Nghiên cứu Kiến thức thái độ Hành vi chăm sóc sức khỏe sinh sản ở nữ thanh niên

Sexual Reproductive Knowledge, Attitudes
and Behavior among Adolescent   Akha
Females, LuangNamtha province, Lao
People’s Democratic Republic   (PDR): A
Qualitative and Quantitative Study 

Faculty of Postgraduate Studies, University of Health
Sciences
7th GMS-ICPH, 26-27 September, 2015
Hue University of Medicine and Pharmacy, Vietnam


Background
• Gender and ethnicity issues have become important
• Government expands the reach of basic services to
remote areas where many ethnic populations live
• Traditional norms and practices are also changing as
young people migrate from remote areas
• Reduction in maternal mortality appears to be slow in
remote rural areas
• The rural maternal mortality ratio is more than three
times higher than urban ratio
• Early marriage and pregnancy in adolescence are the
norm in Laos especially in in remote rural areas


Rational
• In the AKha ethnic group, there was some ritual passage of
puberty and cultural acceptance of multiple sex partners
make adolescents more at risk of STIs
• Low knowledge of sexual reproductive health among those

who are sexually active and barrier of accessibility to
adolescent sexual reproductive health services, will likely
lead to have an impact on sexual health such as STIs and
HIV/AIDS
• Gap of understanding SRH knowledge and attitudes
towards sexuality among Akha girls
• Many complex factors prevent ethnic adolescent girls from
seeking sexual reproductive healthcare services


Research questions
• What is the sexual knowledge of Akha girls?
• How do Akha ethnic girls in Laos utilize health care services?
• How do Akha ethnic girls seek care for their sexual
reproductive healthcare services and the factors that influence
their care seeking?


Methodology
• Design: Cross-sectional study using quantitative and qualitative
methods
• Project Sites: Long and Sing districts Luangnamta province
• Study population: Female AKha adolescents aged 14 to 19 years old.
Other key informants: head villagers, LYU, LWU, directors’ district and
provincial health office and hospitals, and health providers


Methodology
• Measures: Structured questionnaires were used to determine
adolescent’s knowledge and attitudes towards sexual

reproductive health
• Qualitative methods: FGDs, informal discussion, and in-depth
interview to understand the need of comprehensive sexuality
education (CSE) and the barriers of accessibility to ARH
services


Socio-demographic Characteristic
• 409 female Akha adolescents were participated in the
study.
• The mean age of participants was 15.6+.52.
• One third of adolescents are in the age 14 years and
one fourth of them are in the age of 15 years.
• 49.6% had had primary schooling,
• 14.4% had reached middle school,
• 2.2% had reached high school and
• 1% had continued their education beyond high school;
32.8% had had no schooling.
• At the time of the survey, 64.8% are out-of-school.


Socio-demographic Characteristic
• 61.4% of the females indicated that they experienced of
‘Breakthrough Vagina’ and
• 19.3% experienced of welcome guest.
• The age of initiating ‘Breakthrough Vagina’ ranged from 11 to
17 years with a mean of 13.5+1.08;
• The mean age of experience welcome guest was 14.8+1.34
and ranged from 11 to 18 years.

Knowledge
Knowledge

Mean

SD

Min

Max

Reproductive health
knowledge

1.7 0.512

1

Contraceptive knowledge

4.4 0.795

1 51.7

STIs knowledge

7.2 1.620

3

13

HIV knowledge

7.0 2.104

2

12

•

3

Participants had high levels of knowledge of contraception, low levels of knowledge
of STIs/HIV/AIDS, and moderate levels of knowledge on reproductive health.


Source of SRH Information


Factor associated with premarital
sexual behaviors

Having experience of welcome guest (OR ; 95% CI (5.7; 3.1 – 10.
Drinking alcohol (OR ; 95% CI (4.2; 2.1 – 8.4))
Older age (OR ; 95% CI (1.2; 1.0 – 1.5))
Knowledge of HIV/AIDS (OR ; 95% CI(0.8; 0.7 – 0.9)
Knowledge of STIs (OR ; 95% CI(0.8; 0.67 – 0.9)

High education (OR ; 95% CI (0.3; 0.1 – 0.8))

Factor associated with multiple sex
partners

Having experience of welcome guest (OR ; 95% CI (3.8; 2.0 – 7.0))

0

0.25 0.33 0.5 1

Protective effect

α
2

3

4

5

6

7

8

9

10 11

Risk effect


Contributing factors to the sexual risk
behaviors
• Attitudes towards sexuality - premarital sex appears to be more
acceptable to both males and females in the Akha sexual culture.
• Multiple sex partners are perceived as acceptable
• Traditional practices such as Break Through Vagina’ (BV) for girls –
do not usually contraceptives (perceived as not having sex)
• Many girls participated in the welcome guest which entails visiting
men to any Akha village who are entertained and served sexually
by young women of the host village - makes them more vulnerable
to STIs/HIV/AIDS.
• Low condoms even though they know about condoms – perceived
as not natural


Barriers young people’s facing in accessing
SRH services
• Lack of money
•  “Adolescents did not go to hospitals if their parents did not have
money. Some have relatives, so they could borrow from relatives
as there were direct and indirect expenses for using health
services” (Girl, 17 years old)
• Distance to Facilities
• Poor road conditions were mentioned by adolescents as the
barriers to seeking care or use health services. 

•  “We stayed far from the health center and we have to walk from
our village to the health center about 2 hours. There was no public
transportation from our village to the city; however, there was
only one truck in our village.“ (Girl, 17 years old)


Shyness, embarrassment and
communication
• Shyness - adolescent girls dared to discuss with health
care providers.
• Embarrassment –
“They are afraid to be seen by others, so they did not use
health services at the public health facilities” (Male
health care provider, 52 years old)
• Difficulty in communication with the health care
providers - most did not speak Lao loum language


Conclusion
• This is the first study that examines SRH knowledge of,
attitudes and accessibility to ASRH information &
services among female Akha adolescents in the
Luangnamtha province, Lao PDR.
• The study revealed high knowledge of contraception,
low STIs/HIV/AIDS, however, they had moderate
knowledge on reproductive health.
• The findings also found a significant proportion of Akha
girls engaged in premarital sex, early age at first sex,
multiple sex partners, and low condom use.

Recommendation
• Akha girls should be targeted with preventive interventions so
as to discourage their sexual initiation.
• A policy introducing sexuality education to out-of-school Akha
girls should be considered. Sex education must include
material that will increase sex-related knowledge, conception,
sexual development and contraception.


Recommendation
• Keep adolescents in the schools or reduce the number of out
of school youth, and promote enrollment adolescents in
secondary schools and higher education (long term
perspective).
• Increase adolescent’s accessibility to ASRH information and
services by providing the youth friendly services at the district
level.


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