Prevalence and factors associated with teenage pregnancy in refugee settlements of northern Uganda post-COVID-19 (2020-2023): a cross-sectional study

Background: Following the COVID-19 pandemic, there was an increase in teenage pregnancies nationally, however, limited data exists regarding the same among girls living in refugee settlements.

Objectives: We evaluated the prevalence of teenage pregnancy and associated factors in Palorinya and Bidi Bidi refugee settlements in Obongi and Yumbe districts of northern Uganda, in the post-COVID-19 era.

Design: We conducted a cross-sectional study.

Setting: Refugee settlements in northern Uganda.

Participants: We included 385 teenage girls aged 15-19 years.

Methods: We used convenience sampling techniques between March and May 2023. Prevalence of teenage pregnancy was assessed by self-reported pregnancies between January 2020 and May 2023 among participants. We conducted Pearson's χ² and Fisher's exact tests for bivariate analysis. All variables with a p value<0.2 at bivariate analysis were included in multivariable regression. We applied a modified Poisson regression model at the multivariable level to evaluate independent associations. The level of statistical significance was set at p<0.05.

Primary and secondary outcome measures: The primary outcome measure was the prevalence of teenage pregnancy, assessed through self-reported pregnancies among participants. Secondary outcome measures included factors associated with teenage pregnancy, such as living with a husband, lack of formal education, peer pressure and history of sexual abuse.

Results: Overall, the mean age was 17 (IQR: 15-18), and sexual debut was at 16 (IQR: 15-17) years. Lifetime modern contraceptive use was 13.8% (n=53/385) and current use was 7.5% (n=29/385). Teenage pregnancy period prevalence was 34.0% (CI: 29.4% to 38.9%). Factors independently associated with teenage pregnancy were: living with a husband (aPR: 3.8, 95% CI: 2.51 to 5.84, p<0.001), lack of formal education (Adjusted Prevalence Ratios - aPR: 2.3, 95% CI: 1.26 to 4.35, p=0.007), peer pressure (aPR: 2.1, 95% CI: 1.54 to 2.86, p<0.001) and history of sexual abuse (aPR: 1.5, 95% CI: 1.07 to 1.99, p=0.018).

Conclusion: Our study revealed that around 1 in 3 adolescent girls in northern Uganda's refugee settlements experienced pregnancy during the COVID-19 pandemic, with only 1 in 13 currently using modern contraceptives. To address this, targeted strategies by relevant authorities are crucial, including legal actions against sexual abuse, promoting girl child education and enhancing access to long-term contraception to reduce teenage pregnancy and associated health risks in these settings.