Entre Nous Jeunes Peer Education (Cameroon) Print

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 sexual health peer education program to encourage reductions among sexually experienced youth in 1) sexual risk-taking behaviors and 2) incidence of STIs and unintended pregnancy
  • Training of peer educators on sexual health and on facilitation skills*
  • Peer educators working with youth in discussion groups, one-on-one meetings, and health and sports association gatherings
  • Peer educators receiving reimbursement for travel expenses and incentives
  • Peer educators distributing IEC materials, including comic strips and posters
  • Referral of youth for reproductive and sexual health care

For Use With

  • Youth ages 10 to 25
  • Urban youth
  • In- and out-of-school youth

Evaluation Methodology

  • Quasi-experimental evaluation design with youth in intervention (Nkongsamba) and comparison (Mbalmayo) communities
  • Baseline data collected in November and December 1997 from randomly selected youth in the intervention community (n=402) and in the comparison community (n=400); follow-up data collected in April 1999 from randomly selected youth in the intervention community (n=405) and in the comparison community (n=413)

Evaluation Findings

  • Increased use of contraception
  • Increased use of condoms

Program Description

Entre Nous Jeunes Peer Education program is a peer-based adolescent reproductive health intervention, designed to increase contraceptive use and to reduce the prevalence of unintended pregnancy and STIs, including HIV, among sexually active adolescents. The program relies on large numbers of existing, community-based, youth service clubs and youth associations (sports and religious). Program planners recruit youth to be volunteer peer educators and test them for motivation and commitment. Those chosen receive training, lasting one week, in facilitating group discussions as well as in reproductive anatomy, abstinence, contraceptive methods, and skills to negotiate condom use. Every three months, peer educators receive additional training to reinforce their skills and knowledge and to resolve outstanding problems or concerns.[19]

Peer educators work within their own community to educate their peers and to refer them, when necessary, to reproductive and sexual health care. Peer educators arrange discussion groups and meet with their peers in health and sports associations and one-on-one. They also distribute materials including calendars, comic strips with information about contraception and sexual health, and posters. Peer educators receive travel expenses as well as special promotional materials, including tee shirts, shorts, baseball caps, bags, and calendars.[19]

Evaluation Methodology

Between November and December 1997, evaluators conducted a baseline survey among youth in the intervention community of Nkongsamba and in the comparison community of Mbalmayo. A follow-up survey was conducted 17 months later (April 1999) among youth in the two communities. The cities were demographically similar: the intervention city had a population of about 102,000 and the comparison city, about 110,000. The proportion of the population that was age zero to 24 was similar: 53 and 50 percent, respectively. Both cities had imbalanced sex ratios, as young men in both communities typically left home in search of a better life in Douala and Yaoundé. The Christian religion predominated in both cities. Both cities were primarily agricultural and each supported small factories (coffee roasting and palm-oil production in Nkongsamba and woodworking in Mbalmayo).[19]

At baseline, evaluators used a multi-stage sampling approach of clusters, blocks, and households to randomly select a household sample of youth ages 10 to 25. Among eligible respondents in each household, one youth was randomly selected. At baseline, 402 youth in the intervention community were surveyed and 400 youth in the comparison community. At follow-up, the survey was restricted to youth ages 12 through 25; 405 youth from the intervention community were surveyed as were 413 from the comparison community. The change between baseline and follow-up in the ages of those surveyed came primarily from parents' resistance to the interviewing
of children ages 10 through 14.[19]

At baseline, females in the comparison community were more likely to be currently in school than were females in the intervention community (77 versus 56 percent). Males in the comparison community were also significantly more likely to be in school than were males in the intervention community (66 versus 52 percent). Males in the intervention community were significantly more likely to report no religious affiliation than were males in the comparison community (19 versus nine percent, respectively). Males in the intervention community were significantly more educated than males in the comparison community (proportions with no education were two percent and seven percent, respectively; proportions with secondary education or more were 87 percent and 82 percent, respectively). Males in the intervention community were also significantly more likely to have never married than were males in the comparison community (97 and 90 percent, respectively). At baseline, there were no statistically significant differences between youth in intervention and comparison communities for current contraceptive method use or for condom use at most recent sex.[19]

At follow-up, both male and female youth in the intervention community were younger than intervention community adolescents at baseline. For example, at baseline 19 percent of females and 14 percent of males were under age 15; at follow-up, 31 percent of females and 27 percent of males were under age 15. In keeping with this finding, youth from the intervention community at follow-up were also less educated and more likely to be in school than youth from the intervention community at baseline. In the comparison community, the only changes were for females; they were significantly more likely to be currently in school and never married at baseline compared to follow-up. Because the evaluation did not control for age, findings must be viewed cautiously that, at followup, youth in the intervention community were statistically less likely to have ever had sex.[19]

During the two-year intervention, peer educators organized 353 discussion group sessions, attended by about 12,000 youth. Peer educators also had personal contact with over 5,000 adolescents in the intervention community.[19]

Outcomes

  • Knowledge—
    At follow-up, youth in the intervention community were significantly more likely than youth from the comparison community to know females' symptoms of STIs (odds ratio=1.16). Controlling for contact with a peer educator indicated that such contact was significantly associated with knowledge of female STI symptoms among youth in the intervention community relative to youth in the comparison community (OR=0.87). The intervention had no significant effect on knowledge of symptoms of STIs in males.[19]
  • Behaviors—
    • Increased use of contraception—At follow-up, sexually experienced youth in the intervention community were significantly more likely to report use of modern contraceptives than were youth in the comparison community (OR=0.53). Contact with peer educators was separately analyzed, and sexually experienced youth in the intervention community who had individual contact with a peer educator were significantly more likely to report current use of modern contraceptives than were youth from the comparison community (OR=0.92). Further analysis showed that, in the absence of the peer education program, current use of modern methods of contraception among youth in the intervention community would have been 21 percent lower.[19]
    • Increased use of condoms—At follow-up, youth from the intervention community who had an encounter with a peer educator were significantly more likely to be current users of condoms than were youth from the comparison community (OR=2.07). The finding was also significant for in-school youth (OR=1.13) and for in-school youth who had contact with a peer educator (OR=1.09). At the same time, changes in reported condom use at most recent sex, while not statistically significant, were considerable (baseline OR = -0.23; follow-up OR=0.02). Between baseline and follow-up by contrast, youth in the comparison community reported no change in condom use at most recent sex. Further analysis showed that, in the absence of the peer education program, condom use at most recent sex would have been 53 percent lower among youth in the intervention community.[19]

Note: Evaluation found that youth in the intervention community were much less likely to have initiated sex at follow-up than were youth in the comparison community; 44 percent of females and 40 percent of males in the intervention community had never had sex versus 32 percent of females and 23 percent of males in the comparison community. However, since the evaluation did not control for demographic differences in the two samples at follow-up, evaluators said that "attributing these differences to the program is difficult, although they are suggestive of positive impacts."[19]

For More Information, Contact

  • Family Health and AIDS in West and Central Africa Project, Tulane University School of Public Health and Tropical Medicine, Department of International Health and Development, 1440 Canal Street, Suite 2200, New Orleans, Louisiana 70112, USA

     or
  • Institut de Recherche et des Etudes de Comportements, Yaoundé, Cameroon

*Forty-two were trained over two years.