A total of seven hundred thirty-three (733) participants completed the online questionnaire. Nine (9) participants were excluded from the survey because they were above 30 years of age, thus seven hundred twenty-four (724) were in the analysis.
Socio-demographic characteristics of participants (Table 1)
56.4% were male. 78.0% were single. Mean age was of 24.4 (SD± 2.8) years. The majority (87.2%) had attained an educational level of university and 27.2% were salaried employees. Most participants were from central Uganda (37.8%) followed by western Ugandan (35.1%). Most were students (46.5%) at the time of study. 27.2% were paid employees.
Table 1: Socio-demographic characteristics of participants during the COVID-19 lockdown
Variable
|
Frequency N (%)
|
Sample size
|
724 (100)
|
Sex
|
|
Female
|
316 (43.6)
|
Male
|
408 (56.4)
|
Age group in years
|
|
18 to 24
|
395 (54.6)
|
25 to 30
|
329 (45.4)
|
Marital status
|
|
Living single
|
555 (78.0)
|
Married
|
81 (11.2)
|
Cohabiting
|
78 (10.8)
|
Education level
|
|
University
|
631 (87.1)
|
Vocational or Technical Institution
|
46 (6.4)
|
Secondary School and below
|
47 (6.5)
|
Location/Region in Uganda
|
|
Central Uganda
|
274 (37.8)
|
Western Uganda
|
254 (35.1)
|
Eastern Uganda
|
122 (16.9)
|
Northern Uganda
|
74 (10.2)
|
Employment status
|
|
Students
|
337 (46.5)
|
Paid employment (employee on a salary)
|
197 (27.2)
|
Self-employed (Business/Income Generating Activity)
|
62 (8.6)
|
Unemployed: No structured activity
|
69 (9.5)
|
Unemployed: Volunteer or unpaid work
|
59 (8.1)
|
Access to sexual and reproductive health services of participants during the COVID-19 lockdown
Table 2 shows the reported availability of SRH services to the participants in this study. Out of 724 participants, 203 (28.0%) reported no access to information on or education in sexual health. Regarding STI’s, one hundred ninety-five participants (26.9%) reported that they did not have access to testing and treatment for STIs. 29.6% participants did not know whether such services and information were available. 27.2% of participants did not have easy access to their preferred modern method of contraception during the COVID-19 lockdown. 22 % of participants reported that they had needed HIV testing and counselling but could not obtain those services. 50 of the 62 participants who were on HIV treatment had difficulty in getting HIV drugs during the lockdown. 40% of the women who needed menstrual health products had difficulty obtaining these supplies. 8 of the 44 participants who were pregnant at the time of the study could not get maternity care. 5 of the 24 participants who had an abortion during the study could not get follow up care after the procedure.
Table 2. Access to sexual and reproductive health services among Ugandan youths during the COVID-19 lockdown
Variables
|
All (%)
n=724
|
Availability of information and/or education concerning sexuality
|
|
No
|
203 (28.0%)
|
Yes
|
521 (72.0%)
|
Availability of testing and treatment services of STIs
|
|
No
|
195 (26.9%)
|
Yes
|
315 (43.5%)
|
Don't know
|
214 (29.6%)
|
Access to the preferred modern contraceptive
|
|
Not Easily
|
197 (27.2%)
|
Easily
|
132 (18.2%)
|
Not Applicable
|
395 (54.6%)
|
Availability of HIV testing and counselling services
|
|
No
|
159 (22%)
|
Yes
|
349 (48.2%)
|
I Don't know
|
216 (29.8%)
|
Access to Antiretroviral therapy (medication)
|
|
Not Easily
|
50 (6.9%)
|
Easily
|
12 (1.7%)
|
Not Applicable
|
662 (91.4%)
|
Access to menstrual health products such as sanitary pads
|
|
Not Easily
|
127 (17.5%)
|
Easily
|
189 (26.1%)
|
Not Applicable
|
408 (56.4%)
|
Availability of pregnancy care
|
|
Yes
|
36 (81.8%)
|
No
|
8 (18.2%)
|
Access to post abortion care services
|
|
Yes
|
19 (79.2%)
|
No
|
5 (20.8%)
|
Nearly half of the participants (n=357; 49.3%) reported using family planning methods, the overwhelming majority of which used modern methods (Figure 1). Of the 320 participants using modern contraception, the majority (n=232; 72.5%) used condoms. 33 reported using emergency pills, 22 relied on an IUD. 33 on an injectable contraceptive, and 13 used implants.
Lack of transport was the most commonly reported factor that impaired access to SRH services (43%), followed by distance from home (34.5%), cost of services (26.4%) and curfew (24.4%). Other factors were fear or/negative provider attitude (22.5%), no service provider (21.3%), school closure (12.3%) and lack of knowledge as to where SRH services could be obtained (Figure 2).
The Ugandan youths (n=136 or 18.8%) reported having SRH problems during the lockdown. STIs (40.4%) were the commonest problem, followed by unwanted pregnancy (32.4%) and sexual abuse (32.4%). Other SRH problems included unsafe abortions, pregnancy complications, lack of anti-retroviral drugs (ARVs), death of a child and obstetrical fistula (Figure 3).
Influence of socio-demographic status
Bivariate analysis found a statistically significant correlation between marital status and reports of difficulty in accessing SRH information and treatment (p<0.001, Table 3). Cohabiting people were more likely to report problems than married people, while single people were least likely. Both bivariate and multivariate analyses indicated statistically significant correlations of educational status with reports of poor access to SRH information and services (p<0.001). People with university education were less likely to report encountering problems. No statistically significant influence was found for either geographic location or employment status, although there was a trend for.
Table 3: Bivariate and Multivariate regression analyses using Poisson Regression of having a limiting factor to access SRH among Ugandan youths with their social demographics during the COVID-19 lockdown
|
Bivariate
|
|
Multivariate
|
Variable
|
CPR (95%CI)
|
P-Value
|
APR (95%CI)
|
P-Value
|
Sex
|
|
0.965
|
|
0.997
|
Female
|
1
|
|
1
|
|
Male
|
1 (0.89 - 1.12)
|
|
1 (0.89 - 1.12)
|
|
Age group in years
|
|
0.740
|
|
0.424
|
18 to 24
|
1
|
|
1
|
|
25 to 30
|
1 (0.91 - 1.14)
|
|
0.9 (0.83 - 1.08)
|
|
Marital status
|
|
<0.001
|
|
0.016
|
Single
|
1
|
|
1
|
|
Married
|
1.2 (1.04 - 1.41)
|
|
1.1 (0.97 - 1.36)
|
|
Cohabiting
|
1.3 (1.13 - 1.49)
|
|
1.2 (1.06 - 1.41)
|
|
Education level
|
|
<0.001
|
|
0.001
|
University
|
1
|
|
1
|
|
Vocational or Technical Institution
|
1.4 (1.27 - 1.65)
|
|
0.9 (0.72 - 1.08)
|
|
Secondary School
|
1.2 (1 - 1.45)
|
|
1.2 (0.94 - 1.48)
|
|
Location/Region in Uganda
|
|
0.088
|
|
0.294
|
Central Uganda
|
1
|
|
1
|
|
Western Uganda
|
1 (0.91 - 1.2)
|
|
1 (0.9 - 1.2)
|
|
Eastern Uganda
|
1.2 (1.03 - 1.4)
|
|
1.2 (0.99 - 1.34)
|
|
Northern Uganda
|
1.1 (0.95 - 1.39)
|
|
1.1 (0.92 - 1.34)
|
|
Employment status
|
|
0.048
|
|
0.025
|
Student
|
1
|
|
1
|
|
Paid employment (employee on a salary)
|
1.1 (0.94 - 1.23)
|
|
1 (0.87 - 1.2)
|
|
Self-employed (Business/Income Generating Activity)
|
1.2 (1 - 1.44)
|
|
1.1 (0.94 - 1.41)
|
|
Unemployed: No structured activity
|
1 (0.79 - 1.22)
|
|
1 (0.79 - 1.21)
|
|
Unemployed: Volunteer/ non-salaried
|
1.3 (1.09 - 1.53)
|
|
1.2 (1 - 1.42)
|
|
APR: Adjusted Prevalence ratio; CI: Confident Interval; CPR: Crude prevalence ratio
Correlation of socio-demographic factors with the reported SRH health problems
Reported incidence of SRH problems was significantly correlated with marital status (p< .001, Table 4). People who co-habited were most likely to report problems, while single people were least likely. Education level also had a significant influence, as university educated participants were less likely to report SRH problems.
Table 4: Bivariate and Multivariate regression analyses of the correlation demographic factors with reported SRH problems among Ugandan youths during the COVID-19 lockdown
|
Bivariate
|
|
Multivariate
|
|
Variable
|
CPR (95%CI)
|
P-Value
|
APR (95%CI)
|
P-Value
|
Sex
|
|
0.902
|
|
0.994
|
Female
|
1
|
|
1
|
|
Male
|
1 (0.72 - 1.33)
|
|
1 (0.74 - 1.35)
|
|
Age group in years
|
|
0.080
|
|
0.661
|
18 to 24
|
1
|
|
1
|
|
25 to 30
|
1.3 (0.97 - 1.78)
|
|
1.1 (0.76 - 1.54)
|
|
Marital status
|
|
<0.001
|
|
<0.001
|
Single
|
1
|
|
1
|
|
Married
|
2 (1.38 - 3.02)
|
|
1.5 (0.99 - 2.32)
|
|
Cohabiting
|
2.7 (1.88 - 3.74)
|
|
2.3 (1.60 - 3.29)
|
|
Education level
|
|
<0.001
|
|
0.001
|
University
|
1
|
|
1
|
|
Vocational or Technical Institution
|
2.3 (1.51 - 3.47)
|
|
0.5 (0.31 - 0.74)
|
|
Secondary School
|
2.2 (1.47 - 3.4)
|
|
0.8 (0.45 - 1.33)
|
|
Location/Region in Uganda
|
|
0.306
|
|
0.748
|
Central Uganda
|
1
|
|
1
|
|
Western Uganda
|
1.1 (0.74 - 1.56)
|
|
1.1 (0.75 - 1.53)
|
|
Eastern Uganda
|
1.5 (0.97 - 2.2)
|
|
1.2 (0.82 - 1.79)
|
|
Northern Uganda
|
1.1 (0.66 - 1.94)
|
|
0.9 (0.55 - 1.59)
|
|
Employment status
|
|
0.034
|
|
0.198
|
Student
|
1
|
|
1
|
|
Paid employment (employee on a salary)
|
1.5 (1.03 - 2.12)
|
|
1.2 (0.76 - 1.76)
|
|
Self-employed (Business/Income Generating Activity)
|
1.7 (1.04 - 2.79)
|
|
1.2 (0.73 - 2.09)
|
|
Unemployed: No structured activity
|
0.7 (0.32 - 1.41)
|
|
0.7 (0.33 - 1.44)
|
|
Unemployed: Volunteer or unpaid work
|
2 (1.27 - 3.2)
|
|
1.6 (1.03 - 2.64)
|
|
|
|
|
|
|
|
|
|
|
APR: Adjusted Prevalence ratio; CI: Confident Interval; CPR: Crude prevalence ratio