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Young internally displaced persons (YIDPs) face heightened vulnerability to risky sexual behaviours (RSB) due to displacement-related socioeconomic instability, disrupted education, limited access to sexual and reproductive health (SRH) services, and exposure to gender-based violence. Evidence on RSB among YIDPs in Cameroon remains scarce, particularly in humanitarian host communities. This study assessed the prevalence of risky sexual behaviours and identified associated factors among YIDPs aged 10–24 years in the Dschang Health District (DHD) in Cameroon. Methods: A community-based cross-sectional mixed-methods study was conducted between January and July 2025. Quantitative data were collected from 276 YIDPs selected using stratified systematic sampling across seven health areas. Data were analysed using SPSS version 27, with bivariate and multivariate logistic regression to identify predictors of RSB. Qualitative data were collected through four focus group discussions and four key informant interviews involving YIDPs, parents/guardians, teachers, community health workers, and SRH service providers. Thematic content analysis was performed to present quantitative findings. Results: The overall prevalence of RSB was 44.7% among all respondents and 90.4% among sexually active YIDPs. The most common RSBs were inconsistent or non-use of condoms (90.4%), unwanted pregnancy (47.3%), multiple sexual partnerships (35.6%), spontaneous sexual activity (33.3%), transactional sex, and substance use before sexual intercourse (26.7%). Multivariate analysis identified nightclub attendance more than once per month (aOR=5.01, p=0.001), psychoactive substance use (aOR=2.8, p=0.02), non-utlisation of SRH services (aOR=2.9, p=0.002), informal employment (aOR=2.2, p=0.03), and low economic status (aOR=2.5, p=0.038) as independent variables increasing the likelihood of RSB among YIPDs. Living with both parents reduced the likelihood of RSB (aOR=0.58, p=0.025). Qualitative findings highlighted peer pressure, economic difficulties, housing insecurity, misinformation about contraception, and coercion as key drivers of RSB. Conclusion: Risky sexual behaviours are highly prevalent among YIDPs in Dschang, driven by structural, social, and behavioural factors. Integrated, youth-friendly SRH interventions addressing economic vulnerability, substance use, and access to services are urgently needed in displaced populations.
Keywords: Risky Sexual Behaviour; Young internally displaced persons; Sexual and Reproductive Health; Dschang health district; Cameroon; RiskySexualBehaviour; Younginternallydisplacedpersons; SexualandReproductiveHealth; Dschang healthdistrict
InternallyDisplacedPersons(IDPs)areindividualsor groupscompelledtoleavetheirusualhabitationsdue toarmedconflict, humanrightsviolations, ordisasters,butwhoremainwithinthebordersoftheircountryoforigin[1]. AccordingtoInternalDisplacement MonitoringCentre(IDMC)[2],therewasatotalof83.4 millionIDPsrecordedbytheendof2024,representingasubstantialincreasecomparedtopreviousyears. In Cameroon, more than 2.1 million people are displaced, with nearly 646,000 returnees [3]. IDPs encounterdistinctandpressingpublichealthchallenges, notablyaheightenedsusceptibilitytohighriskysexualbehaviours(RSB)[4].HighRSBencompassesany sexualactivitythatelevatesanindividual’sriskofacquiringsexuallytransmittedinfections(STIs),including HIV/AIDS, experiencing unplanned pregnancies, undergoingunsafeabortions,orsufferingpsychosocial consequences [5,6]. Evidence from African settingsindicateshighandheterogeneousprevalenceof RSBamongyoungpeople,withratesexceeding50% amongout-of-schoolyouthsinAddisAbaba[7],and upto78%amongyoungfemaleinternalmigrantsin South Ethiopia [8]. The United Nations Population Fund(UNFPA)CameroonSituationReports(February andMarch2025)[9]detailedthecriticalsexualandreproductivehealth(SRH)needsandchallengesfaced byyoungIDPs.Studiesconductedamongyoungpeople in non-humanitarian settings have documented widevariationsinSRB,withreportedprevalencerangingfrom13.1%to80.4%[10-12].Inconsistentornonuseofcondomsamongunmarriedyouthsrangesbetween32.3%and82%,earlysexualdebutbeforethe ageof16yearsbetween32.6%and80.4%,andmultiplesexualpartnershipsaffectingmorethanhalfofrespondentsinsomestudies[13].Theratesofunwanted pregnancies are between 20.7% and 30%, and STIs among youths have been reported at 5.8% to 8.3% [14]. A bulletin by the Cameroon Ministry of Public Health[15]reportedthatadolescentpregnancyrates inCameroonfluctuatebetween14%and34%, with ahighfertilityrate,averaging4.4birthsperwoman, andanannualpopulationgrowthrateof2.59%[15]. Youngpeopleinhumanitariananddisplacementsettings face additional layers of risk that further exacerbateSRHvulnerabilities. Theseincludedisrupted accesstoeducationandhealthservices,limitedavailabilityofcontraception,entrenchedgenderinequalities,exposuretosexualcoercionandgender-basedviolence,andharmfultraditionalpracticessuchasearly orforcedmarriage[16-18].InCameroon,particularly intheWestandLittoralregionshostingdisplacedpopulationsfromtheNorth-WestandSouth-Westcrisis, inginsecurity,overcrowding,andlackoflivelihoods amongIDPs[19,20].Increasedrentalcostshaveforced manydisplacedhouseholdsintoovercrowdedlivingarrangementsorexploitativehostingsituations,heighteningexposuretosexualviolenceandsurvivalsex,especiallyamongwomenandgirls[20].Despitegrowing recognitionoftheserisks,researchontheSRHofYIDPs inCameroonremainslimited. Existingstudieshave primarilyfocusedonfoodsecurityandnutrition[21], socialintegrationandcommunitysolidarity[22],and mentalhealthoutcomes[23],withlittleattentiongiven totheprevalenceanddeterminantsofRSBamongdisplacedyouth. Therefore,thisstudyaimedtoassess theprevalenceofRSBandidentifyassociatedfactors amongYIDPsresidingintheDschangHealthDistrict, WestCameroon..
Acommunity-basedcross-sectionalmixed-methods studywasconductedfromJanuarytoJuly2025inthe DschangHealthDistrict(DHD),locatedintheWestRegionofCameroon.Thedistricthasanestimatedpopulation of 246,000 inhabitants and hosts more than 3,800IDPsoriginatingprimarilyfromtheNorth-West andSouth-Westregions[24].
Thestudypopulationconsistedofyounginternallydisplacedpersons(YIDPs)aged10–24yearsresidingin theDHDforatleastsixmonthsbeforedatacollection. Eligible participants included unmarried YIDPs who providedinformedconsent(≥21years)orassentwith parental/guardian consent (<21 years). Individuals withseverecognitiveimpairments,minorswhoseparentswithdrewtheirconsentortheythemselveswithdrewtheirassentandmarriedYIDPswereexcluded.
SamplesizewasdeterminedusingtheLorenzformula [25]
Withprepresentingtheexpectedprevalenceexpressed asaproportion,anddastheabsoluteprecision.The resultofapreviousstudyconductedinBanjouninthe WestregionofCameroonamongyoungpeople[26]indicatedanoverallprevalenceofRSBtobe13.1%.This prevalencewasusedasaproxytodeterminetheprevalenceofRSBamongYIDPSintheDHD.Thecalculation employedanabsoluteprecisionof5%(0.05)andaZvalueof1.96,correspondingtoa95%confidencelevel whichgave174.9.However,cconsideringthathouseholdsurveycoverageinCameroonisapproximately 80%[27,28],thusananticipatednon-responserateof 20%,theminimumsamplesizeforthestudywasadjustedaccordinglyto219participants.
Astratifiedsystematicsamplingtechniquewasusedto selectrespondentsage10-24yearsfromthe7health areaswithintheDHD.Thiswasimplementedasfollows:Stage1:Stratificationandselectionofprimary sampling units. A comprehensive list of IDP householdheads,familysizes,andneighbourhoodsofresidence classified in this study as Health Areas (HAs) wasobtainedfromtheDivisionofSocialAffairsatthe OfficeoftheSeniorDivisionalOfficer. Intotal,3,800 IDPswereregisteredwithinMenouaDivision,residing across 672 households. The identified Health areas included Fiala-Foreke, Fometa, Siteu, Fongo-Tongo, Mbeng, Fokoue, andNdoh-Njutitsa. Thislistserved asthesamplingframefromwhichhouseholdswere systematicallyselectedforinclusioninthestudy.The totalsamplesizeof219wasthenproportionallyallocatedacrosseachHealthareabasedontheirrespective householdcounts.Stage2:Determinationofthetotal numberofhouseholdstobeincludedinthestudyin eachhealthareaandproportionalallocationwasdone usingtheformula: TotalnumberofhouseholdsincludedperHA= TotalnumberofreportedIDPhouseholdsinHA TotalnumberofIDPhouseholdsinHD (672)
×samplesize (219)
Thesamplinginterval,denotedas ,wascalculated usingtheformula:
N k = n where: • =totalnumberofhouseholdsintheHA N • n =desiredsamplesize Forthisstudy,thecalculatedvalueofkwas3.13which wasroundedupto4. Selectionofarandomstarting point:Weusedasimplelotterymethodtoselectarandomintegerbetween1andk(inclusive).Subsequent householdswereselectedbyaddingthesamplinginterval(4)tothechosennumber,thenweselectedevery 4thhouseholdthereafterfromthesamplingframeuntil thedesiredsamplesizeforeachHAwasreached.
Quantitative data were collected using a selfadministered questionnaire adapted from the WHO/UNFPA Illustrative Questionnaire for Surveys with Young People [29]. The tool was pretested prior to use and administered in English or Pidgin English.Qualitativedatawerecollectedthroughfour focusgroupdiscussionsandfourkeyinformantinterviews involving YIDPs, parents/guardians, teachers, communityhealthworkers,andSRHserviceproviders.
ThepovertylineinCameroonisofficiallydefinedand regularlyupdatedbytheWorldBank[30]andNational InstituteofStatistics(INS)[31].AccordingtotheFifth CameroonHouseholdSurvey,ECAM5bytheINS[31], thenationalpovertylinein2022wassetat813CFA francsperpersonperday(IPPPD),whichisequivalent to24,724CFAfrancspermonthor296,691CFAfrancs peryear.Thisthresholdwasusedtoclassifyindividualsandhouseholdsaspooriftheirdailyconsumption fell below this amount. Income per person per day (IPPPD)wasdeterminedbydividingthetotalhouseholdincomebythenumberofhouseholdmembers.
Thisencompassedarangeofattributesrelatedtotheir sexualbehavioursuchas:
Ageofsexualdebut: Definedastheageatwhichadolescentsbeginengaginginsexualactivity.ItwasconsideredasearlywhentheYIDPstatedsexualactivityat anage ≤16[32,33] Typeofsexualactivitiesre-
spondent engaged in, including consensual or nonconsensualbehaviours,homosexualbehaviours,spontaneoussex(unplannedsexualintercourse),transactionalsexforaccommodationorfinancesetc.
k
whichwascalculatedusingtheformulabelow:
Numberofsexuallyactivegirls whobecamepregnantafterdisplacement × 100 Totalnumberofsexuallyactivegirls
Unwanted pregnancy Outcomes: Pregnancy outcomeswereself-reportedandincludedcurrentpregnancystatus,abortion,miscarriage,andlivebirth. wasestimatedbytheformulabelow:
TotalnumberofYIDPswhohavebeentestedforHIV × 100 Totalnumberofstudyparticipants(276)
Riskysexualbehaviour(RSB)wastheprimaryoutcome, definedusingindicatorssuchasinconsistentcondom use,multiplesexualpartners,transactionalsex,substance use before sex, and early sexual debut. The keyareasassessedweredevelopedbasedonguidance from systematic reviews [34,35]. Participants were asked:(1)iftheyeverhadsexualintercourse(yes/no), (2)ageoffirstsexualactivity,(3)thetypeofsexualrelationship within the last 12 months (monogamous /polygamous)(4)howfrequenttheyusedcondom(alwaysorirregularly/never),(5)iftheyengagedinsexual activitywithpartnersofthesamegender(6)iftheyengagedinsponctaneousorunplannedsexualactivity(7) iftheyusedalcoholorpsychoactivesubstancesprior tosexualactivityandiftheyhaveeverbeentestedfor HIV/AIDS.Thesequestionswerecategorizedinto1= yesand0=no,andregularityofcondomuseduring sexualintercoursewasdividedintofourcategories(1= always,2=mostofthetime,3=seldomand4=never).
QuantitativedatawereanalysedusingSPSSversion 27.Bivariateandmultivariatelogisticregressionanalyseswereperformedtoidentifyfactorsassociatedwith RSB.Regardingqualitativedata,interviewswereaudiorecordedandtranscribed.Ourteamreviewedalltranscripts,developedacodebook,andidentifiedthemes basedontheliterature,‘usinganartificialintelligenceassistedtranscriptionsoftwarecalledNoScribe.After thistranscription,thequalitativedatawereanalysed usingtheAtlassoftware. Thematiccontentanalysis wasemployedtopresentthedata.
EthicalapprovalwasobtainedfromtheWestRegional CommitteeofEthicsandResearchinHumanSciences (No.387/26/03/2025/CE/CRERSH-OU/VP)andfromadministrativeauthoritiesintheDschangHealthDistrict and Menoua Division (No. 000060/ACS/F.34/SAAJP). Writteninformedconsentwasobtainedfromparticipantsaged 21years,fromlegalrepresentativesfor ≥ thoseaged10–12years,andassentplusguardianconsentfor12-20-year-olds,inlinewithCameroon’sNationalEthicsCommittee(CNEC)guidelines.Allparticipantsandguardianswereinformedaboutthestudy objectives, assured of anonymity and data privacy, andwerefreetowithdrawatanytimewithoutconsequence.
A total of 276 young internally displaced persons (YIDPs)participatedinthestudy,yieldingaresponse rateof94.2%.Themeanageofrespondentswas18.7 ±4.1years.Participantsaged19–24yearsconstituted thelargestagegroup(50.7%)meanwhilefemalesrepresented57.2%ofthestudypopulation.Mostparticipantshadbeendisplacedaftertheyear2000andwere predominantlychristians(65.2%).Themajoritylived belowthenationalpovertyline(62.3%),only27.1% had higher education and 64.1% were unemployed. Alcoholconsumptionwasreportedby38.4%ofrespondents,and13.0%reporteduseofotherpsychoactive substancesmixedinfoodordrinks.Morethanhalfof theparticipantslivedwithoneorbothparents(56.2%) (table1).
Table2presentsthesexualbehaviourpatternsofYIDPs intheDHD.Mostsexuallyactiverespondentswerein monogamous relationships 77 (57.0%). Unplanned sexual encounters were reported by 29 (21.5%) participants.Same-gendersexualrelationshipswerereported by a few participants: 2 females (1.5%) and 3 males (2.2%). Among sexually active females, 52 (47.3%) had experienced an unwanted pregnancy. Pregnancyoutcomesincluded25(48.2%)livebirths,19 (36.5%)abortions,2(3.8%)miscarriages,and6(11.5%) ongoingpregnancies.HIVtestingrateswerelow,with only45(16.3%)ofallrespondentshavingeverbeen tested.Sexualassaultwasreportedby23(17.0%)sexuallyactiveYIDPs,ofwhom16(69.6%)indicatedthat theassaultinvolvedafamilymember.Thequantitative findingsonassaultsweresupportedbyinsightsfrom individualinterviews.AccordingtooneheadofSRHS, hestated,
“Ihadacasehere:awomanlivedwithheroldersister, whowasmarried.Theoldersisterwasneverhome,so thehusbandassaultedthisyounglady.Duringthistime, heconstantlythreatenedhernottotellanyone. She keptittoherselfforaverylongtime.Untiloneday,she saidshecouldn’ttakeitanymore. Shefinallypacked herbagsandcametothehospital. Whenwetriedto questionher,shestartedtellingusallthesestories.”
Contraceptiveuseamongsexuallyactiverespondents wassuboptimal.Only9.6%reportedconsistentuseof contraception,while90.4%reportedinconsistentor nouse.Themostfrequentlyreportedmethodswere thesafeperiod(47.4%),condoms(43.0%),andwith- Variable Modality
Age >14-19
Socioeconomicstatus moderatepoverty
Currentsexualrelationship
Riskperception duringintercourse Sexualrelationship Females withsamegender Mmales Sexualassault Yes (withfamilymember) No
Frequencyofcontraceptionuse Sometimes 53 48.2
Unwantedpregnancy
Pregnancyoutcome
EverdoneHIVtest
Havealreadybeenrape
drawal(27.4%).Useofmodernhormonalmethodswas uncommon(figureI).
MisconceptionsaboutcontraceptionmethodswerereportedduringFGDs:“... Icannotusefamilyplanning
10-14 53 19.2 83 30.1 >19-24 140 50.7 Female 158 57.2 Male 118 42.8 ≤ 4years 177 64.1 >4years 99 35.9 None 5 1.8 Primary 92 33.3 Secondary 119 43.1 Highereducation 60 21.7 Worker 99 35.9 unemployed 177 64.1 Belowpovertyline 172 62.3 91 33 nopoverty 13 4.7 Takealcohol 106 38.4 Takeotherdrugsin 36 13 foodordrinks Parents(fatherormother) 155 56.2 Guardian 64 23.2 alone 57 20.7
ATR:Africantraditionalreligion
Table 2. SexualbehaviourpatternsofYoungIDPs Monogamous 77 70 Multiplepartners 33 30 Unplannedor 45 33.3 sponctaneous
Planned 90 66.7 2 1.8 3 2.73 16 69.6 7 31.4 Always 19 17.3
Never 38 34.5 Yes 52 47.3 No 58 52.7 Currentlypregnant 6 11.5 Miscarriage 2 3.8 Abortion 19 36.5 LiveBirth 25 48.2 Yes 45 16.3 No 231 83.7 Females 7 6.4 Males 0 0
methodsbecausetheyarenotgood. Theyhavetoo muchsideeffectslikemakingawomanfatorbleed duringmenstruation.Someevencausemenstruation to stop” (19 -year-old female). I don’t want it at all, thatitcouldaffectmyreproductivesysteminthefu-
Additionally,duringtheFGDwithparent/guidanceof YIDPs,only3outof12parents/guidancesupportedthe useofcontraception.Oneparentremarked,‘Icannot discusspregnancyorSTIpreventionwithmychildren whoarenotmarried.Imyselfdon’tusethosecontraceptivemethods,andforanunmarriedchild,whatdo theyhavetodowithsex? theirownisabstinence,it pleasesGodlikethat’.
femalesand16.0%ofsexuallyactivemales(FiguresIIa andIIb)
Table3displaysarangeofhigh-risksexualbehaviours thatwerereportedamongYIDPSintheDHD.TheoverallprevalenceofRSBamongYIDPsinDHDwas44.7% andamongsexuallyactiveindividuals,theprevalence was122(90.4%).ThemostcommonRSBwasinconsis-
same-genderpartnerwasreportedby5(3.7%).
ThemostcommonreasonforengagementinRSBwas peerpressure64(47.3%),followedbylackofinformation48(35.5%),financialincentives41(30.0%),desire forexcitement36(26.4%),andaccommodationneeds 33(24.5%)(figureIII).
Tofurthercomplementthequantitativedata,insights fromYIDPsthemselvesrevealedthecomplexrealities behind certain behaviours. One participant shared: “Sometimes we are forced to do it. It’s not that we likethisbadbehaviour.IfIdon’tsleepwiththisman, howwillIhavemoney?Mymotherissickandcannot takecareofmeandImustdoalltosurvive.That’sthe reasonwhywesometimesdoprostitution”(18-yearold female). Again, it was reported that YIDPs were exposedtoRSB,includingunprotectedsexandunsafe abortions, often due to precarious economic conditions.AsoneheadofSRHservicestated:“Theytakesix
Psychoactivesubstanceuse
Multiplesexualpartner
Transactionalsex(accomodation) Transactionalsex Yes 38 28.1 (financialincentive) No 97 71.9 Inconsistentcondomuse
Sponctaneoussexualactivity Unwantedpregnancy Yes 52 47.3
Pregnancyoutcome(abortion) Yes 19 36.5
Sexwithsamegender YIDPs:Younginternallydisplacedpersons,RSB:Riskysexualbehaviour
sachetsofLiond’or(harddrug)tocauseanabortion (HeadofSRHS).Drugandalcoholuse,beinginfluenced bypeersfrequentlyemergedasacommontheme,suggestingthatRSBisofteninfluencedbypeerpressure withinthisgroup. Twomaleparticipantsrecounted, “WealwaysdranksomethingcalledCHICHA”(referring toapsychoactivesubstance).Theyfurtherexplained, “Mostofustakethisafterschool,goingtoaparticularhousewhereinaddition,wedrinkwinecalledEL VINOfromacontainer.”Anotherexperiencesharedwas, “Someofmyfriendsevengoasfaraspreparingwhat theycall‘happyrice,’whichiscookedwithmarijuanato energisethemselvesforsexualactivity”(participants aged15and17,bothin-schoolmales). Theyalsodescribedsituationswhere“agirlmightgooutwitha boy,andtheboywoulddrugher,theninvitehisfriends, leadingtoherbeingexploitedsexuallybymanymales” ThesewerecorroboratedduringtheFGDwithteachersofYIDPS,whofrequentlyreportedthatthereason forRSBwasduetopeerpressure.“Displacedyouths frequentlyfaceriskysexualbehaviourssuchasunprotectedsexandprostitution,oftenduetopeerpressure ortheircircumstances”(higherinstitutionlecturerT2). Anotherteachernotedthat,“duetopermissiveenvironmentsandsharedlivingspaceswithparents,many youngpeopleareexposedtoadultbehavioursatan earlyageandlaterattempttoimitatewhattheyobserved”(SecondaryschoolteacherT5).
Bivariateanalysisshowedthatsubstanceuse(cOR= 3.3,95%CI:1.38–7.9,p=0.005),loweconomicstatus (cOR=2.8,95%CI:1.1–7.1,p=0.02),beingaworker Yes 36 26.7 No 99 73.3 Yes 48 35.6 No 87 64.4 Yes 27 20.0 No 83 80
Yes 122 90.4 No 13 9.9 Yes 45 33.3 No 90 66.7
No 58 52.7
No 33 63.5 Yes 5 3.7 No 130 96.3
(cOR=3.8,95%CI:1.76–8.36,p<0.001)andattending nightclubsmorethanonceamonth(cOR=4.8,95%CI: 2.1-11.0,P=0.001)werecorrelatedwiththeactofengagingintoRSB.OtherfactorslinkedtoRSBarepresentedintable4below.
Afteradjustingforconfounders,attendingnightclub morethanoncepermonth(aOR=5.0195%CI:2.52-10.0, p=0.001; ) substanceuse(aOR=2.8, 95%CI:1.2–6.5, p=0.015);non-utilizationofSRHservices(aOR=2.9 95%CI=1.5–6.0,p<0.002);informaloccupation(aOR= 2.2,95%CI:1.1–4.4,p=0.03);livingwithbothparents (aOR=0.58,95%CI:0.36-0.92,p=0.025);andeconomic status(aOR=2.5,95%CI:1.05-6.0,p=0.038)remained significantindependentpredictorsofRSBamongYIDPs (table5).
ThisstudyhighlightsasubstantialburdenofriskysexualbehavioursamongyounginternallydisplacedpersonsintheDschangHealthDistrict,underscoringthe combinedeffectsofdisplacement,socioeconomicprecarity,andlimitedaccesstosexualandreproductive health services. Almost half of the respondents reportedbeingsexuallyactive,andengagementinrisky sexual practices was particularly high among those whohadinitiatedsexualactivity.ThemajorityofYIDPs inthisstudywereolderadolescentsandyoungadults aged 19–24 years, accounting for 50.7% of the sample,reflectingtheprotractednatureofdisplacement intheregion.Thisagedistributionalignswithglobal
Sexofrespondent Females
Religiousactivities Irregular
Gotoclubs >once/month
Alcoholconsumption ≥5/month
Substanceuse(Drug)
Livingalone
Non-utilization
Durationofdisplacement
Sexualdebut
Economicstatus
SRHknowledge
EducationalLevel
Livingwithbothparents
Employmentstatus
Typeofoccupation ORc=crudeOddratio,X2=Chisquare,p=levelofsignificance(p>0.05),RSB=Riskysexualbehaviour,NPL:National
displacement patterns reported by the Internal DisplacementMonitoringCentre(IDMC)[36]underscoring theneedforage-specificinterventionstargetingdisplacedyouth.AsubstantialproportionofYIDPslived inabjectpoverty(62.3%),withanadditional33.0%experiencingmoderatepoverty. Thismirrorsnational povertytrendsinCameroon[31]buthighlightsheightened socioeconomic vulnerability among displaced youth. Limited access to basic needs such as food, healthcare,education,andincome-generatingopportunitiesmaycontributetosustaineddeprivationand increasedengagementinriskysexualbehaviours.Sexualandreproductivehealthpatternsrevealedearlier sexualdebutamongfemales,withameanageof16.6 ±4.8years,andahigherprevalenceofearlysexualinitiationcomparedtomales.Nearlyhalfofrespondents weresexuallyactive(48.9%).Incontrast,a2019study conductedacrosssixDivisionsintheWestRegion[37] reportedamuchlowerprevalenceof20.3%amongin-
19 139 2.9 0.57(0.3-1.1) 0.088 Males 23 118 16 102 0.45 0.8(0.4-1.6) 0,05 Regular 26 37
22 42 23.7 4.8(2.1-11.0) 0.001* 1/month 20 192 9 19 20.7 1.3(0.5-3.2) 0.6 <5/month 22 59 yes 9 27 7.87 3.3(1.38-7.9) .005* no 22 218 Yes 9 48 1.49 1.68(0.7-3.9) 0.22 No 22 197 No 23 69 19.89 3.4(1.9–5.9) 0.001* yes 98 86 4years 16 161 2.4 0.56(.26-1.1) 0.12 >4years 15 84 16 15 36 2.37 1.1(0.49-2.57) 0.83 >16 16 43 NPL 25 146 5.18 2.8(1.1-7.1) 0.02* >NPL 6 99 Lowknowledge 16 85 0.571 0.57(0.13-2.53) 0.75 Goodknowldege 26 148 Primary 7 90 2.42 0.5(0.2-1.2) 0.12 ≥Secondary 24 155 Yes 37 68 6.0 0.54(0.33-0.89) 0.015* No 86 85 Worker 20 79 12.46 3,8(1.76-8.36) 0.000* Non-worker 11 166 Informal 18 58 5.8 2.8(1.1-7.1) 0.02* Formal 24 176
povertyline.
schooladolescentsaged15–19years.Thisdifference maybeexplainedbythebroaderagerangeincludedin thisstudyandtheprotectiveroleofschoolattendance againstearlysexualactivity[38,39].AlthoughmostsexuallyactiveYIDPsreportedmonogamousrelationships, asignificantproportionengagedinmultiplepartnershipsandspontaneoussexualencounters. Irregular condom use and multiple sexual partnerships were markedlyhigherthanthosereportedinnon-displaced populationsinthesameregion[37],withpeerpressure,lackofinformation,andfinancialincentivesidentifiedaskeybarrierstocontraceptiveuse.Theprevalenceofunwantedpregnancyamongfemales(47.3%) was considerably higher than national estimates reportedinsystematicreviews[40-42]. Similartrends havebeendocumentedamongdisplacedadolescent girlsinothercontexts,includingBogotá,Colombia[43]. Thesefindingshighlightthepersistenceofsexualactivityandpregnancyduringdisplacementandreinforce
Religiousactivities (0.4-1.6) (0.7-1.5)
Gotoclubs month (2.1-11.0) (2.52-10.0)
Livingwithboth Yes 37 68 parents
Psychoactive Yes 9 27 substance use(drug) Utilizationof No 23 69 SRHservices
Economicstatus (1.1-7.1) (1.05-6.0)
Typeofoccupation (1.1-7.1) (1.1–4.0)
Durationof 4years 16 161 displacement
Sexualdebut (0.49-2.57)
SRHknowledge knowledge (0.13-2.53)
Sexofrespondent (0.3-1.1)
Livingalone (0.7-3.9)
Alcohol ≥5/month 9 19 consumption cOR=crudeOddratio,aOR=adjustedoddratio,X2=Chisquare,p=levelofsignificance(p>0),NPL:National
theimportanceofprioritizingfamilyplanningservices alongsideotherhumanitarianinterventions.Evidence indicatesthatfamilyplanningservicesarebothfeasible and effective in crisis settings [44], yet remain insufficientlyaccessibletodisplacedyouth.RSBwas highlyprevalent, affecting44.2%ofallrespondents and90.4%ofsexuallyactiveparticipants.Independent predictorsincludedsubstanceuse,frequentnightclub attendance,non-utilizationofsexualandreproductive healthservices,informalemployment,loweconomic
0.8 0.87 Irregular 16 102 0.05* 0.15 Rregular 26 37 1 1 >once/ 4.8 5.01 22 42 0.001* 0.001* ≤1/ 20 192 1 1 month 0.54 0.58 0.015* 0.025* (0.33-0.89) (0.36-0.92) No 86 85 1 1 3.3 2.8 0.005* 0.02* (1.38-7.9) (1.3–6.6) No 22 218 1 1 3.4 2.9 0.001* 0.002* (1.9–5.9) (1.5-6.0) Yes 98 86 1 1 2.8 2.5 ≤ NPL 25 146 0.02* 0.038* >NPL 6 99 1 1 2.8 2.1 Informal 18 58 0.02* 0.03 Formal 24 176 1 1 0.56 0.12 (.26-1.1) >4years 15 84 1.1 16 15 36 0.83 >16 16 43 Low 0.57 16 85 0.75 Good 26 148 1 1 knowldege 0.57 Females 19 139 0.088 Males 23 118 1 1 1.68 Yes 9 48 0.22 No 22 197 1 1 1.3 0.6 (0.5-3.2) <5/month 22 59 1 1
povertyline,1=referencevalue
status,andnotlivingwithbothparents.Thesefindings areconsistentwithexistingliteraturelinkingsubstance useandsocioeconomicvulnerabilitytounsafesexual practicesamongadolescents[45-48].Qualitativefindingsfurtherillustratedhoweconomichardship,peer influence,andcoercioncontributetotransactionalsex, unprotectedintercourse,andunsafeabortions.Overall,theseresultsemphasizetheneedforintegratedinterventionscombiningsubstanceuseprevention,economicempowerment,andaccessible,youth-friendly sexualandreproductivehealthservicestoreducesexualriskamongYIDPs
Thisstudyhasseveralimportantstrengths.Itfocuses onyounginternallydisplacedpersons,ahighlyvulnerableandunder-studiedpopulationinCameroon. In addition, the study examined a broad set of socioeconomic,behavioural,andservice-relatedfactors,enablingamultidimensionalanalysisofdeterminantsof RSB. The integration of quantitative and qualitative findingsfurtherstrengthenedtheinterpretationofresults.Despitethesestrengths,thestudyhassomelimitations.Itscross-sectionaldesignprecludesestablishingcausalrelationshipsbetweenidentifiedexposures andriskysexualbehaviours.Furthermore,relianceon self-reporteddatamayhaveintroducedrecallbiasand socialdesirabilitybias,potentiallyinfluencingtheaccuracyofparticipants’responses
ThisstudyprovidesimportantevidenceonthemagnitudeanddeterminantsofRSBamongYIDPsinthe DHD. RSB was highly prevalent, particularly among sexuallyactiveyouth,withinconsistentcondomuse, unwanted pregnancies and abortions frequently reported.Multipleinterrelatedfactorscontributedtothis highrisk,includingpeerpressureandlimitedaccessto accuratesexualandreproductivehealthinformation. Thesefindingshighlighttheurgentneedforintegrated, youth-friendly sexual and reproductive health interventionstailoredtoIDPsettings. Suchprogrammes shouldcombinecomprehensivesexualityeducation, accessibleandconfidentialSRHservices,substance useprevention,andsocioeconomicandpsychosocial supporttoeffectivelyreducevulnerabilityandpromote safersexualbehavioursamongdisplacedyouth. Competinginterests: Theauthorsdeclarenocompetinginterests.