Prevalence and factors associated with adolescent pregnancy in Hoima district, Uganda: A community-based cross-sectional study

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Abstract
Adolescent pregnancy is a global public health problem with serious social and medical implications relating to maternal and child health. In Uganda, particularly Hoima district, limited information about the factors influencing adolescent pregnancy is available. The study estimated the prevalence of adolescent pregnancy and identified factors independently associated with adolescent pregnancy among girls aged 13–19 years in Hoima district. We conducted a community-based cross-sectional study among 543 adolescent girls randomly selected using multistage sampling. Data were collected using a structured, interviewer-administered questionnaire. Bivariate logistic regression was used to assess associations between independent variables and adolescent pregnancy. Variables with p < 0.20 at bivariate analysis were included in a multivariable logistic regression model to identify factors independently associated with adolescent pregnancy. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and statistical significance was set at p < 0.05. Findings revealed 29.1% prevalence of adolescent pregnancy. Age (18–19 years) AOR 4.4 (95%CI 1.5–12.8), low parents’ economic status AOR 5.4 (95%CI 2.5–11.8), multiple sexual partners AOR 8.0 (95%CI 4.5–14.2), being out of school AOR 12.0 (95%CI 5.0–29.1), early marriage AOR 37.0 (95%CI 13.4–107.5), having no control over sex AOR 7.4 (95%CI 3.7-16.4), not discussing SRH with parents AOR 8.4 (95%CI 3.3–21.5), witnessed domestic violence AOR 30.0 (95%CI 12.0–77.5), never received counselling AOR 5.7 (95%CI 3.6–9.0), and, rural residence AOR 1.8 (95%CI 1.2–2.9) were significant predictors of adolescent pregnancy. These findings suggest that adolescent pregnancy in Hoima district remains high and is associated with interconnected individual, family, health system, and community-level factors. Interventions should prioritize keeping girls in school, strengthening adolescent-friendly and non-judgmental health services, addressing household poverty, preventing early marriage, and promoting supportive family and community environments to reduce adolescent pregnancy in rural Ugandan settings.
Citation: Wandeka JW, Kooko R, Bukenya J, Kisame R (2026) Prevalence and factors associated with adolescent pregnancy in Hoima district, Uganda: A community-based cross-sectional study. PLOS Glob Public Health 6(7): e0005331. https://doi.org/10.1371/journal.pgph.0005331
Editor: Mamothena Carol Mothupi, International Rescue Committee, KENYA
Received: September 27, 2025; Accepted: June 8, 2026; Published: July 15, 2026
Copyright: © 2026 Wandeka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All raw data required to replicate the results of this study are included within the Supporting information files (S1 File).
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Abbreviations: AOR, Adjusted Odds Ratio; COR, Crude Odds Ratio; DHS, Demographic Health Survey; IQR/SD, Interquartile Range/Standard Deviation; PRB, Population Reference Bureau; SRH, Sexual and Reproductive Health; SSA, Sub-Saharan Africa; UBOS, Uganda Bureau of Statistics; UNICEF, United Nations International Children’s Emergency Fund; WHO, World Health Organization.
Introduction
Adolescent pregnancy, defined by the United Nations International Children’s Emergency Fund (UNICEF) as pregnancy occurring among girls aged 10–19 years, remains a major public health and social concern globally, particularly in low- and middle-income countries (LMICs) [1,2]. An estimated 21 million girls aged 15–19 years become pregnant annually in LMICs, nearly half of which are unintended, resulting in approximately 12 million births each year [3]. These pregnancies are associated with adverse maternal, neonatal, and socio-economic outcomes that undermine girls’ health, education, and long-term wellbeing.
Sub-Saharan Africa bears the highest burden of adolescent pregnancy worldwide, with adolescent birth rates remaining substantially higher than global averages despite recent declines elsewhere [4]. Uganda in general and Hoima district in particular continue to report one of the highest adolescent pregnancy rates, estimated at approximately 24.0% and 30.6% respectively, posing a significant challenge to local health systems, communities, and development efforts [5,6].
Despite the implementation of policies and related laws such as the Uganda’s National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights (2017) emphasizing reduction of adolescent pregnancies by increasing access to reproductive health services, the Penal Code Act criminalizing sexual exploitation of minors, and the school health policy that advocates for comprehensive sex education to mitigate early pregnancies, adolescent pregnancies remain relatively high in Uganda, especially in Hoima district [6,7].
Therefore, to address the impact of adolescent pregnancies, there is a need to continuously understand the risk factors associated with adolescent pregnancy. Despite the high prevalence of adolescent pregnancies in Hoima district, previous research on the sexual and reproductive health was limited to in-school adolescent girls’ population with less focus on community-based studies thus neglecting adolescents who are out of school for various socio-economic or personal reasons [6].
Even though numerous studies have been done in Uganda to identify a wide variety of risk factors associated with adolescent pregnancies, there is a need for context-specific evidence to inform locally feasible interventions to reduce adolescent pregnancies in Hoima district. This study therefore assessed the prevalence of adolescent pregnancies and factors associated among adolescent in Hoima district, Uganda. The findings from this study will support policymakers and stakeholders to strengthen adolescent reproductive health interventions and inform the implementation of existing policies such as the National Health Policy, School Health Policy, and Adolescent Health Policy.
Materials and methods
Ethical considerations
Study design and setting
This was a community-based cross-sectional study involving quantitative data collection approaches in three sub-counties of Hoima district: Buseruka, Buhanika, and Kitoba. The district is located in the mid-western region of Uganda and it is predominantly rural, with livelihoods mainly based on subsistence farming, fishing, and small-scale trade. The district has documented high levels of adolescent pregnancy compared to the national average, attributed to early marriage practices, school dropout, poverty, and limited access to adolescent-friendly sexual and reproductive health (SRH) services.
Study population
Adolescent girls aged 13–19 years who had resided in the selected areas for at least 12 months prior to the study to ensure participants had adequate exposure to local contextual factors influencing adolescent pregnancy and to reduce bias from recent migrants.
Inclusion criteria
Exclusion criteria
The study excluded girls who were severely ill or cognitively unable to respond to the questionnaire.
Sample size determination
The sample size formula for Kish Leslie (1965) was used as expressed below,
Where Z is the standard normal deviate of 1.96 (95% confidence interval)
P= Prevalence of adolescent pregnancies in Hoima district at 30.6% [6].
d = level of precision (+/- 5%)
Considering a non-response rate of 10%
Final sample size= Effective sample size/ (1- non response rate anticipated)
n= 326/ (1-10%) ~ 362 adolescents
To account for cluster sampling, a design effect of 1.5 was applied, consistent with community-based surveys where intra-cluster correlation is expected.
Therefore, considering a design effect of 1.5, n=543
Sampling procedure
Multi-stage random sampling was used to select study respondents. Hoima district is divided into two counties, Bugahya and Kigorobya. The counties are sub divided into 5 sub counties and 1 Town Council namely; Bugahya County – Buseruka, Buhanika, Kitoba and Kyabagambire sub counties; Kigorobya County – Kigorobya Sub County and Kigorobya Town Council. Three sub counties (Buseruka, Buhanika, Kitoba) were randomly selected by simple random sampling using rotary method to participate in the study. The principal investigator then randomly selected half of the parishes from each selected sub-county. Here the names of all parishes in each selected sub-county were written on individual pieces of paper, folded, and placed in a container. Half of the parishes were then drawn from the container without replacement for participation in the study and this sampling technique was also applied at parish level to select half the number of villages in each parish to participate in the study. From each village, a list of households was obtained and systematic random sampling was used to select households. In households with more than one eligible adolescent girl, simple random selection was applied to select one respondent. The number of participants selected per village was determined using probability proportional to size (PPS) based on the estimated number of adolescent girls aged 13–19 years per village. Village population data were obtained from the Hoima district population officer (Table 1).
Study variables
The primary outcome variable was adolescent pregnancy, operationally defined as self-reported current pregnancy or ever been pregnant. Pregnancy status was determined through self-report, as biological verification was not feasible in this community-based study.
Independent variables included: Socio-demographic factors (age, residence, education), Individual factors (school attendance, sexual partners, control over sex), Family factors (parent-child communication, domestic violence), Health facility factors (youth-friendly services, counselling), and Community factors (peer influence, residence).
Data collection
Trained research assistants with support from the principal investigator collected data for a period of one month from 6th March 2024 to 6th April 2024 using a pre-tested interviewer administered structured questionnaire. Local leaders and village health teams only facilitated community entry and did not participate in data collection to minimize social desirability bias. The questionnaire was adapted from validated tools used in similar studies [6,7] and customized to meet the study objectives. The questionnaire covered socio-demographic characteristics, sexual behavior, family environment, health service access, and pregnancy history.
Training of research assistants
The principal investigator selected the research assistants, trained them for four days on questionnaire administration, data collection, and ethical considerations; they were also trained in effective communication skills, showing empathy and never being judgmental. The research assistants were aged between 20 and 30 years and fluent in the local language and attained at least certificate qualification with some holding diploma and bachelor’s degree in health-related or social science field. This helped to ensure free, open communication for the participants and reliable administration of the questionnaire.
Quality control measures
The questionnaire was translated into Runyoro and back-translated into English to ensure semantic consistency. Pretesting was conducted among 20 adolescent girls in Kakumiro District, which has similar socio-demographic characteristics to Hoima.
Internal consistency reliability was assessed using Cronbach’s alpha, yielding a coefficient of ≥0.78 across key domains, indicating acceptable reliability. Feedback from pretesting informed refinement of question wording and sequencing. Fieldwork was overseen by the principal investigator to ensure completeness and accuracy of data collected.
Data analysis
Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 26. Descriptive statistics were used to summarize participants’ characteristics, with categorical variables presented as frequencies and percentages. Prior to multivariable modeling, multicollinearity among independent variables was assessed using the variance inflation factor (VIF), and all variables had VIF values below 5, indicating absence of significant multicollinearity. Bivariate logistic regression analysis was conducted to examine the association between each independent variable and adolescent pregnancy. Variables with a p-value < 0.20 at the bivariate level were retained for inclusion in the multivariable logistic regression model in order to avoid excluding potential predictors. Multivariable logistic regression analysis was then performed to identify factors independently associated with adolescent pregnancy, and adjusted odds ratios (AORs) with corresponding 95% confidence intervals were reported. Statistical significance was set at p < 0.05. Model fit was assessed using the Hosmer–Lemeshow goodness-of-fit test (χ² = 1.20, p = 0.99), indicating adequate model fit.
Results
Sociodemographic characteristics of participants
In this study, data from 543 participants were analyzed. The mean age was 15.9 ± 1.9 years and the median age was 16 years, with an interquartile range of 14–17 years old.
The majority of participants (61.1%) included in this study were living in rural areas, over 44.0% were between the ages of 15–17 years and 24.1% between the ages of 18–19 years, majority of the respondents 58.8% had attained primary level of education, 33.0% of them were married and 39.0% had multiple sexual partners.
About two-thirds, (77.2%) of the parents whose adolescents were included the study had low/poor economic status, a high number (66.1%) of participants had both parents alive and catholic was the dominant religion at 34.4%. Approximately, (44.4) % of the adolescents had witnessed domestic violence. There was almost a uniform sample distribution among the sub-counties, Buhanika, Buseruka and Kitoba at 34.4%, 33.0% and 32.6% respectively (Table 2)
Prevalence of adolescent pregnancies in Hoima district
Out of 543 adolescent girls included in the study, 158 reported having ever been pregnant, giving a prevalence of 29.1%.
Factors associated with adolescent pregnancies in Hoima district (Unadjusted analysis)
Sociodemographic characteristics of respondents.
In this study, age was significantly associated with adolescent pregnancy. There was a significantly high prevalence of adolescent pregnancy among adolescents aged 18–19 at 64.9% compared to 4.7% among those aged 13–14. Adolescents aged 18–19 were 37 times more likely to get pregnant as compared to adolescents aged 13–14 COR 37.0 (95%CI 17.1-83.9). The prevalence of adolescent pregnancy among adolescents who were married was high at 74.1% and 25 times more likely to get pregnant than their counterparts who were not married COR 25.0 (95%CI 15.7-41.6). The education of the caretaker/parent was significantly associated with adolescent pregnancy with about 45.6% pregnancies happening among adolescents whose parents had no formal education and 18.1% among those whose parents had at least attained secondary level of education. There was a substantially high proportion of adolescent pregnancies 34.4% among adolescents whose parents fall under a low (poor) economic status strata compared to 11.3% whose parents belong to a high (rich) economics status. Adolescents whose parents were poor were 4.1 times more likely to report having ever been pregnant compared to those whose parents were rich COR 4.1 (95%CI 2.3-7.4). More than half of adolescent pregnancies 54.9% were among adolescents who did not have both biological parents alive and these adolescents were 6.4 times more like to get pregnant than their counterparts who had both parents alive COR 6.4 (95%CI 4.3-9.7) (Table 3).
Individual factors
At a bivariate level, all factors were significantly associated with adolescent. There was a significantly high adolescent pregnancy prevalence of 74.7% among adolescents with multiple sexual partners compared to 21.1% among adolescents with no multiple partners. Those with multiple sexual partners were 9.1 times more likely to get pregnant compared to their peers with only one sexual partner COR 9.1 (95%CI 6.0-14.0). Similarly, adolescents who were not in school were 26 times more likely to get pregnant than their peers who were in school COR 26.0 (95%CI 15.9-44.1). Additionally, other individual factors that were associated with adolescent pregnancy included early marriage, control over sex, sex for material support, family planning awareness (Table 4).
Family-related factors
All family-related factors were significantly associated with adolescent pregnancy at a bivariate level of analysis. Adolescents neglected by parents exhibited a significantly high prevalence of adolescent pregnancies 60.0% and were 7.7 times more likely to get pregnant than their counterparts who did not experience parental neglect COR 7.7 (95%CI 5.1-11.8). Similarly, other family-related factors associated with adolescent pregnancy were; do not discuss SRH with parents, parents talk about sex education, witnessed domestic violence, do not stay with parents, and low socioeconomic status of family (Table 4).
Health facility factors
At a bivariate level of analysis, all health facility related factors were significantly associated with adolescent pregnancy. There was a significantly high prevalence of adolescent pregnancy 59.8% among adolescents who felt judged by healthcare service providers/healthcare workers while seeking care because of their age compared to 19.2% among those who did not feel judged. Adolescents who felt judged by healthcare workers while seeking care because of their age were 6.2 times more likely to get pregnant compared to those who did not feel judged COR 6.2 (95%CI 4.1-9.6). Similarly, other adolescent pregnancy associated health facility factors included; no provision of youth tailored health services, affordability of HF services, attitude of healthcare providers, not receiving counselling, costs involved in accessing HCS (Table 4).
Community related factors
Place of residence and peer influence including early marriage practices were the only community related factors significantly associated with adolescent pregnancy at a bivariate level of analysis. Adolescent pregnancy was more prevalent among adolescents in rural areas (33.7%) than their urban settings (21.8%) with those in rural areas being more likely to get pregnant 1.8 times higher those in urban areas COR 1.8 (95%CI 1.2-2.7). Community related factors like Religious influence including early marriage practices, Cultural influence including early marriage practices, media help mitigate issue of adolescent pregnancy, and, media talk about adolescent pregnancy were insignificantly associated with adolescent pregnancy in Hoima district (Table 4).
Multivariable analysis
All variables with P values <0.2 at the bivariate level of analysis were selected for the multivariable analysis. The final model depicts the best fit for this analysis. All variables that remained in the multivariable model were statistically significant and they are thus significantly associated with adolescent pregnancy among girls in Hoima district.
Factors independently associated with adolescent pregnancy
The factors that remained significantly associated with increased odds of adolescent pregnancy at multivariate analysis level included; age (18–19 years) AOR 4.4 (95%CI 1.5–12.8, p = 0.006), low parents’ economic status AOR 5.4 (95%CI 2.5–11.8, p < 0.001), multiple sexual partners AOR 8.0 (95%CI 4.5–14.2, p < 0.001), being out of school AOR 12.0 (95%CI 5.0–29.1, p < 0.001), early marriage AOR 37.0 (95%CI 13.4–107.5, p < 0.001), having no control over sex AOR 7.4 (95%CI 3.7-16.4, p < 0.001), not discussing SRH with parents AOR 8.4 (95%CI 3.3–21.5, p < 0.001), witnessed domestic violence AOR 30.0 (95%CI 12.0–77.5, p < 0.001), never received counselling AOR 5.7 (95%CI 3.6–9.0, p < 0.001), and, rural residence AOR 1.8 (95%CI 1.2–2.9, p = 0.011) (Table 5).
Discussion
This study determined the prevalence of adolescent pregnancies and described the socio-demographic, individual, family, community and Health facility factors associated with pregnancy among adolescent girls aged 13–19 years in Hoima district, Uganda. The findings indicate adolescent pregnancy remains an important public health challenge in Hoima district. The prevalence observed suggests persistent geographical inequalities despite national efforts to reduce adolescent pregnancy.
The higher likelihood of pregnancy among older adolescents may reflect cumulative exposure to sexual relationships, greater social pressure to enter marriage, and increasing expectations of childbearing as girls approach adulthood. The finding is consistent with studies from Uganda and Ethiopia, which demonstrate that pregnancy risk increases with age due to prolonged exposure to sexual activity and higher likelihood of marriage [6,8]. Unlike younger adolescents, older girls in rural Uganda are more likely to be perceived as socially “ready” for marriage and childbearing, even when still legally minors. This socio-cultural expectation may explain why age remains a strong predictor despite increased awareness of sexual and reproductive health information among older adolescents.
Poverty has been consistently associated with adolescent vulnerability in many settings. Girls from economically disadvantaged households may engage in early sexual relationships as a coping strategy for unmet basic needs, school fees, or material support as seen in a related Ugandan socioeconomic vulnerability models [9]. Similar associations have been reported in Uganda, Tanzania, and other low-resource settings, where poverty exacerbates school dropout, early marriage, and transactional sex [7,10,11]. These findings reinforce the need to address structural economic factors alongside behavioral interventions.
Evidence from Ethiopia and Sri Lanka suggest that being in school not only delays marriage and sexual debut but also provides structured supervision, access to reproductive health information, and future aspirations that discourage early childbearing [8,11,12]. In Hoima district, school dropout is often associated with poverty, early marriage, and domestic responsibilities, creating a cyclical relationship in which leaving school and adolescent pregnancy frequently coexist and reinforce social disadvantage. This interaction may explain why school attendance remains one of the most consistent predictors across diverse settings [13].
Similar associations between early marriage and adolescent pregnancy have been reported across Uganda and other sub-Saharan African countries (SSA), where marriage is often accompanied by expectations of immediate childbearing [13,14]. Married adolescents may have reduced autonomy over reproductive decisions and less opportunity to delay pregnancy through contraceptive use. Although Uganda has legal frameworks prohibiting child marriage, implementation remains challenging in some rural communities. In Hoima District, prevailing social norms that link marriage with motherhood may help explain the strong association observed between early marriage and adolescent pregnancy
Similar findings have been reported in Ethiopia and other SSA countries. These findings suggest heightened exposure to unprotected sex, coercion, and inconsistent contraceptive use [11,15,16]. Limited sexual autonomy among adolescent girls may result from gender power imbalances, economic dependency, or partner manipulation, all of which reduce the ability to negotiate safe sex and delay pregnancy [11]. In rural Hoima, girls may lack bargaining power within relationships, reducing their ability to negotiate condom use or delay sex, thereby increasing pregnancy risk even when awareness of contraception exists.
Findings from Zambia and Kenya suggest that open family communication is associated with healthier sexual behaviours and delayed sexual initiation among adolescents [17,18]. Open parent–child communication may provide adolescents with accurate information and guidance that may support informed reproductive health decisions. In rural settings such as Hoima district, cultural discomfort around discussing sexuality may limit these conversations, leaving adolescents more dependent on peers or other informal sources of information. This challenge may be particularly important where access to adolescent-friendly health services is limited
Evidence from Brazil and Uganda has linked household violence to adverse adolescent reproductive outcomes [18,19]. Witnessing violence within the household may normalize harmful gender norms, undermine emotional well-being, and increase susceptibility to risky sexual behavior. Emotional distress, low self-esteem, and disrupted family support systems may drive adolescents toward early sexual relationships as coping mechanisms. In Hoima District, domestic violence often coexists with alcohol misuse and economic stress, potentially compounding its impact on adolescent girls’ vulnerability.
Similar findings have been reported in Nigeria, where limited access to SRH counselling has been associated with higher levels of unprotected sexual activity and unintended pregnancy among adolescents [20]. Counselling may provide adolescents with accurate information on contraception, fertility awareness, and negotiation skills, enabling informed decision-making. In Hoima District, limited counselling opportunities may reflect shortages of trained personnel, high patient loads, and inadequate prioritization of adolescent-specific services. Without counselling, adolescent girls may rely on peers or informal sources for information, increasing susceptibility to misinformation and risky sexual behavior.
Evidence from sub-Saharan Africa suggest that affordability remains an important consideration in adolescents’ utilization of sexual and reproductive health services [21]. Even when public health services are nominally free, indirect costs such as transportation, registration fees, and opportunity costs related to time away from school or household responsibilities can deter adolescents from seeking care. A study in Nigeria has similarly shown that adolescents from low-income households are less likely to access contraceptive services due to cost-related barriers [20]. In Hoima district, where poverty levels remain high and health facilities are sparsely distributed, these costs may disproportionately affect rural adolescents, limiting timely access to preventive SRH services, which may partly explain the observed association.
Perceived judgement or negative attitudes from healthcare providers have been identified as important barrier to effective SRH service utilization among adolescents. This finding aligns with studies from Uganda which document how stigma, breaches of confidentiality, and moralizing attitudes discourage adolescents from accessing SRH services [7,14]. In conservative rural settings like Hoima, fear of being reprimanded or reported to parents can further intensify adolescents’ reluctance to seek care. Such experiences undermine trust in the health system and highlight the need for provider training in adolescent-friendly, non-judgmental care.
Similar findings have been reported in Zambia [17]. Rural residence often reflects broader structural disadvantages, including limited access to quality education, adolescent-friendly health services, and economic opportunities. In Hoima district, rural communities are also characterized by strong cultural norms that support early marriage and childbearing, which may override formal policy restrictions. Although some multi-country analyses have reported lower adolescent pregnancy risk in rural settings due to reduced exposure to sexualized media, the present findings suggest that in Hoima, the effects of poverty, service inaccessibility, and entrenched social norms may outweigh any potential protective factors [2].
Study limitations
The cross-sectional study design makes it impossible to determine temporal relationships between exposure and adolescent pregnancy because causality cannot be established using this study design. Self-reporting for the pregnant status of the respondents as well as other sensitive data, which could be subject to recall and social desirability biases. These biases were minimized by conducting an interview under a trained interviewer in a private setting using memory aids. Although multicollinearity assessment indicated no evidence of problematic multicollinearity, residual confounding from unmeasured factors cannot be entirely ruled out. In addition, some estimates were associated with relatively wide confidence intervals, which may reflect sparse data within some exposure categories, potentially leading to unstable estimates. Consequently, the magnitude of these associations should be interpreted with caution, although the direction of the observed relationships remains informative. Lastly, the study used a probability sample design through multistage probability sampling; however, household listing and community registers might have excluded mobile adolescents. These limitations should be considered when interpreting the findings
Conclusion and recommendations
Adolescent pregnancy remains a major public health concern in Hoima district, with a prevalence of 29.1%. Several factors were independently associated with adolescent pregnancy. These included older age of adolescents (18–19 years), lower parental socio-economic status, having multiple sexual relationships, being out of schools, early marriage, lack of control over sexual decision-making, inadequate communication between parents and their daughters about sexual matters, witnessing domestic violence in the home, not receiving counselling services, and living in rural areas.
These findings suggest that adolescent pregnancy is associated with a combination of individual, family, community, and health system factors. Therefore, policymakers and stakeholders should implement multisectoral interventions that aim at ensuring that girls remain in schools, avoid getting married at an early age, have access to adolescent-friendly health care providers without any stigma, foster open communication within families, and address poverty in households. The findings should be incorporated into various policies to address the problem of adolescent pregnancies in the district.
Supporting information
S1 File. Dataset used for analysis.
An anonymized dataset containing variables used in the quantitative analysis of the prevalence and associated factors of adolescent pregnancy in Hoima.
https://doi.org/10.1371/journal.pgph.0005331.s001
(XLSX)
Acknowledgments
We acknowledge the Hoima District administrative authorities and the District Health Team for granting permission to conduct the study, and we thank Simon P.S. Kibira for his contribution during the initial stages of the study.
References
- 1. United Nations Children’s Fund. Early childbearing and teenage pregnancy rates by country. Available from: https://data.unicef.org/topic/child-health/adolescent-health/. 2023. Accessed 2024 November 12.
- 2. Ahinkorah BO, Kang M, Perry L, Brooks F, Hayen A. Prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa: a multi-country analysis. PLoS One. 2021;16(2):e0246308. pmid:33539394
- 3. World Health Organization, WHO. Early marriages, adolescent and young pregnancies. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy. 2022. Accessed 2025 December 21.
- 4. Asare BY-A, Baafi D, Dwumfour-Asare B, Adam A-R. Factors associated with adolescent pregnancy in the Sunyani Municipality of Ghana. Int J Afr Nurs Sci. 2019;10:87–91.
- 5.
Uganda Bureau of Statistics. Uganda demographic and health survey 2022: key findings. Kampala, Uganda: UBOS; 2023. Available from: https://www.ubos.org/uganda-demographic-and-health-survey-udhs-2022-key-findings/
- 6. Musinguzi M, Kumakech E, Auma AG, Akello RA, Kigongo E, Tumwesigye R, et al. Prevalence and correlates of teenage pregnancy among in-school teenagers during the COVID-19 pandemic in Hoima district western Uganda—a cross sectional community-based study. PLoS One. 2022;17(12):e0278772. pmid:36525426
- 7. Ochen AM, Chi PC, Lawoko S. Predictors of teenage pregnancy among girls aged 13-19 years in Uganda: a community based case-control study. BMC Pregnancy Childbirth. 2019;19(1):211. pmid:31234816
- 8. Ayele BG, Gebregzabher TG, Hailu TT, Assefa BA. Determinants of teenage pregnancy in Degua Tembien District, Tigray, Northern Ethiopia: a community-based case-control study. PLoS One. 2018;13(7):e0200898. pmid:30044850
- 9. Kooko R, Wafula ST, Orishaba P. Socioeconomic determinants of malaria prevalence among under five children in Uganda: evidence from 2018-19 Uganda Malaria Indicator Survey. J Vector Borne Dis. 2023;60(1):38–48. pmid:37026218
- 10. Moshi FV, Tilisho O. The magnitude of teenage pregnancy and its associated factors among teenagers in Dodoma Tanzania: a community-based analytical cross-sectional study. Reprod Health. 2023;20(1):28. pmid:36737763
- 11. Mezmur H, Assefa N, Alemayehu T. Teenage pregnancy and its associated factors in Eastern Ethiopia: a community-based study. Int J Womens Health. 2021;13:267–78. pmid:33664597
- 12. Dulitha F, Nalika G, Upul S, Chrishantha WM, De Alwis SR, Hemantha S, et al. Risk factors for teenage pregnancies in Sri Lanka: perspective of a community based study. Health Sci J. 2013;7(3):269.
- 13. Yaya S, Odusina EK, Bishwajit G. Prevalence of child marriage and its impact on fertility outcomes in 34 sub-Saharan African countries. BMC Int Health Hum Rights. 2019;19(1):33. pmid:31856810
- 14. Gideon R. Factors associated with adolescent pregnancy and fertility in Uganda: analysis of the 2011 demographic and health survey data. Am J Sociol Res. 2013;3(2):30–5.
- 15. Trussell J, Raymond EG, Cleland K. Emergency contraception: a last chance to prevent unintended pregnancy. Contemp Read Law Soc Justice. 2014;6(2).
- 16. Barnert ES, Godoy SM, Hammond I, Kelly MA, Thompson LR, Mondal S, et al. Pregnancy outcomes among girls impacted by commercial sexual exploitation. Acad Pediatr. 2020;20(4):455–9. pmid:31841662
- 17. Isaksen KJ, Musonda P, Sandøy IF. Parent-child communication about sexual issues in Zambia: a cross sectional study of adolescent girls and their parents. BMC Public Health. 2020;20(1):1120. pmid:32677930
- 18. Maina BW, Ushie BA, Kabiru CW. Parent-child sexual and reproductive health communication among very young adolescents in Korogocho informal settlement in Nairobi, Kenya. Reprod Health. 2020;17(1):79.
- 19. Miura PO, Tardivo LS, Barrientos DM, Egry EY, Macedo CM. Adolescence, pregnancy and domestic violence: social conditions and life projects. Revista Brasileira de Enfermagem. 2020;73(Suppl 1):e20190111.
- 20. Akanbi MA, Ope BW, Adeloye DO, Amoo EO, Iruonagbe TC, Omojola O. Influence of socio-economic factors on prevalence of teenage pregnancy in Nigeria. Afr J Reprod Health. 2021;25(s5):138–46. pmid:37585778
- 21.
Guttmacher Institute. How much does it cost to get contraception? [Internet]. New York: Guttmacher Institute; 2019. Available from: https://www.guttmacher.org/report/adding-it-up-investing-in-sexual-reproductive-health-2019. Accessed December, 2025.