Abstract
BackgroundHigh prevalence of Sexually Transmitted Infections (STIs) among adolescents is a serious public health concern. Although many factors are attributed to adolescents’ risk of STI infections, the association between out of school adolescents’ employment status and STIs has not been thoroughly explored in Uganda, yet many adolescents are known to be employed. Consequently, the extent to which adolescents’ employment status may be a risk factor for unprotected sex and STIs among female adolescents is unclear. This study examines the association between female out of school adolescents’ employment status and STI status using the Uganda Demographic and Health Survey (UDHS) data for 2016.MethodsBoth descriptive and multilevel binary logistic regressions were used to analyse the data. The descriptive statistics provided an overview of the association between the two main variables while the multilevel binary logistic estimated the relationship between employment status and STI status, while controlling for other fixed factors and community random factors.ResultsCompared to female adolescents who were not employed or not working, the odds of reporting positive STIs were significantly higher for female adolescents who were working but received no pay (1.801(95% CI = 1.105–2.936), were self-employed in agriculture (1.502 (95% CI = 1.003–2.250) and who did manual jobs (2.258(95% CI = 1.429–3.568) whether skilled or not. Likewise, female adolescents who had two or more lifetime sexual partners (11.679 (95% CI = 1.254–2.248) had significantly higher odds of reporting STIs than those who had only one lifetime sexual partner.ConclusionOut of school female adolescents who are employed in various types of low wage employments are at greater risk of exposure to STIs than their counterparts who do not work in Uganda. Instead of being a protective factor against the risk of STIs, their employment may expose them to risky sexual behaviour and STIs, given the vulnerabilities female adolescents who have dropped out of school tend to report. Therefore, the provision of decent employment opportunities for these females may provide an avenue for instructional scaffolding to build the life skills and empower these females so that they are better able to reduce their exposure to STIs.
Highlights
High prevalence of Sexually Transmitted Infections (STIs) among adolescents is a serious public health concern
Disaggregation by employment status shows that a third of the respondents (33.4%) were not working, 11.5% worked but received no payment, while 12% of the respondents worked in sales and services and approximately 4% were household or domestic workers
Disaggregation by employment status revealed that female adolescents who Variables STI status in last 12 months No Yes Employment status Not employed and not paid Employed but not paid Sales and services &paid in cash or kind Self- employed in Agriculture and paid in cash or kind Household/domestic worker and paid in cash or kind Manual workers paid in cash or kind Number of lifetime sexual partners One partner Two or more Marital status Never married Ever married Age difference with recent sexual partner 0–4 5–9 10 above Age at first sex 15 and below 16–19 or in union Age of respondent 15–17 18–19 Education level None /Primary Secondary+ Total
Summary
High prevalence of Sexually Transmitted Infections (STIs) among adolescents is a serious public health concern. STIs could lead to serious financial and health costs for both individuals and the wider public [3,4,5]. Scholars have identified both risk and protective factors for STIs among adolescents; these factors include: adolescents’ sexual behaviours and practices [6], family–parental factors [7], socio-economic factors, and partner characteristics [1]. The role of adolescent employment status as a potential protective or risk factor for STIs in Uganda has yet to be critically examined, despite the fact that many adolescents who drop out of school are engaged in work. Uganda Bureau of Statistics (UBOS) [8] further estimated that about 21% of females aged 14–17 were engaged in some form of work
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