Materials 9,896 in private schools. When we see

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Last updated: December 24, 2019

Materialsand Methods Study design Aschool-based cross-sectional study was conducted among high school students inmekelle city from March one up to thirty, 2017.Study area and periodThe study was conducted in Mekelle cityGovernmental and privet high schools.

Mekelle is located in the northern partof the country at about 783 Kilometers from Addis Ababa. Educational coverageof Mekelle city was 74%. In 2016 there were eleven governmental and fourteenprivet totals of twenty-five High schools.

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In the academic year 2016/17, atotal of 26,762 students were enrolled. Of those, about 16,866 were ingovernmental and 9,896 in private schools. When we see sex composition ofstudents, about 40.5% (10,825) were females and 59.5% (15,937) was malesstudents(19)Study populationQuantitativephase: All adolescents from randomly selected high school in Mekelle cityenrolled for 2016/2017 academic year and who fulfilled the inclusion criteria.Qualitativephase:  Purposely selected high schooladolescents among those who did not participate in the quantitative phase andwho were expected to be informative.Inclusioncriteria:All regular high school adolescents within agecategory between 14 and 19 were included.

Exclusion criteria:Students who were visually impaired and those who were absent during the datacollection time were excluded. Sample size and sampling procedureSampleSize DeterminationThesample size was calculated using a single population proportion formula by consideringthe proportion older siblings influence on the sexual behavior of schooladolescents as 50% and 5% margin of error and 95% confidence level.n= (Z?/2)2P (1 ? P)   d2n= (1.96)2*0.5*(1-0.

5) = 384            (0.05)2Assuming 10% non-response rate and designeffect 2, the sample size was:-n=2*384+ 10% =768+77= 845 Indepth interview 12 (IDI) was conducted for collecting qualitative data and thenumber of interviewees were determined by information saturation.  Samplingtechnique and procedureMultistagesampling procedure was employed to select representative sample students forquantitative data.

First, from 21 schools high schools (Four from governmentaland four from private) were selected randomly through lottery method.  The sample size was proportionally allocatedto each selected school and to grade base on their population size.  Students were selected through simple randomsampling (computer generated number) using the roster of students as a samplingframe.

For qualitative data, students were selected purposively for IDI. Havingolder or younger sibling, Participation in clubs, sex and school grade wereconsidered for segmenting students for the IDIs.Dependent VariablesSexualbehavior of school adolescentsIndependent Variables                                               ·        Sibling’s characteristics: Have oldersibling, elders gender, age difference, dyad type·        Perceived older Siblings Sexualactivity:o  Elder’s abstinenceo  Age at first sex, o  Consistent condom useo  Numbers of sexual partnero  Drug or substance use before sex andpregnancy prevention method.

·        Sibling’s relationship quality:sibling’s, intimacy, modeling, and communication.Operational DefinitionsAdolescents: studentsbetween the age category of 14 and 19. Older Sibling: olderbrother, sister or relatives that grow together with adolescents as a family. Older sibling’s perceivedsexualactivities:Youngeradolescent’s perception on older sibling’s sexual engagement, age at first sex,condom use, Numbers of partner, drug or substance use before sex and pregnancyprevention method.Intimate Sibling: Thoseadolescent scores greater than the total mean score for 6 Likert scale itemswith scale range from 1= (never) to 5= (very often)  on relationalintimacy scale(20).Sibling modeling: Theextent to which they tried to be like their sibling and their siblingencouraged them to participate in particular activities as well as the degreeto which their sibling set a positive example.

For those with percent score> 75% of five items was considered as High older Sibling modeling(21).Risky sexual behavior:If Adolescents any of the following was commuted; early sexual engagement,inconsistent condom use, multiple sexual partners, drug or substance use beforesex and poor unintended pregnancy prevention (22).High school adolescents:Age 14- 19 years Students who enrolled in the academic year to grade 9thup to12th.Data collection processData collection tools Toassess the quantitative data first structured self-administered questionnairewas adapted from YSBS (youths sexual behavior surveillance) (22) for adolescentsin high school, a powerful questionnaire tool to assess the direct markers ofsexual behavior developed in English. Also tool to assess siblings relationshipquality, communication, and intimacy developed by white mane and Blyth (20, 21). Some questionswere added by reviewing relevant literature and considering the localsituation. The content validity of the questionnaire was assured by experts andthe internal consistency of the items with Likert scales was checked throughCronbach alpha (> 0.

7).Inthe quantitative phase, nature of and the extent to which high schooladolescents engage in both observational and verbal exchanges was assessedthrough four domains(1) Observational learning (2) Environmental influence (3)Older sibling’s role (4) Sibling relationships effect.Data collectors Eightprofessional Nurse and midwives data collector and one MSC in nursingsupervisor were recruited. The responsibility of  the data collectors was to distribute the questionnaire,  collect, checkfor  missing data while in the study  site. The supervisors  provide all items necessary  for data  collection, check filled questionnaire forcompleteness,  and solving    raised problems.Data quality control issuesThequestionnaire was translated to  Tigrignaand   then back – translatedindependently  into  English to check for consistency. Data collectors were trained for one day aboutadministering the instruments and IDI.

Follows up of activities by thesupervisors on data collection days was strengthened. The questionnaire andin-depth interview guide were pre-tested on 10%  of study  and modifications were incorporated to thequestionnaire. During the data collection day, due to the sensitive nature ofthe study, briefs explanation was given on the aim of the study to minimizemiss understanding of the study purpose. To do this separate envelope for maleand female for collecting the questioner were prepared to enhance privacy andto minimize over reporting good behavior and to improve data quality. For thequalitative study, the in-depth interview was conducted by an expert and a Taperecorder was used to catch every-interviewed information.Data processing, Analyses & interpretationDatawere checked for its completeness every day.

For edition and  cleaning, the collected data were double entered into Epi-info version 7  and exported into  SPSS version-22  for analysis. Bivariate logistic regressionwas done to determine the association between independent and dependentvariables and those variables with a p-value < 0.3 were introduced tomultivariate logistic regression in order to control confounders. Beforeinclusion of predictors to the final logistic regression model, themulticollinearity effect was checked using VIF/Tolerance test and the valueswere <10and > 0.1 respectively. The Hosmer-Lemeshow goodness-of-fitstatistic was used to check if the data were fit to the logistic model and thep-value was (0.599).

Adjusted Odds ratio with 95% confidence interval for thosevariables with a p-value < 0.05 was declared to show the level ofassociation and statistical significance. The qualitative information wasanalyzed (quoted, coded and exported)  byATLAS.7 then major findings were summarized based on thematic areas andtriangulated with the quantitative finding in order to better understand thephenomenon.

Ethical ConsiderationEthical clearance was obtained fromInstitutional   Review Board of MekelleUniversity College of health sciences and an official letter of cooperation waswritten to regional education bureau to get permission to conduct the study inthe selected schools. Full written informed consent was obtained fromparticipants greater than 18 ages and for student’s age less than 18, writtenconsent was obtained from their parent and assent were obtained from thestudents as well. Privacy and strict confidentiality were maintained  during the data collection process nopersonal  details were recorded orproduced on  any documentation  related to the study and collectedinformation was anonymous and confidential. Issues like the absence of anydirect benefit from participating in the study and risks following notparticipating in this study were included in the information sheet and declaredduring data collection..