presenter: prosper faustine njau (md) supervisor: elia j mmbaga (md, mph, phd )
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Effects of Sexual Health Education Intervention (PREPARE) on Proximal Determinants of Sexual Debut and Condom Use Among Primary School
Children in Dar es Salaam
Presenter: Prosper Faustine Njau (MD)Supervisor: Elia J Mmbaga (MD, MPH, Phd)
Perspective
• This intervention evaluation uses baseline and first follow-up data– Six months since
baseline survey
Research Question and Analysis Objectives• What is the effect of PREPARE intervention on proximal determinants of
sexual debut and condom use among primary school children aged 12 to 14 years in Dar es Salaam?
AIMs:1 To compare baseline socio-demographic and household characteristics of
primary school aged children from intervention and control schools in Dar es salaam
2 To compare baseline proximal determinants of sexual debut and condom use among primary school children from intervention and control school in Dar Es Salaam
3 To determine the baseline proportion of sexual debut and condom use among primary school children by intervention status in Dar Es Salaam
4 To determine the change in the determinants of sexual debut and condom use among primary school children following the PREPARE intervention
5 To determine changes in sexual behavior immediately after intervention
Materials and Analysis Plan
Data collection and analysis• Data collection– Data were collected using a self administered
questionnaire (same questionnaire at baseline and at follow-up)
• Analysis– We paired baseline and first follow-up data– All analyses were done using STATA 12; and adjusted
for clustering at school level– We used the Difference in Difference model to
determine the effect of the intervention on outcomes
Arguments for use of the difference in difference Model
• Enables us to– Compare between
groups at baseline– Compare within controls
to see the time effect– Take into account the
time effect to determine the intervention effect
Source; Impact Evaluation In Practice
Results
Sex and age distribution
• A total of 5099 students were involved in the study at baseline (BL)
• 2,488(49.4) were females
• Mean age was 12.4 years and ranged from 12 to 14
• At first follow-up, 4,609 (90.4) of the baseline
students were interviewed; 2,332 (50) were females
BL: Socio-demographic characteristicsVariable
Controln (%)
Interventionn (%)
Chi-Square
p-value
Class Five 771 (34.6) 845(36.5) 1.66 0.19
Six 1,454 (65.5) 1471(63.5)
Age 12yrs 1,518 (64.9) 1597 (67.5) 0.87 0.65
13yrs 607 (27.1) 608 (25.8)
14yrs 168 ( 8.0) 163 ( 6.7)
Sex Female 1270 (49.7) 1218 (49.2) 0.17 0.69
Male 1284 (50.3) 1260 (50.8)
Religion Christian 1318 (51.1) 1235 (49.3) 3.54 0.32
Muslim 1255 (48.7) 1260 (50.3)
Traditional 3 (0.1) 7 (0.3)
Other 2 (0.1) 1 (0.0)
Intervention effects on knowledge and myths
Variables Female MaleBaseline
Difference (I-C)
Difference among control
group (F1-Baseline)
Intervention Effect
Baseline Difference
(I-C)
Difference among control
group (F1-Baseline)
Intervention Effect
Knowledge
HIV knowledge (mean difference)
0.000 -0.072** 0.083** 0.001 -0.048** 0.039
Protection knowledge (mean difference) -0.013 -0.052* 0.099** -0.002 -0.026* 0.068**Myths
Myths – HIV (mean difference) 0.022 -0.010 -0.119** -0.045 -0.022 -0.056Myths – Condom(mean difference) 0.021 0.125** -0.152** -0.057 0.050 -0.089
* <0.05; ** <0.001
Intervention effects Condom use and delaying sex attitudes
Variables Female Male
Baseline Difference
(I-C)
Difference among control
group (F1-Baseline)
Intervention Effect
Baseline Difference
(I-C)
Difference among control
group (F1-Baseline)
Intervention Effect
Attitudes
+ve attitude–Condom use (mean difference)
-0.099 0.041 0.160* -0.018 0.104* 0.033
-ve attitude–Condom use (mean difference)
-0.006 -0.004 0.004 0.032 0.003 -0.063
+ve attitude delayed sex initiation(mean difference)
0.014 0.060 0.205** -0.025 0.017 0.094
-ve attitude delayed sex initiation (mean difference)
-0.027 -0.061 -0.004 0.105 0.055 -0.171*
* <0.05; ** <0.001
Intervention effects: Norms and self-efficacy measures
Variables Female Male
Baseline Difference
(I-C)
Difference among
control group (F1-Baseline)
Intervention Effect
Baseline Difference
(I-C)
Difference among
control group (F1-Baseline)
Intervention Effect
Norms Delaying sex(mean difference)
0.036 -0.014 0.207* -0.005 -0.032 0.089
Condom use(mean difference)
-0.076 -0.056* 0.230** -0.057 -0.104* 0.124
Self-Efficacy
Delaying sex(mean difference)
0.008 0.094* 0.128* -0.038 0.096* 0.007
Condom use(mean difference)
-0.042 0.065 0.094 -0.063 0.033 0.021
* <0.05; ** <0.001
Intervention effects: Communication and intentions
Variables Female Male
Baseline Difference
(I-C)
Difference among
control group (F1-Baseline)
Intervention Effect
Baseline Difference
(I-C)
Difference among
control group (F1-Baseline)
Intervention Effect
Communication
With parents(mean difference)
0.029 -0.031 0.094* 0.017 -0.016 -0.009
With friends(mean difference)
0.012 -0.030 0.213** 0.044 0.045 0.005
Intentions
To have Sex(mean difference)
-0.007 0.072 0.020 0.055 0.049 0.046
To use condoms(mean difference)
-0.041 -0.132** 0.211** 0.008 -0.015 -0.009
* <0.05; ** <0.001
Intervention effects: Reported sexual activity• At baseline:– 500 (10.8% [SE 0.6, 95 CI; 9.5, 12.2]) participants
report to have ever had sex– 279 - 55.8% of the sexually active (Chi square 9.12,
p=0.03) were in the intervention schools
• At immediate follow-up:– 352 (8.6% [SE, 0.6 CI 7.3, 9.8]) of the respondents
reported incident sex initiation (4,617 naïve at BL) – 265 (74.3 %) of incident sex learners were males (Chi-
square; 127.99, df;2 p;<0.01)• There was no intervention effect on sexual activity, immediately
post intervention.
Intervention effects: Condom UseAt baseline•Among those with reported sex initiation, 152 (34.2% [SE 2.6, 95 CI 28.9, 39.4]) reported to have ever used a condom
At immediate follow-up•Among those who reported incident sex initiation, 61 (17.3% [SE 2.4 CI; 12.4, 22.4]) report to have ever used a condom
•No intervention effect noted on Condom Use
Discussion• We found PREPARE to have effect on some proximal determinants of
sexual behavior that varied by sex:– HIV (females only) and protection (males and females) knowledge and myths
(females only) reduction– In females: positive attitudes on delayed sex initiation and condom use & positive
norms related to delaying sex and condom use as well as self efficacy (SE) to delay sex though not condom use
– In males: reduction in negative attitudes towards delayed sex initiation was the only attitudinal change effected.
– In females: Increase communications with parents and peers on protection• No effects were noted on actual behaviors – expected as behaviors takes
some time to change
• Overall on the short term, the intervention seem to have more effect among girls; probably due to norms and risk perception
Limitations
• Potential information bias due to lack of specific biological markers to validate self reported sex initiation
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 effects by improving proximal determinants of sexual debut and condom use
• The intervention seems to be working more effective on the short-term among female compared to male pupils
Recommendations
• The intervention is effective– However effects of the intervention is most evident in
females; there is a need to explore why this was the case from formative data to determine specific barriers for male pupils
• Effect on actual behavior was not observed in the first follow-up survey (six moths from baseline)– actual behavior takes some time to change, analyses
of the repeat follow-up survey is recommended to determine if the intervention had an effect on actual reported sexual behaviors
Acknowledgement
• Profs. Sylvia Kaaya & Gad Kilonzo; Dr. K. Mrumbi, Ms. Lusajo Kajula & Mrema Noel
• Dr. Elia Mmbaga – Main supervisor• Other PREPARE Dar es Salaam Team Members– Richard Rutahiwa – Admin support– Edward Lema – Data Manager
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