Modeling timing of sexual debut among women in Zimbabwe using a Geoadditive Discrete-Time survival approach

Abstract Background Early sexual debut has undesirable health consequences such as an increased risk of contracting sexually transmitted infections (STIs) including HIV, mental health problems, pregnancy-related complications and death including abortion-related deaths. Despite a global decline in a...

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Main Authors: Alphonce Bere, Innocent Maposa, Zvifadzo Matsena-Zingoni, Halima S. Twabi, Jesca M. Batidzirai, Geoffrey C. Singini, Nobuhle Mchunu, Justine B. Nasejje, Maureen Moyo-Chilufya, Oludoyinmola Ojifinni, Portia Nevhungoni, Alfred Musekiwa
Format: Article
Language:English
Published: BMC 2025-03-01
Series:BMC Women's Health
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Online Access:https://doi.org/10.1186/s12905-025-03590-w
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author Alphonce Bere
Innocent Maposa
Zvifadzo Matsena-Zingoni
Halima S. Twabi
Jesca M. Batidzirai
Geoffrey C. Singini
Nobuhle Mchunu
Justine B. Nasejje
Maureen Moyo-Chilufya
Oludoyinmola Ojifinni
Portia Nevhungoni
Alfred Musekiwa
author_facet Alphonce Bere
Innocent Maposa
Zvifadzo Matsena-Zingoni
Halima S. Twabi
Jesca M. Batidzirai
Geoffrey C. Singini
Nobuhle Mchunu
Justine B. Nasejje
Maureen Moyo-Chilufya
Oludoyinmola Ojifinni
Portia Nevhungoni
Alfred Musekiwa
author_sort Alphonce Bere
collection DOAJ
description Abstract Background Early sexual debut has undesirable health consequences such as an increased risk of contracting sexually transmitted infections (STIs) including HIV, mental health problems, pregnancy-related complications and death including abortion-related deaths. Despite a global decline in adolescent birth rates, Zimbabwe continues to face a high prevalence of underage pregnancies, highlighting significant early sexual debut among Zimbabwean adolescents. This study examined the spatial variation and the demographic and socio-economic determinants of the timing of early sexual debut among Zimbabwean women. Methods Data for 9,882 Zimbabwean women of reproductive age were drawn from the 2015 Zimbabwe Demographic and Health Survey (ZDHS). We defined early sexual debut as having first sexual intercourse before the 18 years of age. A fully Bayesian geoadditive discrete-time survival model was used. Adjustments for unequal sampling probabilities were done using the provided survey weights. Results Our findings show that women with primary education (aOR = 0.62,95% Crl:0.47–0.81), secondary education (aOR = 0.25,95% Crl:0.19–0.33) and higher education (aOR = 0.06,95% Crl:0.04–0.09) had lower odds of early sexual debut than those with no education. In comparison to those with middle household wealth index, women with higher household wealth index (aOR = 0.83, 95% CrI: 0.71–0.98) had lower odds of early sexual initiation. On the other hand, women with lower household wealth index had higher likelihood of early sexual debut (aOR = 1.13, 95% CrI: 1.03–1.26) than those with middle household wealth index. The type of place of residence and birth year cohort did not have a significant association with the odds of early sexual debut. The hotspots of early sexual debut were in Matabeleland North and Matabeleland South provinces. Conclusion To mitigate early sexual debut in Zimbabwe, targeted interventions are essential in Matabeleland North and Matabeleland South provinces as well as in the identified high-risk groups.
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spelling doaj-art-2421f1716c4e4b31a77146830c8ee3062025-08-20T02:10:21ZengBMCBMC Women's Health1472-68742025-03-0125111110.1186/s12905-025-03590-wModeling timing of sexual debut among women in Zimbabwe using a Geoadditive Discrete-Time survival approachAlphonce Bere0Innocent Maposa1Zvifadzo Matsena-Zingoni2Halima S. Twabi3Jesca M. Batidzirai4Geoffrey C. Singini5Nobuhle Mchunu6Justine B. Nasejje7Maureen Moyo-Chilufya8Oludoyinmola Ojifinni9Portia Nevhungoni10Alfred Musekiwa11Department of Mathematical and Computational Sciences, University of VendaDivision of Epidemiology & Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityCenter for Biomedical Modeling, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of CaliforniaDepartment of Mathematical Sciences, School of Natural and Applied Sciences, University of MalawiSchool of Mathematics, Statistics, and Computer Science, University of KwaZulu-NatalDepartment of Mathematical Sciences, School of Natural and Applied Sciences, University of MalawiBiostatistics Research Unit, South African Medical Research CouncilSchool of Statistics and Actuarial Science, University of the WitwatersrandSchool of Health Systems and Public Health, Faculty of Health Sciences, University of PretoriaSchool of Clinical Medicine, Faculty of Health Sciences, University of the WitwatersrandBiostatistics Research Unit, South African Medical Research CouncilSchool of Health Systems and Public Health, Faculty of Health Sciences, University of PretoriaAbstract Background Early sexual debut has undesirable health consequences such as an increased risk of contracting sexually transmitted infections (STIs) including HIV, mental health problems, pregnancy-related complications and death including abortion-related deaths. Despite a global decline in adolescent birth rates, Zimbabwe continues to face a high prevalence of underage pregnancies, highlighting significant early sexual debut among Zimbabwean adolescents. This study examined the spatial variation and the demographic and socio-economic determinants of the timing of early sexual debut among Zimbabwean women. Methods Data for 9,882 Zimbabwean women of reproductive age were drawn from the 2015 Zimbabwe Demographic and Health Survey (ZDHS). We defined early sexual debut as having first sexual intercourse before the 18 years of age. A fully Bayesian geoadditive discrete-time survival model was used. Adjustments for unequal sampling probabilities were done using the provided survey weights. Results Our findings show that women with primary education (aOR = 0.62,95% Crl:0.47–0.81), secondary education (aOR = 0.25,95% Crl:0.19–0.33) and higher education (aOR = 0.06,95% Crl:0.04–0.09) had lower odds of early sexual debut than those with no education. In comparison to those with middle household wealth index, women with higher household wealth index (aOR = 0.83, 95% CrI: 0.71–0.98) had lower odds of early sexual initiation. On the other hand, women with lower household wealth index had higher likelihood of early sexual debut (aOR = 1.13, 95% CrI: 1.03–1.26) than those with middle household wealth index. The type of place of residence and birth year cohort did not have a significant association with the odds of early sexual debut. The hotspots of early sexual debut were in Matabeleland North and Matabeleland South provinces. Conclusion To mitigate early sexual debut in Zimbabwe, targeted interventions are essential in Matabeleland North and Matabeleland South provinces as well as in the identified high-risk groups.https://doi.org/10.1186/s12905-025-03590-wEarly sexual debutGeoadditive modelSpatial analysisDiscrete-time survival; bayesian estimationZimbabwe
spellingShingle Alphonce Bere
Innocent Maposa
Zvifadzo Matsena-Zingoni
Halima S. Twabi
Jesca M. Batidzirai
Geoffrey C. Singini
Nobuhle Mchunu
Justine B. Nasejje
Maureen Moyo-Chilufya
Oludoyinmola Ojifinni
Portia Nevhungoni
Alfred Musekiwa
Modeling timing of sexual debut among women in Zimbabwe using a Geoadditive Discrete-Time survival approach
BMC Women's Health
Early sexual debut
Geoadditive model
Spatial analysis
Discrete-time survival; bayesian estimation
Zimbabwe
title Modeling timing of sexual debut among women in Zimbabwe using a Geoadditive Discrete-Time survival approach
title_full Modeling timing of sexual debut among women in Zimbabwe using a Geoadditive Discrete-Time survival approach
title_fullStr Modeling timing of sexual debut among women in Zimbabwe using a Geoadditive Discrete-Time survival approach
title_full_unstemmed Modeling timing of sexual debut among women in Zimbabwe using a Geoadditive Discrete-Time survival approach
title_short Modeling timing of sexual debut among women in Zimbabwe using a Geoadditive Discrete-Time survival approach
title_sort modeling timing of sexual debut among women in zimbabwe using a geoadditive discrete time survival approach
topic Early sexual debut
Geoadditive model
Spatial analysis
Discrete-time survival; bayesian estimation
Zimbabwe
url https://doi.org/10.1186/s12905-025-03590-w
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