Risk factors for pregnancy among rural and urban-dwelling adolescents in a high adolescent-pregnancy setting; a case control study.

Background: In Uganda, 1 in 4 girls has been pregnant by 18 years. This was worse during the COVID 19 pandemic. We determined risk factors for pregnancy among rural and urban dwelling adolescents in Uganda. Methods: We conducted a mixed-methods study among girls aged 13 to 19 years in a rural and urban district in Uganda. Quantitatively, we used an unmatched case control design involving 200 adolescents with pregnancy experience and 400 controls with no pregnancy experience. Quantitative data was analyzed using STATA version 14. Qualitative methods included 17 focus group discussions, 10 in-depth interviews and 20 key informant interviews with key stakeholders. Transcribed audio recordings were analyzed using a content thematic approach using Nvivo. Results: Of the 600 girls, mean age was 16.9 years (SD 3.84). Independent risk factors for pregnancy were age, out-of-school, a friend with teenage pregnancy, cigarette smoking, working for money and correct contraceptive knowledge. Protective factors included positive personal attitudes, father's education and larger household size. Qualitatively, inadequate information on sexual and reproductive health, early sexual debut, alcohol and drug abuse, absence of parental supervision, negative peer influence and poverty were reported. Conclusion: Overall, individual characteristics, behaviors and inadequate information increased the risk of pregnancy.