Knowledge, attitudes and factors associated with the utilization of youth- friendly sexual and reproductive health services among teenagers and young adults in Kigali city, Rwanda

Abstract Background Youth-friendly sexual and reproductive health services (YFSRHSs) play a paramount role in supporting the physiological, cognitive, emotional, and social evolution of young people into healthy and productive adults. In Rwanda, services are provided by health facilities with trained healthcare providers and youth centers where young people are additionally equipped with short professional courses such as welding, cooking, football, and computer literacy, among others. This study was conducted to assess knowledge and attitudes toward YFSRHS and determine the factors associated with their use among non-married or cohabiting teenagers and young adults (TYAs) aged 15–24 years. Methods This was a cross-sectional survey in which data were collected from July 8 to 22, 2024. The collected data were analyzed via STATA version 17. A generalized estimating equation (GEE) model was used to identify factors associated with the utilization of the YFSRHS. Statistical significance was assumed at a p value less than 0.05. Setting: Data were collected in three districts of Kigali city in Rwanda, Eastern Africa. Results This study revealed that out of the 850 TYAs included in the study, both sexes were nearly equally represented: 49.4% females versus 50.6% males. The proportions of TYAs with adequate knowledge, positive attitudes, and practices were 76.9%, 70.0%, and 60.0%, respectively. The predictors of YFSRHS use include living in the Gasabo district [aOR:4 with 95% C. I: 2.5–6.1], being aware of the services [aOR:3.8 with 95% C. I: 2.3–6.2], having adequate knowledge of YFSRHS [aOR: 2.6 with 95% C. I: 1.7–3.9], being a student in a school located near lodges/guest houses [aOR:1.6 with 95% C. I: 1.0–2.6], being female [aOR: 1.6 with 95% C. I: 1.1–2.3], being cared for by a father [aOR:2.4 with 95% C. I: 1.4–4.1] or a mother only [aOR: 1.8 with 95% C. I: 1.8–2.7], and having positive attitudes toward YFSRHS [aOR: 1.8 with 95% C. I: 1.2–2.7]. Furthermore, the number of TYAs who ever used YFSRHS was 2.2 [aOR: 2.2 with 95% C. I: 0.9–5.1] times more likely to be using contraceptives, and 2.4 [aOR:2.4 with 95% C. I: 1.6–3.4] more likely to have been tested for HIV than those who were not. Conclusion Despite the apparent benefits of YFSRH in increasing the uptake of HIV testing and contraception services among TYAs in Kigali city, their use remains low, mainly due to a lack of adequate knowledge, which in turn affects the positive attitudes of TYAs toward YFSRHS, especially among males. Thus, efforts aimed at increasing the utilization of services should focus on increasing awareness of TYAs in services, with a particular emphasis on males and those at greater risk of HIV and unintended pregnancies.