Utilization of reproductive health services by high school adolescents in the Thaba-Tseka District in Lesotho

Abstract

Background: Youth friendly services were introduced in all the ten districts t of Lesotho to meet the adolescents health needs including reproductive health of adolescents. Despite this initiative there is still a high prevalence of teenage pregnancy and human immunodeficiency virus (HIV) infection among young people. Aim: The aim of the study was to investigate the utilization, and factors influencing the utilization of reproductive health services (RHS) among high school adolescents in Thaba-Tseka district of Lesotho. Methodology: This was a quantitative descriptive cross-sectional study. The study population was adolescents aged between 13 -19 years in the two high schools in the district. A total of 800 adolescents were asked to complete a structured, self-administered questionnaire. Descriptive statistics were used to summarise demographics, sexual activity, experience of sexually transmitted infections (STIs), and awareness and use of RHS. The chi-square test was used to identify associations between categorical variables, and binary logistical regression modelling was used to identify significant predictors of utilisation of RHS. Results: The response rate was 97.5% (780/800), but only 723 questionnaires had sufficient data to be analysed. The mean age of respondents was 16.4 years with a standard deviation of 1.7years. Of the respondents, 49.5% (358/723) had been sexually active with the youngest age at sexual debut of 8 years. Of these, 71.5% (256/358) were presently sexually active; 82.4% (295/358) had low overall levels of awareness of RHS; 37.9% (136/358) had ever visited the adolescent health corner (AHC); 34.9% (125/358) reported that there was a place that provided RHS in their local clinic; 57.3% (205/358) had ever used condoms; and 56.7% (203/358) had experienced a STI; Of those presently sexually active, 89.5% (229/256) used some form of contraceptive, with 95.2% (218/229) buying condoms from a retail shop although only 94.0% (205/218) reported using them, while 38.9% (89/229) also obtained them from the AHC. Only 13.3% (27/203) of those who had experienced signs of STI ever visited the AHC for treatment. Of those who knew about RHS, 54.4% (68/125) utilized the services. Statistically significant predictors of RHS utilization were having a friend using RHS (odds ratio [OR] =8.87; P value< 0.001) and access to RHS (OR=7.97; P < 0.001). Participants in higher grades were significantly less likely to use RHS compared to participants in lower grades (OR=0.21; P<0.001). Conclusion: Almost half of the adolescents engage in sexual activity at an early age and RHS are under-utilised, mostly because of lack of access. There is a need to embark on increasing accessibility of RHS among adolescents to promote utilization of RHS.