Determinants of adolescent pregnancy among adolescents in Wakiso and Kamuli Districts in Uganda; a case control study

Abstract Background: Uganda has unacceptably high teenage pregnancy rates whereby 1 in 4 adolescent girls have been pregnant by 18 years. This has social, financial and health consequences for the adolescents, their children and the whole society. It is therefore important to identify the adolescents at highest risk so that they can be targeted with interventions to reduce teenage pregnancy. Our study aimed to determine risk factors for pregnancy among adolescents in one rural and one urban district in Uganda. Methods We conducted a mixed-methods study among girls aged 13 to 19 years in a rural and urban district in Uganda. Quantitatively, we used an unmatched case control design where cases were 200 adolescents who were currently or previously pregnant while 400 controls were adolescents who had ever experienced a pregnancy. The 600 were divided equally between the 2 districts. Quantitative data was analyzed using STATA version 14. Qualitative methods included 17 focus group discussions with adolescents and their parents, 10 in-depth interviews with adolescents and 20 key informant interviews with various key stakeholders. Audio recordings were transcribed and analyzed using a content thematic approach using Nvivo. Results Of the 600 girls, mean age was 16.9 years (SD 3.84), 57.6% were not in a sexual relationship and 75.3% were in-school. Independent risk factors for adolescent pregnancy were age; AOR 1.69 (95%CI; 1.48–1.95), out-of-school AOR 6.13 (95%CI 2.91–12.92), a friend with pregnancy AOR 1.91 (95%CI; 1.23–2.96), cigarette smoking experience AOR 6.68 (1.42–31.46), working for money AOR 1.70 (1.05–2.74) and correct contraceptive knowledge AOR 1.32 (95%CI; 1.13–1.54). Protective factors included positive personal attitudes, higher education of the father and larger household size.