Prevalence and determinants of heterosexual anal and oral sex practice among young people in Ethiopia: systematic review and Meta-analysis

Belete Feyera Olkaba; Desalegn Wirtu Teso; Dejene Hailu Kassa

doi:10.12688/f1000research.164902.1

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Systematic Review

Prevalence and determinants of heterosexual anal and oral sex practice among young people in Ethiopia: systematic review and Meta-analysis

[version 1; peer review: awaiting peer review]

Belete Feyera Olkaba ¹, Desalegn Wirtu Teso², Dejene Hailu Kassa³

PUBLISHED 27 Jun 2025

Author details Author details

¹ Department of Referral Hospital, Ambo University College of Medicine and Public Health, Ambo, Oromia, Ethiopia
² Department of Public Health, Institute of Health, Wollega University, Nekemte, Oromia, Ethiopia
³ Department of Public Health, Hawassa University College of Medicine and Health Sciences, Awassa, Southern Nations, Nationalities, and People's Region, Ethiopia

Belete Feyera Olkaba
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Desalegn Wirtu Teso
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Dejene Hailu Kassa
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

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Abstract

Introduction

Young people in developing nations are particularly affected by HIV infection, which primarily spreads through sexual contact, including anal, oral, and vaginal sex. Heterosexual couples engage in female anal sex, a receptive sexual behavior in which the penis is placed in the female partner’s anus. Anal intercourse has a higher risk of HIV transmission than vaginal intercourse, especially when there is appropriately low condom use, and the majority of couples are unaware of the risk of HIV transmission during anal intercourse.

PROSPERO Registration number

CRD42024629445

Objectives of the review

To determine the pooled prevalence and determinants of heterosexual anal and oral sex practices among young Ethiopian people.

Methods

This systematic review of peer reviews published in English up to January 31, 2025, measures heterosexual anal and oral sex practices and contributing factors among young people in Ethiopia. STATA version 17 software was used to analyze the pooled prevalence and determinants of heterosexual anal and oral sex practices among young people in Ethiopia.

Result

Female young people were 2.45 times more likely to engage in heterosexual anal sex practice 95%CI, OR 4.05[1.57-3.33]. Young people who were living alone were 2.50 more likely involved in heterosexual anal sex practice with 95% CI, OR 2.50[1.60-3.40]).Those young people who live alone were 1.91 more likely engaged in heterosexual oral sex practice with 95% CI, OR 1.91[1.7-2.12]. Young people whose intimate partners engaged in heterosexual oral sex practice were 5.13 times more likely to engage in heterosexual oral sex practice in Ethiopia.

Conclusions

The pooled prevalence of heterosexual oral and anal sex practices in Ethiopia is high. Living alone and female sex were associated with heterosexual anal sex practices, while intimate partner engagement in oral heterosexual sex practice was associated with heterosexual oral sex practice among young people in Ethiopia.

Keywords

Hetero sexual, anal sex, oral sex, determinants, Ethiopia

Corresponding author: Belete Feyera Olkaba

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2025 Feyera Olkaba B et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Feyera Olkaba B, Wirtu Teso D and Hailu Kassa D. Prevalence and determinants of heterosexual anal and oral sex practice among young people in Ethiopia: systematic review and Meta-analysis [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:634 (https://doi.org/10.12688/f1000research.164902.1) First published: 27 Jun 2025, 14:634 (https://doi.org/10.12688/f1000research.164902.1) Latest published: 27 Jun 2025, 14:634 (https://doi.org/10.12688/f1000research.164902.1)

Introduction

Anal sex was described as the insertion of a man’s penis into a woman’s anus or, in the case of women, the reception of the penile shaft into a woman’s anus; oral sex was defined as oral contact with the vulva, vagina, penile shaft, or anus. In many districts and areas, oral and anal sex are considered sensitive sexual practices that are difficult to discuss.¹ Young people in developing nations are particularly affected by HIV, which primarily spreads through sexual contact, including anal, oral, and vaginal sex.² Heterosexual couples engage in female anal sex, a receptive sexual behavior in which the penis is placed into the female partner’s anus.³ Anal intercourse has a higher risk of HIV transmission than vaginal intercourse for receptors, especially when there is an appropriately low condom use, and the majority of couples are unaware of the risk of HIV transmission during anal intercourse.⁴ Sexually transmitted diseases are required and spread during heterosexual anal and oral intercourse.⁵ In Kinshasa City, oral sex was experienced by 59%, anal sex by 22%, and both by 18%, while multiple sexual partners, use of the Internet, and forced sex were linked to oral sex practice.⁶ Some population groups are more susceptible to HIV/AIDS than others, particularly those who engage in transactional sex.⁷ Adolescents who reported ever engaging in oral sex ranged in prevalence from 1.7 to 26.6%, while those who reported ever engaging in anal sex ranged from 6.4 to 12.45. A higher prevalence of oral and anal sex was found among university students and populations at high risk for HIV and STDs, and heterosexual oral and anal sexual acts were linked to certain high-risk behaviors, including inconsistent condom use and multiple sexual partners.⁸ Developing effective interventions to prevent and control sexually transmitted illnesses, including HIV, requires an understanding of the entire spectrum of sexual behaviors shown by young people in developing countries like Ethiopia, how ever there is a dearth of such data.⁹ Traditional concepts of sexual practices frequently change as the reasons influencing them change.¹⁰ There are no pooled estimates or determinants of heterosexual anal and oral sex in Ethiopia. Therefore, designing effective prevention strategies based on pooled estimates and factors associated with heterosexual anal and oral sex practices among young people in Ethiopia is essential.

Methods

Searching strategies

This review was based on the PRISMA checklist.¹¹ The incidence of and factors contributing to heterosexual anal and oral sex behaviors among Ethiopian youth were assessed in this systematic analysis of peer-reviewed articles published until January 31, 2025. Only quantitative research conducted until January 31, 2025, was included. We examined the Cumulated Index to Nursing and Allied Health and Literature (CINAHL), Google Scholar, Psycho Info, Web of Science, EMBASE, PubMed, Scopus, and Cochrane Library. “Heterosexual OR anal OR oral OR prevalence OR magnitude OR determinants OR associated factors OR adolescent*OR, youth*‘OR,’young*‘OR,’ teenagers AND Ethiopia” were the search phrases used to go through the databases. The study’s PROSPERO registration number was CRD42024629445. All observational studies published until January 31, 2025, examined the prevalence and contributing factors of heterosexual oral and anal sex habits among Ethiopian youth. The condition or domain under investigation was the incidence and determinants of oral and anal sex behaviors among Ethiopian youth aged 10–24 years (oral and anal sexual intercourse).

Eligibility criteria

To be illegible, the study must present quantifiable empirical data on the prevalence and contributing factors of heterosexual oral and anal sex behaviors among Ethiopian youth. Quantitative research on the prevalence and contributing factors of heterosexual oral and anal sex practices among Ethiopian youth, published and carried out in Ethiopia up until January 31, 2025, was included in this systematic review and meta-analysis. Only an original published research articles about oral and anal sex with an apposite sex partner among young people in Ethiopia were include. The criteria for exclusion were Studies that reported individuals under the age of 10 or older than 24, studies carried out outside of Ethiopia, studies carried out after January 31, 2025, systematic reviews, qualitative studies, newspapers, and studies that failed to report the prevalence and determinants of heterosexual anal and oral sex practices among Ethiopian youth were all excluded. The identification and screening processes are illustrated in Figure 1.

Figure 1. PRISMA flow diagram adapted.

Outcomes

The prevalence of heterosexual anal and oral sex behaviors among Ethiopian youth and the factors associated with these activities were the two main outcomes of the review.

Data collection process and analysis

A Chochrane data abstraction sheet was used to extract the data after determining the databases to search and retrieve all unreadable articles.¹²

Data extraction (selection and coding)

Two reviewers extracted the data using the data extraction tools Belete Feyera (BF) and Dejene Hailu (DJ). The third team member, reviewer Desalegn Wirtu (DW), served as a moderator to resolve disagreements on inclusion criteria after the two reviewers separately applied the eligibility criteria and selected studies for inclusion in the systematic review. The data were extracted, recorded, and aggregated, and the PRISMA checklist¹⁸ was used to collect information from selected papers.¹³ The PRISMA flow chart was also utilized for article drop-offs and quantity documentation.¹⁴ During data extraction, the following details were recorded:

Study details: Study design, study environment, authors, title, year of publication, location, sample recruitment strategy, and response rate. Features of participants: age, sex, demographic data, and sample size. The following information was extracted: measures or definitions of heterosexual anal and oral sex practices, the prevalence of these practices, effect size, confidence intervals, and covariates related to these practices among Ethiopian youth.

Risk of bias assessment

Two reviewers independently evaluated the systematic review’s risk of bias, and a third team member served as a moderator to resolve conflicts.

Prior to inclusion in the final meta-analysis, a thorough evaluation of the papers was carried out using keywords, abstracts, and titles. The assessment was conducted utilizing the survey and appraisal tool developed by Joanna Briggs for coordinated meta-analysis measurements.^15,16 The quality of the studies included in the meta-analysis was evaluated using the mean quality score; studies with scores higher than the mean were grouped and deemed high quality, while studies with scores lower than the mean were grouped and deemed low quality. Tools for adapted risk of bias. They employed the Newcastle-Ottawa scale.¹⁷ To assess the three reviewers’ agreement, actual agreement, beyond-the-chance agreement, and unweighted kappa were used.¹⁸ The reviewers’ agreement, specifically for this manuscript, was 0.84, indicating a perfect agreement.

Strategy for data synthesis and analysis

A meta-analysis of heterosexual anal and oral sex practices and their determinants among Ethiopian youth was conducted using STATA version 17 software, which generated forest plots of combined estimates with a 95% confidence intervals. The study’s standard error and prevalence rate were inputted into STATA version 17 to determine pooled prevalence and its 95% CI.

Pooled prevalence was calculated using a meta-analysis random-effect model. The heterogeneity of the studies was assessed using Q¹⁹ and I² statistics.²⁰ Using I² statistics, the degree of statistical heterogeneity among the studies was evaluated; 25%, 50%, and 75% were deemed low, medium, and high, respectively.²⁰

Features of studies: All seven studies included were cross-sectional studies, and all studies were conducted in Ethiopia up to January 31, 2025 ( Table 1).

Table 1. Characteristics of included studies on systematic review and meta-analysis on heterosexual anal and oral sex practices among young peoples in Ethiopia.

Author name	Year	Region	Study design	Sample size	Prevalence (oral sex)	Prevalence (anal sex)
Jecolia Mesele et al, 2023²³	2023	Harari	cross-sectional	387	5.9	23
Azwihangwisi Helen et al, 2015²⁶	2015	somale	cross sectional	236	12.7	8.9
Fentie A. et al, 2010²⁷	2010	Oromia	cross-sectional	1986	9.2	4.3
Deresse Daka et al, 2014²⁸	2014	SNNE	cross-sectional	508	5.1	1.3
Amsale Cherie et al, 2012⁹	2012	Addis Ababa	cross-sectional	3840	5.4	4.3
Mengistu Tiruneh Alemu et al, 2018²	2018	Dire dawa	cross sectional	1067	9	6.7
Yonas Tesfaye et al, 2020²⁹	2020	Oromia	cross sectional	395	25.8	15.2

Result

A total of 9547 participants from 7 studies were included in the analysis. Seven investigations documented both heterosexual oral and anal sex habits, according to a number of literature items that were part of the study.^{2,9–11,21–24} The prevalence of heterosexual anal sex practice ranged from 1.3-23%, Accordingly, the pooled prevalence of heterosexual anal sex practice was 8.9%% with 95%CI [3.42-14.38].

The I² test result revealed high heterogeneity (I² = 99.22%), indicating the use of a random effect model ( Figure 2)

Figure 2. Prevalence of heterosexual anal sex among young people in Ethiopia.

.

The prevalence of hetero-sexual oral sex practice ranged from 1.5.10-25.8%; the pooled prevalence of hetero-sexual oral sex practice was 10.24%% with 95%CI [5.5-15.44]. The I² test results revealed high heterogeneity (I² = 98.52%), which also indicated the use of a random effect model. Pooled Prevalence of Oral Sexual Practice (Figure 3 below)

Figure 3. Prevalence of heterosexual oral sex practices among young peoples in Ethiopia.

.

Sensitivity analysis

To ascertain the effect of each study’s findings on the combined prevalence of heterosexual anal sex practice, a sensitivity analysis was conducted by methodically excluding one study. Therefore, as long as one study didn’t materially change the prevalence in the systematic review and meta-analysis, all numbers fell within the anticipated 95% CI ( Figure 4 below).

Figure 4. Publication bias test for heterosexual anal sex practice by one leave out.

Similarly, to ascertain the effect of each study’s findings on the combined prevalence of heterosexual oral sex practice, a sensitivity analysis was conducted by methodically excluding one study. Therefore, as long as one study didn’t materially change the prevalence in the systematic review and meta-analysis, all numbers fell within the anticipated 95% CI ( Figure 5 below)

Figure 5. Publication bias for heterosexual oral sex practice using one leave-out.

.

Heterogeneity and publication bias

The standard funnel plot technique, which showed a symmetric distribution and absence of publication bias, was used to test for publication bias ( Figure 6 below)

Figure 6. Publication bias test using standard funnel plot for heterosexual oral sex practice.

.

Gender difference

Two studies found a substantial correlation between anal sexual practices and gender differences.^9,23 Gender differences are a significant determinant of heterosexual anal sex practices among young Ethiopian people. Females young people were 2.45 times more likely to engage in heterosexual anal sex practice 95% CI, OR 4.05[1.57-3.33] ( Figure 7 below).

Figure 7. Sex difference as a Predictor of anal sexual practice.

Living arrangement

Two studies reported living arrangements as significant factors for heterosexual anal sex practices in Ethiopia.^10,21 Young people who are living alone were 2.50 more likely to engage in heterosexual anal sex practice 95% CI, OR 2.50[1.60-3.40] ( Figure 8 below).

Figure 8. Living alone as a predictor of anal sex practice.

Living arrangements for heterosexual oral sex practice

Two studies^10,21 reported that living arrangements are a significant determinant of heterosexual oral sex practice. Those young people who lived alone were 1.91 more likely to engage in heterosexual oral sex practice with 95% CI, OR 1.91[1.7-2.12] ( Figure 9 below).

Figure 9. Living Alone as a predictor of heterosexual oral sex practice.

Intimate partner engagement

Two studies identified intimate partner engagement in heterosexual oral sex practice as a significant determinant of heterosexual oral sex practice.^2,9 Young people whose intimate partners engaged in heterosexual oral sex practice were 5.13 times more likely to engage in heterosexual oral sex practice in Ethiopia ( Figure 10 below).

Figure 10. Intimate partner engaged in Oral sex practice as oral sex practice.

Discussions

In these systematic review and meta-analysis investigations, two of them were conducted in the Oromia region,^10,24 one study was conducted in the Harari region,²³ one study was conducted in the Somale region,²² one study was conducted in South nations and nationalities of Ethiopia,²¹ one study was conducted in Dire Dawa² and the other was conducted in Addis Ababa.⁹ Accordingly, the pooled prevalence of heterosexual anal sex practice among young people in Ethiopia was 8.9%% with 95%CI [3.42-14.38]. This finding was lower than the systematic review and meta-analysis done in sub-Saharan Africa at 12.4%⁸ and The pooled prevalence of heterosexual oral sex practice ranged from 1.5.10-25.8%; the pooled prevalence of heterosexual oral sex practice was 10.24%% with 95%CI [5.5-15.44] among young peoples in Ethiopia which were lower than systematic review and meta analysis.⁸ The variations might be due to socioeconomic, geographic, and study year. Living arrangements are significantly associated with heterosexual anal sex practices among young Ethiopian people. Young people who are living alone were 2.50 more likely to engage in heterosexual anal sex practice 95% CI, OR 2.50[1.60-3.40]. Even though no systematic review or meta-analysis conducted on this factor, two articles revealed that it was significantly associated with heterosexual anal and oral sex practice.^10,21 Two studies reported that sex differences were significantly associated with anal sexual practice.^9,23 Gender differences are a significant determinant of heterosexual anal sex practices among young Ethiopian people. Females young people were 2.45 times more likely to engage in heterosexual anal sex practice 95% CI, OR 4.05[1.57-3.33]. Another determinant is intimate partner engagement. Two studies identified intimate partner engagement in heterosexual oral sex practice as a significant determinant of heterosexual oral sex practice.^2,9 Young people whose intimate partners engaged in heterosexual oral sex practice were 5.13 times more likely to engage in heterosexual oral sex practice in Ethiopia. Generally, the pooled prevalence of heterosexual oral and anal sex practices among young people in Ethiopia was high; intimate partner engagement, living alone, and female sex were significant predictors of heterosexual anal and oral sex practices among young people in Ethiopia.

Conclusions

The pooled prevalence of heterosexual anal and oral sex practices among young people in Ethiopia is high. Gender difference (female) and living arrangement were determinants of heterosexual anal sex practice in Ethiopia while living alone and intimate partner engagement in heterosexual oral sex practice were significant determinants for heterosexual oral sex practice in Ethiopia.

Ethical considerations

Ethical approval and consent were not required.

PROSPERO registration: CRD42024629445

Data availability statement

Underlying data

No data associated with this article.

Extended data

Figshare: PRISMA checklist, https://doi.org/10.6084/m9.figshare.29114573.v1²⁵

This project contains the following underlying data:

• PRISMA_2020_checklist
• anal factors
• anal prevalence
• oral factors
• oral prevalence

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

References

1. Morhason-Bello IO, et al.: Heterosexual Oral and Anal Sex: Perceptions, Terminologies, and Attitudes of Younger and Older Adults in Ibadan, Nigeria. Arch. Sex. Behav. 2023; 52(1): 161–175. PubMed Abstract | Publisher Full Text | Free Full Text
2. Alemu MT, Dessie Y, Gobena T, et al.: Oral and anal sexual practice and associated factors among preparatory school youths in Dire Dawa city administration, Eastern Ethiopia.2018.
3. Shayo EH, et al.: Prevalence and risk factors associated with female anal sex in the context of HIV/AIDS in the selected districts of Tanzania. BMC. Res. Notes. 2017; 10(1): 140. PubMed Abstract | Publisher Full Text | Free Full Text
4. Mazeingia YT, Olijjira L, Dessie Y: Anal sexual experience and HIV risk awareness among female sex workers in Dire Dawa, eastern Ethiopia. Glob. Health Res. Policy. 2017; 2: 27. PubMed Abstract | Publisher Full Text | Free Full Text
5. Habel MA, et al.: Heterosexual Anal and Oral Sex in Adolescents and Adults in the United States, 2011-2015. Sex. Transm. Dis. 2018; 45(12): 775–782. PubMed Abstract | Publisher Full Text | Free Full Text
6. Carlos S, et al.: Heterosexual oral and anal sex in Kinshasa (D.R.Congo): Data from OKAPI prospective cohort. PLoS One. 2019; 14(1): e0210398. PubMed Abstract | Publisher Full Text | Free Full Text
7. Kounta CH, et al.: Transactional sex among men who have sex with men participating in the CohMSM prospective cohort study in West Africa. PLoS One. 2019; 14(11): e0217115. PubMed Abstract | Publisher Full Text | Free Full Text
8. Morhason-Bello IO, et al.: Reported oral and anal sex among adolescents and adults reporting heterosexual sex in sub-Saharan Africa: a systematic review. Reprod. Health. 2019; 16(1): 48. PubMed Abstract | Publisher Full Text | Free Full Text
9. Cherie A, Berhane Y: Oral and anal sex practices among high school youth in Addis Ababa, Ethiopia. BMC Public Health. 2012; 12: 5. PubMed Abstract | Publisher Full Text | Free Full Text
10. Fentie Ambaw AM, Gobena T: SEXUAL PRACTICES AND THEIR DEVELOPMENT PATTERN AMONG JIMMA UNIVERSITY STUDENTS.2011.
11. Page MJ, et al.: The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71. Publisher Full Text
12. Data Extraction Form adapted from the Cochrane Collaboration. BMJOPEN. 2017.
13. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021.
14. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews, PRISMA Flow chart. BMJ. 2021.
15. Institute, B: The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Review, Checklist for Systematic Reviews and Research Syntheses.2017.
16. Downes MJ, et al.: Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open. 2016; 6(12): e011458. PubMed Abstract | Publisher Full Text | Free Full Text
17. Wells GA, Shea B, O’Connell D, et al.: The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.2021.
18. Warrens MJ: Kappa coefficients for dichotomous-nominal classifications. ADAC. 2020; 15(1): 193–208. Publisher Full Text
19. Kulinskaya E, Hoaglin DC: On the Q statistic with constant weights in meta-analysis of binary outcomes. BMC Med. Res. Methodol. 2023; 23(1): 146. PubMed Abstract | Publisher Full Text | Free Full Text
20. von Hippel PT : The heterogeneity statistic I(2) can be biased in small meta-analyses. BMC Med. Res. Methodol. 2015; 15: 35. PubMed Abstract | Publisher Full Text | Free Full Text
21. Deresse D, Debebe S: Magnitude of risky sexual behavior among high school adolescents in Ethiopia: A cross-sectional study. J. Public Health Epidemiol. 2014; 6(7): 211–215. Publisher Full Text
22. Mavhandu-Mudzusi AH, Asgedom T: The prevalence of risky sexual behaviours amongst undergraduate students in Jigjiga University, Ethiopia. Health SA Gesondheid. 2016; 21: 179–186. Publisher Full Text
23. Mesele J, et al.: Level and determinants of knowledge, attitude, and practice of risky sexual behavior among adolescents in Harar, Ethiopia. SAGE Open Med. 2023; 11: 20503121221145539. PubMed Abstract | Publisher Full Text | Free Full Text
24. Tesfaye Y, Agenagnew L: Knowledge, Attitude, and Practices of Jimma Teacher Training College Students Toward Risky Sexual Behaviors, Jimma, Ethiopia.2020.
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29. Tesfaye Y, Agenagnew L: Knowledge, Attitude, and Practices of Jimma Teacher Training College Students Toward Risky Sexual Behaviors, Jimma, Ethiopia. Sex Med. 2020; 8: 554–564. Publisher Full Text

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VERSION 1 PUBLISHED 27 Jun 2025

Author details Author details

¹ Department of Referral Hospital, Ambo University College of Medicine and Public Health, Ambo, Oromia, Ethiopia
² Department of Public Health, Institute of Health, Wollega University, Nekemte, Oromia, Ethiopia
³ Department of Public Health, Hawassa University College of Medicine and Health Sciences, Awassa, Southern Nations, Nationalities, and People's Region, Ethiopia

Belete Feyera Olkaba
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Desalegn Wirtu Teso
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Dejene Hailu Kassa
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

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https://doi.org/10.12688/f1000research.164902.1

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Feyera Olkaba B, Wirtu Teso D and Hailu Kassa D. Prevalence and determinants of heterosexual anal and oral sex practice among young people in Ethiopia: systematic review and Meta-analysis [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:634 (https://doi.org/10.12688/f1000research.164902.1)

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[1] 1. Morhason-Bello IO, et al.: Heterosexual Oral and Anal Sex: Perceptions, Terminologies, and Attitudes of Younger and Older Adults in Ibadan, Nigeria. Arch. Sex. Behav. 2023; 52(1): 161–175. PubMed Abstract | Publisher Full Text | Free Full Text

[2] 2. Alemu MT, Dessie Y, Gobena T, et al.: Oral and anal sexual practice and associated factors among preparatory school youths in Dire Dawa city administration, Eastern Ethiopia.2018.

[3] 3. Shayo EH, et al.: Prevalence and risk factors associated with female anal sex in the context of HIV/AIDS in the selected districts of Tanzania. BMC. Res. Notes. 2017; 10(1): 140. PubMed Abstract | Publisher Full Text | Free Full Text

[4] 4. Mazeingia YT, Olijjira L, Dessie Y: Anal sexual experience and HIV risk awareness among female sex workers in Dire Dawa, eastern Ethiopia. Glob. Health Res. Policy. 2017; 2: 27. PubMed Abstract | Publisher Full Text | Free Full Text

[5] 5. Habel MA, et al.: Heterosexual Anal and Oral Sex in Adolescents and Adults in the United States, 2011-2015. Sex. Transm. Dis. 2018; 45(12): 775–782. PubMed Abstract | Publisher Full Text | Free Full Text

[6] 6. Carlos S, et al.: Heterosexual oral and anal sex in Kinshasa (D.R.Congo): Data from OKAPI prospective cohort. PLoS One. 2019; 14(1): e0210398. PubMed Abstract | Publisher Full Text | Free Full Text

[7] 7. Kounta CH, et al.: Transactional sex among men who have sex with men participating in the CohMSM prospective cohort study in West Africa. PLoS One. 2019; 14(11): e0217115. PubMed Abstract | Publisher Full Text | Free Full Text

[8] 8. Morhason-Bello IO, et al.: Reported oral and anal sex among adolescents and adults reporting heterosexual sex in sub-Saharan Africa: a systematic review. Reprod. Health. 2019; 16(1): 48. PubMed Abstract | Publisher Full Text | Free Full Text

[9] 9. Cherie A, Berhane Y: Oral and anal sex practices among high school youth in Addis Ababa, Ethiopia. BMC Public Health. 2012; 12: 5. PubMed Abstract | Publisher Full Text | Free Full Text

[10] 10. Fentie Ambaw AM, Gobena T: SEXUAL PRACTICES AND THEIR DEVELOPMENT PATTERN AMONG JIMMA UNIVERSITY STUDENTS.2011.

[11] 11. Page MJ, et al.: The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71. Publisher Full Text

[12] 12. Data Extraction Form adapted from the Cochrane Collaboration. BMJOPEN. 2017.

[13] 13. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021.

[14] 14. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews, PRISMA Flow chart. BMJ. 2021.

[15] 15. Institute, B: The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Review, Checklist for Systematic Reviews and Research Syntheses.2017.

[16] 16. Downes MJ, et al.: Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open. 2016; 6(12): e011458. PubMed Abstract | Publisher Full Text | Free Full Text

[17] 17. Wells GA, Shea B, O’Connell D, et al.: The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.2021.

[18] 18. Warrens MJ: Kappa coefficients for dichotomous-nominal classifications. ADAC. 2020; 15(1): 193–208. Publisher Full Text

[19] 19. Kulinskaya E, Hoaglin DC: On the Q statistic with constant weights in meta-analysis of binary outcomes. BMC Med. Res. Methodol. 2023; 23(1): 146. PubMed Abstract | Publisher Full Text | Free Full Text

[20] 20. von Hippel PT : The heterogeneity statistic I(2) can be biased in small meta-analyses. BMC Med. Res. Methodol. 2015; 15: 35. PubMed Abstract | Publisher Full Text | Free Full Text

[21] 21. Deresse D, Debebe S: Magnitude of risky sexual behavior among high school adolescents in Ethiopia: A cross-sectional study. J. Public Health Epidemiol. 2014; 6(7): 211–215. Publisher Full Text

[22] 22. Mavhandu-Mudzusi AH, Asgedom T: The prevalence of risky sexual behaviours amongst undergraduate students in Jigjiga University, Ethiopia. Health SA Gesondheid. 2016; 21: 179–186. Publisher Full Text

[23] 23. Mesele J, et al.: Level and determinants of knowledge, attitude, and practice of risky sexual behavior among adolescents in Harar, Ethiopia. SAGE Open Med. 2023; 11: 20503121221145539. PubMed Abstract | Publisher Full Text | Free Full Text

[24] 24. Tesfaye Y, Agenagnew L: Knowledge, Attitude, and Practices of Jimma Teacher Training College Students Toward Risky Sexual Behaviors, Jimma, Ethiopia.2020.

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Prevalence and determinants of heterosexual anal and oral sex practice among young people in Ethiopia: systematic review and Meta-analysis

Abstract

Introduction

PROSPERO Registration number

Objectives of the review

Methods

Result

Conclusions

Keywords

Introduction

Methods

Searching strategies

Eligibility criteria

Figure 1. PRISMA flow diagram adapted.

Outcomes

Data collection process and analysis

Data extraction (selection and coding)

Risk of bias assessment

Strategy for data synthesis and analysis

Table 1. Characteristics of included studies on systematic review and meta-analysis on heterosexual anal and oral sex practices among young peoples in Ethiopia.

Result

Figure 2. Prevalence of heterosexual anal sex among young people in Ethiopia.

Figure 3. Prevalence of heterosexual oral sex practices among young peoples in Ethiopia.

Sensitivity analysis

Figure 4. Publication bias test for heterosexual anal sex practice by one leave out.

Figure 5. Publication bias for heterosexual oral sex practice using one leave-out.

Heterogeneity and publication bias

Figure 6. Publication bias test using standard funnel plot for heterosexual oral sex practice.

Gender difference

Figure 7. Sex difference as a Predictor of anal sexual practice.

Living arrangement

Figure 8. Living alone as a predictor of anal sex practice.

Living arrangements for heterosexual oral sex practice

Figure 9. Living Alone as a predictor of heterosexual oral sex practice.

Intimate partner engagement

Figure 10. Intimate partner engaged in Oral sex practice as oral sex practice.

Discussions

Conclusions

Ethical considerations

Data availability statement

Underlying data

Extended data

References

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