Sexual risk behaviour among school-going adolescents in Sierra Leone and Liberia: a secondary analysis of the 2017 Global school-based student health surveys

Abstract

Background Sierra Leone and Liberia have experienced civil wars and, recently, Ebola outbreaks that led to profound economic hardship, psychopathologies and family disruptions. These factors are associated with sexual risk behaviours among youths. However, there is very little information on sexual risk behaviour among Sierra Leonean and Liberian school-going adolescents. The present study assessed the prevalence and determinants of sexual risk behaviours among school-going adolescents (10–19 years) in Sierra Leone and Liberia. Method We used publicly available nationally representative cross-sectional datasets of the 2017 Sierra Leone and Liberia Global school health survey. The sample consisted of 2798 and 2744 school-going adolescents from Sierra Leone and Liberia, respectively. Complex sample descriptive and regression analysis was used to analyse our data. Results The majority of adolescents in the two countries were involved in multiple sexual risk behaviour (80.2%), with a higher prevalence observed in Sierra Leone (85.2%) than in Liberia (75.3%). Liberian adolescents showed lesser odds of indulging in multiple sexual risk behaviours than their Sierra Leonean counterparts (AOR = 0.572; 95%CI: 0.345–0.946). Male, compared to females, were more likely to engage in multiple sexual risk behaviour (AOR = 2.310;95%CI:1.543–3.458), with a similar pattern observed in both countries. Alcohol use was associated with multiple sexual risk behaviour (AOR = 3.064; 95%CI: 2.137–4.392). Also, in Sierra Leone and Liberia, adolescents with one and two or more forms of psychological distress were more likely to have ever had sex than those who did not show any form of psychological distress. Missing class/school was associated with multiple sexual risk behaviour (AOR = 1.655; 95%CI:1.133–2.418). Peer support was only found to be a protective factor against no condom use among Liberian adolescents (AOR = 0.608; 95%CI: 0.435–0.850). Less parental support was only associated with ever had sex among adolescents in Sierra Leone (AOR = 2.027; 95%CI: 1.322–3.107) but not in Liberia (AOR = 1.034; 95%CI: 0.650–1.644). Conclusion Our study found a high sexual risk behaviour among school-going adolescents in Sierra Leone and Liberia. Our finding highlights the need to strengthen sexual and reproductive health education in schools and communities that incorporate mental health promotion activities tailored to this group.

Alcohol use among in-school adolescents in Sierra Leone

“…Males may experience social pressure to conform, make a favourable impression on others or cope with stress by consuming alcohol. On the other hand, females may encounter increased social shame, discrimination or violence if they consume alcohol, particularly in conservative or religious groups 46. Males may have a higher likelihood of associating with those individuals who consume alcohol or being exposed to alcohol in their social environments.…”

“…Males may have a higher likelihood of associating with those individuals who consume alcohol or being exposed to alcohol in their social environments. They may also have easier access to alcohol, whether obtained legally or illegally, compared with females 46. Additionally, males may be more susceptible to psychological distress and trauma as a result of poverty, violence, warfare and displacement.…”

“…On the other hand, females may encounter increased social shame, discrimination or violence if they consume alcohol, particularly in conservative or religious groups. 46 Males may have a higher likelihood of associating with those individuals who consume alcohol or being exposed to alcohol in their social environments. They may also have easier access to alcohol, whether obtained legally or illegally, compared with females.…”

“…They may also have easier access to alcohol, whether obtained legally or illegally, compared with females. 46 Additionally, males may be more susceptible to psychological distress and trauma as a result of poverty, violence, warfare and displacement. These factors can impact their mental health and overall well-being, potentially leading to conditions such as depression, anxiety, post-traumatic stress disorder or suicidal thoughts.…”

Cannabis use and its psychosocial correlates among school-going adolescents in Sierra Leone

“…The study found an association between cannabis use and sexual risk behaviours among school-going adolescents in Sierra Leone. School-going adolescents who engage in sexual risk behaviours might use cannabis to cope with emotional distress or adverse consequences arising from those behaviours [ 29 ]. Policymakers in Sierra Leone should provide comprehensive and age-appropriate sexual health education to promote safe sexual practices.…”