Exploring the determinants of sexual and reproductive health knowledge and intentions for safer sexual practice among out-of-school adolescents in northern rural settings in Burundi: a cross-sectional population-based study

Introduction Comprehensive Sexual and Reproductive Health and Rights (SRHR) knowledge is critical for reducing unintended pregnancies and sexually transmitted infections (STIs) among adolescents in low-resource settings. We assessed SRHR knowledge gaps among rural, out-of-school adolescents in Burundi and examined associations with intentions for safer practices (eg, condom use).Methods We purposively sampled and surveyed 767 out-of-school adolescents aged between 10 and 19 years from the rural settings of Ngozi health district in northern Burundi examining their SRHR knowledge and practice. We employed the Rasch model of the Item Response Theory (IRT) to examine overall SRHR knowledge and by gender, assuming that the test was administered an infinite number of times and supplemented this model with a multiple linear regression to detect factors affecting knowledge. Determinants of intentions for safer sexual practice were investigated using logistic regression.Results First, although the test drew on basic SRHR skills, it appeared to be difficult for the study population. Indeed, participants needed a minimum underlying competence θ>2.4 on –4 to 4 scale (with θ>2.4 indicating in the IRT model high difficulty while average knowledge corresponds to θ≈0) to succeed the whole exam and θ>0 to attempt 14/15 questions. The most challenging topics related to condom use, menstruation versus pregnancy, contraception and STIs. Younger females had slightly better knowledge than males, but this has crossed over past 16 years. Second, SRHR knowledge was higher among adolescents who completed primary education and those whose parents or siblings are educated. Further, the long distance to a youth health centre and the lack of prior SRHR information decrease knowledge. Finally, adolescents who have higher SRHR knowledge are more likely to report intentions for safer sexual health practices.Conclusion Rural and out-of-school adolescents have lower than expected SRHR knowledge. Those who have never heard about SRHR and those whose parents and/or siblings have lower or no education are worse off. SRHR knowledge determines intentions for sexual health behaviours (eg, condom use, seeking HIV testing). Tailored SRHR programmes for rural adolescents should address misconceptions on condoms/contraception.