Science and Success in Developing Countries: Holistic Programs That Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections

Full Study Report [HTML] [PDF]
Executive Summary [HTML] [PDF]

Program Components

• Comprehensive health and sexuality education program with messages to encourage 1) delay in the initiation of sex and 2) reductions in sexual risk-taking behaviors among sexually experienced youth
• Peer education related to HIV and AIDS, sexuality, and health
• School health clubs sponsoring health-related competitions in plays, essays, poetry, and songs
• Teacher training to improve tutors' and science teachers' skills as health educators
• Students' question box, with senior tutors answering students' questions
• Community and parents' involvement in forums to discuss health and sex education issues
• School supervisors' monitoring the health education program

For Use With

• Upper primary school students, ages 10 to 18
• In-school youth
• Rural and urban youth

Evaluation Methodology

• Quasi-experimental design with intervention and comparison groups, average ages 13 to 14, in two counties and in Soroti, a municipality, in northeastern Uganda
• Baseline survey (March 1994) of 400 randomly selected youth in the 1994 P-7 class; post intervention survey (November 1996) of 400 randomly selected youth in the 1996 P-7 class
• Data from youth in P-7 classes in intervention and comparison schools

Evaluation Findings

• Increased communication about sexual health
• Delayed initiation of sexual intercourse
• Reduced number of sex partners

Program Description

This school health and sexuality education program is based on social learning theory. The program intends to change basic attitudes about sexual intercourse and to encourage safer sexual behaviors, especially delays in the initiation of sexual intercourse and, among sexually experienced youth, reductions in the number of their sex partners. The program relies on existing structures, including a fulltime health educator and current teaching and health professionals. A local steering committee oversees the involvement and training of local leaders and heads of schools as well as of parents, teachers, and senior tutors. During each school term, supportive supervisors visit each school to monitor the implementation of health education activities. These activities include:

• Implementing the school health curriculum
• Involving youth in forming school health clubs that sponsor competitions in plays, essays, poetry, and song on health issues
• Training peer educators and implementing one-on-one peer education on health issues
• Convening regular meetings of parents, teachers, and community leaders to discuss sexual health issues
• Weekly training of senior tutors and science teachers to improve their skills as health educators
• Senior tutors answering students' questions and providing advice to students
• Training students in local teachers' colleges to implement the school health curriculum.[16]

Evaluation Methodology

The African Medical and Research Foundation, in conjunction with the Soroti School District Administration, implemented this intensified school health education program in primary schools in a rural county (Kalaki) and the municipality of Soroti in northeastern Uganda between 1994 and 1996. Kaberamaido country was the comparison area, where students were exposed to the standard school health and HIV/AIDS education program of Uganda. A survey of youth regarding their sexual health knowledge, attitudes, and behaviors informed the design of the program, provided baseline data for evaluation, and offered a means of informing local leaders and students about the magnitude of risk for HIV faced by students in this area of Uganda.[16]

Researchers collected baseline data during February and March, 1994, from 38 primary schools randomly selected from all the primary schools in Kabermaido sub-district, which includes Kalaki and Kaberamaido counties and the municipality of Soroti. Ten students, five boys and five girls, were selected randomly from the P7 class, using a serial counting method, in each of 12 schools in Kaberamaido county, 15 schools in Kalaki county, and 11 schools in Soroti. In two of Soroti's largest schools, 20 students (10 male and 10 female) were randomly selected to participate in the baseline survey (total n=400; n=287 youth from intervention schools; n=113 youth from comparison schools). Students answered the self-administered, anonymous questionnaire in circumstances designed to ensure confidentiality. The same procedure was used in November 1996 to collect post-intervention data from students in the 1996 P-7 class. Questionnaires were in English, the language of instruction in upper primary schools in Uganda.[16]

At baseline, the mean age of surveyed youth from the intervention schools was 14.0, that of youth from comparison schools was 13.8. The age range of youth from intervention schools was 10 through 18; the age range of youth from comparison schools was nine through 22. Of the 287 youth from intervention schools, 147 were male and 140 were female. Of the 113 youth from comparison schools, 54 were male and 59 were female. There were no significant differences in religious affiliation. A larger proportion of youth from intervention schools lived with someone other than parents versus youth from comparison schools (20 percent versus four percent), but there was no statistically significant difference in self-reported sexual activity between those who lived with one or both biological parents and those who lived with others. A statistically significant difference at baseline occurred between intervention and comparison schools in students' reports of having had sex. In 1994, the youth from intervention schools were 3.7 times more likely to be sexually active than those from comparison schools (43 versus 26 percent, respectively). The youth from rural intervention schools were also 3.7 times more likely to have had sex than youth from comparison schools.[16]

Outcomes

• Behaviors—
  • Increased communication about sexual health—The proportion of youth from intervention schools who discussed sexual health with teachers, as opposed to listening to lectures, increased significantly from nine to 44 percent, while among youth at comparison schools, the proportion rose from 12 to 21 percent. In the intervention schools, the proportion of students who discussed sexual health matters with schoolmates increased from 30 percent at baseline to 50 percent at follow-up while the change among youth at comparison schools was much smaller (29 percent at pretest; 36 percent at follow-up).[16]
  • Delayed initiation of sexual intercourse—Between 1994 and 1996, the proportion of students at intervention schools who reported having ever had sex fell significantly from 43 to 11 percent. At the same time, the proportion of youth from comparison schools who reported ever having had sex remained virtually unchanged (26 percent in 1994 versus 27 percent in 1996).[16]
  • Reduced number of sex partners—Among sexually experienced youth in 1994, youth at intervention schools reported an average of 2.2 sex partners; by 1996, this number had fallen to an average of 1.4 sex partners. By contrast, reported numbers of sex partners among sexually experienced youth in comparison schools were 2.1 in 1994 and 2.0 in 1996. The difference was statistically significant.[16,17]

For More Information,Contact

• African Medical and Research Foundation (AMREF), P.O. Box 10663, Plot 17, Nakasero Road, Kampala, Uganda; www.amref.org