School-based sexual health education interventions to prevent STI/HIV in sub- Saharan Africa: a systematic review and meta-analysis (original) (raw)
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School-Based Sexual Health Education Interventions in Sub-Saharan Africa: A Multiple Case Study
School-based sexual health education is one of the most comprehensive and effective ways of promoting young people's sexual health, reducing risky sexual behaviours and preventing sexually transmitted infections. This study investigated the design, implementation and evaluation of seven school-based sexual health education interventions in five sub-Saharan African countries, to identify features that may be associated with effectiveness or ineffectiveness on self-reported condom use and preventing sexually transmitted infections. A multiple case study design was employed. Data from each intervention were collected through documents review and interviews with key investigators. Data were analysed using a combination of case study methods. The findings confirmed that interventions that had greater numbers of features recommended by previous evidence synthesis studies were more likely to be effective. Findings suggested that young people's sexual health needs assessment could be improved by applying ethnography, and Sexual Script research, which, in turn, could make interventions more effective. School-based interventions should consider environmental factors by incorporating community-based approaches and using ecological models as theories underpinning interventions. Interventions were also more likely to be effective if delivered by both teachers and peer educators. Finally, optimum impact is likely if young people are exposed to interventions for at least two years/academic sessions. Future intervention design should consider these features to optimise effectiveness of school-based sexual health education in sub-Saharan Africa.
School-based sexual health education is one of the most comprehensive and effective ways of promoting young people's sexual health, reducing risky sexual behaviours and preventing sexually transmitted infections. This study investigated the design, implementation and evaluation of seven school-based sexual health education interventions in five sub-Saharan African countries, to identify features that may be associated with effectiveness or ineffectiveness on self-reported condom use and preventing sexually transmitted infections. A multiple case study design was employed. Data from each intervention were collected through documents review and interviews with key investigators. Data were analysed using a combination of case study methods. The findings confirmed that interventions that had greater numbers of features recommended by previous evidence synthesis studies were more likely to be effective. Findings suggested that young people's sexual health needs assessment could be improved by applying ethnography, and Sexual Script research, which, in turn, could make interventions more effective. School-based interventions should consider environmental factors by incorporating community-based approaches and using ecological models as theories underpinning interventions. Interventions were also more likely to be effective if delivered by both teachers and peer educators. Finally, optimum impact is likely if young people are exposed to interventions for at least two years/academic sessions. Future intervention design should consider these features to optimise effectiveness of school-based sexual health education in sub-Saharan Africa.
International Health, 2012
In this study, the effects on young adolescent sexual risk behaviour of teacher-led school HIV prevention programmes were examined in two sites in South Africa (Cape Town and Mankweng) and one site in Tanzania (Dar es Salaam). In Cape Town, Dar es Salaam and Mankweng, 26, 24 and 30 schools, respectively, were randomly allocated to intervention or comparison groups. Primary outcomes were delayed sexual debut and condom use among adolescents aged 12-14 years (grade 8 in South Africa and grades 5 and 6 in Tanzania). In total, 5352, 4197 and 2590 students participated at baseline in 2004 in Cape Town, Dar es Salaam and Mankweng, respectively, and 73% (n = 3926), 88% (n = 3693) and 83% (n = 2142) were retained 12-15 months later. At baseline, 13% (n = 224), 5% (n = 100) and 17% (n = 164) had had their sexual debut, and 44% (n = 122), 20% (n = 17) and 37% (n = 57) of these used a condom at last sex, respectively. In Dar es Salaam, students in the intervention were less likely to have their sexual debut during the study (OR 0.65, 95% CI 0.48-0.87). In Cape Town and Mankweng, the intervention had no impact. The current interventions were effective at delaying sexual debut in Dar es Salaam but not in South Africa, where they need to be supplemented with programmes to change the environment in which adolescents make decisions about sexual behaviour.
Effective Adolescent Sexual and Reproductive Health Education Programs in Sub-Saharan Africa
2013
The objective of this review was to explore and identify feasible, socially acceptable and effective adolescent sexual and reproductive health education (ASRHE) programs in sub-Saharan Africa. Methods: Four databases were searched to identify studies conducted within the past 15 years which evaluate the effectiveness of ASRHE programs in sub-Saharan Africa. The databases searched were Embase, Medline, CINAHL, PyscINFO. A further search for relevant articles was made in the Google scholar website. The title and abstract of each article were analyzed for relevance by applying inclusion and exclusion criteria. Further scrutiny and extraction of the studies was completed by selecting only those studies which met the criteria for inclusion. Results: Fifteen studies were identified. School, peer, mass media, health facility and community based ASRHE programs showed positive impact in one or more of the following outcomes in adolescents in sub-Saharan Africa: ( i) knowledge of HIV transmission; (ii) perceived personal risk of contracting HIV/ AIDS; (iii) self-efficacy to negotiate condom use; (iv) discussion with others about HIV/AIDS or condom use; (v) abstinence from sexual relations; (vi) reduction in high-risk sexual behavior; (vii) condom use (vii) testing for sexually transmitted infection (STI) and (viii) treatment seeking behavior. Conclusion: ASRHE programs of diverse forms can produce positive change in adolescent sexual and reproductive health (ASRH). There is need for rigorous research to assess long term behavioral effects of culturally tailored comprehensive ASRHE programs in sub-Saharan Africa.
2021
Introduction Early sexual debut is associated with poor sexual and reproductive health outcomes across the life course. A majority of interventions aimed at delaying sexual debut among adolescents in sub-Saharan Africa (SSA) have been implemented in schools with mixed findings on the effectiveness of such interventions. This systematic review will summarise and synthesise existing evidence on the effectiveness of school-based interventions in delaying sexual debut among adolescents aged 10–19 years. Methods and analysis We will conduct a comprehensive database search of peer-reviewed studies published in PubMed, Scopus, Science Direct, Web of Science, HINARI and EBSCO (PsycINFO, Global Health, CINAHL) and in Cochrane library, National Institute of Health and Turning Research into Practice databases for ongoing studies yet to be published. All studies conducted in SSA between January 2009 and December 2020, regardless of the study design, will be included. Two authors will independen...