KNOWLEDGE REGARDING SEXUAL AND REPRODUCTIVE HEALTH AMONG ADOLESCENTS IN HIGHER SECONDARY SCHOOL

BACKGROUND: Adolescent reproductive health is one of the component of the reproductive health. It is most important issue in the world. Reproductive capability is taking place at an earlier age and adolescents are indulging in risk taking behaviors day by day. The objective of this study is to assess knowledge regarding sexual and reproductive health among adolescents. METHODS: A descriptive cross-sectional study was conducted in Kathmandu valley to assess the knowledge regarding sexual and reproductive health among adolescents. Total of 200 respondents were selected through nonprobability purposive sampling technique. Self-administered written questionnaire was used for data collection. The collected data were analyzed by using descriptive statistics such as frequency, percentage, mean, standard deviation and inferential statistics such as Chi-square test. RESULTS: The findings revealed that most of the respondents had knowledge regarding transmission and protection of HIV/AIDS and STIs but still some respondents had misconception regarding it. The statistical analysis revealed that the total mean knowledge score with standard deviation was 45.02±8.674. Nearly half of the respondents (49.5%) had moderate level of knowledge, followed by inadequate level of knowledge 29.5% and adequate level of knowledge 21.0% regarding sexual and reproductive health. There was statistically significant association of level of knowledge with area of residence (p-value 0.002). CONCLUSION: Nearly half of the respondents possess some knowledge about sexual and reproductive health but still effective educational intervention is required to increase their knowledge.


INTRODUCTION
Globally, adolescents (age 10-19 years) account for nearly one-fifth (18%) of the total population. 1 In Nepal, adolescents (age 10-19 years) comprise an even larger proportion of the population that is 24%. 2 This huge group faces unique emotional and physical health challenges.
Adolescent pregnancy carries an increased risk of adverse health outcomes in many countries. An estimated about 16 million girls aged 15-19 years give birth every year worldwide. Among them, 95% occurs in developing countries. Adolescents aged 15-19 years are twice as likely die in childbirth and those under 15 years are five times more likely to die in childbirth as women in their twenties. Infant and child mortality is also higher among children born to adolescent mother. Adolescents suffer a significant and disproportionate share of deaths and disability from unsafe abortion practices. Adolescents account for an estimated 40% of all new HIV infections among adults worldwide. 3 In India, the level of knowledge regarding reproductive health among urban adolescent girls was 35%. At least two or more modes of contraception were known to 80.7% of girls and oral contraceptive pills and Copper-T were the most common known methods. Sexual intercourse with an infected person and sharing needles were the most common modes of transmission of STIs/AIDS was known to 73.9% of girls. Regarding abortion, 39.7% of girls knew that it can be performed at government and private health facilities but none of them knew about the indications, criterion for the place where legal abortion can be performed and person who can carry out legal abortion. 4 In Nepal, 26% of female and 34% of male adolescents and youth had comprehensive knowledge about HIV and AIDS. The level of comprehensive knowledge among adolescents and youth varies by place of residence, education and marital status. About two in every five urban adolescents and youth, both male and female had comprehensive knowledge as compared to about one-third of young men and one-fourth of young women in rural areas. 5 There were more research on knowledge regarding HIV/AIDS and STIs. Although there were few researches on knowledge regarding sexual and reproductive health among adolescents, comprehensive knowledge among them was inadequate. Therefore, there was a need to undertake research to assess knowledge regarding sexual and reproductive health among adolescents. General objective of the study is to assess the existing knowledge regarding sexual and reproductive health among adolescents in higher secondary school. Specific objectives of the study are to identify the knowledge regarding sexual health problems particularly on sexually transmitted infections like HIV/AIDS and STIs, to assess the knowledge regarding reproductive health particularly on family planning, marriage and child bearing, abortion and reproductive rights and to find out association between selected socio-demographic variables and knowledge regarding sexual and reproductive health.

METHODS
A descriptive cross-sectional research design was adopted to assess the knowledge regarding sexual and reproductive health among adolescents in certain higher secondary schools in Kathmandu valley. Non-probability purposive sampling technique was used to select the sample. Sample size was 200. Self-administered written questionnaire was used for data collection. Content validity of the instrument was maintained by developing the research questionnaire on the basis of the objectives after reviewing literature and through consultation with research advisor, subject experts and faculty teacher. The reliability of the instrument was maintained by doing pre-test of the instrument among 10% of total sample size in a similar situation. Ethical approval was taken from the Institutional Review Board, Institute of Medicine, Tribhuvan University. Permission was taken from the concerned authorities in selected colleges. The purpose of the study was explained and verbal informed consent was obtained from each respondent prior to data collection. Anonymity was maintained by keeping code number in questionnaires. Confidentiality was maintained by using the obtained information for the purpose of study only. Collected data were checked, organized, reviewed and analyzed daily for the completeness and accuracy. Coding was done before data entry. Statistical Package for Social Science (SPSS) version 20 was used for data analysis. Data were analyzed by using descriptive statistics such as frequency, percentage, mean and standard deviation and inferential statistics such as Chi-Square test to find out association between selected sociodemographic variables and knowledge regarding sexual and reproductive health.     .5% responded correctly that family planning is a way of thinking and living that promotes health and welfare of the family, 74.5% stated maintaining health of mother and baby by control of birth, 53.5% reported bringing wanted birth only and 1.0% didn't know the meaning of family planning. Regarding temporary family planning devices, majority (97.0%) replied condom followed by 83.0% stated oral pills, 55.0% answered copper-T and some respondents had confusion about temporary family planning devices because 7.0% and 4.5% of respondents replied that minilap/laproscopy and vasectomy are also temporary family planning devices.

*Correct response
Above table 6 illustrates knowledge regarding marriage and child bearing. Regarding response of legal age for marriage with consent of parents, only 10.0% of respondents responded correctly that 18 years is the legal age for marriage with consent of parent. Other 90.0% of respondents did not know the legal age for marriage with consent of parents. Likewise, knowledge regarding legal age for marriage without consent of parents, 17.5% of respondent gave the correct answer. Regarding how pregnancy occurs, majority (90.0%) of respondents responded correctly that pregnancy will occur when sperm of male combine with the ovum of female.
Regarding transmission of HIV/AIDS, majority (98.0%) reported sexual contact followed by 92.5% replied blood and blood product, 91.0% answered sharing of used needle and syringe and 87.5% stated mother to child. This finding is also supported by the findings of study conducted by Rana G., (2014) which revealed that 90% adolescence answered transmit through unprotected sexual contact, 84% through contaminated blood products, 90% through infected mother to child. 6 Regarding reproductive health, majority (95.0%) heard about it. Among them, 86.45% of respondents responded correct meaning of reproductive health. This study was limited only in selected private colleges of Kathmandu valley with small sample size so findings of study can't be generalized in large population.
These research findings might be helpful to teachers and health workers for providing information regarding sexual and reproductive health to adolescents.

CONCLUSION
Knowledge regarding sexual and reproductive health is crucial for the development of the adolescents in Nepal. Nearly half (49.5%) of respondents had moderate level of knowledge, less than half (29.5%) had inadequate level of knowledge and only 21.0% had adequate level of knowledge regarding sexual and reproductive health. There was significant association between level of knowledge and area of residence. Hence the study can conclude that overall knowledge regarding sexual and reproductive health is satisfactory but misconception is there in some aspects. Effective educational intervention is required in higher secondary schools to increase knowledge regarding sexual and reproductive health among adolescents. Sexual health education should be incorporated in the curriculum of higher secondary school. Sexual and reproductive health related information should be provided through mass media to improve their sexual and reproductive health. Sexual health messages can be broadcasted through social medias. Adolescents health messages, services and service providers should be adolescents friendly.