The study examined the prevalence and determinants of condom use among sexually active youth in the last sexual intercourse within 4 months before the study. The results showed the prevalence of condom use to be higher among the male 861 (55.8%) than female 952 (18.5%). Similar results were also found in some studies conducted in Kenya and Benin [15, 28]. Low prevalence of condom use facilitates the spread of STI’s including HIV and unplanned pregnancies [2]. The vulnerability of women affects their negotiation power to safer sex unless a man initiates condom use. On the other hand male condoms are easily accessible than female condoms as such it is easier for men to have control over their use it than women. However, some studies conducted in Cambodia, Ethiopia, and Ghana showed a high prevalence of condom use among female[17, 29, 30]. The difference in the findings could be due to socio-economic status, availability of condoms, carrier aspirations, and expectations of the youth [17]. In the current study, the highest level of education for about 69% of the youth was no education and primary, indicating low socio-economic status.

Among all the youth low prevalence of 27.1% for condom use was established during the last sexual intercourse within 4 months before the study. These findings were similar to a study conducted by Perera and Abeysena (2018) in Sri Lanka who found that 85.8% of sexually active undergraduates did not use condoms in their last sexual activity. Sex distribution in the study population explains why the percentage was very low since female youth consisted of the majority of the study population. On the contrary, Nesidai and colleagues in Kenya established the prevalence of condom use to be high among the youth 72.8% [2]. The results were expected to be similar to Malawi because the government and other stakeholders provide condoms free. Since some literature has shown that providing free condoms increases the level of condom use [31].. This calls for an assessment of the effectiveness of the interventions responding to condom use among the youth in Malawi.

Regarding the determinants of condom use among the youth in Malawi, results revealed some gender differences. The study established male youth to be more likely to use condoms than female youth in their last sexual encounter within 4 months before the study. The results were similar to research done in the United States, Kenya, and Benin [15, 28, 32]. These results were due to a lack of negotiation skills for protected sex, unavailability of female condoms, not being comfortable to talk about sex with a partner, and having insufficient knowledge on condom use and its importance among the female youth [15].

A difference in age range among male and female youth was noted, as younger male (15–19 years) were insignificantly more likely to use a condom while female of same age were significantly less likely to use condom. The results were contrary to a study carried out in Kenya which found that the majority of older youth (20–24 years) were more likely to use condoms and similarly with female aged 15–19 [2]. In both cases, the results may be because of differences age distribution of the study population. In addition, not wanting to become pregnant or getting someone pregnant at a tender age might have attributed to the results.

Marital status was another variable taken into consideration. The study established among all the male and female youth those who were ever married were more likely to practice safe sex than those were never married. The findings are similar to a study conducted in Brazil [31] but differ with Nesidai and colleagues in Kenya who found no significant results on marital status[2]. As far as population distribution might have contributed to the results. The other reason could be that never married male and female youth may engage in transaction sex in exchange of material goods or other benefits[33, 34].

In terms of place of residence, the study found that male and female youth residing in a rural area had a decreased likelihood of using condoms in their last sexual intercourse within 4 months before the study. On contrary, a study by Sabegeh, place of residence did not produce significant results [13]. The reason for the contrary results was due to population distribution in the place of residence. In Malawi, majority (86%) of the population resides in rural areas which are characterized by insufficient knowledge on condom use and services..

Education level was also given consideration and among all the youth education was found not significant. The results differ from other studies conducted in Malawi[16, 35]. Education status was expected to be significant as in the past studies because the Malawian government-owned schools offer free education, which gives room for every child to have access to at least primary education. Education equips with different knowledge including on STI's including HIV and unplanned pregnancies and this has the ability to empower the youth to decide whether to practice safe sex or not [2, 35].

On working status, currently, working male were more likely to practice safe. On the contrary, the female who were working were more likely to practice safe, but insignificantly so.. However, the study did not produce the results as expected because working-class males often engage in multiple relationships and some studies found this often leads to unprotected sexual intercourse [16]. For the female, it was expected female who are currently working to more likely to use condoms because of being empowered and able to negotiate for safer sex [2].

Region and ethnic group was also taken into consideration. There was no significant result in ethnic group. On region, youth whether male or female in the central and southern regions were significantly less likely to use condom compared to those in the Northern region. The results were attributed by population distribution as majority of the study population were from these region.

A “lifetime number of sexual partners”[27] was not significant in the study the result was contrary to other studies that found it to be significant [16]. Despite these findings, it was expected that an individual with multiple partners often use condoms to prevent STI's including HIV.

Among all the youth, those who have ever tested for HIV were more likely to use condoms. The reason is to protect themselves from contracting the virus in instances where the youth is tested negative. However, this is not always the case when one is tested positive some youth start engaging in unprotected sex to spread the virus. A study conducted in Brazil found a negative association on condom use for female youth who tested for HIV [31].

Concerning sex, the odds significantly higher for female who had ever tested for of HIV. The results have implications for the development of policies and programs regarding condom use among the youths. Intensifying HIV testing among the youth and the general public can promote the practicing of safe sex thereby preventing STI's including HIV and unplanned pregnancies. In addition, education should be emphasized among all the youths to empower them to make the right decisions about condom use.