Network analysis of knowledge and practices regarding sexual and reproductive health: a study among adolescent street girls in Kinshasa (DRC)

Abstract

Objectives: The aim of the study was to ascertain the influence of knowledge and interventions in sexual and reproductive health and contraception practices among adolescent street girls from Kinshasa, Democratic Republic of the Congo.

Methods: A cross-sectional study was carried out among street girls between 12 and 21 years of age. A standardised questionnaire was used, encompassing socio-demographic data and knowledge and practices regarding sexual and reproductive health. A network analysis was carried out.

Results: The study comprised 293 street girls. The mean age was 17.1 years (range 12–21 years) and the mean time spent living on the streets was 3.9 years (range 0–15 years). Commercial sex was reported by 78.5% (95% confidence interval [CI] 73.3%, 83.2%) as the main source of their income. During their last sexual intercourse, 44.0% (95%CI 38.1%, 50.4%) had not used a condom; 29.3% (95%CI 23.3%, 35.9%) had used hormonal contraception. Previous pregnancy was reported by 62.5% (95%CI 56.7%, 68.3%) and current pregnancy by 12.3% (95%CI 8.8%, 17.2%); 24.5% of previous pregnancies ended in voluntary termination, with a higher rate among the youngest street girls (12–15 years, 50.0%; p = 0.01). Time spent living on the streets was independently associated with pregnancy (odds ratio 1.2; 95%CI 1.1, 1.4). Practices and outcomes (previous or current pregnancy) were poorly correlated with knowledge about sexual and reproductive health. The network analysis confirmed the poor influence of exposure to intervention activities on sexual and reproductive health practices and outcomes, but did confirm a centrality effect of knowledge about HIV/AIDS.

Conclusion: Street girls in Kinshasa are extremely vulnerable with regard to their sexual and reproductive health, especially the youngest street girls. Behavioural and biomedical interventions have had limited influence. Structural and societal changes are necessary to positively impact street girls’ sexual and reproductive health. Knowledge about HIV/AIDS than about risk of pregnancy had a greater influence on sexual and reproductive health practices.

Chinese abstract

目的：研究的目的是确定在性和生殖健康方面的认知, 干预产生的影响以及来自金沙萨, 刚果民主共和国的青春期站街女孩的避孕行为产生的影响。

方法：对12至21岁的站街女孩进行横断面研究。使用标准化问卷, 包括社会人口数据和关于性和生殖健康的认知和实践, 进行网络分析。

结果：该研究包括293名站街女孩。平均年龄17.1岁（范围12-21岁）并且站街的平均时间是3.9年（范围0-15年）。记录表明商业性行为占其78.5％（95％置信区间[CI] 73.3％, 83.2％）的主要收入来源。在他们持续的性交期间, 44.0％（95％CI 38.1％, 50.4％）没有使用避孕套；29.3％（95％CI 23.3％, 35.9％）使用激素类避孕药。报告显示以前怀孕率为62.5％（95％CI为56.7％, 68.3％）, 目前的妊娠率为12.3％（95％CI为8.8％, 17.2％）。以前的怀孕 24.5％以自愿终止的方式结束, 最年轻的站街女自愿终止妊娠的比例更高（12-15岁, 50.0％； p= 0.01）。站街时间与怀孕之间是独立相关的（优势比1.2；95％CI 1.1, 1.4）。实践和结局（以前或当前怀孕）与关于性和生殖健康的知识了解关系不大。 网络分析证实暴露于干预活动对性和生殖健康的实践和结局影响很小, 但确实证实了对HIV/AIDS认知的核心作用。

结论：金沙萨的站街女特别是最年轻的站街女在性和生殖健康方面极为脆弱。 行为和生物医学干预的影响有限。 结构和社会变化对站街女性和生殖健康的积极作用是必要的。对HIV/AIDS而不是对怀孕风险的认识, 对性和生殖健康实践会产生更大的影响。

Keywords:

• Contraception
• HIV/AIDS
• Kinshasa (DRC)
• network analysis
• sexual and reproductive health
• street girls

Acknowledgements

We would like to acknowledge the support and collaboration of the field team of Médecins du Monde–France, Kinshasa; the personnel of the Centre Bomoyi Bwa Sika; members of the REJEER; and the team of enumerators and data managers. This study was supported by funds from the Agence Française pour le Développement (AFD).

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Funding

This study was supported by funds from the Agence Française pour le Développement (AFD).