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Abstract. Background: Although some studies in Tanzania have addressed the question of sexuality and STIs among adolescents, mostly those aged 15 – 19 years, evidence on how multiple sexual partners influence condom use among 10 – 19 year-olds is limited. This study attempts to bridge this gap by testing a hypothesis that sexual relationships with multiple partners in the age group 10 – 19 years spurs condom use during sex in four districts in Tanzania. Methods. Secondary analysis was performed using data from the Adolescents Module of the cross-sectional household survey on Maternal, Newborn and Child Health (MNCH) that was done in Kigoma, Kilombero, Rufiji and Ulanga districts, Tanzania in 2008. A total of 612 adolescents resulting from a random sample of 1200 households participated in this study. Pearson Chi-Square was used as a test of association between multiple sexual partners and condom use. Multivariate logistic regression model was fitted to the data to assess the effect of multiple sexual partners on condom use, having adjusted for potential confounding variables. STATA (10) statistical software was used to carry out this process at 5% two-sided significance level. Results: Of the 612 adolescents interviewed, 23.4% reported being sexually active and 42.0% of these reported having had multiple (> 1) sexual partners in the last 12 months. The overall prevalence of condom use among them was 39.2%. The proportion using a condom at the last sexual intercourse was higher among those who knew that they can get a condom if they want than those who did not. No evidence of association was found between multiple sexual partners and condom use (OR = 0.77, 95% CI = 0.35 – 1.67, P = 0.504). With younger adolescents (10 – 14 years) being a reference, condom use was associated with age group (15 – 19: OR = 3.69, 95% CI = 1.21 – 11.25, P = 0.022) and district of residence (Kigoma: OR = 7.45, 95% CI = 1.79 – 31.06, P = 0.006; Kilombero: OR = 8.89, 95% CI = 2.91 – 27.21, P < 0.001; Ulanga: OR = 5.88, 95% CI = 2.00 – 17.31, P = 0.001), Rufiji being a reference category. Conclusion: No evidence of association was found between multiple sexual partners and condom use among adolescents in the study area. The large proportion of adolescents who engage in sexual activity without using condoms, even those with multiple partners, perpetuates the risk of transmission of HIV infections in the community. Strategies such as sex education and easing access to and making a friendly environment for condom availability are important to address the risky sexual behaviour among adolescents. © 2011 Exavery et al; licensee BioMed Central Ltd.
The data for this study was collected as part of a larger household survey on Maternal, Newborn and Child Health (MNCH). This was a cross-sectional study that was carried out by the Ifakara Health Institute (IHI) in partnership with the WHO (Regional Office for Africa) and the MoHSW in four districts in Tanzania mainland where the IHI's Empower project is being implemented, namely Kigoma, Kilombero, Rufiji and Ulanga. "Multiple sexual partners" was defined as having had more than one sexual partner in the last 12 months preceding the interview. Condom use was measured dichotomously as having used/not used a condom at the last sexual intercourse for either partner. Following the standard age categorization, two groups of the study participants' age were formed as 10 – 14 and 15 – 19 years and referred to as younger adolescents and older adolescents respectively [25,26]. Sampling was done systematically using the CSurvey software. The sample size was determined depending on the indicators to be measured on population demographics (e.g. household size, fertility) and on local prevalence of selected conditions such as diarrhoea, cough with rapid breathing and fever. A total of 1200 random households, being 300 households selected randomly from each district were sampled. The target population was school-aged adolescents (10 – 19 years) and this survey was conducted during their mid-year holiday. In addition, sampled households were informed in advance by their respective community leaders to be available at home for an interview on agreed day. Respondents were childbearing-aged women with a child aged < 5 years and adolescents. Information regarding children aged < 5 years was given voluntarily by a child's mother or guardian after signing a written informed consent. Adolescents aged 18 and above signed the consent by themselves after which they were interviewed. For the minors (under 18), the consent was sought from their parents/guardians. The response rate of this household survey on MNCH was as high as 94%. Data collection took place between June and July 2008 through face-to-face interviews, using a questionnaire that was organized in different non-overlapping modules. Personal Digital Assistants (PDAs) were used for data collection and then the data were being synchronized into a laptop computer and backed up daily. The current study analyzed the Adolescents Module of the questionnaire, whereby 612 adolescents aged 10 – 19 years were interviewed. We analyzed some demographic variables particularly sex, age and place of residence. The analysis focused on five key questions: 1. Have you ever had sex? 2. The last time you had sex, did you or your partner use condom? 3. Have you ever had more than one sexual partner in the last 12 months? 4. Have you ever had a HIV test? 5. If you wanted, could you get a condom? The data were first analyzed descriptively to obtain summary statistics of the study participants. This was followed by testing for associations between condom use and the explanatory variables using Chi-square and student t-tests for categorical and continuous variables respectively. Multivariate logistic regression model was finally fitted to the data to assess the effect of multiple sexual partners on condom use, controlling for other potential confounding variables. This process was carried out using STATA (version 10) statistical software at 5% two-sided significance level.
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