This study was a descriptive cross-sectional study conducted among full-time undergraduate students in Tamale, Ghana. The study population comprises of nursing students of the School of Nursing and Midwifery, Tamale campus, University for Development Studies (UDS), Ghana. The UDS is the largest university in the northern part of Ghana. Currently, programs run in Tamale campus include Medicine (MBchB), Community Nutrition, Education, Nursing, Midwifery, Nurse Practitioner, Medical Laboratory Science, and Public Health related programmes, among others.

From a total population of 709 nursing students, a sample size of 230 individuals was chosen. The overall sample size was estimated by taking 30% of the total enrollment in each class. The sum of these values represented the total number of subjects used for the study.

The researchers adapted structured questionnaire from the adolescent reproductive health data collection instrument by the United Nations Development Programme (UNDP)/United Nations Population Fund (UNFPA)/the World Health Organization (WHO)/World Bank [16]. The data collected after students consented to participate in the study included the demographic characteristics of students, contraceptive knowledge, knowledge of type of contraceptives used, and identified challenges and/or adverse effects associated with its use.

Data was managed to ensure completeness, accuracy, and consistency. A total of two hundred and twenty (250) questionnaires were distributed, with two hundred and thirty (230) returned. Cleaned and processed data were analyzed using the SPSS version 22 and the results presented using tables.

The study was conducted after approval from the ethics committee of the Tamale Teaching Hospital. Permission was also obtained from the School of Nursing and Midwifery, and the Department of General Nursing. Verbal consent was obtained from each participant.

Majority (104, 52%) of the respondent’s age fell within the age bracket of 20 - 24. Most of the respondents were female (121, 60.5%), 80.5% were single, and 65% (130) of the respondents were Christians. Sociodemographic characteristics of the students are summarized in Table 1.

Knowledge of contraceptives was measured by students’ ability to name at least a contraceptive method. Table 2 shows participants knowledge of contraceptives, modern and traditional, by their level of study. There seemed to be gradient in students’ knowledge from levels 100 to 400, with the level 100 being the least and level 400 with the highest level of knowledge. Condoms, emergency contraceptive, and oral pills registered the highest level of knowledge among students. Generally, female students recorded more knowledge (132, 93.6%) of different

Source: Author Constructed, July-August 2021.

Source: Author Constructed, July-August 2021.

contraceptive techniques than their male (51, 57.3%) counterparts and this was prominent among those in level 400. Overall, students had good knowledge (138, 60%) of contraceptives however, there is room for improvement.

Current users or ever used contraceptives were 58.3%. As shown in Table 3, respondents indicated they got information on contraceptives from more than one source, but the major one was from friends (51, 38.8%). With regards to source(s) of access to contraceptives used, pharmaceutical/drug stores were the highest (54, 40.3%), 76.1% indicated that contraceptives could be obtained without prescription.

Knowledge of types of contraceptives used by participants was defined as any contraceptive method (modern and traditional) students mentioned to have used or are currently using. Of the current users or ever used contraceptives (134, 58.3%), 70 (52.2%) mentioned condoms. As to who uses contraceptives during intercourse, 56.0% of them indicated they used it themselves. Reasons for using contraceptives: 56.7% said they use contraceptive(s) to prevent themselves or others from getting pregnant, 43.3% said they used it to prevent acquiring STIs, among others. Table 4 summarizes these findings.

Source: Author Constructed, July-August 2021.

Source: Author Constructed, July-August 2021.

Table 5 presents information on the distribution of respondents regarding challenges (perceived or real) they attribute to the use contraceptives, reasons for nonuse of contraceptives and adverse effects (perceived or real) of contraceptive use. Of those who were either current users or ever used contraceptives (134, 58.3%), 50.9% said they do not experience any challenge using contraceptives, while 18.7% said otherwise, citing delay of coitus and irritations especially with condoms use. Of the nonusers of contraceptives (96, 41.7%) who are sexually active, 26% (25) indicated it was against their faith/religion beliefs, 25% (24) cited fear of side effects, among others. The most prominent adverse effect of contraceptive use

Source: Author Constructed, July-August 2021.

related to irregular menses (23.0%). Furthermore, female students achieved higher level of knowledge about adverse effects of oral pills (short- and long-term). These adverse effects identified by female students included: infertility (35, 24.8%); weight gain (71, 50.4%); irregular menstruation (68, 48.2%); headache/body pain (82, 58.2%); Nausea and vomiting (36, 25.5%); and between period bleeding (32, 22.7%). There were however, deficient in identifying the method of contraception with the greatest adverse effect, whether it was the injectables (Depo-Provera), oral pills, or intrauterine device (IUD).

We enrolled male and female nursing students between the ages of 15 and 34, with a mean age of 27.4 years. This was an appropriate age limit, as contraceptive use is mostly dependent on one’s age. We discovered that the majority of our participants (61.3%) were female and unmarried (78.7 percent), a finding that is comparable to that conducted among university students in Uganda [18], Dodoma, in Tanzania [19], and Imo State, in Nigeria [20]. Majority of our study participants (59.6 percent) had their first sexual debuts between the ages of 15 and 19, and this was also consistent with the findings of Hansen et al. [21], Magnusson et al. [22], and Zaba et al. [23]. It also conforms to the reported legal age for initiating sexual relations in Ghana [24]. The apparent connection is unsurprising, given that majority of our study participants were in their teens, a stage of life marked by a desire to explore one’s sexual debuts in order to create one’s identity. Again, our study reported a significant proportion (65.2 percent) of the participants did not use contraceptive during their first sexual debut and this is consistent with other studies [18] [22].

We found knowledge of at least one contraceptive method among the students to be very high, especially knowledge of condoms. However, knowledge of the types of contraceptives was not encouraging. The deficiency in knowledge relative to the types of contraceptive methods in use other than condoms seems to be a major one among adolescents and tertiary students in Ghana and other sub-Saharan Africa countries [1] [2] [25] [26]. The high level of knowledge related to condoms among adolescents in Ghana is not surprising given the enormous campaign programmes that were rolled out at the peak of HIV pandemic [25]. Furthermore, the high level of knowledge related to condoms may be attributable to condoms being the easiest to use contraceptive method by unmarried adolescents; given its dual ability to prevent STIs and unwanted pregnancy.

Knowledge of at least one contraceptive technique varied across students’ level of study, with level 400 students recording higher levels of knowledge compared to level 100 students. Implication of these findings is that interventions designed to improve students’ knowledge of contraceptives should be initiated.

Contraceptive use among the students was relatively low, as has been found in similar studies [2] [26] [27] [28] [29]. Notwithstanding the fact that some (58.3%) of the students reported ever or currently using contraceptives, this was not consistent. Many reasons were given to be responsible for this including being against their faith, fear of side effects, unsupportive partner, being against their culture, among others. Although low contraceptive use was recorded, there was increasing use of condoms among students compared to the other methods as has been found in similar studies [1] [30]. The likely explanation could be the ease with which condoms can be accessed by students. Our findings corroborated those conducted in Nigeria [31] and other Sub-Saharan Africa countries [32] [33] [34] [35]. The fact that students have more knowledge about condoms relative to the other methods may have accounted for high levels of condoms usage.

The low and inconsistent use of contraceptives among students may have been responsible for the adoption of risky sexual behaviours likely to expose them to the acquisition of STIs [36]. Menon et al. [36] found that students with less use of contraceptives (condoms for example), were 3.44 times more likely to be diagnosed with STIs compare to those who use it every time.

Our findings indicate that the most frequently used sources of knowledge were friends, the media, and books/magazines. Jones et al. [37] reported similar findings. This however, differ from those of Majer et al. [38], who found that internet and television were preferred sources of information over friends and media, and Fatimah et al. [17], who found that health care professionals were the preferred source of information. It was established from the study that having a credible source of information was likely to offer adolescents with more accurate information. Participants expressed contradictory attitudes about contraceptive use.

We observed some limitations to this study that should be noted when interpreting the findings: the study population was restricted to students enrolled in a single university and from a single program of study. Hence study’s findings cannot be generalized to all undergraduate students in UDS or other Ghanaian universities. There may be an information bias, since some information deemed sensitive by the students may have been withheld. Again, the study does not establish any relationship/association between student sociodemographic characteristics and contraceptive knowledge, knowledge of the types, use, and identified challenges associated with its use.