CPQ Medicine (2023) 14:4
Research Article

Assessment of Premarital Sexual Initiation Practice and Associated Factors among Orthodox Sunday School Students at Miskaye Hizunan Medhane Alem Monastry Church, Addis Ababa, Ethiopia, 2022

Bekalu Abebe¹, Trhas Tadesse Berhe^2*, Yared Shiferaw³, Addisu Tadesse Sahile⁴, Getachew Woldeyohannes Tedla² & Binyam Gintamo¹

¹Public Health Department, Addis Ababa Medical and Business College, Addis Ababa, Ethiopia
²Public Health Department, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
³Maternity and Child Health Department Head, Eka Kotebe General Hospital, Addis Ababa, Ethiopia
⁴Public Health Department, Unity University Addis Ababa, Ethiopia

*Correspondence to: Dr. Trhas Tadesse Berhe, Public Health Department, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.

Copyright © 2023 Dr. Trhas Tadesse Berhe, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 14 December 2022
Published: 24 February 2023

Keywords: Monastery Church; Miskaye Hizunan Medhane Alem; Premarital Sexual Initiation; Reproductive Health; Sunday School Students

Abstract

Background: Youths’ risky behavior is one of the public health issues which gained paramount importance in the developed as well as developing counties like. Therefore, this study investigated the prevalence of premarital sexual practice and associated factors among Orthodox Sunday School Students at Miskaye Hizunan Medhane Alem Monastry Church, Addis Ababa, Ethiopia, 2022.

Methods: A quantitative institutional based cross-sectional study was employed. Using the single population proportion formula ,414 Orthodox Sunday School Students were randomly selected using simple random sampling technique based on their registration book. A structured and pretested self –administered questionnaire was used to collect the data and was analyzed using SPSS Version 25. Binary logistic regression was used to identify independent predictors of premarital sexual practices at 95% CI and P value less than 0.05.

Result: The prevalence of premarital sex was 46.3% (CI: 41.3, 51.3). The mean age of sexual initiation in the study population was 17 ± 1.9 years for both sexes. Age between 21-24 years [AOR 7.134 (1.127, 45.154)], having pocket money [AOR 0.102(0.026, 0.394)], having girl/boyfriend [AOR 0.03(0.005, 0.013)] and watching sex video [ AOR 0.157(0.54, 0.455)] were found to be significantly associated with premarital sex.

Conclusion and Recommendation: The current study found that premarital sexual practice was high which was unplanned and unprotected. Since factors such as age range between 21-24, having pocket money, having boy/girlfriend, and watching sex video are significantly associated with premarital sexual practice, consistent Provision of information about adolescent reproductive health should be provided to Sunday school adolescents by the concerned governmental or nongovernmental bodies.

Introduction
Youths are undergoing a rapid shift in their physical and psychological makeup. They are curious and eager to try out novel experiences [1]. Despite this, young people experience a variety of situations, including anxieties, worries, and diverse wants. They sometimes feel embarrassed to ask their parents and other adults for help [2]. Youths and their communities need to be educated on reproductive health from a life cycle perspective so they can make responsible choices about their sexuality and reproductive health [3].

There is an increase in premarital sex everywhere. Premarital sex is seen as dangerous if no action is taken since it puts young people at risk for risky sexual activity, which includes STIs, HIV, unwanted pregnancies, unsafe abortions, teenage pregnancies, childbearing, school dropout, and other problems, including death [4-7]. For example, globally, 35.3 million people live with HIV/AIDS of which 2.1 million are youths. Among 2.3 million new HIV infections, youths (15-24 years) account more than half [8] . Studies in Sub- Saharan African countries reveled that less than one-third of sexually active adolescent girls report using condom during their most recent sexual experience [4,9].

In Ethiopia, the prevalence of premarital sex is increasing [10]. A study conducted in Eastern part of Ethiopia and Lalibela Town reported that above one-fourth of the school youths were exposed to premarital sex [8].

Research finding indicated that premarital sexual practice among university students of Ethiopia have been increasing [2,5,10]. Although religious Sunday schools are institutions where premarital sexual practice is officially prohibited and formal educations are provided to youths, premarital sexual practice among Orthodox Sunday School Students is not sufficiently investigated. But if these students equip with right and sufficient information, they may be role model and turning agents for university students.

Since one of the goals of national AYRH strategy of Ethiopia is to design and implement innovative and evidence based AYRH programs that are segmented and tailored to meet diverse needs of youth by marital status, age, school status, residence, and sex, including younger adolescents and marginalized and most vulnerable young people in the context of Ethiopian priorities and culture [11], the aim of this study was to investigate the prevalence and associated factors of premarital sexual practice among Orthodox Sunday School Students at Miskaye Hizunan Medhane Alem Monastry Church, Addis Ababa, Ethiopia, 2022. So that this study may help policy makers and other concerned bodies in designing appropriate intervention.

Methods and Materials
Study Area and Period: The study was conducted to assess the prevalence of premarital sexual initiation practice and associated factors among Sunday School students, at Sunday school in Miskaye Hizunan Medhane Alem Monastry Church, Addis Ababa, Ethiopia, 2022. Miskaye Hizunan Medhane Alem Monastry Church is one of the Ethiopian Orthodox Twahido Church Which is located in Addis Ababa region, Ethiopia and It is one of the most famous Monastery churches in Ethiopia which is known for its training center for Priests ,monks and Sunday school students. Currently, it has a large number of Sunday school students and is hosting 3,144 males and 9,096 Females (total 12,240) Sunday school adolescent and youth age group students. The study period was from March30 to April 20, 2022.

Study Design: Quantitative institutional based cross-sectional study was employed among all Miskaye Hizunan Medhane Alem Monastry Church, Addis Ababa Sunday school students and the study population were the sampled students selected by simple random sampling technique and who fulfilled the inclusion criteria.

Inclusion and Exclusion Criteria: All male and female Sunday school students who were in the age range of 13-24 and who accepted the assent/ consent for participation in the study were included. Those Sunday school students who were unable to speak, write, hear, see, who were married and absent during data collection period were excluded.

Sample Size Determination: Sample size (n) was calculated based on single population proportion formula from previous study the prevalence of premarital sexual initiation (p) is 42.7 % [12], z-value of 1.96 at 95% confidence interval (CI) and margin of error (d) is 5%. By adding 10% nonresponse rate, the final sample size was 414.

Sampling Procedure: A total of 414 from 12,240 students (males, 3,144 and females, 9,096). Assuming that sex difference affects their premarital sexual practice, Stratified sampling technique was applied. Based on proportion to size allocation, one hundred six male and three hundred eight female students were randomly selected.

Variables: Premarital sexual initiation practice was dependent variable and Socio-demographic characteristics like; Age, Sex, Educational level, marital status, ethnicity, religion, pocket money, and Risky behavior and peer pressure like; chat chewing, drinking alcohol, cigarette smoking, sex film watching, Sexual status of peer and Parental socioeconomic status and discussion about sex matters like; Parental educational level, Parental occupational status, Sexual discussion with parents, Sexual discussion with peer were independent variables.

Data Collection Tool, Method and Procedure: Data were collected using pretested structured, close ended and self-administered questionnaire adopted and adopted from different literatures [12-18]. This selfadministered questionnaire included four parts; the first section inquired about socio demographic data; the second part elicited parental socio-economic status; the third section inquired risky behavior and peer pressure for premarital sexual initiation and the fourth part explored history of premarital sexual initiation practices. To check the accuracy and its consistency, pretest was done on 5% of the total sample size of the participants in similar setting which was outside the study area before the actual study period and the questioner was modified accordingly. The data collectors and supervisors were recruited outside the study area including hospitals and health centers and who had an age of less than 30 years old and supervisors with MPH degree holders.

Data Quality Assurance: Before data collection, a clear introduction explaining the purpose and objectives of the study to respondents was provided. Training was given to data collectors and supervisors on the objective, relevance of the study, confidentiality of information, respondent’s right, and informed consent and assent. The principal investigator and the supervisor made frequent checks on the data collection process to ensure the completeness and consistency of the gathered information and errors found during the process was corrected. A close supervision, honest communication and on spot decision in the field work phase were implemented.

Data Processing and Analysis: After checking the collected data for its completeness and accuracy code was given to the questionnaire, then the data were entered using EPI Data version4.6 statistical software and analyzed using SPSS version 25 statistical package. Data cleaning were performed to check for accuracy, consistencies, missed values, and variables to fix errors. Binary Logistic regression was used to find out the association between the independent variable and premarital sexual practice. To control the confounders, multivariable logistic regressions were used to find out the association between dependent and independent variables, at 95% CI P-value <0.05 was considered as a statistically significant.

Ethical Consideration: Ethical clearance was obtained from the Institutional Review Board of Addis Ababa Medical and Business College (AAMBC/STU/4005/14) and from the church. Written permission letter was obtained from all concerned authorities. Written consents from parents of Sunday school youths were collected and verbal consent from each participant was obtained after explaining the purpose of the study. The objective and importance of the study was explained to the study participants then data were collected only after full informed verbal and written consent/assent was obtained. Confidentiality of the information was maintained by excluding names in the questionnaire.

Operational Definitions and Its Measurements

Adolescents: In this research, it is considered to be the period between age 13 to 24 [2].

Premarital Sex- A penetrative vaginal penile sexual intercourse performed before marriage [2]. It was measured by the answers to the question: “Have you ever had sexual intercourse?” The youths were free to respond either “Yes” or “No”. Those who responded “Yes” and were never married were considered as having premarital sexual practice.

Premarital Sex Initiation - starting of a penetrative vaginal penile sexual intercourse performed before marriage [8].

Unsafe Sex- A penetrative vaginal penile sexual intercourse performed without using condom [13].

Sexually Active- A student who had had premarital sex at least once prior to this study [8].

Result

Socio-Demographic Characteristics
Out of 414 respondents interviewed 400 interview tools were completed with response rate of 96.6%. Of the total respondents 302 (75.5%) were females. Majority of the study participants 311 (78.8%) were in the age group 17-20 years old with the mean age of 17 years. while the majority 170 (47.8 %) were in the age group 15-17 years old. The minimum and the maximum age were 14 and 23 respectively. The minimum and the maximum age were 14 and 23 respectively. More than half proportion (56.3%) of the participants was grade twelve and above students. Two hundred and four (51.0%) of the respondent reported that they had pocket money and 82.5% got the money from their both parents. About 78.3% attending religious services every day (Table 1).

Table 1: Socio Demographic Characteristics towards premarital sexual initiation among Sunday school students at Miskaye Hizunan Medhane Alem Monastry Church, Addis Ababa, Ethiopia (n=400), from march 15-April 10,2022.

*From friends, relatives

Parental Educational and Socio-Economic Status
Regarding parents’ socio-economic status, 5(1.2%) and 29(7.2%) of the respondents reported that their mother and father were not alive respectively. About 97.5% of adolescents were living with their parents. Regarding parents’ educational status 289(72.3%) mother and 209(56.3%) fathers were above grade 12th. Majority of the respondents’ mother 156 (39.5%) were private employer whereas 172(46.4%) of the respondents’ father were merchants. Respondents’ self-rating of their family income shows that majority 233(58.3%) were middle income family (Table 2).

Table 2: Description of parents of the study participants’ educational and socio-economic Status education among Sunday school students at Miskaye Hizunan Medhane Alem Monastry Church, Addis Ababa, Ethiopia (n=400), 2022.

*Unable to read and write, read and write, grade 1-4,
**Alone, mother only, father only, brother, sister

Risky Behavior and Peer Pressure for Premarital Sexual Initiation
From a total of 400 respondents, Majority of the respondent 280(70.0%) had peer friends with 94(33.6%) of them discussed about sexual issue with their peer friends. Regarding risky behaviors, 3(0.8%) had ever chew chat and all of them chew every day. six (1.5%) of the respondent had ever drink alcohol. Six (1.7%) of the respondents’ smoke cigarette. Sixty-two (15.5%) had watched sex film and 50(12.5%) visited Pubs or Bars. Regarding respondents’ peer friend 62(15.5%) of the chew chat, 82(20.5%) drink alcohol, 59(14.8%) smoke cigarette and 59(14.8%) watch sex film. Fifty-eight (14.5%) of the respondents’ peer friend influence the respondents to start sexual intercourse (Table 3).

Table 3: Description of Risky behavior and peer pressure for premarital sexual initiation of among Sunday school students at Miskaye Hizunan Medhane Alem Monastry Church, Addis Ababa, Ethiopia (n=400), 2022.

History of Premarital Sexual Initiation
From total of 400 respondents 142(35.5%) had boy/girlfriend and one hundred eighty-five (46.3 %) of respondents reported that they had premarital sexual intercourse. The mean age at first sexual intercourse was 17 with the minimum and maximum age started sexual intercourse was 14 and 20 respectively. From the total of sexually active students, the majority 62(33.5%) had their first sexual intercourse were under 17 and below years old. Majority of the respondent134 (72.4%) had their first sexual intercourse with their girl or boy friends.

On the other hand, from the total of sexually active respondents, 178(96.2%) had one sexual partner in the past, 2 (1.1%) had two sexual partners and the rest, 7 (2.2%) had three and above partners (Table 4).

Table 4: Description of history of premarital sexual practice among Sunday school students at Miskaye Hizunan Medhane Alem Monastry Church, Addis Ababa, Ethiopia (n=400), 2022.

From Figure 1, Forty-six-point three percent of the respondents had generally premarital sexual initiation practice whereas fifty-three-point seven percent had not premarital sexual intercourse.

Figure 1: Premarital sex practice among Sunday school students at Miskaye Hizunan Medhane Alem Monastry Church, Addis Ababa, Ethiopia (n=400), 2022.

The main reason for initiation of sexual intercourse were fell in love which accounts 93(23.3%) followed by desire to practice sex which accounts 77(19.5%) (Figure 2).

*Material gift, Peer pressure, raped and for money

Figure 2: Reason to start premarital sex among Sunday school students at Miskaye Hizunan Medhane Alem Monastry Church, Addis Ababa, Ethiopia (n=400), 2022.

Binary Logistic Regression Analysis
The relationship between premarital sex and socio-demographic variables such as gender, age, religion, educational level etc. was tested in a binary logistic regression both univariate and multi-variate analysis was done. In univariate logistic regression, age greater than 16 years, educational level above grade 9th and having pocket money were found to be significantly associated with premarital sex.

In multivariate logistic regression analysis was used to minimize the effect of other confounding variables and to identify the real factors contributing to premarital sex initiation. Among the socio-demographic variables, having pocket money were significantly associated with premarital sex [AOR 0.102 (0.026, 0.394)] (Table 5).

Regarding respondent’s behavior, peer pressure and parents’ socio-economic status, both univariate and multivariate logistic regression analysis was done. In univariate logistic regression, having boy/girlfriend, respondent self-behavior like, watching sex film, peer behavior like peer watching sex film and Peer friend initiate sexual intercourse and having alive mother and parents’ economic status were found to be positively and significantly associated with premarital sex (Table 5).

Table 5: Association; pre-marital sex with selected variables among Sunday school students at Miskaye Hizunan Medhane Alem Monastry Church, Addis Ababa, Ethiopia (n=400), 2022

*Indicates significant association, OR-Odd ratio, COR-Crude odds Ratio, AOR-Adjusted Odds Ratio, CIConfidence Interval.

In multivariate logistic regression it was found out that having boy/girlfriend, and watching sex film, were significantly associated with premarital sex. Accordingly, those respondents who had boy or girl friend more likely to had premarital sex than those who did not have [AOR 0.03(0.005, 0.013)]. Those respondents who watch sex film were more likely to have premarital sex than those who did not watch [AOR 0.157(0.54, 0.455)].

Discussion
This study tried to assess the prevalence of premarital sexual initiation and associated factors among Sunday school students at Miskaye Hizunan Medhane Alem Monastry Church. Moreover, the study tried to see associations between premarital sex and socio-demographic variables, risky behavior, peer pressure, and parental socio-economic status.

From the total respondents, the overall prevalence of premarital sex was 46.3% (CI: 41.3, 51.3) which is much higher than other similar studies done in Ethiopia (5, 14-17). In our societies where premarital sex is not culturally or religiously accepted, this result is quite high. The cultural taboos of society, the close and strong supervision of families prevent the young adolescent from engaging in sexual relations before marriage. This finding revealed that there is a high level of sexual practice in the study area. It has been reported that sexual activity among young people is on the rise worldwide. Several studies in sub-Saharan Africa have also documented high and increasing levels of premarital sexual activity among adolescents [18]. The higher finding in this study may be related to low supervision, and control from their family. The mean age of sexual initiation in the study population was 17 ± 1.9 for years for both sexes. From the total of respondents who had history of premarital sex majority of the respondents (78.8%) were in the age 17-20 years; however significant number of respondents also started sex below age 16 which accounts 11.5%. A study done in Uganda also showed that adolescent start sex as early as 10-15 years [19]. This shows that the training of young people in the field of this study with similar age diagrams begin with that of other regions of Ethiopia, although it is higher than the study carried out in Uganda. In this study, it was also found that the risk of an advanced sex increases with the increase in age. The main reason claimed by school adolescents to start sex includes falling in love 93 (23.3%), 77(19.3%) desire practice sex, 5(1.3%) to get money, peer pressure 4(1.0%) and the same as 4(1.0%) by material gift, and 2(0.5%) raped or forced by opposite sex.

The other similar study conducted in East Wollega in the city of Nekemte reported a similar reason for starting premarital sex. Even if the human the physical maturity of reproduction at the onset of puberty, he/she qualifies for: mating and reproduction can be much later after the age of 18 or 20. Most of them too society, including the Ethiopian, insists that any sexual practice outside of marriage is inappropriate. However, in this finding most of Sunday school adolescents 312(78.0%) start sex below age 18 and they proposed the above reasons to start sex. It is true that sex is not wrong in any age; But pre - -marital sex can damage the mental development of adults in different forms. Primary sexual experiences lead many times to the wrong idea that sex should be enjoyed in any way. Forced pre -marital sex will lead to mental depression and dilemma. Another danger is possible to exchange diseases; since the pre-marital partners may not be aware of the diseases that spread through interviews.

Obtain Preliminary sex pregnancy is another disaster. Emotional imbalances and guilt could be the result of most premarital sex. In this study, age between 21-24 years old, having pocket money were found to be positively and significantly associated with premarital sex in the study area. In these findings, sexual activity prior to marriage started as early as age less than 16 years; however age between 21-20 years old had significant association with premarital sex. [COR 0.064 (0.023, 0.181) and AOR 7.134(1.127,45.154)].Similarly work to earn money was found to be positively associated with premarital sex in this study [COR 0.607 (0.408, 0.92) and AOR 0.102(0.026, 0.394)]. Similar studies done in Debre Markos Town reported the same result [2].

Regarding self-risky behavior and peer pressure for premarital sexual initiation, having boy/girlfriend, and watching sex films were significantly associated with premarital sexual practice.142 respondents (35.5%) had boy/girlfriends and those who have a boyfriend or girlfriend Sunday school students were more likely to have premarital sexual intercourse than those who don’t [COR 0.032 (0.004,0.113) and AOR 0,03(0.005,0.013). This could be due to the pressure from their boy/girl friend to have sexual practice.

Students who watched pornographic films were more likely to have premarital sex than those who did not. Something similar can be found in Northern Ethiopia (39). The possible reason could be pornography film leads youth’s physiological and psychological motive for sexual intercourse.

Limitation
In addition, as this study used only quantitative data, the behavioral related information might be missed.

ConclusionThis study showed that early premarital sexual initiation was high. Age between 21 and 24 years old, having pocket money, having a boyfriend/girlfriend, watching pornographic films were identified as factors and found to be positively and significantly associated with premarital sex. And that Sunday school youth started having sex at an early age. So, the Sunday school community and respective health sector need to establish and strengthen school health program about identified risks of premarital sex. Family should supervise their children in addition to link to religious education in parallel to formal school education.

Researchers should conduct further researches to investigate, why early sexual initiation is still a challenge in Ethiopia especially among Sunday school students in the other religious schools like protestant, Islamic etc.

Declaration
Acknowledgments
We would like to thank Addis Ababa Medical and business College for funding to conduct this study. We also would like to also thank the study participants and data collectors’ facilitators for their willingness to take part in this study.

Conflict of Interests
The authors affirm that there is no conflict of interest concerning the publication of this manuscript.

Authors’ Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Permission for Publication
Consent to publish is not applicable for this manuscript because there are no individual data details like images or videos.

Accessibility of Data and Materials
The result of this research was extracted from the data gathered and analyzed based on the stated methods and materials. There are no supplementary files. The original data supporting this finding will be available at any time upon request.

Funding
This research is funded by Addis Ababa Medical and Business College but they had no other role in the manuscript.

Ethical Consideration
Ethical clearance was obtained from the Institutional Review Board of Addis Ababa Medical and Business College (AAMBC/STI/4005/14) and from the church. Written permission letter was obtained from all concerned authorities. Written consents from parents of Sunday school youths were collected and verbal consent from each participant was obtained after explaining the purpose of the study. The objective and importance of the study was explained to the study participants then data were collected only after full informed verbal and written consent/assent was obtained. Confidentiality of the information was maintained by excluding names in the questionnaire.

Bibliography