Co-occurrence of risk factors for non-communicable diseases among in-school adolescents in Tanzania: an example of a low-income setting of sub-Saharan Africa for adolescence health policy actions

Co-occurrence of and factors associated with health risk behaviors among adolescents: a multi-center study in sub-Saharan Africa, China, and India

Background

Despite lifelong and detrimental effects, the co-occurrence of health risk behaviors (HRBs) during adolescence remains understudied in low- and middle-income countries. This study examines the co-occurrence of HRBs and its correlates among adolescents in sub-Saharan Africa, China, and India.

Methods

A multi-country cross-sectional study was conducted in 2021-2022, involving 9697 adolescents (aged 10-19 years) from eight countries, namely Burkina Faso, China, Ethiopia, India, Ghana, Nigeria, Tanzania, and Uganda. A standardized questionnaire was administered to examine five types of HRBs - physical inactivity, poor dietary habits, smoking, alcohol consumption, and risky sexual behavior. Latent class analysis was employed to identify clustering patterns among the behaviors, and logistic regression was used to identify the correlates of these patterns.

Findings

Three clusters of HRBs were identified, with Cluster 1 (27.73%) characterized by the absence of any specific risky behavior, Cluster 2 (68.16%) characterized by co-occurrence of physical inactivity and poor dietary habits, and Cluster 3 (4.11%) characterized by engagement in smoking, alcohol consumption, and risky sexual behavior. Relative to Cluster 1, being in Cluster 2 was associated with being female (aOR 1.20, 95% CI 1.09-1.32), not enrolled in education (aOR 0.84, 95% CI 0.71-0.99), and not engaged in paid work (aOR 1.23, 95% CI 1.08-1.41). Compared with those Cluster 1, adolescents in Cluster 3 were less likely to be female (aOR 0.41, 95% CI 0.32-0.54), be engaged in paid work (aOR 0.54, 95% CI 0.41-0.71), more likely to be older (aOR 7.56, 95% CI 5.18-11.03), not be enrolled in educational institution (aOR 1.74, 95% CI 1.27-2.38), and more likely to live with guardians other than parents (aOR 1.56, 95% CI 1.19-2.05).

Interpretation

The significant clustering patterns of HRBs among adolescents in sub-Saharan Africa, China, and India highlights the urgent need for convergent approaches to improve adolescent health behaviors. Early life and school-based programs aimed at promoting healthy behaviors and preventing risky and unhealthy behaviors should be prioritized to equip adolescents with the tools and skills for lifelong well-being.

Funding

Fondation Botnar (Grant #INV-037672) and Harvard T.H. Chan School of Public Health, partially funded this study.

Co-occurrence of non-communicable disease risk factors among adolescents in Jos, Nigeria

BACKGROUND

The co-occurrence and clustering of risk factors for non-communicable disease (NCD) is a global public health concern.

AIM

This study aimed to assess the co-occurrence and clustering of risk factors for NCDs among in-school and out-of-school adolescents in Jos North Local Government Area, Plateau State, Nigeria.

SETTING

Secondary schools and markets in Jos North Local Government Area.

METHODS

A comparative cross-sectional study was conducted among 377 in-school and 377 out-of-school adolescents, aged 10-19 years of age. An interviewer-administered questionnaire was used to collect information on behavioural and physical risk factors for NCDs. Chi-square and Mann-Whitney U tests were used for comparisons at a 5% level of significance. Statistical analysis was carried out using Statistical Product and Service Solutions (SPSS) version 23.0.

RESULTS

Of the 754 sampled adolescents, 386 (51.2%) were females and 368 (48.8%) were males. Adolescents aged 10-14 years made up 37.8% of the participants, 15 to 17 years of age accounted for 46.9% and 18-19 years 15.3%. Risk factors with the highest prevalence were a sedentary lifestyle (94.2%) and an unhealthy diet (92.4%). Majority (97.2%) had two or more risk factors while 1.9% of adolescents had no risk factor. More in-school adolescents (24.1%) had two risk factors compared to 14.1% of out-of-school adolescents (p 0.001); 14.1% of out-of-school adolescents had five or more risk factors compared to 2.9% of those in school (p 0.001).

CONCLUSION

Co-occurrence and clustering of behavioural and physical risk factors was found among both in-school and out-of-school adolescents.Contribution: This study highlighted the burden of risk factors for NCDs among both in-school and out-of-school adolescents in the North-Central part of Nigeria. This is especially useful in developing targeted interventions to tackle these risk factors.

Prevalence of suicide attempts across the African continent: A systematic review and meta-analysis

BACKGROUND

Over 700,000 people worldwide lose their lives through suicide every year. The prevalence of suicide has increased, especially in low- and middle-income countries such as many African countries. For every fatal suicidal attempt, there are approximately 20 other non-fatal suicide attempts within the population. The purpose of this study is to investigate the prevalence of attempts of suicides in the African continent through a systematic review and meta-analysis.

METHODS

To identify relevant sources, the PubMed, Scopus, Web of Science, Embase, ScienceDirect and Google Scholar repositories and databases were systematically searched without a lower time limit and until July 2023. The heterogeneity of the studies was checked with the I2 index, and accordingly random effects model was adopted to perform the analysis. Data analysis was conducted within the Comprehensive Meta-Analysis software (v.2).

RESULTS

In the review of 48 studies with a sample size of 244,701 people, the prevalence of suicide attempts in Africa was found to be 9.9% (95%CI: 8.5%-11.6%). With the increase in the year of study, the prevalence of suicide attempt in the African continent increases. Also, with the increase in the sample size, the prevalence of suicide attempts in Africa decreases. The suicide attempt prevalence among African men and woman slightly differed with 7.6% and 8.2%, respectively.

CONCLUSION

Suicide attempt is an important public health concern in Africa. The findings of this study are important not only for African health policy making, but also to contribute to the accuracy of global estimates with respect to suicide attempts.

Measuring alcohol use among adolescents in Africa: A systematic scoping review of consumption, screening and assessment tools

ISSUES

Globally, adolescent drinking is a major public health concern. Alcohol measurements are influenced by local consumption practices, patterns and perceptions of alcohol-related harm. This is the first review to examine what tools are used to measure alcohol consumption, or screen for or assess harmful use in African adolescents, and how these tools take into account the local context.

APPROACH

A systematic scoping review was conducted in line with the Arksey and O'Malley framework. A search in MEDLINE, CINAHL, Global Health and the Cochrane Database covered the period of 2000-2020.

KEY FINDINGS

The search identified 121 papers across 25 African countries. A range of single- and multi-item tools were identified. Very few adaptations of existing questions were specified, and this search identified no tools developed by local researchers that were fundamentally different from established tools often designed in the USA or Europe. Inconsistencies were found in the use of cut-off scores; many studies used adult cut-off scores.

IMPLICATIONS AND CONCLUSION

The possible impact of African drinking practices and culture on the accuracy of alcohol screening tools is currently unknown, but is also not taken into account by most research. This, in combination with a limited geographical distribution of alcohol-related research across the continent and inconsistent use of age- and gender-specific cut-off scores, points towards probable inaccuracies in current data on adolescent alcohol use in Africa.

Influence of Personal Factors on Health-Promoting Behavior in College Students: A Structural Equation Modeling Approach

Purpose

This study aimed to determine how personal factors influence health-promoting behavior in university students using a structural equation modeling approach guided by the Health Promotion Model.

Patients and Methods

An analytical cross-sectional study was conducted. The study included 763 health science students from four universities in Cali, Colombia, who answered a questionnaire on personal factors and Health Promoting Lifestyle Profile II, Spanish version, which was validated in the study population. The direct and indirect relationships between personal factors and health-promoting behaviors were assessed using structural equation modeling. Data analysis was performed using descriptive statistics and structural equation modeling.

Results

A significant relationship was noted between the biological and psychological personal factors of the measurement model (p < 0.05). Psychological personal factors (self-esteem and perceived health status) positively influence health promoting behavior in university students (Hypothesis 2). It's not possible to demonstrate that health promoting behavior is positively influenced by personal biological factors (Hypothesis 1) and by personal sociocultural factors (Hypothesis 3).

Conclusion

There is a need for interventions that help improve the health-promoting lifestyle profile and are focused on enhancing the self-esteem and perceived health status of university students.

Prevalence of multiple non-communicable diseases risk factors among adolescents in 140 countries: A population-based study

BACKGROUND

Modifiable non-communicable disease (NCD) risk factors are becoming increasingly common among adolescents, with clustering of these risk factors in individuals of particular concern. The aim of this study was to assess global status of clustering of common modifiable NCD risk factors among adolescents.

METHODS

We used latest available data from nationally representative survey for 140 countries, namely the Global School-based Student Health Survey, the Health Behaviour in School-Aged Children and the longitudinal study of Australian Children. Weighted mean estimates of prevalence with corresponding 95% confidence intervals of nine NCD risk factors - physical inactivity, sedentary behaviour, insufficient fruits and vegetable consumption, carbonated soft drink consumption, fast food consumption, tobacco use, alcohol consumption and overweight/obesity - were calculated by country, region and sex.

FINDINGS

Over 487,565 adolescents, aged 11-17 years, were included in this study. According to trend analysis, prevalence of four or more NCD risk factors increased gradually over time. Prevalence of four or more NCD risk factors was 14.8% in 2003-2007 and increased to 44% in 2013-2017, an approximately three-fold increase (44.0%). Similar trends were also observed for three and two risk factors. Large variation between countries in the prevalence of adolescents with four or more risk factors was found in all regions. The country level range was higher in the South-East Asia Region (minimum Sri Lanka = 8%, maximum Myanmar = 84%) than Western Pacific Region (minimum China = 3%, maximum Niue = 72%), European Region (minimum Sweden = 13.9%, maximum Ireland = 66.0%), African Region (minimum Senegal = 0.8%, maximum Uganda = 82.1%) and Eastern Mediterranean Region (minimum Libya = 0.2%, maximum Lebanon = 80.2%). Insufficient vegetable consumption, insufficient fruit consumption and physically inactivity were three of the four most prevalent risk factors in all regions.

INTERPRETATION

Our results suggest a high prevalence of four or more NCD risk factors in adolescents globally, although variation was found between countries. Results from our study indicate that efforts to reduce adolescent NCD risk factors and the associated health burden need to be improved. These findings can assist policy makers to target the rollout of country- specific interventions.

FUNDING

None.

Co-occurrence of non-communicable disease risk factors and its determinants among school-going adolescents of Kathmandu Metropolitan City

Background

Adolescence is a critical transition in human growth and adolescents tend to engage in various risky behaviors which are likely to continue into adulthood. Co-occurrence of non-communicable disease risk factors has the potential to increase risks of chronic disease comorbidity and increased mortality in later life. Behavioral risk factors are adopted due to changes in lifestyle and adolescents are more prone to acquire them. This study aimed to determine the prevalence and associated factors of co-occurrence of non-communicable disease risk factors among school-going adolescents of Kathmandu Metropolitan City.

Methods

We conducted a cross-sectional study among school-going adolescents of Kathmandu Metropolitan City in January/February 2020. We used stratified random sampling to select 1108 adolescents studying in 9, 10, 11, and 12 grades. We used Global Schools Health Survey tools to collect data. We entered data in EpiData 3.1 and exported it into Statistical Package for Social Science (SPSS) version 20 for statistical analysis. We estimated prevalence of NCDs risk factors and co-occurrence of risk factors. We applied multivariate multinomial logistic regression analysis adjusting for age, gender, ethnicity, religion, education, type of school, and parental education to determine factors associated with co-occurrence of NCDs risk factors.

Results

The prevalence of physical inactivity, unhealthy diet, harmful use of alcohol and tobacco among school-going adolescents were 72.3% (95%CI: 69.6–74.9), 41.1% (95%CI: 38.2–44.0), 14.8% (95%CI: 12.8–17.0) and 7.8% (95%CI:6.3–9.5) respectively. The adolescent with co-occurrence of two or more risk factors was 40.7% (95%CI: 37.8–43.7). The school-going adolescents who were in higher age group (AOR = 1.72, 95% CI- 1.06, 2.77), Hindus (AOR = 1.78, 95% CI-1.09, 2.89), other than Brahmin/Chhetri by ethnicity (AOR = 2.11, 95% CI-1.39, 2.22) and with lower education level of mothers (AOR = 2.40, 95% CI- 1.46,3.98) were more likely to have co-occurrence of NCDs risk factors after adjusting for all socio-demographic variables.

Conclusion

The co-occurrence of non-communicable disease risk factors was high among school going adolescents and was associated with age, religion, ethnicity and mother’s education. Integrated and comprehensive interventional programs should be developed by concerned authorities.

Clustering Lifestyle Risk Behaviors among Vietnamese Adolescents and Roles of School: A Bayesian Multilevel Analysis of Global School-Based Student Health Survey 2019

Background

Adolescence is a vulnerable period for many lifestyle risk behaviors. In this study, we aimed to 1) examine a clustering pattern of lifestyle risk behaviors; 2) investigate roles of the school health promotion programs on this pattern among adolescents in Vietnam.

Methods

We analyzed data of 7,541 adolescents aged 13–17 years from the 2019 nationally representative Global School-based Student Health Survey, conducted in 20 provinces and cities in Vietnam. We applied the latent class analysis to identify groups of clustering and used Bayesian 2-level logistic regressions to evaluate the correlation of school health promotion programs on these clusters. We reassessed the school effect size by incorporating different informative priors to the Bayesian models.

Findings

The most frequent lifestyle risk behavior among Vietnamese adolescents was physical inactivity, followed by unhealthy diet, and sedentary behavior. Most of students had a cluster of at least two risk factors and nearly a half with at least three risk factors. Latent class analysis detected 23% males and 18% females being at higher risk of lifestyle behaviors. Consistent through different priors, high quality of health promotion programs associated with lower the odds of lifestyle risk behaviors (highest quality schools vs. lowest quality schools; males: Odds ratio (OR) = 0·67, 95% Highest Density Interval (HDI): 0·46 – 0·93; females: OR = 0·69, 95% HDI: 0·47 – 0·98).

Interpretation

Our findings demonstrated the clustering of specific lifestyle risk behaviors among Vietnamese in-school adolescents. School-based interventions separated for males and females might reduce multiple health risk behaviors in adolescence.

Funding

The 2019 Global School-based Student Health Survey was conducted with financial support from the World Health Organization. The authors received no funding for the data analysis, data interpretation, manuscript writing, authorship, and/or publication of this article.

Clustering of Lifestyle Risk Factors among Algerian Adolescents: Comparison between Urban and Rural Areas: GSHS Data

Objective: Compare the clustering of LBRs between urban and rural Algerian adolescents. Design: Data of this cross-sectional study was derived from the Global School-based Health Survey (GSHS). A self-administered, anonymous questionnaire was filled out by 4532 adolescents (11–16 years), which addressed LBRs of NCDs. Life style behavioral risk factors (LBRs) clustering was measured by the ratios of observed (O) and expected (E) prevalence of one or more simultaneously occurring LBRs for urban and rural areas separately. Multivariate logistic regression was performed to examine the association of LBRs as dependent variable with demographic variables (location, age, gender). Results: The most common LBR was physical inactivity (84.6%: 50.9% for urban and 49.1% for rural). Adolescents in urban areas had a higher prevalence of two (56.8% vs. 43.2%) and three and more (61.3% vs. 38.7%) LBRs than in rural areas. In urban areas, a significant positive association was found between (low fruit and vegetable consumption + physical inactivity) [2.06 (1.61–2.64)] and (high SB + smoking) [2.10 (1.54–2.76)], while (physical inactivity + high SB) [0.70 (0.54–0.91)] showed a significant negative association. In rural areas, (high SB + overweight/obesity) [1.49 (1.09–2.04)] had a significant positive association. While, (low fruit and vegetable consumption + high SB) [0.75 (0.60–0.94)], (physical inactivity + high SB) [0.65 (0.49–0.86)], and (physical inactivity + smoking) [0.70 (0.49–0.99)] had a negative association. Conclusions: Several socio-demographic factors have been identified to play a role in LBRs clustering among Algerian adolescents. Results of the study suggest the development of intervention aiming to tackle different LBRs rather than focusing on a single LBR.

Subcutaneous Adipose Tissue Measured by B-Mode Ultrasound to Assess and Monitor Obesity and Cardio-Metabolic Risk in Children and Adolescents

Simple Summary

The prevention and treatment of childhood and adolescent overweight and obesity raises the need for accurate body fat assessment. Precise methods are at high technical expense, require exposure to ionizing radiation and are limited to institutional investigations, while common body indicators fail to identify excess body fat. Subcutaneous adipose tissue measured by ultrasound is an alternative approach, which was evaluated in relation to commonly applied body indicators to assess cardio–metabolic risk and its applicability in the field. Subcutaneous adipose tissue measured by ultrasound indicated a clear advantage over commonly applied body indicators and implies that severe body fat assessment errors are to be expected when BMI is used as a measure for body fatness in children. Children or adolescents with identical BMIs may have large differences (>200%) in their amount of subcutaneous adipose tissue. Ultrasound provides an easily applicable, reliable and safe method for accurate assessment of obesity and monitoring treatment responses in children and adolescents at cardio–metabolic risk.

Abstract

Monitoring of children at heightened risk of cardio–metabolic diseases raises the need for accurate assessment of obesity. A standardized approach for measuring subcutaneous adipose tissue (SAT) by bright-mode ultrasound was evaluated in relation to body indices and anthropometry in a cross-sectional sample of 76 South African children (7–10 years) and 86 adolescents (13–17 years) to assess cardio–metabolic risk. SAT was higher in girls as compared to boys (children: 50.0 ± 21.7 mm > 34.42 ± 15.8 mm, adolescents: 140.9 ± 59.4 mm > 79.5 ± 75.6 mm, p < 0.001) and up to four times higher in adolescents than in children. In children, measures of relative body weight showed only a poor correlation to SAT (BMI: r = 0.607, p < 0.001), while in adolescents, BMI correlated high with SAT (r = 0.906, p < 0.001) based on high rates of overweight and obesity (41.8%). Children with identical BMIs may have large differences (>2–3-fold) in their amount of SAT. The moderate association to systolic (r = 0.534, r = 0.550, p < 0.001) and diastolic blood pressure (r = 0.402, r = 0.262, p < 0.001) further substantiates that SAT measured by ultrasound provides an accurate, safe and easy applicable approach for monitoring in children and adolescents at cardio–metabolic risk.

Cardiometabolic risk factors and early indicators of vascular dysfunction: a cross-sectional cohort study in South African adolescents

OBJECTIVES

Prevalence of child and adolescents' overweight and obesity in low- and middle-income countries has increased dramatically. Simultaneously, the incidence of pre-hypertension/hypertension is also increasing in children, which, in turn, predisposes these children to the risk of cardiovascular disease (CVD) in later life. The present study assessed cardiometabolic risk factors and early indicators of vascular dysfunction in adolescents from a low socio-economic rural area in South Africa.

DESIGN

Cross-sectional cohort study.

SETTING

The study was conducted in public schools in Mthatha, OR Tambo district municipality, Eastern Cape Province, South Africa.

PARTICIPANTS

A total of 244 adolescents (188 females) of African ancestry aged 13-16 years were enrolled.

PRIMARY AND SECONDARY OUTCOME MEASURES

Anthropometric and haemodynamic measures and pulse wave velocity (PWV) were related to overweight/obesity and hypertension. Blood markers of cardiometabolic syndrome were assessed as well as vascular function (via PWV).

RESULTS

One-third (33.0%) of the adolescents exceeded the age and sex-specific body mass index percentiles for overweight (≥85th) or obesity (>95th) with a prevalence of 61.1% pre-hypertensives in this group. Overweight/obesity and hypertension were associated with higher triglycerides (lean:overweight: 0.79<1.01 mmol/L; normotensive:hypertensive: 0.82<0.89 mmol/L). Fasting glucose was higher in hypertensive as compared to normotensive adolescents (4.85>4.69 mmol/L, p<0.05). PWV was elevated in 25.9% of the children and significantly correlated with asymmetric dimethylarginine and systolic blood pressure (p<0.001).

CONCLUSION

Overweight/obesity and hypertension show a high prevalence in rural South African youth. Almost half of the studied adolescents are at risk for developing CVD. The high association between cardiometabolic risk factors and PWV further suggests that hypertension in adolescents may promote the progression of CVD in adulthood. Early detection of those at risk and the implementation of preventive strategies in underprivileged young people is urgently needed to stop the progression of vascular damage and manifestation of CVD in rural African children.

Impact of a behaviourally focused nutrition education intervention on attitudes and practices related to eating habits and activity levels in Indian adolescents

OBJECTIVE

To evaluate the effectiveness of a behaviourally focused nutrition education (NE) intervention based on the Health Belief Model (HBM) to improve knowledge, attitudes and practices (KAP) related to eating habits and activity levels in 10–12-year-old adolescents in Mumbai, India.

DESIGN

School-based cluster randomised controlled trial. The experimental group (EG) received weekly NE and three parent sessions over 12 weeks; no sessions were conducted for the control group (CG). The theoretical framework of HBM and focus group discussion results guided the development of behaviour change communication strategies and NE aids. KAP were measured using a validated survey instrument, administered at baseline and endline in EG and CG. Paired and independent t tests determined within-group and between-group changes in pre–post scores.

SETTING

Two aided and two private schools that were randomly allocated to either an EG or CG.

PARTICIPANTS

Adolescent boys and girls (n 498; EG n 292 and CG n 206).

RESULTS

EG reported improvements in mean knowledge (39·3%), attitude (7·3 %), diet (9·6 %) and activity practice (9·4%) scores from pre to post intervention. No significant changes were observed in CG. Significant improvements in scores associated with perceived benefits, barriers and self-efficacy, breakfast and vegetable consumption, and moderate-to-vigorous activities were observed in EG.

CONCLUSIONS

Integrating NE into the academic curriculum and adopting evidence-based lessons that entail targeted information delivery and participatory activities can improve knowledge, foster right attitudes and facilitate better eating and activity-related practices in Indian adolescents.

Opportunities and challenges for delivering non-communicable disease management and services in fragile and post-conflict settings: perceptions of policy-makers and health providers in Sierra Leone

BACKGROUND

The growing burden of non-communicable diseases in low- and middle-income countries presents substantive challenges for health systems. This is also the case in fragile, post-conflict and post-Ebola Sierra Leone, where NCDs represent an increasingly significant disease burden (around 30% of adult men and women have raised blood pressure). To date, documentation of health system challenges and opportunities for NCD prevention and control is limited in such settings. This paper aims to identify opportunities and challenges in provision of NCD prevention and care and highlight lessons for Sierra Leone and other fragile states in the battle against the growing NCD epidemic.

METHODS

This paper focuses on the case of Sierra Leone and uses a combination of participatory group model building at national and district level, in rural and urban districts, interviews with 28 key informants and review of secondary data and documents. Data is analysed using the WHO's health system assessment guide for NCDs.

RESULTS

We highlight multiple challenges typical to those encountered in other fragile settings to the delivery of preventive and curative NCD services. There is limited government and donor commitment to financing and implementation of the national NCD policy and strategy, limited and poorly distributed health workforce and pharmaceuticals, high financial barriers for users, and lack of access to quality-assured medicines with consequent high recourse to private and informal care seeking. We identify how to strengthen the system within existing (low) resources, including through improved clinical guides and tools, more effective engagement with communities, and regulatory and fiscal measures.

CONCLUSION

Our study suggests that NCD prevention and control is of low but increasing priority in Sierra Leone; challenges to addressing this burden relate to huge numbers with NCDs (especially hypertension) requiring care, overall resource constraints and wider systemic issues, including poorly supported primary care services and access barriers. In addition to securing and strengthening political will and commitment and directing more resources and attention towards this area, there is a need for in-depth exploratory and implementation research to shape and test NCD interventions in fragile and post-conflict settings.

Does bullying predict suicidal behaviors among in-school adolescents? A cross-sectional finding from Tanzania as an example of a low-income country

BACKGROUND

Bullying and suicidal behaviors are a silent public health problem among adolescents. Little is known about the link between bullying and suicidal behaviors in low-income countries such as Tanzania. In the current study, we estimated the prevalence of being bullied and determined its association with suicidal behaviors among in-school adolescents.

METHODS

We performed a secondary analysis of the Tanzania Global School-based Student Health Survey (GSHS) conducted in 2014. This was the first nationally representative survey conducted to a sample of 3793 in-school adolescents. The primary independent variable was being bullied, while the outcome variables of interest were suicide ideation and suicide attempt. We used a chi-square χ2 test for group variables comparisons and multivariate logistic regression for statistical associations between independent and outcome variables. In our analysis, a p < 0.05 was considered statistically significant at 95% confidence intervals.

RESULTS

The prevalence of being bullied among 3793 surveyed in-school adolescents was 27.0%. In an adjusted multivariate regression model, being bullied was independently associated with suicidal ideation and suicide attempt: [AOR; 1.9, 95% C.I; 1.5-2.4], and [AOR; 3.6, 95% C.I; 2.9-4.5] respectively, p < 0.001.

CONCLUSIONS

Bullying is prevalent and possibly a potential predictor of suicidal behaviors among in-school adolescents in Tanzania. There is a need for all educational stakeholders: teachers, parents, students, mental health professionals, and policymakers to design a program for mitigating the problem of bullying in schools.

Prevalence and correlates of sexual intercourse among sexually active in-school adolescents: an analysis of five sub-Sahara African countries for the adolescent's sexual health policy implications

BACKGROUND

Early and unprotected sex with multiple partners among adolescents carries a high risk of acquiring HIV infections, other sexually transmitted infections as well as high rates of teenage pregnancy. Sub-Saharan Africa (SSA) has a higher burden of HIV/AIDS: the leading cause of deaths among adolescents. We estimated the prevalence and examined the correlates of sexual intercourse among in-school adolescents of SSA. The purpose is to inform the public health programs dedicated to tackling the burden of HIV/AIDS.

METHODS

We did a secondary analysis of the Global School-based Student Health Surveys (GSHS) datasets pooled from five SSA countries Benin, Mozambique, Namibia, Seychelles, and Tanzania. Our current analysis included a sample of 15,318 in-school adolescents. The primary independent variables were ever had sexual intercourse and sex with multiple partners, while the dependent variables were smoking cigarettes, alcohol use, use of marijuana and amphetamine, and parental connectedness. We performed descriptive statistics, and multivariate logistic regression stratified by gender using SPSS Complex Sample Statistics. A p-value of less than 0.05 was considered statistically significant at 95% confidence intervals.

RESULTS

Out of 15,318 participants, the overall prevalence of ever had sexual intercourse and sex with multiple partners were 43·5% (6670) and 20·9% (3204), respectively. In overall and across each country, male adolescents had a significantly higher proportion of sex with multiple partners than female adolescents, p < 0·001. The predictors of sexual intercourse with multiple partners in both male and females were smoking cigarettes, alcohol use, and use of marijuana and amphetamine. Female adolescents who smoked cigarettes and used marijuana had a significant likelihood of sex with multiple partners than male adolescents: [aOR 3.6, 95% CI: 2.6-5.1] vs [aOR 2.1, 95% CI: 1.7-2.7] and [aOR 2.4, 95% CI: 1.6-3.7] vs [aOR 1.9, 95% CI: 1·3-2·7], respectively.

CONCLUSIONS

Adolescents sexual intercourse and more especially sex with multiple partners was prevalent and strongly correlated with substance use. However, the correlation was higher among female adolescents than male adolescents. A customized public health intervention that targets multiple risk factors concurrently may benefit adolescents with clustering of sexual and non-sexual risk-taking behaviors.