Prevalence of premarital sexual practice and associated factors among Goba town high school students, Southeast-Ethiopia

Background: Premarital sexual practice signifi cantly attributes for increase adolescent’s risk of unintended pregnancy, early marriage, abortion and STIs. In Ethiopia adolescents were intended to engage at early initiation to sexual intercourse without having proper protection has been one of the concerns. Study aimed to assess the prevalence of premarital sexual practice and associated factors among high school students.


Introduction
World Health Organization (WHO) de ines adolescent people as those between the ages of 10-19 years [1]. Adolescent is the time of transition from childhood to adult hood during which young people experiencing following puberty and human beings faced once in their life time [2]. The world today is experiencing a rapid increasing in the number of young people. Today adolescents constitute approximately one-ifth of the world's population with more than four-ifth in developing countries [3].
According to Ethiopian demographic and health survey (EDHS), 2011, 1.5% of Ethiopian adults age 15-49 are infected with HIV and the number of women age [15][16][17][18][19] years who tested positive for HIV is much higher than the number of males in the same age group which is due to early sexual initiation among young females and having multiple sexual partner [4].
Pre-marital sex is any sexual activity with an opposite sex partner or with same sex partner before he/she has started a marriage life. The term is usually used to refer the intercourse before a marriage. Sexual activities among young people have been increasing worldwide. Several studies in Sub-Saharan Africa have also documented high and increasing pre-marital sexual activities among young peoples [5].
In Ethiopia, an increasingly large number of adolescents are enrolled in preparatory schools. Early initiation to sexual intercourse without having proper protection has been one of the concerns. Adolescents often encounter high-risk situations, such as contracting STD/HIV/AIDS and often experience unintended pregnancy, illicit abortions and its negative sequel. Both female and male adolescents are usually curious to discover sexes which are usually unprotected [6].
Another study done among Ambo high school students revealed that 30.5% of sexually active female students had got pregnant at least once prior to the study out of which 66.7% reported history of abortion and from sexually active male respondents 15.94% were also impregnated at least once prior to that assessment. The existing literatures also document that adolescents engage in pre-marital sex with insuf icient knowledge of reproductive health and the proportion of pre-marital sex is higher among older age groups than younger age groups [7]. Different studies conducted in Ethiopia identi ied inconsistent factors of sexual practice. Thus, this study tries to assess prevalence of pre-marital sexual practice and factors associated with it among Goba town high school students.

Study setting
Study conducted in Goba town high schools, which were found in Bale zone of the Oromia region. The town was located in Oromia region approximately 446 km south east from the Capital city, Addis Ababa and 13km from capital city of Bale zone, Robe town. And in this town there were two secondary schools that served a population of Goba town and the surrounded kebeles. The total enrolled students in Negade high school were 1564, out of which 762 were females and 802 were males. The total enrolled students in Finca 'a Bamo were 400, out of which 208 were females and 192 were males. The total number of students were recruited in Grade 9 and 10 were 1245 and 719 respectively. Totally 1964 students, out of which 970 were females, were attended high school education in Goba town.

Study design and participants
A facility based cross-sectional study was carried out in Goba town (Negade and Finca Bamo high school), Bale zone, south east Ethiopia from June1 to June 30, 2018. The students who attended during the study period were selected as participants that were speci ically ensure the inclusion criteria.

Sample size determinations and sampling techniques
The sample size for this study was determined using single population proportion formula: assuming, 95% con idence interval (CI), 5% margin of error (d), 10% Nonresponse rate and P = By taking 28.3% of prevalence of premarital sexual practice that were conducted in Sebata secondary school [8]. Therefore, the determined sample size by considering 5% contingency was 343. Since the total population was < 10,000 this might needs the correction formula then the inal sample size was 291. During the study consultation with high school administration was made to obtained details of classes and respective numbers of students in the school. A Simple random sampling technique was used and the sample size allocated proportionally to 9th and 10th grade students.

Data collection procedures
Structured, pretested and self-administer questionnaire Oromia version questionnaires were used to collect the data adapted from different literatures. The questionnaire incorporates student information of, socio demographic characteristic, sexual history of the respondent and associated factors were major factors that contributed for the involvement of the respondents into premarital sexual activity. The principal investigator was coordinating the overall activity of the study.

Data analysis
Data coded and entered into a computer using Epi info version 7.2.0.1 and checked for completeness and transferred to SPSS version 20 for analysis. During the process of statistics analysis like frequencies, percentage, pie chart, table and mean computed. Bi-variate logistic regression used to identify variables that crudely associated and variables with p-values less than or equal to 0.05 itted to multiple logistic regression. Then association between dependent and independent variables was assessed using adjusted odds ratio (AOR), 95% CI and p value of <0.05 considered statistically signi icant.

Operational defi nition
Premarital sexual practice: in this study refers to penetration of males' penis into vagina.
Premarital sex: refers to sexual practice with any one before the marriage between has been launched.

Ethical consideration
Before data collection procedure, letter of permission was obtained from Madda Wallabu University Research and Community Service Directorate and verbal consent was taken from the study subjects. The respondent right and dignity was also respected in order to keep con identiality of each respondents' name was not included.

Sociodemographic characteristics of study participants
Two hundred sixty respondents aged between 15-19 years were participated yielding a response rate of 276 (94.9%). One hundred ifty eight (57.2%) of the respondents were males. Regarding education, majority of the respondents were from grade nine (66.7%). Similarly the followers of orthodox Christianity were (43.5%), were followed by Muslims (36.2%) and (2.5%) were other (wakifeta, hawariat).
The most predominant ethnic group was Oromo (75.7%). Majority of the respondents (95.3%) were unmarried. Regarding place of residence more than half (72.5%) were from urban. Regarding educational status of father, most of them were (43.1%) completed primary and secondary school, whereas (33.7%) attained college/ university respectively. Regarding, educational level of mother, majority of them were attained primary and secondary (35.1%), and (32.2%) can read and write. Monthly income of most of the study subjects' family ranges from >2000 Birr which accounts (37.7%).
More than half of the respondents (65.2%) were lived with their families while the rest (34.8%) were living away from their families. Most of the respondent were (54.3%) attended religious service regularly. The study subjects reported that their school expenses mostly covered by both parents (58%). Most of the respondents were (34.8%) had do not work to get money and the rest one hundred eighty (65.2 %) work different type of jobs to get money (Table 1). 31/35

Sexual history of the participants
Regarding to sexual practice one hundred ninety (68.84%) of participants were did not ever engaged in premarital sexual practice. Eighty six (31.16%) of the participants were experienced sexual intercourse with different people during the study. More than half of the participants (67.4%) were having sexual intercourse with their intimate friends and some of them were with teacher.
Most of the participants should initiate for sexual intercourse due to love; this accounted (39.5%) from the mentioned reasons, to get money, with forces, individual desire and due to substance abuse. From the total participants engaged in premarital sexual practice, almost nearly half (33.7%) had a regular sexual partner during a data collection period. More than half (66.3%) have had sex with more than one sexual partner.
Regarding safe sexual practice, (34.9%) of the students was used condom in their irst sexual intercourse. But more than half of the participants (65.1%) did not use condom during their irst sexual practice. The reason not to use condom among nonusers were (37.5%) of them ashamed to ask partner, (14.3%) of them not available, (35.7%) didn't think, (7.1%) of them was substance abuse and the remaining (5.4%) are due to not know how to use ( Table 2).

Prevalence of premarital sexual practice
Regarding the premarital sexual practice (68.84%) of them did not ever involved in any sexual practice (no) but (31.16%) were experienced sexual intercourse (yes) with different people (Figure 1).

Discussion
This study revealed that more than one fourth (31.16%) of the respondents had premarital sexual intercourse. It was in line with from Sebeta town, 28.3% [8], Bahir-Dar, 30.8% [9], Maichew, 29.3% [3], Gondar and Meteme, 31.9% [14]. But this study inding was higher than study done in Agaro, 25% [10] and Shendi town, 19% [11]. This could be explained by decrement of discussion about reproductive health risks and rise of pornography. Also, this study's inding was lower than the study from Nepal, 36.5% [12]. This inconsistence could be justi ied by the difference in a background of the study participants and variation in the study areas.
Other inding revealed that condom use during irst sexual intercourse in this study is about (34.9%). This inding is higher than from a study result 33.6% among students of Jimma town [13]. This could be due to fact that availability of information about condom has got an impact on condom use through time.
Study showed that, the student reason claimed to have the irst sexual intercourse was due to fall in love, 39.5%, had desire, 24.4%, Peer pressure, 8.2% and to get money or gifts, 3.4%, Raped, 5.8%, and substance abuse, 18.7%. This inding is similar to the study conducted in Addis Zemen Town South Gondar (14). But the reason of having premarital sex among northern Ethiopia High School students was due to peer pressure (35.2%), and use of drugs, which is different from the current study [3]. The possible reason may be adapting of western culture and style.
One of the predictor variables in this study were students who drink alcohol four times more likely to report and begin premarital sexual practice than that of those who did not drink alcohol (AOR=4.06, 95% CI, (2.06, 7.99)). The possible reason might be, drinking alcohol decrease self-control and predispose to risky behavior such as early initiation of sexual intercourse [15]. This study found that students whose educational status of mother attended college and above education were odds of 0.33 premarital sexual practice than those of not attended formal education [AOR= 0.33, 95% CI, (0. 13 On the other hand, students whose educational status of mother attended college and above education were 0.33 time less likely to have odds of premarital sexual practice than those of not attended formal education [AOR= 0.33, 95% CI, (0.13-0.84)]. This inding is in line with study done in gedeo zone [AOR=0.81, 95% CI, (1.12, -2.35)].
In addition, those students who were watching pornography were reported high risk of premarital sexual practice than those who did not watch pornography [AOR=2.78, 95%CI, (1.45, 5.3)]. This inding is higher than result of study done in shendi town of east gojjam [AOR=1.74 95% CI, (1.18, 2.54)] .This may be due to the difference in study population culture [11].

Conclusion
This study has revealed that signi icant numbers of high school students are engaged in premarital sexual practice very early, with risky situation (different sexual partner, due to alcoholic consumption and non-use of condom). Attending to watch pornography, educational status of mother and dirking alcohol were independent predictors of premarital sexual practice among high school students. Therefore, health information supply on sexuality and reproductive health to disrupt the deep rooted believes and traditions should establish so as to bring behavioral change among students. As well students should be aware about high risk sexual behavior through behavioral materials and their family. Further interventional study design should need to be done.