Sexual and Reproductive Health Behaviors among Ethiopian University Students: A Scoping Review

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However, adolescents and youths in middle-and low-income countries like Ethiopia are of a particular concern where limited social, educational and health services leads to poor sexual and reproductive health outcomes such as unwanted pregnancy, unsafe abortion and sexually transmitted infections including Immune Deficiency Virus. Identify and synthesis the available evidence on sexual and reproductive health of university students in Ethiopia has a paramount importance to inform policy makers, governmental and non-governmental organizations, to tailor health services in Higher Educational Institutions and to understand evidence gaps. Thus, we did a descriptive systematic review of available published information on sexual and reproductive health among Ethiopian university students. Method: We performed a systematic review to collect and analyze observational data on sexual and reproductive health behaviours among Ethiopian university students. Publications were identified using PubMed, Scopus, and Google scholar databases and manual search from 2015 to December 2023. We defined a protocol to identify relevant studies. We included original observational studies conducted in Ethiopia among university students, both qualitative and quantitative studies and that consider at list one of the following elements: sexual activity, condom use, multiple sexual partners, contraceptive use, family planning use, sexual transmitted infections, unwanted pregnancy, abortion, sexual and reproductive health knowledge, early sexual debut, risky sexual behavior. All include article were coded according to relevant outcomes and experiences and subsequently analyzed to assess frequencies. Result: After screening for inclusion criteria 15 publications were include in the datasheet developed to record the findings. Surprisingly all 15 studies reported that university students are sexually active with high prevalence of having multiple sexual partners and limited use of sexual and reproductive health services such as condom use and family planning /contraceptive use. Unwanted pregnancy, abortion, STIs infections, early sexual debut and premarital sex were frequently reported. Only two studies reported transactional sex. Conclusion : Adolescents and youths enrolled at Ethiopian Public Universities engage in risky sexual behaviours and experience its adverse consequences. It is essential to collect more evidence, but the available information supports a need for improving provision of sexual and reproductive health services, among Ethiopian university students. Youth friendly sexual and reproductive health services should be avail in Higher Education Institutions. Reproductive Health Sexual Heath Risky Sexual Behaviours University Students Ethiopia Figures Figure 1 Figure 2 Figure 3 Background The health of adolescents and youths is very vital to achieve Sustainable Development Goals (SDGs) pledged by United Nation member States in 2015 to be achieved by 2030( 1 ). However, the issue of adolescent health has been neglected for several decades ( 2 , 3 ). Indeed, investing on adolescents’ health gives a triple dividend of benefits for adolescents themselves now, for their future adulthood life and for the next generation( 2 ). Despite, adolescents face a number of health challenges including sexual and reproductive health problems such as early pregnancy, difficulties to access contraception and safe abortion, unintended pregnancy, high prevalence of HIV and other sexually transmitted infection ( 2 – 4 ). This could hamper the crucial contribution of young people to the development of their nation and their fruitful transition to adulthood. Adolescence which is a transition period from childhood to adulthood refers to a person aged 10–19 years ( 2 , 5 ) while youth refers to a person aged 15–24 years old and young people refers to a person aged 10–24 years old( 2 , 3 ). Although this definition of young population is relatively internationally accepted definition, the age classification of young people differs from place to place and culture to culture. According to Ethiopian youth national policy classification, youth are young population aged 15–29 years old( 6 ). Adolescence is characterized by significant biophysical and psychosocial changes that bring risks and opportunities which influence the future life of young people. Problems happened during this life period have a long lasting impact in the prospectus adults( 5 ). Adolescence also is the age of emerging sexual desires, behaviors and relationships( 7 ). Even if the issue of adolescent sexual and reproductive health has been neglected for centuries, it has been given a due attention when International Conference on Population and Development (ICPD) was held in Cairo in 1994( 3 , 8 , 9 ). Due to the impact of ICPD program of action, significant progress was gained in adolescents’ sexual reproductive health ASRH. Evidences showed that adolescent girls today are more likely to delay early sexual initiation and early marriage and delay first birth and to use contraceptive compare to the time three decades ago( 5 , 9 ). However, the issue of ASRH is continued to be a pressing agenda at global, regional and national level particularly in low and middle income countries due to a myriad of reasons ( 7 , 9 , 10 ). Among the reasons, each year, nearly 13 million of young women aged 15–24 years gives birth accounting for 11 percent of all births globally and 95 percent occur in the developing countries( 7 , 10 ),maternal mortality and morbidity among adolescents aged 15–19 years is continued to be high( 9 , 10 ) and the world has a lager young population than ever( 7 , 10 ). Ethiopia is the second most populous country in Africa next to Nigeria with an estimate of more than 120 million people( 11 ). Adolescents and youth constitute nearly one-third of the total population of the country( 12 ). Even though Ethiopia has made a substantial progress in sexual and reproductive health of young people during the last two decades, challenges in adolescent and youth sexual and reproductive health needs and problems persist( 13 ). According to a 2016 Ethiopian Demographics and Health Survey (EDHS), teen-age pregnancy (13%) and child marriage (40%) and young people HIV infection were highly prevalent in the country( 14 ). Early sexual initiation, teen-ager pregnancy, unwanted pregnancy, and unsafe abortion are common in Ethiopia and the median age at first sex is 16.5 years ( 6 ). Nearly 40 percent of girls get married before 18th birth day and 20 percent before 15th birth day. Nearly half of girls in Amhara region get married before the 18th birth day which is the highest in the world( 6 ). In addition, young women in Ethiopia are a high risk group of population, being particularly vulnerable to gender-based violence, female genital cutting and other harmful traditional practices that are linked directly to the gender norms( 15 ). Furthermore, evidences from different parts of the country revealed that adolescents and youths in Ethiopia are engaged in risky sexual behaviours such as early sexual initiation, premarital sexual practice, having multiple sexual partners and others that predispose them to poor sexual and reproductive (SRH) outcomes such as unwanted pregnancy, unsafe abortion, maternal mortality and morbidity and sexually transmitted infections including HIV/AIDS ( 16 – 20 ). Ethiopia has made a remarkable progress in expanding tertiary level education during the last two decades ( 21 ). Following this, millions of Ethiopian adolescents and youths have got chances to enroll in the Higher Educational Institutions ( 22 ). In the country, it is estimated that nearly 800,000 under graduate students are enrolled in the public Higher Educational Institutions ( 15 , 22 ). However, the expansion of higher education could have both a negative and a positive impact on adolescent and youth sexual and reproductive health. On one hand, evidences showed that higher education institutions are overwhelmed with young population and becoming one of the risk corridors for adolescent and youth sexual and reproductive health problems including spread of HIV infection, on the other hand education could empower adolescent girls and has a strong positive impact on health status, being prevented from exposure to health risks, access to health care and positive health seeking behaviours( 6 ).Young people enrolled in HEIs leave their family for the first time and lack parental supervision so that they are probably to be exposed to risky sexual behaviours which predispose them to poor SRH outcomes( 6 ). Different studies across universities in Ethiopian showed that university students are engaged in risky sexual behaviours ( 18 , 19 , 23 – 25 ). In order to improve the sexual and reproductive health of university students, there is a need to gather information to ensure that the SRH problems, needs and services of university students are addressed. To date, there is limited evidence on health problems, needs and services of university students in Ethiopia. To our knowledge, no study has compiled evidence on SRH problems, needs and services of university students in Ethiopia. This systematic review could help identify gaps and opportunities tailoring public health programs to address the specific SRH problems, needs and services of university students in the context of Ethiopia. Therefore, the purpose of this scoping review is to identify and synthesis the available evidence on sexual and reproductive health of university students in Ethiopia. Method The current systematic review followed a five-stage methodological framework which includes ( 1 ) identifying the research question, ( 2 ) identifying the relevant studies, ( 3 ) selecting the studies according to inclusion criteria, ( 4 ) charting and interpreting data and ( 5 ) summarizing and reporting of results( 26 ). In addition, backward citation tracking on the eligible studies and manual search were applied to identify additional sources of information. Moreover, we adapted as appropriate the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement( 27 ) even though we did not register the protocol. Since the purpose of this review is to map the available evidence on sexual and reproductive health of adolescents and youth enrolled in (HEIs) in Ethiopia, our research question was broadly tailored as-“what is the type and extent of available information on the Sexual and Reproductive Health among University students”. Search Strategy A comprehensive literature search was conducted to identify all relevant studies reporting on sexual and reproductive behaviors of Ethiopian youth enrolled in higher educational institutions, by searching the following databases (PubMed, Scopus, and Google scholar),for peer-reviewed publications. The search strategy included a range of relevant combination of keywords: (“sexual health” OR “reproductive health” OR “family planning” OR “sex education” OR “sexual behavior” “sexual violence” OR “contraception” OR “contraceptive use” OR “condoms” OR “pregnancy” OR “abortion” OR “termination of pregnancy” OR “sexually transmitted infections” OR “Sexually Transmitted Infections”) AND (“Adolescent” OR “youth” OR “University Students”) AND Ethiopia. Articles were included if they met the following criteria: Original observational studies, articled employed quantitative, qualitative or mixed method; describe at least one of the following components of SRH: condom use, multiple sexual partners, contraceptive use, family planning use, sexual transmitted infections, unwanted pregnancy, abortion, sexual and reproductive health knowledge, early sexual initiation, risky sexual behavior, and conducted among students enrolled in public universities or HEIs of Ethiopia. Only articles in the English language were included due to the language limitation of the authors. Our search strategy has looked for papers published from January 2015 to December 2023 published after Sustainable Development Goals declaration( 1 ). To reduce the potential for reviewer bias, titles and abstracts of all identified records were independently screened by two authors (TA and DP) and checked for agreement. If disagreements were raised, they had been resolved by agreement or the arbitrary of the third author (SA). Study screening and selection Subsequently, the full text of potentially relevant studies were read and independently screened by two authors (TA and SA) for the eligibility criteria. Discrepancies in the study selection were resolved by consensus or were discussed with a third author (DP) for a final decision. All relevant studies fulfilling eligibility criteria were organized and exported to EndNote Reference Manager. In the first step of literature search, 520 articles were identified. Additional 150 articles were identified in other sources through manual and backward tracing search. After screening for title and abstract, full text review was done for 26 articles. Based further analyses of the full text reviewed article 11 articles were excluded from final analysis due to lack of inclusion criteria. Finally, 15 articles meeting the inclusion criteria and were selected for data extraction [ Figure1. ]. Charting and Data Extraction Data was extracted from each eligible publication by two reviewers (TA and SA) using a structured data sheet which specifically was developed by the authors for this review. We extracted the following information from each included study: Author, Title, Publication year, Study area (University), Study design, Sample size, Year of study and summary main results which includes prevalence of condoms utilization, prevalence sexual activity/practice, prevalence multiple sexual partners, mean age of sexual initiation, prevalence transactional sex, prevalence STIs including HIV, prevalence pregnancy, prevalence HIV testing and counseling, prevalence premarital sexual practice, prevalence of early sexual debut, prevalence family planning utilization, prevalence of SRH services utilization, and proportion of knowledge of SRH&STIs/HIV/AIDS services [ Supplementary1 ,Excel sheet ]. All the extracted data from eligible articles were first summarized on an Excel spreadsheet purposely prepared for this systematic review [ Suplementary1, Excel shee t]. Among the summarized data, Author, Year of Publication, Study Location (HEI), Study Design, Sample Size, Age Rang/Mean Age ± SD and summary of finding were separately displayed on another table[Table 1 ]. Table 1 Studies on sexual and reproductive health among University students in Ethiopia Author, Year of Publication Study Location (HEI) Study Design Sample Size Study Title Age Rang/Mean Age &SD Summary of Findings 1 . Muluken Gunta et al.,2021( 28 ) Wolaita Sodo University Mixed Method 759 Sexual and Reproductive Health Services Utilization among Wolaita Sodo University Students, Ethiopia: A Mixed Method Approach 17–25+ -49.80% use SRHS -14.5% used condom -79.50% were sexually active − 15.50% had multiple sexual partners − 29.5% ever had premarital sexual practice − 4.5% had STIs − 12.4% used family planning − 38.1% had been tested for HIV − 1.4% Faced abortion or received abortion care − 83.30% had knowledge on SRH, STIs &HIV/AIDS 2 . Kassie et al.,2019( 29 ) University of Gondar Quant. C-Sectional 845 Prevalence of sexually transmitted infections and associated factors among the University of Gondar students, Northwest Ethiopia: a cross-sectional study 15–34 -18.20% of participants had STIs infection − 42.8 had used condom − 61.1% had ever sex − 73.5% 12 months prior to the study period -54.2% had multiple sexual partners − 23.6% had experienced early sexual initiation/ sex before 18 years for this review. -98% had information about STIs & HIV/AIDS - The mean age at 1st sex was 18 years (SD ± 2.2) 3. Shimie et al.,2022( 30 ) University of Gondar Quant. C- Sectional 832 Information-seeking behavior on sexually transmitted infections and its associated factors among university students in Ethiopia: a cross-sectional study 15–23+ − 55.5% of participants had information seeking behavior − 57.2% had used condom − 35.2% had engaged in sexual activity − 10.2% had experienced STIs − 34% had been tested for HIV 4 .Tomas Benti Tefera et.al,2015( 31 ) Madawalabu University Quant. C- Sectional 324 Prevalence of premarital sexual practice and associated factors among undergraduate health science students of Madawalabu University, Bale Goba, South East Ethiopia: institution based cross sectional study 15–34 -42.7%)have had premarital sexual intercourse − 54.7% did not used condom -42.7% were engaged in sexual activity -33.6% had multiple sexual partners -42.7% had practiced premarital sex - The mean age at 1st sex was 18.4 with SD ± 2.14 5 .Yared et al.,2017( 32 ) Ambo University Mixed Method 400 Sexual and reproductive health experience, knowledge and problems among university students in Ambo, central Ethiopia 15–34 - Mean number of past 12 months regular sexual partners of 1.36 ± SD 0.505 were recorded -Only 21.1% of participants perceived themselves to be at risk of HIV. -94.5% of participants ever heard of STIs -98% participants heard about HIV/AIDS − 89.4% knew modern contraceptives − 64.8% participants knew pills -56.8% participants knew condoms -22.8% had STIs one year prior to the study period -5% had experienced unwanted pregnancy -2.5%) experienced abortion - The qualitative data showed high rate of unwanted pregnancy and abortion - The mean age at 1st sex was 17.29 with SD ± 2.21 6 . Asmamaw Atnafu et al.,2019( 33 ) University of Gondar Quant. C- Sectional 874 Sexual and Reproductive Health Services Utilization and Associated Factors Among University Students, Northwest Ethiopia: Cross Sectional Study 19–23 -62.3% participants had used SRH services -57.6% used condom -18.9% reported sexual practice -49.1% had multiple sexual partners -25.1% had early sexual initiation/<18 years for this review - High f risky sexual behaviour was reported but not quantified -16.7% had used SRH services including family planning -16% get tested for HIV - The mean age at first sex was 18 years with (SD ± 2.2) 7. Awoke Derbie,et al,2016( 20 ) Debre Tabor University Quant. C- Sectional 394 Risky sexual behaviour and associated factors among students of Debre Tabor University, Northwest Ethiopia: a cross-sectional study 19–23 − 28.4% had risky sexual behaviour − 62.1% had multiple sexual partner -mean age at first sex was 18.9 years with SD ± 1.9 − 72.6% participants had knowledge of SRH&STIs/HIV/AIDS services 8.Kebede et al.,2018( 23 ) Aksum University Quant. C- Sectional 287 Assessment of risky sexual behavior and practice among Aksum University students, Shire Campus, Shire Town, Tigray, Ethiopia, 2017 18–27 − 28.4% had risky sexual behaviour − 59.2% have used condom − 60.6% had sexual activity − 64.4% had multiple sexual partner − 45% practiced premarital sex − 37.9% had early sexual initiation history/<18 years -Risky sexual behavior was reported but not in terms of multiple sexual partner, nonuse of condom quantified − 54.6% had used family planning services - Mean age at first sex was 18 years 9. Abdissa B et al., 2017( 34 ) Ambo University Mixed Method 650 Premarital Sexual Practices, Consequences and Associated Factors among Regular Undergraduate Female Students in Ambo University, Oromia Regional State, Central Ethiopia 15–29 − 53.9% had practiced premarital sex - only 7.2% had used condom − 25.7% were sexually active − 18.6% had early sexual initiation / <18 years old − 16.8% had experienced pregnancy − 56.8% had been tested and counseled for HIV − 95.4% had received a negative screening result − (1.6%) and (3%) had got positive and unknown screening result respectively − 53.6% of existed pregnancies ended up with abortion - Mean age at was 16.9 ± 2.7 10.Kene et al.,2023( 35 ) Madda Walabu University Quant. C- Sectional 483 Knowledge of Sexual and Reproductive Health Rights Among University Students: A Cross-Sectional Study in Southeast Ethiopia 18–25 − 52.1% had optimal knowledge − 23.96% had used condom − 60% were practicing sex − 23.07% had experienced early sexual initiation / sex < 18 years old 11. Dida et al.2015( 36 ) Madawalabu University Quant. C-Sectional 568 Reproductive health services utilization and its associated factors among Madawalabu University students, Southeast Ethiopia: cross-sectional study 15–25+ − 89.3% had new modern family planning methods − 27.7% had used condom − 40.3% were sexually active − 80.5% had used family planning − 72.2% knew condom as a contraceptive − 95.6% heard about VCT -82% discussed on V T -74.1% tested for HIV -t he mean and median ages of the respondents’ first sexual intercourse were 18.3 (SD ± 2.18) and 18 years respectively. 12. Getachew Mullu Kassa et al. 2015( 37 ) Debre Markos University Quant. C-Sectional 260 Early Sexual Initiation and Associated Factors among Debre Markos University Students, North West Ethiopia 17–32 -44.6% had sex prior to the data collection period -64.7% start sexual intercourse during the age range of 16–19 years old. -63.8% had used condom -26% had multiple sexual partner -44.6% were sexually active -5.2% had practiced transactional sex - mean age at first sex was 18.28 SD ± 2.04 13. Tekletsadik et al., 2022( 24 ) University of Gondar Quant. C-Sectional 420 Determinants of risky sexual behaviour among undergraduate students at the University of Gondar, Northwest Ethiopia 18–34 − 44.0%. had practiced risky sexual practice − 18% had used condom − 51% were sexually active − 48.5% had multiple sexual partner − 34.18% had history of early sexual initiation 14. Yonas Tesfaye et al.,2019( 38 ) Jimma University Quant. C-Sectional 700 Is There Association between Risky Sexual Behaviors and Depression Symptoms among Youth? A Case of Jimma University Students, Ethiopia. 18–24 -70.1% had used condom − 35.5% had practice Risky sexual behavior − 61.1% had multiple sexual partners − 44.9% had history of early sexual initiation − 5.5% reported transactional − 30.2% had risky sexual behavior 15. Berhe et al.2022( 39 ) Aksum University Quant. C-Sectional 420 Low-Level Knowledge and Associated Factor of Sexual and Reproductive Health Rights Among Aksum University Students, Aksum Ethiopia 19–23 - Only 16.4% had knowledge of SRHSR − 19.2% had history of early sexual initiation -Mean age at first sexual activity was 18.5 years with SD ± 2.1 Analysis Thematic analysis was employed for this review. The major thematic areas or major outcomes identified for this review were risky sexual behaviours, sexually transmitted infections, sexual and reproductive health knowledge, sexual and reproductive health services utilization, premarital sexual practice, and early sexual debut. Other sub-thematic areas identified for this review were condom utilization, sexual activity, multiple sexual partners, transactional sex, pregnancy, abortion and HIV testing and counseling. The prevalence of the aftermentioned themes were extracted and recorded on a spreadsheet and analyzed carefully and discussed in the result and discussion section. Result Of the 15 studies identified, 12 used a quantitative cross-sectional study design. Three studies use a mixed design (both quantitative and qualitative). No study was found used qualitative study design approach [Table 1 ]. The sample size ranged from 260 to 874 participants. All studies included both male and female participants. Nine studies included all year regular students while 6 studies included under graduate regular students. All studies included in this were conducted in public universities i.e. HEIs. Amongst them, 4 studies were conducted in University of Gondar ( 24 , 29 , 30 , 33 ), 3 studies were conducted in Madawalabo University ( 31 , 35 , 36 ), 2 studies were conducted in Ambo University ( 32 , 34 ), another 2 studies conducted in Aksum University ( 23 , 39 ) and 4 studies( 20 ) ,( 28 ), ,( 37 ),( 38 ) were conducted in Debretabor University, Wolaita Sodo University, Debre Markos University and Jimma University respectively. Regarding to the main theme of reviewed studies 3 studies ( 28 , 33 , 36 ) had addressed SRH services utilization with reported prevalence of 62.3%,89.3% and 49.8% respectively, 2 studies ( 29 , 30 ) had addressed sexually transmitted infection(STIs) with reported prevalence of 18.2% and 55.5%, another 3 studies ( 32 , 35 , 39 ) had addressed sexual and reproductive health (SRH) knowledge with a reported prevalence of94.5%,52.1% and 16.4%, 4 studies ( 20 , 23 , 24 , 38 ) had addresses risky sexual behaviour with reported prevalence of 28.4%,60%,44% and 30.2%, one study ( 23 ) has addressed early sexual initiation and the reported prevalence was 64.7% and another 2 studies ( 31 , 34 ) had addressed premarital sexual practices with reported prevalence of 42.7% and 53.9%. No study was found addressing youth friendly services and the topic of sexual violence or coercion was omitted because it has been already compiled in a meta-analysis study ( 40 )(Fig. 2). Concerning behaviours, experiences, outcomes in the reviewed studies, surprisingly, all studies reported sexual activity and the prevalence was ranged from 18.9–79.5% ( 20 , 23 , 24 , 28 – 39 ).Among this, 2 studies had reported both the past (61.1% and 28.4%) and current (73.5% and 53.1%) status of sexual activity among participants( 20 , 29 ) while the rest of studies ( 23 , 24 , 28 , 30 – 39 ) reported only the status of sexual activity at the time of the study. Similarly, 14 studies reported condom utilization ( 20 , 23 , 24 , 28 – 38 ). Among these, 3 studies described the prevalence of condom non-use during sexual activity and ranged from 23.3–57.2% ( 29 – 31 ) while the rest 10 studies described the prevalence of condom use during sexual activity and ranged 7.2–64.7% ( 20 , 23 , 24 , 28 , 32 – 38 ). Ten studies had reported the prevalence of multiple sexual partners which is one the most important risky sexual behaviors ( 20 , 23 , 24 , 28 , 29 , 31 , 33 , 37 – 39 ) and ranged from 26–64% and one study reported the mean number of multiple sexual partners as (1.36 (± SD 0.505) ( 32 ). Moreover, the prevalence premarital sexual practice was reported in four studies ranging from 25.5%( 34 ) to 45%( 23 ) and early sexual initiation i.e. sex before the 18th birth day for this review was stated in eight studies( 23 , 24 , 29 , 33 , 34 , 37 – 39 ) and the prevalence ranged from 18.6–64.7%. Only two studies have reported transactional sex i.e. sex for money as 5.2%( 37 ) and 5.5%( 38 ). Sexual transmitted infection was reported by four studies ( 28 – 30 , 32 ) and was ranged from 10.2–22.8%. Pregnancy test/care was another reported behaviour in two studies with prevalence of 5% ( 32 )and 16.8% ( 34 ). Five studies out of fifteen described risky sexual behaviour ( 23 , 24 , 33 , 36 , 38 ). Among them, two studies ( 23 , 33 ) did not quantify the prevalence while three studies quantified the prevalence as 30.2%( 38 ) ,31%( 36 ) and 44%( 24 ). One study has described the non-sexual risk behaviors such as smoking, drinking and khat chewing which have a propounding effect on risky sexual behavior( 37 ). Sexual and reproductive health services (SRHS) including family planning was one of the outcomes described in the reviewed studies. One study( 23 ) has reported a 54.6% of (FP) service utilization and the other 3 studies reported the prevalence of SRH services ranging from 12.4–80.5%( 28 , 33 , 36 ). HIV counseling and testing has been described in five studies ( 28 , 30 , 33 , 34 , 36 ) with the prevalence ranging from 16–74.1%. Two studies reported unwanted pregnancy prevalence as 5%( 38 ) and 16.8%( 34 ). Abdissa B et al.( 34 ) has reported that 56.8% of the occurred pregnancies (16.8%) ended up in abortion. Another two studies have reported the prevalence of abortion as 1.4%( 28 ) and 2.5%( 32 ). Knowledge and information on SRH&STIs/HIV/AIDS has been discussed in eight studies ( 20 , 28 , 29 , 31 , 32 , 35 , 36 , 39 ). The proportions of participants having the knowledge and information on SRH&STIs/HIV/AIDS have been ranged 16.4%( 39 ) to 98%( 29 ). Finally mean age at first sex was reported in 9 studies ( 20 , 23 , 31 – 34 , 36 , 37 , 39 ). The lowest mean age at first sex was reported as 16.9 years ( 34 ) highest mean age at first sex was reported as 18.9 years ( 20 ) [Fig. 3&Table 1 ]. Discussion In this review, we included only studies conducted among Public Universities students in Ethiopia. The main themes addressed in this review were SRH Service utilization, sexually transmitted infection (STI), experience and knowledge SRH, risky sexual behaviour; early sexual initiation/debut and premarital sexual practices (Fig. 2).Other outcomes, experiences and behaviours addressed in the reviewed studies include condom utilization, sexual activity, multiple sexual partners, premarital sexual practice, transactional sex, pregnancy, family planning use/SRH services use, HIV testing and counseling, abortion cases/care and mean age at first sex (Fig. 3). The prevalence reported in these main outcomes and behaviours is very troublesome. On the other hand, no study has been conducted on youth friendly services; indicating that there is limited youth friendly services at public universities in Ethiopia. Though universities in Ethiopia have student clinics in their campuses, they do not provide organized health care services including adolescent and youth friendly services. In fact, youth friendly services in Ethiopia are provided at public health institutions and youth centers ( 41 , 42 ). Even if there were studies done on sexual violence/ coercion among university adolescents and youths, we excluded them from this review because of they were already addressed in a systematic review and meta-analysis study( 40 ). The reviewed studies indicated that university students in Ethiopia are exposed to high-risk sexual behaviours and as a consequence to an increased risk adverse SRH outcome including STI transmissions( 29 , 30 , 32 ), abortion( 28 , 32 ) and unwanted pregnancy( 34 ). Adolescents and youths enrolled in Ethiopian Universities have multiple sexual partners, early sexual debut, premarital sexual activity, nonuse of condoms, limited SRH services including family planning. Surprisingly, all studies reviewed have reported that university students are engaged in sexual activity. This implies that even if university students are expected to engage in their curricular activity, they are engaged in risky behaviours that exposed them to sexual and reproductive health problems which have a negative impact on their educational achievements. A qualitative study conducted in Madawalabu University but not included due to exclusion criteria has reported a high occurrence of sexual activity among university students( 43 ). Another quantitative study done among poly technique college students in Bonga Ethiopia reported a worrisome prevalence of sexual practice, pregnancy and abortion( 44 ). The majority of studies reviewed reported a worrisome prevalence of having multiple sexual partners. This implies that HIV transmission and STI infection among university students could be very high. The result is supported by the evidence from Sub Saharan African(SSA) countries’ universities which has reported that HIV/AIDS remains the troublesome problem among university students and other communities universities in SSA ( 45 ). In fact, evidences showed that adolescent and youth reproductive health remains a major public health problem for Sub Saharan African countries including Ethiopia particularly for adolescent girls( 46 ). Even if it is culturally and religiously prohibited, adolescents and youths enrolled in universities in Ethiopia practiced premarital sex. This behaviour can predispose students to adverse SRH out comes such as unwanted pregnancy, abortion and STIs transmission including HIV. Studies in other settings in Ethiopia reported a high prevalence of premarital sexual practices ( 47 – 50 ). Moreover, evidences indicated that premarital sexual practices among adolescents and youths is alarmingly increasing at the global level( 51 ). This implies that adolescent and youth friendly services must be avail at public universities in Ethiopia. To date, adolescent and youth friendly service are effective interventions to mitigate adolescents and youths sexual and reproductive health problems in many parts of the world( 2 ). Early sexual debut was one of the reported SRH behaviours in the reviewed studies. A significant number of university students practiced early sexual debut in the reviewed studies. Evidences from other settings indicated that early sexual debut is highly prevalent in Ethiopia. For example, a study conducted among poor urban females in Ethiopia showed that nearly half of female experienced early sexual debut ( 52 ). Furthermore, evidence from a nationally representative data analyzed from Ethiopian Demographic and Health Survey (EDHS) revealed that 1 in 5 adolescent girls in Ethiopia experienced early sexual debut( 53 ). Another SRH experience reported in the reviewed studies was transactional sex. Even if “transactional is thought to be a common experience among university student” only two studies have reported with low prevalence ( 37 , 38 ). The low prevalence and limited information in the reviewed studies on transactional sex could be due the respondents’ bias due to privacy issue. This implies that appropriate rigorous methodological approach should be employed to get the accurate information from respondents on transactional sex other than simple cross-sectional studies. On the other hand, transactional sex practice can be a criminal act in some circumstances so that participants might hide the information for fear of being accused ( 54 ). In fact, evidences revealed that transactional sex is a common practice among adolescents who seek improved livelihood, particularly in poor countries ( 55 ). Moreover, evidences indicated that transactional sex is becoming a common practice in Ethiopia( 6 ) in which Ethiopian adolescents and youths practice transactional as a means of income generation for food, cash, cosmetics, mobile phone, school fee and other materials( 6 ). University students in Ethiopia are not invulnerable for sexually transmitted infections. The reviewed studies revealed that significant number of students have experienced STIs. Reviewed studies in this review clearly showed that university students are engaged in risky sexual behaviours such as early sexual debut, transactional sex, multiple sexual partners, unprotected sex and premarital sex which predispose for STIs and HIV. For example the study conducted to assess SRH experience, knowledge and problems among university students in Ambo University showed that 22.8% of participants have experienced STIs infection( 32 ).This study also has reported that 23.3% of participants have not used condoms while 37.2% participants were sexually active ( 32 ). This suggests that unsafe sex accompanied with sexual activity predisposes the students to STIs infection including HIV. An interrelated SRH outcomes pregnancy and abortion have been investigated in the reviewed studies( 32 , 34 ). A mixed method study among Ambo University students showed that pregnancy and abortion were the poor SRH outcomes among students( 32 ). Though the quantitative part this study reported low prevalence of pregnancy, the qualitative data has indicated the high prevalence of unwanted pregnancy and abortion among university students( 32 ). In fact, unwanted pregnancy and abortion are the most common SRH problems among Ethiopian adolescents and youths including college and university students( 6 ). This is reinforced in the evidence from a study done among college students in Arisi Zone which has reported that 37.2% and 26.0% of college students have received pregnancy test and abortion care services respectively( 56 ). The other discussed theme in the reviewed studies was knowledge of sexual and reproductive health and service including HIV/AIDS. Eight studies out of fifteen have reported information and knowledge status of participants on SRH ( 20 , 28 , 29 , 31 , 32 , 35 , 36 , 39 ). One study reported that 98% of participants heard about STIs( 29 ). The rest seven studies reported SRH knowledge prevalence16.4–95.4%. However, they were not immune from sexual and reproductive health problems. For example, in a study conducted to assess SRH experience and knowledge, 22.8% of participants had STIs infection and 5% and 2.5% had experience unwanted pregnancy and abortion respectively( 32 ). Lastly, mean age at first sex was one issue discussed in reviewed studies. Nine out of fifteen studies have discussed age at first sex. The lowest mean age at first sex was 16.5 years old. This shows that university students in Ethiopia start sexual debut early at secondary school. In fact, studies from different part of country among secondary school students indicated early sexual debut is a common practice among this group of population ( 49 , 52 , 57 , 58 ). This implies that appropriate intervention should be implemented at secondary schools to avoid early initiation of sexual practice among teenagers. Limited youth-friendly health services in higher educational institution in Ethiopia might have an important contribution for high prevalence of risky sexual behaviours among university students and its consequences. Effort should be made to establish youth friendly health services at public universities that are tailored towards the needs of university students. Youth-friendly health services should be rendered in campus clinics of universities. Campus clinic health care provides should be trained on youth-friendly service so that their misconception and negative attitude will not hamper youth-friendly health services implementation in campus clinics. Health education for university students on major SRH problems and services is also imperative. Limitation Although a comprehensive search was done for this scoping review, the exclusion of articles with languages other than English presents a limitation which leads to language bias. Yet, this review delivers a comprehensive overview of the available evidence on sexual and reproductive behaviours of university students in Ethiopia which can contribute to identify the evidence gap in sexual and reproductive among university students in Ethiopia.. Conclusion The available published information showed that university students in Ethiopia engaged in high risk sexual behaviors and experience adverse consequences. Although, it seems essential to collect more information both qualitative and quantitative, the reviewed one evidenced a need to establish and strengthen youth friendly reproductive health services at higher educational institution in Ethiopia specifically tailored for university students. Abbreviations SDGs Sustainable Development Goals ASRH Adolescent Sexual and Reproductive Health ICPD International Conference on Population and Development EDHS Ethiopian Demographic and Health Survey HIV Human Immunodeficiency Virus SRH Sexual and Reproductive Health AIDS Acquired Immunodeficiency Syndrome HEIs Higher Educational Institutions PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analysis SD Standard Deviation STIs Sexually Transmitted Infections SSA Sub Saharan Africa. Declarations Acknowledgement Not applicable Authors’ contribution TA conceived the study. All authors participated in the conception and design of the study. TA and SA undertook the review to gather the include studies. TA wrote the first draft. Both TA and SA revised the second draft. DP revised the second draft and all authors contributed the final manuscript. All authors approved the final manuscript. Funding We did not receive any funding for this review paper. Availability of data and material All data generated and analyzed during this study are included in this article. Ethical approval and consent to participate Not applicable Consent for publication Not applicable Competing interests We declare that we have no competing interests. References Transforming our world: the 2030 Agenda for Sustainable Development: sustainabledevelopment.un.org, (2015). WHO. Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to support country implementation. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO. 2017. Jessica L. Morris , Hamid Rushwan. Adolescent sexual and reproductive health: The global challenges. International Journal of Gynecology and Obstetrics (2015) 131 40–S2. Protecting the Next Generation in Sub-Saharan Africa: Learning from Adolescents to Prevent HIV and Unintended Pregnancy, New York: Guttmacher Institute, 2007, (2007). M. Liang et al. The State of Adolescent Sexual and Reproductive Health. 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The Pan African Medical Journal - ISSN 1937-868. 2015. Yared et al. Sexual and reproductive health experience, knowledge and problems among university students in Ambo, central Ethiopia. Reproductive health. 2017;14(41). Asmamaw Atnafu, Adane Kebede, Gizachew AssefaTessema, Kasahun Emiru, Tinsae Berihun, Tarekegn Asmamaw, et al. Sexual and Reproductive Health Services Utilization and Associated Factors Among University Students, Northwest Ethiopia: Cross Sectional Study. Journal of Gynecology and Women’s Health. 2019;15(3). Bayisa Abdissa, Mesfin Addisie, Wubareg Seifu. Premarital Sexual Practices, Consequences and Associated Factors among Regular Undergraduate Female Students in Ambo University, Oromia Regional State, Central Ethiopia. Health Science Journal. 2017;11(1:482). Chala Kene, Girma Geta , Neway Ejigu, Desta F. Knowledge of Sexual and Reproductive Health Rights Among University Students: A Cross-Sectional Study in Southeast Ethiopia. Adolescent Health, Medicine and Therapeutics Dove press. 2023;14(1–12). Dida et al. Reproductive health services utilization and its associated factors among Madawalabu University students, Southeast Ethiopia: cross-sectional study. BMC Research Notes 2015;8:8. Getachew Mullu Kassa, Girmay Tsegay, Nurilign Abebe Woldie Bogale, Teferi Tadesse, Desalegne Amare, Girma Alem. Early Sexual Initiation and Associated Factors among Debre Markos University Students, North West Ethiopia. Science Journal of Clinical Medicine. 2015;4(5):80-5. Yonas Tesfaye , Alemayehu Negash, Tsegaye Tewelde Gebrehiwot , Worknesh Tessema SA, GutemaAhmed, Daniel Alemu. Is There Association between Risky Sexual Behaviors and Depression Symptoms among Youth? A Case of Jimma University Students, Ethiopia. Hindawi Psychiatry Journal. 2019;Volume 2019,:12 Berhe et al. Low-Level Knowledge and Associated Factor of Sexual and Reproductive Health Rights Among Aksum University Students, Aksum Ethiopia. Frontiers in Public Health | wwwfrontiersinorg. 2022. Kefale B YM, Damtie Y, Arefaynie M, Adane B,. Predictors of sexual violence among female students in higher education institutions in Ethiopia: A systematic review and metaanalysis. PLoS ONE 2021;https:// doi.org/10.1371/journal.pone.0247386;16(2:e0247386). Alemtsehay Mekonnen Munea, Getu Degu Alene, Debelew GT. Does Youth-Friendly Service Intervention Reduce Risky Sexual Behavior in Unmarried Adolescents? A Comparative Study in West Gojjam Zone, Northwest Ethiopia, Risk Management and Healthcare Policy, , 941-954, DOI: 10.2147/RMHP.S254685. (2021) Alemtsehay Mekonnen Munea, Getu Degu Alene, Debelew GT. Quality of youth friendly sexual and reproductive health Services in West Gojjam Zone, north West Ethiopia: with special reference to the application of the Donabedian model. BMC Health Services Research. 2020;20(245). Tesfaye Setegn Mengistu, Abulie Takele Melku. Sexual and reproductive health problems and service needs of university students in south east Ethiopia: Exploratory qualitative study. Science Journal of Public Health. 2013;1: (4):184-8. Agegnehu Alemu, MuluegtaShegaze, TeshomeGobena, Hailay Abraha, Gebremaryam Temesgen, Yohannes Markos. Assessment of Substance Use and Risky Sexual Behaviour Among Public College Students in Bonga Town, Southwest Ethiopia. American Journal of Biomedical and Life Sciences. 2015 3(5):91-7. M. J. Kelly. The Significance of HIV/AIDS for Universities in Africa. Journal of Higher Education in Africa, . 2003;Volume 1,(Number 1,):pages 1 - 23. Melesse DY, Mutua MK, Choudhury A, et al. Adolescent sexual and reproductive health in sub- Saharan Africa: who is left behind?BMJ Global Health 5:e002231. doi:10.1136/ bmjgh-2019-002231. 2020. Assefa Seme, Worku d. Premarital Sexual Practice among School adolescents in Nekemte Town, Esat Wolega. Ethiopia J Health Dev. 2008;22(2):167-73. al. Oe. Pre-marital sexual debut and its associated factors among in-school adolescents in eastern Ethiopia. BMC Public Health , 12:375 http://wwwbiomedcentralcom/1471-2458/12/375. 2012. Alemayehu Bogale, Assefa Seme. Premarital sexual practices and its predictors among in-school youths of shendi town, west Gojjam zone, North Western Ethiopia. Reproductive Health 2014, 11:49; http://wwwreproductive-health-journalcom/content/11/1/49. 2014. Nigussie Ahmedin Salih a, Henok Metaferia b, Ayalu A. Reda c d, Sibhatu Biadgilign. Premarital sexual activity among unmarried adolescents in northern Ethiopia: a cross-sectional study. Sexual & Reproductive Healthcare. 2014;6:9-13. Tun W. Lat, Yan Aung MT, Thandar Tun, Mya KS. Awareness and perception on sexual and reproductive health and selfreported premarital sex among never married youth in Chaungzone township, Mon State, Myanmar International Journal of Community Medicine and Public Health. 2020 7(3):815-22. Annabel Erulkar, Ferede A. International Perspectives on Sexual and Reproductive Health, Dec., 2009, Vol. 35, No. 4 (Dec., 2009), pp. 186-193. GUTTMUCHER INSTITUTION. Ebisa Turi, Bedasa Taye Merga, Ginenus Fekadu, Amanuel Alemu Abajobir. Why Too Soon? Early Initiation of Sexual Intercourse Among Adolescent Females in Ethiopia: Evidence from 2016 Ethiopian Demographic andHealth Survey. International Journal of Women’s Health, Dove Press ;12:269–75. UNAIDS, Global AIDS Monitoring 2022. Indicators and questions for monitoring progress on the 2021 Political Declaration on HIV and AIDSJoint United Nations Programme on HIV/AIDS ,Geneva: Joint United Nations Programme on HIV/AIDS; Licence: CC BY-NC-SA 3.0 IGO. 2022. Helen Epstein et al. HIV/AIDS Prevention Guidance for Reproductive Health Professionals in Developing-Country Settings. New York, New York: Population Council Library Cataloging-in-Publication Data; 2002. Demelash Wachamo et al. Sexual and Reproductive Health Services Utilization and Associated Factors among College Students at West Arsi Zone in Oromia Region, Ethiopia. Hindawi The Scientific World Journal , . 2020;Volume 2020:7 Alem Girmay, Mariye T. Risky sexual behavior practice and associated factors among secondary and preparatory school students of Aksum town, northern Ethiopia, 2018. BMC Research Notes. 2019. Eskeziaw Abebe Kassahun, Abebaw Addis Gelagay, Achenef Asmamaw Muche, Amanuel Addisu Dessie, Belayneh Ayanaw Kassie. Factors associated with early sexual initiation among preparatory and high school youths in Woldia town, northeast Ethiopia: a cross-sectional study. BMC Public Health. 2019;19(378). Additional Declarations No competing interests reported. Supplementary Files SRHOFUNIVERSITYSTUDENTSRefined2Autosaved.xlsx UniversitystudentsSRMTATRIX.docx2Refined.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4112385","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":280693128,"identity":"83981d09-a03d-44e0-b08b-e39539a4f3e0","order_by":0,"name":"Tilksew Ayalew Abitie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACxgYogx9EJBSQokUSxEgwIMU6gwNgkgiVzO29xx7z1BxO3Hx+deKHBwYM8vxiBwg4rOdcujHPscOJ22683SwBdJjhzNkJBLTMyDGT5mEDaTm7AaQlweA2UVr+AR024+zmH8Rr4W07nLiBv3cbkbb0nDGTnNuXbjzjBu82iwQDCcJ+MWzvMZN4881atr//7OabPyps5PmlCWlpYGBg4mFoZmCQAKuUwK8cBORBjvvBUAdMMQcIqx4Fo2AUjIKRCQAvL0bxU3ogYwAAAABJRU5ErkJggg==","orcid":"","institution":"Bahir Dar University","correspondingAuthor":true,"prefix":"","firstName":"Tilksew","middleName":"Ayalew","lastName":"Abitie","suffix":""},{"id":280693129,"identity":"1d137ce9-6440-4cf6-991d-b385e82857bb","order_by":1,"name":"Simachew Animen","email":"","orcid":"","institution":"Bahir Dar University","correspondingAuthor":false,"prefix":"","firstName":"Simachew","middleName":"","lastName":"Animen","suffix":""},{"id":280693130,"identity":"f097bca2-86af-484b-948d-5e508ff68180","order_by":2,"name":"Desta Debalkie 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diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4112385/v1/d228c2270f65302192db22eb.png"},{"id":53116393,"identity":"9e4aa099-9447-4bce-b348-16048e0c2b06","added_by":"auto","created_at":"2024-03-20 19:36:03","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":8938,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of studies adressed the main themes discussed in the review\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4112385/v1/131689b18cbb6fa838f14c34.png"},{"id":53116397,"identity":"5cfbef8f-ffb1-429a-9528-e0c865792a14","added_by":"auto","created_at":"2024-03-20 19:36:03","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":26127,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of studies adressing main behaviours, experiences and results evaluated 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19:36:03","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21357,"visible":true,"origin":"","legend":"","description":"","filename":"SRHOFUNIVERSITYSTUDENTSRefined2Autosaved.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4112385/v1/178c18da8b9236ffb6e25505.xlsx"},{"id":53116396,"identity":"12cf3a49-3643-4fd1-845c-da3b1eb95561","added_by":"auto","created_at":"2024-03-20 19:36:03","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":56827,"visible":true,"origin":"","legend":"","description":"","filename":"UniversitystudentsSRMTATRIX.docx2Refined.docx","url":"https://assets-eu.researchsquare.com/files/rs-4112385/v1/39e8c46bd55ff27f35ffb59d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sexual and Reproductive Health Behaviors among Ethiopian University Students: A Scoping Review","fulltext":[{"header":"Background","content":"\u003cp\u003eThe health of adolescents and youths is very vital to achieve Sustainable Development Goals (SDGs) pledged by United Nation member States in 2015 to be achieved by 2030(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). However, the issue of adolescent health has been neglected for several decades (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Indeed, investing on adolescents\u0026rsquo; health gives a triple dividend of benefits for adolescents themselves now, for their future adulthood life and for the next generation(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Despite, adolescents face a number of health challenges including sexual and reproductive health problems such as early pregnancy, difficulties to access contraception and safe abortion, unintended pregnancy, high prevalence of HIV and other sexually transmitted infection (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This could hamper the crucial contribution of young people to the development of their nation and their fruitful transition to adulthood.\u003c/p\u003e \u003cp\u003eAdolescence which is a transition period from childhood to adulthood refers to a person aged 10\u0026ndash;19 years (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) while youth refers to a person aged 15\u0026ndash;24 years old and young people refers to a person aged 10\u0026ndash;24 years old(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Although this definition of young population is relatively internationally accepted definition, the age classification of young people differs from place to place and culture to culture. According to Ethiopian youth national policy classification, youth are young population aged 15\u0026ndash;29 years old(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Adolescence is characterized by significant biophysical and psychosocial changes that bring risks and opportunities which influence the future life of young people. Problems happened during this life period have a long lasting impact in the prospectus adults(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Adolescence also is the age of emerging sexual desires, behaviors and relationships(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEven if the issue of adolescent sexual and reproductive health has been neglected for centuries, it has been given a due attention when International Conference on Population and Development (ICPD) was held in Cairo in 1994(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Due to the impact of ICPD program of action, significant progress was gained in adolescents\u0026rsquo; sexual reproductive health ASRH. Evidences showed that adolescent girls today are more likely to delay early sexual initiation and early marriage and delay first birth and to use contraceptive compare to the time three decades ago(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, the issue of ASRH is continued to be a pressing agenda at global, regional and national level particularly in low and middle income countries due to a myriad of reasons (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Among the reasons, each year, nearly 13\u0026nbsp;million of young women aged 15\u0026ndash;24 years gives birth accounting for 11 percent of all births globally and 95 percent occur in the developing countries(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e),maternal mortality and morbidity among adolescents aged 15\u0026ndash;19 years is continued to be high(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) and the world has a lager young population than ever(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEthiopia is the second most populous country in Africa next to Nigeria with an estimate of more than 120\u0026nbsp;million people(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Adolescents and youth constitute nearly one-third of the total population of the country(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Even though Ethiopia has made a substantial progress in sexual and reproductive health of young people during the last two decades, challenges in adolescent and youth sexual and reproductive health needs and problems persist(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). According to a 2016 Ethiopian Demographics and Health Survey (EDHS), teen-age pregnancy (13%) and child marriage (40%) and young people HIV infection were highly prevalent in the country(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Early sexual initiation, teen-ager pregnancy, unwanted pregnancy, and unsafe abortion are common in Ethiopia and the median age at first sex is 16.5 years (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Nearly 40 percent of girls get married before 18th birth day and 20 percent before 15th birth day. Nearly half of girls in Amhara region get married before the 18th birth day which is the highest in the world(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In addition, young women in Ethiopia are a high risk group of population, being particularly vulnerable to gender-based violence, female genital cutting and other harmful traditional practices that are linked directly to the gender norms(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Furthermore, evidences from different parts of the country revealed that adolescents and youths in Ethiopia are engaged in risky sexual behaviours such as early sexual initiation, premarital sexual practice, having multiple sexual partners and others that predispose them to poor sexual and reproductive (SRH) outcomes such as unwanted pregnancy, unsafe abortion, maternal mortality and morbidity and sexually transmitted infections including HIV/AIDS (\u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEthiopia has made a remarkable progress in expanding tertiary level education during the last two decades (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Following this, millions of Ethiopian adolescents and youths have got chances to enroll in the Higher Educational Institutions (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In the country, it is estimated that nearly 800,000 under graduate students are enrolled in the public Higher Educational Institutions (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). However, the expansion of higher education could have both a negative and a positive impact on adolescent and youth sexual and reproductive health. On one hand, evidences showed that higher education institutions are overwhelmed with young population and becoming one of the risk corridors for adolescent and youth sexual and reproductive health problems including spread of HIV infection, on the other hand education could empower adolescent girls and has a strong positive impact on health status, being prevented from exposure to health risks, access to health care and positive health seeking behaviours(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).Young people enrolled in HEIs leave their family for the first time and lack parental supervision so that they are probably to be exposed to risky sexual behaviours which predispose them to poor SRH outcomes(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Different studies across universities in Ethiopian showed that university students are engaged in risky sexual behaviours (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn order to improve the sexual and reproductive health of university students, there is a need to gather information to ensure that the SRH problems, needs and services of university students are addressed. To date, there is limited evidence on health problems, needs and services of university students in Ethiopia. To our knowledge, no study has compiled evidence on SRH problems, needs and services of university students in Ethiopia. This systematic review could help identify gaps and opportunities tailoring public health programs to address the specific SRH problems, needs and services of university students in the context of Ethiopia. Therefore, the purpose of this scoping review is to identify and synthesis the available evidence on sexual and reproductive health of university students in Ethiopia.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThe current systematic review followed a five-stage methodological framework which includes (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) identifying the research question, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) identifying the relevant studies, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) selecting the studies according to inclusion criteria, (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) charting and interpreting data and (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) summarizing and reporting of results(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In addition, backward citation tracking on the eligible studies and manual search were applied to identify additional sources of information. Moreover, we adapted as appropriate the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) even though we did not register the protocol. Since the purpose of this review is to map the available evidence on sexual and reproductive health of adolescents and youth enrolled in (HEIs) in Ethiopia, our research question was broadly tailored as-\u0026ldquo;what is the type and extent of available information on the Sexual and Reproductive Health among University students\u0026rdquo;.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSearch Strategy\u003c/h2\u003e \u003cp\u003eA comprehensive literature search was conducted to identify all relevant studies reporting on sexual and reproductive behaviors of Ethiopian youth enrolled in higher educational institutions, by searching the following databases (PubMed, Scopus, and Google scholar),for peer-reviewed publications.\u003c/p\u003e \u003cp\u003eThe search strategy included a range of relevant combination of keywords: (\u0026ldquo;sexual health\u0026rdquo; OR \u0026ldquo;reproductive health\u0026rdquo; OR \u0026ldquo;family planning\u0026rdquo; OR \u0026ldquo;sex education\u0026rdquo; OR \u0026ldquo;sexual behavior\u0026rdquo; \u0026ldquo;sexual violence\u0026rdquo; OR \u0026ldquo;contraception\u0026rdquo; OR \u0026ldquo;contraceptive use\u0026rdquo; OR \u0026ldquo;condoms\u0026rdquo; OR \u0026ldquo;pregnancy\u0026rdquo; OR \u0026ldquo;abortion\u0026rdquo; OR \u0026ldquo;termination of pregnancy\u0026rdquo; OR \u0026ldquo;sexually transmitted infections\u0026rdquo; OR \u0026ldquo;Sexually Transmitted Infections\u0026rdquo;) AND (\u0026ldquo;Adolescent\u0026rdquo; OR \u0026ldquo;youth\u0026rdquo; OR \u0026ldquo;University Students\u0026rdquo;) AND Ethiopia.\u003c/p\u003e \u003cp\u003eArticles were included if they met the following criteria: Original observational studies, articled employed quantitative, qualitative or mixed method; describe at least one of the following components of SRH: condom use, multiple sexual partners, contraceptive use, family planning use, sexual transmitted infections, unwanted pregnancy, abortion, sexual and reproductive health knowledge, early sexual initiation, risky sexual behavior, and conducted among students enrolled in public universities or HEIs of Ethiopia.\u003c/p\u003e \u003cp\u003eOnly articles in the English language were included due to the language limitation of the authors. Our search strategy has looked for papers published from January 2015 to December 2023 published after Sustainable Development Goals declaration(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). To reduce the potential for reviewer bias, titles and abstracts of all identified records were independently screened by two authors (TA and DP) and checked for agreement. If disagreements were raised, they had been resolved by agreement or the arbitrary of the third author (SA).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy screening and selection\u003c/h2\u003e \u003cp\u003eSubsequently, the full text of potentially relevant studies were read and independently screened by two authors (TA and SA) for the eligibility criteria. Discrepancies in the study selection were resolved by consensus or were discussed with a third author (DP) for a final decision. All relevant studies fulfilling eligibility criteria were organized and exported to EndNote Reference Manager.\u003c/p\u003e \u003cp\u003eIn the first step of literature search, 520 articles were identified. Additional 150 articles were identified in other sources through manual and backward tracing search. After screening for title and abstract, full text review was done for 26 articles. Based further analyses of the full text reviewed article 11 articles were excluded from final analysis due to lack of inclusion criteria. Finally, 15 articles meeting the inclusion criteria and were selected for data extraction [\u003cb\u003eFigure1.\u003c/b\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eCharting and Data Extraction\u003c/h2\u003e \u003cp\u003eData was extracted from each eligible publication by two reviewers (TA and SA) using a structured data sheet which specifically was developed by the authors for this review. We extracted the following information from each included study: Author, Title, Publication year, Study area (University), Study design, Sample size, Year of study and summary main results which includes prevalence of condoms utilization, prevalence sexual activity/practice, prevalence multiple sexual partners, mean age of sexual initiation, prevalence transactional sex, prevalence STIs including HIV, prevalence pregnancy, prevalence HIV testing and counseling, prevalence premarital sexual practice, prevalence of early sexual debut, prevalence family planning utilization, prevalence of SRH services utilization, and proportion of knowledge of SRH\u0026amp;STIs/HIV/AIDS services [\u003cb\u003eSupplementary1 ,Excel sheet\u003c/b\u003e]. All the extracted data from eligible articles were first summarized on an Excel spreadsheet purposely prepared for this systematic review [\u003cb\u003eSuplementary1, Excel shee\u003c/b\u003et]. Among the summarized data, Author, Year of Publication, Study Location (HEI), Study Design, Sample Size, Age Rang/Mean Age\u0026thinsp;\u0026plusmn;\u0026thinsp;SD and summary of finding were separately displayed on another table[Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudies on sexual and reproductive health among University students in Ethiopia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor, Year of Publication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudy Location\u003c/p\u003e \u003cp\u003e(HEI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSample Size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStudy Title\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAge Rang/Mean Age \u0026amp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSummary of Findings\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e. Muluken Gunta et al.,2021(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWolaita Sodo University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMixed Method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSexual and Reproductive Health Services Utilization among Wolaita Sodo University Students, Ethiopia: A Mixed Method Approach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17\u0026ndash;25+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-49.80% use SRHS\u003c/p\u003e \u003cp\u003e-14.5% used condom\u003c/p\u003e \u003cp\u003e-79.50% were sexually active\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;15.50% had multiple sexual partners\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;29.5% ever had premarital sexual practice\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;4.5% had STIs\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;12.4% used family planning\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;38.1% had been tested for HIV\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;1.4% Faced abortion or received abortion care\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;83.30% had knowledge on SRH, STIs \u0026amp;HIV/AIDS\u003c/p\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e. Kassie et al.,2019(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity of Gondar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuant. C-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrevalence of sexually transmitted infections and associated factors among the University of Gondar students, Northwest Ethiopia: a cross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-18.20% of participants had STIs infection\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;42.8 had used condom\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;61.1% had ever sex\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;73.5% 12 months prior to the study period\u003c/p\u003e\u003cp\u003e-54.2% had multiple sexual partners\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;23.6% had experienced early sexual initiation/ sex before 18 years for this review.\u003c/p\u003e\u003cp\u003e-98% had information about STIs \u0026amp; HIV/AIDS\u003c/p\u003e\u003cp\u003e- The mean age at 1st sex was\u003c/p\u003e \u003cp\u003e18 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2)\u003c/p\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3.\u003c/b\u003e Shimie et al.,2022(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity of Gondar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuant. C- Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e832\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eInformation-seeking behavior on sexually transmitted infections and its associated factors among university students in Ethiopia: a cross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15\u0026ndash;23+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;55.5% of participants had information seeking behavior\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;57.2% had used condom\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;35.2% had engaged in sexual activity\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;10.2% had experienced STIs\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;34% had been tested for HIV\u003c/p\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e.Tomas Benti Tefera et.al,2015(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMadawalabu University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuant. C- Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrevalence of premarital sexual practice and associated factors among undergraduate health science students of Madawalabu University, Bale Goba, South East Ethiopia: institution based cross sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-42.7%)have had premarital sexual intercourse\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;54.7% did not used condom\u003c/p\u003e \u003cp\u003e-42.7% were engaged in sexual activity\u003c/p\u003e \u003cp\u003e-33.6% had multiple sexual partners\u003c/p\u003e \u003cp\u003e-42.7% had practiced premarital sex\u003c/p\u003e \u003cp\u003e- The mean age at 1st sex was 18.4 with SD\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14\u003c/p\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e.Yared et al.,2017(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmbo University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMixed Method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSexual and reproductive health experience, knowledge and problems among university students in Ambo, central Ethiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e- Mean number of past 12 months regular sexual partners of 1.36\u0026thinsp;\u0026plusmn;\u0026thinsp;SD 0.505 were recorded\u003c/p\u003e \u003cp\u003e-Only 21.1% of participants perceived themselves to be at risk of HIV.\u003c/p\u003e \u003cp\u003e-94.5% of participants ever heard of STIs\u003c/p\u003e \u003cp\u003e-98% participants heard about HIV/AIDS\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;89.4% knew modern contraceptives \u0026minus;\u0026thinsp;64.8% participants knew pills\u003c/p\u003e\u003cp\u003e-56.8% participants knew condoms\u003c/p\u003e\u003cp\u003e-22.8% had STIs one year prior to the study period\u003c/p\u003e\u003cp\u003e-5% had experienced unwanted pregnancy\u003c/p\u003e\u003cp\u003e-2.5%) experienced abortion\u003c/p\u003e \u003cp\u003e- The qualitative data showed high rate of unwanted pregnancy and abortion\u003c/p\u003e\u003cp\u003e- The mean age at 1st sex was 17.29 with SD\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e. Asmamaw Atnafu et al.,2019(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity of Gondar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuant. C- Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e874\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSexual and Reproductive Health Services Utilization and Associated Factors Among University Students, Northwest Ethiopia: Cross Sectional Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-62.3% participants had used SRH services\u003c/p\u003e \u003cp\u003e-57.6% used condom\u003c/p\u003e\u003cp\u003e-18.9% reported sexual practice\u003c/p\u003e \u003cp\u003e-49.1% had multiple sexual partners\u003c/p\u003e \u003cp\u003e-25.1% had early sexual initiation/\u0026lt;18 years for this review\u003c/p\u003e\u003cp\u003e- High f risky sexual behaviour was reported but not quantified\u003c/p\u003e\u003cp\u003e-16.7% had used SRH services including family planning\u003c/p\u003e \u003cp\u003e-16% get tested for HIV\u003c/p\u003e\u003cp\u003e- The mean age at first sex was 18 years with (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2)\u003c/p\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Awoke Derbie,et al,2016(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDebre Tabor University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuant. C- Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e394\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRisky sexual behaviour and associated factors among students of Debre Tabor University, Northwest Ethiopia: a cross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;28.4% had risky sexual behaviour\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;62.1% had multiple sexual partner\u003c/p\u003e \u003cp\u003e-mean age at first sex was 18.9 years with SD\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;72.6% participants had knowledge of SRH\u0026amp;STIs/HIV/AIDS services\u003c/p\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8.Kebede et al.,2018(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAksum University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuant. C- Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAssessment of risky sexual behavior and practice among Aksum University students, Shire Campus, Shire Town, Tigray, Ethiopia, 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18\u0026ndash;27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;28.4% had risky sexual behaviour\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;59.2% have used condom\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;60.6% had sexual activity\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;64.4% had multiple sexual partner\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;45% practiced premarital sex\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;37.9% had early sexual initiation history/\u0026lt;18 years\u003c/p\u003e\u003cp\u003e-Risky sexual behavior was reported but not in terms of multiple sexual partner, nonuse of condom quantified\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;54.6% had used family planning services\u003c/p\u003e \u003cp\u003e- Mean age at first sex was 18 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Abdissa B et al., 2017(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmbo University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMixed Method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e650\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePremarital Sexual Practices, Consequences and Associated Factors among Regular Undergraduate Female Students in Ambo University, Oromia Regional State, Central Ethiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;53.9% had practiced premarital sex\u003c/p\u003e \u003cp\u003e- only 7.2% had used condom\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;25.7% were sexually active\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;18.6% had early sexual initiation / \u0026lt;18 years old\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;16.8% had experienced pregnancy\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;56.8% had been tested and counseled for HIV\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;95.4% had received a negative screening result\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;(1.6%) and (3%) had got positive and unknown screening result respectively\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;53.6% of existed pregnancies ended up with abortion\u003c/p\u003e \u003cp\u003e- Mean age at was 16.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10.Kene et al.,2023(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMadda Walabu University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuant. C- Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e483\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKnowledge of Sexual and Reproductive Health Rights Among University Students: A Cross-Sectional Study in Southeast Ethiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;52.1% had optimal knowledge\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;23.96% had used condom\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;60% were practicing sex\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;23.07% had experienced early sexual initiation / sex\u0026thinsp;\u0026lt;\u0026thinsp;18 years old\u003c/p\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. Dida et al.2015(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMadawalabu University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuant. C-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReproductive health services utilization and its associated factors among Madawalabu University students, Southeast Ethiopia: cross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15\u0026ndash;25+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;89.3% had new modern family planning methods\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;27.7% had used condom\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;40.3% were sexually active\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;80.5% had used family planning\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;72.2% knew condom as a contraceptive\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;95.6% heard about VCT\u003c/p\u003e\u003cp\u003e-82% discussed on V T\u003c/p\u003e\u003cp\u003e-74.1% tested for HIV\u003c/p\u003e\u003cp\u003e-t he mean and median ages of the respondents\u0026rsquo; first sexual intercourse were 18.3 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18) and 18 years respectively.\u003c/p\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. Getachew Mullu Kassa et al. 2015(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDebre Markos University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuant. C-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEarly Sexual Initiation and Associated Factors among Debre Markos University Students, North West Ethiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17\u0026ndash;32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-44.6% had sex prior to the data collection period\u003c/p\u003e \u003cp\u003e-64.7% start sexual intercourse during the age range of 16\u0026ndash;19 years old.\u003c/p\u003e \u003cp\u003e-63.8% had used condom\u003c/p\u003e \u003cp\u003e-26% had multiple sexual partner\u003c/p\u003e \u003cp\u003e-44.6% were sexually active\u003c/p\u003e \u003cp\u003e-5.2% had practiced transactional sex\u003c/p\u003e \u003cp\u003e- mean age at first sex was 18.28 SD\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04\u003c/p\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13. Tekletsadik et al., 2022(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity of Gondar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuant. C-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDeterminants of risky sexual behaviour among undergraduate students at the University of Gondar, Northwest Ethiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e18\u0026ndash;34\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;44.0%. had practiced risky sexual practice\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;18% had used condom\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;51% were sexually active\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;48.5% had multiple sexual partner\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;34.18% had history of early sexual initiation\u003c/p\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14. Yonas Tesfaye et al.,2019(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJimma University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuant. C-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIs There Association between Risky Sexual Behaviors and Depression Symptoms among Youth? A Case of Jimma University Students, Ethiopia.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-70.1% had used condom\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;35.5% had practice Risky sexual behavior\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;61.1% had multiple sexual partners\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;44.9% had history of early sexual initiation\u003c/p\u003e\u003cp\u003e\u0026minus;\u0026thinsp;5.5% reported transactional\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;30.2% had risky sexual behavior\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15. Berhe et al.2022(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAksum University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuant. C-Sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLow-Level Knowledge and Associated Factor of Sexual and Reproductive Health Rights Among Aksum University Students, Aksum Ethiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e- Only 16.4% had knowledge of SRHSR\u003c/p\u003e \u003cp\u003e\u0026minus;\u0026thinsp;19.2% had history of early sexual initiation\u003c/p\u003e \u003cp\u003e-Mean age at first sexual activity was 18.5 years with SD\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis\u003c/h2\u003e \u003cp\u003eThematic analysis was employed for this review. The major thematic areas or major outcomes identified for this review were risky sexual behaviours, sexually transmitted infections, sexual and reproductive health knowledge, sexual and reproductive health services utilization, premarital sexual practice, and early sexual debut. Other sub-thematic areas identified for this review were condom utilization, sexual activity, multiple sexual partners, transactional sex, pregnancy, abortion and HIV testing and counseling. The prevalence of the aftermentioned themes were extracted and recorded on a spreadsheet and analyzed carefully and discussed in the result and \u003cspan refid=\"Sec8\" class=\"InternalRef\"\u003ediscussion\u003c/span\u003e section.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003eOf the 15 studies identified, 12 used a quantitative cross-sectional study design. Three studies use a mixed design (both quantitative and qualitative). No study was found used qualitative study design approach [Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e]. The sample size ranged from 260 to 874 participants. All studies included both male and female participants. Nine studies included all year regular students while 6 studies included under graduate regular students. All studies included in this were conducted in public universities i.e. HEIs. Amongst them, 4 studies were conducted in University of Gondar (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), 3 studies were conducted in Madawalabo University (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), 2 studies were conducted in Ambo University (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), another 2 studies conducted in Aksum University (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) and 4 studies(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) ,(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), ,(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e),(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) were conducted in Debretabor University, Wolaita Sodo University, Debre Markos University and Jimma University respectively.\u003c/p\u003e \u003cp\u003eRegarding to the main theme of reviewed studies 3 studies (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) had addressed SRH services utilization with reported prevalence of 62.3%,89.3% and 49.8% respectively, 2 studies (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) had addressed sexually transmitted infection(STIs) with reported prevalence of 18.2% and 55.5%, another 3 studies (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) had addressed sexual and reproductive health (SRH) knowledge with a reported prevalence of94.5%,52.1% and 16.4%, 4 studies (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) had addresses risky sexual behaviour with reported prevalence of 28.4%,60%,44% and 30.2%, one study (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) has addressed early sexual initiation and the reported prevalence was 64.7% and another 2 studies (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) had addressed premarital sexual practices with reported prevalence of 42.7% and 53.9%. No study was found addressing youth friendly services and the topic of sexual violence or coercion was omitted because it has been already compiled in a meta-analysis study (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e)(Fig.\u0026nbsp;2).\u003c/p\u003e \u003cp\u003eConcerning behaviours, experiences, outcomes in the reviewed studies, surprisingly, all studies reported sexual activity and the prevalence was ranged from 18.9\u0026ndash;79.5% (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan additionalcitationids=\"CR29 CR30 CR31 CR32 CR33 CR34 CR35 CR36 CR37 CR38\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).Among this, 2 studies had reported both the past (61.1% and 28.4%) and current (73.5% and 53.1%) status of sexual activity among participants(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) while the rest of studies (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31 CR32 CR33 CR34 CR35 CR36 CR37 CR38\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) reported only the status of sexual activity at the time of the study. Similarly, 14 studies reported condom utilization (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan additionalcitationids=\"CR29 CR30 CR31 CR32 CR33 CR34 CR35 CR36 CR37\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Among these, 3 studies described the prevalence of condom non-use during sexual activity and ranged from 23.3\u0026ndash;57.2% (\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) while the rest 10 studies described the prevalence of condom use during sexual activity and ranged 7.2\u0026ndash;64.7% (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan additionalcitationids=\"CR33 CR34 CR35 CR36 CR37\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTen studies had reported the prevalence of multiple sexual partners which is one the most important risky sexual behaviors (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) and ranged from 26\u0026ndash;64% and one study reported the mean number of multiple sexual partners as (1.36 (\u0026plusmn;\u0026thinsp;SD 0.505) (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Moreover, the prevalence premarital sexual practice was reported in four studies ranging from 25.5%(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) to 45%(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and early sexual initiation i.e. sex before the 18th birth day for this review was stated in eight studies(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) and the prevalence ranged from 18.6\u0026ndash;64.7%. Only two studies have reported transactional sex i.e. sex for money as 5.2%(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) and 5.5%(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Sexual transmitted infection was reported by four studies (\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) and was ranged from 10.2\u0026ndash;22.8%. Pregnancy test/care was another reported behaviour in two studies with prevalence of 5% (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)and 16.8% (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Five studies out of fifteen described risky sexual behaviour (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Among them, two studies (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) did not quantify the prevalence while three studies quantified the prevalence as 30.2%(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) ,31%(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) and 44%(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). One study has described the non-sexual risk behaviors such as smoking, drinking and khat chewing which have a propounding effect on risky sexual behavior(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Sexual and reproductive health services (SRHS) including family planning was one of the outcomes described in the reviewed studies. One study(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) has reported a 54.6% of (FP) service utilization and the other 3 studies reported the prevalence of SRH services ranging from 12.4\u0026ndash;80.5%(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). HIV counseling and testing has been described in five studies (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) with the prevalence ranging from 16\u0026ndash;74.1%. Two studies reported unwanted pregnancy prevalence as 5%(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) and 16.8%(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Abdissa B et al.(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) has reported that 56.8% of the occurred pregnancies (16.8%) ended up in abortion. Another two studies have reported the prevalence of abortion as 1.4%(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) and 2.5%(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Knowledge and information on SRH\u0026amp;STIs/HIV/AIDS has been discussed in eight studies (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The proportions of participants having the knowledge and information on SRH\u0026amp;STIs/HIV/AIDS have been ranged 16.4%(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) to 98%(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Finally mean age at first sex was reported in 9 studies (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The lowest mean age at first sex was reported as 16.9 years (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) highest mean age at first sex was reported as 18.9 years (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) [Fig.\u0026nbsp;3\u0026amp;Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this review, we included only studies conducted among Public Universities students in Ethiopia. The main themes addressed in this review were SRH Service utilization, sexually transmitted infection (STI), experience and knowledge SRH, risky sexual behaviour; early sexual initiation/debut and premarital sexual practices (Fig.\u0026nbsp;2).Other outcomes, experiences and behaviours addressed in the reviewed studies include condom utilization, sexual activity, multiple sexual partners, premarital sexual practice, transactional sex, pregnancy, family planning use/SRH services use, HIV testing and counseling, abortion cases/care and mean age at first sex (Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eThe prevalence reported in these main outcomes and behaviours is very troublesome. On the other hand, no study has been conducted on youth friendly services; indicating that there is limited youth friendly services at public universities in Ethiopia. Though universities in Ethiopia have student clinics in their campuses, they do not provide organized health care services including adolescent and youth friendly services. In fact, youth friendly services in Ethiopia are provided at public health institutions and youth centers (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Even if there were studies done on sexual violence/ coercion among university adolescents and youths, we excluded them from this review because of they were already addressed in a systematic review and meta-analysis study(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe reviewed studies indicated that university students in Ethiopia are exposed to high-risk sexual behaviours and as a consequence to an increased risk adverse SRH outcome including STI transmissions(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), abortion(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) and unwanted pregnancy(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Adolescents and youths enrolled in Ethiopian Universities have multiple sexual partners, early sexual debut, premarital sexual activity, nonuse of condoms, limited SRH services including family planning.\u003c/p\u003e \u003cp\u003eSurprisingly, all studies reviewed have reported that university students are engaged in sexual activity. This implies that even if university students are expected to engage in their curricular activity, they are engaged in risky behaviours that exposed them to sexual and reproductive health problems which have a negative impact on their educational achievements. A qualitative study conducted in Madawalabu University but not included due to exclusion criteria has reported a high occurrence of sexual activity among university students(\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Another quantitative study done among poly technique college students in Bonga Ethiopia reported a worrisome prevalence of sexual practice, pregnancy and abortion(\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe majority of studies reviewed reported a worrisome prevalence of having multiple sexual partners. This implies that HIV transmission and STI infection among university students could be very high. The result is supported by the evidence from Sub Saharan African(SSA) countries\u0026rsquo; universities which has reported that HIV/AIDS remains the troublesome problem among university students and other communities universities in SSA (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). In fact, evidences showed that adolescent and youth reproductive health remains a major public health problem for Sub Saharan African countries including Ethiopia particularly for adolescent girls(\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEven if it is culturally and religiously prohibited, adolescents and youths enrolled in universities in Ethiopia practiced premarital sex. This behaviour can predispose students to adverse SRH out comes such as unwanted pregnancy, abortion and STIs transmission including HIV. Studies in other settings in Ethiopia reported a high prevalence of premarital sexual practices (\u003cspan additionalcitationids=\"CR48 CR49\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). Moreover, evidences indicated that premarital sexual practices among adolescents and youths is alarmingly increasing at the global level(\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e). This implies that adolescent and youth friendly services must be avail at public universities in Ethiopia. To date, adolescent and youth friendly service are effective interventions to mitigate adolescents and youths sexual and reproductive health problems in many parts of the world(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEarly sexual debut was one of the reported SRH behaviours in the reviewed studies. A significant number of university students practiced early sexual debut in the reviewed studies. Evidences from other settings indicated that early sexual debut is highly prevalent in Ethiopia. For example, a study conducted among poor urban females in Ethiopia showed that nearly half of female experienced early sexual debut (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). Furthermore, evidence from a nationally representative data analyzed from Ethiopian Demographic and Health Survey (EDHS) revealed that 1 in 5 adolescent girls in Ethiopia experienced early sexual debut(\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnother SRH experience reported in the reviewed studies was transactional sex. Even if \u0026ldquo;transactional is thought to be a common experience among university student\u0026rdquo; only two studies have reported with low prevalence (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). The low prevalence and limited information in the reviewed studies on transactional sex could be due the respondents\u0026rsquo; bias due to privacy issue. This implies that appropriate rigorous methodological approach should be employed to get the accurate information from respondents on transactional sex other than simple cross-sectional studies. On the other hand, transactional sex practice can be a criminal act in some circumstances so that participants might hide the information for fear of being accused (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). In fact, evidences revealed that transactional sex is a common practice among adolescents who seek improved livelihood, particularly in poor countries (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). Moreover, evidences indicated that transactional sex is becoming a common practice in Ethiopia(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) in which Ethiopian adolescents and youths practice transactional as a means of income generation for food, cash, cosmetics, mobile phone, school fee and other materials(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUniversity students in Ethiopia are not invulnerable for sexually transmitted infections. The reviewed studies revealed that significant number of students have experienced STIs. Reviewed studies in this review clearly showed that university students are engaged in risky sexual behaviours such as early sexual debut, transactional sex, multiple sexual partners, unprotected sex and premarital sex which predispose for STIs and HIV. For example the study conducted to assess SRH experience, knowledge and problems among university students in Ambo University showed that 22.8% of participants have experienced STIs infection(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).This study also has reported that 23.3% of participants have not used condoms while 37.2% participants were sexually active (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). This suggests that unsafe sex accompanied with sexual activity predisposes the students to STIs infection including HIV.\u003c/p\u003e \u003cp\u003eAn interrelated SRH outcomes pregnancy and abortion have been investigated in the reviewed studies(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). A mixed method study among Ambo University students showed that pregnancy and abortion were the poor SRH outcomes among students(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Though the quantitative part this study reported low prevalence of pregnancy, the qualitative data has indicated the high prevalence of unwanted pregnancy and abortion among university students(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). In fact, unwanted pregnancy and abortion are the most common SRH problems among Ethiopian adolescents and youths including college and university students(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). This is reinforced in the evidence from a study done among college students in Arisi Zone which has reported that 37.2% and 26.0% of college students have received pregnancy test and abortion care services respectively(\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe other discussed theme in the reviewed studies was knowledge of sexual and reproductive health and service including HIV/AIDS. Eight studies out of fifteen have reported information and knowledge status of participants on SRH (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). One study reported that 98% of participants heard about STIs(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The rest seven studies reported SRH knowledge prevalence16.4\u0026ndash;95.4%. However, they were not immune from sexual and reproductive health problems. For example, in a study conducted to assess SRH experience and knowledge, 22.8% of participants had STIs infection and 5% and 2.5% had experience unwanted pregnancy and abortion respectively(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLastly, mean age at first sex was one issue discussed in reviewed studies. Nine out of fifteen studies have discussed age at first sex. The lowest mean age at first sex was 16.5 years old. This shows that university students in Ethiopia start sexual debut early at secondary school. In fact, studies from different part of country among secondary school students indicated early sexual debut is a common practice among this group of population (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). This implies that appropriate intervention should be implemented at secondary schools to avoid early initiation of sexual practice among teenagers.\u003c/p\u003e \u003cp\u003eLimited youth-friendly health services in higher educational institution in Ethiopia might have an important contribution for high prevalence of risky sexual behaviours among university students and its consequences. Effort should be made to establish youth friendly health services at public universities that are tailored towards the needs of university students. Youth-friendly health services should be rendered in campus clinics of universities. Campus clinic health care provides should be trained on youth-friendly service so that their misconception and negative attitude will not hamper youth-friendly health services implementation in campus clinics. Health education for university students on major SRH problems and services is also imperative.\u003c/p\u003e"},{"header":"Limitation","content":"\u003cp\u003eAlthough a comprehensive search was done for this scoping review, the exclusion of articles with languages other than English presents a limitation which leads to language bias. Yet, this review delivers a comprehensive overview of the available evidence on sexual and reproductive behaviours of university students in Ethiopia which can contribute to identify the evidence gap in sexual and reproductive among university students in Ethiopia..\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe available published information showed that university students in Ethiopia engaged in high risk sexual behaviors and experience adverse consequences. Although, it seems essential to collect more information both qualitative and quantitative, the reviewed one evidenced a need to establish and strengthen youth friendly reproductive health services at higher educational institution in Ethiopia specifically tailored for university students.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSDGs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSustainable Development Goals\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eASRH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdolescent Sexual and Reproductive Health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICPD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Conference on Population and Development\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEDHS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEthiopian Demographic and Health Survey\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSRH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSexual and Reproductive Health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAIDS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcquired Immunodeficiency Syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHEIs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHigher Educational Institutions\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePRISMA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePreferred Reporting Items for Systematic Reviews and Meta-Analysis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTIs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSexually Transmitted Infections\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSub Saharan Africa.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contribution\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTA conceived the study. All authors participated in the conception and design of the study. TA and SA undertook the review to gather the include studies. TA wrote the first draft. Both TA and SA revised the second draft. DP revised the second draft and all authors contributed the final manuscript. All authors approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe did not receive any funding for this review paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated and analyzed during this study are included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe declare that we have no competing interests.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eTransforming our world: the 2030 Agenda for Sustainable Development: sustainabledevelopment.un.org, (2015).\u003c/li\u003e\n \u003cli\u003eWHO. 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Why Too Soon? Early Initiation of Sexual Intercourse Among Adolescent Females in Ethiopia: Evidence from 2016 Ethiopian Demographic andHealth Survey. International Journal of Women\u0026rsquo;s Health, Dove Press ;12:269\u0026ndash;75.\u003c/li\u003e\n \u003cli\u003eUNAIDS, Global AIDS Monitoring 2022. Indicators and questions for monitoring progress on the 2021 Political Declaration on HIV and AIDSJoint United Nations Programme on HIV/AIDS ,Geneva: Joint United Nations Programme on HIV/AIDS; Licence: CC BY-NC-SA 3.0 IGO. 2022.\u003c/li\u003e\n \u003cli\u003eHelen Epstein et al. HIV/AIDS Prevention Guidance for Reproductive Health Professionals in Developing-Country Settings. New York, New York: Population Council Library Cataloging-in-Publication Data; 2002.\u003c/li\u003e\n \u003cli\u003eDemelash Wachamo et al. Sexual and Reproductive Health Services Utilization and Associated Factors among College Students at West Arsi Zone in Oromia Region, Ethiopia. Hindawi The Scientific World Journal , . 2020;Volume 2020:7\u003c/li\u003e\n \u003cli\u003eAlem Girmay, Mariye T. Risky sexual behavior practice and associated factors among secondary and preparatory school students of Aksum town, northern Ethiopia, 2018. BMC Research Notes. 2019.\u003c/li\u003e\n \u003cli\u003eEskeziaw Abebe Kassahun, Abebaw Addis Gelagay, Achenef Asmamaw Muche, Amanuel Addisu Dessie, Belayneh Ayanaw Kassie. Factors associated with early sexual initiation among preparatory and high school youths in Woldia town, northeast Ethiopia: a cross-sectional study. BMC Public Health. 2019;19(378).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Reproductive Health, Sexual Heath, Risky Sexual Behaviours, University Students, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-4112385/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4112385/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThere is a wide variation among societies in profiles of adolescent and youth health and behaviours, however they all experience sexual and reproductive health as a major health challenge. However, adolescents and youths in middle-and low-income countries like Ethiopia are of a particular concern where limited social, educational and health services leads to poor sexual and reproductive health outcomes such as unwanted pregnancy, unsafe abortion and sexually transmitted infections including Immune Deficiency Virus. Identify and synthesis the available evidence on sexual and reproductive health of university students in Ethiopia has a paramount importance to inform policy makers, governmental and non-governmental organizations, to tailor health services in Higher Educational Institutions and to understand evidence gaps. Thus, we did a descriptive systematic review of available published information on sexual and reproductive health among Ethiopian university students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eWe performed a systematic review to collect and analyze observational data on sexual and reproductive health behaviours among Ethiopian university students. Publications were identified using PubMed, Scopus, and Google scholar databases and manual search from 2015 to December 2023. We defined a protocol to identify relevant studies. We included original observational studies conducted in Ethiopia among university students, both qualitative and quantitative studies and that consider at list one of the following elements: \u0026nbsp;sexual activity, condom use, multiple sexual partners, contraceptive use, family planning use, sexual transmitted infections, unwanted pregnancy, abortion, sexual and reproductive health knowledge, early sexual debut, risky sexual behavior. All include article were coded according to relevant outcomes and experiences and subsequently analyzed to assess frequencies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult: \u003c/strong\u003eAfter screening for inclusion criteria 15 publications were include in the datasheet developed to record the findings. Surprisingly all 15 studies reported that university students are sexually active with high prevalence of having multiple sexual partners and limited use of sexual and reproductive health services such as condom use and family planning /contraceptive use. Unwanted pregnancy, abortion, STIs infections, early sexual debut and premarital sex were frequently reported. Only two studies reported transactional sex.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Adolescents and youths enrolled at Ethiopian Public Universities engage in risky sexual behaviours and experience its adverse consequences. It is essential to collect more evidence, but the available information supports a need for improving provision of sexual and reproductive health services, among Ethiopian university students. Youth friendly sexual and reproductive health services should be avail in Higher Education Institutions.\u003c/p\u003e","manuscriptTitle":"Sexual and Reproductive Health Behaviors among Ethiopian University Students: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-20 19:35:58","doi":"10.21203/rs.3.rs-4112385/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"87b15e96-0926-416d-8a96-780489e0cb41","owner":[],"postedDate":"March 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-01T11:01:57+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-20 19:35:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4112385","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4112385","identity":"rs-4112385","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}