Effect of sexual health education intervention (prepare) on proximal determinants of sexual debut and condom use among primary school children in Dar es salaam A randomised trial

Abstract

Background;Sub –Saharan Africa still bear the largest burden of HIV and other Sexually Transmitted Infections(STIs) with youth below 24 years continuing being at the highest risk of infections. This group contributes the large proportion of new HIV infections, with 80% occurring in sub Saharan Africa. There is more call for innovative and effective interventions for primary preventions. A school-based sexual behavioral intervention named PREPARE was developed to promotesafer sexual and reproductive health behaviorsamong primary school adolescents in Dar es Salaam Tanzania. This innovative best practice intervention included classroom teaching and peer led education sessions Objective;This study sought to evaluate the effect of PREPARE intervention on sexual debut, condom use and proximal determinants of these sexual behaviorsamong primary school children aged 12-14 in Dar Es Salaam. Material and Methods;A cluster-randomized controlled trial, involving 38 (19 intervention and 19 delayed intervention) primary schools in Dar es Salaam was conducted. Using the same standardized questionnaire, data was collected at baseline and at 6 monthsfollow-up after intervention. All analyses were carried using STATA 12 statistical software.Factor analysis was performed and scales created. Difference in difference model was used to determine intervention effect. Clustering was assumed at school level. All analyses were two tailed and type-1 error was set at 5% level. Results;A total of 5099 students were involved in the study at baseline. Six months after the baseline a follow-up survey was conducted where 4661 (91.4%) among those who participated in the baseline survey were interviewed. Baseline characteristics of participants were comparable where no statistically significant differences between the groups were noted. 487 (10.8% SE 0.6%, 95% CI; 9.5%, 12.2%) participants report to have ever had sex; 274 (Chi square 9.12, p=0.03) were in the intervention schools. Among those who report to have ever had sex; 152 (34.2%, SE 2.6%, 95% CI 28.9%, 39.4%) reported to have ever used condom. At follow-up, 352 (8.6% SE, 0.6% CI 7.3%, 9.8%) of the respondents who had no sexual experience at baseline report to have had sex, 265(74.3%) were males (Chi-square; 127.99, 2 df;2 p;<0.01). The incidence of 86 per 1000 pupils transitioned into sex over the period of six months since baseline. PREPARE intervention was found to significantly improve HIV transmission knowledge among females and protection knowledge for both males and females(p<0.01) and reduced HIV and condom myths among female pupils. It was also found to improve attitudes among female students (positive attitude for sex delay and positive attitude for condom; 0.205, and 0.160, p<0.05 and p<0.01 respectively) and reduced negative attitude towards sex delay among males. The adjusted mean scores on perception of norms supportive of delayed sex and condom use significantly increased among females. The intervention also showed effect on self-efficacy for sex delay (0.128, p<0.05) and improved communication with parents (0.094, p<0.05) and friends (0.213, p<0.01) among females. Intention to use condom was noted to improve among females (0.211, p-value <0.01). No intervention effect was noted on sexual debut and condom use between the groups. Overall more intervention effect was observed among females than males. Conclusion;In this study we were able to explore sexual debut, condom use and proximal determinants of these sexual behaviors as purported in the theory of planned behavior. PEPRARE intervention was found to have significant effect by improving proximal determinants of sexual debut and condom use but not on actual behaviors this is likely due to the timing of our follow-up. Actual behavior changes are likely to occur after a considerable lapse of time.Overall the intervention seems to have more effect among female pupils as compared to male pupils.