Health Care : Current Reviews

Youth Friendly Services Utilization and Associated Factors among Young People in Tehuledere District, Northeast Ethiopia: A Cross-sectional Study

Toyeb Yasine^* School of Public Health, College of Medicine and Health Sciences, Wollo University, Ethiopia
^*Correspondence: Toyeb Yasine, School of Public Health, College of Medicine and Health Sciences, Wollo University, Ethiopia, Tel: +251938434917, Email:

Received: 22-Aug-2020 Published: 18-Sep-2020, DOI: 10.35248/2375-4273.20.8.259

Introduction

The world comprises the largest generation of young people in history, with more than 1.8 billion people aged between 10 and 24 years [1].

The World Health Organization (WHO) defines young people as those aged 10–24 years, while adolescents are defined as those aged 10–19 years. Youth age groups 10 to 24 years comprise of 35% of Ethiopia’s population. Hence ensuring their health and future is vital to the nation [2].

The vast majority of youth lives in developing countries and is at risk of adverse health outcomes that are preventable. Adolescence is also an important formative period during which many life style behaviors are learned and established. Thus, acquiring beneficial knowledge, developing positive attitudes, and establishing healthy practices and behaviors at an early age sets the stage for longer-term health [3].

Young people today are facing multilayered problems. They have socio-cultural and economic challenges, uncomfortable and inappropriate environment, absence of comprehensive sexual and reproductive health (SRH) information, and lack of adequate and quality services. And therefore, they are exposed to unwanted pregnancy, sexually transmitted infections (STIs), unsafe abortion, life-long health habits and the like [3,4].

Youth friendly services represent an approach which brings together the qualities that young people demand with high standards that have to be achieved in the best public services. They should be delivered in the right place, at the right time, at the right price (free where necessary) and in the right, accessible, acceptable and appropriate manner without discrimination against any sector [5]. As a result, it has been recognized as an appropriate and effective strategy to address SRH needs of young people since the 1994 International Conference on Population Development (ICPD) in Cairo, Egypt [5].

The essential package of what is offered at youth friendly health services in Ethiopia include: Information and Counselling on reproductive and sexual health issues, and sexuality, promotion of healthy sexual behaviors through various methods including peer education, family planning information, counselling and methods including emergency contraceptive methods, condom promotion and provision, availability of testing services including that of pregnancy and HIV counselling and testing (HCT), management of sexually transmitted infections, antenatal care ( ANC), delivery services, postnatal Care (PNC) and prevention of mother to child transmission (PMTCT)PMTCT, abortion and post Abortion Care, appropriate referral linkage between facilities at different levels [6].

According to the studies conducted in different parts of Ethiopia, youth friendly health services utilization were low, forinstance, it was 63.8% in Harrar 21.5%) in Machakal district, Northwest Ethiopia and 32.2% in Bahirdar [3,7,8].

The major barriers which affect Service utilization of youths were lack of information, accessibility of services, inconvenient location and working hours of health facilities, poor quality of services, and un affordable costs of the services [7,8].

Despite 35% of the Ethiopia population being in the 10-24 age groups, their sexual and reproductive health needs have neither been researched nor addressed adequately [9]. Therefore, this study was conducted to assess youth friendly services utilization and associated factors among young people in Tehuledere district.

Methods and Materials

According Study setting and design

Community based crossectional study was employed in Tehuledere district, Amhara Regional State, Ethiopia from December 1 to15, 2018. The district has a total population of 145,625 of whom 71,356 were males and 74,269 were females and 36,947 were young people ages from 10-24 years. The study population were young people of 10-24 years aged from selected Kebeles of the district.

Sample size determination and sampling procedure

The sample size was calculated by single population proportion formula by considering the following assumptions: proportion 21.5% taken from previous study done in Ethiopia, 95% confidence level, 5% margin of error, designing effect of 2 and 10 % for non-response, the final sample size was 572. Multi stage sampling technique was used to select ten Kebeles [3]. Kebeles were selected by simple random sampling method. The total sample size was allocated proportionally to population size. Finally, respondents were selected systematically, in every Kth intervals. Data were collected through interviewer administered questionnaire developed by review of similar literatures.

Variable Measurment

Youth friendly services utilization: use of at least one service from sexual and reproductive health service packages (medical checkup, consultations, FP counseling and methods, health education, VCT, STIs treatment, pregnancy test, safe abortion and other re-enforcement services rendered to the young people) at health facilities for the last 6 months of data collection [10].

Community conversation: Ongoing community dialogues to increase awareness and health seeking behavior through mutual learning develop decisions and agreement on how to address challenging issues while preserving dignity and maintaining trust and accountability.

Data Process and Analysis

Data were cleared, edited and entered using EPI-info and analyzed using Statistical Package for Social Sciences (SPSS) Version 23 for statistical analysis. First bi-variable binary logistic regression analysis were done to see the association between each independent variable and outcome variable and those variables with p value less than 0.2 were entered to multiple logistic regression model to control for all possible confounders and to identify predictors of the outcome variable. In the final model, those variables with p value less than 0.05 were considered as statistically significant. Adjusted dds ratio (AOR) along with 95% confidence interval (CI) was estimated to measure the strength and direction of association.

Ethical Consideration

Ethical clearance was obtained from the Ethical Review Committee of Wollo University, College of Medicine and Health Sciences. Official letter was written to Tehuledere district health ofice and the respected Kebeles to get permission for the study procedures. An informed oral consent was obtained from each study subjects (≥ 18years) and assent was obtained from their parents/guardians (<18 years) after providing brief explanations about the purpose and objectives of the study. To maintain confidentiality, anonymity was maintained throughout the research process. Furthermore, the right to participate or withdraw from the study at any time was respected.

Results

Characteristics of Respondents

Five hundred seventy two youths were participated in the study with response rate of 100%. About 304 (53.1%) of respondents were males and the mean age of the respondents was 17.16 years with a SD of +4,25. Regarding the occupation of the respondents, 409(71.5%) and 118(20.6%) of them were students and farmers respectively (Table 1).

Table 1. Socio-demographic characteristics of respondents in Tehuledere district, Northeast Ethiopia, 2018.

Access to Information and Youth Friendly Services

Out of 572 respondents 265(46.32%) were heard about youth friendly services. Regarding to sources of information 153 (58.0%), 138 (52 %) and 111(42%) were got information from school, teachers, peers and clubs respectively. On the other hand; 301 (52.62%) were attended community dialogues.

Out of the total 572 respondents, 219(38.3%) of them lived in a distance within 30 minutes walking time to reach to the nearest health facility and the remaining 353(61.7%) were lived more than 30 minutes walking time.

From the total respondents, 248 (43.4%) and 324 (56.6%) participants were responded that working hours were convenient and inconvenient to use the services respectively.

Moreover, respondents of this study were asked whether they faced reproductive illness or not. Out of the total respondents 69 (12.1%) had faced reproductive illness whereas the remaining 503 (87.9%) never had been faced reproductive illness.

Youth Friendly Service Utilization

From the total 572 participants, only 196 (34.3%) were utilized at least one service from youth friendly service packages in the last 6 months before data collection period. From the service packages, 141(72%), 101(52 %) and 110(56%) respondents were utilized SRH information, family planning and recreational services like indoor and outdoor games respectively.

Factors associated with youth friendly service utilization

In multivariable logistic regression analysis, history of RH illness, information on YFS, walking time to reach healthy facility, percieved convenience of working hours and participation in community dialogues were found to be predictors of the outcome variable.

Those who faced RH illness were used YFS services 3.64 times more likely compared with those who not faced RH illness [AOR= 3.64, 95% CI (1.75, 7.60)]. Respondents who had information on YFS used services 9.76 times more likely compared to who had not heard about YFS [AOR=9.76, 95% CI (6.03, 15.79)].

Youths who lived in a distance within 30 minutes walking time to reach to health facility were 3 times utilized youth friendly service than youths who lived more than 30 minutes walking time [AOR=3.00, 95% CI (1.89,4.74)]. Youths who had convenient perception on the working hours of the health facilities were utilized the services 1.7 times than those who had inconvenient perception [AOR=1.69; 95% CI(1.07,2.68)]. Respondents were participated in community dialogues were 1.8 times utilized the services than those who were not participated [AOR=1.77, 95% CI (1.12, 2.78)] (Table 2).

Table 2. Bivariable and multivariable binary logistic regression for youth friendly services utilization among youths in Tehuledere district, Ethiopia, 2018.

Discussion

The finding of this study revealed that about 34.3% of participants utilized youth friendly services. This is similar with the study conducted at Bahirdar (32.2%) and Jimma (34.7%). But YFS utilization has to be excelled by 12.8% than compared with the study conducted at Mechakel (21.5%), Northwest Ethiopia [11]. On the contrary, this study reported less YFS utilization than the study carried out at Harar (63.8%) [12]. The difference might be accounted by the socio-economic differences of study participants. The study showed that among youth friendly service types, the main services utilized by the respondents were sexual information 141 (72%), family planning counseling 101 (52%), and condom utilization 97 (49%). Those services provided to young people also recognized as they are essential packages/ranges of services that has to be provided to young people in friendly manner [10,13].

In multivariable logistic regression analysis, history of RH illness, information on YFS, walking time to reach healthy facility, perceived convenience of working hours and participation in community dialogues were found to be predictors of the outcome variable.

Those who faced RH illness were used YFS services 3.64 times more likely compared with those who not faced RH illness. The main sources of information to young people were school teachers, peers and reproductive health clubs. These findings are consistent with the studies conducted at Harara and Bahirdar [14].

Youths who lived in distance within 30 minutes walking time to reach to health facility were 3 times utilized youth friendly service than youths who lived more than 30 minutes walking time. This is supported by the study conducted at Harrer that is the utilization of services associated with distance to facility [15].

Youths who had convenient perception on the working hours of the health facilities were utilized the services 1.7 times than those who had inconvenient perception. This finding is suported by the study conducted in Jimma, in which one of the associated factor which affects youths not to utilize service was inconvenient working hours of health facilities.

In the same manner respondents who were participated in community dialogues were 1.8 times utilized the services than those who were not participated. A review of literature shows that cultural and social norms influence adolescents to adopt unsafe sex practices in most African countries including Kenya, Malawi, Nigeria, Ethiopia and Uganda. To break the negative norms and to enhance health seeking behaviors, community conversations contributing advantages. As the study carried out at Debremarikos, Jimma & Gonder, discussion with family/relatives, peer group/ friends, sexual partners and teachers on family planning were also the other factors significantly associated with the utilization of the service [6,15].

Conclusions

Less than half of the young people were utilized youth friendly health services. Accessibility of health facilities, convenient working hours of health facilities, participation of youths in community dialogues and information about youth friendly services were factors associated with youth friendly health services utilization.

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