Summary
Background
Adolescent pregnancy remains a major challenge in both developed and developing countries. Adolescence is a phase of transition of physical and mental maturation and development that includes the biological, social and psychological parameters. It is between 10-19 years of age as per the World Health Organization (WHO). Early and unintended pregnancies among adolescents are associated with several adverse healths, educational, social and economic outcomes. The aim of this study is to determine the prevalence, awareness and factors associated to teenage pregnancy among secondary and high school students in the Bueal Health District.
Method: This study will be a cross-sectional community based study conducted from the month of January 2023 to July 2023 in the Buea Health District to collect data. The participants of this study will be secondary and high school teenagers. A multistage sampling method will be used. 300 participants will be recruited for this study. Chi squared test will be used to test association between variables, while multiple logistic regression model will be used to determine associated factors. Statistical significance will be set at a 95% CI, with a p-value < 0.05.
Expected Outcome
The prevalence of the study, factors associated to teenage pregnancy will be used by policy
makers to come up with strategies to limit or prevent teenage pregnancy among secondary school adolescent students in the BHD, SWR, Cameroon.
Keywords: Teenage pregnancy, Risk factors, Prevention, Awareness, Sexuality, Adolescent

CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND

Teenage pregnancy, also known as adolescent pregnancy, is pregnancy in a female adolescent or young adult under the age of 20 years. This includes those who are legally considered adults in their country[1],[2]. Adolescent pregnancy remains a major challenge in both developed and developing countries. Early and unintended pregnancies among adolescents are associated with several adverse health, educational, social and economic outcomes[3]. Teenage pregnancies constitute a serious health and social problem worldwide[4].Teenage pregnancy and teenage motherhood are a call for concern worldwide. Adolescence is a phase of transition of physical and mental maturation and development that includes the biological, social and psychological parameters. It is between 10-19 years of age as per The World Health Organization (WHO)[5]. Among the social consequences of adolescent pregnancies are school drop-out, juvenile violence, suicide and sometimes homicide [6],[7],[8]. It carries major health and social issues with unique medical and psychosocial consequences for both adolescents and society in general. According to World Health Organization(WHO), about16 million girls aging between 15 and 19 years and about, one million girls younger than 15 years give birth every year[9],[10]. WHO in 2014 report showed that the global adolescent birth rate was 49 per
1000 girls aged 15 to 19 years old[11]. Nowadays, the vast majority of teenage pregnancies occur in low- and middle- income countries’ characterized by poor health-care services; therefore, complications during pregnancy, birth and postpartum phase are the second cause of death among girls aging between 15 and 19 years worldwide. Additionally, it is estimated that some three million
teenage girls undergo unsafe abortions, may result in consecutive reproduction problems or even death [9]. Globally, 11% of all births result from adolescent pregnancies, with 95% of these births
occurring in low and middle income countries (WHO; 2014) [12]. Teenage pregnancy remains an important and complex issue around the world [12]. It is estimated that about 16 million girls 15–19 years old give birth each year, contributing nearly 11% of all births worldwide [13]. Pregnancy in adolescence is associated with higher risk of caesarean deliveries, low infant birth weight, neonatal asphyxia and prematurity; consequently increasing maternal and infant morbidity and mortality[14]. Teenage/Adolescent pregnancy is a global issue raising concerns for all who are interested
in the health and well-being of young women and their children. It carries major health and social issues with unique medical and psychosocial consequences for both adolescents and society in general[15].Teenage pregnancy rates have declined since 2001, although progress has been uneven across regions and countries. Eastern Europe has a higher average teenage pregnancy rate (41.7/1000) than Northern (30.7/1000), Western (18.2/1000) and Southern Europe (17.6/1000). While data on teenage live births are available across Europe, data on teenage abortions are unavailable or incomplete in more than one-third of EU countries. Reported teenage pregnancy rates are generally lower for countries where parental consent for abortion is not required[16]. About 12 million adolescent girls aged 15-19 give birth every year – most in low- and middle-income countries[17]. An estimated 3.9 million girls aged 15–19 undergo unsafe abortions every year[17]. In low- and middle-income countries, complications from pregnancy and childbirth are a leading cause of death among girls aged 15–19 years[17]. A wide range of factors contribute to the high rates of unintended pregnancy and unplanned births among  adolescents; Poor knowledge of sexual and reproductive health services, legal barriers to accessing services, provider bias, stigma around premarital sex and lower decision making autonomy of married adolescents are among the factors contributing to unintended pregnancies[18],[19],[20]. The rate of teenage pregnancy in the United Kingdom is
relatively high, when compared with other developed countries; the only other Western countries with higher teenage pregnancy rates are the United States and New Zealand[21],[22]. Although in tradition societies, the majority of these pregnancies are socially desired, several studies have pointed out the enormous risks which are associated associated with teenage pregnancies, such as anemia, preterm labor, urinary tract infections, preeclampsia, high rate of cesarean- sections, preterm birth, and low birth weight infants and even maternal and new mortality [9].Several studies examined the risk and protective factors associated with adolescent pregnancy using an ecological perspective, thus identifying multidimensional factors at the individual, relational, familial and structural levels that
influence adolescent pregnancy. Among the several factors at the different levels, systematic reviews showed that poverty, and lower educational attainment are consistently associated with adolescent pregnancy[23]. Teenage pregnancies, however, still also occur in high-income countries and despite much better medical care[9]. Teenage pregnancies are also considered as risky and policy tries to
avoid too early motherhood.[9]. This is not only due to medical problems, but first to all social consequences of teenage motherhood. Therefore, the analysis of causes and consequences of teenage pregnancies have been the topic of much research and debate[24]. Adolescent pregnancy is a major public health problem, particularly in Africa[25]. It is associated with high maternal and child morbidity and mortality and affects the socio economic development of a country[25]. Evidence from sub-Saharan Africa indicates that 35 percent of pregnancies among 15-19- year (s)-olds were unplanned, unwanted, or untimed and that the teenagers’ relationships were unstable[26]. Today, Sub Saharan African countries lead the world in teen pregnancies: With Niger on the top list of 203.604 births per 100,000 teenage women. Mali follows with 175.4438, Angola (166.6028), Mozambique (142.5334), Guinea (141.6722), Chad (137.173), Malawi (136.972), and Cote d’Ivoire (135.464) [26]. Several studies have shown that the high level of maternal and perinatal morbidity and mortality can be reduced by lowering the high rate of adolescent pregnancy in developing countries[27], [28], [29]. Consequently, reducing the high rate of adolescent pregnancy and maternal mortality is Considered as the key Sustainable Development Goals (SDG), target[30]. The Cameroon Medical Council reports that 25 percent of pregnancies occur in girls of school age, and 20 percent of pregnant teens do not return to school[31]. In Cameroon,  about 25% of 15 – 19 -year-old females are already sexually active[32] .The fertility rate in this age group is 127 per 1000 women[32]. with 30% of these births resulting from unplanned pregnancies[33]. The 2018 Demographic and Health Survey (DHS) inCameroon showed that adolescent girls contribute nearly 19% to fertility. Furthermore, 24% of these adolescent girls aged 15 to 19 had already begun their reproductive life[34] .A
prevalence of adolescence pregnancy of 13.3% has been revealed in a study conducted in
the Buea Health District of the Southwest Region of Cameroon[34].

1.2 Problem Statement
Teenage pregnancy is one of the major causes of maternal and neonatal mortalityworldwide with the majority of the cases seen in the low and middle-income countries like Cameroon. Cameroon has recorded the highest fertility rate among teenagers in the entire Central African region as of 2017. Notably, there are limited data available on assessing the awareness and prevention of teenage pregnancies among secondary and high school students in Cameroon. Furthermore, the emotional, psychological, and social needs of pregnant adolescent girls can be greater than those of other women. Early childbearing has been shown to increase risks for newborns, as well as young mothers. Hence, this study came into conception due to the lack of adequate studies on the awareness of teenage pregnancy among secondary and high school students in Cameroon, despite its alarming rate, and as it is an important indicator of maternal and neonatal morbidity and mortality. Thus, this study will seek to assess the prevalence, awareness and factors associated to teenage pregnancy in the Buea Health District, South West Region, Cameroon.
1.3 Rationale of the Study

There are few data on teenage pregnancy specifically but the few available show that 5% of girls in Buea terminate schooling every academic year because of pregnancy[35]. Morbidity, health, and social problems from teenage pregnancy lead to short-term and long medical, psychological and socio-economic implications affecting the individuals, involved their families, and society at large. Thus, this explains why this study is necessary to assess the prevalence, awareness and factors associated to teenage pregnancy among secondary and high school student in the Buea Health District.

1.4 Research Questions
1. What is the prevalence of teenage pregnancy among secondary in the BHD, SW,
Cameroon?
2. How aware are secondary teenagers in the prevention of teenage pregnancy in the BHD,
SWR, Cameroon?
3. What are the risk factors associated to teenage pregnancy among secondary in the BHD,
SWR, Cameroon?
4. What is the uptake of contraceptives usage among secondary in the BHD, SWR,
Cameroon?
1.5 Research Hypothesis
1. The prevalence of teenage pregnancy among secondary and high school students in the
BHD, SWR, Cameroon is low
2. There is poor awareness of teenage pregnancy prevention among secondary school
students in the BHD, SWR, Cameroon.
3. There are some associated factors with teenage pregnancy among secondary school
students in the BHD, SWR, Cameroon.
4. The uptake of contraceptives among secondary school students in the BHD, SWR,
Cameroon is low
1.6 Research Goal
To improve teenagers’ awareness among secondary school students by providing data that
will guide the management of factors that influence teenagers into early sexual activities in
the BHD, SWR, Cameroon.
1.7 Research Objectives
1.7.1 General Objective
To assess prevalence, awareness and associated factors of teenage pregnancy among
secondary school students in the BHD, SWR, Cameroon.
1.7.2 Specific Objectives
1. To determine the prevalence of teenage pregnancy among secondary school teenagers
in the BHD, SWR, Cameroon.
2. To assess the level of awareness of teenage pregnancy prevention among secondary
school teenagers in the BHD, SWR, Cameroon.
3. To identify factors associated with teenage pregnancy among secondary school
teenagers in the BHD, SWR, Cameroon.
4. To determine the uptake of contraceptives us among secondary school teenagers in the
BHD, SWR, Cameroon.
1.8 Definition of Operational Term
 Pregnancy
The state of carrying a developing embryo or fetus within the female body.
This condition can be indicated by positive results on an over- the- counter urine test, and

confirmed through a blood test, ultrasound, detection of fetal heartbeat, or an X-ray.
Pregnancy lasts for about nine months, measured from the date of the woman’ last
menstrual period (LMP). It is conventionally divided into three trimesters, each roughly
three months long[36]
 Teenage pregnancy
Teenage pregnancy is when a woman under 20 gets pregnant. It usually refers to teenagers
between the ages of 15-19. But it can include girls as young as 10. It’s also called teen
pregnancy or adolescent pregnancy.
 Awareness
The quality or state of being aware : knowledge and understanding that something is
happening or exists[38]. Awareness is the state or ability to perceive, to feel, or to be
conscious of events, objects, or sensory patterns. In this level of consciousness, sense data
can be confirmed by an observer without necessarily implying understanding
 Associated factor
It is a thing or things connected with each other.
 Determining factor
Something immaterial (as a circumstance or influence) that contributes to producing a
result. an argument that is conclusive.