Sexual and Reproductive Health Knowledge, Attitudes, Practices and Associated Factors Among School-Going Adolescents in Conflict-Affected Eastern Democratic Republic of Congo: A Cross-Sectional Study

Abstract

Background Adolescents living in conflict-affected settings face major barriers to accessing sexual and reproductive health (SRH) information and services. Evidence on SRH knowledge, attitudes and practices (KAP) among adolescents in eastern Democratic Republic of the Congo (DRC) remains limited. This study assessed SRH KAP and identified factors associated with good SRH knowledge among school-going adolescents in North and South Kivu. Methods A school-based cross-sectional study was conducted from April to July 2023 among 559 school-going adolescents from 28 secondary schools in seven health zones of North and South Kivu. Data were collected using a pre-tested structured questionnaire. Good SRH knowledge was defined as an overall knowledge score of ≥75%. Factors associated with good SRH knowledge were assessed using Poisson regression with robust variance, and adjusted prevalence ratios (aPRs) with 95% confidence intervals (95% CIs) were estimated. Results Overall, 559 participants were included and 50.5% were girls. After age recoding, mean age was 17.2 ± 1.3 years. Overall, 29.7% had ever had sexual intercourse, while 8.1% had ever used SRH services. High domain knowledge was recorded for 32.7% of the 379 participants with general genital-organ categories, 30.2% for HIV transmission, and 26.8% for contraceptive methods. In the adjusted analysis (n=550), high overall SRH knowledge was associated with South Kivu residence (aPR=6.94; 95% CI: 3.84–12.56; p<0.001), Internet information (aPR=1.53; 95% CI: 1.22–1.93; p<0.001), information from another doctor (aPR=1.64; 95% CI: 1.26–2.15; p<0.001), and information from the mother (aPR=1.56; 95% CI: 1.08–2.24; p=0.017). Household size was inversely associated with high knowledge (aPR=0.957 per additional person; 95% CI: 0.917–0.999; p=0.046). Age and school year were not significant after adjustment. Conclusion Adolescents in North and South Kivu showed substantial gaps in SRH knowledge, low utilization of SRH services, and several indicators of sexual vulnerability. Important differences in SRH knowledge were observed between the two provinces, with higher prevalence of good knowledge among adolescents in South Kivu. Strengthening comprehensive sexuality education and improving access to reliable, adolescent-friendly SRH information through schools, families, healthcare providers, digital platforms, and other appropriate communication channels may help address these gaps. Interventions should also consider the social and contextual barriers that may affect adolescents’ access to SRH information and services in conflict-affected settings.