Effectiveness of school-based interventions in delaying sexual debut among adolescents in sub-Saharan Africa: a protocol for a systematic review and meta-analysis (original) (raw)
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Scandinavian Journal of Public Health, 2006
Aims: Action to prevent the spread of HIV among young people in Sub-Saharan Africa is needed urgently. In order to be effective, such action should be theory and evidence based and carefully adapted to local cultures and contexts. The present article describes the organization, theoretical basis, and methodological approach of a project that aims at developing and evaluating school-based interventions targeting adolescents aged 12-14 years. Methods: Researchers from European and African universities have developed interventions that were conducted in three sites: Cape Town and Polokwane (South Africa) and Dar es Salaam (Tanzania). In each site the interventions were evaluated through large-scale field experiments with intervention schools and delayed intervention schools and with baseline and two follow-up data collections. Mimimum sample sizes were estimated for each site based on local data and taking into acount that the unit of allocation was schools and not individual students (the design effect). During the formative phase as well as within the field experiments, qualitative studies were also conducted. Discussion: The interventions were developed consistent with the Intervention Mapping approach, and the theoretical framework was based on a modified version of the Theory of Planned Behaviour. The limitations of Western social cognition models were recognized, and the theoretical framework has therefore been expanded in two directions: towards integrating cultural processes and towards taking societal factors and constraints into account. Conclusion: The project will throw light on the application of social cognition models as well as the usefulness of the Intervention Mapping approach to intervention development in sub-Saharan Africa.
BMJ Open, 2022
Introduction Targeting very young adolescents (VYAs) with sexual health (SH) interventions is increasingly being recognised as one of the strategies for addressing SH challenges in late adolescence. However, there is a dearth of literature regarding SH interventions implemented specifically for VYAs in sub-Saharan Africa (SSA). This scoping review aims to provide a summary of documented evidence on SH interventions that include VYAs in SSA, identify gaps in existing interventions and provide recommendations for further programmatic work on SH for VYAs. Methods and analysis The methods for this scoping review will be guided by the framework proposed by Arksey and O'Malley and further enhanced by Levac et al and the Joanna Briggs Institute. We will search electronic databases: Popline, EMBASE, PubMed, CINAHL, Dimensions, African Journals Online (AJOL) and specific summon country-specific search. We will include published studies from SSA and only adolescent SH interventions published from the year 2003-2022. Furthermore, we will include programmatic and intervention literature that has not been published in peerreviewed articles. The data will be charted using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review. The data will then be collated and summarised. Ethics and dissemination The scoping review methodology involves putting together information from articles or grey literature that is either publicly available or shared by the authors, this study does not require ethical approval. Findings of this scoping review will be published in a scientific journal and presented at relevant scientific fora and conferences. This scoping review will provide a comprehensive overview of the evidence base of adolescent SH interventions for VYAs in SSA and will highlight critical gaps in the existing interventions and areas where further programmatic work is needed for VYAs in SSA. Registration https://archive.org/details/osf-registrations-gn538-v1.
Background: School-based sexual health education has the potential to provide an inclusive and comprehensive approach to promoting sexual health among young people. We reviewed evaluations of school-based sexual health education interventions in sub-Saharan Africa to assess effectiveness in reducing sexually transmitted infections and promoting condom use. Methods: We searched ten electronic databases, hand-searched key journals, and reference lists of included articles for potential studies. Data were extracted on outcomes, intervention characteristics, methods and study characteristics indicative of methodological quality. Where possible, data were synthesized using random effect meta-analysis. Intervention features found predominantly in effective interventions were noted.
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.
BMC Public Health, 2014
Background: Young people in sub-Saharan Africa are affected by the HIV pandemic to a greater extent than young people elsewhere and effective HIV-preventive intervention programmes are urgently needed. The present article presents the rationale behind an EU-funded research project (PREPARE) examining effects of community-based (school delivered) interventions conducted in four sites in sub-Saharan Africa. One intervention focuses on changing beliefs and cognitions related to sexual practices (Mankweng, Limpopo, South Africa). Another promotes improved parent-offspring communication on sexuality (Kampala, Uganda). Two further interventions are more comprehensive aiming to promote healthy sexual practices. One of these (Western Cape, South Africa) also aims to reduce intimate partner violence while the other (Dar es Salaam, Tanzania) utilises school-based peer education.
Prevalence and Predictors of Early Sexual Debut among Adolescents in Ogbomoso, Nigeria
American Journal of Public Health Research, 2018
Background: Adolescent sexuality is an important subject of social concern because of its connection to negative outcomes like adolescent pregnancy and sexually transmitted infections. The timing of an adolescent's first sexual intercourse is thus a key variable affecting those negative outcomes. This study thought to determine the prevalence and predictors of early sexual debut among never-married adolescents in Ogbomoso, SouthWestern Nigeria. Methods: It was a cross-sectional study carried out between January and March 2016. Data was collected from a total of 447 never-married adolescents between 16 and 19 years using semi-structured interviewer administered questionnaires. Data was analyzed in SPSS version 20. Descriptive, bivariate and multivariate logistic regression analyses were performed. Results: About a quarter (26.80%) of the adolescents were sexually active with mean age at sexual debut of 15.80 in girls and 15.40 years in boys. An average of 18.60% had experienced sexual debut before their 15th birthday, 16.60 % in boys, and 20.20% in girls. Polygamous family setting, peer sex education, alcohol use, and poor reproductive health knowledge were predictors of early sexual debut. Conclusion: The study concluded that early initiation of sexual debut is high among study participants that have initiated sex. Religiosity and good social behavior were found to be protective against early sexual debut. Therefore, there is the need to ensure effective programmes that will built upon the understanding of those factors associated with an increased likelihood of an early sexual debut.
Pre-marital sexual debut and its associated factors among in-school adolescents in eastern Ethiopia
BMC Public Health, 2012
Background: More adolescents in Ethiopia are in school today than ever, but few studies have assessed the sexual behaviour of these learners. Thus, this study tried to assess premarital sexual debut and factors associated with it among in-school adolescents in Eastern Ethiopia. Methods: A cross-sectional school-based study was conducted using a facilitator guided selfadministered questionnaire. Respondents were students attending regular school classes in fourteen high schools. The proportion of adolescents involved in premarital sexual debut and the mean age at sexual debut was computed. Factors associated with premarital sexual debut were assessed using bivariate and multivariable logistic regression. Results: About one in four, 686 (24.8%) never married in-school adolescent respondents reported premarital sexual debut of these 28.8% were males and 14.7% were females (p < 0.001). Premarital sexual debut was more common among adolescents who had their parents in urban areas (Adjusted OR and [95% CI] =1.42 [1.17-1.73]), who received higher pocket money per month (Adjusted OR and [95% CI] = 1.56 [1.19-2.04]), who perceived low self-educational rank (Adjusted OR and [95% CI] =1.89 [1.07-3.34]) and who lived in rented houses (Adjusted OR and [95% CI] =1.32 [1.03-1.70]). The females and those who were less influenced by external pressure were more protected against premarital sexual debut (Adjusted OR and [95% CI] = 0.44 [0.35-0.56; 0.62 [0.52-0.74, respectively]) than their counterparts. Conclusion: A significant proportion of in-school adolescents were engaged in sexual relationship. Thus, public health interventions should consider the broader determinants of premarital sexual debut, including the ecological factors in which the behavior occurs.