Trends and socioeconomic differences in early sexual debut before marriage among teenage and young girls in sub-Saharan Africa, 2000-2023

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This study analyses trends in ESD and socioeconomic differences according to place of residence. Methods: The data come from three cycles of Demographic and Health Surveys conducted between 2000 and 2023 in 18 countries, covering 80,432 sexually active adolescent girls and young women. The analyses combine cross-tabulations, comparison of proportions tests and binary logistic regressions, at the 5% threshold, using STATA 17. Results: The results indicate that the prevalence of ESD gradually decreased from 18.7% during the first half of the Millennium Development Goals (MDGs, 2000-2008) to 18.2% during the second half (2009-2015), and then to 15.5% during the first half of the Sustainable Development Goals (SDGs, 2016-2023). The decline is significant, reaching 14.8% between the end of the MDGs and the start of the SDGs (p=0.000), and 17.1% between the start of the MDGs and the start of the SDGs (p=0.000). Adolescent girls are at least twice as likely to be at risk of ESD as older girls, with greater vulnerability in rural areas (Ajusted Odds Ratio: aOR=3.04; p<0.001) than in urban areas (aOR=2.88; p<0.001). Socio-economic disparities are also notable. Adolescent girls and young women from poor or very poor households are 1.48 times more exposed to ESD, especially in urban areas (aOR=1.98; p<0.000) compared with 1.17 in rural areas (p<0.05). Conversely, education appears to be a protective factor regardless of place of residence. Conclusion: These results underline the urgent need to strengthen sexual and reproductive health awareness strategies, particularly targeting rural areas and the least educated young girls. Public policies should promote access to education and information to delay the onset of ESD and reduce its impact on the health and schooling of adolescent girls in sub-Saharan Africa. Trends Differences Early sexuality Teenage Sub-Saharan Africa Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction In sub-Saharan Africa (SSA), early sexual debut among teenage girls is a worrying phenomenon that raises major issues in terms of public health, education and socio-economic development [ 1 ]. It is defined by an age threshold before which the first sexual intercourse takes place. According to previous studies, it varies from less than 15 years old [ 2 , 3 ] under 16 years of age [ 4 , 5 ] and under the age of 18 [ 6 , 7 ]. Several studies have identified early sexuality as a factor associated with risky sexual behavior, with a "cause and effect" link [ 8 – 10 ]. It exposes teenage girls to a higher risk of unwanted pregnancy, sexually transmitted infections (STIs) and dropping out of school than teenage boys, perpetuating a cycle of poverty and inequality [ 11 – 13 ]. These marked inequalities between adolescent boys and girls continue to contribute to their vulnerability to risky sexual behaviour in sub-Saharan Africa and raise challenges to be met in order to contribute to a quality adult life for adolescent girls and protect their health [ 14 , 15 ]. Studies have shown that teenage girls who have their first sexual encounter at a very early age are more likely to adopt risky sexual behaviour such as multiple sexual partnerships, not using condoms and having casual or transactional sex [ 16 ]. What's more, early sexual activity not only exposes teenage girls to the risk of Human Immunodeficiency Virus (HIV) infection over a long period of time [ 16 , 17 ] but also have long-term psychological and social repercussions, affecting their well-being and their future [ 18 ]. A study in Uganda has shown that delaying the age of sexual debut helps to reduce the prevalence of HIV and protect the health of adolescent girls [ 19 ]. As a result, since the 1990s, initiatives aimed at delaying sexual debut have been incorporated into HIV prevention programs in SSA [ 20 ]. This initiative raises a number of questions: how does early sexual debut among teenage girls in SSA evolve over time? Furthermore, the literature has shown that this phenomenon is linked to a combination of socio-cultural, economic and environmental factors such as poverty, gender inequalities, social pressures and lack of access to comprehensive education [ 9 , 21 – 26 ]. Studies carried out in north-western and north-eastern Ethiopia have shown that having less contact with parents or not discussing sexual and reproductive health issues with one's mother increases the risk of early sexual intercourse among adolescent girls [ 7 , 23 ]. Other studies have shown that the fact that an adolescent has at least a primary education, comes from a low-income family or is exposed to the media, reduces the risk of early sexual debut [ 9 , 27 – 29 ]. In addition, peer pressure, gender and alcohol consumption are risk factors for early premarital sex in teenage girls [ 22 , 24 , 25 ]. However, urban-rural differences were observed in the prevalence of early sexual initiation in sub-Saharan Africa. Young girls living in rural areas were more likely than young girls living in urban areas to have an early sexual initiation [ 30 ]. This is also the case for the findings of a study carried out in SSA, where the risk of having sexual intercourse at an early age was higher among adolescent girls in rural areas than those in urban areas [ 29 ]. In Nigeria, Folayan et al, using primary data, found that initiation of premarital sex was more common among young girls living in rural areas than those living in urban areas [ 31 ]. In Cambodia, however, girls living in rural areas are less likely to be initiated into premarital sex than those living in urban areas [ 32 ]. These results were also observed in a study carried out in Côte d'Ivoire, where the fact that a young girl lives in an urban area increases the risk of premarital sexual debut [ 33 ]. Although these studies reveal differences in the precociousness of premarital sex between areas of residence, what is the situation, over time, with regard to socioeconomic inequalities in the precociousness of premarital sex among adolescent girls and young women in their areas of residence? This study examines the socio-economic inequalities associated with early premarital sexuality among adolescent girls and young women in the countries of SSA, taking into account the differences between rural and urban areas and their evolution over time. By analyzing data from three recent rounds of Demographic and Health Surveys (DHS) conducted respectively in the 1st half of the Millennium Development Goals (MDGs), the 2nd half of the MDGs and the 1st half of the Sustainable Development Goals (SDGs), the study aims to fill existing gaps in research on this topic. The results of the study will provide crucial information to help policy makers and programs planners reorient their strategies to delay sexual debut among adolescent girls, thereby reducing risky sexual behaviour and protecting their health. Methods Data sources The data used come from series of DHS carried out in sub-Saharan African countries. These surveys are cross-sectional studies conducted, at best, every five years to obtain varied and up-to-date information on sexual activity, reproductive health, family planning (FP) and other related issues. The study focuses on countries with DHS conducted between 2000 and 2023, i.e. in the 1st half of the MDGs (2000–2008), the 2nd half of the MDGs (2009–2015) and the 1st half of the SDGs (2016–2023). To this end, countries that had not conducted a DHS in these periods were not included. In addition, the most recent DHS was selected for each of these periods in the case of countries that had conducted several DHSs during the period in question. A total of eighteen (18) countries were included in the study: Benin, Burkina Faso, Cameroon, Ethiopia, Gabon, Ghana, Guinea, Kenya, Liberia, Mali, Mozambique, Nigeria, Rwanda, Senegal, Sierra Leone, Tanzania, Uganda and Zambia. All data are publicly available on the EDS website: https://dhsprogram.com/data/available-datasets.cfm . They are representative household surveys at national and regional level and by area of residence (urban and rural). A multi-stage stratified cluster sampling technique was used to recruit survey participants. The 'IR woman' database for each survey was used, and each database contained responses from women of childbearing age. For the purposes of this study, all unmarried women aged between 15 and 24 who are sexually active constitute the study population and are referred to as 'teenage and young girls'. For the purposes of analysis, the study sample comprises 15048, 24812 and 27296 sexually active teenage and young girls, for the three survey periods in SSA respectively. The total sample was 67156 sexually active, never-married teenage and young girls with complete responses to the variables used. This sample is described in Table 1 below by survey year and country. Table 1 Sample size by survey year, by region and country Country name 2000–2008 2009–2015 2016–2023 Overall DHS Number DHS Number DHS Number Sub-Saharan Africa 15048 24812 27296 67156 East Africa 4893 9392 10983 25268 Ethiopia 2005 221 2011 285 2016 303 809 Kenya 2008 776 2014 2695 2022 3297 6768 Mozambique 2003 1264 2011 1345 2022 1538 4147 Rwanda 2005 539 2014 1057 2019 1163 2759 Tanzania 2004 657 2015 1144 2022 1110 2911 Uganda 2006 637 2011 744 2016 1632 3013 Zambia 2007 799 2013 2122 2018 1940 4861 West Africa 7974 12138 12905 33017 Benin 2006 1451 2011 1590 2017 1667 4708 Burkina Faso 2003 720 2010 803 2021 1298 2821 Ghana 2008 584 2014 1263 2022 1977 3824 Guinea 2005 460 2012 718 2018 683 1861 Liberia 2007 1277 2013 1539 2019 1586 4402 Mali 2006 164 2012 428 2018 461 1053 Nigeria 2008 2431 2013 2738 2018 2458 7627 Senegal 2005 114 2015 225 2023 256 595 Sierra Leone 2008 773 2013 2834 2019 2519 6126 Central Africa 2181 3282 3408 8871 Cameroon 2004 1008 2011 1716 2018 1815 4539 Gabon 2000 1173 2012 1566 2019 1593 4332 Dependent variable In this study, early sexual debut before marriage was identified as a dependent variable. It is based on the question asked of teenage and young girls in the DHS: "How old were you when you first had sexual intercourse? The response of women aged 15–24 to this question is shown in the figure below. According to the distribution of responses to this question, a peak emerges at the age of 15, considered in this study as the minimum age at which an adolescent can have her first sexual intercourse (Fig. 1 ). To this end, the dependent variable is dichotomized, taking the value 1" when the teenager had her first sexual intercourse before the age of 15, and taking the value "0" when the teenager had her first sexual intercourse at an age equal to or greater than 15. Independent variables The main independent variables in this study are age cohort (15–19 "Teenagers"; 20–24 "Young girls"), place of residence (urban; rural) and household standard of living (Very poor; Poor; Average; Rich and Very rich). This last variable is obtained from a principal component analysis of household goods and equipment. In addition, other variables were used to control for the net effect of these variables on early sexuality among teenage and young girls. These were level of education (None; Primary; Secondary and Higher), the variables "Having heard about FP on the radio (Yes or No)", "Having heard about FP on television (Yes or No)", "Having heard about FP in the newspaper (Yes or No)". The variables region, year, country as well as variables linked to the characteristics of the head of household (HH), notably the age of the HH (Under 50 years; 50–59 years and 60 year or over) and the sex of the HH (Male and Female), were also used to control for the net effect of socio-economic variables on ESD in teenage and young girls. The "region" variable was created by grouping the countries included in the study according to their geographical position in SSA. It comprises three modalities: East Africa (Ethiopia, Kenya, Mozambique, Rwanda, Tanzania, Uganda, Zambia); West Africa (Benin, Burkina Faso, Ghana, Guinea, Liberia, Mali, Nigeria, Senegal, Sierra Leone) and Central Africa (Cameroon, Gabon). The "survey period" variable, created from the survey years of each country, has three modalities: "2000–2008", corresponding to the first half of the MDGs, "2009–2015", corresponding to the second half of the MDGs, and "2016–2023", corresponding to the first half of the MDGs. The "pays" variable represents the name of the countries included in the study. Analysis methods Firstly, bivariate descriptive analyses are carried out, using cross-tabulations, to describe weighted trends in premarital ESD in SSA countries and areas of residence between the 1st half of the MDGs and 1st half of the SDGs. In addition, comparison tests of proportions are carried out using the "ttest" command to check the significance of variation in the prevalence of ESD between survey periods. Next, bivariate descriptive analysis techniques are applied to estimate the prevalence of ESD among teenager and young girls by place of residence and standard of living in all 18 countries, by region and by country. Finally, bivariate logistic regressions, broken down by area of residence, were carried out to examine socioeconomic differences in the prevalence of ESD among teenager and young girls. This analysis technique highlights, at the multivariate level, the net effect of age cohort and standard of living on ESD among adolescent girls and boys, controlled by level of education, FP radio viewing, FP Television viewing, FP newspaper viewing, sex of HH, age of HH, region, survey period and country. The binary logistic regression model for the probability logit is written as follows: Z= logit (P)=log ( ) Avec Z= β 0 + β 1 X 1 + β 2 X 2 + ……+ β k X k + E et P= β 0 : model constant, it is used to calculate the probability of Y when the mode-variables are zero. β k : the coefficients associated respectively with X k X k : independent variables or individual observations k P : probability associated with Y=1 if the event under study has occurred; ( ) is called Odds or Odds. E : represents the prediction error Results Levels and trends of early sexual debut among teenager and young girls in SSA Overall, Fig. 2 shows that the prevalence of ESD among teenager and young girls in SSA was 18.7% [95% CI: 18.0-19.4] during the first half of the MDGs, 18.2% [95% CI: 17.7–18.8] during the second half of the MDGs, and 15.5% [95% CI: 15.0-16.1] during the first half of the SDGs. Trend analysis reveals a non-significant decline of 2.7% between the two halves of the MDGs (p = 0.2855), followed by a significant decrease of 14.8% between the second half of the MDGs and the first half of the SDGs (p = 0.000), and an overall significant decline of 17.1% between the first half of the MDGs and the first half of the SDGs (p = 0.0000). With regard to differences by place of residence, similar dynamics were observed in urban areas. Thus, ESD prevalence fell from 15.8–14.4%, then to 12.2% between the three periods, i.e. a non-significant drop of 8.9% between the two halves of the MDGs (p = 0.0636), followed by a significant drop of 14.8% between the second half of the MDGs and the first half of the SDGs (p = 0.0008), and of 22.8% over the whole period (p = 0.0000). In rural areas, the trend is different. First, there was a slight non-significant increase of 3.6% between the first two periods (p = 0.5902), followed by a significant drop of 15.9% between the second half of the MDGs and the first half of the SDGs (p = 0.0000), and an overall significant decrease of 12.9% between the first half of the MDGs and the first half of the SDGs (p = 0.0000). Prevalence in rural areas fell from 22.5–23.3%, then to 19.6%. It should be noted that, although the fall was more marked in urban areas (22.8%; p = 0.0000), the prevalence of ESD remains systematically higher in rural than in urban areas, whatever the time of the survey. Early sexual debut regional trends The data in Fig. 3 show a significant drop in ESD prevalence in East Africa (p < 0.05) over the reference period. However, differences between urban and rural areas remained constant across the three survey periods. In West Africa, there was a significant drop in ESD (p < 0.001) between the second half of the MDGs and the first half of the SDGs, after a significant rise between the two halves of the MDGs. In this region, the gap between rural and urban areas remains visible, with a general downward trend in rural areas, although rates remain higher there. In Central Africa, Fig. 3 also reveals a significant decline in ESD, but with contrasting dynamics depending on the area of residence between the second half of the MDGs and the first half of the SDGs. In urban areas, there is a slight increase between the two halves of the MDGs, followed by a decrease, while in rural areas, prevalence increases slightly between the latter two periods, without this increase being statistically significant. National dynamics of early sexual debut Country-by-country analysis, illustrated in Fig. 4, highlights three distinct patterns of change in ESD among teenager and young girls between the first half of the MDGs and the first half of the SDGs. The first group, comprising Burkina Faso, Cameroon, Gabon, Guinea, Kenya, Mali, Mozambique, Nigeria, Rwanda, Tanzania and Uganda, is characterized by a significant decline in ESD prevalence. A second group, comprising Ethiopia, Ghana, Liberia and Senegal, shows an upward trend in prevalence over the period 2000–2023, although the increases observed in Ethiopia and Senegal are not statistically significant. Finally, a third group, comprising Benin, Sierra Leone and Zambia, shows relative stability in ESD prevalence over the reference period. Furthermore, an analysis of trends in ESD prevalence between the second half of the MDGs and the first half of the SDGs reveals two groups of countries. On the one hand, in countries such as Gabon, Guinea, Kenya, Mozambique, Nigeria, Rwanda, Senegal, Tanzania and Uganda, a significant drop in EPVS prevalence was observed between the second half of the MDGs and the first half of the SDGs (p < 0.05). On the other hand, in the other countries, the variation in the high rate of ESD between these two periods is not statistically significant. However, there was an upward trend in Benin, Ethiopia, Ghana, Liberia and Sierra Leone, and a downward trend in Burkina Faso, Cameroon, Mali and Zambia. In addition, it should be noted that urban-rural gaps in ESD persist, and have even widened in some countries in the first half of the SDGs. At this time, the prevalence of ESD remains higher among adolescent girls and young women living in rural areas, regardless of the survey period. This disparity is particularly marked in countries such as Cameroon, Ethiopia, Gabon, Kenya, Liberia, Sierra Leone and Tanzania. These results call for special attention and targeted interventions in rural areas to reduce inequalities in ESD prevalence among teenager and young girls. Prevalence of early sexual debut by place of residence and standard of living in the first half of the SDGs In the first half of the SDGs, the data presented in Table 2 reveal a higher prevalence of ESD among teenage and young girls living in rural areas, compared to those residing in urban areas, in East and West Africa (p < 0.001). This disparity is confirmed at the SSA level, where almost 60% of rural girls and adolescents have had an ESD, compared with around 40% in urban areas (p < 0.001). In Central Africa, on the other hand, the trend is reversed, with a higher prevalence of ESD in urban areas (65.3%) than in rural areas (34.7%). In terms of standard of living, teenage and young girls from poor, middle-income and wealthy households have higher rates of ESD (20.5%, 22.4% and 21.4% respectively) than those from very poor households (16.9%). This trend is also observed in West Africa, where ESD is more frequent among teenager and young girls from medium (23.3%) and wealthy (22.5%) households, while teenager and young girls from very poor households have the lowest rate (14.8%). In Central Africa, ESD is most widespread among teenage and young girls from poor households (23.8%), while very wealthy households have the lowest rate (13.5%). In East Africa, although the relationship between standard of living and ESD is significant, the differences between categories are less pronounced. Table 2 Prevalence of early sexual debut by area of residence and household standard of living for teenage and young girls, by region, 2000–2023 Socio-economic variables Region Sub-Saharan Africa East Africa West Africa Central Africa Place of residence *** *** *** *** Urban 30,9 [28, 3–33, 7] 48,2 [45,7–50,8] 65,3 [60,4–70,0] 40,6 [38, 8–42, 3] Rural 69,1 [66,3–71,7] 51,8 [49,2–54,4] 34,7 [30,0–39,7] 59,4 [57,7–61,2] Standard of living *** *** *** *** Very poor 18,9 [16,9–21,0] 14,8 [13, 1–16, 7] 22,7 [18, 3–27, 8] 16,9 [15, 7–18, 2] Poor 20,3 [18, 3–22, 5] 20,6 [18, 7–22, 7] 23,8 [19, 9–28, 2] 20,5 [19, 2–21, 9] Medium 20,9 [18, 8–23, 2] 23,3 [21, 2–25, 6] 21,3 [17,0–26,2] 22,4 [21,0–23,9] Rich 20,4 [18, 1–22, 8] 22,5 [20, 4–24, 8] 18,7 [14, 6–23, 7] 21,4 [20, 1–22, 9] Very rich 19,5 [17,4–22,0] 18,8 [16,8–21,0] 13,5 [09,8–18,5] 18,7 [17, 4–20, 2] Significance Level : *** : p < 0,001 Analysis by country (Table 4a and 4b in appendix) confirms significant differences according to place of residence. In Benin, Ethiopia, Kenya, Nigeria, Rwanda and Zambia, the prevalence of ESD is higher among rural adolescent girls. Conversely, in Gabon and Liberia, urban teenager and young girls are more affected. In countries such as Cameroon, Ghana, Mozambique and Sierra Leone, although the association between ESD and place of residence was significant, no clear difference was observed in these countries with regard to the confidence intervals. The analysis also reveals three country profiles according to the nature of the relationship between standard of living and ESD among teenager and young girls. The first group, made up of Burkina Faso, Mozambique, Nigeria, Uganda and Tanzania, are characterized by a higher prevalence of ESD among teenager and young girls from rich or very rich households, and a lower prevalence among those from poor or very poor households. The second group, made up of Cameroon, Gabon, Ghana and Kenya, presents a situation where ESD is more prevalent among adolescent girls from disadvantaged households, while it is less common among those from very wealthy households. Finally, in the third group, comprising Benin, Liberia, Rwanda, Sierra Leone and Zambia, no significant differences were observed between the different socio-economic categories, with confidence intervals that largely overlapped. Socio-economic differences in the early sexual debut by place of residence and in SSA The results in Table 3, based on adjusted odds ratios, show a strong association between socioeconomic characteristics and the risk of ESD according to place of residence. In the first half of the SDGs, adolescent girls had at least twice the risk of adolescent boys, with a higher risk in rural areas (aOR = 3.04; CI95%: 2.81–3.29) than in urban areas (aOR = 2.88; CI95%: 2.64–3.15), both highly significant (p < 0.001). The risk of ESD decreases overall as the standard of living improves. Adolescent girls and young women from very poor or poor households are 1.18 times more likely to have a risk of ESD than those from very rich households. In urban areas, this risk is even greater: teenage and young girls living in very poor and poor households are 1.98 times and 1.53 times more likely respectively to have a risk of ESD (p < 0.001). Similar inequalities were observed in rural areas (p < 0.01). Table 3: Adjusted logistic regressions of early sexual debut on socioeconomic characteristics among teenage and young girls, by area of residence Variables Urban aOR [95%CI] Rural aOR [95%CI] Overall aOR [95%CI] Socio-economic variables Age cohort (Ref: Young girl) Teenager 2,88***[2,64-3,15] 3,04***[2,81-3,29] 2,97***[2,80-3,15] Standard of living (Ref: Very rich) Very poor 1,98***[1,60-2,47] 1,17* [1,01-1,37] 1,48***[1,35-1,62] Poor 1,53***[1,29-1,82] 1,22** [1,05-1,41] 1,48***[1,35-1,61] Medium 1,32***[1,16-1,51] 1,12ns [0,97-1,30] 1,33***[1,22-1,44] Rich 1,15** [1,04-1,27] 1,08ns [0,93-1,26] 1,17***[1,08-1,27] Control variables Level of education (Ref: None) Primary 1,08ns [0,92-1,28] 1,08ns [0,96-1,21] 1,11* [1,01-1,22] Secondary 0,51***[0,43-0,60] 0,57***[0,51-0,65] 0,55***[0,50-0,61] Superior 0,19***[0,14-0,25] 0,19***[0,12-0,28] 0,19***[0,15-0,24] Heard about FP on the radio (Ref: No) Yes 0,91ns [0,83-1,01] 0,94ns [0,87-1,02] 0,93* [0,87-0,99] Heard about FP on Television (Ref: No) Yes 0,95ns [0,86-1,06] 0,91ns [0,81-1,02] 0,93ns [0,86-1,01] Heard about FP in the newspapers (Ref: No) Yes 0,94ns [0,82-1,07] 0,95ns [0,83-1,10] 0,95ns [0,86-1,05] Sex of HH (Ref: Male) Female 1,02ns [0,94-1,11] 0,99ns [0,92-1,06] 1,00ns [0,94-1,05] Age of head of HH (Ref: Under 50 years) 50-59 year 0,99ns [0,90-1,09] 0,96ns [0,89-1,04] 0,98ns [0,92-1,04] 60 year and over 0,92ns [0,83-1,02] 0,96ns [0,89-1,04] 0,95ns [0,89-1,01] Region (Ref: East Africa) West Africa 1,60***[1,31-1,94] 1,27** [1,09-1,48] 1,39***[1,24-1,57] Central Africa 1,30* [1,05-1,61] 1,68***[1,38-2,05] 1,24** [1,08-1,43] Survey period (Ref: 2000-2008) 2009-2015 0,98ns [0,89-1,09] 1,08ns [0,99-1,18] 1,03ns [0,96-1,10] 2016-2023 0,89* [0,80-0,98] 0,95ns [0,87-1,04] 0,91** [0,85-0,98] Country (Ref: Zambia) Benin 0,60***[0,51-0,72] 0,67***[0,58-0,79] 0,65***[0,58-0,73] Burkina Faso 0,37***[0,28-0,47] 0,34***[0,27-0,43] 0,36***[0,30-0,42] Cameroon 0,85ns [0,71-1,03] 0,65***[0,53-0,81] 0,85* [0,74-0,98] Ethiopia 0,45** [0,26-0,77] 0,70ns [0,42-1,17] 0,6** [0,41-0,87] Gabon 1,00 1,00 1,00 Ghana 0,81* [0,66-1,00] 0,80* [0,67-0,97] 0,81** [0,70-0,93] Guinea 0,96ns [0,77-1,20] 0,78* [0,62-0,97] 0,87ns [0,74-1,01] Kenya 0,94ns [0,72-1,23] 1,03ns [0,89-1,18] 1,05ns [0,92-1,18] Liberia 0,89ns [0,74-1,08] 0,86ns [0,73-1,02] 0,88* [0,77-1,00] Mali 1,03ns [0,79-1,34] 0,67** [0,49-0,90] 0,83ns [0,68-1,02] Mozambique 1,43***[1,17-1,76] 1,01ns [0,83-1,23] 1,2** [1,05-1,38] Nigeria 0,66***[0,55-0,79] 0,83* [0,72-0,97] 0,77***[0,69-0,86] Rwanda 1,27ns [0,98-1,64] 1,18ns [1,00-1,38] 1,26** [1,10-1,45] Senegal 0,76ns [0,46-1,27] 0,87ns [0,61-1,24] 0,82ns [0,60-1,12] Sierra Leone 1,00 1,00 1,00 Tanzania 1,11ns [0,86-1,43] 0,68***[0,57-0,82] 0,85* [0,73-0,99] Uganda 1,61***[1,24-2,10] 0,87ns [0,73-1,04] 1,10ns [0,95-1,27] Ref: Reference modality; aOR : Adjusted odds ratios; ns: not significant; *: p<0,05; **: p<0,01; ***: p<0,001 Among the control variables, level of education appears to be a protective factor. Compared with teenage and young girls with no education, those with secondary or higher education had a significantly lower risk of ESD in urban areas (OR = 0.51 and 0.19 respectively; p < 0.001) and rural areas (reduction of 47% for secondary and 81% for higher education; p < 0.001). Finally, exposure to family planning information through the media plays a differentiated role. Hearing about FP on the radio was associated with a significant 7% reduction in the risk of ESD (p < 0.05). On the other hand, no significant association was observed between ESD and exposure to television or the written press, either at the SSA level or according to place of residence. Discussion The aim of this study was to describe the levels and trends in early sexual debut (ESD) among adolescent girls and young women in sub-Saharan Africa (SSA), by area of residence, between the first half of the Millennium Development Goals (MDGs) and the first half of the Sustainable Development Goals (SDGs). It also aimed to estimate the prevalence of ESD according to socio-economic characteristics in the first half of the MDGs, at national and regional level, and in SSA countries as a whole, while analyzing socio-economic inequalities according to place of residence. The results show a significant drop in ESD over the reference period, from 18.7–15.5%. This prevalence is lower than those reported in other studies conducted in SSA (46,4% ;[ 29 ]), in Ethiopia (38,4% ; [ 27 ]), or in Kenya (36% ;[ 21 ]). These differences could be explained by variations in the definition of the ESD and in the size of the sample considered. For example, this study included 67,156 unmarried teenage girls and young women and defined a first sexual intercourse before the age of 15, whereas the study by Abate and al defines the ESD as sexual practice before the age of 18 [ 27 ], and the study of Ferede and al. conducted in ASS is based on a larger sample (184,942 young girls) [ 29 ]. Furthermore, the decline in ESD observed in SSA is particularly marked in urban areas, although prevalence remains higher in rural areas in each survey period. This reflects the persistence of traditional and conservative norms in rural areas, where cultural expectations such as early marriage or pressure to enter childbearing early are still practiced. In addition, often limited access to information in rural areas hinders efforts to raise awareness of sexual and reproductive health, helping to maintain high prevalence despite a general downward trend [ 34 ]. Multivariate analyses indicate that the risk of ESD is significantly higher in adolescent girls (15–19 years) than in young girls (20–24 years), especially in rural areas. This result is consistent with the findings of studies conducted in Ghana [ 28 ], but differs from an Ethiopian study [ 27 ], which reports a risk six times higher than in young women. This result could be explained by the hormonal upheavals that occur during adolescence, which intensify sexual desires and encourage some girls to explore their sexuality at an early age [ 35 ]. Another possible explanation lies in the fact that in rural areas, early marriages, rooted in cultural and traditional norms, frequently expose girls to a sexual life that begins in adolescence [ 36 , 37 ]. In addition, the household standard of living is an important risk factor, especially in urban areas during the reference period. Adolescent girls and young women from very poor and poor households have a significantly higher risk of ESD than those from very rich households, as other studies in Africa have shown. [ 26 – 28 , 38 ]. However, a study in Ethiopia [ 30 ] suggests an inverse relationship for women of childbearing age. In the context of this study, it may be that in urban areas, where poverty may be more visible and contrasted, adolescent girls from poor households are often vulnerable to transactional sex [ 39 ]. Often dependent on external support to meet their basic needs, they may be led to exchange sexual relations for material or financial benefits, which increases their vulnerability to the risk of ESD. Education is a major protective factor throughout SSA, whatever the area of residence. The higher the level of education of adolescent girls, the lower their risk of ESD, confirming the findings of studies conducted in East Africa [ 37 ] and in Ethiopia [ 26 ]. This finding highlights the central role of education in developing the awareness and skills needed to make informed decisions. According to Fentie et al., adolescent girls and young women who have reached at least secondary school level generally benefit from more comprehensive sex education and have a better understanding of the risks associated with early sexual relations [ 40 ]. Exposure to the media, particularly radio, is also associated with a lower probability of early sexual debut. At the SSA level, adolescent girls and young women who have heard about family planning on the radio present a reduced risk, which is in line with the results observed in East Africa [ 37 ], in Ethiopia [ 27 ] and in India [ 41 ]. This difference could be explained by the fact that teenage girls have greater and more diversified access to the media, particularly radio, television and the internet [ 42 ]. Access to these sources of information helps to strengthen their understanding of the issues involved in early sexuality, which can reduce their vulnerability to premarital sexual debut. Strengths and limitations of the study The study has a number of strengths that are worth noting. Its main strength lies in its multi-country approach, based on the three most recent Demographic and Health Surveys (DHS) conducted in each of the countries included. It also stands out for its approach to estimating early sexual debut among sexually active adolescent girls and young women by including those who have never had sex, thus providing a more complete estimate of ESD. The use of the svyset and svy commands in the statistical analyses is another strong point, guaranteeing the robustness and representativeness of the results obtained. However, this study has certain limitations. It does not claim to cover all the factors likely to explain the ESD in adolescent girls and young women. Variables linked to the family environment, such as household structure, parent-child communication and parental presence, were not taken into account, even though they could have a significant influence. In addition, only two countries were considered to represent Central Africa, which limits the generalizability of the results to this region. Despite these constraints, the study provides valuable data to guide public policies and sexual and reproductive health programs. It offers concrete ways of adapting strategies to delay sexual initiation among adolescent girls and young women, thereby reducing risky behaviour and helping to preserve their health. Conclusion This study documented the levels and trends in early sexual debut among adolescent girls and young women in sub-Saharan Africa, while highlighting the associated socio-economic inequalities. Although the prevalence of early sexual debut declined overall during the reference period, it remains significantly higher in rural than in urban areas. The disparities observed according to standard of living and education highlight the increased vulnerability of adolescent girls from poor households with little schooling, particularly in rural areas. In addition, limited access to information on family planning, particularly via the radio, is an aggravating factor. These findings suggest that sexual and reproductive health awareness strategies need to be stepped up, with priority given to young girls with the least education and from disadvantaged backgrounds. Political decision-makers and public health actors must promote specific interventions, combining improved access to education and increased dissemination of appropriate information, in order to delay sexual debut and reduce the associated health risks. 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Differences in Rural and Urban Health Information Access and Use. J Rural Health juin. 2019;35(3):405–17. Additional Declarations No competing interests reported. Supplementary Files Appendix.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 16 Oct, 2025 Reviewers agreed at journal 01 Oct, 2025 Reviewers invited by journal 25 Sep, 2025 Editor invited by journal 01 Sep, 2025 Editor assigned by journal 28 Aug, 2025 Submission checks completed at journal 28 Aug, 2025 First submitted to journal 26 Aug, 2025 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. 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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-7463174","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":525202058,"identity":"72dcad83-c694-443c-a016-66f4fe857771","order_by":0,"name":"Matè Alonyenyo 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2","display":"","copyAsset":false,"role":"figure","size":27745,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in early sexual debut in Sub-Saharan Africa\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7463174/v1/061b2744535e3594b61a53f5.png"},{"id":92963270,"identity":"3762e738-1c5f-4bed-9141-5011682778f1","added_by":"auto","created_at":"2025-10-07 15:16:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":48058,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in early sexual debut in three regions of sub-Saharan Africa\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7463174/v1/be7c5375553816e40c9a0b22.png"},{"id":92961419,"identity":"3d7fa93f-f531-4cfd-84da-ae8f729fcbcb","added_by":"auto","created_at":"2025-10-07 15:00:44","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":180563,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in early sexual debut before marriage in 18 sub-Saharan African countries\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7463174/v1/1d1d3f82b591b7511e683fbb.png"},{"id":92964139,"identity":"e97a83ad-fcea-46e6-bc6f-baaf2b2467a0","added_by":"auto","created_at":"2025-10-07 15:24:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1517007,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7463174/v1/d721e409-befe-4229-bf27-6a2a0c684f25.pdf"},{"id":92961416,"identity":"23a0bb13-2642-4802-9756-61750498ad18","added_by":"auto","created_at":"2025-10-07 15:00:44","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20827,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-7463174/v1/563c4c9a1ef1dd2358da7dd4.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Trends and socioeconomic differences in early sexual debut before marriage among teenage and young girls in sub-Saharan Africa, 2000-2023","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn sub-Saharan Africa (SSA), early sexual debut among teenage girls is a worrying phenomenon that raises major issues in terms of public health, education and socio-economic development [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is defined by an age threshold before which the first sexual intercourse takes place. According to previous studies, it varies from less than 15 years old [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] under 16 years of age [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and under the age of 18 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Several studies have identified early sexuality as a factor associated with risky sexual behavior, with a \"cause and effect\" link [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. It exposes teenage girls to a higher risk of unwanted pregnancy, sexually transmitted infections (STIs) and dropping out of school than teenage boys, perpetuating a cycle of poverty and inequality [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These marked inequalities between adolescent boys and girls continue to contribute to their vulnerability to risky sexual behaviour in sub-Saharan Africa and raise challenges to be met in order to contribute to a quality adult life for adolescent girls and protect their health [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStudies have shown that teenage girls who have their first sexual encounter at a very early age are more likely to adopt risky sexual behaviour such as multiple sexual partnerships, not using condoms and having casual or transactional sex [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. What's more, early sexual activity not only exposes teenage girls to the risk of Human Immunodeficiency Virus (HIV) infection over a long period of time [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] but also have long-term psychological and social repercussions, affecting their well-being and their future [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A study in Uganda has shown that delaying the age of sexual debut helps to reduce the prevalence of HIV and protect the health of adolescent girls [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. As a result, since the 1990s, initiatives aimed at delaying sexual debut have been incorporated into HIV prevention programs in SSA [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This initiative raises a number of questions: how does early sexual debut among teenage girls in SSA evolve over time?\u003c/p\u003e\u003cp\u003eFurthermore, the literature has shown that this phenomenon is linked to a combination of socio-cultural, economic and environmental factors such as poverty, gender inequalities, social pressures and lack of access to comprehensive education [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR22 CR23 CR24 CR25\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Studies carried out in north-western and north-eastern Ethiopia have shown that having less contact with parents or not discussing sexual and reproductive health issues with one's mother increases the risk of early sexual intercourse among adolescent girls [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Other studies have shown that the fact that an adolescent has at least a primary education, comes from a low-income family or is exposed to the media, reduces the risk of early sexual debut [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In addition, peer pressure, gender and alcohol consumption are risk factors for early premarital sex in teenage girls [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, urban-rural differences were observed in the prevalence of early sexual initiation in sub-Saharan Africa. Young girls living in rural areas were more likely than young girls living in urban areas to have an early sexual initiation [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This is also the case for the findings of a study carried out in SSA, where the risk of having sexual intercourse at an early age was higher among adolescent girls in rural areas than those in urban areas [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In Nigeria, Folayan et al, using primary data, found that initiation of premarital sex was more common among young girls living in rural areas than those living in urban areas [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In Cambodia, however, girls living in rural areas are less likely to be initiated into premarital sex than those living in urban areas [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These results were also observed in a study carried out in C\u0026ocirc;te d'Ivoire, where the fact that a young girl lives in an urban area increases the risk of premarital sexual debut [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough these studies reveal differences in the precociousness of premarital sex between areas of residence, what is the situation, over time, with regard to socioeconomic inequalities in the precociousness of premarital sex among adolescent girls and young women in their areas of residence? This study examines the socio-economic inequalities associated with early premarital sexuality among adolescent girls and young women in the countries of SSA, taking into account the differences between rural and urban areas and their evolution over time. By analyzing data from three recent rounds of Demographic and Health Surveys (DHS) conducted respectively in the 1st half of the Millennium Development Goals (MDGs), the 2nd half of the MDGs and the 1st half of the Sustainable Development Goals (SDGs), the study aims to fill existing gaps in research on this topic. The results of the study will provide crucial information to help policy makers and programs planners reorient their strategies to delay sexual debut among adolescent girls, thereby reducing risky sexual behaviour and protecting their health.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData sources\u003c/h2\u003e\u003cp\u003eThe data used come from series of DHS carried out in sub-Saharan African countries. These surveys are cross-sectional studies conducted, at best, every five years to obtain varied and up-to-date information on sexual activity, reproductive health, family planning (FP) and other related issues. The study focuses on countries with DHS conducted between 2000 and 2023, i.e. in the 1st half of the MDGs (2000\u0026ndash;2008), the 2nd half of the MDGs (2009\u0026ndash;2015) and the 1st half of the SDGs (2016\u0026ndash;2023). To this end, countries that had not conducted a DHS in these periods were not included. In addition, the most recent DHS was selected for each of these periods in the case of countries that had conducted several DHSs during the period in question.\u003c/p\u003e\u003cp\u003eA total of eighteen (18) countries were included in the study: Benin, Burkina Faso, Cameroon, Ethiopia, Gabon, Ghana, Guinea, Kenya, Liberia, Mali, Mozambique, Nigeria, Rwanda, Senegal, Sierra Leone, Tanzania, Uganda and Zambia. All data are publicly available on the EDS website: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dhsprogram.com/data/available-datasets.cfm\u003c/span\u003e\u003cspan address=\"https://dhsprogram.com/data/available-datasets.cfm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. They are representative household surveys at national and regional level and by area of residence (urban and rural). A multi-stage stratified cluster sampling technique was used to recruit survey participants. The 'IR woman' database for each survey was used, and each database contained responses from women of childbearing age. For the purposes of this study, all unmarried women aged between 15 and 24 who are sexually active constitute the study population and are referred to as 'teenage and young girls'. For the purposes of analysis, the study sample comprises 15048, 24812 and 27296 sexually active teenage and young girls, for the three survey periods in SSA respectively. The total sample was 67156 sexually active, never-married teenage and young girls with complete responses to the variables used. This sample is described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below by survey year and country.\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\u003eSample size by survey year, by region and country\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCountry name\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e2000\u0026ndash;2008\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2009\u0026ndash;2015\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e2016\u0026ndash;2023\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDHS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDHS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDHS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSub-Saharan Africa\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15048\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24812\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e27296\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e67156\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\u003eEast Africa\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e4893\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e9392\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e10983\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e25268\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEthiopia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e221\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e285\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e303\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e809\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKenya\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e776\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2695\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6768\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMozambique\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1264\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1345\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1538\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4147\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRwanda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e539\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1057\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1163\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2759\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTanzania\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e657\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2911\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUganda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e637\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e744\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1632\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZambia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e799\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1940\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4861\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWest Africa\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e7974\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e12138\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e12905\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e33017\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBenin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1451\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1590\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1667\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4708\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBurkina Faso\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e720\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e803\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1298\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2821\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGhana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e584\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1977\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3824\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGuinea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e460\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e718\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e683\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1861\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiberia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1277\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1539\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1586\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4402\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMali\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e428\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e461\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1053\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNigeria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2431\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2738\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e2458\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7627\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSenegal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e225\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e595\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSierra Leone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e773\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2834\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e2519\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6126\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCentral Africa\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2181\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3282\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e3408\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e8871\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCameroon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1716\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1815\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4539\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGabon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1173\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1566\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1593\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4332\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\n\u003ch3\u003eDependent variable\u003c/h3\u003e\n\u003cp\u003eIn this study, early sexual debut before marriage was identified as a dependent variable. It is based on the question asked of teenage and young girls in the DHS: \"How old were you when you first had sexual intercourse? The response of women aged 15\u0026ndash;24 to this question is shown in the figure below. According to the distribution of responses to this question, a peak emerges at the age of 15, considered in this study as the minimum age at which an adolescent can have her first sexual intercourse (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). To this end, the dependent variable is dichotomized, taking the value 1\" when the teenager had her first sexual intercourse before the age of 15, and taking the value \"0\" when the teenager had her first sexual intercourse at an age equal to or greater than 15.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eIndependent variables\u003c/h3\u003e\n\u003cp\u003eThe main independent variables in this study are age cohort (15\u0026ndash;19 \"Teenagers\"; 20\u0026ndash;24 \"Young girls\"), place of residence (urban; rural) and household standard of living (Very poor; Poor; Average; Rich and Very rich). This last variable is obtained from a principal component analysis of household goods and equipment. In addition, other variables were used to control for the net effect of these variables on early sexuality among teenage and young girls. These were level of education (None; Primary; Secondary and Higher), the variables \"Having heard about FP on the radio (Yes or No)\", \"Having heard about FP on television (Yes or No)\", \"Having heard about FP in the newspaper (Yes or No)\".\u003c/p\u003e\u003cp\u003eThe variables region, year, country as well as variables linked to the characteristics of the head of household (HH), notably the age of the HH (Under 50 years; 50\u0026ndash;59 years and 60 year or over) and the sex of the HH (Male and Female), were also used to control for the net effect of socio-economic variables on ESD in teenage and young girls. The \"region\" variable was created by grouping the countries included in the study according to their geographical position in SSA. It comprises three modalities: East Africa (Ethiopia, Kenya, Mozambique, Rwanda, Tanzania, Uganda, Zambia); West Africa (Benin, Burkina Faso, Ghana, Guinea, Liberia, Mali, Nigeria, Senegal, Sierra Leone) and Central Africa (Cameroon, Gabon). The \"survey period\" variable, created from the survey years of each country, has three modalities: \"2000\u0026ndash;2008\", corresponding to the first half of the MDGs, \"2009\u0026ndash;2015\", corresponding to the second half of the MDGs, and \"2016\u0026ndash;2023\", corresponding to the first half of the MDGs. The \"pays\" variable represents the name of the countries included in the study.\u003c/p\u003e\n\u003ch3\u003eAnalysis methods\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eFirstly, bivariate descriptive analyses are carried out, using cross-tabulations, to describe weighted trends in premarital ESD in SSA countries and areas of residence between the 1st half of the MDGs and 1st half of the SDGs. In addition, comparison tests of proportions are carried out using the \"ttest\" command to check the significance of variation in the prevalence of ESD between survey periods. Next, bivariate descriptive analysis techniques are applied to estimate the prevalence of ESD among teenager and young girls by place of residence and standard of living in all 18 countries, by region and by country. Finally, bivariate logistic regressions, broken down by area of residence, were carried out to examine socioeconomic differences in the prevalence of ESD among teenager and young girls. This analysis technique highlights, at the multivariate level, the net effect of age cohort and standard of living on ESD among adolescent girls and boys, controlled by level of education, FP radio viewing, FP Television viewing, FP newspaper viewing, sex of HH, age of HH, region, survey period and country.\u003c/p\u003e\n\u003cp\u003eThe binary logistic regression model for the probability logit is written as follows:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eZ= logit (P)=log (\u003c/strong\u003e\u003cimg width=\"26\" height=\"34\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvec Z= \u0026beta;\u003csub\u003e0\u003c/sub\u003e + \u0026beta;\u003csub\u003e1\u0026nbsp;\u003c/sub\u003eX\u003csub\u003e1\u0026nbsp;\u003c/sub\u003e+ \u0026beta;\u003csub\u003e2\u0026nbsp;\u003c/sub\u003eX\u003csub\u003e2\u0026nbsp;\u003c/sub\u003e+ \u0026hellip;\u0026hellip;+ \u0026beta;\u003csub\u003ek\u0026nbsp;\u003c/sub\u003eX\u003csub\u003ek\u003c/sub\u003e+ E\u003csub\u003e\u0026nbsp;\u0026nbsp;\u003c/sub\u003e et P=\u0026nbsp;\u003c/strong\u003e\u003cimg width=\"40\" height=\"34\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026beta;\u003c/strong\u003e\u003cstrong\u003e\u003csub\u003e0\u003c/sub\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;:\u003c/strong\u003e model constant, it is used to calculate the probability of Y when the mode-variables are zero.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026beta;\u003c/strong\u003e\u003cstrong\u003e\u003csub\u003ek\u003c/sub\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;:\u003c/strong\u003e the coefficients associated respectively with\u0026nbsp;\u003cstrong\u003eX\u003csub\u003ek\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eX\u003csub\u003ek\u003c/sub\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;:\u003c/strong\u003e independent variables or individual observations \u003cstrong\u003ek\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eP\u0026nbsp;:\u003c/strong\u003e probability associated with \u003cstrong\u003eY=1\u003c/strong\u003e if the event under study has occurred;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003cimg width=\"26\" height=\"34\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e\u003cstrong\u003e)\u0026nbsp;\u003c/strong\u003eis called Odds or Odds.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eE\u0026nbsp;\u003c/strong\u003e: represents the prediction error\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\"\u003e\n \u003ch2\u003eLevels and trends of early sexual debut among teenager and young girls in SSA\u003c/h2\u003e\n \u003cp\u003eOverall, Fig.\u0026nbsp;2 shows that the prevalence of ESD among teenager and young girls in SSA was 18.7% [95% CI: 18.0-19.4] during the first half of the MDGs, 18.2% [95% CI: 17.7\u0026ndash;18.8] during the second half of the MDGs, and 15.5% [95% CI: 15.0-16.1] during the first half of the SDGs. Trend analysis reveals a non-significant decline of 2.7% between the two halves of the MDGs (p\u0026thinsp;=\u0026thinsp;0.2855), followed by a significant decrease of 14.8% between the second half of the MDGs and the first half of the SDGs (p\u0026thinsp;=\u0026thinsp;0.000), and an overall significant decline of 17.1% between the first half of the MDGs and the first half of the SDGs (p\u0026thinsp;=\u0026thinsp;0.0000).\u003c/p\u003e\n \u003cp\u003eWith regard to differences by place of residence, similar dynamics were observed in urban areas. Thus, ESD prevalence fell from 15.8\u0026ndash;14.4%, then to 12.2% between the three periods, i.e. a non-significant drop of 8.9% between the two halves of the MDGs (p\u0026thinsp;=\u0026thinsp;0.0636), followed by a significant drop of 14.8% between the second half of the MDGs and the first half of the SDGs (p\u0026thinsp;=\u0026thinsp;0.0008), and of 22.8% over the whole period (p\u0026thinsp;=\u0026thinsp;0.0000). In rural areas, the trend is different. First, there was a slight non-significant increase of 3.6% between the first two periods (p\u0026thinsp;=\u0026thinsp;0.5902), followed by a significant drop of 15.9% between the second half of the MDGs and the first half of the SDGs (p\u0026thinsp;=\u0026thinsp;0.0000), and an overall significant decrease of 12.9% between the first half of the MDGs and the first half of the SDGs (p\u0026thinsp;=\u0026thinsp;0.0000). Prevalence in rural areas fell from 22.5\u0026ndash;23.3%, then to 19.6%. It should be noted that, although the fall was more marked in urban areas (22.8%; p\u0026thinsp;=\u0026thinsp;0.0000), the prevalence of ESD remains systematically higher in rural than in urban areas, whatever the time of the survey.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eEarly sexual debut regional trends\u003c/h3\u003e\n\u003cp\u003eThe data in Fig.\u0026nbsp;3 show a significant drop in ESD prevalence in East Africa (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) over the reference period. However, differences between urban and rural areas remained constant across the three survey periods. In West Africa, there was a significant drop in ESD (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) between the second half of the MDGs and the first half of the SDGs, after a significant rise between the two halves of the MDGs. In this region, the gap between rural and urban areas remains visible, with a general downward trend in rural areas, although rates remain higher there. In Central Africa, Fig.\u0026nbsp;3 also reveals a significant decline in ESD, but with contrasting dynamics depending on the area of residence between the second half of the MDGs and the first half of the SDGs. In urban areas, there is a slight increase between the two halves of the MDGs, followed by a decrease, while in rural areas, prevalence increases slightly between the latter two periods, without this increase being statistically significant.\u003c/p\u003e\n\u003cdiv id=\"Sec11\"\u003e\n \u003ch2\u003eNational dynamics of early sexual debut\u003c/h2\u003e\n \u003cp\u003eCountry-by-country analysis, illustrated in Fig.\u0026nbsp;4, highlights three distinct patterns of change in ESD among teenager and young girls between the first half of the MDGs and the first half of the SDGs. The first group, comprising Burkina Faso, Cameroon, Gabon, Guinea, Kenya, Mali, Mozambique, Nigeria, Rwanda, Tanzania and Uganda, is characterized by a significant decline in ESD prevalence. A second group, comprising Ethiopia, Ghana, Liberia and Senegal, shows an upward trend in prevalence over the period 2000\u0026ndash;2023, although the increases observed in Ethiopia and Senegal are not statistically significant. Finally, a third group, comprising Benin, Sierra Leone and Zambia, shows relative stability in ESD prevalence over the reference period.\u003c/p\u003e\n \u003cp\u003eFurthermore, an analysis of trends in ESD prevalence between the second half of the MDGs and the first half of the SDGs reveals two groups of countries. On the one hand, in countries such as Gabon, Guinea, Kenya, Mozambique, Nigeria, Rwanda, Senegal, Tanzania and Uganda, a significant drop in EPVS prevalence was observed between the second half of the MDGs and the first half of the SDGs (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). On the other hand, in the other countries, the variation in the high rate of ESD between these two periods is not statistically significant. However, there was an upward trend in Benin, Ethiopia, Ghana, Liberia and Sierra Leone, and a downward trend in Burkina Faso, Cameroon, Mali and Zambia. In addition, it should be noted that urban-rural gaps in ESD persist, and have even widened in some countries in the first half of the SDGs. At this time, the prevalence of ESD remains higher among adolescent girls and young women living in rural areas, regardless of the survey period. This disparity is particularly marked in countries such as Cameroon, Ethiopia, Gabon, Kenya, Liberia, Sierra Leone and Tanzania. These results call for special attention and targeted interventions in rural areas to reduce inequalities in ESD prevalence among teenager and young girls.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePrevalence of early sexual debut by place of residence and standard of living in the first half of the SDGs\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eIn the first half of the SDGs, the data presented in Table\u0026nbsp;2 reveal a higher prevalence of ESD among teenage and young girls living in rural areas, compared to those residing in urban areas, in East and West Africa (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This disparity is confirmed at the SSA level, where almost 60% of rural girls and adolescents have had an ESD, compared with around 40% in urban areas (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In Central Africa, on the other hand, the trend is reversed, with a higher prevalence of ESD in urban areas (65.3%) than in rural areas (34.7%).\u003c/p\u003e\n \u003cp\u003eIn terms of standard of living, teenage and young girls from poor, middle-income and wealthy households have higher rates of ESD (20.5%, 22.4% and 21.4% respectively) than those from very poor households (16.9%). This trend is also observed in West Africa, where ESD is more frequent among teenager and young girls from medium (23.3%) and wealthy (22.5%) households, while teenager and young girls from very poor households have the lowest rate (14.8%). In Central Africa, ESD is most widespread among teenage and young girls from poor households (23.8%), while very wealthy households have the lowest rate (13.5%). In East Africa, although the relationship between standard of living and ESD is significant, the differences between categories are less pronounced.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003ePrevalence of early sexual debut by area of residence and household standard of living for teenage and young girls, by region, 2000\u0026ndash;2023\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSocio-economic variables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eRegion\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSub-Saharan Africa\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEast Africa\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWest Africa\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCentral Africa\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30,9 [28, 3\u0026ndash;33, 7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48,2 [45,7\u0026ndash;50,8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65,3 [60,4\u0026ndash;70,0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40,6 [38, 8\u0026ndash;42, 3]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69,1 [66,3\u0026ndash;71,7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51,8 [49,2\u0026ndash;54,4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34,7 [30,0\u0026ndash;39,7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59,4 [57,7\u0026ndash;61,2]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard of living\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery poor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18,9 [16,9\u0026ndash;21,0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14,8 [13, 1\u0026ndash;16, 7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22,7 [18, 3\u0026ndash;27, 8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16,9 [15, 7\u0026ndash;18, 2]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,3 [18, 3\u0026ndash;22, 5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,6 [18, 7\u0026ndash;22, 7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23,8 [19, 9\u0026ndash;28, 2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,5 [19, 2\u0026ndash;21, 9]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,9 [18, 8\u0026ndash;23, 2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23,3 [21, 2\u0026ndash;25, 6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21,3 [17,0\u0026ndash;26,2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22,4 [21,0\u0026ndash;23,9]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRich\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,4 [18, 1\u0026ndash;22, 8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22,5 [20, 4\u0026ndash;24, 8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18,7 [14, 6\u0026ndash;23, 7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21,4 [20, 1\u0026ndash;22, 9]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery rich\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19,5 [17,4\u0026ndash;22,0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18,8 [16,8\u0026ndash;21,0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13,5 [09,8\u0026ndash;18,5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18,7 [17, 4\u0026ndash;20, 2]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eSignificance Level : *** : p\u0026thinsp;\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eAnalysis by country (Table 4a and 4b in appendix) confirms significant differences according to place of residence. In Benin, Ethiopia, Kenya, Nigeria, Rwanda and Zambia, the prevalence of ESD is higher among rural adolescent girls. Conversely, in Gabon and Liberia, urban teenager and young girls are more affected. In countries such as Cameroon, Ghana, Mozambique and Sierra Leone, although the association between ESD and place of residence was significant, no clear difference was observed in these countries with regard to the confidence intervals.\u003c/p\u003e\n \u003cp\u003eThe analysis also reveals three country profiles according to the nature of the relationship between standard of living and ESD among teenager and young girls. The first group, made up of Burkina Faso, Mozambique, Nigeria, Uganda and Tanzania, are characterized by a higher prevalence of ESD among teenager and young girls from rich or very rich households, and a lower prevalence among those from poor or very poor households. The second group, made up of Cameroon, Gabon, Ghana and Kenya, presents a situation where ESD is more prevalent among adolescent girls from disadvantaged households, while it is less common among those from very wealthy households. Finally, in the third group, comprising Benin, Liberia, Rwanda, Sierra Leone and Zambia, no significant differences were observed between the different socio-economic categories, with confidence intervals that largely overlapped.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\"\u003e\n \u003ch2\u003eSocio-economic differences in the early sexual debut by place of residence and in SSA\u003c/h2\u003e\n \u003cp\u003eThe results in Table 3, based on adjusted odds ratios, show a strong association between socioeconomic characteristics and the risk of ESD according to place of residence. In the first half of the SDGs, adolescent girls had at least twice the risk of adolescent boys, with a higher risk in rural areas (aOR\u0026thinsp;=\u0026thinsp;3.04; CI95%: 2.81\u0026ndash;3.29) than in urban areas (aOR\u0026thinsp;=\u0026thinsp;2.88; CI95%: 2.64\u0026ndash;3.15), both highly significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The risk of ESD decreases overall as the standard of living improves. Adolescent girls and young women from very poor or poor households are 1.18 times more likely to have a risk of ESD than those from very rich households. In urban areas, this risk is even greater: teenage and young girls living in very poor and poor households are 1.98 times and 1.53 times more likely respectively to have a risk of ESD (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similar inequalities were observed in rural areas (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3: Adjusted logistic regressions of early sexual debut on socioeconomic characteristics among teenage and young girls, by area of residence\u003c/strong\u003e\u003c/p\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"636\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrban\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eaOR [95%CI]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRural\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eaOR [95%CI]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eaOR [95%CI]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocio-economic variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge cohort (Ref: Young girl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Teenager\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e2,88***[2,64-3,15]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e3,04***[2,81-3,29]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e2,97***[2,80-3,15]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard of living (Ref: Very rich)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Very poor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e1,98***[1,60-2,47]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1,17* \u0026nbsp; \u0026nbsp;[1,01-1,37]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1,48***[1,35-1,62]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Poor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e1,53***[1,29-1,82]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1,22** \u0026nbsp;[1,05-1,41]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1,48***[1,35-1,61]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Medium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e1,32***[1,16-1,51]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1,12ns \u0026nbsp; [0,97-1,30]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1,33***[1,22-1,44]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Rich\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e1,15** \u0026nbsp;[1,04-1,27]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1,08ns \u0026nbsp; [0,93-1,26]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1,17***[1,08-1,27]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of education (Ref: None)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Primary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e1,08ns \u0026nbsp; [0,92-1,28]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1,08ns \u0026nbsp; [0,96-1,21]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1,11* \u0026nbsp; \u0026nbsp;[1,01-1,22]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,51***[0,43-0,60]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,57***[0,51-0,65]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,55***[0,50-0,61]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Superior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,19***[0,14-0,25]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,19***[0,12-0,28]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,19***[0,15-0,24]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeard about FP on the radio (Ref: No)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,91ns \u0026nbsp; [0,83-1,01]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,94ns \u0026nbsp; [0,87-1,02]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,93* \u0026nbsp; \u0026nbsp;[0,87-0,99]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeard about FP on Television (Ref: No)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,95ns \u0026nbsp; [0,86-1,06]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,91ns \u0026nbsp; [0,81-1,02]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,93ns \u0026nbsp; [0,86-1,01]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeard about FP in the newspapers (Ref: No)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,94ns \u0026nbsp; [0,82-1,07]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,95ns \u0026nbsp; [0,83-1,10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,95ns \u0026nbsp; [0,86-1,05]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex of HH (Ref: Male)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e1,02ns \u0026nbsp; [0,94-1,11]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,99ns \u0026nbsp; [0,92-1,06]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1,00ns \u0026nbsp; [0,94-1,05]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge of head of HH (Ref: Under 50 years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;50-59 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,99ns \u0026nbsp; [0,90-1,09]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,96ns \u0026nbsp; [0,89-1,04]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,98ns \u0026nbsp; [0,92-1,04]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;60 year and over\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,92ns \u0026nbsp; [0,83-1,02]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,96ns \u0026nbsp; [0,89-1,04]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,95ns \u0026nbsp; [0,89-1,01]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion (Ref: East Africa)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;West Africa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;1,60***[1,31-1,94]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1,27** \u0026nbsp;[1,09-1,48]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1,39***[1,24-1,57]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Central Africa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e1,30* \u0026nbsp; \u0026nbsp; [1,05-1,61]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1,68***[1,38-2,05]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1,24** \u0026nbsp;[1,08-1,43]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvey period (Ref: 2000-2008)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;2009-2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,98ns \u0026nbsp; [0,89-1,09]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1,08ns \u0026nbsp; [0,99-1,18]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1,03ns \u0026nbsp; [0,96-1,10]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;2016-2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,89* \u0026nbsp; \u0026nbsp; [0,80-0,98]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,95ns \u0026nbsp; [0,87-1,04]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,91** \u0026nbsp; [0,85-0,98]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCountry (Ref: Zambia)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Benin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,60***[0,51-0,72]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,67***[0,58-0,79]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,65***[0,58-0,73]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Burkina Faso\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,37***[0,28-0,47]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,34***[0,27-0,43]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,36***[0,30-0,42]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Cameroon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,85ns \u0026nbsp; [0,71-1,03]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,65***[0,53-0,81]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,85* \u0026nbsp; \u0026nbsp; [0,74-0,98]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Ethiopia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,45** \u0026nbsp;[0,26-0,77]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,70ns \u0026nbsp; [0,42-1,17]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,6** \u0026nbsp; \u0026nbsp; [0,41-0,87]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Gabon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e1,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Ghana\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,81* \u0026nbsp; \u0026nbsp;[0,66-1,00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,80* \u0026nbsp; \u0026nbsp;[0,67-0,97]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,81** \u0026nbsp;[0,70-0,93]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Guinea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,96ns \u0026nbsp; [0,77-1,20]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,78* \u0026nbsp; \u0026nbsp;[0,62-0,97]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,87ns \u0026nbsp; [0,74-1,01]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Kenya\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,94ns \u0026nbsp; [0,72-1,23]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1,03ns \u0026nbsp; [0,89-1,18]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1,05ns \u0026nbsp; [0,92-1,18]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Liberia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,89ns \u0026nbsp; [0,74-1,08]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,86ns \u0026nbsp; [0,73-1,02]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,88* \u0026nbsp; \u0026nbsp; [0,77-1,00]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mali\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e1,03ns \u0026nbsp; [0,79-1,34]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,67** \u0026nbsp; [0,49-0,90]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,83ns \u0026nbsp; [0,68-1,02]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mozambique\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e1,43***[1,17-1,76]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1,01ns \u0026nbsp; [0,83-1,23]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1,2** \u0026nbsp; \u0026nbsp; [1,05-1,38]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Nigeria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,66***[0,55-0,79]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,83* \u0026nbsp; \u0026nbsp; [0,72-0,97]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,77***[0,69-0,86]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Rwanda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e1,27ns \u0026nbsp; [0,98-1,64]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1,18ns \u0026nbsp; [1,00-1,38]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1,26** \u0026nbsp;[1,10-1,45]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Senegal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0,76ns \u0026nbsp; [0,46-1,27]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,87ns \u0026nbsp; [0,61-1,24]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,82ns \u0026nbsp; [0,60-1,12]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Sierra Leone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e1,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Tanzania\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e1,11ns \u0026nbsp; [0,86-1,43]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,68***[0,57-0,82]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0,85* \u0026nbsp; \u0026nbsp; [0,73-0,99]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Uganda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e1,61***[1,24-2,10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0,87ns \u0026nbsp; [0,73-1,04]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1,10ns \u0026nbsp; [0,95-1,27]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 636px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRef:\u003c/strong\u003e Reference modality; \u003cstrong\u003eaOR\u0026nbsp;:\u003c/strong\u003e Adjusted odds ratios; \u003cstrong\u003ens:\u003c/strong\u003e not significant; \u003cstrong\u003e*:\u003c/strong\u003e p\u0026lt;0,05; \u003cstrong\u003e**:\u003c/strong\u003e p\u0026lt;0,01; \u003cstrong\u003e***:\u003c/strong\u003e p\u0026lt;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAmong the control variables, level of education appears to be a protective factor. Compared with teenage and young girls with no education, those with secondary or higher education had a significantly lower risk of ESD in urban areas (OR\u0026thinsp;=\u0026thinsp;0.51 and 0.19 respectively; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and rural areas (reduction of 47% for secondary and 81% for higher education; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Finally, exposure to family planning information through the media plays a differentiated role. Hearing about FP on the radio was associated with a significant 7% reduction in the risk of ESD (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). On the other hand, no significant association was observed between ESD and exposure to television or the written press, either at the SSA level or according to place of residence.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of this study was to describe the levels and trends in early sexual debut (ESD) among adolescent girls and young women in sub-Saharan Africa (SSA), by area of residence, between the first half of the Millennium Development Goals (MDGs) and the first half of the Sustainable Development Goals (SDGs). It also aimed to estimate the prevalence of ESD according to socio-economic characteristics in the first half of the MDGs, at national and regional level, and in SSA countries as a whole, while analyzing socio-economic inequalities according to place of residence.\u003c/p\u003e\u003cp\u003eThe results show a significant drop in ESD over the reference period, from 18.7\u0026ndash;15.5%. This prevalence is lower than those reported in other studies conducted in SSA (46,4% ;[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]), in Ethiopia (38,4% ; [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]), or in Kenya (36% ;[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]). These differences could be explained by variations in the definition of the ESD and in the size of the sample considered. For example, this study included 67,156 unmarried teenage girls and young women and defined a first sexual intercourse before the age of 15, whereas the study by Abate and al defines the ESD as sexual practice before the age of 18 [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], and the study of Ferede and al. conducted in ASS is based on a larger sample (184,942 young girls) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurthermore, the decline in ESD observed in SSA is particularly marked in urban areas, although prevalence remains higher in rural areas in each survey period. This reflects the persistence of traditional and conservative norms in rural areas, where cultural expectations such as early marriage or pressure to enter childbearing early are still practiced. In addition, often limited access to information in rural areas hinders efforts to raise awareness of sexual and reproductive health, helping to maintain high prevalence despite a general downward trend [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMultivariate analyses indicate that the risk of ESD is significantly higher in adolescent girls (15\u0026ndash;19 years) than in young girls (20\u0026ndash;24 years), especially in rural areas. This result is consistent with the findings of studies conducted in Ghana [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], but differs from an Ethiopian study [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], which reports a risk six times higher than in young women. This result could be explained by the hormonal upheavals that occur during adolescence, which intensify sexual desires and encourage some girls to explore their sexuality at an early age [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Another possible explanation lies in the fact that in rural areas, early marriages, rooted in cultural and traditional norms, frequently expose girls to a sexual life that begins in adolescence [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn addition, the household standard of living is an important risk factor, especially in urban areas during the reference period. Adolescent girls and young women from very poor and poor households have a significantly higher risk of ESD than those from very rich households, as other studies in Africa have shown. [\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. However, a study in Ethiopia [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] suggests an inverse relationship for women of childbearing age. In the context of this study, it may be that in urban areas, where poverty may be more visible and contrasted, adolescent girls from poor households are often vulnerable to transactional sex [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Often dependent on external support to meet their basic needs, they may be led to exchange sexual relations for material or financial benefits, which increases their vulnerability to the risk of ESD.\u003c/p\u003e\u003cp\u003eEducation is a major protective factor throughout SSA, whatever the area of residence. The higher the level of education of adolescent girls, the lower their risk of ESD, confirming the findings of studies conducted in East Africa [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] and in Ethiopia [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This finding highlights the central role of education in developing the awareness and skills needed to make informed decisions. According to Fentie et al., adolescent girls and young women who have reached at least secondary school level generally benefit from more comprehensive sex education and have a better understanding of the risks associated with early sexual relations [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eExposure to the media, particularly radio, is also associated with a lower probability of early sexual debut. At the SSA level, adolescent girls and young women who have heard about family planning on the radio present a reduced risk, which is in line with the results observed in East Africa [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], in Ethiopia [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and in India [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. This difference could be explained by the fact that teenage girls have greater and more diversified access to the media, particularly radio, television and the internet [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Access to these sources of information helps to strengthen their understanding of the issues involved in early sexuality, which can reduce their vulnerability to premarital sexual debut.\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations of the study\u003c/h2\u003e\u003cp\u003eThe study has a number of strengths that are worth noting. Its main strength lies in its multi-country approach, based on the three most recent Demographic and Health Surveys (DHS) conducted in each of the countries included. It also stands out for its approach to estimating early sexual debut among sexually active adolescent girls and young women by including those who have never had sex, thus providing a more complete estimate of ESD. The use of the svyset and svy commands in the statistical analyses is another strong point, guaranteeing the robustness and representativeness of the results obtained. However, this study has certain limitations. It does not claim to cover all the factors likely to explain the ESD in adolescent girls and young women. Variables linked to the family environment, such as household structure, parent-child communication and parental presence, were not taken into account, even though they could have a significant influence. In addition, only two countries were considered to represent Central Africa, which limits the generalizability of the results to this region. Despite these constraints, the study provides valuable data to guide public policies and sexual and reproductive health programs. It offers concrete ways of adapting strategies to delay sexual initiation among adolescent girls and young women, thereby reducing risky behaviour and helping to preserve their health.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study documented the levels and trends in early sexual debut among adolescent girls and young women in sub-Saharan Africa, while highlighting the associated socio-economic inequalities. Although the prevalence of early sexual debut declined overall during the reference period, it remains significantly higher in rural than in urban areas. The disparities observed according to standard of living and education highlight the increased vulnerability of adolescent girls from poor households with little schooling, particularly in rural areas. In addition, limited access to information on family planning, particularly via the radio, is an aggravating factor.\u003c/p\u003e\u003cp\u003eThese findings suggest that sexual and reproductive health awareness strategies need to be stepped up, with priority given to young girls with the least education and from disadvantaged backgrounds. Political decision-makers and public health actors must promote specific interventions, combining improved access to education and increased dissemination of appropriate information, in order to delay sexual debut and reduce the associated health risks. Such initiatives would help to improve the well-being of adolescent girls in sub-Saharan Africa, while reducing the socio-economic inequalities associated with early sexual debut.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eESD: early sexual debut;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMDGs: Millennium Development Goals;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSDGs: Sustainable Development Goals;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eaOR: Adjusted odds ratio;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSSA: Sub-Saharan Africa;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSTIs: Sexually transmitted infections;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHIV: Human Immunodeficiency Virus;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDHS: Demographic and Health Surveys;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFP: Family Planning;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHH: Head of Household.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUNFPA. 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J Rural Health juin. 2019;35(3):405\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Trends, Differences, Early sexuality, Teenage, Sub-Saharan Africa","lastPublishedDoi":"10.21203/rs.3.rs-7463174/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7463174/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eIn sub-Saharan Africa, early sexual debut (ESD) exposes adolescent girls to increased risks of unwanted pregnancy, sexually transmitted infections and dropping out of school. This study analyses trends in ESD and socioeconomic differences according to place of residence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eThe data come from three cycles of Demographic and Health Surveys conducted between 2000 and 2023 in 18 countries, covering 80,432 sexually active adolescent girls and young women. The analyses combine cross-tabulations, comparison of proportions tests and binary logistic regressions, at the 5% threshold, using STATA 17.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThe results indicate that the prevalence of ESD gradually decreased from 18.7% during the first half of the Millennium Development Goals (MDGs, 2000-2008) to 18.2% during the second half (2009-2015), and then to 15.5% during the first half of the Sustainable Development Goals (SDGs, 2016-2023). The decline is significant, reaching 14.8% between the end of the MDGs and the start of the SDGs (p=0.000), and 17.1% between the start of the MDGs and the start of the SDGs (p=0.000). Adolescent girls are at least twice as likely to be at risk of ESD as older girls, with greater vulnerability in rural areas (Ajusted Odds Ratio: aOR=3.04; p\u0026lt;0.001) than in urban areas (aOR=2.88; p\u0026lt;0.001). Socio-economic disparities are also notable. Adolescent girls and young women from poor or very poor households are 1.48 times more exposed to ESD, especially in urban areas (aOR=1.98; p\u0026lt;0.000) compared with 1.17 in rural areas (p\u0026lt;0.05). Conversely, education appears to be a protective factor regardless of place of residence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e These results underline the urgent need to strengthen sexual and reproductive health awareness strategies, particularly targeting rural areas and the least educated young girls. Public policies should promote access to education and information to delay the onset of ESD and reduce its impact on the health and schooling of adolescent girls in sub-Saharan Africa.\u003c/p\u003e","manuscriptTitle":"Trends and socioeconomic differences in early sexual debut before marriage among teenage and young girls in sub-Saharan Africa, 2000-2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-07 15:00:39","doi":"10.21203/rs.3.rs-7463174/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-16T15:27:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"60452190789845119713386626998459163540","date":"2025-10-01T11:43:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-25T09:09:31+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-01T07:50:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-28T05:01:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-28T05:00:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-08-26T12:48:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"691cc1f7-92f5-4d13-84ef-abccb54a562e","owner":[],"postedDate":"October 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-07T15:00:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-07 15:00:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7463174","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7463174","identity":"rs-7463174","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}