIV/AIDS, sexually transmitted diseases, unwanted pregnancy, adverse birth outcomes, and psychosocial problems. However, there is limited evidence on the prevalence and associated factors of early sexual initiation among youth females in SSA.
A secondary data analysis was employed based on the recent DHSs of sub-Saharan African countries. A total weighted sample of 184,942 youth females was considered for analysis. Given the hierarchical nature of DHS data, a multilevel binary logistic regression model was fitted. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), and Likelihood Ratio (LR) test were used to assess the presence of clustering. Four nested models were fitted and the model with the lowest deviance (-2LLR0 was selected as the best-fitted model. Variables with p-value < 0.2 in the bivariable multilevel binary logistic regression analysis were considered for the multivariable analysis. In the multivariable multilevel binary logistic regression analysis, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) was reported to declare the strength and statistical significance of the association.
The prevalence of early sexual initiation among youth females in sub-Saharan Africa was 46.39% [95%CI: 41.23%, 51.5%] ranging from 16.66% in Rwanda to 71.70% in Liberia. In the final model, having primary level education [AOR = 0.82, 95% CI; 0.79, 0.85], and [AOR = 0.50, 95%CI; 0.48, 0.52], being rural [AOR = 1.05, 95%CI: 1.03, 1.07], having media exposure [AOR = 0.91, 95%CI: 0.89, 0.94], and belonged to a community with high media exposure [AOR = 0.92, 95%CI: 0.89,0.96] were found significantly associated with early sexual initiation.
The prevalence of early sexual initiation among youth females in SSA was high. Educational status, wealth index, residence, media exposure, and community media exposure have a significant association with early sexual initiation. These findings highlight those policymakers and other stakeholders had better give prior attention to empowering women, enhancing household wealth status, and media exposure to increase early sexual in the region.
性早熟是全球范围内的一个主要公共卫生问题，尤其是在撒哈拉以南非洲（SSA）国家，这些国家的生殖保健服务有限。它与艾滋病毒/艾滋病、性传播疾病、意外怀孕、不良生育结局和心理社会问题的风险增加密切相关。然而，关于 SSA 青年女性性早熟的流行率和相关因素的证据有限。
本研究采用了基于撒哈拉以南非洲国家最近的 DHS 数据的二次数据分析。总共考虑了 184942 名青年女性的加权总样本进行分析。考虑到 DHS 数据的层次性质，拟合了一个多水平二元逻辑回归模型。使用组内相关系数（ICC）、中位数优势比（MOR）和似然比（LR）检验来评估聚类的存在。拟合了四个嵌套模型，并选择具有最低偏差的模型（-2LLR0）作为最佳拟合模型。在双变量多水平二元逻辑回归分析中，p 值<0.2 的变量被认为是多变量分析的候选变量。在多变量多水平二元逻辑回归分析中，报告调整后的优势比（AOR）及其 95%置信区间（CI），以表明关联的强度和统计学意义。
撒哈拉以南非洲青年女性性早熟的流行率为 46.39%[95%CI：41.23%，51.5%]，范围从卢旺达的 16.66%到利比里亚的 71.70%。在最终模型中，具有小学教育水平[AOR=0.82，95%CI；0.79，0.85]和[AOR=0.50，95%CI；0.48，0.52]，农村居住[AOR=1.05，95%CI：1.03，1.07]，媒体接触[AOR=0.91，95%CI：0.89，0.94]和属于媒体接触度高的社区[AOR=0.92，95%CI：0.89，0.96]与性早熟显著相关。
撒哈拉以南非洲青年女性性早熟的流行率很高。教育状况、财富指数、居住地、媒体接触度和社区媒体接触度与性早熟有显著关联。这些发现强调了决策者和其他利益相关者最好优先关注增强妇女权能、提高家庭财富状况和增加该地区的媒体接触度，以降低性早熟的发生率。
