Institution: | 1. Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK;2. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK;3. National Institute for Medical Research, Mwanza, Tanzania;4. Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium;5. Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania;6. Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
National Institute for Medical Research, Mwanza, Tanzania;7. Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar;8. Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania;9. Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium |
Abstract: | Objectives This cross-sectional survey aimed to explore associations between age of menarche, early sexual debut and high-risk sexual behaviour among urban Tanzanian schoolgirls. Methods Secondary schoolgirls aged 17–18 years from Mwanza, Tanzania, participated in structured face-to-face questionnaire-based interviews, conducted by nurses and clinicians. Age of menarche was evaluated in categories of 11–12, 13–14, 15–16 or ≥17 years. Primary outcome measures were self-reported early sexual debut (first vaginal sex at <16 years) and high-risk sexual behaviour, including non-use of condoms, having sex for gifts/money, having older sexual partners and/or other risky behaviours. Results Of 401 girls enrolled, 174 (43.4%) reported prior vaginal sex. Prevalence of early sexual debut was 14.2% but pressured/forced sex and risky sexual behaviours were common. Adjusted for potential confounding, younger age at menarche was associated with early sexual debut (adjusted odds ratio for linear trend: 1.88 per category, 95% confidence interval: 1.21–2.92, p = 0.005). This association remained after excluding girls with first sex at <8 years or experiencing pressure or force at first sex. Further, adjusted for potential confounding (including ever experiencing forced sex), early sexual debut was associated with high-risk sexual behaviour (adjusted odds ratio: 2.85, 95% confidence interval: 1.38–5.88, p = 0.004). Conclusions Among urban Tanzanian school girls, younger age of menarche was associated with early sexual debut, and early sexual debut was associated with high-risk sexual behaviour. Researchers and public health professionals developing and delivering interventions aimed at preventing adverse sexual health outcomes should consider the impact of these early biological and sexual exposures. |