Evaluation of a school based comprehensive sexuality education program among very young adolescents in rural Uganda

Abstract Background Limited research has been conducted on the effectiveness of sexuality education for very young adolescents (VYAs) ages 10–14 years in Sub-Saharan Africa. Furthermore, evaluations of sexuality education programs often report outcomes of risky sexual practices, yet positive aspects of sexuality are hardly studied and rarely reported. This study evaluates the effectiveness of a Comprehensive Sexuality Education (CSE) intervention for VYAs in Uganda, analyzing both positive and negative outcome indicators. Methods We conducted a mixed methods study, incorporating a cluster randomized trial (NCT03669913) among pupils in 33 randomly selected primary schools in Mbarara district. This was followed by a qualitative evaluation of the intervention in 4 schools that included 14 in-depth interviews and 3 focus group discussions distributed among pupils, teachers and parents. Quantitative data were analyzed using ordered logistic regression to compare differences in the change from baseline to endline between the intervention and control arms. We conducted bivariate analysis and multiple regression analysis controlling for key covariates, including age, gender, school location (rural vs urban), truancy, and orphanhood. Qualitative data were analyzed by thematic approach using ATLAS TI. Results Between July 2016 and August 2017, 1096 pupils were recruited. Outcomes were studied among 380 pupils in the intervention arm and 484 pupils in the control arm. The proportion of pupils who ever had sex increased from 9 to 12.1% in intervention compared to 5.2 to 7.4% in the control group between baseline and endline, however the differences between groups were not statistically significant. We found greater improvements in sexual and reproductive health (SRH) knowledge among intervention schools (AOR: 2.18, 95% CI: 1.66–2.86) and no significant differences in self-esteem, body image or gender equitable norms. Qualitative evidence echoes perceived SRH knowledge acquisition, increased their perception of SRH related risks, and intentions to delay sexual intercourse to prevent unwanted pregnancy, HIV and other STIs. Conclusion This study demonstrates that CSE can improve SRH knowledge and behavioral intentions among VYAs in Uganda. These results further emphasize the importance of initiating sexuality education before most adolescents have started engaging in sexual activity, enabling them to make informed decisions in the future. Trial registration NCT03669913, registered retrospectively on September 13th, 2018.

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Person Centered Antenatal Care and Associated Factors in Rwanda: A Secondary Analysis of Program Data

10.21203/rs.3.rs-103136/v1 ◽

2020 ◽

Author(s):

Phoebe Miller ◽

Patience Afulani ◽

Sabine Furere Musange ◽

Felix Sayingoza ◽

Dilys Walker

Keyword(s):

Antenatal Care ◽

Secondary Analysis ◽

Sub Saharan Africa ◽

Bivariate Analysis ◽

Control Group ◽

Levels Of Care ◽

Sub Saharan ◽

Systematic Understanding ◽

Cluster Randomized ◽

Survey Responses

Abstract Background: Research suggests that person centered antenatal care (PCANC) provides an effective tool for addressing maternal deaths in Sub-Saharan Africa through the delivery of health care which is both respectful of, and responsive to, the preferences, needs, and values of women. Yet little is known in Rwanda about either the extent to which PCANC is practiced or the factors that might determine its use. This is the first study to quantitatively examine the extent of and the factors associated with PCANC in Rwanda.Methods: We used quantitative data from a pair-matched cluster randomized control trial (CRCT) in Rwanda. A total of 2,150 surveys were used from 36 health centers across five districts. Eligible women were 16 – 49 years old and were not referred to higher levels of care or had incomplete survey responses. Results: PCANC was found to be sub-optimal with 30% of women leaving antenatal care (ANC) either with questions or confused and 24% feeling disrespected. In bivariate analysis, factors that significantly predict high PCANC are better levels of cognitive maternal empowerment, greater parity, being in the traditional care (control group), and being from Burera district. The study group to which women were assigned and the district in which women received care were significantly associated with PCANC in the multivariate analysis.Conclusions: Given the benefits of PCANC, improvements in PCANC through provider training in Rwanda might promote an institutional culture shift towards a more person-centered model of care. We also found that better measurement tools are needed to more comprehensively measure PCANC and recommend wider use of these validated tools in national surveys to get a systematic understanding of PCANC in Rwanda. Additionally, we recommend thoughtful measures of empowerment during antenatal care to capture the social experiences of women in Rwanda. Trial registration: Not applicable

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School Area Road Safety Assessment and Improvements (SARSAI) programme reduces road traffic injuries among children in Tanzania

Injury Prevention ◽

10.1136/injuryprev-2018-042786 ◽

2018 ◽

Vol 25 (5) ◽

pp. 414-420 ◽

Cited By ~ 4

Author(s):

Ayikai Poswayo ◽

Simon Kalolo ◽

Katheryn Rabonovitz ◽

Jeffrey Witte ◽

Alejandro Guerrero

Keyword(s):

Injury Prevention ◽

Road Safety ◽

Primary Schools ◽

Road Traffic ◽

Sub Saharan Africa ◽

Prevention Programme ◽

Control Group ◽

School Aged Children ◽

Catchment Areas ◽

The Impact

PurposeTo determine the impact of a paediatric road traffic injury (RTI) prevention programme in urban Sub-Saharan Africa.SettingDares Salaam, Republic of Tanzania.MethodsHousehold surveys were conducted in catchment areas around 18 primary schools in Dar es Salaam, Republic of Tanzania; the catchment areas were divided into control and intervention groups. Collected data included basic demographic information on all school-aged household members and whether or not they had been involved in an RTI in the previous 12 months, and, if so, what the characteristics of that RTI were. Based on these findings, a separate road safety engineering site analysis and consultation with the communities and other stakeholders, an injury-prevention programme was developed and implemented, consisting of infrastructure enhancements and a site-specific educational programme. The programme was initially implemented at the intervention schools. After 1 year, data were collected in the same manner. The control group received the same intervention after follow-up data were collected.ResultsData were collected on 12 957 school-aged children in the baseline period and 13 555 school-aged children in the post-intervention period, in both the control and intervention communities. There was a statistically significant reduction in RTIs in the intervention group and a non-significant increase in RTI in the control group. The greatest reduction was in motorcycle–pedestrian RTI, private vehicle–pedestrian RTI and morning RTI.ConclusionThe programme demonstrated a significant reduction in paediatric RTI after its implementation, in very specific ways. This study demonstrates that for a reasonable investment, scientifically driven injury-prevention programmes are feasible in resource-limited settings with high paediatric RTI rates.

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Effects of Comprehensive Sexuality Education on the comprehensive knowledge and attitude to condom use among first-year students in Arba Minch University: a quasi-experimental study

10.21203/rs.2.14432/v2 ◽

2019 ◽

Author(s):

Negussie Boti ◽

Sultan Hussen ◽

Mulugeta Shegaze ◽

Simon Shibru ◽

Tamiru shibiru ◽

...

Keyword(s):

Condom Use ◽

Sexuality Education ◽

Control Group ◽

First Year ◽

First Year Students ◽

Comprehensive Sexuality Education ◽

Education Group ◽

Comprehensive Knowledge ◽

Average Change ◽

Knowledge And Attitude

Abstract ABSTRACT Objective: To assess the effect of comprehensive sexuality education on the comprehensive knowledge and attitude to condom use among first-year students at Arba Minch University . Results: A total of 832 students participated at a baseline, and 820 students participated at the posttest. This study found that there was a significant effect on changing students’ knowledge and attitude towards a condom. In the education group, the students’ average change of comprehensive condom knowledge score was 0.229 higher than the average score of students' in the control group (ATE=0.229, 95% CI, 0.132 to 0.328; p < 0.001). The average change of attitude toward condom score of students’ in the education group was 1.834 higher than the average change score of students’ in the control group (ATE=1.834, 95% CI, 1.195 to 2.772; p < 0.001).This study provides further evidence on the effectiveness of comprehensive sexuality education in terms of knowledge and attitude towards a condom. Therefore, the implementation of this education should be strengthened in order the prevent youths from STI/HIV and unintended pregnancies.

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Process evaluation of a comprehensive sexuality education intervention in primary schools in South Western Uganda

Sexual & Reproductive Healthcare ◽

10.1016/j.srhc.2019.06.006 ◽

2019 ◽

Vol 21 ◽

pp. 51-59 ◽

Cited By ~ 1

Author(s):

Elizabeth Kemigisha ◽

Olena Ivanova ◽

Gad N. Ruzaaza ◽

Anna B. Ninsiima ◽

Ruth Kaziga ◽

...

Keyword(s):

Process Evaluation ◽

Primary Schools ◽

Sexuality Education ◽

Education Intervention ◽

Comprehensive Sexuality Education ◽

Western Uganda

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Why teach sexuality education in school? Teacher discretion in implementing comprehensive sexuality education in rural Zambia

International Journal for Equity in Health ◽

10.1186/s12939-019-1023-1 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Joseph Mumba Zulu ◽

Astrid Blystad ◽

Marte E. S. Haaland ◽

Charles Michelo ◽

Haldis Haukanes ◽

...

Keyword(s):

Reproductive Health ◽

Sexuality Education ◽

Health Knowledge ◽

School Teacher ◽

Unwanted Pregnancy ◽

Design Data ◽

Comprehensive Sexuality Education ◽

School Activities ◽

International Agencies ◽

Unwanted Pregnancies

Abstract Background Reproductive health problems such as HIV, unwanted pregnancy and unsafe abortion among adolescents are closely linked to insufficient knowledge about sexuality and reproduction and lack of access to contraceptives. Supported by international agencies, Zambia has introduced an ambitious nation-wide program for comprehensive sexuality education (CSE) to be implemented into ordinary school activities by teachers. The curriculum is firmly based in a discourse of sexual and reproductive rights, not commonly found in the public debate on sexuality in Zambia. This paper explores how teachers perceive the curriculum and practice discretion when implementing the CSE in mid-level schools in Nyimba district in Zambia. Methods Using a case study design, data were collected through in-depth interviews with 18 teachers and analyzed thematically drawing upon theories of discretion and policy implementation. Results Individual teachers make decisions on their own regarding what and when to teach CSE. This discretion implies holding back information from the learners, teaching abstinence as the only way of preventing pregnancy or cancelling sexuality education sessions altogether. Teachers’ choices about the CSE program were linked to lack of guidance on teaching of the curriculum, especially with regards to how to integrate sexuality education into existing subjects. Limited prioritization of CSE in the educational sector was observed. The incompatibility of CSE with local norms and understandings about adolescent sexuality combined with teacher-parent role dilemmas emerged as problematic in implementing the policy. Limited ownership of the new curriculum further undermined teachers’ motivation to actively include CSE in daily teaching activities. Use of discretion has resulted in arbitrary teaching thus affecting the acquisition of comprehensive sexual and reproductive health knowledge among learners. Conclusion The CSE had limited legitimacy in the community and was met with resistance from teachers tasked with its’ implementation. In order to enhance ownership to the CSE program, local concerns about the contents of the curriculum and the parent-teacher role dilemma must be taken into consideration. Not addressing these challenges may undermine the policy’s intention of increasing knowledge about sexuality and reproduction and empowering adolescents to access contraceptive services and avoid unwanted pregnancies.

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Comprehensive sexuality education in sub-Saharan Africa: adaptation and implementation challenges in universal access for children and adolescents

Sexual and Reproductive Health Matters ◽

10.1080/26410397.2020.1851346 ◽

2020 ◽

Vol 28 (2) ◽

pp. 1851346

Author(s):

Cynthia Khamala Wangamati

Keyword(s):

Children And Adolescents ◽

Sexuality Education ◽

Universal Access ◽

Sub Saharan Africa ◽

Comprehensive Sexuality Education ◽

Implementation Challenges ◽

Sub Saharan

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Effects of Comprehensive Sexuality Education on the comprehensive knowledge and attitude to condom use among first-year students in Arba Minch University: a quasi-experimental study

10.21203/rs.2.14432/v3 ◽

2019 ◽

Author(s):

Negussie Boti ◽

Sultan Hussen ◽

Mulugeta Shegaze ◽

Simon Shibru ◽

Tamiru shibiru ◽

...

Keyword(s):

Condom Use ◽

Sexuality Education ◽

Control Group ◽

First Year ◽

First Year Students ◽

Comprehensive Sexuality Education ◽

Education Group ◽

Comprehensive Knowledge ◽

Average Change ◽

Knowledge And Attitude

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Effects of comprehensive sexuality education on the comprehensive knowledge and attitude to condom use among first-year students in Arba Minch University: a quasi-experimental study

BMC Research Notes ◽

10.1186/s13104-019-4746-6 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 1

Author(s):

Negussie Boti ◽

Sultan Hussen ◽

Mulugeta Shegaze ◽

Simon Shibru ◽

Tamiru Shibiru ◽

...

Keyword(s):

Condom Use ◽

Sexuality Education ◽

Control Group ◽

First Year ◽

First Year Students ◽

Comprehensive Sexuality Education ◽

Education Group ◽

Comprehensive Knowledge ◽

Average Change ◽

Knowledge And Attitude

Abstract Objective To assess the effect of comprehensive sexuality education on the comprehensive knowledge and attitude to condom use among first-year students at Arba Minch University. Results A total of 832 students participated at a baseline, and 820 students participated at the posttest. This study found that there was a significant effect on changing students’ knowledge and attitude towards a condom. In the education group, the students’ average change of comprehensive condom knowledge score was 0.229 higher than the average score of students’ in the control group (ATE = 0.229, 95% CI 0.132 to 0.328; p < 0.001). The average change of attitude toward condom score of students’ in the education group was 1.834 higher than the average change score of students’ in the control group (ATE = 1.834, 95% CI 1.195 to 2.772; p < 0.001).This study provides further evidence on the effectiveness of comprehensive sexuality education in terms of knowledge and attitude towards a condom. Therefore, the implementation of this education should be strengthened in order the prevent youths from STI/HIV and unintended pregnancies.

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Zambia: Peer educators can promote safer sex behaviors

10.31899/rh2001.1031 ◽

2001 ◽

Author(s):

Keyword(s):

High Risk ◽

Urban Communities ◽

Sexual Behaviors ◽

Unwanted Pregnancy ◽

Sexual Practices ◽

Control Group ◽

Peer Educators ◽

Sexually Transmitted ◽

Small Business Loans ◽

Stis And Hiv

Zambian adolescents are at high risk of unwanted pregnancy, sexually transmitted infections (STIs), and HIV infection due to early sexual initiation, low use of contraceptives and condoms, and other high-risk sexual behaviors. During 1996–1998, CARE Zambia and the Population Council conducted a study to test community-based approaches to improve adolescent sexual and reproductive health. CARE Zambia talked to adolescents in four communities outside Lusaka. Using participatory learning and action techniques, researchers identified factors leading to high-risk sexual behaviors, including lack of economic, recreational, and educational opportunities for youth. This information helped to design the study. Two interventions—condom distribution by peer educators and small business loans to youth—led to safer sexual practices among adolescents in peri-urban communities. Both program participants and their peers reported an increase in abstinence and monogamy and a decrease in STIs. As noted in this brief, youth in the intervention areas were better informed about ways to prevent HIV/AIDS than those in the control group, however the interventions did not lead to greater use of contraception or condoms for dual protection.

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