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Report
Condom Use among Unmarried
Male Youths in Nigeria:
Modelling Socio-demographic
Predictors
Adebowale Stephen Ayo
Department of
Epidemiology, Medical
Statistics and
Environmental Health,
Faculty of Public Health,
College of Medicine,
University of Ibadan,
Nigeria
Background
 The HIV prevalence in Nigeria is becoming
worrisome, particularly among youths.
 Realization of the 6th theme of the
Millennium Development Goal (combat
HIV/AIDS, malaria and other diseases) in
Nigeria will be a hallucination, if research
on underlying factors influencing the use of
condom among youths is neglected.
 Nigeria: Most Populous African country
 Population pyramid: Broad base
 Life Expectancy at Birth 47 years (PRB,
2010).
 The population figures over years:
158.3Million, 2010; projected
217.4Million, 2025 (PRB, 2010).
 Population growth rate (2.4)
 Population doubling time (28.9 years)
 approximately two-third of the
population live in rural areas, which are
characterized with poor modern social
and health facilities (NPC, 2006).
 The total population of male youths is
13,774,081 which constituted 9.81% of
the population, while 12,399,007 are
unmarried male youths (NPC, 2006).
 HIV prevalence is 3.6% (UNAIDS,
2010)
 Knowledge of condom as a method of
protecting STDs is high in Nigeria, but the
utilization is low, particularly among
unmarried male youths who are more
sexually active than other segments of the
males’ population (NDHS, 2003; NDHS,
2008).
 Engaging in sexual intercourse with
someone other than a faithful spouse or
partner is considered high-risk sex in
terms of contacting STDs.
 There are evidences that the risk of
contracting STDs could be reduced by
using condom (CDC, 1999; de Vincenzi,
1994; Prata et al., 2005)
 Constant use of condom remains an important
public health prevention strategy against the
spread of STDs and HIV.
 However, there are diverse challenges in
condom utilization in terms of affordability,
accessibility and acceptability.
 A handful of studies have examined that
condom use is influenced by numerous sociodemographic factors (Kiragu and Zabin,
1995; Gueye et al., 2001; Akinwande and
Brieger, 2007).
 Findings from sub-Saharan Africa countries
indicate that a considerable proportion of
youth belief that requesting condom use
communicates distrust between spouses or
sexual partners, believing that contacting
STDs is inevitable and express concern that
condom might break and cause injury when
in use (Van Rossem et al, 2001).
In Nigeria:
 There are unmet needs for condom use
among male youths.
 The cost of condom and poverty.
 Availability, accessibility and acceptability
 The adverse consequences of not using
condom among unmarried male youths
are numerous, among which are;
 Unwanted pregnancies, abortion, high risk
abortion, high risk pregnancies, STDs, negative
influence on female partner’s education e.t.c
 None or partial utilization of condom can
predispose sexually active young men to
morbidity, poor health and mortality as a
result of contacting STDs including
HIV/AIDS.
 Improving the sexual health of
male youths and their female sexual
partners would be accomplished
easily if condom is used constantly
during sexual intercourse.
 Unmarried male youths are a critical
target group for sexual behavioral
change programs.
 Realization of the efforts of achieving good
reproductive health outcome will not
materialize in a setting where the prevalence
of condom use is low, particularly among
sexually active male youths.
 Few studies have focused on; modeling
socio-demographic predictors of condom
use among unmarried male youths in
Nigeria.
 These insights informed the motivation for
this study.
Method
 The study was retrospective crosssectional in design and utilized NDHS,
2008 data.
 During the survey, men aged 15-59
were interviewed.
 The current study focuses on male
youths aged 15-24 years (n=1629) who
ever had sexual intercourse (vaginal,
oral and anal).
Method (contd.)
 Ever use and currently using of condom
were used as dependent variables; while
socio-demographic characteristics were
the independent variables.
Method (contd.)
 In the original questionnaire designed for the
survey, a question was asked from the
respondents on the “currently using
contraceptive method”. Here, the respondents
were to choose from the list of contraceptives
both natural and modern methods.
 The variable was therefore recoded into two
categories; Condom = 1 and Otherwise = 0.
This is the first dependent variable. The other
dependent variable was obtained from similar
question, but on “ever used of contraceptive”.
Method (contd.)
 Analysis was done using Chi-square
and logistic regression models.
 Different Models were generated based
on the Chi-square statistic.
Method (Contd.)
Study Limitations
 The use of secondary data, because the
data was not specifically collected for
the actualization of the objectives of this
study.
 Some youths who are sexually active
could claim otherwise because of shame.
Findings
 The data show that;
 61.7% of the respondents had ever used
condom.
 Significant difference existed between the mean
age of those who never used condom
(19.60±2.5) and ever users (21.08±2.2).
 Demographic factors such as age, region,
residence, education and wealth index were
found to be significantly associated with
condom use (p<0.05).
 Religion was not significantly associated with
condom use (p=0.05).
Findings (contd.)
 The percentage of male youths who ever used
condom in the south (68.2%) was more than that of
the North (44.5%).
 Male youths residing in urban, ever used condom
(70.8%) more than their rural counterparts (54.9%).
 Ever used of condom increases consistently with
increasing level of education. For instance, 50.4%,
60.2% and 84.7% of male youths with primary,
secondary and higher level of education ever used
condom respectively, while 28.3% of those with no
formal education ever used condom.
 Ever used of condom ranges between 30.5% among
youths from poorest wealth index category through
73.4% for those in richest wealth index.
Findings (contd.)
 Among all the socioeconomic variables considered in
the analysis, smoking status, recent sexual activity,
knowledge of STDs, ever tested for HIV and the total
life-time number of sexual partners were
significantly associated with ever use of condom status.
 But, health insurance status (p=0.190), work status
(p=0.435), had STD in the last 12 months before the
survey (p=0.304) and paid for sex in the last 12
months (p=0.207) were not significantly associated
with ever use of condom.
 Those who ever smoked cigarette ever used condom
(76.8%) than never smokers (60.7%).
 Male youths who were sexually active in the last
1month before the survey (74.3%), ever used condom
than those who were not sexually active (56.0%).
Findings (contd.)
 The percentage of those who ever used
condom was higher among those who ever
heard of STDs (62.1%) than those who never
heard of STDs (31.8%).
 Those who have undergone HIV test (77.7%)
were more likely to ever used condom than
those who never went for such test (58.9%).
 The proportion of condom users was more
among respondents who have more than one
life-time number of sexual partners (71.3%)
than those who had only one (42.0%).
Findings (contd.)
 Demographic characteristics and
current condom use status among
sexually active unmarried male youths.
 49.5% are currently using condom
 There was significant association
between current use of condom and
demographic characteristics such as; age
(p = 0.004), region (p<0.001), residence
(p<0.001), education (p<0.001) and
wealth index (p<0.001).
Findings (contd.)
 The percentage of male youths aged 20-24 years who are
currently using condom (53.7%) was higher than that of
younger male youths (39.7%).
 Sexually active male youths living in Southern Nigeria
(54.7%) are currently using condom than their
counterparts residing in the North (36.1%).
 The urban male youth residents were currently using
condom (61.9%) than those residing in the rural areas
(41.1%).
 The proportion of current condom users among sexually
active male youth increases with increasing level
education, it ranges from 8.3% among illiterates through
70.4% among those who had higher education.
 The higher the wealth index, the higher the percentage of
male youths who are currently using condom.
Approximately 64.0% of male youths that belong to
richest wealth index categories are currently using
condom as against 11.9% from the poorest.
Findings (contd.)
 Higher prevalence of condom use was
observed among those who ever tested than
never tested for HIV (68.8% vs 45.7%)
(p<0.001). .
 Those who have more than one total life-time
sexual partner (52.3%) were currently using
condom than those with only one sexual
partner (36.3%) (p<0.01).
 Variables such as; smoking status, covered
with health insurance, work status, ever heard
about STDs , had STD in the last 12 months
and paid for sex in the last 12 months prior
the survey were not significantly associated
with current use of condom.
Findings (contd.)
 The multiple logistic regression analysis of
current use of condom by demographic and
socio-economic characteristics combined.
 Male youths who were 20 years and older were
2.19 (p = 0.001) times more likely to ever use
condom than younger youths.
 Living in southern region predisposes male
youths to the use of condom (AOR=2.05;
C.I=1.55-2.72). Than their counterparts in the
North.
 The odd of ever use of condom was higher
among male youth who were in the middle
(AOR=2.45; C.I=1.48-4.07), richer
(AOR=2.59; C.I=1.56-4.29) and richest
(AOR=3.13; C.I=1.80-5.42) wealth indices than
poorest.
Findings (contd.)
 Male youths who were not sexually active
in the last one month were less likely
(AOR=0.40; C.I=0.38-0.64) to ever used
condom than their counterparts who were
sexually active.
 Those who ever had an HIV test were 1.52
(p<0.018) times more likely to ever used
condom than those who have not undergone
the test.
 Having multiple sexual partners increases
the chances of using condom (AOR=2.59;
C.I=2.01-3.32).
Findings (contd.)
 Multiple logistic regression model of current
use of condom among sexually active male
youths by demographic and socio-economic
characteristics.
 Only wealth index and those who ever had
HIV test show evidence of significant
relationship with current use of condom.
 Male youths who belong to richer and richest
wealth index were 4.9 (C.I=1.76-13.68) and 4.4
(C.I=1.47-13.03) more likely to currently using
condom than those in poorest wealth index
category.
 Currently using condom behaviour was higher
among those who ever undergone HIV test
(AOR=1.88, C.I=1.10-3.22) than those who
never tested for the disease.
Findings (contd.)
 The TABLE below shows the Adjusted
Multiple logistic regression models of
predicting the strength of Relationship
between Ever Used of Condom, currently
using condom among sexually active male
youths and Socio-demographic
Characteristics in Nigeria (NDHS, 2008).
*Significant at 0.1%
**Significant at 1%
***Significant at 5%
Ever Used Condom
Currently Using Condom
Background
Model 1
Model 2
Model 3
Model 4
Model 1
Model 2
Model 3
Model 4
Characteristics
N=1557
N=1557
N=1520
N=1520
N=510
N=510
N=504
N=503
Exp(β)
Exp(β)
Exp(β)
Exp(β)
Exp(β)
Exp(β)
Exp(β)
Exp(β)
Total life-time number of sexual partners
One
R.C
R.C
R.C
R.C
R.C
Two and above
2.862*
2.993*
2.601*
2.586*
1.340
15-19
R.C
R.C
R.C
R.C
R.C
20-24
2.564*
2.220*
2.198*
2.191*
1.266
Poorest
R.C
R.C
R.C
R.C
R.C
R.C
R.C
Poorer
1.636
1.677
1.684
3.970**
3.416***
2.833
2.598
Middle
2.322**
2.447**
2.454*
4.340**
3.416***
2.751
2.700
Richer
2.682*
2.556*
2.587*
9.429*
6.396*
5.198**
4.903*
Richest
3.362*
3.091*
3.126*
12.427*
6.957*
4.620**
4.369*
None
R.C
R.C
R.C
R.C
R.C
R.C
Primary
1.586
1.136
1.078
1.857
1.691
1.580
Secondary
1.886
1.304
1.234
3.087
2.762
2.693
Higher
3.839**
2.483***
2.337
5.666
3.974
3.562
North
R.C
R.C
R.C
R.C
R.C
South
2.025*
2.113*
2.052*
1.483
1.472
Active
R.C
R.C
Not Active
0.490*
0.491*
Urban
R.C
R.C
R.C
R.C
R.C
Rural
0.808
0.793
0.761
0.695
0.711
No
R.C
R.C
R.C
R.C
Yes
1.539***
1.523***
1.930***
1.883***
Age
Wealth Index
Education
Region
Recent sexual activity
Place of residence
Ever been tested for HIV
Cigarette smoking
No
R.C
Yes
1.230
Religion
Christian
R.C
Islam
0.861
Traditional
1.215
Others
0.492
Constant
0.438*
0.061*
0.172*
0.192*
0.145*
0.077***
0.082***
0.059**
-2 LogL
1906.34
1774.982
1688.734
1686.115
648.238
637.317
620.942
618.002
Nagelkerke R2
0.154
0.251
0.275
0.277
0.132
0.157
0.171
0.178
3
Not/irregularly using condom
with/without STDs
STDs
Excluding
HIV/AIDs
Constantly using condom
with STDs Treated
2
Constantly using condom
1 but STDs not Treated
2
Not/irregularly using condom
with/without STDs
3
1.
2.
3.
Population of People having STDs reduces and the contacting rate closes to 0
Population of People having STDs slightly increases above the initial value
and the contacting rate closes to 0
Population of People having STDs and the contacting rate amplify.
Conclusion
 The prevalence of current use of condom
among sexually active unmarried male
youths in Nigeria is low and must be
improved.
 Undergoing HIV test and Free access to
condom are good measures for increasing
utilization of condom among unmarried male
youths in Nigeria.
 These will reduce the chances of contacting
STDs including HIV and unwanted
pregnancies among youths (male and female)
in Nigeria.
Acknowledgements
 The author is grateful to MacroInternational U.S.A and National
Population Commission for allowing
us to use their data (NDHS, 2008) for
this study.
Thank you
for
listening

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