PREVALENCE, AWARENESS AND FACTORS ASSOCIATED TO TEENAGE PREGNANCY AMONG SECONDARY SCHOOL STUDENTS IN THE BUEA HEALTH DISTRICT, SOUTH WEST REGION, CAMEROON

Summary
Background

Adolescent pregnancy remains a major challenge in both developed and developing countries. Adolescence is a phase of transition of physical and mental maturation and development that includes the biological, social and psychological parameters. It is between 10-19 years of age as per the World Health Organization (WHO). Early and unintended pregnancies among adolescents are associated with several adverse healths, educational, social and economic outcomes. The aim of this study is to determine the prevalence, awareness and factors associated to teenage pregnancy among secondary and high school students in the Bueal Health District.

Method: This study will be a cross-sectional community based study conducted from the month of January 2023 to July 2023 in the Buea Health District to collect data. The participants of this study will be secondary and high school teenagers. A multistage sampling method will be used. 300 participants will be recruited for this study. Chi squared test will be used to test association between variables, while multiple logistic regression model will be used to determine associated factors. Statistical significance will be set at a 95% CI, with a p-value < 0.05.
Expected Outcome
The prevalence of the study, factors associated to teenage pregnancy will be used by policy makers to come up with strategies to limit or prevent teenage pregnancy among secondary school adolescent students in the BHD, SWR, Cameroon.
Keywords: Teenage pregnancy, Risk factors, Prevention, Awareness, Sexuality, Adolescent

CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND

Teenage pregnancy, also known as adolescent pregnancy, is pregnancy in a female adolescent or young adult under the age of 20 years. This includes those who are legally considered adults in their country[1],[2]. Adolescent pregnancy remains a major challenge in both developed and developing countries. Early and unintended pregnancies among adolescents are associated with several adverse health, educational, social and economic outcomes[3]. Teenage pregnancies constitute a serious health and social problem worldwide[4].Teenage pregnancy and teenage motherhood are a call for concern worldwide.

Adolescence is a phase of transition of physical and mental maturation and development that includes the biological, social and psychological parameters. It is between 10-19 years of age as per The World Health Organization (WHO)[5]. Among the social consequences of adolescent pregnancies are school drop-out, juvenile violence, suicide and sometimes homicide [6],[7],[8].

It carries major health and social issues with unique medical and psychosocial consequences for both adolescents and society in general. According to World Health Organization(WHO), about16 million girls aging between 15 and 19 years and about, one million girls younger than 15 years give birth every year[9],[10]. WHO in 2014 report showed that the global adolescent birth rate was 49 per 1000 girls aged 15 to 19 years old[11].
Nowadays, the vast majority of teenage pregnancies occur in low- and middle- income countries’ characterized by poor health-care services; therefore, complications during pregnancy, birth and postpartum phase are the second cause of death among girls aging between 15 and 19 years worldwide.

Additionally, it is estimated that some three million teenage girls undergo unsafe abortions, may result in consecutive reproduction problems or even death [9].
Globally, 11% of all births result from adolescent pregnancies, with 95% of these births occurring in low and middle income countries (WHO; 2014) [12]. Teenage pregnancy remains an important and complex issue around the world [12]. It is estimated that about 16 million girls 15–19 years old give birth each year, contributing nearly 11% of all births worldwide [13]. Pregnancy in adolescence is associated with higher risk of caesarean deliveries, low infant birth weight, neonatal asphyxia and prematurity; consequently increasing maternal and infant morbidity and mortality[14].
Teenage/Adolescent pregnancy is a global issue raising concerns for all who are interested in the health and well-being of young women and their children. It carries major health and social issues with unique medical and psychosocial consequences for both adolescents and society in general[15].Teenage pregnancy rates have declined since 2001, although progress has been uneven across regions and countries. Eastern Europe has a higher average teenage pregnancy rate (41.7/1000) than Northern (30.7/1000), Western (18.2/1000) and Southern Europe (17.6/1000). While data on teenage live births are available across Europe, data on teenage abortions are unavailable or incomplete in more than one-third of EU countries.

Reported teenage pregnancy rates are generally lower for countries where parental consent for abortion is not required[16]. About 12 million adolescent girls aged 15-19 give birth every year – most in low- and middle-income countries[17]. An estimated 3.9 million girls aged 15–19 undergo unsafe abortions every year[17].

In low- and middle-income countries, complications from pregnancy and childbirth are a leading cause of death among girls aged 15–19 years[17]. A wide range of factors contribute to the high rates of unintended pregnancy and unplanned births among adolescents; Poor knowledge of sexual and reproductive health services, legal barriers to accessing services, provider bias, stigma around premarital sex and lower decision making autonomy of married adolescents are among the factors contributing to unintended pregnancies[18],[19],[20]. The rate of teenage pregnancy in the United Kingdom is relatively high, when compared with other developed countries; the only other Western countries with higher teenage pregnancy rates are the United States and New Zealand[21],[22].

Although in tradition societies, the majority of these pregnancies are socially desired, several studies have pointed out the enormous risks which are associated associated with teenage pregnancies, such as anemia, preterm labor, urinary tract infections, preeclampsia, high rate of cesarean- sections, preterm birth, and low birth weight infants and even maternal and new mortality [9].Several studies examined the risk and protective factors associated with adolescent pregnancy using an ecological perspective, thus identifying multidimensional factors at the individual, relational, familial and structural levels that influence adolescent pregnancy. Among the several factors at the different levels, systematic reviews showed that poverty, and lower educational attainment are consistently associated with adolescent pregnancy[23].
Teenage pregnancies, however, still also occur in high-income countries and despite much better medical care[9]. Teenage pregnancies are also considered as risky and policy tries to avoid too early motherhood.[9]. This is not only due to medical problems, but first to all social consequences of teenage motherhood.

Therefore, the analysis of causes and consequences of teenage pregnancies have been the topic of much research and debate[24].
Adolescent pregnancy is a major public health problem, particularly in Africa[25]. It is associated with high maternal and child morbidity and mortality and affects the socio-economic development of a country[25]. Evidence from sub-Saharan Africa indicates that 35 percent of pregnancies among 15-19- year (s)-olds were unplanned, unwanted, or untimed and that the teenagers’ relationships were unstable[26].
Today, Sub Saharan African countries lead the world in teen pregnancies: With Niger on the top list of 203.604 births per 100,000 teenage women. Mali follows with 175.4438, Angola (166.6028), Mozambique (142.5334), Guinea (141.6722), Chad (137.173), Malawi (136.972), and Cote d’Ivoire (135.464) [26].
Several studies have shown that the high level of maternal and perinatal morbidity and mortality can be reduced by lowering the high rate of adolescent pregnancy in developing countries[27], [28], [29].
Consequently, reducing the high rate of adolescent pregnancy and maternal mortality is considered as the key Sustainable Development Goals (SDG), target[30].
The Cameroon Medical Council reports that 25 percent of pregnancies occur in girls of school age, and 20 percent of pregnant teens do not return to school[31]. In Cameroon, about 25% of 15 – 19 -year-old females are already sexually active[32] .The fertility rate in this age group is 127 per 1000 women[32]. with 30% of these births resulting from unplanned pregnancies[33].

The 2018 Demographic and Health Survey (DHS) in Cameroon showed that adolescent girls contribute nearly 19% to fertility. Furthermore, 24% of these adolescent girls aged 15 to 19 had already begun their reproductive life[34] .A prevalence of adolescence pregnancy of 13.3% has been revealed in a study conducted in the Buea Health District of the Southwest Region of Cameroon[34].
Reproductive health in Cameroon remains a major public health challenge with an elevated maternal mortality rate. The maternal mortality rate is estimated at 782 deaths per 100,000 live births[12] This high mortality rate remains a dilemma because it involves the young mothers at the moment where they are given birth.
In addition, adolescents contribute 28% of maternal mortality in Cameroon [12]. Cameroon has one of the highest adolescent fertility rates in West and Central Africa. According to DHS 2011, 25.6% of adolescents 15-19 have started sexual intercourse and 21% of them have had a child and 4% are pregnant for the first time.

Adolescent pregnancy constitutes a public health problem in Cameroon: 12 % and deliveries at the University Teaching Hospital (CHU) are teenager [4]. However, the country’s adolescent pregnancy rate is difficult to assess accurately, not least because national statistics on legal abortion are unreliable. They are so because of the wide differences in the local application of the law, and the discrepancies in public health data from one region of Cameroon to the other[4]. Statistics from the Social Welfare Centre in Buea, South West Region (SWR), Cameroon indicate that 5 % of girls in Buea terminate schooling every academic year because of pregnancy.
1.2 Problem Statement