Prevalence of adolescent motherhood and gender-based violence awareness among adolescent girls in conflict-affected health districts of Cameroon: a cross-sectional study

Abstract

Introduction: adolescent motherhood and gender-based violence (GBV) remain critical public health concerns in conflict-affected settings. In Cameroon, the ongoing Anglophone crisis has intensified adolescent vulnerability to early pregnancy and GBV. This study aimed to determine the prevalence of adolescent motherhood and identify factors independently associated with GBV awareness among adolescent girls in conflict-affected health districts of Cameroon. Methods: a cross-sectional survey was conducted among 606 adolescent girls aged 10-19 years across three health districts in the Northwest and Southwest regions of Cameroon (Bamenda, Buea, and Mamfe) between July and December 2024. A multistage cluster sampling approach was used. Data were collected using structured, interviewer-administered questionnaires. The primary outcome was adolescent motherhood (having been pregnant at least once) and the secondary outcome was GBV awareness (self-reported knowledge of GBV and its forms). Multivariable binary logistic regression was performed to identify factors independently associated with GBV awareness. Results are reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI) and p-values. Results: among 606 participants, adolescent motherhood prevalence was 21.6% (95% CI: 18.5-25.0%), with marked district-level variation: Bamenda 37.7%, Mamfe 14.7%, and Buea 7.3%. Marital status, age, educational attainment, religious affiliation, and occupational status were each significantly associated with adolescent motherhood in bivariate analyses. In multivariable logistic regression for GBV awareness, factors independently associated with higher awareness included experience of sexual harassment (aOR: 4.97, 95% CI: 3.30-7.56; p < 0.001), current sexual activity (aOR: 2.74, 95% CI: 1.23-6.16; p = 0.014), prior pregnancy (aOR: 2.16, 95% CI: 1.13-4.19; p = 0.021), and paternal primary education (aOR: 2.00, 95% CI: 1.01-4.02; p = 0.048). Conversely, residence in Buea (aOR: 0.44, 95% CI: 0.25-0.76; p = 0.004), Mamfe (aOR: 0.39, 95% CI: 0.19-0.79; p = 0.009), paternal university education (aOR: 0.36, 95% CI: 0.18-0.72; p = 0.004), and longer duration of conflict-area residence (aOR: 0.92, 95% CI: 0.86-0.99; p = 0.017) were independently associated with lower GBV awareness. Conclusion: adolescent motherhood prevalence was high across conflict-affected districts in Cameroon, with marked inter-district variation likely reflecting differential conflict intensity and access to services. GBV awareness was predominantly driven by direct personal experience rather than proactive education, indicating a critical gap in preventive GBV programming. Targeted multi-sectoral interventions addressing school retention, reproductive health access, and community GBV sensitisation are urgently needed in these settings.