Is drinking alcohol associated with sexual coercion among Ugandan university students?: a cross-sectional study

Spatial accessibility to health facilities among pregnant women with and without exposure to intimate partner violence in Uganda

BACKGROUND

Poor physical access to health facilities could increase the likelihood of undetected intimate partner violence (IPV) during pregnancy. We aimed to determine sub-regional differences and associations between spatial accessibility to health facilities and IPV among pregnant women in Uganda.

METHOD

Weighted cross-sectional analyses were conducted using merged 2016 Uganda Demographic and Health Survey and 2014 Uganda Bureau of Statistics health facility datasets. Our study population were 986 women who self-reported being currently pregnant and responded to IPV items. Outcome was spatial accessibility computed as the near point linear distance [< 5 km (optimal) vs. ≥ 5 km (low)] between women's enumeration area and health facility according to government reference cutoffs. Primary independent variable (any IPV) was defined as exposure to at least one of physical, emotional, and sexual IPV forms. Logistic regression models were sequentially adjusted for covariates in blocks based on Andersen's behavioral model of healthcare utilization. Covariates included predisposing (maternal age, parity, residence, partner controlling behavior), enabling (wealth index, occupation, education, economic empowerment, ANC visit frequency), and need (wanted current pregnancy, difficulty getting treatment money, afraid of partner, and accepted partner abuse) factors.

RESULTS

Respondents' mean age was 26.1 years with ± 9.4 standard deviations (SD), mean number of ANC visits was 3.8 (± 1.5 SD) and 492/986 (49.9%) pregnant women experienced IPV. Median spatial accessibility to the nearest health facility was 4.1 km with interquartile range (IQR) from 0.2 to 329.1 km. Southwestern, and Teso subregions had the highest average percentage of pregnant women experiencing IPV (63.8-66.6%) while Karamoja subregion had the highest median spatial accessibility (7.0 to 9.3 km). In the adjusted analysis, pregnant women exposed to IPV had significantly higher odds of low spatial accessibility to nearest health facilities when compared to pregnant women without IPV exposure after controlling for enabling factors in Model 2 (aOR 1.6; 95%CI 1.2, 2.3) and need factors in Model 3 (aOR 1.5; 95%CI 1.1, 3.8).

CONCLUSIONS

Spatial accessibility to health facilities were significantly lower among pregnant women with IPV exposure when compared to those no IPV exposure. Improving proximity to the nearest health facilities with ANC presents an opportunity to intervene among pregnant women experiencing IPV. Focused response and prevention interventions for violence against pregnant women should target enabling and need factors.

Prevalence and predictors of sex under the influence of psychoactive substances among young people in informal settlements in Kampala, Uganda

BACKGROUND

The use of psychoactive substances such as alcohol, heroin and marijuana is associated with negative health outcomes such as sexual violence and unintended pregnancies, and risky sexual behaviours. Although there is evidence linking psychoactive substance use and risky sexual behaviours such as inconsistent condom use and multiple sexual relationships, there is limited data on sex under the influence of psychoactive substances among young people. This study aimed to investigate the prevalence and predictors of sex under the influence of psychoactive substances among young people in informal settlements in Kampala, Uganda.

METHODS

A cross-sectional study was conducted among 744 sexually active young psychoactive substance users in informal settlements in Kampala, Uganda. Data were collected through face-to-face interviews using a digitalized structured questionnaire, preloaded on the Kobocollect mobile application. The questionnaire captured data on the socio-demographic characteristics of the respondents, history of psychoactive substance use, and sexual behaviours. Data were analysed using STATA Version 14.0. A modified Poisson regression model was used to determine the predictors of sex under the influence of psychoactive substances.. Adjusted prevalence ratios at a p-value value ≤ 0.05 with a 95% confidence interval were considered.

RESULTS

About 61.0% (454/744) of the respondents had had sex under the influence of psychoactive substances in the last 30 days. The predictors of sex under the influence of psychoactive substances were being female (PR 1.18, 95% CI: 1.04-1.34), being 20-24 years of age (PR: 1.22, 95% CI: 1.04-1.44), being married (PR 1.15, 95% CI: 1.01-1.31) or divorced/separated (PR 1.43, 95% CI: 1.26-1.61), not living with biological parents or guardians (PR 1.22, 95% CI: 0.99-1.50), earning 71 USD and below (PR 0.86, 95% CI: 0.79-1.03) and using alcohol (PR 1.43, 95% CI: 1.25-1.69), marijuana (PR 1.16, 95% CI: 1.02-1.31) and khat (PR 1.25, 95% CI: 1.10-1.42) in the last 30 days.

CONCLUSION

The study found that a high proportion of sexually active young people in informal settlements in Kampala, Uganda had engaged in sex under the influence of psychoactive substances in the past 30 days. The study also identified several factors associated with sex under the influence of psychoactive substances, including being female, being aged 20-24 years, being married or divorced or separated, not living with biological parents or guardians, and using alcohol, marijuana, or khat in the past 30 days. Our findings suggest the need for targeted sexual and reproductive health programs that incorporate risk-reduction interventions aimed at reducing sex under the influence of psychoactive substances, especially among females and those who do not live with their parents.

Sexual violence and risk factors among night shift female college students in Hawassa city, South Ethiopia, 2020

BACKGROUND

Sexual violence is any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, against a person's sexuality using coercion, by any person regardless of their relationship to the victim, in any setting. Several studies were undertaken on sexual violence among students in general. Nevertheless, there is paucity of information about sexual violence among night shift students in particular; even if they are more vulnerable to sexual violence due to the nature of the class time. The government has embraced legal and policy frameworks to discourse the problem of sexual violence in Ethiopia; nevertheless, the problem still is quite pervasive.

OBJECTIVE

This study was aimed to assess the prevalence of sexual violence and risk factors among night shift female college students in Hawassa city.

METHODS

Institution-based cross-sectional study design was employed. A structured questionnaire was used to collect the data from 345 study participants. Systematic random sampling technique was used to choice study participants. Epi data version 3.1statistical software and Statistical Package for Social Sciences version 22.0 were used to enter and analysis the data. Both bivariable and multivariable logistic regression analyses were performed to recognize risk factors. P values < 0.05 with 95% confidence level were used to state statistical significance.

RESULTS

A total of 330 students were participated in the study making a response rate of 95.6% with a mean age of 24.9. The prevalence of last 12 month sexual violence was 202 (61.2%) 95% CI (55.8, 66.4) which includes rape, attempted rape and sexual harassment. The 12 month prevalence of each form of violence was 46 (13.9%) 95% CI (10.6, 17.9), 23 (6.9%) 95% CI (3.6, 10.9) and 163 (49.4%) 95% CI (46.2, 53.6) of rape, attempted rape and sexual harassment respectively. The independent predictors of sexual violence having a father with no formal education (AOR = 2.39, 95% CI 1.04, 5.33) presence of multiple sexual partners (AOR = 3.44, 95% CI 1.64, 7.2), having sexual partner (AOR = 1.89, 95% CI 1.03, 3.5), and consuming alcohol (3.55, 95% CI 1.84-6.85) by the victims.

CONCLUSION

This study shown that the prevalence of sexual violence is high among night shift female college students in Hawassa city. Having a father with no formal education, drinking alcohol, having multiple sexual partners and having sexual partner were more likely to have sexual violence within the last 12 month. Thus, students should prevent themselves from health risky behaviors and Hawassa educational bureau should be work on awareness creation concerning women empowerment with in marriage and Further broad and longitudinal studies are needed to determine the predictors of the problem among female students at Hawassa and Ethiopia as a whole.

Risky sexual behaviours among Ugandan university students: A pilot study exploring the role of adverse childhood experiences, substance use history, and family environment

Background

University students are known to have risky sexual behaviours (RSBs). The severity of the RSB is influenced by many factors, including the family environment, exposure to adverse childhood events (ACEs), and the use of addictive substances. However, there is limited information about the influence of ACEs and the family environment of these students in low-and medium-income countries (LMICs). Therefore, a pilot study was conducted among university students from a LMIC, Uganda.

Methods

The present study comprised a cross-sectional online survey among Ugandan students at a public university (N = 316; 75% male; 52.2% aged between 18–22 years). The survey included questions relating to socio-demographic information, family environmental information, the Sexual Risk Survey (SRS), and the Adverse Childhood Experiences-International Questionnaire (ACE-IQ).

Results

Over half (53.8%) reported having had sexual intercourse. Males reported over two times higher mean total SRS score compared to females (χ2 = 4.06, p = 0.044). Approximately one-sixth of the sample had drunk alcohol or used illicit psychoactive substances in the past six months (16.1%). Among four regression analysis models, sociodemographic variables predicted the highest variance (13%), followed by family environment variables (10%), and both psychoactive substance use history (past six months) and ACEs individually explained approximately 5% variance in total SRS score, with the final model predicting 33% of the variance in RSB.

Conclusions

The present study demonstrated a gender disparity with males involved in more RSB than females, as has been reported in most previous RSB studies. Family environment, sociodemographic factors, substance use, and ACEs all appear to contribute to RSB among university students. These findings will benefit other researchers exploring factors associated with RSB among university students and will help develop interventions to reduce RSB to protect students from unwanted pregnancies, sexually transmitted diseases, and HIV/AIDS.

Association of Teen Dating Aggression With Risk Behavior and Academic Adjustment

This study constructed a six-item Teen Dating Aggression (TDA) scale, investigated the prevalence of TDA in a statewide sample, and identified associations between TDA and high-risk behaviors and academic adjustment. Based on a review of literature, TDA included physical harm, threats to harm, verbal aggression, forced sexual contact, coercion to use alcohol or drugs, and harassment after the relationship ended. The sample consisted of 32,428 students (Grades 9-12) in 320 Virginia high schools who completed a statewide school climate survey. Participation rates were 99% for schools and 80.5% for students. Confirmatory factor analysis and hierarchical regression analyses investigated the associations between TDA and high-risk behaviors and poor academic adjustment. School fixed-effects analyses accounted for school-level influences in student responses. Nearly four in 10 students (39%) reported experiencing at least one form of dating aggression in the past year. The 12,596 students who experienced TDA (40%) in the past year reported more marijuana use (26% vs. 13%), alcohol use (40% vs. 22%), fighting (13% vs. 5%), suicidal ideation (31% vs. 13%), and suicide attempts (17% vs. 5%), as well as lower school engagement, educational aspirations, and grades than 19,832 students who dated without TDA. The current study emphasized the need for dating aggression to be a focus of secondary school prevention programs due its associations with poorer academic performance, high-risk behavior with potentially serious mental health consequences. Accurate assessment of TDA can also guide the evaluation of intervention programs that target TDA.

Utilization of skilled birth attendant at birth and associated factors among women who gave birth in the last 24 months preceding the survey in Gura Dhamole Woreda, Bale zone, southeast Ethiopia

BACKGROUND

Maternal morbidity and mortality continued to be major issues in many countries. Globally a total of 10.7 million women have died between 1990 and 2015 due to maternal causes where sub-Saharan Africa alone accounts for 66% of maternal death. Since most maternal deaths are avoidable; skilled attendance during pregnancy, childbirth, and the postpartum is among the most critical interventions for improving maternal and neonatal survival. The study aimed to assess the magnitude and associated factors of utilization of skilled birth attendant at birth among women who gave birth in the last 24 months preceding the study in Gura Dhamole Woreda, Bale Zone Southeast Ethiopia, 2017.

METHODS

Community based cross-sectional study was implemented from March 25 to April 24, 2017 in Gura Dhamole Woreda on total of 402 study subjects who were selected by Multi-stage sampling technique. The data were collected using pre-tested structured questionnaire and data was coded, entered, cleaned and analyzed using Statistical Package for Social Service (SPSS) Version 20. Odds ratio with 95% Confidence Interval (CI) was used to assess associations the dependent and independent variables. Logistic regression model was employed to identify independent predictors and variables were declared statistically significant at P value < 0.05.

RESULT

In this study only 29.2% of women were assisted by Skilled Birth Attendance (SBA) during their child birth. Place of residence, mother education, travel time, joint decision on the place of delivery, ANC visit frequency, birth preparedness and complication readiness status, knowledge on obstetric danger signs after delivery and knowledge of presence of maternity waiting homes were significantly associated with SBA utilization.

CONCLUSION

Skilled birth attendant utilization in the study area was low. Strategies that improve attendance of antenatal care utilization and attention to birth preparedness and complication readiness and counseling on danger signs are recommended.

Tobacco and Alcohol Use Among Youth in Low and Middle Income Countries: A Multi-Country Analysis on the Influence of Structural and Micro-Level Factors

BACKGROUND

The transition from adolescence to adulthood is a critical life phase as it is during this period that substance use and disorders typically emerge and escalate. Globally, few studies have examined the prevalence and correlates of alcohol and tobacco use among youth (ages 15-24). This study seeks to bridge this gap by assessing the influence of structural and micro-level factors on tobacco and alcohol use among youth in Low- and Middle-income countries (LMICs).

METHODS

Data are drawn from the Multiple Indicator Cluster Surveys (MICS) conducted in 29 countries or regions in Eastern Europe, Latin America, Asia and Africa between 2010 and 2015. Analyses focus on lifetime prevalence and age of onset for tobacco and alcohol use.

RESULTS

Descriptive analyses highlight regional variations in the prevalence and age of onset of tobacco and alcohol use: tobacco use is more concentrated among youth in Eastern Europe but alcohol use is generalized across the regions. Using multi-level analyses, we find statistically significant main effects for age, gender, educational attainment, rural residence, marital status and exposure to mass media on tobacco and alcohol use outcomes as well as interaction effects for age, gender and education on tobacco and alcohol use outcomes. Conclusions/importance: These findings highlight the need for structural interventions to control tobacco social marketing, and for gender considerations in tobacco and alcohol use prevention programs and policies.

Alcohol use in a rural district in Uganda: findings from community-based and facility-based cross-sectional studies

Background

Uganda has one of the highest per capita alcohol consumption rates in sub-Saharan Africa. However, the prevalence of alcohol use disorders (AUD) remains unknown in many areas, especially in rural districts. This study aimed to estimate the prevalence of alcohol consumption and of alcohol use disorder among men, and to describe the distribution of drinking intensity, among men in in Kamuli District, Uganda.

Methods

Men attending primary care clinics in Kamuli District were consecutively interviewed in a facility-based cross-sectional study, and a separate group of men were interviewed in a population-based cross-sectional study. In both studies the men were administered a structured questionnaire, which included the alcohol use disorder identification test (AUDIT) to screen for AUD, as well as sections about demographic characteristics, depression screening, internalized stigma for alcohol problems and treatment-seeking.

Results

Among the 351 men enrolled in the Community study, 21.8% consumed alcohol in the past 12 months, compared to 39.6% of 778 men in the Facility Survey. The proportion of men who screened positive for AUD was 4.1% in the community study and 5.8% in the facility study. AUDIT scores were higher among older men, men with paid/self-employment status and higher PHQ-9 score (P < 0.05). Nearly half (47.5%) of the men with AUDIT-positive scores reported that alcohol use problems had ruined their lives. A majority (55.0%) of men with AUDIT-positive scores did not seek treatment because they did not think AUD was a problem that could be treated.

Conclusions

Internalized stigma beliefs among AUDIT-positive men impede treatment-seeking. As part of any efforts to increase detection and treatment services for alcohol use problems, routine screening and brief interventions for internalized stigma must be incorporated within the normal clinical routine of primary health care.

Electronic supplementary material

The online version of this article (10.1186/s13033-018-0191-5) contains supplementary material, which is available to authorized users.

Sexual violence against female university students in Ethiopia

Background

Though many women are suffering the consequences of sexual violence, only few victims speak out as it is sensitive and prone to stigma. This lack of data made it difficult to get full picture of the problem and design proper interventions. Thus, the aim of this study was to assess the prevalence and factors associated with sexual violence among female students of Wolaita Sodo University, south Ethiopia.

Methods

Institution based cross-sectional study was conducted among 462 regular female Wolaita Sodo University students on April 7/2015. Participants were selected by simple random sampling. Data were collected by self-administered questionnaire. Data entry and analysis was done by EPI info and SPSS statistical packages respectively. Descriptive statistics were done. Moreover, bivariate and multivariate analyses were also carried out to identify predictors of sexual violence.

Result

The age of respondents ranged from 18 to 26 years. Lifetime sexual violence was found to be 45.4%. However, 36.1% and 24.4% of respondents reported experiencing sexual violence since entering university and in the current academic year respectively. Life time sexual violence was positively associated with witnessing inter-parental violence as a child, rural childhood residence, having regular boyfriend, alcohol consumption and having friends who drink regularly; while it was negatively associated with discussing sexual issues with parents.

Conclusion

Sexual violence is a common phenomenon among the students. More detailed research has to be conducted to develop prevention and intervention strategies.

Electronic supplementary material

The online version of this article (doi:10.1186/s12914-017-0127-1) contains supplementary material, which is available to authorized users.

Alcohol use among adults in Uganda: findings from the countrywide non-communicable diseases risk factor cross-sectional survey

Background

There are limited data on levels of alcohol use in most sub-Saharan African countries.

Objective

We analyzed data from Uganda's non-communicable diseases risk factor survey conducted in 2014, to identify alcohol use prevalence and associated factors.

Design

The survey used the World Health Organization STEPS tool to collect data, including the history of alcohol use. Alcohol users were categorized into low-, medium-, and high-end users. Participants were also classified as having an alcohol-use-related disorder if, over the past 12 months, they were unable to stop drinking alcohol once they had started drinking, and/or failed to do what was normally expected of them because of drinking alcohol, and/or needed an alcoholic drink first in the morning to get going after a heavy drinking session the night before. Weighted logistic regression analysis was used to identify factors associated with medium- to high-end alcohol use.

Results

Of the 3,956 participants, 1,062 (26.8%) were current alcohol users, including 314 (7.9%) low-end, 246 (6.2%) medium-end, and 502 (12.7%) high-end users. A total of 386 (9.8%) were classified as having an alcohol-use-related disorder. Male participants were more likely to be medium- to high-end alcohol users compared to females; adjusted odds ratio (AOR)=2.34 [95% confidence interval (CI)=1.88–2.91]. Compared to residents in eastern Uganda, participants in central and western Uganda were more likely to be medium- to high-end users; AOR=1.47 (95% CI=1.01–2.12) and AOR=1.89 (95% CI=1.31–2.72), respectively. Participants aged 30–49 years and those aged 50–69 years were more likely to be medium- to high-end alcohol users, compared to those aged 18–29 years, AOR=1.49 (95% CI=1.16–1.91) and AOR=2.08 (95% CI=1.52–2.84), respectively.

Conclusions

The level of alcohol use among adults in Uganda is high, and 9.8% of the adult population has an alcohol-use-related disorder.