Associations between disordered eating behaviour and sexual behaviour amongst emerging adults attending a tertiary education institution in Coastal Kenya

Background: Sexual behavior (SB) is a well-documented pathway to HIV acquisition in emerging adults and remains common amongst African emerging adults. Previous research in high-income countries indicates a correlation between disordered eating behavior (DEB) and engaging in sexual behaviors. We aimed to describe the relationship between DEB and SB amongst emerging adults attending a tertiary educational institution at the Kenyan Coast. Methods: We applied a cross-sectional design nested in a young adults’ cohort study. Eligibility included sexually active emerging adults aged 18–24 years. Three DEBs (emotional, restrained and external eating) were assessed using the Dutch Eating Behavior Questionnaire and analysed using exploratory factor analysis. Seven SB indicators were assessed: non-condom use, casual sex, multiple sex partners, transactional sex, group sex, age-disparate relationship and anal sex, and grouped into low vs. high SB using latent class analysis. Logistic regression was used to assess the association between DEB and SB. Results: Of 273 eligible participants (female, n = 110 [40.3%]), the mean of emotional, restrained and external eating was 1.9 [0.6], 2.0 [0.6] and 3.0 [0.5] respectively. Overall, 57 (20.9%) were grouped into the latent high SB class. Emotional (Adjusted odds ratio, AOR [95% confidence interval, CI]: 1.0 [0.9–1.0], p = 0.398), restrained (AOR, 1.0 [CI: 0.9–1.1], p = 0.301) and External (AOR, 1.0 [CI: 0.8–1.2], p = 0.523) eating were not independently associated with latent high SB. Conclusion: There was no significant association between DEB and SB in this study sample. In low- and middle-income countries like Kenya, interventions targeted at DEB among emerging adults towards controlling SB are unnecessary

Associations between disordered eating behaviour and sexual behaviour amongst emerging adults attending a tertiary education institution in Coastal Kenya

Background Sexual behavior (SB) is a well-documented pathway to HIV acquisition in emerging adults and remains common amongst African emerging adults. Previous research in high-income countries indicates a correlation between disordered eating behavior (DEB) and engaging in sexual behaviors. We aimed to describe the relationship between DEB and SB amongst emerging adults attending a tertiary educational institution at the Kenyan Coast. Methods We applied a cross-sectional design nested in a young adults’ cohort study. Eligibility included sexually active emerging adults aged 18–24 years. Three DEBs (emotional, restrained and external eating) were assessed using the Dutch Eating Behavior Questionnaire and analysed using exploratory factor analysis. Seven SB indicators were assessed: non-condom use, casual sex, multiple sex partners, transactional sex, group sex, age-disparate relationship and anal sex, and grouped into low vs. high SB using latent class analysis. Logistic regression was used to assess the association between DEB and SB. Results Of 273 eligible participants (female, n = 110 [40.3%]), the mean of emotional, restrained and external eating was 1.9 [0.6], 2.0 [0.6] and 3.0 [0.5] respectively. Overall, 57 (20.9%) were grouped into the latent high SB class. Emotional (Adjusted odds ratio, AOR [95% confidence interval, CI]: 1.0 [0.9–1.0], p = 0.398), restrained (AOR, 1.0 [CI: 0.9–1.1], p = 0.301) and External (AOR, 1.0 [CI: 0.8–1.2], p = 0.523) eating were not independently associated with latent high SB. Conclusion There was no significant association between DEB and SB in this study sample. In low- and middle-income countries like Kenya, interventions targeted at DEB among emerging adults towards controlling SB are unnecessary

Sexual risk-taking behavior amongst emerging adults in a tertiary institution of learning in Coastal Kenya: A qualitative study of stakeholders’ perspectives using causal loop mapping

Background It is known from previous studies that university students in sub-Saharan Africa (sSA) engage in sexual risk-taking behaviour (SRTB). However, there is paucity of data on factors contributing to SRTB among university students (emerging adults) at the Kenyan Coast thus hindering intervention planning. This study seeks to provide an in-depth qualitative understanding of the factors contributing to SRTB and their interconnectedness among university students at the Kenyan Coast combining qualitative research with a systems thinking approach. Methods Using the ecological model, and employing in-depth interviews, we explored the perceptions of twenty-six key informants (twenty-one emerging adults and five other stakeholders) on what constitutes and influences SRTB among emerging adults at a tertiary institution of learning in Coastal Kenya. Data were analysed using a thematic framework approach. A causal loop diagram (CLD) was developed to map the interconnectedness of the correlates of SRTB. Results Our findings show that unprotected sex, transactional sex, cross-generational sex, multiple sex partnerships, gender-based violence, sex under influence of alcohol/drugs, early sex debut, and sharing sex toys were common SRTBs. Based on the ecological model and CLD, most of the reported risk factors were interconnected and operated at the individual level. Conclusion Our study shows that emerging adults are frequently engaging in unprotected sex. Enhancing sexuality education programs for students in Kenyan universities and strengthening support systems including counselling for those using alcohol/drugs may help reduce SRTB among emerging adults in Kenyan universities

Are self-reported symptoms of sexually transmitted infections associated with mental health disorders, disordered eating behaviour and nutritional indicators? A multiple methods study among emerging adults in a tertiary education institution in Coastal Kenya

Summary Globally, absolute incidence cases of sexually transmitted infections (STI) are increasing and emerging adults in Sub-Saharan Africa remain disproportionately affected. To develop targeted interventions on STI/HIV among emerging adults, it is important to understand the drivers of infection. Previous studies in Sub-Saharan Africa have mainly focused on the role of sociodemographic, relationship, family/community factors and sexual behavior on the spread of STI. This thesis explores associations between three potentially relevant, but neglected indicators: mental health, eating behavior and nutritional indicators, with self-reported symptoms of STI in Sub-Saharan Africa. The overall aim was to understand the relationship between Mental health disorders, disordered eating behaviour (DEB) and nutritional indicators on the one hand and self-reported symptoms of STI on the other amongst emerging adults attending a tertiary institution of learning in Coastal Kenya. Specific objectives were: i) To review and summarize literature on prevalence of different sexual behaviours (SB) and associated risk factors among emerging adults in Africa. ii) To provide an in-depth understanding of the factors contributing to high risk sexual behaviour and their interconnectedness among emerging adults attending a tertiary educational institution at the Kenyan Coast, combining qualitative research with a systems thinking approach. iii) To describe the relationship between disordered eating behavior and sexual behaviour amongst emerging adults attending a tertiary educational institution at the Kenyan Coast. iv) To describe the association between mental health disorders and disordered eating behaviour and nutritional indicators with self-reported symptoms of STI amongst emerging adults attending a tertiary educational institution at the Kenyan Coast. To explore the first objective, a systematic review and meta-analysis of literature on sexual behaviour among emerging adults in Africa was conducted. To explore the second, third and fourth objectives, a longitudinal study design that included mixed (quantitative and qualitative) methods was applied. The study targeted to recruit and follow up 600 emerging adults (18-24 years) attending Pwani University, a public institution of tertiary education located in Kilifi County, along the Coastal region of Kenya. Assessment for sociodemographic characteristics, sexual behaviour, mental health disorders, disordered eating behavior, nutritional indicators, clinical indicators including self-reported STI symptoms and HIV oral self-testing were done at enrollment and repeated three-monthly for a planned one-year period. For the first objective, the systematic review and meta-analysis observed that non-condom use had the highest pooled prevalence (47% [95% CI: 42-51]), followed by study-defined SB (37% [95% CI: 25-50]), concurrency (37% [95% CI: 21-54]), multiple sex partnerships (31% [95% CI: 25-37]), younger age at sexual debut (26% [95% CI: 20-32]), age disparate relationships (24% [95% CI: 17-32]), and transactional sex (19% [95% CI: 13-26]). Heterogeneity was partially explained by sex, with female participants having higher pooled prevalence estimates compared to their male counterparts. Alcohol/substance use was the most reported risk factor for sexual behaviour. For the second objective, in-depth interviews with 21 students and 5 staff of Pwani university were conducted to explore sexual behaviour among the students. The findings showed that emerging adults are frequently engaging in unprotected sex, transactional sex, cross-generational sex, multiple sex partnerships, gender-based violence, sex under influence of alcohol/drugs, younger age at sexual debut, and sharing sex toys. Based on the ecological model and Causal Loop Diagram, most of the reported risk factors were interconnected and operated at the individual level followed by those that operate at social level. For the third objective, a cross sectional design (n=273) nested within the cohort study was applied to describe associations between disordered eating behaviour and sexual behaviour. Three disordered eating behaviour constructs (emotional, restrained and external eating) were explored. Overall, about a fifth (20.9%) of eligible participants were grouped into the latent high sexual behaviour class. There were no significant associations between Emotional (adjusted odds ratio, AOR [95% confidence interval, CI]: 1.0 [0.9 – 1.0], p = 0.398), restrained (AOR, 1.0 [CI: 0.9 – 1.1], p = 0.301) and External (AOR, 1.0 [CI: 0.8 – 1.2], p = 0.523) eating with latent high sexual behaviour. For the fourth objective, the longitudinal study design was used to determine associations between mental health disorders, disordered eating behaviour and nutritional indicators with self-reported STI symptoms at enrolment and during follow up. Of 572 volunteers recruited, 97 (16.9%) reported STI symptoms at enrolment. Generalized anxiety disorder (AOR 2.7 [CI: 1.4–5.2], p = 0.002]) and alcohol binge drinking (AOR, 2.6 [CI: 1.4–4.7], p = 0.001) were independently associated with self-reported symptoms of STI at enrolment. Only one volunteer tested positive for HIV at enrolment. Of 475 volunteers without self-reported symptoms of STI at enrolment, 60 reported STI symptoms during follow up (incidence rate, 3.2/100 [95% CI: 2.4–4.1] person months of follow up). Baseline mental health, eating behaviour and nutritional indicators did not predict incidence of self-reported symptoms of STI. No volunteers tested positive for HIV during follow up. Our findings are relevant for HIV/ STI control among emerging adults in Kenya. Specifically, the findings may imply that interventions on sexual behaviour among emerging adults may to focus on those taking alcohol. This may include enhancing sexuality education programs for emerging adults in Kenyan universities and strengthening support systems including counselling for those using alcohol/drugs which may help mitigate high risk sexual behaviours among emerging adults in Kenyan universities. Our finding that emerging adults with generalised anxiety disorders and binge drinkers had increased odds of reporting STI symptoms may imply that support for emerging adults with generalized anxiety disorder or those who are binge drinkers need to be considered in STI clinics in Kenya

Sexual behavior among emerging adults in Africa : a systematic review and meta-analysis

Background Estimates on sexual behavior (SB) among emerging adults (EmA) is varied in literature, which presents a challenge when designing targeted interventions. We aimed to summarize literature on prevalence and risk factors of SB among EmA in Africa. Methods A search for studies published in PubMed, Embase and Psych Info by March 2023 was done. Studies involving EmA (18–25 years), conducted in Africa and reporting one or more of seven SB were reviewed. Pooled prevalence estimates were summarized using forest plots. Heterogeneity in SB was explored. Risk factors were synthesized using a modified socio-ecological model. Results Overall, 143 studies were analyzed. Non-condom use had the highest pooled prevalence (47% [95% CI: 42-51]), followed by study-defined SB (37% [95% CI: 25-50]) and concurrency (37% [95% CI: 21-54]), multiple sex partners (31% [95% CI: 25-37]), younger age at sexual debut (26% [95% CI: 20-32]), age disparate relationships (24% [95% CI: 17-32]) and transactional sex (19% [95% CI: 13-26]). Heterogeneity was partially explained by sex, with female participants having higher pooled prevalence estimates compared to their male counterparts. In four of the seven outcomes, alcohol/drug use was the most common risk factor. Conclusions SB was common among EmA and differentially higher in emerging female adults. Non-condom use had the highest pooled prevalence, which may contribute to the transmission of HIV and other sexually transmitted infections (STIs). Interventions targeting emerging female adults and alcohol/drug use may reduce SB, which may in-turn mitigate transmission of HIV and other STIs among EmA in Africa

Associations between disordered eating behaviour and sexual behaviour amongst emerging adults attending a tertiary education institution in Coastal Kenya

Background Sexual behavior (SB) is a well-documented pathway to HIV acquisition in emerging adults and remains common amongst African emerging adults. Previous research in high-income countries indicates a correlation between disordered eating behavior (DEB) and engaging in sexual behaviors. We aimed to describe the relationship between DEB and SB amongst emerging adults attending a tertiary educational institution at the Kenyan Coast. Methods We applied a cross-sectional design nested in a young adults’ cohort study. Eligibility included sexually active emerging adults aged 18–24 years. Three DEBs (emotional, restrained and external eating) were assessed using the Dutch Eating Behavior Questionnaire and analysed using exploratory factor analysis. Seven SB indicators were assessed: non-condom use, casual sex, multiple sex partners, transactional sex, group sex, age-disparate relationship and anal sex, and grouped into low vs. high SB using latent class analysis. Logistic regression was used to assess the association between DEB and SB. Results Of 273 eligible participants (female, n = 110 [40.3%]), the mean of emotional, restrained and external eating was 1.9 [0.6], 2.0 [0.6] and 3.0 [0.5] respectively. Overall, 57 (20.9%) were grouped into the latent high SB class. Emotional (Adjusted odds ratio, AOR [95% confidence interval, CI]: 1.0 [0.9–1.0], p = 0.398), restrained (AOR, 1.0 [CI: 0.9–1.1], p = 0.301) and External (AOR, 1.0 [CI: 0.8–1.2], p = 0.523) eating were not independently associated with latent high SB. Conclusion There was no significant association between DEB and SB in this study sample. In low- and middle-income countries like Kenya, interventions targeted at DEB among emerging adults towards controlling SB are unnecessary

Reasons for home delivery among HIV infected women who delivered their reference child at home (n = 108).

<p>Reasons for home delivery among HIV infected women who delivered their reference child at home (n = 108).</p