| 1. |
- Agardh, Anette
(författare)
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Between love and fear - determinants of sexual behavior among Ugandan university students
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: More than half of all new HIV infections in sub-Saharan African countries, including Uganda, occur among young people between the ages of 15 and 24, the most sexually active period of their lives. Understanding the contextual determinants of sexual behavior in this group is crucial in combating the pandemic. Aim: The overall aim of this study was to assess the impact of demographic, religious, social capital, mental health, and sexual coercion factors on risky sexual behavior among a student population in Uganda in order to gain a deeper understanding of the forces that shape sexual behavior of young people with the purpose of contributing to policy formulation and implementation of more effective interventions to prevent the spread of HIV/AIDS. Method: In 2005, 980 Ugandan university students responded to a self-administered questionnaire (response rate 80%) that assessed socio-demographic, social capital, and religious factors, as well as alcohol use, mental health, experience of sexual coercion, age of sexual debut, number of sexual partners, and condom use. Mental health was assessed using items from the Hopkins Symptoms Checklist-25(HSCL-25) and the Symptom Checklist-90 (SCL-90). Logistic regression analysis was applied as the main analytical tool, and synergistic effects between some of the main determinants were investigated. Results: Thirty-seven percent of the male and 49% of the female students had not previously had sexual intercourse. Of the male and female students with sexual experience, 46% of the males and 23% of the females had had three or more lifetime sexual partners, and 32% of the males and 38% of the females did not consistently use condoms with a new partner. Minor importance of religion in one’s family while growing up was correlated to a statistically significant degree with early sexual debut and having many sexual partners (OR 1.7, 95% CI: 1.2–2.4 and OR 1.6, 95% CI: 1.1–2.3, respectively). Being of Protestant faith interacted with gender among those who had debuted sexually. Protestant female students were more likely to have had three or more sexual partners; the opposite was true for Protestant male students. Non-dominant bridging trust among male students was associated with a higher risk for having had many sexual partners (OR 1.8, 95% CI: 1.2–2.9). Low trust in others was associated with a greater likelihood of sexual debut in men, while the opposite was true in women. A similar pattern was seen regarding a high number of lifetime sexual partners in individuals who were raised in families where religion played a major role. After controlling for potential confounding factors, high scores on depression and a high number of sexual partners were significantly associated among both males (OR 2.0, 95% CI: 1.2–3.3) and females (OR 3.3, 95% CI: 1.3–8.6). Elevated anxiety scores among men were associated with a high number of sexual partners (OR 1.9, 95% CI: 1.1–3.3) and inconsistent condom use (OR 1.9, 95% CI: 1.1–3.6). Experience of sexual coercion was found to be statistically significantly associated with previously had sex (OR 1.6, 95% CI: 1.1−2.3), early sexual debut (OR 2.4, 95% CI: 1.5−3.7), as well as with having had a high number of sexual partners (OR 1.9, 95% CI: 1.2−3.0), but not with inconsistent condom use. Good mental health scores, reporting high trust in others, or stating that religion played a major role in one’s family of origin seemed to buffer the effect that the experience of sexual coercion had on the likelihood of having many sexual partners. Conclusion: Religion, social capital, mental health, and sexual coercion appear to be important determinants of sexual behavior among Ugandan university students. Using such knowledge, one may design and implement more effective programs to prevent the spread of HIV/AIDS. Policy makers would benefit from involving young people in the planning of interventions against HIV/AIDS, and in the formulation and implementation of youth-friendly policies to better understand how strategies should be tailored in relation to the needs of the target group. It would also be desirable to introduce coordinated youth-friendly health services to address both the psychological as well as the sexual and reproductive health-related concerns of young people.
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| 2. |
- Agardh, Anette, et al.
(författare)
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Experience of sexual coercion and risky sexual behavior among Ugandan university students
- 2011
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Growing worldwide evidence shows that the experience of sexual coercion is fairly prevalent among young people and is associated with risky sexual behavior thereafter. The causal mechanisms behind this are unclear but may be dependent on specific contextual determinants. Little is known about factors that could buffer the negative effects of coercion. The aim of this study was to assess the association between the experience of sexual coercion and risky sexual behavior among university students of both sexes in Uganda. Methods: In 2005, 980 (80%) out of a total of 1,220 students enrolled in Mbarara University of Science and Technology in Uganda participated in a self-administered questionnaire covering socio-demographic and religious factors, social capital, mental health, alcohol use, and sexual behavior. A validated scale of six items was used to assess the experience of sexual coercion. Logistic regression analyses were applied to control for confounders. Potential buffering factors were analyzed by testing for effect modification. Results: Fifty-nine percent of those who responded had previously had sexual intercourse. Among the male students 29.0%, and among the female students 33.1% reported having had some experience of sexual coercion. After controlling for age, gender, and educational level of household of origin, role of religion and trust in others sexual coercion was found to be statistically significantly associated with previously had sex (OR 1.6, 95% CI; 1.1-2.3), early sexual debut (OR 2.4, 95% CI; 1.5-3.7), as well as with having had a great number of sexual partners (OR 1.9, 95% CI; 1.2-3.0), but not with inconsistent condom use. Scoring low on an assessment of mental health problems, reporting high trust in others, or stating that religion played a major role in one's family of origin seemed to buffer the negative effect that the experience of sexual coercion had on the likelihood of having many sexual partners. Conclusion: The findings of this study suggest that the experience of sexual coercion is common among youth/young adults in Uganda and is subsequently associated with risky sexual behavior in both sexes. The existence of individual and contextual factors that buffer the effects mentioned was also demonstrated. In the Ugandan context, this has implications for policy formulation and the implementation of preventive strategies for combating HIV/AIDS.
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| 3. |
- Agardh, Anette, et al.
(författare)
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Social capital and sexual behavior among Ugandan university students
- 2010
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Ingår i: Global health action. - : Informa UK Limited. - 1654-9880 .- 1654-9716. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- In general, social capital was associated with less risky sexual behavior in our sample. However, gender and role of religion modified the effect so that we can not assume that risky sexual behavior is automatically reduced by increasing social capital in a highly religious society. The findings indicate the importance of understanding the interplay between social capital, religious influence, and gender issues in HIV/AIDS preventive strategies in Uganda.
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| 4. |
- Agardh, Anette, et al.
(författare)
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The Impact of Socio-Demographic and Religious Factors upon Sexual Behavior among Ugandan University Students.
- 2011
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 6:8
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: More knowledge is needed about structural factors in society that affect risky sexual behaviors. Educational institutions such as universities provide an opportune arena for interventions among young people. The aim of this study was to investigate the relationship between sociodemographic and religious factors and their impact on sexual behavior among university students in Uganda. METHODS: In 2005, 980 university students (response rate 80%) were assessed by a self-administered questionnaire. Validated instruments were used to assess socio-demographic and religious factors and sexual behavior. Logistic regression analyses were applied. RESULTS: Our findings indicated that 37% of the male and 49% of the female students had not previously had sex. Of those with sexual experience, 46% of the males and 23% of the females had had three or more sexual partners, and 32% of the males and 38% of the females did not consistently use condoms. For those who rated religion as less important in their family, the probability of early sexual activity and having had a high number of lifetime partners increased by a statistically significant amount (OR = 1.7; 95% CI: 1.2-2.4 and OR = 1.6; 95% CI: 1.1-2.3, respectively). However, the role of religion seemed to have no impact on condom use. Being of Protestant faith interacted with gender: among those who had debuted sexually, Protestant female students were more likely to have had three or more lifetime partners; the opposite was true for Protestant male students. CONCLUSION: Religion emerged as an important determinant of sexual behavior among Ugandan university students. Our findings correlate with the increasing number of conservative religious injunctions against premarital sex directed at young people in many countries with a high burden. of HIV/AIDS. Such influence of religion must be taken into account in order to gain a deeper understanding of the forces that shape sexual behavior in Uganda.
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| 5. |
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| 6. |
- Agardh, Anette, et al.
(författare)
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Youth, Sexual Risk-Taking Behavior, and Mental Health: a Study of University Students in Uganda.
- 2012
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Ingår i: International Journal of Behavioral Medicine. - : Springer Science and Business Media LLC. - 1070-5503 .- 1532-7558. ; 19, s. 208-216
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Little focus has been paid to the role of mental health among young people with regard to risky sexual behavior and HIV prevention in sub-Saharan Africa. The aim of this study was to investigate the relationship between poor mental health and risky sexual behavior (HIV/AIDS) among a population of university students in Uganda. METHODS: In 2005, 980 Ugandan university students completed a self-administered questionnaire (response rate 80%) assessing sociodemographic and religious background factors, mental health, alcohol use, and sexual behavior. Mental health was assessed using items from the Hopkins Symptoms Checklist-25 and the Symptom Checklist-90. RESULTS: High scores on depression and high numbers of sexual partners among both males (odds ratio (OR) 2.0, 95% confidence interval (CI) 1.2-3.3) and females (OR 3.3, 95% CI 1.3-8.6) were significantly associated. Elevated anxiety scores among men were associated with high numbers of sexual partners (OR 1.9, 95% CI 1.1-3.3) and inconsistent condom use (OR 1.9, 95% CI 1.1-3.6). Psychoticism was also significantly associated with high numbers of sexual partners among men. The associations remained statistically significant after controlling for sociodemographic factors and level of alcohol consumption. CONCLUSION: These findings indicate that previous conclusions on the association between sexual behavior and mental health from high- and middle-income countries also are valid in a low-income setting, such as in Uganda. This knowledge has implications for policy formation and HIV/AIDS preventive strategies. Coordinated youth-friendly mental health and sexual and reproductive health services to meet the needs of young people would be desirable.
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| 7. |
- Asamoah, Benedict Oppong, et al.
(författare)
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Alcohol consumption in relation to maternal deaths from induced-abortions in Ghana
- 2012
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Ingår i: Reproductive Health. - : Springer Science and Business Media LLC. - 1742-4755. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The fight against maternal deaths has gained attention as the target date for Millennium Development Goal 5 approaches. Induced-abortion is one of the leading causes of maternal deaths in developing countries which hamper this effort. In Ghana, alcohol consumption and unwanted pregnancies are on the ascendancy. We examined the association between alcohol consumption and maternal mortality from induced-abortion. We further analyzed the factors that lie behind the alcohol consumption patterns in the study population. Method: The data we used was extracted from the Ghana Maternal Health Survey 2007. This was a national survey conducted across the 10 administrative regions of Ghana. The survey identified 4203 female deaths through verbal autopsy, among which 605 were maternal deaths in the 12 to 49 year-old age group. Analysis was done using Statistical software IBM SPSS Statistics 20. A case control study design was used. Cross-tabulations and logistic regression models were used to investigate associations between the different variables. Results: Alcohol consumption was significantly associated with abortion-related maternal deaths. Women who had ever consumed alcohol (ORadjusted 2.6, 95% CI 1.38-4.87), frequent consumers (ORadjusted 2.6, 95% CI 0.89-7.40) and occasional consumers (ORadjusted 2.7, 95% CI 1.29-5.46) were about three times as likely to die from abortion-related causes compared to those who abstained from alcohol. Maternal age, marital status and educational level were found to have a confounding effect on the observed association. Conclusion: Policy actions directed toward reducing abortion-related deaths should consider alcohol consumption, especially among younger women. Policy makers in Ghana should consider increasing the legal age for alcohol consumption. We suggest that information on the health risks posed by alcohol and abortion be disseminated to communities in the informal sector where vulnerable groups can best be reached.
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| 8. |
- Asamoah, Benedict Oppong, et al.
(författare)
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Inequality in fertility rate and modern contraceptive use among Ghanaian women from 1988-2008
- 2013
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Ingår i: International Journal for Equity in Health. - : Springer Science and Business Media LLC. - 1475-9276. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: In most resource poor countries, particularly sub-Saharan Africa, modern contraceptive use and prevalence is unusually low and fertility is very high resulting in rapid population growth and high maternal mortality and morbidity. Current evidence shows slow progress in expanding the use of contraceptives by women of low socioeconomic status and insufficient financial commitment to family planning programs. We examined gaps and trends in modern contraceptive use and fertility within different socio-demographic subgroups in Ghana between 1988 and 2008. Methods: We constructed a database using the Women's Questionnaire from the Ghana Demographic and Health Survey (GDHS) 1988, 1993, 1998, 2003 and 2008. We applied regression-based Total Attributable Fraction (TAF); we also calculated the Relative and Slope Indices of Inequality (RII and SII) to complement the TAF in our investigation. Results: Equality in use of modern contraceptives increased from 1988 to 2008. In contrast, inequality in fertility rate increased from 1988 to 2008. It was also found that rural-urban residence gap in the use of modern contraceptive methods had almost disappeared in 2008, while education and income related inequalities remained. Conclusions: One obvious observation is that the discrepancy between equality in use of contraceptives and equality in fertility must be addressed in a future revision of policies related to family planning. Otherwise this could be a major obstacle for attaining further progress in achieving the Millennium Development Goal (MDG) 5. More research into the causes of the unfortunate discrepancy is urgently needed. There still exist significant education and income related inequalities in both parameters that need appropriate action.
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| 9. |
- Asamoah, Benedict Oppong, et al.
(författare)
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Magnitude and trends of inequalities in antenatal care and delivery under skilled care among different socio-demographic groups in Ghana from 1988-2008
- 2014
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Background: Improving maternal and reproductive health still remains a major challenge in most low-income countries especially in sub-Saharan Africa. The growing inequality in access to maternal health interventions is an issue of great concern. In Ghana, inadequate attention has been given to the inequality gap that exists amongst women when accessing antenatal care during pregnancy and skilled attendance at birth. This study therefore aimed at investigating the magnitude and trends in income-, education-, residence-, and parity-related inequalities in access to antenatal care and skilled attendance at birth. Methods: A database was constructed using data from the Ghana Demographic and Health Surveys (DHS) 1988, 1993, 1998, 2003, and 2008. The surveys employed standard DHS questionnaires and techniques for data collection. We applied regression-based Total Attributable Fraction (TAF) as an index for measuring socioeconomic inequalities in antenatal care and skilled birth attendance utilization. Results: The rural-urban gap and education-related inequalities in the utilization of antenatal care and skilled birth attendants seem to be closing over time, while income-and parity-related inequalities in the use of antenatal care are on a sharp rise. Income inequality regarding the utilization of skilled birth attendance was rather low and stable from 1988 to 1998, increased sharply to a peak between 1998 and 2003, and then leveled-off after 2003. Conclusions: The increased income-related inequalities seen in the use of antenatal care and skilled birth attendance should be addressed through appropriate strategies. Intensifying community-based health education through media and door-to-door campaigns could further reduce the mentioned education-and parity-related inequalities. Women should be highly motivated and incentivized to attend school up to secondary level or higher. Education on the use of maternal health services should be integrated into basic schools so that women at the lowest level would be inoculated with the appropriate health messages.
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| 10. |
- Asamoah, Benedict Oppong, et al.
(författare)
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Spatial analysis of skilled birth attendant utilization in ghana.
- 2014
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Ingår i: Global journal of health science. - 1916-9736. ; 6:4, s. 34552-34552
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Tidskriftsartikel (refereegranskat)abstract
- Maternal mortality is a major health problem in most resource-poor settings, especially in sub-Saharan Africa. In Ghana, maternal mortality remains high and births attended by skilled health professionals are still low despite the introduction, in 2005, of free maternal health care for all women seeking care in public health facilities.
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