Peer-reviewed article
Prevalence and factors associated with teenage pregnancy in refugee settlements of northern Uganda post-COVID-19 (2020-2023): a cross-sectional study.
Otika D, Odongo G, Muzaki RMM, Lamwaka BO, Bongomin F et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined teenage pregnancy in two refugee settlements in northern Uganda between 2020 and 2023, finding that approximately one in three teenage girls (34%) had experienced pregnancy during this period. The research identified four main risk factors: living with a husband, lack of formal education, peer pressure, and history of sexual abuse. Contraceptive use was extremely low, with only 7.5% of girls currently using modern contraception. The study suggests that targeted interventions including legal protections, education promotion, and better access to contraception are needed to address this health crisis in refugee settings.
Key points
- Teenage pregnancy prevalence was 34.0% (95% CI: 29.4% to 38.9%) among girls aged 15-19 in the two settlements
- Living with a husband was the strongest risk factor, with girls who did so 3.8 times more likely to be pregnant
- Only 7.5% of girls were currently using modern contraceptives, and 13.8% had ever used them
- History of sexual abuse increased pregnancy risk 1.5-fold independently
- Lack of formal education and peer pressure each approximately doubled the risk of teenage pregnancy
Limitations
The study used convenience sampling and self-reported data on pregnancies, which may introduce selection bias and recall bias. The cross-sectional design cannot establish causal relationships between the identified factors and teenage pregnancy.
Abstract
Background Following the COVID-19 pandemic, there was an increase in teenage pregnancies nationally, however, limited data exists regarding the same among girls living in refugee settlements. Objectives We evaluated the prevalence of teenage pregnancy and associated factors in Palorinya and Bidi Bidi refugee settlements in Obongi and Yumbe districts of northern Uganda, in the post-COVID-19 era. Design We conducted a cross-sectional study. Setting Refugee settlements in northern Uganda. Participants We included 385 teenage girls aged 15-19 years. Methods We used convenience sampling techniques between March and May 2023. Prevalence of teenage pregnancy was assessed by self-reported pregnancies between January 2020 and May 2023 among participants. We conducted Pearson's χ2 and Fisher's exact tests for bivariate analysis. All variables with a p value<0.2 at bivariate analysis were included in multivariable regression. We applied a modified Poisson regression model at the multivariable level to evaluate independent associations. The level of statistical significance was set at p<0.05. Primary and secondary outcome measures The primary outcome measure was the prevalence of teenage pregnancy, assessed through self-reported pregnancies among participants. Secondary outcome measures included factors associated with teenage pregnancy, such as living with a husband, lack of formal education, peer pressure and history of sexual abuse. Results Overall, the mean age was 17 (IQR: 15-18), and sexual debut was at 16 (IQR: 15-17) years. Lifetime modern contraceptive use was 13.8% (n=53/385) and current use was 7.5% (n=29/385). Teenage pregnancy period prevalence was 34.0% (CI: 29.4% to 38.9%). Factors independently associated with teenage pregnancy were: living with a husband (aPR: 3.8, 95% CI: 2.51 to 5.84, p<0.001), lack of formal education (Adjusted Prevalence Ratios - aPR: 2.3, 95% CI: 1.26 to 4.35, p=0.007), peer pressure (aPR: 2.1, 95% CI: 1.54 to 2.86, p<0.001) and history of sexual abuse (aPR: 1.5, 95% CI: 1.07 to 1.99, p=0.018). Conclusion Our study revealed that around 1 in 3 adolescent girls in northern Uganda's refugee settlements experienced pregnancy during the COVID-19 pandemic, with only 1 in 13 currently using modern contraceptives. To address this, targeted strategies by relevant authorities are crucial, including legal actions against sexual abuse, promoting girl child education and enhancing access to long-term contraception to reduce teenage pregnancy and associated health risks in these settings.