ABSTRACT

Background: Teenage pregnancy is a common public health problem with global estimates of 16 million teenage births yearly. It is one of the major causes of maternal and neonatal mortality worldwide with the majority of the cases seen in the low and middle-income countries. Cameroon has recorded the highest fertility rate among teenagers in the entire Central African region as of 2017. Thus is study aimed  at assessing the knowledge, prevention challenges and risk behaviors associated to teenage pregnancy in the Tole community. Methods: A cross-sectional descriptive study was used whereby, Data was collected using self-administered questionnaires from 100 female adolescents from Tole community. Data was analyzed using SPSS version 29 and represented using frequency tables and charts.RESULTS: Out of the 100 participants, 16.0% had poor knowledge and perception of abstinence as a preventive measure against teenage pregnancy. 84.0% agreed having sex at their age was save and healthy and an overall 84.0% of teenagers were engaged in sexual activities. 60.0% of these teenagers sometimes used preventive measures before sexual activities and 11.0% rarely used it.After adjusting the confounders, early exposure to media ,peer pressure and pornographic sharing (32.0%,31.0%,30.0% respectively)we’re risk behaviors associated with teenage pregnancy.Limited knowledge about sex and contraceptives (46.0%),desire to have a child (20.0%) and being victim to sexual violence (14.0%)were identified to be practices that exposed adolescents to teenage pregnancy.The most commonly found contraceptive used was condom(52.0% and pills (38.0%).Stigma/shy to buy (36.0%),limited finance (14.0%) and not being sure of its effectiveness and side effects (7.0%) were potential barriers to contraceptive use.Conclusion:Majority of teenagers had good knowledge and perception of abstinence as a preventive measure against teenage pregnancy.Risk behaviors identified to be associated to teenage pregnancy were limited knowledge of sex and contraceptives, having sex at their young ages and being victims of sexual violence while potential barriers to contraceptives use were; stigmatization, shy to buy contraceptives,limited finance and not being sure of its effectiveness.

CHAPTER ONE

INTRODUCTION

1.1 Background

According to the United Nations International Children’s Emergency Fund (UNICEF, 2008), Teenage pregnancy is defined as a pregnancy in girls within the ages 13-19 years. It is a global issue raising concerns for all who are interested in the health and wellbeing of young women and their children. Although it is considered a serious problem globally,approximately 95% occurs in girls aged 15-19 years become pregnant, around half of these pregnancies were unintended and more than half ended in abortion (WHO ,2022).

According to the International Development Research Center Niger recorded the highest prevalence of teenage pregnancy in 2022 with a number of 203.6 out of 1,000 teenage girls(IDRS ,2022).Over 15 countries identified. For more than 30% of women giving birth before the age of 18 World Wide, 14 of them were found in Sub-Saharan Africa including Niger, Mozambique, Malawi, Uganda and Cameroon. Factors contributing  teenage pregnancy are multifactorial ranging from individual behavior, traditional, socio-cultural and religious in nature. Including increased accessibility to social media and pornographic sharing have led to early initiation of sexual activity by teenagers (Ochen et al.,2019).According to Ethiopia Demographic and Health Survey (EDHS 2016).The prevalence of teenage pregnancy is most high in rural than in urban areas .There was a 17% spike in teenage pregnancy Between March 2020 and June 2021 in Uganda .A total of 354,736 teenage pregnancy were registered in 2020 and 196,499 in the first six months of 2021(UNFPA 2021).Adolescents  knowledge of pregnancy and sexual reproductive health was a deficient as adolescents have no better informed about pregnancy and sexual reproductive health (Govender et al.,2019).For thousands of years, fertility control has been used in different forms coitus interruptus (withdrawal) and abstinence are  the oldest known methods. abstinence does not feature much in the teenage conversations,Where it is discussed it is usually embedded in religious beliefs, other than that teenagers expressed how it is difficult to have sexless relationships (Murima,2013). Modern contraceptives include intrauterine device,condoms and pills just to name a few.In many countries women aged 15-24 years  have high rates of contraceptives discontinuation which is attributed to side effects and poor quality of care (Cathryn, 2021).

Adolescent Pregnancy constitutes a Public Health Problem in Cameroon, 12% and 9.3% of all deliveries at the University Teaching Hospital and central hospital Yaounde respectively are teenagers (fouelefack et al.,2014).Cameroon has one of the highest adolescent fertility rates. According to data collected in 2004 as part of the DHS, 22.7% of adolescents under 20 were mothers of at least one child. Cameroons adolescent fertility rate of 138 birth per 1000 women aged <19 is the highest in central Africa (Thomas et al., 2015). Adolescent pregnancy is still a major public health challenge with a national prevalence of 14.2%. According to the US president, Emergency Plan for AIDS Relief (PEPFAR) the HIV prevalence in Cameroon among adolescent 14-19 years in 2018 was 3.4% with about 2% of young people between 15-24years living with HIV (Rita et al., 2022).

According to UNPFA Cameroon fertility rate represented at 12% of general fertility in 2015 while in 2018 this rate was at 16.31%. In Cameroon the prevalence of teenage pregnancy was 40%-50% (District Health Survey statistics 2009) in the South West Region of Cameroon the prevalence of teen pregnancy in Buea health District was 13-32% (Halle-Ekane, 2015).

In addition, adolescent contribute 28% of maternal mortality in Cameroon. According to (DHS, 2011) 25.6% of adolescents 15-19 have started sexual intercourse and 21% of them have had a child and 4% were pregnant for their first pregnancy.  Cameroon adolescent engage themselves in unprotected sexual practice and having more than one partner at very tender ages existing data on Cameroon indicated that adolescents represent 21% of total population and contributed 13.8% of deliveries (Fosmax et al.,2013). Statistics from the social Welfare Centre in Buea, South West Region (SWR) Cameroon indicate that 5% of girls in Buea terminate schooling every year because of Pregnancy.

However, limited study have been carried out in rural areas like tole community in the South West Region of Cameroon.

 1.2 Problem statement

Based on observations as a nursing student on Community internship at Tole Intergrated Health Center, the health burden of Tole is significant with a high proportion of women attending delivery service being teenagers (from records of Tole Health Center ).Which is an indication that teenagers at Tole do not practice abstinence.Abstaining from sexual activity is the only setting way to avoid out-of- wed lock pregnancy.Even if these teenagers have to have sex at their tender age why don’t they use contraception which does not only exposes them to getting pregnancy but it also puts them at risk of contracting sexually transmitted diseases and falling prey to criminal act .

Every year, an estimated 21 million girls aged 15-19 years in developing region become pregnant and approximately 12 million of them give birth (WHO, 2022). When a girl becomes pregnant her life can change radically, her education may end, her job prospects diminish, becomes vulnerable to poverty and exclusion. These teens turn to develop a social stigma which goes a long way to hinder their progress in future (Malika, 2012).

Adolescent pregnancy is generally not the result of deliberate choice rather it is a consequence of little or no assess to school (UNFPA). Works to address these issue by focusing and protecting girl’s right which include supporting comprehensive sexual education and reproductive health to help girls avoid pregnancy.

1.3 Rationale

This study will help generate data on the knowledge on prevention, risky behaviors that might expose teenagers to pregnancy,contraceptive methods use and barriers in getting contraceptive by teenagers at tole.

This research could serve as basis for healthcare workers and the government to improve on curbing and negative effects of teenage pregnancies in Tole community. Moreover, it is important to have knowledge and effects of teenage pregnancy in order to identify any gaps and to enable them to understand the benefits of overcoming teenage pregnancy.

Finally, this information will contribute to the existing body of literature and serve as reference for future research.

1.4 Research Questions

1. How is adolescents knowledge and attitude in the prevention of teenage pregnancy in the tole community?
2. How does risky behaviors expose adolescents to teenage pregnancy in the tole community?
3. What are the contraceptives used and challenges in getting these contraceptive by teenagers in tole community ?

1.5 Objectives

1.5.1 General Objectives

To assess the knowledge, prevention challenges and risk behaviors to teenage pregnancy amongst adolescent in the Tole community.

1.5.2 Specific Objectives

1. To asses the knowledge and attitude of adolescent on abstinence as a preventive approach of teenage pregnancy in the Tole community
2. To identify risky behavior that might expose teenagers to pregnancy at the Tole community
3. To identify contraceptive methods used and challenges in acquiring the contraceptives by teenagers in the Tole community