Exploring the determinants of sexual and reproductive health knowledge and intentions for safer sexual practice among out-of-school adolescents in northern rural settings in Burundi: a cross-sectional population-based study.

Introduction: Comprehensive Sexual and Reproductive Health and Rights (SRHR) knowledge is critical for reducing unintended pregnancies and sexually transmitted infections (STIs) among adolescents in low-resource settings. We assessed SRHR knowledge gaps among rural, out-of-school adolescents in Burundi and examined associations with intentions for safer practices (eg, condom use). Methods: We purposively sampled and surveyed 767 out-of-school adolescents aged between 10 and 19 years from the rural settings of Ngozi health district in northern Burundi examining their SRHR knowledge and practice. We employed the Rasch model of the Item Response Theory (IRT) to examine overall SRHR knowledge and by gender, assuming that the test was administered an infinite number of times and supplemented this model with a multiple linear regression to detect factors affecting knowledge. Determinants of intentions for safer sexual practice were investigated using logistic regression. Results: First, although the test drew on basic SRHR skills, it appeared to be difficult for the study population. Indeed, participants needed a minimum underlying competence Conclusion: Rural and out-of-school adolescents have lower than expected SRHR knowledge. Those who have never heard about SRHR and those whose parents and/or siblings have lower or no education are worse off. SRHR knowledge determines intentions for sexual health behaviours (eg, condom use, seeking HIV testing). Tailored SRHR programmes for rural adolescents should address misconceptions on condoms/contraception.