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Determinants of self-reported sexually transmitted infections among reproductive age women in Senegal: evidenced by Senegal demographic and health survey

Contraception and Reproductive Medicine volume 9, Article number: 53 (2024) Cite this article

Abstract

Background

Globally, access to sexual and reproductive health is a significant public health issue for women of the reproductive age group. Senegal is a low-income country with limited access to reproductive health services, such as in the prevention and treatment of STIs. The prevention and treatment of STIs is one of the goals set by the government to decrease reproductive health-related morbidity and mortality among women. So, the main objective of this research was to evaluate the prevalence’s and determinant of self-reported sexually transmitted infections among reproductive-age women.

Methods

Data from the 2023 Senegal Demographic and Health Survey datasets were used for secondary data analysis. A total of 16,583 women of reproductive age participated in the study. Bivariate analysis was employed in order to select the factors for multivariate analysis. In the multivariate analysis, variables with p < 0.05 significance levels were considered to be significant predictors of sexually transmitted infections among reproductive-age women. Finally, the percentage and odd ratio, together with their 95% confidence intervals, were reported.

Results

The prevalence of sexually transmitted infection among women was 3.21% with a 95 CI. [2.95–3.49] in the last 12 months. Being between the age range of 20 and 44 years old; attending higher education [AOR: 2.70, 95% CI (1.74, 4.19); P = 0.0001]; women who were never in union [AOR: 0.09, 95% CI (0.046, 0.17); P = 0.001] were positively associated with sexually transmitted infections among women. In contrast to this, living in Louga [AOR: 0.41, 95% CI (0.23,0.69); P = 0.001]; Fatick [AOR: 0.33, 95% CI (0.18,0.61); P = 0.0001]; Kolda [AOR: 0.23, 95% CI (0.11,0.49); P = 0.0001]; Kedougou [AOR: 0.34, 95% CI (0.17,0.68); P = 0.002]; and Sedhiou [AOR: 0.43, 95% CI (0.23,0.79); P = 0.007] and women who had history terminated pregnancy [AOR: 1.27, 95% CI (1.03,1.58); P = 0.023] were negatively associated with sexually transmitted infections among women.

Conclusions and recommendations

Women’s sexually transmitted infection has been associated with sociodemographic and geographic determinants such as the age of the woman, region, educational status, marital status, and history of terminated pregnancy. Therefore, to prevent the spread of sexually transmitted infections among women, the governments of Senegal and other concerned stakeholders should give special attention to women by addressing sociodemographic and geographic determinants.

Introduction

Background

Globally, access to sexual and reproductive health (SRH) is a significant public health issue for women of the reproductive age group [1]. Sexually transmitted infections (STIs) are an important public health challenge worldwide, with an estimated 357 million new cases of four curable STIs (chlamydia, gonorrhea, trichomoniasis, and syphilis) among 15–49 year old’s, 417 million cases of herpes simplex type 2 (HSV2), and 291 million cases of human papillomavirus (HPV) among women each year [2]. In sub-Saharan Africa (SSA), the incidence of STI was estimated at 63 million per year, making it one of the most affected areas in the world, sharing an estimated 40% of the global STI burden [2, 3]. Women often have more serious health problems from STIs than men; including pelvic inflammatory disease, ectopic pregnancy, postpartum endometriosis, infertility, and chronic abdominal pain in women; adverse pregnancy outcomes, including abortion, intrauterine death, and premature delivery; neonatal and infant infections and blindness [4]. In 2018, new infections totaled nearly $16 billion in direct lifetime medical costs. While medical costs alone are significant, the overall cost of STIs is higher when factoring in costs associated with maternal transmission, STI prevention, lost productivity, or other non-medical costs [5]. Several studies in Senegal demonstrated that sexually transmitted infections among women were associated with sociodemographic factors such as age groups, marital status, place of residence, education status, religion, and media exposures [6,7,8,9,10,11].

Although, there are several studies that were done in Senegal related to STI among reproductive age women in different settings [12,13,14,15,16]. Up to our knowledge, there is no studies that were done in this particular topic at national Level. So, the major objective of this research was to evaluate the prevalence’s and determinant of self-reported sexually transmitted infections among reproductive-age women in Senegal at national level. Furthermore, policymakers and other stakeholders can use this finding as a foundation to create and implement appropriate intervention programs aimed at reducing the incidences of sexually transmitted infections among women.

Methods and materials

Study setting and period

The Republic of Senegal, is the westernmost country in West Africa, situated on the Atlantic Ocean coastline. Senegal is located 14 degrees north of the equator and 14 degrees west of the Prime Meridian. Senegal is bordered by Mauritania to the north, Mali to the east, Guinea to the southeast and Guinea-Bissau to the southwest [17]. The National Agency for Statistics and Demography (ANSD), in collaboration with other relevant stakeholders and with technical support from ICF, conducted the 2023 Senegal demographic and health survey on behalf of the Government of Senegal. Data collection was carried out from January to August 2023 with a break of approximately two months, i.e., five-month collection period [18].

Data source / data extraction and study population

After permission was secured through an online request by explaining the aim of the study, the data for this analysis were obtained from the 2023 Senegal Demographic and Health Survey that were accessible at DHS portal of (https://dhsprogram.com/data/dataset_admin/index.cfm). The study population for this study was extracted from the IR (individual record) of the 2023 Senegal demographic and health survey. All reproductive age women (15–49) extracted from the IR file was included in this analysis.

Study design

The data for this analysis were obtained from the 2023 Senegal Demographic and Health Survey that employed a community-based cross-sectional study design. The 2023 Senegal DHS sample was designed to ensure adequate representation at the national level but also at the level of urban and rural areas, as well as for the 14 regions of the country. This is an area survey, stratified and drawn in two stages. The primary sampling unit is also called a cluster. Each region was separated, partly urban and partly rural, to form the sampling strata, and the sample was drawn independently in each sampling stratum. In total, 28 sampling strata were created. In the first stage, 400 clusters were drawn with a probability proportional to their size, the size being the number of households residing in the cluster. At the second level, in each of the clusters selected at first stage, a fixed number of 22 households was selected with a systematic probability drawing equal, from the newly established lists at the time of enumeration. Among the 400-clusters selected, 186 are located in urban areas and 214 in rural areas. A total of 8,423 households have been selected to be included in the 2023 Senegal Demographic health survey. In the selected household; 17,459 reproductive age women were eligible for individual interviews; 16,583 women were interviewed, resulting in a 95% response rate (Figure 1) [18].

Fig. 1
figure 1

demonstrated that the sampling process of Senegal women of reproductive age was presented diagrammatically [18]

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Study variables

The outcome variable for this study was self-reported sexually transmitted infections among women. It is a variable with a dichotomous outcome (no or yes). Women were asked whether they had a disease that had acquired through sexual contact in the past 12 months. If the women hadn’t sexually transmitted infections in the last twelve months, which was labeled as “no” and coded as “0,” and if the women had sexually transmitted infections in the last twelve months, which was labeled as “yes” and coded as “1,”.

Independent Variables

age of the women, region, place of residence, educational status, marital status, religion, sex of household head, combined wealth index, community wealth quantile, frequency of reading magazine, frequency of listening to radio, frequency of watching television, community media exposure, history of terminated pregnancy, number of living children, smoking cigarettes, and modern contraceptive use (Table 1).

Table 1 The description of the independent variables
Full size table

Data management and analysis

STATA version 14 was used for data extraction, recoding, descriptive analysis, and analytical analysis. We carried out weighting by dividing the total number of women in the entire country by the appropriate survey sampling proportion and the standard weights of the women. Bivariate analysis was employed to select the factors for multivariate analysis. In the multivariate analysis, variables with p < 0.05 significance levels were significant predictors of sexually transmitted infection among reproductive-age women. Finally, the percentage and odd ratio were provided, together with their 95% confidence intervals.

Ethical consideration

For this investigation, an ethical review and participant agreement were not required because the demographic and health survey program utilized secondary, easily accessible survey data. We requested permission from the DHS Program to use the data we obtained from their website, and they gave it to us.

Results

Socio-demographic characteristics of the participants

In all, 16,583 women of reproductive age participated in this investigation. There were about 4,024 (24.27%) found between the age range of 15–19 years; 1,531 (9.23%) lived in Thiès region; 9,112 (54.95%) were rural residents; 7,673 (46.27%) did not attend formal education; 11,005 (66.36%) were married; 16,051 (96.79%) were Muslims. 12,155 (73.30%) were households headed by men; 3,900 (23.52%) were poorest in wealth; 14,605 (88.07%) didn’t read magazines at all; and 6,756 (40.74%) didn’t listen to the radio at all. 9,050 (54.57%) were watched on television at least once a week. 14,306 (86.27%) had community media exposure; 2,347 (14.15%) had a history of terminated pregnancy; 5,952 (35.89%) haven’t had children; 16,477 (99.55%) were non-smokers; and 2,722 (16.41%) used modern contraceptives (Table 2). The prevalence of sexually transmitted infection among women of reproductive age was 3.21% with a 95 CI. [2.95–3.49] in the last 12 months (Table 3).

Table 2 Socio demographic characteristics of reproductive age women in Senegal 2023
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Table 3 Prevalence’s of sexual transmitted infection among reproductive age women in Senegal 2023
Full size table

Factors analysis associated with sexually transmitted infections

The results of the bivariable analysis showed that among women, sexually transmitted infections were statistically and significantly associated with age of the women, region, place of residence, educational status, marital status, wealth index, frequency of listening to radio, frequency of watching television, community media exposure, history of terminated pregnancy, number of living children, and modern contraceptive use. Those variables were considered for the multivariate analysis. The results of the multivariate analysis demonstrated that sexually transmitted infections were statistically and significantly associated with the age of the women, region, educational status, marital status, and history of terminated pregnancy.

The finding from this study shows that the odds of sexually transmitted infections between the age range of 20 and 44 years old were more likely compared to women whose ages were between 15- and 19-years old’s. The odds of sexually transmitted infections among women who lived in Louga [AOR: 0.41, 95% CI (0.23,0.69); P = 0.001]; Fatick [AOR: 0.33, 95% CI (0.18,0.61); P = 0.0001]; in Kolda [AOR: 0.23, 95% CI (0.11,0.49); P = 0.0001]; in Kedougou [AOR: 0.34, 95% CI (0.17,0.68); P = 0.002]; and Sedhiou [AOR: 0.43, 95% CI (0.23,0.79); P = 0.007] were less likely relative to women who were living in Dakar region.

Sexually transmitted infections among women who were attending higher education were 2.70 times more likely [AOR: 2.70, 95% CI (1.74, 4.19); P = 0.0001] relative to women who weren’t attending formal education. Sexually transmitted infections among the women who were never in union were 0.09 times less likely [AOR: 0.09, 95% CI (0.046, 0.17); P = 0.001] compared to the others (living with partner, divorced, widowed, and separated). The odds of sexually transmitted infections among women who had a history terminated pregnancy were 1.27 times more likely [AOR: 1.27, 95% CI (1.03, 1.58); P = 0.023] compared to their counterparts (Table 4).

Table 4 Factors associated with sexual transmitted infection among reproductive age women in Senegal 2023
Full size table

Discussions

In the last 12 months, the prevalence of sexually transmitted infection among women was 3.21%, with a 95 CI [2.95–3.49]. This finding was higher than study which was conducted in Hong Kong (2.5%) [19]. This finding was lower than studies which were conducted in Gambia (53.6%) [20], in Morocco (38.6%) [21], in Mali (14.1%) [22], in Kenya (13%) [23], and in Brazil (36.5%) [24]. The possible reasons for this variation could be the difference in the study period, method of estimation, sample size, socioeconomic, sociocultural, and geographic location of the study area.

The finding from this study shows that the odds of sexually transmitted infections between the age range of 20 and 44 years old were more likely compared to women whose ages were between 15- and 19-years old’s. This finding was opposed by the studies which were conducted in Swaziland [25], in Dubai [26], in Brazil [27] and in Malawi [28]. This could be further explained by reasons that young women’s are sexually active and engaged in unprotective or unsafe sexual activity that prone them to STIs; some young people do not get the recommended STI tests; and many young people are hesitant to talk openly and honestly with a doctor or nurse about their sex lives [29].

Sexually transmitted infections among women who lived in Louga, Fatick, Kolda, Kedougou, and Sedhiou were less likely relative to women who were living in the Dakar region. This might be due to the variations in health care’s facilities, health-seeking behaviors, access to media, socioeconomic, sociocultural, knowledge, attitude, and practice towards risky sexual behaviors across the regions, which contribute to the regional differences in STIs in Senegal. Furthermore, Dakar, the smallest and most populated region of Senegal, encompasses the country’s capital city and may have had a higher prevalence of STIs due to the high number of migrant women, commercial sex workers, construction workers, and long-distance truck drivers that increase the risk of engagements in the risky sexual behaviors.

Sexually transmitted infections among women who were attending higher education were more likely relative to women who weren’t attending formal education. This finding was in line with studies which were conducted in Ethiopia [30] and in Malawi [28]. This might be more explained by the study that has reported a positive relationship between education and the spread of STIs and HIV/AIDS [31] suggesting that an increase in the level of education increases the likelihood of STIs and HIV/AIDS infections. This view indicated that an increased education level improved the wealth index of people, and the migration of women from the rural to the urban area to live better life, which increases the risk of engagements in sex with multiple partners. Additionally, other studies have revealed that adolescents get involved in sex while still at school [32, 33]. This finding was opposed by the studies which were conducted in Dutch [34], in Indonesia [35], in Durban [36], in sub-Saharan Africa [37], in Swaziland [25] and in Tanzania [38]. This might be that education, in many respects, increases knowledge of STIs and HIV/AIDS that helps to mitigate the spread of STIs [39, 40]. It also prevents new infections because knowledgeable persons can make informed decisions about their sexual life.

Sexually transmitted infections among the women who were never in union were less compared to the others (divorced, widowed, and separated). It could be the case that being divorced, widowed, and separated is linked to feelings of loneliness and relationship dissatisfaction. So, divorced, widowed, and separated people engaged in risky sexual behavior (unsafe sex) to cope with negative feelings associated with social isolation or disconnection, which has been identified as a major risk for STIs.

Sexually transmitted infections among women who had a history terminated pregnancy were more likely compared to their counterparts. This finding was in line with the studies that were conducted in Ethiopia [41], in China [42], in Ethiopia [43, 44], and in Shandong province of China [45]. The scientific explanation for this could be that having a history of abortions makes women very susceptible to sexually transmitted infections. When an unsafe abortion does occur, it may be performed by unskilled or traditional practitioners without adherence to aseptic techniques, further facilitating the transmission of STIs [46, 47]. Furthermore, this might be due to the fact that those women who had a history of termination of pregnancy would have better access to reproductive health care services, sexual health services, and a better understanding of the symptoms of STIs, which prevents underreporting and underscreening of STIs and contributes to high detection rates of STIs among women who had a history of terminated pregnancy.

Conclusion and recommendations

Women’s sexually transmitted infection has been associated with sociodemographic and geographic determinants such as the age of the woman, region, educational status, marital status and history terminated pregnancy. Therefore, to prevents sexually transmitted infections among women, the governments of Senegal and other concerned stakeholders should give special attention to women by addressing sociodemographic and geographic determinants.

Strengths and limitations of this study

  • The DHS has a similar design, with identical variables in a different environment; the result may, therefore, be applicable to other similar locations.

  • The study used a sufficiently large sample size at the national level to ensure its representativeness.

  • Recall bias is one of the potential drawbacks, especially for retrospective data based on past experiences.

  • The magnitude of the bias is often unknown and correcting for the bias is difficult.

  • Since, this study was cross sectional study.it doesn’t showed temporal relationships between independent and dependent variable.

  • Finally, due to the sensitivity of the issue and the nature of the data collections method is self-report that might contribute to the low prevalence’s of STIs among women Sengal.

Data availability

The data were obtained from the Senegal demographic and health Survey that was found at DHS portal of (https://dhsprogram.com/data/dataset_admin/index.cfm).

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Acknowledgements

The authors would like to thank measure DHS for their permission to access the Senegal demographic and health survey 2023 datasets.

Funding

For this study, the authors did not receive any financial support.

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Authors and Affiliations

  1. Department of occupational Health and safety, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia

    Beletu Kinfe

  2. Department of Biomedical Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia

    Habtemariam Mulugeta Abate & Gosa Mankelkl

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Contributions

B.K., H.M.A. and G.M. Worked on this study from start to finish, including design, data extraction, and data cleaning and coding, data analysis and interpretation, and composing and revising the manuscript. G.M. then completed the final draft of the manuscript.

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Correspondence to Beletu Kinfe or Gosa Mankelkl.

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Kinfe, B., Abate, H.M. & Mankelkl, G. Determinants of self-reported sexually transmitted infections among reproductive age women in Senegal: evidenced by Senegal demographic and health survey. Contracept Reprod Med 9, 53 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40834-024-00318-3

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40834-024-00318-3

Keywords

Contraception and Reproductive Medicine

ISSN: 2055-7426

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