This study had assessed access and utilization of adolescents' and youths' sexual and reproductive health services and related challenges. Information about sexual and reproductive health services is a precondition for adolescent and youth sexual and reproductive health (AYSRH) service utilization (17). In this study, 28.1% of participants were reported to have heard about adolescents' and youths' sexual and reproductive health (AYSRH) services. This finding is lower than studies conducted in Pakistan (52%) , Nigeria (82%) , Northwest Ethiopia (89.4%) , Bale Zone, Ethiopia (96.1%) ,and Eastern Ethiopia (72.4%) . This difference might be explained by, in this study, the inclusion of a greater number of participants from rural areas and out of schools where there is no access to information.
In this study, the majority of the participants reported that schools were the major source of information about AYSRH services. Similarly, a study conducted in Eastern Ethiopia among youths indicated that the main source of information on AYSRH was school teachers (31.5%) . But, other studies conducted in other countries like Nigeria, Lagos (45.7%), and Pakistan, Labore (71%) revealed that the main source of information about adolescents and youths reproductive health services were friends [19, 20]. Mass media were the main source of information in Bale Zone, Ethiopia  and another study in Nigeria. This difference might be a result of school-based AYSRH education campaign activities by health professionals in the current study areas.
In this study, 219 (28.4%) of the study participants ever had sexual intercourse. This is similar to a study conducted in Osun in Nigeria where 25.5% of adolescents had experienced sexual intercourse . However, the finding in the current study is lower than that of study in Bale Zone, Ethiopia (39.5%) and North West Ethiopia (63.5%) [17, 22]. The observed difference might be attributed to the narrow geographical coverage in later studies than this study.
The utilization of AYSRH services was very low in the current study. Only 66 (8.6%) had ever visited health facilities for AYSRH services. This finding is lower than findings of similar studies conducted in Ethiopia among youths (63.8%) in Eastern Ethiopia , high school students in Bahirdar town (32%) ], and adolescents in Debre Berhan (33.8%)  and Northwest Ethiopia (18.4%) . The finding is also lower than reports from studies conducted among youths aged between 15 and 24 years in Mynamar (67%)  and Makassar Indonesia (24.3%) . The difference might be attributed to, in this study, the inclusion of a large number of participants from rural areas where access to information and health facility is limited.
In this study, the common AYSRH services adolescents and youths were using were HIV counseling & testing (65.15%) and contraceptives(40.91%). Similarly, more than half (60.57%) of youths in Northwest Ethiopia had used HIV counseling and testing . Youths in Debre Berhan used HIV counseling and testing service(43.6%) followed by AYSRH information and education services (23.7%) . A study in Myanmar among sub-urban youths aged between 15 and 24 years also showed family planning (70%) to be the most utilized service . In the current study, utilization of other sexual and reproductive health services was low. Therefore, the focus should be given to improve access and utilization of AYSRH services in the study areas.
In this study, not all participants had received the services they need at the initial visit. It was found that 48 (72.73%) had received the services on the same day of their visit. However, a study conducted in Bale Zone, Ethiopia showed 95% of the youths who came to health facilities, received all services they need on the day of their visit . This might be attributed to the differences in readiness of health facilities in terms of logistics, human power, and commitment of facility leaders. Study. The other possible explanation could be due to the work overload of care providers and the erratic supply of services in the current study as explained in the in-depth interview. For example, one male provider explained as “My work here is an additional job. I am primarily working in the expanded program for immunization (EPI) room where it has to be open always. When youths come for the service, I will ask them if their case is sensitive and will serve them at the EPI. Otherwise, I will either appoint on another day or refer them.”
This study showed that only 120(15.6%) of adolescents and youths reported that they had discussed at least one AYSRH topic with their family. This is lower compared to the studies conducted in Mecha District  and Awebal district (25.3%)  of Northwestern Ethiopia where respondents had a discussion on SRH issues with their families 32% and 25.5% respectively. The difference might be because the current study involved more participants from rural areas who are less encouraged to discuss SRH issues due to conservative cultural and religious practices than participants in later studies. Because societal norms like taboos of discussing sexuality with children are highly valued in rural communities.
Adolescents and youths Sexual and reproductive health services utilization were affected by different factors . The current study identified factors like the previous history of sexual intercourse, age of participants, information about sexual and reproductive health services, and history of visiting health facilities for other services. Study participants who had ever had sexual intercourse were more than 5 times likely to use the services compared to those who never experienced sexual intercourse. This could be due to a difference in risk perception. Adolescents and youths who had sexual intercourse might relatively have a high level of risk perception for sexual and reproductive health-related than those who abstain. The same finding was also from similar studies conducted in Ethiopia [5, 17].
In this study, participants aged 15 to 19 years were 64% less likely to use adolescents and youths' sexual and reproductive health services compared to those aged from 20 to 24 years. This might be explained as those participants greater than 20 might be those who already engage in sexual intercourse as the median age at first sexual intercourse was found to be 18 years. This finding is consistent with a study conducted in Southern Ethiopia  and Northwest Ethiopia, Bahirdar  were those aged 20 to 24 used youth-friendly service more likely than those aged 15 to 19 years.
The participants who have ever had sexual intercourse practice were more than 5 times likely to use AYSRH services compared to those who did not practice it. This might be because those with experience of sexual intercourse might visit the health facilities either to get condoms, contraception, and HIV/AIDS counseling and testing or to get some interventions like abortion services when they experience negative consequences from unprotected sexual practice. This finding is in line with other similar studies conducted in Ethiopia [29, 30] where sexually active youths were more likely to use the youth-friendly services.
In this study, participants who have ever heard about SRH services had used the service more than 11 times likely compared to those who never heard about it. It is consistent with studies conducted in Mandalay city, Myanmar , in Indonesia, Makassar , in Nigeria, Lagos , and Eastern Ethiopia, Harar  which indicated that those who heard about the service were more likely to use the youth health service than those who never heard. This indicates raising awareness on SRH and the services improve utilization of AYSRH services.
Participants who have ever visited health facilities for any type of health services had used the SRH service 5 times more likely compared to the youths who have never visited facilities for any service. This might be due to those who came to health facilities for other services might hear the presence of AYSRH services from health professionals. Thus, integrating AYSRH services to other services in health facilities could improve its utilization.