Plain english summary
Background
Methods
Contextual background
Cross-sectional surveys
Results
Socio-demographic characteristics (Table 1)
Characteristic | Durban (N = 400) | Tete (N = 308) | Mombasa (N = 400) | Mysore (N = 458) | ||||
---|---|---|---|---|---|---|---|---|
RDS-Adjusted | RDS-Adjusted | RDS-Adjusted | RDS-Adjusted | |||||
% | 95% CI | % | 95% CI | % | 95% CI | % | 95% CI | |
Age (years) | ||||||||
Median | 27 | 29 | 26 | 34 | ||||
< =20 | 6.4 | 3.6 – 9.7 | 15.6 | 9.0 – 23.8 | 11.6 | 7.5 – 16.3 | 0.3 | 0.2 – 0.8 |
21-25 | 37.3 | 30.1 – 44.4 | 20.6 | 15.3 – 26.6 | 30.6 | 24.6 – 37.5 | 16.6 | 11.2 – 23.4 |
26-30 | 31.3 | 24.9 – 38.1 | 27.1 | 20.3 – 34.5 | 29.0 | 23.5 – 34.7 | 33.0 | 20.8 – 42.1 |
31-35 | 12.8 | 8.7 – 17.3 | 19.8 | 14.6 – 25.6 | 15.7 | 11.0 – 21.1 | 19.5 | 13.7 – 25.2 |
> =36 | 12.2 | 6.7 – 18.4 | 16.9 | 11.2 – 22.2 | 13.0 | 9.3 – 17.2 | 30.7 | 23.2 – 39.2 |
Nationality | ||||||||
National | 99.0 | 97.9 – 99.9 | 32.5 | 23.9 – 40.1 | 97.3 | 95.6 – 98.9 | 100.0 | - |
Foreign | 1.0 | 0.1 – 2.1 | 67.5 | 59.9 – 76.1 | 2.7 | 1.1 – 4.4 | 0.0 | - |
Education | ||||||||
None or less than primary | 10.5 | 6.3 – 15.0 | 10.2 | 5.7 – 15.2 | 47.6 | 40.8 – 54.2 | 79.0 | 67.4 – 87.7 |
Primary completed, secondary not completed | 68.7 | 61.4 – 75.7 | 69.3 | 62.3 – 76.0 | 41.1 | 34.8 – 47.3 | 16.7 | 8.1 – 27.8 |
Secondary completed or higher education | 20.8 | 14.9 – 26.8 | 20.4 | 15.3 – 25.8 | 11.3 | 7.2 – 16.5 | 4.3 | 2.3 – 7.0 |
Years living in current residence | ||||||||
< 3 years | 39.8 | 32.4 – 47.4 | 55.0 | 47.4 – 62.0 | 56.6 | 49.9 – 63.2 | 11.6 | 7.0 – 17.5 |
> = 3 years | 60.2 | 52.6 – 67.6 | 45.0 | 38.0 – 52.6 | 43.4 | 36.8 – 50.1 | 88.4 | 82.5 – 93.0 |
Was away from residence | ||||||||
In the past year | 56.5 | 48.8 – 63.3 | 27.4 | 21.6 – 33.8 | 48.2 | 41.5 – 55.1 | 8.5 | 5.1 – 13.2 |
Present relationship | ||||||||
Married or cohabiting | 28.7 | 22.2 – 35.4 | 8.2 | 2.9 – 15.1 | 1.2 | 0.3 – 2.3 | 54.1 | 44.0 – 6.3 |
Single, never married or cohabited | 70.5 | 63.6 – 77.1 | 31.0 | 24.1 – 37.5 | 61.8 | 55.1 – 67.7 | 3.5 | 1.2 – 6.8 |
Single, previously married or cohabited | 0.8 | 0.2 – 1.6 | 60.8 | 52.9 – 68.8 | 37.1 | 31.1 – 43.7 | 42.4 | 33.4 – 52.6 |
No of commercial sex acts in the past month | ||||||||
Median | 29 | 30 | 20 | 20 | ||||
< =15 | 30.6 | 23.3 – 37.9 | 15.0 | 10.6 – 20.2 | 8.8 | 5.7 – 12.2 | 41.9 | 31.8 – 51.7 |
16-25 | 25.0 | 18.8 – 31.4 | 26.0 | 18.3 – 33.0 | 73.3 | 67.6 – 78.4 | 55.6 | 45.8 – 65.5 |
26-40 | 20.9 | 15.2 – 27.1 | 32.2 | 24.5 – 40.6 | 17.6 | 13.1 – 22.4 | 2.5 | 0.8 – 4.6 |
> 40 | 23.5 | 18.0 – 29.2 | 26.7 | 20.2 – 33.2 | 0.3 | 0.2 – 0.8 | ||
Non-commercial sex partners in the past month | ||||||||
Regular partnera
| 46.8 | 39.6 – 54.2 | 33.8 | 26.0 – 41.0 | 51.7 | 44.9-58.3 | 96.8 | 94.2 – 98.8 |
Occasional partnera
| 20.2 | 14.7 – 25.9 | 48.7 | 40.9 – 56.5 | 24.0 | 17.7 – 30.7 | 59.6 | 50.0 – 69.4 |
Has other source of income | ||||||||
Yes | 10.5 | 6.5 – 15.0 | 19.2 | 13.9 – 25.1 | 42.6 | 36.3 – 49.0 | 27.8 | 21.2 – 35.1 |
Occurrence of SRH risks and use of SRH commodities and services (Table 2 and 3)
RDS-Adjusted % | ||||
---|---|---|---|---|
Durban | Tete | Mombasa | Mysore | |
Currently using contraceptionb
|
N = 381
|
N = 244
|
N = 388
|
N = 381
|
Yes | 91.3 | 86.2 | 98.4 | 95.8 |
Main contraception method usedc
|
N = 346
|
N = 212
|
371
|
373
|
Injectable contraceptives | 29.7 | 42.8 | 25.9 | 0.0 |
Oral contraceptives | 3.2 | 33.3 | 6.4 | 0.6 |
IUD | 0.1 | 2.4 | 0.8 | 1.0 |
Implant | 0.0 | 3.5 | 33.0 | 0.3 |
Condom | 63.7 | 17.0 | 33.3 | 10.0 |
Female sterilization | 3.2 | 0.9 | 0.6 | 88.2 |
Currently using a non-barrier modern contraceptive methodb
|
N = 378
|
N = 244
|
N = 379
|
N = 379
|
Yes | 33.4 | 70.6 | 65.6 | 85.1 |
Ever used emergency contraception |
N = 389
|
N = 298
|
N = 400
|
N = 455
|
Yes | 27.9 | 13.4 | 38.1 | 2.4 |
Unwanted pregnancy in the last five years |
N = 394
|
N = 301
|
N = 345
|
N = 458
|
Yes | 37.6 | 7.5 | 30.6 | 8.0 |
Action taken for unwanted pregnancyd
|
N = 150
|
N = 19
|
N = 122
|
N = 43
|
Went to a health facility for an abortion | 15.0 | (35.9)a
| 21.9 | (93.7)a
|
Kept the pregnancy | 81.2 | (64.1)a
| 70.8 | (6.3)a
|
Went elsewhere for an abortion | 3.8 | (0.0) a
| 7.3 | (0.0)a
|
Ever tested for cervical cancer |
N = 400
|
N = 304
|
N = 399
|
N = 458
|
Yes | 29.0 | 0.0 | 14.4 | 11.5 |
Ever tested for cervical cancere
|
N = 124
|
N = 144
|
N = 122
|
N = 337
|
Yes | 43.8 | 0.0 | 21.1 | 13.6 |
Forced sex in the past 12 months |
N = 393
|
N = 264
|
N = 399
|
N = 458
|
Yes | 36.3 | 13.5 | 14.9 | 7.1 |
Condom use at last forced sex incidentf
|
N = 129
|
N = 38
|
N = 63
|
N = 39
|
Yes | 47.5 | (20.4)a
| 26.2 | (38.5)a
|
Sought medical care for last forced sex incidentf
|
N = 121
|
N = 40
|
N = 62
|
N = 41
|
Yes | 38.8 | (40.2)a
| 34.4 | (51.9)a
|
Used all services she neededg
|
N = 393
|
N = 272
|
N = 391
|
N = 428
|
Yes | 19.4 | 32.7 | 40.9 | 25.7 |
Tete vs Durban | Mombasa vs Durban | Mysore vs Durban | Mombasa vs Tete | Mysore vs Tete | Mysore vs Mombasa | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
ORb
|
p-value | OR |
p-value | OR |
p-value | OR |
p-value | OR |
p-value | OR |
p-value | |
Currently using contraceptionc
| ||||||||||||
Yes | 0.76 | 0.988 | 6.74 | 0.001 | 3.96 | 0.979 | 8.81 | 0.001 | 5.17 | 0.942 | 0.59 | 1.000 |
Main contraception method usedd
| ||||||||||||
Injectable contraceptives | 1.94 | 0.110 | 0.91 | 0.999 | <0.01 | <0.001 | 0.47 | 0.016 | <0.01 | <0.001 | <0.01 | <0.001 |
Oral contraceptives | 21.61 | <0.001 | 6.50 | 0.106 | 0.51 | 0.979 | 0.30 | 0.002 | 0.02 | <0.001 | 0.08 | 0.100 |
IUD | 6.49 | 0.651 | 7.37 | 0.577 | 8.67 | 0.816 | 1.14 | 1.000 | 1.34 | 1.000 | 1.78 | 1.000 |
Implant | - | - | - | - | - | - | 17.18 | <0.001 | 0.34 | 0.538 | 0.02 | <0.001 |
Condom | 0.12 | <0.001 | 0.29 | <0.001 | 0.07 | 0.072 | 2.32 | 0.021 | 0.54 | 0.994 | 0.23 | 0.691 |
Female sterilization | 0.19 | 0.377 | 0.08 | 0.150 | 79.36 | 0.004 | 0.42 | 0.988 | 411.6 | 0.001 | 988.9 | <0.001 |
Currently using a non-barrier modern contraceptive methodc
| ||||||||||||
Yes | 4.11 | <0.001 | 3.74 | <0.001 | 6.98 | 0.059 | 0.91 | 0.999 | 1.70 | 0.982 | 1.86 | 0.958 |
Ever used emergency contraception | ||||||||||||
Yes | 0.62 | 0.598 | 1.76 | 0.062 | 0.11 | <0.001 | 2.82 | 0.003 | 0.169 | 0.003 | 0.06 | <0.001 |
Unwanted pregnancy in the last five years | ||||||||||||
Yes | 0.16 | <0.001 | 0.86 | 0.985 | 0.18 | <0.001 | 5.39 | 0.001 | 1.14 | 1.000 | 0.211 | <0.001 |
Action taken for unwanted pregnancye
| ||||||||||||
Went to a health facility | 3.46 | 0.622 | 5.44 | 0.016 | 47.97 | 0.002 | 1.57 | 0.997 | 13.86 | 0.242 | 8.81 | 0.246 |
Ever tested for cervical cancer | ||||||||||||
Yes | - | - | 0.39 | 0.008 | 0.25 | <0.001 | - | - | - | - | 0.63 | 0.673 |
Ever tested for cervical cancerf
| ||||||||||||
Yes | - | - | 0.36 | 0.091 | 0.21 | 0.002 | - | - | - | - | 0.57 | 0.641 |
Forced sex in the past 12 months | ||||||||||||
Yes | 0.38 | 0.003 | 0.31 | <0.001 | 0.21 | <0.001 | 0.83 | 0.989 | 0.55 | 0.441 | 0.66 | 0.822 |
Condom use at last forced sex incidentg
| ||||||||||||
Yes | 0.43 | 0.841 | 0.31 | 0.168 | 2.68 | 0.599 | 0.72 | 0.998 | 6.21 | 0.275 | 8.64 | 0.040 |
Sought medical care for last forced sex incidentg
| ||||||||||||
Yes | 0.81 | 0.999 | 1.63 | 0.972 | 3.41 | 0.477 | 2.02 | 0.894 | 4.23 | 0.355 | 2.09 | 0.752 |
Used all services she neededg
| ||||||||||||
Yes | 2.77 | 0.002 | 3.99 | <0.001 | 1.76 | 0.622 | 1.44 | 0.498 | 0.64 | 0.872 | 0.44 | 0.287 |
Discussion
Conclusion
Acknowledgements
Funding
Availability of data and materials
Authors’ contributions
Competing interests
Consent for publication
Ethics approval and consent to participate
-
The University of Witwatersrand’s Human Research Ethics Committee in South Africa (Ref: M120324),
-
The National Committee of Bioethics for Health in Mozambique (Ref: 358/CNBS/12)
-
The KNH/UoN Ethics and Research Committee in Kenya (Ref: KNH-ERC/A/233), and
-
The Asha Kirana Institutional Ethics Committee in India (Ref: AK-IEC 021/2011), and by the ethical board of the coordinating agency in Belgium:
-
The Commission for Medical Ethics of the University Hospital Ghent (Ref: 2012/843).