Access to selected sexual reproductive health services among adolescent refugees in Rhino camp refugee settlement in Arua district.

Abstract

Introduction: Uganda hosts 1.4 million refugees and conflict-affected people. Widely regarded as the best place in Africa to be a refuge. Adolescents in refugee camps in West Nile Region face challenges that can be mitigated with creating a comprehensive access to Sexual Reproductive Health Services (SRHs). The limited access to SRHs among adolescent refugees is associated with low availability of social services like health education in the context of sexual and reproductive health services like Family Planning Services (FP), Antenatal Care (ANC), Post-Natal and Post Abortion Care (PAC). Access to Sexual Reproductive Health Services is low among adolescents living in the refugee camp settings as compared to counterpart in the normal settings in Uganda. Objectives: The main objective was to investigate the level of access to Sexual Reproductive Health Services (SRHs) and associated factors among adolescent refugees in Rhino Camp Refugee Settlement in Arua District West Nile Region Uganda. Methods: This was a cross sectional study among 310 out of the 427 sample calculated refugee adolescents aged 14-19 years, these were selected using a systematic method with a random start in Rhino camp refugee settlement, Arua District. The (03) FGDs were used to collect qualitative data which were analyzed using t hematic analysis. Quantitative data was obtained using interviewer administered questionnaire and check list (This helped the team to verify and observe the available family planning commodities, PAC medicines etc). Data was analyzed using STATA 15. Modified Poisson regression with robust standard errors was done to assess the association between the independent and dependent variables at the bivariate and multivariate analyses. Variables with P-value of ≤ 0.2 at bivariate were considered for multivariate analysis. Variables with a P-value less than 0.05 were considered to be statistically significant. Results: A total of 310 (73% response rate) adolescents were recruited for quantitative part of the study, 24 adolescents and 14 health workers (Midwives and NGO Officials) total 38 respondents for qualitative part of the study. The mean (SD) age of adolescents at recruitment was 17.3 (±1.5) years. Of the 310 adolescents, 132 (42.6%) were male and 178 (57.4%) were female. The overall level of access to SRHs (FP, ANC and PAC) among the adolescents was 50%. This was measured by the proportion of adolescents who had the need and opportunity to reach and obtain any of the three services: The level of access is still very low SRH interventions must be put in place to increase access. At multivariate analysis, the factors that were independently associated with access to SRHS were lack of awareness of sexual reproductive health services (PR=0.33, 95% CI: 0.16, 0.93) and being single adolescents (PR=0.53, 95% CI: 0.29, 0.98). Qualitative data also revealed that long distance to health facilities, low income earning, health workers’ attitude, stock out of commodities, fear and shyness, parents’ attitude, and long waiting hours in health facilities were some of the factors that deterred access to SRHs by adolescents in refugee camps. Conclusion: The prevalence of access to SRHs among refugee adolescents in Rhino refugee settlement camp is low (50%). This was achieved by summarizing proportions for the considered three components of SRHs (YES/NO) among the adolescent refugees in Rhino camp compared to their counterparts of Ugandan, Tanzanian and Ethiopian nationalities (65%). Factors that were independently associated with access to SRHS among refugee adolescents were awareness of SRHs, level of education (primary level and secondary level), and married adolescents. There is need for effective SRH interventions in order to at least achieve the minimum sphere standards recommended in such situations including mobile clinics, awareness creation, health outreaches, availability of FP commodities, emergency transport services among others. Keywords: Sexual and reproductive health, adolescent, refugee, access to SRHs, availability, acceptability, Arua, Uganda.