Factors Associated with Sexual and Reproductive Health Knowledge, Behaviours and Access to Services among Adolescents in Four Secondary Schools in Mbouda, Cameroon

Abstract

Background: Adolescence is a critical developmental period marked by increased vulnerability to sexual and reproductive health (SRH) risks, particularly in low- and middle-income countries. In Cameroon, adolescents continue to face significant challenges related to early sexual initiation, unintended pregnancies, sexually transmitted infections, and limited access to youth-friendly SRH services. Objective: To assess the level of sexual and reproductive health knowledge, practices, access to services, and associated factors among secondary school adolescents in Mbouda, Cameroon. Methodology: A cross-sectional study with an analytical component was conducted among 1,087 adolescents from four secondary schools in the city of Mbouda using a structured questionnaire. Bivariate analyses were performed using the chi-square test, and multivariate analyses were conducted using logistic regression models. Data were analysed using R software, with statistical significance set at p < 0.05. Results: Overall, 74.0% of adolescents demonstrated good knowledge of SRH, while only 25.9% had ever accessed SRH services at a health facility. The primary barrier to accessing SRH services was financial constraints (26.2%). Only 20.9% used a contraceptive method. Sexual activity was significantly associated with male sex (aOR = 3.72; p < 0.001), living with extended family members (aOR = 1.99; p < 0.001) or alone (aOR = 4.09; p = 0.006), and parent–adolescent discussions on sexuality (aOR = 1.62; p = 0.003). Contraceptive use was independently associated with male sex (aOR = 2.04; p = 0.015) and a history of abortion (aOR = 4.79; p = 0.040). Conclusion: Despite relatively good knowledge of SRH, important gaps persist in service utilisation among adolescents in Mbouda. Interventions should prioritise youth-friendly, affordable, and accessible SRH services, alongside strengthened family and school-based education, to reduce risky sexual behaviours and improve adolescent health outcomes.