Teenage Pregnancy in Agago District, Uganda | AHMT

Introduction

Teenage pregnancy, defined as “pregnancy in a teenage girl, usually within the ages of 10–19 years, without having reached legal adulthood, has been recognized as a public health concern that contributes a significant economic, health, and social cost to the mothers and newborn babies, their families, and the wider society. The global pregnancy rate in 2021 was 42.5 births per 1000 women, with Latin America and Sub-Saharan African (SSA) regions having the highest rates of 53.2 and 101 births per 1000 women, respectively. According to the World Health Organisation (WHO), about 21 million teenage pregnancies occurred each year by 2019 with 55% of the unintended teenage pregnancies occurring in low- and middle-income countries. Teenage pregnancy rate is highest in SSA followed by South Asia, and the relatively high fertility desires in SSA were rooted in traditional pronatalist practices that partly explained the lowest prevalence of contraception in the region.

Sustainable Development Goals (SDGs)

• Goal 3: Good Health and Well-being
• Goal 4: Quality Education
• Goal 5: Gender Equality
• Goal 10: Reduced Inequalities
• Goal 16: Peace, Justice, and Strong Institutions

Methods

Study Design and Settings

We conducted a community-based, descriptive, cross-sectional study between October and November 2020 among teenage girls in Lapono Sub-County, Agago district.

Study Population

We recruited teenage girls aged 13–17 years who were residing within Lapono Sub-County for at least one year and provided a written informed assent. Teenage girls aged 13–17 years were considered because they might be aware of their bodies and below the adult age of 18 years as per the Constitution of Uganda. Teenage girls who were severely sick and those with mental impairment were excluded from the study.

Study Procedures

A multi-stage sampling technique was employed in this study. Three parishes and four villages from each parish were randomly selected from Lapono Sub-County, Agago district. Kish Leslie’s (1965) formula was utilized to obtain the optimal number of participants. A total of 289 households with teenage girls 13–17 years were randomly enrolled in this study given a standard error of the confidence level (1.96) at 95% confidence interval, the proportion of teenage pregnancy among teenage girls, estimated at 24% for Acholi Sub-region and margin of error assumed at 5%. Lists of all the households in the selected villages were generated with the support of the Local Council one. Using a computer-generated random numbers in the range of 1–300, the required numbers of households in each village were randomly chosen. In each household, one teenage girl was randomly selected for the interview and testing for pregnancy. The household selection was based on probability proportional to size. Data on socio-demographic, individual, familiar and socio-cultural characteristics of the teenage girls and their parents were collected using a pre-tested semi-structured questionnaire consisting of 28 questions (17 for individual, 5 for familial, and 6 for socio-cultural variables) that provide answers on the prevalence of teenage pregnancy and the individual, familiar socio-cultural factors associated with teenage pregnancy.

Assessment of Teenage Pregnancy

Pregnancy was tested using the human chorionic gonadotropin (hCG) hormone assay on urine samples. About 10–15 mls of fresh mid-stream urine samples into sterile universal containers by teenage girls under the supervision of female research assistants (Laboratory Technician or Clinical Officer). Within 1–2 minutes after urine sample collection, the urine containers were placed on a flat surface, hCG strips were inserted vertically for 10–15 seconds into them and removed. Pregnancy test results were read after 15 minutes, positive pregnancy test results were shown by two distinct red lines in control (C) and test (T) regions, and negative pregnancy test results by one red line in the control (C) region only.

Data Analysis

All analyses were done in STATA version 17.0 at 95% confidence and 5% margin of error for univariate, bivariate and multivariate levels. We estimated the prevalence of teenage pregnancy among teenage girls in percentage and reported confidence intervals. The factors associated with teenage pregnancy among teenage girls in Lapono Sub-County, Agago district, Uganda were assessed using logistic regression analysis. In univariate analysis, we summarized continuous variable (age) using mean with its corresponding standard deviation. Categorical variables were summarized by means of frequencies and percentages. In bivariate analysis, the associations of independent variables against teenage pregnancy were assessed and variables with p <0.2 were considered in multivariate analysis. In multivariate analysis, variables were manually removed, starting with the least significant variable. Product terms were formed between variables with p < 0.05 and assessed for interaction using a chunk test. Assessment of confounding was done by bringing back the basic variables that were dropped in the model, starting with the variables that were dropped last and checking for percentage change. A percentage change of >10% meant there was confounding. All confounders were retained in the final model. Goodness-of-fit test was done using Hosmer-Lemeshow test. Variables with p <0.05 after multivariate analysis were statistically significant.

Results

Sociodemographic Characteristics

A total of 289 participants were enrolled mean age of 15.1±1.5 years. Most of the teenage girls lived in rural areas 155 (53.6%), attained primary education 246 (81.5%) and had both parents alive 240 (83.0%). Only 18 (6.2%) girls were married and a third 88 (30.5%) were living with either only one parent or a relative. Forty-one (14.2%) participants reported alcohol use. Christianity was the dominant religion 265 (91.7%) and majority of their parents had a low socio-economic 273 (94.5%) background.

Sexual History

Sixty-two (21.5%) participants had a lifetime history of sexual intercourse. Participants who experienced sexual and physical abuse were 32 (11.1%) and 116 (40.1%), respectively. Sixty-eight (23.5%) participants had sexual education and 148 (51.2%). Close to a third 84 (29.1%) of the participants reported having felt pressure to engage in sexual intercourse. Most teenage girls disagreed that it was not acceptable to have sex 264 (91.4%) and get married 262 (90.7%) before the age of 18 years.

Prevalence of Teenage Pregnancy

SDGs, Targets, and Indicators

Analysis

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The issues highlighted in the article are connected to the following SDGs:

– SDG 3: Good Health and Well-being

– SDG 4: Quality Education

– SDG 5: Gender Equality

– SDG 10: Reduced Inequalities

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s content, the specific targets that can be identified are:

– Target 3.7: Ensure universal access to sexual and reproductive health-care services

– Target 4.1: Ensure that all girls and boys complete free, equitable, and quality primary and secondary education

– Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights

– Target 10.2: Empower and promote the social, economic, and political inclusion of all

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, there are indicators mentioned or implied in the article that can be used to measure progress towards the identified targets:

– Indicator 3.7.2: Adolescent birth rate (aged 10-14 years; aged 15-19 years) per 1,000 women in that age group

– Indicator 4.1.1: Proportion of children and young people (a) in grades 2/3; (b) at the end of primary; and (c) at the end of lower secondary achieving at least a minimum proficiency level in (i) reading and (ii) mathematics, by sex

– Indicator 5.6.1: Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use, and reproductive health care

– Indicator 10.2.1: Proportion of people living below 50 percent of median income, by age, sex, and persons with disabilities

SDGs, Targets, and Indicators