Journal of | | Open Access Pub

Full Text Article Abstract Introduction Materials and Methods Results Discussion Reference

Knowledge About Sexual And Reproductive Health Among School Enrolled Adolescents In Tololar, Nicaragua, A Cross-Sectional Study

S. Bergström Anna ¹ J. Ugarte Guevara William ¹ ² Eustachio Colombo Patricia ¹ Källestal Carina ¹

1 International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala University Hospital, SE 75185, Sweden.

2 Centro de Investigacion en Demografia y Salud, UNAN-Leon, Parque Iglesia La Merced 1/2 cuadra al Oeste, Leon, Nicaragua.

3 Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.

Abstract

Background

Nicaragua has the highest prevalence of teenage pregnancies in Latin America. Knowledge regarding sexual and reproductive health plays an integral part in sexual behavior. The objective was to assess school going adolescents' knowledge about sexual and reproductive health and possible factors affecting it in the semi-rural community of Tololar, Nicaragua.

Methods

A cross-sectional study with a self-administered questionnaire on tablets was used for data collection. All 253 registered students at the school present at the time of fieldwork who gave written informed consent were deemed eligible for the study. A total of 225 participants in the ages of 11-19 years were included. Simple linear regression and multiple linear regression were performed analyzing the outcome knowledge. A p-value <0.05 was considered significant.

Results

The general knowledge about sexual and reproductive health was moderate; however, knowledge gaps were found such as prevailing myths and poor knowledge regarding human immunodeficiency virus (hiv) transmission and contraceptive methods. Being female and single were significant negative determinants of knowledge (p-value < 0.01) and knowledge increased significantly with age (p-value < 0.05). School teachers, websites, social networks, and TV were the most frequently chosen sources of information on the topic.

Conclusions

Increased education on sexual and reproductive health with new interventions particularly for young females is recommended. Using IT-based materials as a complement may be an effective way to reach out to adolescents.

Author Contributions

Received Nov 05, 2018 Accepted Dec 10, 2018 Published Dec 11, 2018

Copyright© 2018 S. Bergström Anna, et al.
License
This work is licensed under a Creative Commons Attribution 4.0 International License. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Competing interests

The authors have declared that no competing interests exist.

Funding Interests:

Citation:

S. Bergstrom Anna, J. Ugarte Guevara William, Eustachio Colombo Patricia, Kallestal Carina et al. (2018) Knowledge About Sexual And Reproductive Health Among School Enrolled Adolescents In Tololar, Nicaragua, A Cross-Sectional Study Journal of Public Health International. - 1(2):27-38

DOI 10.14302/issn.2641-4538.jphi-18-2464

Introduction

Each year, about 16 million adolescent girls (15-19 years) of age give birth. For many young women, the pregnancy and childbirth are neither planned nor wanted. The complications of pregnancy and childbirth are the leading causes of death among young women in low- and middle-income countries 1. Unsafe abortions remain as one of the most neglected problems within sexual and reproductive health worldwide 2. In Latin America, the risks regarding teenage pregnancies can be evidenced in adolescents aged 15 years or younger having a higher risk for maternal death compared with women aged 20 to 24 years 3.

Nicaragua is a lower middle-income country where the Catholic Church wields a powerful influence on sexual and reproductive health and rights. Premarital sex is widely considered a sin, and there is a lack of formal sexual and reproductive education 4. The country has one of the highest prevalence of teenage pregnancies in Latin America 5. A recent demographic and health survey in Nicaragua has suggested that 65% of pregnancies among women aged 15-29 are unintended 6. Early marriage, romanticism, machismo and religious prohibition of contraception have been suggested as contributors to the early start of childbearing 4 as well as gender differences in attitudes, social pressure and social approval for premarital sex where women are punished for premarital sex while men are encouraged 7. Machismo is the creed of male sexual dominance the female being subordinated 8. In Nicaragua, women lack access to legal abortion services to terminate an unintended pregnancy 9 as the law of 2006 prohibits the termination of pregnancy also including incest, rape, and cases of danger to the life of the woman 10.

Sexual health knowledge is a prerequisite for good sexual health and constitutes an integral part in models of human behavior and decision-making, especially when it comes to the ability to take informed protective action 11. It has been suggested that factors such as gender, age, religion, personal belief and attitude toward sources related to sex affect sexual knowledge. Regarding gender, research has shown both a higher knowledge among females and similar levels of knowledge among males and females 12 as well as young men may in some contexts have greater knowledge 13. Age has shown a positive relationship to sexual knowledge, with older adolescents having more accurate knowledge 1214. Education has further been highlighted as vital protective factors for adolescents concerning sexual and reproductive health and rights 15.

In many low and middle-income countries sex education is not offered in schools or starts too late to be of help; also, some children do not attend school or leave school before being provided with the information 16. There is strong evidence that curriculum-based sex education in school improves risk awareness, knowledge of risk reduction strategies and leads to higher intention to practice safer sex 17. Some underline the responsibility of parents 11 although, in Nicaragua, half of the young people have reported to never communicate with parents on doubts or questions regarding sex 7.

The contexts have changed in low and middle-income countries, including improved school enrolment and technology transformations 18. Almost all young people in Latin America have access to media 13. Irrespective of adolescent’s Internet source, it is sensible making sure they can evaluate the information’s credibility and give them access to correct information 19 were one way for states and other agencies to provide information is through web-based learning sites 11.

Aim

This study aimed to assess the knowledge of sexual and reproductive health among adolescents enrolled in school in the semi-rural community of Tololar outside León, Nicaragua. The following research questions guided the research:

Are there knowledge gaps in the studied population regarding sex and reproduction, contraception, human immunodeficiency virus (hiv) and other sexually transmitted infections (STIs)?

How do sex, age, religion, and socioeconomic status affect knowledge?

What sources of information are used on these issues in the studied population?

Discussion

Discussion Key Results

This study showed that the general knowledge of sexual and reproductive health among adolescents in the studied population was moderate. Significant knowledge gaps were found, particularly regarding the transmission of hiv. Young men had significantly higher knowledge regarding sexual and reproductive health compared to young women. Knowledge on this topic increased significantly with age. To be in a relationship was found as a significant positive determinant of sexual and reproductive knowledge.

Implications and Limitations

We found more profound knowledge gaps among young Nicaraguans than those found in previous studies 1116 which may be explained by the additional inclusion in this study of the youngest span of adolescents since we found a positive relationship between age and sexual knowledge. The importance of their knowledge on these issues has previously been stated 216. The low knowledge regarding routes of hiv transmission is a worrying new finding regarding the spread of the virus. With Nicaragua s high level of teenage pregnancies in mind, it is troubling that 95% of adolescents were unaware that hiv could transmit during childbirth.

The present study found young men to have greater sexual knowledge than young women, an issue where previous research is divided. The same findings earlier described, where greater exposure for men to media and education, as well as to learning through greater access to public spaces, have been mentioned as possible explanations. Social barriers could also explain the dissimilarities, such as a lower acceptance of women demonstrating their knowledge of condoms and sexual matters in some societies 16. For the context under study, the ideology of machismo could comprise a part of this social barrier. Women are expected to act sexually naive, while men are rewarded for being sexually experienced.

In this study, civil status was found to be a predictor for a higher knowledge of sexual and reproductive health, which is consistent with previous evidence 17. Since premarital sex is widely considered sinful in Nicaragua 7, it may be less taboo to learn on the subject if being in a relationship.

The sources of information most frequently opted for were websites, social networks, and TV. These types of media may prove an effective way of reaching out to adolescents with information on sexual and reproductive health, especially since adolescents may face obstacles in accessing sexual and reproductive health care. Those not having access to these types of media shall however not be forgotten.

This study identified school teachers to be the persons most frequently selected as a source which was consistent with previous findings 14. This finding may suggest that sex education and contact with teachers was common in this setting or that it was less acceptable or more sensitive to talk about this subject when not in the context of formal sex education.

Reporting bias due to the use of a self-reporting survey is one limitation. Social desirability bias might also have affected the answers; the social barriers regarding knowledge 16 may, in this case, have played a part, with for example women perceiving it less acceptable to demonstrate their knowledge. The use of tablets as a means of data collection represents both strengths and limitations to the study, with the use of new technology being considered an extra motivation and a definite strategy to increase participation as well as a user-friendly tool, while it may also have led to a dependence on skills of this technology. Another limitation was the use of cross-sectional study design; thus only associations and no causal relationships could be stated. Regarding the variables, the design of the socioeconomic variable was a limitation since the required full information for the Unsatisfied Basic Needs index was missing, which implied that economic standard might not have been adequately measured. The investigation of knowledge of contraceptive methods used in this study ("have heard of" the different methods) is a measure of general awareness and cannot guarantee a correct knowledge of the method. This study focused on knowledge as one possible way of improving sexual and reproductive health among adolescents. There are however a wide variety of factors except for the knowledge that may play a part and could be investigated, such as social and cultural influences on sexual behavior.

Generalizability

The data can be considered representative for Tololar, and at best for semi-rural areas in western Nicaragua, however, it cannot be generalized to all Nicaraguan adolescents. It is notable that this study only measured knowledge among adolescents enrolled in school and moreover that the rate of adolescents dropping out of school was considerable, of which the majority was females due to pregnancy which in itself is an important finding.

Journal of Public Health International