Abstract
BACKGROUND: Condom use in Rwanda is a significant public health topic, especially in efforts to prevent sexually transmitted infections (STIs), including HIV/AIDS, unplanned pregnancies and other health problems such as cervical cancer. In Rwanda, the government and various organizations actively promote condom use through comprehensive sexual and reproductive health initiatives such as sexual health education and condom distribution in schools, communities and public places. Despite these efforts, many individuals still fail to adopt consistent condom use, leading to significant health consequences. To enhance health and condom promotion programs, it is crucial to understand the factors contributing to low condom use and to identify regions with the lowest uptake. METHODS: This study analyzes data from the 2019/2020 Rwanda Demographic and Health Survey (RDHS) to investigate the prevalence and determinants of condom use during the last sexual intercourse among reproductive-aged women in Rwanda. A geo-additive model was employed to account for geographical variation in condom use, enabling the identification of regional disparities and spatial patterns. These methodological approaches provide a robust framework for understanding individual and contextual factors influencing condom use in Rwanda. RESULTS: The findings revealed a 10.8% prevalence of condom use and highlighted significant regional disparities in usage patterns. Women who reported living with a man had significantly lower odds of condom use compared to those not living with a man (AOR = 0.07, 95% CrI: 0.06-0.09). Those with primary education had significantly higher odds of condom use compared to those with no education (AOR = 1.39, 95% CrI: 1.04-1.84). Central and Northern districts, such as Ruhango and Musanze, showed positive structured spatial effects, suggesting regionally correlated factors promoting condom use. Unstructured spatial effects highlighted significant district-specific variations, with areas like Ruhango and Rusizi exhibiting higher odds of condom use, while Nyamagabe and Gasabo had lower odds. CONCLUSION: Spatial disparities in condom use suggest a need for region-specific interventions, particularly in the Southern and Northern regions of Rwanda. Efforts should focus on enhancing education access and economic empowerment while addressing cultural and relational barriers to condom use in cohabiting relationships.