Correlates of early sex debut among adolescents and young women: A National cross-sectional study

Samuel Kiiru; Mary Thiongo; Peter Gichangi

doi:10.12688/gatesopenres.15272.1

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Research Article

Correlates of early sex debut among adolescents and young women: A National cross-sectional study

[version 1; peer review: 1 approved]

Samuel Kiiru ¹, Mary Thiongo¹, Peter Gichangi^2,3

PUBLISHED 24 Apr 2024

Author details Author details

¹ Research, International Centre for Reproductive Health Kenya, Mombasa, Mombasa County, Kenya
² Technical University of Mombasa, Mombasa, Mombasa County, Kenya
³ Public Health and Primary Care, Ghent University, Ghent, Flanders, Belgium

Samuel Kiiru
Roles: Conceptualization, Data Curation, Formal Analysis, Software, Writing – Original Draft Preparation, Writing – Review & Editing

Mary Thiongo
Roles: Investigation, Project Administration, Supervision, Writing – Review & Editing

Peter Gichangi
Roles: Funding Acquisition, Investigation, Methodology, Project Administration

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Early sexual debut among adolescents and young women may predispose them to unwanted pregnancies and sexually transmitted diseases. In Kenya, this consequently results in education discontinuation hence poverty levitation. Sexual debut has been studied in relation to HIV, school programs or review of demographic and health surveys. We report correlates of early sexual debut among women aged 15-24 years from a household-based survey in Kenya.

Methods

Performance, Monitoring for Action (PMA) is a cross-sectional survey using a multi-stage cluster design with urban-rural stratification. The sampling was done at the county level using probability proportional to size to select 11 counties and enumeration areas (EAs) achieving 308 EAs. Interviews were conducted from 35 randomly selected households, from which the eligible women were also interviewed. Descriptive statistics were generated to determine the social demographic characteristics of respondents, and bivariate analysis for the correlation of independent variables and early sexual debut. A logistic regression model was used to determine the association between social demographic characteristics and early sexual debut among women of 15-24 years old. P <0.05 was considered significant.

Results

A total of 3,706 women were interviewed, and about 1 in 100 (10.2%) of the respondents reported having ever engaged in sexual intercourse before the age of 16 years. Educational level, ever-given birth, contraceptive use and wealth status were found to be statistically associated with early sexual initiation in Kenya. Women who reported having ever given birth had higher odds of early sexual initiation (AOR 2.36, 95% CI, 1.51-3.68, p<0.005) than those who have never given birth. Respondents who were contraceptive users were 1.4 times more likely (AOR 1.39, 95% CI, 1.01-1.90, p<0.001) to have experienced early sex debut than non-users.

Conclusions

Several individual factors influence early sexual debut, and hence interventions at the policy and program levels are required.

Keywords

Adolescents, Early sex debut, household, survey, Kenya

Corresponding author: Samuel Kiiru

Competing interests: No competing interests were disclosed.

Grant information: This work was supported by grants OPP1198333 and OPP1198339 by the Bill & Melinda Gates Foundation (BMGF). Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. BMGF had no involvement in study design, data analysis/interpretation, or manuscript preparation.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2024 Kiiru S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Kiiru S, Thiongo M and Gichangi P. Correlates of early sex debut among adolescents and young women: A National cross-sectional study [version 1; peer review: 1 approved]. Gates Open Res 2024, 8:33 (https://doi.org/10.12688/gatesopenres.15272.1) First published: 24 Apr 2024, 8:33 (https://doi.org/10.12688/gatesopenres.15272.1) Latest published: 24 Apr 2024, 8:33 (https://doi.org/10.12688/gatesopenres.15272.1)

Introduction

Adolescents and young women's sexuality continues to be a global source of social concern due to its link to negative outcomes such as adolescent pregnancy and sexually transmitted infections. Sexual debut is a critical life event in the life of a young woman worldwide. Modern lifestyle changes brought on by civilization and urbanization have had a significant impact on sexual and reproductive health. Thus, the timing of an adolescent's first sexual encounter is a critical influencer of those negative outcomes, hence the need to study the determinants of early sex debut among adolescents. Research has shown that early age at first sex, before 16 years as per WHO definition marks the initiation of exposure to unwanted and complicated pregnancies, HIV and sexually transmitted infections, unsafe abortions, unwanted and teenage pregnancies, and increased incidence of multiple sexual partners^1–4. Early sexual activity is a global public health problem that is particularly prevalent in developing countries^5,6.

Early sexual debut is a major public health concern around the world among adolescents and young women. A 50 countries study on correlates of early sexual initiation among adolescents aged 12–15 years reported that 14.2% of adolescents had early sexual initiation⁷. In Brazil, a study among adolescents found that the prevalence rate of early sexual debut was about 18% among boys and 7% among girls⁸. About 27% among boys and 20.7% among girls in the United States of America reported being sexually active⁹. Among the Jamaican adolescents, girls had an earlier mean age at sexual debut (11 years) than boys (15 years). In Ohio State in the USA, 31.2% of the adolescents were found to be sexually active before age 15⁴.

In Sub-Saharan Africa, about 54.3% of adolescent women aged 15–19 years reported having had sex before the age of 18 and 12.3% before the age of 15¹⁰. A study on the impact of sexual behaviors of adolescent girls in 12 sub-Saharan African countries showed that 19.9% of all adolescent girls had made their coitarche, while their mean age at sexual debut was 13.2 years old¹¹. In central Africa, 32.4% and 8.6% of the girls had a sexual debut before the age of 18 and 15 years respectively¹⁰. In East Africa, a study on the prevalence and associated factors of early sex debut found the prevalence rate of early sex debut to be 21.1%¹².

In Ghana, a study on sexually active women aged 15 to 24 years found that more women 33.1% than men 26.4% were more likely to initiate sex earlier³ with a national prevalence of early sexual debut among unmarried women of 56.9%⁵. The prevalence of early sexual debut among adolescent girls in Mozambique was 45.8%, 43.6% in Namibia and 7.0% in Swaziland¹¹. In Ethiopia, a study assessing the timing of sexual debut and its associated factors found that about 45% of the adolescents of 10–19 years old who were not in school had reported commencement of sex¹³. It was also evident that children who are semi or complete orphans are consistently more likely to report younger age of sexual debut¹⁴. In Sierra Leone, orphan girls were more likely to have had sex and have multiple sexual partners than non-orphans¹⁵. A multi-country study found that in Burkina Faso, Ghana and Malawi, women who were total orphans had earlier sexual debuts compared to non-orphans¹⁴. In Kenya, a study on the impact of multisector cash plus programs found that 21% of adolescent girls reported ever having sex¹⁶, further¹⁷, found that about 50% of the adolescents and young women had ever had sex.

Several factors have been identified to influence the timing of first sexual commencement among adolescents. Findings from several studies have shown that demographic, socioeconomic status, peer influence, mothers' age at first sex, substance and alcohol abuse, large family size and religious factors among others have an impact on sexual debut among adolescents and young women^{5,13,14,18–20}. One in every three girls aged 15–19 years compared to two in every three girls aged 20–24 years reported ever having had sex¹⁷. Schooling was also found to be protective against early sexual debut. The longer the adolescents and young women are in school, the less likely they are to initiate early sex¹⁸. Also, adolescents who live with their fathers are less likely to have an early sex debut or even engage regularly in sexual activity¹¹.

Various studies evaluating early sexual debut among adolescents and young women have been conducted in Kenya^6,11,12,17. The majority of these studies concentrate on adolescents in HIV settings, adolescents in school-based programs, data from the 2014 Kenya Demographic and Health Survey^21,22 and data from surveys specific to certain counties like Nairobi, Kisumu and Mombasa²³. This study fills the gap by using the PMA data which is nationally representative to identify the correlates of early sexual debut among adolescents and young women in Kenya.

Methods

Study design, population and data source

Performance Monitoring for Action (PMA) is a cross-sectional survey using a multi-stage cluster design with urban-rural stratification sampling. The first stage of sampling was at the county level using probability proportional to size to select 11 out of 47 counties based on households: Nairobi, Kilifi, Nandi, Nyamira, Kiambu, Bungoma, Siaya, Kericho, Kitui, Kakamega, and West Pokot. Within each county, enumeration areas (EAs) were selected with urban-rural stratification. A total of 308 EAs from 11 counties were included in this survey. Sampling was done in collaboration with the Kenya National Bureau of statistics (KNBS). A full household listing was done within each EA and 35 households were randomly selected for interview. All women aged 15–49 years old in the selected households were eligible for the survey. The final sample was designed to provide national and county level estimates of modern contraceptive prevalence rate among all women with a margin-of-error of 3% and 5% at the national and county level respectively, power of 80% and 95% confidence. More information on the design of the surveys has been published elsewhere²⁴ and from the PMA website²⁵.

Data management

Using Open Data Kit (ODK), sufficient constraints were included to reduce/eliminate data-capturing errors. Data were uploaded to the aggregation server, regularly reviewed and cleaned and 10% of the households were re-interviewed by the supervisors for quality control. The data was finally de-identified to conceal all the personal identification information before analysis.

Dependent variable

The dependent variable was early or no early sexual debut. Among the eligible women in this survey, respondents were asked how old they were when they had their first sexual intercourse and the age was recorded in whole numbers. Those who reported having ever had sex were further classified as having started sexual intercourse before the age of 16 years, hence were considered to have had an early sexual debut, coded as yes and the rest as not having had an early sexual debut, coded as no.

Independent variables

Independent variables were the social demographic characteristics. They included; the age of the participant, rural/urban residence, education level, religion, marital status, the county they came from, access to FP messaging, those who had ever given birth, and knowledge of contraceptives and contraceptive use. The wealth quintile was constructed using data on a household’s ownership of assets, materials used for house construction, and water, sanitation and hygiene. The wealth quintiles position individual households on a continuous scale of five wealth quintiles²⁶.

Statistical analyses

Weighting was done to account for the complex survey design. Descriptive statistics were used to show the frequency and percentage of different characteristics of the survey respondents. Bivariate analyses were used to examine the relationship between sociodemographic factors and early sexual debut among sexually active adolescents and young women. A logistic regression model was used to measure the association between sociodemographic characteristics and early sexual debut. The odds ratio (OR) and 95 per cent confidence intervals were generated for this analysis. In all analyses, Stata SE V.15.1 statistical software was used for the analyses (StataCorp, College Station, Texas, USA).

Ethical considerations

Written informed consent was obtained for all participants of 18 years old and above, while for the minors, parental/guardian consent and minor assent were obtained. The informed consent process emphasized the voluntary nature of the study, and that services at the youth facilities participating would not be affected by non-participation. The study was approved by the Kenyatta National Hospital Ethical Review Committee (KNH ERC) reference number (KNH-ERC/A/412) issued on 1^st November 2019. Administrative approval was obtained from (County health directors and the National Commission for Science, Technology and Innovation (NACOSTI) issued on 09 December 2019. The PMA project that was implemented in Kenya by the International Center for Reproductive Health, was funded by the Bill and Melinda Gates foundation. Since it was implemented in Kenya, all ethical approvals were approved by the stated ERC, that is the Kenyatta National Hospital Ethical Review Committee, which approves all PMA work in Kenya. SK and MT are affiliated with the International Center for Reproductive Health.

Results

From the 2019 survey, a total of 3,706 adolescents and young women aged 15–24 years, who consented to voluntary participation were interviewed. More than half of the participants were adolescents (55.2%) while the rest were young women. About 32% of the participants were married, 72% were from rural areas and about 6 in every 10 had attained secondary or higher level of education. About 21% were from the lowest wealth quintile, while 15% were from the highest wealth quintile. About 29% were using a contraceptive while 97% were knowledgeable about contraceptives at the time of the survey. Most of the respondents were Protestants 69% while 18% were Catholics (Table 1).

Table 1. Social demographic characteristics of the respondents.

	15–19 yrs.		20–24yrs.		All
	N	%	N	%	N	%
Total	2039	55.2	1667	44.8	3706	100
Marital status
Married*	1858	8.8	673	59.7	2531	31.6
Never married	180	91.3	992	40.4	1172	68.4
Residency
Urban	576	21.8	683	36.3	1259	28.3
Rural	1463	78.2	984	63.7	2447	71.7
Education
Never/Primary	756	38.3	562	33	1318	36.0
Secondary/Higher	1283	61.7	1105	67	2388	64.0
Religion
Catholic	416	19.2	300	17	716	18.2
Islam	81	4	58	3.9	139	4.0
Protestants	1389	68.4	1190	70.8	2579	69.5
Other	46	2.8	43	3.3	89	3.0
No religion	106	5.6	76	5	182	5.3
Ever given birth
Yes	242	11.8	1071	63.3	1313	34.9
No	1796	88.1	596	36.7	2392	65.1
Contraceptive Knowledge
Yes	1933	95.4	1651	99.5	3584	97.2
No	106	4.6	16	0.5	122	2.8
Fp messaging exposure
Yes	1519	75.2	1428	87	2947	80.5
No	520	24.8	239	13	759	19.5
Wealth index
lowest	440	22.3	307	18.8	747	20.7
Lower	500	25.7	334	21.7	834	23.9
Middle	476	22.8	349	19.8	825	21.5
High	367	17.1	364	21.3	731	19.0
Highest	256	12.1	313	18.4	569	14.9
Contraceptive use
Yes	261	12.7	834	49.9	1095	29.4
No	1778	87.3	833	50.1	2611	70.6
County
Bungoma	192	9.8	136	8.8	328	9.4
Kakamega	158	17.2	128	17.2	286	17.2
Kericho	193	11.8	155	11.6	348	11.7
Kiambu	133	5.4	144	7.7	277	6.4
Kilifi	211	11.2	170	10.6	381	10.9
Kitui	265	9.6	131	5.6	396	7.8
Nairobi	107	5.7	188	12.6	295	8.8
Nandi	268	7.5	251	8.8	519	8.1
Nyamira	151	5.5	92	4.1	243	4.9
Siaya	180	9.2	122	6.5	302	8.0
West Pokot	181	7.1	150	6.5	331	6.8

Other* include: shop, relative and any other source of FP

Married* this includes (married, living with a partner, divorced, separated, widow and widower

Bivariate analysis

Bivariate analysis shows an association between sexual debut and sociodemographic characteristics. Marital status, residency, level of education, religion, birth history, respondent wealth status, contraceptive use, and county of residence were significantly associated with an early sexual debut (p<0.05). Overall, about 10% of the respondents aged 15 to 24 years reported early sexual debut. There were no differences in the proportion of those reporting early sexual debut among adolescents aged 15–19 years as compared to young women aged 20–24 years, p>0.05. The rest of the analysis is based on all women of 15–24 years old. Of the married women, 16% reported early sexual debut compared to 8% among those who were unmarried. More women living in rural settings, 12% than women living in urban areas, 7% reported early sexual debut. More adolescents and young women without formal or up to primary education, 17% reported early sexual debut than 6% among those with secondary or higher level of education attainment. Similarly, 17% of the respondents who reported having ever given birth reported early sexual debut compared to 6% among those who had not given birth. A higher proportion of women from the lowest and lower wealth quintiles (28%) reported early sexual debut as compared to those in the high and highest wealth quintiles (11%). Among those who were using a contraceptive method, about 15% had started sex before the age of 15 years, as compared to non-user (8%). The majority of the respondents who experienced early sexual debut were from West Pokot, 25% and Nyamira, 16% counties, while the least were from Kiambu county, 5.4% (Table 2).

Table 2. Bivariate analysis of early sexual debut by selected socio-demographic variables.

	Early Sexual Debut
	Yes		No
Variables	N	%	N	%	cOR	p-value
Total	376	10.2	3330	89.8
Age category						0.609
15–19 years	202	9.9	1842	90.1	Ref
20–24years	174	10.5	1487	89.5	1.069
Marital status						0.000
Married	182	15.6	987	84.4	Ref
Never married	194	7.7	2340	92.3	2.218
Residency						0.002
Urban	70	6.7	978	93.3	Ref
Rural	306	11.5	2351	88.5	1.807
Education						0.000
Never/Primary	225	16.9	1107	83.1	Ref
Secondary/Higher	152	6.4	2222	93.6	0.336
Religion						0.038
Catholic	61	9.1	614	90.9	Ref
Islam	4	2.4	143	97.6	0.252
Protestants	274	10.6	2302	89.4	1.192
Other	9	8.1	102	91.9	0.886
Unreligious	29	14.7	167	85.4	1.721
Ever given birth						0.000
Yes	222	17.2	1071	82.8	Ref
No	155	6.4	2258	93.6	3.031
Source of contraceptive						0.066
Private	35	11.3	278	88.7	Ref
Public	116	17.4	552	82.6	1.651
Others	1	6.3	15	93.7	0.531
Contraceptive Knowledge						0.566
Yes	368	10.2	3235	89.8	Ref
No	8	8.1	95	91.9	1.290
FP messaging exposure						0.174
Yes	283	9.5	2701	90.5	Ref
No	94	13.0	629	87.0	0.703
Wealth index						0.000
Lowest	129	16.8	639	83.3	Ref
Lower	99	11.1	788	88.9	0.622
Middle	73	9.2	723	90.8	0.504
High	56	7.9	648	92.1	0.426
Highest	21	3.7	531	96.3	0.192
Contraceptive use						0.000
Yes	158	14.5	931	85.5	Ref
No	218	8.3	2399	91.7	1.868
County						0.007
Bungoma	35	10.1	312	89.9	Ref
Kakamega	40	6.3	598	93.7	0.599
Kericho	44	10.1	390	89.9	1.009
Kiambu	13	5.4	225	94.6	0.511
Kilifi	33	8.1	372	91.9	0.786
Kitui	35	12.2	254	87.8	1.245
Nairobi	22	6.8	304	93.2	0.651
Nandi	29	9.7	270	90.3	0.962
Nyamira	28	15.6	153	84.4	1.654
Siaya	34	11.3	263	88.7	1.142
West Pokot	63	25.0	190	75.0	2.982

FP – Family Planning, Ref – Reference, cOR – Crude Odds Ratio

Multivariable analysis

Multivariable analysis for covariates of early sex debut that were statistically significant in the bivariate analysis were included (Table 3). Education attainment of secondary level and above was about 2-fold protective from early sexual debut, p<0.05. The odds of the early sexual debut were 2.4 higher among women who had ever given birth than women who had never given birth (AOR=2.36, p<0.05). The economic status of a woman was also found to be a significant determinant of early sexual debut. The woman from the highest wealth quintile was 3 times less likely to have experienced early sexual debut as compared to those from the poorest wealth quintile (AOR=0.33, p<0.05). Women who were using contraceptives were 1.4 more likely to had experienced early sexual debut as compared to non-users (AOR=1.39, p<0.05). The odds of early sexual debut among adolescents and young women from Nyamira county were 1.9 higher than their counterparts from Bungoma county (AOR=1.94, p<0.05) (Table 3).

Table 3. Multivariable analysis for Early Sexual Debut.

Variables	AOR	[95% CI]	P-value
Marital status
Never married	Ref	Ref
Married	0.88	(0.6, 1.29)	0.514
Residency
Urban	Ref	Ref
Rural	1.14	(0.77, 1.71)	0.511
Education
Never/Primary	Ref	Ref
Secondary/Higher	0.43	(0.34, 0.55)	0.000
Ever given birth
No	Ref	Ref
Yes	2.36	(1.51, 3.68)	0.000
Wealth quintile
Poorest	Ref	Ref
Poorest	0.76	(0.53, 1.10)	0.146
Middle	0.68	(0.46, 1.0)	0.048
High	0.67	(0.41, 1.11)	0.121
Highest	0.33	(0.16, 0.70)	0.004
Contraceptive use
No	Ref	Ref
Yes	1.39	(1.01, 1.90)	0.043
Religion
Catholic	Ref	Ref
Islam	0.41	(0.13, 1.28)	0.123
Unreligious	1.34	(0.69, 2.59)	0.383
Other	0.78	(0.30, 2.03)	0.606
protestant	1.29	(0.89, 1.87)	0.181
County
Bungoma	Ref	Ref
Kakamega	0.63	(0.36, 1.09)	0.097
Kericho	1.18	(0.71, 1.96)	0.524
Kiambu	1.02	(0.56, 1.85)	0.958
Kilifi	0.74	(0.46, 1.20)	0.228
Kitui	1.32	(0.84, 2.07)	0.222
Nairobi	1.57	(0.71, 3.47)	0.263
Nandi	0.85	(0.47, 1.53)	0.579
Nyamira	1.94	(1.04, 3.62)	0.037
Siaya	1.30	(0.79, 2.15)	0.298
West Pokot	2.52	(0.92, 6.88)	0.071

Abbreviations: AOR, Adjusted odds ratio; CI, confidence interval;

Ref: denotes reference category (OR=1.00).

Discussion

We found that 10.2% of adolescents and young women in Kenya had early sexual debut. Early sex initiation was more prevalent among respondents from West Pokot County 25%, unmarried sexually active respondents 18%, and among parous and respondents from the least wealth quintile 17%. Educational attainment, ever-given birth, contraceptive use and wealth status were significant determinants of early sexual initiation among adolescents and young women in Kenya.

Prevalence of 10.2% in our study is lower than that reported from other Sub-Saharan Africa, ranging from 55% in Ghana, 35.7%, in Nigeria, 21.14% in Mozambique, while in East Africa the prevalence rate was reported to be 21.14%^2,5,12. Another study conducted in Kenya in a different setting found the prevalence to be 6.7% among youths aged 18–24 years²⁷.

Like in other studies, educational level, ever-given birth, contraceptive use and wealth status were determinants of early sexual initiation in Kenya^12,27–29. Higher education attainment has been shown to have an impact on the likelihood of experiencing decreased early sexual initiation. These findings were supported by previous studies^9,12,30. Higher education levels may be empowering adolescents and young women to make informed decisions, thus avoiding early sexual debut. Longer duration of schooling has also been reported to be protective against adolescent early sex debut and pregnancies^2,18. Further, education reduces the possibility of indulging in risks such as substance abuse, which may expose them to early sexual initiation³¹.

Respondents from the highest wealth quintile households were less likely to engage in early sex than respondents from the other household quintiles. This is consistent with other studies^7,19,30 that have shown women from high wealth quintile households delaying their sexual debut. This may be due to women from low-income families engaging in earlier sexual relations for monetary gain and other benefits, unlike those from wealthy families who have good quality of life and better health-seeking behavior^12,32.

A strong association exists between early sexual debut and ever giving birth. Young women who had given birth were 2-times more likely to have had an early sexual onset than their counterparts. Women who had early sexual debut likely did not use contraception at their sexual onset, and hence the likelihood of pregnancy.

The odds of early sexual debut among contraceptive users were 1.4 higher as compared to non-users (AOR = 1.39, 95% CI (1.01 - 1.90). Other studies have shown that women with a contraceptive use history were likely to engage in early sex^5,12, as it this would assure them of pregnancy protection hence the early sexual debut. The positive association of early sexual and contraceptive use could be indicative of a functional health system where sexually active adolescents are more likely to receive family planning/contraceptive services.

Study limitations

There are some limitations which needed to be considered when interpreting the results of this study. First, though we strived to include both in and out of school adolescents and young women, the sample may not be representative of all adolescents and young women. Sexual activities might vary between those included and those not included. Second, because of the cross-sectional nature of the study, we cannot establish the temporal direction of associations between early sexual debut and various factors. Third, information about sexual behaviours was collected using self-reported measures, which can introduce reporting recall bias.

Conclusions

The prevalence of early sexual debut among adolescents and young women is influenced by personal factors. Our findings suggest there is need to implement targeted program which can address covariates of early sexual debut including strengthening information, education and communication on adverse consequences of early sexual initiation and improving contraceptive knowledge of teenagers as well as promoting schooling.

What is known about this topic

Early sexual debut has life-long consequences

Adolescent stage is an experimental stage which may include early sexual debut

Contraceptives can prevent some of the consequences of early sexual debut

What this study adds

That among a general population generated via household survey of adolescents and young women in Kenya, early sexual debut remains a public health problem at 10.2%

There are covariates at different levels which if addressed could mitigate and reduce early sexual debut and its consequences.

Data availability

Underlying data

Complete data is available at https://datalab.pmadata.org/user/register. Here users need to create an account on the website.

They will then choose Kenya as the country and choose the dataset name Kenya Phase 1 HQFQ Survey. Upon submitting the request, the dataset, code book and analysis guide will be shared within 24 hours.

Faculty Opinions recommended

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9. Ethier KA, et al.: NIH Public Access. PLoS One. 2015; 16(1): 1–8.
10. Melesse DY, Mutua MK, Choudhury A, et al.: Adolescent sexual and reproductive health in sub-Saharan Africa: Who is left behind? BMJ Glob Health. BMJ Publishing Group, 2020; 5(1): e002231. PubMed Abstract | Publisher Full Text | Free Full Text
11. Darfour-Oduro SA, Grigsby-Toussaint DG: Impact of social environment on sexual behaviors of adolescent girls in 12 sub-Saharan African countries: a cross-sectional study. Reprod Health. 2022; 19(1): 139. PubMed Abstract | Publisher Full Text | Free Full Text
12. Hailegebreal S, Gilano G, Seboka BT, et al.: Prevalence and associated factors of early sexual initiation among female youth in East Africa: further analysis of recent demographic and health survey. BMC Womens Health. 2022; 22(1): 304. PubMed Abstract | Publisher Full Text | Free Full Text
13. Bizuayehu HM, Abyu DM, Demessie HF: Assessment of time of sexual initiation and its associated factors among students in Northwest Ethiopia. Int J Public Health. 2015; 3(1): 10–18. Publisher Full Text
14. Neville SE, Saran I, Crea TM: Parental care status and sexual risk behavior in five nationally-representative surveys of sub-Saharan African nations. BMC Public Health. 2022; 22(1): 59. PubMed Abstract | Publisher Full Text | Free Full Text
15. Stark L, Tan TM, Muldoon KA, et al.: Family structure and sexual and reproductive health outcomes among adolescents in rural Sierra Leone. Glob Public Health. 2016; 11(3): 309–321. PubMed Abstract | Publisher Full Text
16. Kangwana B, Austrian K, Soler-Hampejsek E, et al.: Impacts of multisectoral cash plus programs after four years in an urban informal settlement: Adolescent Girls Initiative-Kenya (AGI-K) randomized trial. PLoS One. 2022; 17(2): e0262858. PubMed Abstract | Publisher Full Text | Free Full Text
17. Okigbo CC, Speizer IS: Determinants of sexual activity and pregnancy among unmarried young women in urban Kenya: A cross-sectional study. PLoS One. 2015; 10(6): e0129286. PubMed Abstract | Publisher Full Text | Free Full Text
18. Handa S, Palermo T, Rosenberg M, et al.: How does a national poverty programme influence sexual debut among Kenyan adolescents? Glob Public Health. 2017; 12(5): 617–638. PubMed Abstract | Publisher Full Text | Free Full Text
19. Turi E, Merga BT, Fekadu G, et al.: Why too soon? Early initiation of sexual intercourse among adolescent females in Ethiopia: Evidence from 2016 Ethiopian demographic and health survey. Int J Womens Health. 2020; 12: 269–275. PubMed Abstract | Publisher Full Text | Free Full Text
20. Oshi DC, Mckenzie J, Baxter M, et al.: ASSOCIATION between SINGLE-PARENT FAMILY STRUCTURE and AGE of SEXUAL DEBUT among YOUNG PERSONS in JAMAICA. J Biosoc Sci. 2019; 51(2): 177–187. PubMed Abstract | Publisher Full Text
21. Munga B, Nyanjom O, Onsomu E, et al.: Youth and Employment in Sub-Saharan Africa Working but Poor. Kenya, 2014; 303–355.
22. Mudhune V, Sabben G, Ondenge K, et al.: The Efficacy of a Smartphone Game to Prevent HIV Among Young Africans: Protocol for a Randomized Controlled Trial in the Context of COVID-19. JMIR Res Protoc. 2022; 11(3): e35117. PubMed Abstract | Publisher Full Text | Free Full Text
23. Speizer IS, Fotso JC, Davis JT, et al.: Timing and circumstances of first sex among female and male youth from select urban areas of Nigeria, Kenya, and Senegal. J Adolesc Health. 2013; 53(5): 609–616. PubMed Abstract | Publisher Full Text | Free Full Text
24. Zimmerman L, Olson H, PMA2020 Principal Investigators Group, et al.: PMA2020: Rapid Turn-Around Survey Data to Monitor Family Planning Service and Practice in Ten Countries. Stud Fam Plann. 2017; 48(3): 293–303. PubMed Abstract | Publisher Full Text | Free Full Text
25. Survey Methodology. PMA Data. (accessed Jul.26, 2023). Reference Source
26. Rutstein SO: Steps to construct new DHS Wealth Index. Wealth Index Constr. 2020; 6. Reference Source
27. Seff I, Steiner JJ, Stark L: Early sexual debut: A multi-country, sex-stratified analysis in sub-Saharan Africa. Glob Public Health. 2021; 16(7): 1046–1056. PubMed Abstract | Publisher Full Text
28. Tadesse G, Yakob B: Risky sexual behaviors among female youth in Tiss Abay, a semi-urban area of the Amhara Region, Ethiopia. PLoS One. 2015; 10(3): e0119050. PubMed Abstract | Publisher Full Text | Free Full Text
29. Nigatu AM, Birhanu AY, Endehabtu BF: Geographical variations of early age sexual initiation among reproductive-age women in Ethiopia: Evidence from EDHS 2016. Arch Public Health. 2020; 78(1): 28. PubMed Abstract | Publisher Full Text | Free Full Text
30. Nigatu AM, et al.: Early Coital Debut and Associated HIV Risk Factors Among Young Women and Men in South Africa. PLoS ONE. HHS Public Access, 2017; 17(1): 1–8.
31. Muhammad T, Srivastava S, Kumar P, et al.: What predicts the early sexual debut among unmarried adolescents (10– 19 years)? Evidence from UDAYA survey, 2015-16. PLoS One. 2021; 16(6): e0252940. PubMed Abstract | Publisher Full Text | Free Full Text
32. Ningpuanyeh WC, Sathiya Susuman A: Correlates of Early Sexual Debut and Its Associated STI/HIV Risk Factors among Sexually Active Youths in Malawi. J Asian Afr Stud. 2017; 52(8): 1213–1224. Publisher Full Text

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VERSION 1 PUBLISHED 24 Apr 2024

Author details Author details

¹ Research, International Centre for Reproductive Health Kenya, Mombasa, Mombasa County, Kenya
² Technical University of Mombasa, Mombasa, Mombasa County, Kenya
³ Public Health and Primary Care, Ghent University, Ghent, Flanders, Belgium

Samuel Kiiru
Roles: Conceptualization, Data Curation, Formal Analysis, Software, Writing – Original Draft Preparation, Writing – Review & Editing

Mary Thiongo
Roles: Investigation, Project Administration, Supervision, Writing – Review & Editing

Peter Gichangi
Roles: Funding Acquisition, Investigation, Methodology, Project Administration

Competing interests

No competing interests were disclosed.

Grant information

This work was supported by grants OPP1198333 and OPP1198339 by the Bill & Melinda Gates Foundation (BMGF). Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. BMGF had no involvement in study design, data analysis/interpretation, or manuscript preparation.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Published: 24 Apr 2024, 8:33

https://doi.org/10.12688/gatesopenres.15272.1

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Kiiru S, Thiongo M and Gichangi P. Correlates of early sex debut among adolescents and young women: A National cross-sectional study [version 1; peer review: 1 approved]. Gates Open Res 2024, 8:33 (https://doi.org/10.12688/gatesopenres.15272.1)

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Reviewer Report 15 Sep 2025

Gideon Mauti Ogutu, The Catholic University of Eastern Africa, Nairobi, Nairobi County, Kenya

Approved

https://doi.org/10.21956/gatesopenres.16620.r39840

General comment:

The authors have explored an important topic. The objectives and methodology is appropriate and results are adequately presented.
I would recommend publication.

Specific comments:

1. Title: Why the ... Continue reading

General comment:

The authors have explored an important topic. The objectives and methodology is appropriate and results are adequately presented.
I would recommend publication.

Specific comments:

1. Title: Why the word "Adolescents" in the title yet the inclusion criteria in PMA is 15-49, yet the definition of 'adolescents according to WHO is 10-19 years?

2. Findings: In bivariate analysis (table 2), majority of those who experienced early sexual debut were from West Pokot and Nyamira and in multivariate analysis (table 3) those from Nyamira were 1.9 as likely to have experienced early sexual debut as compared to those from Bungoma. Would the authors show the characteristics in these counties that likely brings the differences. Eg, Wealth status?

3. Discussion: The prevalence of early sexual debut reported by authors is significantly lower than regional prevalence and or national prevalence reported by others. The authors should discuss the possible reasons- Is it the methodologies adopted by the other authors? Definition of early sexual debut (dependent variable) by other authors? Is it the target population?

In the conclusion: There is a suggestion to improve knowledge on contraception use. Yet in discussion, the authors note that "Women who had early sexual debut likely did not use contraception at their sexual onset, and hence the likelihood of pregnancy" and also "Other studies have shown that women with a contraceptive use history were likely to engage in early sex, as it this would assure them of pregnancy protection hence the early sexual debut". There is a conflict between the discussion and the conclusion. The discussion suggests that knowledge of and use of contraceptives encourages early sexual debut. Yet the conclusion is to increase knowledge on contraceptive use. The conclusion could be revised to either explicitly note the need for "contraceptive use to avoid early pregnancy among those who initiate early sexual debut"

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Patient safety, Non-communicable diseases, reproductive health

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Gideon Mauti Ogutu, The Catholic University of Eastern Africa, Nairobi, Kenya

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Reviewer Report

3 Views

15 Sep 2025 | for Version 1

Gideon Mauti Ogutu, The Catholic University of Eastern Africa, Nairobi, Nairobi County, Kenya

3 Views Cite this report Responses(0)

Approved

General comment:

The authors have explored an important topic. The objectives and methodology is appropriate and results are adequately presented.
I would recommend publication.

Specific comments:

1. Title: Why the word "Adolescents" in the title yet the inclusion criteria in PMA is 15-49, yet the definition of 'adolescents according to WHO is 10-19 years?

2. Findings: In bivariate analysis (table 2), majority of those who experienced early sexual debut were from West Pokot and Nyamira and in multivariate analysis (table 3) those from Nyamira were 1.9 as likely to have experienced early sexual debut as compared to those from Bungoma. Would the authors show the characteristics in these counties that likely brings the differences. Eg, Wealth status?

3. Discussion: The prevalence of early sexual debut reported by authors is significantly lower than regional prevalence and or national prevalence reported by others. The authors should discuss the possible reasons- Is it the methodologies adopted by the other authors? Definition of early sexual debut (dependent variable) by other authors? Is it the target population?

In the conclusion: There is a suggestion to improve knowledge on contraception use. Yet in discussion, the authors note that "Women who had early sexual debut likely did not use contraception at their sexual onset, and hence the likelihood of pregnancy" and also "Other studies have shown that women with a contraceptive use history were likely to engage in early sex, as it this would assure them of pregnancy protection hence the early sexual debut". There is a conflict between the discussion and the conclusion. The discussion suggests that knowledge of and use of contraceptives encourages early sexual debut. Yet the conclusion is to increase knowledge on contraceptive use. The conclusion could be revised to either explicitly note the need for "contraceptive use to avoid early pregnancy among those who initiate early sexual debut"

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Patient safety, Non-communicable diseases, reproductive health

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (0)

[1] 1. Doyle AM, Mavedzenge SN, Plummer ML, et al.: The sexual behaviour of adolescents in sub-Saharan Africa: Patterns and trends from national surveys. Trop Med Int Health. 2012; 17(7): 796–807. PubMed Abstract | Publisher Full Text

[2] 2. Funmito Omolola F, Olusegun FA, Olumuyiwa OA, et al.: Prevalence and Predictors of Early Sexual Debut among Adolescents in Ogbomoso, Nigeria. Am J Public Health Res. 2018; 6(3): 148–154. Publisher Full Text

[3] 3. Asante KO, Nketiah-Amponsah E, Andoh-Arthur J, et al.: Correlates of Early Sexual Debut Among Sexually Active Youth in Ghana. Int Q Community Health Educ. 2018; 39(1): 9–17. PubMed Abstract | Publisher Full Text

[4] 4. Durowade KA, Babatunde OA, Omokanye LO, et al.: Early sexual debut: prevalence and risk factors among secondary school students in Ido-ekiti, Ekiti state, South-West Nigeria. Afr Health Sci. 2017; 17(3): 614–622. PubMed Abstract | Publisher Full Text | Free Full Text

[5] 5. Alhassan AR, Abdulai K, Alhassan MA: Early Sexual Debut among Ghanaian Women: Correlates and Psychological Effect. BioMed Res Int. 2021; 2021: 5838510. PubMed Abstract | Publisher Full Text | Free Full Text

[6] 6. Seff I, Steiner JJ, Stark L: Early sexual debut: A multi-country, sex-stratified analysis in sub-Saharan Africa. Glob Public Health. 2021; 16(7): 1046–1056. PubMed Abstract | Publisher Full Text

[7] 7. Kushal SA, Amin YM, Reza S, et al.: Regional and Sex Differences in the Prevalence and Correlates of Early Sexual Initiation Among Adolescents Aged 12-15 Years in 50 Countries. J Adolesc Health. 2022; 70(4): 607–616. PubMed Abstract | Publisher Full Text

[8] 8. Lay AAR, Fujimori E, Duarte LS, et al.: Prevalence and correlates of early sexual initiation among Brazilian adolescents. PLoS One. 2021; 16(12): e0260815. PubMed Abstract | Publisher Full Text | Free Full Text

[9] 9. Ethier KA, et al.: NIH Public Access. PLoS One. 2015; 16(1): 1–8.

[10] 10. Melesse DY, Mutua MK, Choudhury A, et al.: Adolescent sexual and reproductive health in sub-Saharan Africa: Who is left behind? BMJ Glob Health. BMJ Publishing Group, 2020; 5(1): e002231. PubMed Abstract | Publisher Full Text | Free Full Text

[11] 11. Darfour-Oduro SA, Grigsby-Toussaint DG: Impact of social environment on sexual behaviors of adolescent girls in 12 sub-Saharan African countries: a cross-sectional study. Reprod Health. 2022; 19(1): 139. PubMed Abstract | Publisher Full Text | Free Full Text

[12] 12. Hailegebreal S, Gilano G, Seboka BT, et al.: Prevalence and associated factors of early sexual initiation among female youth in East Africa: further analysis of recent demographic and health survey. BMC Womens Health. 2022; 22(1): 304. PubMed Abstract | Publisher Full Text | Free Full Text

[13] 13. Bizuayehu HM, Abyu DM, Demessie HF: Assessment of time of sexual initiation and its associated factors among students in Northwest Ethiopia. Int J Public Health. 2015; 3(1): 10–18. Publisher Full Text

[14] 14. Neville SE, Saran I, Crea TM: Parental care status and sexual risk behavior in five nationally-representative surveys of sub-Saharan African nations. BMC Public Health. 2022; 22(1): 59. PubMed Abstract | Publisher Full Text | Free Full Text

[15] 15. Stark L, Tan TM, Muldoon KA, et al.: Family structure and sexual and reproductive health outcomes among adolescents in rural Sierra Leone. Glob Public Health. 2016; 11(3): 309–321. PubMed Abstract | Publisher Full Text

[16] 16. Kangwana B, Austrian K, Soler-Hampejsek E, et al.: Impacts of multisectoral cash plus programs after four years in an urban informal settlement: Adolescent Girls Initiative-Kenya (AGI-K) randomized trial. PLoS One. 2022; 17(2): e0262858. PubMed Abstract | Publisher Full Text | Free Full Text

[17] 17. Okigbo CC, Speizer IS: Determinants of sexual activity and pregnancy among unmarried young women in urban Kenya: A cross-sectional study. PLoS One. 2015; 10(6): e0129286. PubMed Abstract | Publisher Full Text | Free Full Text

[18] 18. Handa S, Palermo T, Rosenberg M, et al.: How does a national poverty programme influence sexual debut among Kenyan adolescents? Glob Public Health. 2017; 12(5): 617–638. PubMed Abstract | Publisher Full Text | Free Full Text

[19] 19. Turi E, Merga BT, Fekadu G, et al.: Why too soon? Early initiation of sexual intercourse among adolescent females in Ethiopia: Evidence from 2016 Ethiopian demographic and health survey. Int J Womens Health. 2020; 12: 269–275. PubMed Abstract | Publisher Full Text | Free Full Text

[20] 20. Oshi DC, Mckenzie J, Baxter M, et al.: ASSOCIATION between SINGLE-PARENT FAMILY STRUCTURE and AGE of SEXUAL DEBUT among YOUNG PERSONS in JAMAICA. J Biosoc Sci. 2019; 51(2): 177–187. PubMed Abstract | Publisher Full Text

[21] 21. Munga B, Nyanjom O, Onsomu E, et al.: Youth and Employment in Sub-Saharan Africa Working but Poor. Kenya, 2014; 303–355.

[22] 22. Mudhune V, Sabben G, Ondenge K, et al.: The Efficacy of a Smartphone Game to Prevent HIV Among Young Africans: Protocol for a Randomized Controlled Trial in the Context of COVID-19. JMIR Res Protoc. 2022; 11(3): e35117. PubMed Abstract | Publisher Full Text | Free Full Text

[23] 23. Speizer IS, Fotso JC, Davis JT, et al.: Timing and circumstances of first sex among female and male youth from select urban areas of Nigeria, Kenya, and Senegal. J Adolesc Health. 2013; 53(5): 609–616. PubMed Abstract | Publisher Full Text | Free Full Text

[24] 24. Zimmerman L, Olson H, PMA2020 Principal Investigators Group, et al.: PMA2020: Rapid Turn-Around Survey Data to Monitor Family Planning Service and Practice in Ten Countries. Stud Fam Plann. 2017; 48(3): 293–303. PubMed Abstract | Publisher Full Text | Free Full Text

[25] 25. Survey Methodology. PMA Data. (accessed Jul.26, 2023). Reference Source

[26] 26. Rutstein SO: Steps to construct new DHS Wealth Index. Wealth Index Constr. 2020; 6. Reference Source

[27] 27. Seff I, Steiner JJ, Stark L: Early sexual debut: A multi-country, sex-stratified analysis in sub-Saharan Africa. Glob Public Health. 2021; 16(7): 1046–1056. PubMed Abstract | Publisher Full Text

[28] 28. Tadesse G, Yakob B: Risky sexual behaviors among female youth in Tiss Abay, a semi-urban area of the Amhara Region, Ethiopia. PLoS One. 2015; 10(3): e0119050. PubMed Abstract | Publisher Full Text | Free Full Text

[29] 29. Nigatu AM, Birhanu AY, Endehabtu BF: Geographical variations of early age sexual initiation among reproductive-age women in Ethiopia: Evidence from EDHS 2016. Arch Public Health. 2020; 78(1): 28. PubMed Abstract | Publisher Full Text | Free Full Text

[30] 30. Nigatu AM, et al.: Early Coital Debut and Associated HIV Risk Factors Among Young Women and Men in South Africa. PLoS ONE. HHS Public Access, 2017; 17(1): 1–8.

[31] 31. Muhammad T, Srivastava S, Kumar P, et al.: What predicts the early sexual debut among unmarried adolescents (10– 19 years)? Evidence from UDAYA survey, 2015-16. PLoS One. 2021; 16(6): e0252940. PubMed Abstract | Publisher Full Text | Free Full Text

[32] 32. Ningpuanyeh WC, Sathiya Susuman A: Correlates of Early Sexual Debut and Its Associated STI/HIV Risk Factors among Sexually Active Youths in Malawi. J Asian Afr Stud. 2017; 52(8): 1213–1224. Publisher Full Text

Correlates of early sex debut among adolescents and young women: A National cross-sectional study

Abstract

Background

Methods

Results

Conclusions

Keywords

Introduction

Methods

Study design, population and data source

Data management

Dependent variable

Independent variables

Statistical analyses

Ethical considerations

Results

Table 1. Social demographic characteristics of the respondents.

Bivariate analysis

Table 2. Bivariate analysis of early sexual debut by selected socio-demographic variables.

Multivariable analysis

Table 3. Multivariable analysis for Early Sexual Debut.

Discussion

Study limitations

Conclusions

What is known about this topic

What this study adds

Data availability

Underlying data

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Are you a Gates-funded researcher?

Thank you!

Correlates of early sex debut among adolescents and young women: A National cross-sectional study

Abstract

Background

Methods

Results

Conclusions

Keywords

Introduction

Methods

Study design, population and data source

Data management

Dependent variable

Independent variables

Statistical analyses

Ethical considerations

Results

Table 1. Social demographic characteristics of the respondents.

Bivariate analysis

Table 2. Bivariate analysis of early sexual debut by selected socio-demographic variables.

Multivariable analysis

Table 3. Multivariable analysis for Early Sexual Debut.

Discussion

Study limitations

Conclusions

What is known about this topic

What this study adds

Data availability

Underlying data

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Competing Interests Policy

Stay Updated

Are you a Gates-funded researcher?

Thank you!