Determinants Of Contraceptive Use Among Sexually Active Adolescents Aged 15-19 Years In Sierra Leone: An Analysis Of The Sierra Leone Demographic And Health Surveys 2008 – 2019

Abstract

Background: Low contraceptive use remains a public health challenge, especially in developing countries where over half (57%) of adolescent pregnancies occur annually. Sierra Leone has a sexually active youthful population with a high adolescent pregnancy rate of 21% and low contraceptive use (21.3%). The objectives of this study were to determine; knowledge and awareness of contraceptives, the prevalence of contraceptive use and the determinants of contraceptive use among sexually active adolescents (15-19 years) in Sierra Leone from 2008 to 2019. Methods: The study was a secondary data analysis of the Sierra Leone Demographic and Health Surveys for the years 2008, 2013 and 2019. Relevant data were extracted, cleaned and recoded where appropriate. The extracted data were analysed using Stata SE version 16 after Complex survey setting of the DHS data was accounted for. Both binary and multivariate logistic regression model were applied to evaluate the association between contraceptive use and the independent variables. A p-value of 0.05 was used to determine statistical significance whilst odds ratios with their 95% confidence intervals were utilized to assess the strength of association. Results: A total of 5,213 respondents were involved in this study with a mean age of 17.5 years (SD=1.31). The majority of them were Muslims (75.9%), single (70.1%) and had secondary school education (58.7%). The knowledge of contraceptive method was (93.9%) with a pooled contraceptive prevalence rate (CPR) of 31.7%. The significant variables during the bivariate analysis were further analysed in a multivariable logistic model. After adjusting for the covariates in the multivariable logistic regression, the determinants of contraceptive use identified were age group (AOR 2.13,95% CI 1.41-3.22 p < 0.001), age at first birth (AOR 0.17, 95% CI 0.09- 0.30,p<0.001), marital status (AOR 0.36, 95% CI 0.25-0.53, p<0.001), secondary level of education (AOR 2.70, 95% CI 1.70-4.29, p<0.001) and told of FP in health facility (AOR 1.51, 95% CI1.03 -2.22, p=0.034). Conclusion: Contraceptive use among sexually active adolescents is low, however, it is noticed to increase with a higher level of education. Therefore, there is the need for improvement in sexual and reproductive health education. This will in turn optimize contraceptive use among adolescents in Sierra Leone.