Determinants for utilization of adolescent sexual and reproductive health services in Njeru municipality – Buikwe district, Uganda

Abstract

Background: Sexual and reproductive health challenges among adolescents can significantly be prevented by the use of adolescent sexual and reproductive health services (ASRHS). There was a gap in research when it came to the determinants for utilization ASRHS among female adolescents especially Njeru Municipality.

Objective: The purpose of this study was to identify the determinants for utilization of adolescent and youth friendly sexual and reproductive health services among females aged between 15 and 19 years in Njeru Municipality – Buikwe District in Uganda. Methods: A cross sectional study design employing both qualitative and quantitative methods was used. Systematic random sampling was used to select 364 female adolescents. Structured interviews, focus group discussions (4), and key informant interviews (5) were used to collect data. Quantitative data were analyzed using the robust Poisson regression model, while qualitative data were analyzed thematically. Results: Few adolescents 26.0% utilized at least one of the Adolescent Sexual Reproductive Health Services in 12 months’ period prior to the study. Two interpersonal determinants (schooling status and parent alive) were noted to be the most influential in the utilization of ASRHS. The prevalence of utilization was least among adolescents who reported that they were currently in school (aPR = 0.93, [CI = 0.86 - 0.99], p = 0.034) as compared to those who were not in school. Utilization was also least among adolescents who reported that their parents were still alive (aPR = 0.92 [CI = 0.87 - 0.98, p = 0.005) compared to those without a living parent. From both FGD and KII it was noted that age, schooling status and staying with parents were most influential in determining utilization of ASRHS. Two institutional determinants were noted to influence utilization of ASRHS (opening of facilities on weekends and after 5pm). utilization was noted to be least among adolescents who reported that health facilities in the town council do not open on weekends (aPR = 0.91, [CI = 0.84 - 0.99], p = 0.037), as compared to those who said they didn’t know facilities open on weekends. Utilization was also least among adolescents who reported that facilities in town council do not open to adolescents beyond 5pm (aPR = 0.92 (0.86 - 0.99], p = 0.018) as compared to those who said they didn’t know facilities open after 5pm. Both FGD and KII noted that opening times only during work hours and not on weekends has a negative influence on utilization of ASRHS. Adolescents also stated that privacy, availability of health workers and confidentiality were also important for them to utilize the service. Conclusion: Utilization of ASRHS among adolescents in Njeru municipality was low. This health behavior is determined by both individual and institutional characteristics with equal power. Any interventions to augment service use among adolescents in the town council should focus on increasing availability of services to in-school adolescents and sensitizing parents about the need for ASRHS and changes in health facilities mode of operation like operation on weekends and working after 5pm.