Prevalence of premarital sexual practices and its associated factors among high school students in Addis Zemen Town , South Gondar , Ethiopia , 2017

1 Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. 2 Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. 3 Department of Comprehensive Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.


INTRODUCTION
Premarital sex is a penetrative vaginal or anal sexual intercourse performed before formal marriage.Some people may be engaged in such sexual practices with many sexual partners and therefore they may have high number of life time sexual partners that could be liable to acquire sexually transmitted infections (STIs) including Human Immunodeficiency Virus (HIV) (Vos, 2004).Young adults are highly affected by sexual related problems and early onset of sexual practice among people in different countries of the world (Laumann, 2006).Most young people often challenged with strong social, peer and cultural pressure to engage in premarital sex (Alemu et al., 2017), which increased their risk of early pregnancy, abortion and exposure to STDs including HIV/AIDS (5).In addition, unwanted pregnancy among female students may lead to school dropout and a failure to complete their education.Hence, unwanted pregnancies may end up with illegal and unsafe abortions, which may lead to death.Therefore, studying premarital sexual practice and associated risk factors among high school students is an essential issue.
On the sexual behavior of the youth the individual, family, drinking alcohol, chewing chat, use of substances other than chat and the peer variables have considerable influences to practice premarital sex (Alemu et al., 2017;Adisu and Abdulbasit, 2014).However, it is one of the least researched topics in the current study area, due to the sensitivity of the topic of premarital sexuality; youth receive inadequate education, guidance and services on reproductive health.To fill the gap, it is thus imperative to study the prevalence of premarital sex and the factors surrounding premarital sex in the context of high school students to inform Ministry of Health, Ministry of Education and planners to develop appropriate and timely intervention programs to prevent high risk sexual behavior such as premarital sex and unsafe sexual practices in these population.Therefore, this study aimed to assess the prevalence of premarital sexual practice and associated factors among high school students in Addis Zemen, South Gondar, Ethiopia.

Study setting and design
A cross-sectional study design was employed at Addis Zemen High School from April to June 2017.Addis Zemen is found in South Gondar Administration Zone in the Amhara region of north western Ethiopia and is around, at a distant of 640 km far from the capital city of Ethiopia.Addis Zemen is the capital town of libokemkem weeds (district) which has average population of 198,374.It has an average altitude of 2,000 m above sea level.Addis Zemen has only one high school named Addis Alem High School which is located 2 km away the main road and it was found in the gate way of Bahir dar

Source population
All Addis Zemen High School regular students enrolled in 2009 E.C Habte et al. 357 academic calendar were the source population.

Study population
The population of the study consist of all Addis Zemen High School students attending their regular education at the time of data collection

Inclusion criteria
All regular high school students and attending their regular education at the time of data collection were included.

Sample size determination
The required sample size was calculated by single population proportion formula and p-value obtained from study conducted in Nekemte, where prevalence of premarital sex among high school adolescents was 21.4%.A formula, [n = , was used to estimate the sample size.where, n= sample size, Z=1.96, p=proportion and d=precision (0.05), (p = 0.214), 95% confidence interval, margin of error 5% (d = 0.05).Computing with the above formula and 10% of contingency for non-response rate gives a total sample size of 284.A Simple random sampling technique was used and the sample size allocated proportionally to 9 th and 10 th grade students.

Data collection tools and procedures
Structured, pretested and self-administered Amharic version questionnaires were used to collect the data.The questionnaires contain socio-demographic, premarital sexual practice and associated factors.Data were collected by six data collectors after training.Participants were informed about the study and written consent were obtained from them.

Data quality management
The questionnaires were initially developed in English and translated to Amharic language then back to English to ensure consistency.It was assessed for clarity and completeness where missed pattern was rephrased.Then it was pre-tested with 10% of total population at Woreta High School students.The data were double entered in EpiEnfo to check the consistency and were cleaned and edited before analysis.

Data processing and analysis
The data were analyzed using Statistical Packages for Social *Corresponding author.E-mail: netmersy@gmail.com,Tel: 0918775130 Author(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution License 4.0 International License

Ethical consideration
Ethical clearance was obtained from Ethical Review Comittie (ERC) of department of Comprehensive Nursing, School of Nursing College of Medicine and Health Sciences and letter of permission from the school was obtained.The study was conducted after getting oral consent from the study participants.Students were not subjected to any harm as far as the confidentiality was kept.No personal identifiers were used on data collection form.

Socio demographic characteristics of the respondent
The response rate was 97.18% and the age ranges of the respondents 'were from 13-25 years with the mean age of 17.51 1.796.One hundred fifty (54.3%) of the study subjects were female.Most of the students were grade 10 th 158(57.2%).Most of the study participants, 271(98.2%),were Amhara, 243(88%) were Orthodox.Majority of the student's family 111(40.2%)can read and write.Monthly income of most of the study subjects' family ranges from 500-1000 Birr which accounts 93(33.7%).Regarding their school payment were covered by both parents 238(86.2%).One hundred ninety-five 195(70.7%)study subjects work different jobs to get money.Majority of them were farm workers (158(57.2%)(Table 1).

Premarital sex
Out of 276 study participants 32.6% had the practice of premarital sexual.Eighty four points four percent (84.4%) were experienced sexual intercourse with only one sexual partner.The minimum age at which the study subjects had sexual intercourse was 13 years and the maximum age was 23 years with the mean age of 17.51.Forty four percent of the respondents responded that falling in love with their sexual partner is their main reason of having the first sexual intercourse (Table 2).

Factors associated with premarital sex
The risk factors associated with premarital sex among the  )) (Table 3).

DISCUSSION
Pre-marital sex is a penetrative vaginal or anal sexual intercourse performed before formal marriage.This study has tried to assess the premarital sexual practice and associated factors among high school students in Addis Zemen, South Gondar.The current study revealed that the mean age of 15.5 years at first sexual intercourse.Studies conducted at Addis Ababa and Gamogofa show that the mean age at first sexual intercourse/initiation was 16.03 and 17.07 years respectively.Practicing at the access technology that could increase watching of pornography and sex movies (Dereje et al., 2015;Marelign and Gistane, 2013).The prevalence of premarital sex among the study participants was 32.6% with the 95% CI (27.5-38.4).This study is in line with the study conducted in Oromia Region, Sebeta Town High School students (28.3%) (Helen, 2014).The current study was higher than a study conducted in Agaro and Nekemte High Schools (25 and 21.4%) (Girma et al., 2004;Dessalegn, 2006), respectively and the possible reason for this difference might be due to advancement and access to technologies in recent years as well as effect of globalization.This study was lower than the study conducted in Kenya (64%) (Mensch et al., 2003) and this might be attributed In this study the main reason to have sexual practice was fall in love 40 (44.4%).Premarital sexual practice by their desire/ interest accounted 44.4% while peer pressure was 6(6.6%).This finding is similar to the study conducted in Sebeta Town Oromia Region where falling in love registered as 46.8% followed by had desire to have sexual practice (38.9%).But the reason of having premarital sex among Northern Ethiopia High School students was due to peer pressure (35.2%), and use of drugs, which is different from the current study (Salih et al., 2015).The possible reason may be adapting of western culture and style.
In this study majority 76(84.4%) of the students who have experienced premarital sex, had one sexual partner.Similarly, the study conducted among Agaro High School adolescent students showed that larger proportion of the study participants 55.6% had one sexual partner (Girma et al., 2004).Having girl/boy friends were 20.66 times at a higher risk than those who have no girl/boyfriend and the association was significant (AOR=20.66,95%CI (9.39,45.46).Students in the lower age groups were 2.48 times high risk than those of higher age groups (AOR=2.4895%CI, (1.24-4.95) and this finding is more or less in agreement with reports made by Bogale and Seme (2014).The study showed that as grade level and age increases the practice of premarital sex decreases and this indicate that level of awareness increases with increased maturity.

Limitation of the study
Although their confidentiality was reassured, since sexuality is a sensitive issue and the respondents may feel that their privacy is violated.As a result, tendency to hold back or give false information could be a limitation to this study.Relying only on self-administered questionnaire, which compromises the quality of raw data in such sensitive issue, is another drawback to this study.

CONCLUSION AND RECOMMENDATION
This study revealed that the prevalence of premarital sex among the study participants is higher than the studies conducted in other parts of Ethiopia.Premarital sexual practice among the study participants was strongly associated with age group and having boy/girlfriends.Furthermore the study showed that students started premarital sexual practice at their lower age group of 13-18 years old.The study showed that as grade level and age increases the practice of premarital sex decreases.Providing school psychosexual services/education to younger populations and establishing club to teach about premarital sexual practice and its risk factor are suggested.

Figure 1 .
Figure 1.Types substance abused by high school students in Addis Zemen Town, 2017.

Table 3 .
Factors associated with premarital sexual practice among high school adolescent students in Addis Zemen Town, 2017.