Transcript Effect Of Sexual Health Education Intervention (PREPARE

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
5,573 Recruited; 5,099 Baseline
388 Not in Class
72 Discarded prior to entry
14 Discarded after Entry
4,609 Fu1
1 week post-intervention
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 characteristics
Variable
Class
Age
Sex
Religion
Control
n (%)
Five
Intervention
n (%)
771 (34.6)
845(36.5)
Six
1,454 (65.5)
1471(63.5)
12yrs
1,518 (64.9)
1597 (67.5)
13yrs
607 (27.1)
608 (25.8)
14yrs
168 ( 8.0)
163 ( 6.7)
Female
1270 (49.7)
1218 (49.2)
Male
1284 (50.3)
1260 (50.8)
Christian
1318 (51.1)
1235 (49.3)
Muslim
1255 (48.7)
1260 (50.3)
Traditional
3 (0.1)
7 (0.3)
Other
2 (0.1)
1 (0.0)
ChiSquare
pvalue
1.66
0.19
0.87
0.65
0.17
0.69
3.54
0.32
Intervention effects on knowledge and myths
Variables
Female
Male
Baseline
Difference
Intervention Baseline
Difference among control
Effect
Difference
(I-C)
group
(I-C)
(F1-Baseline)
Difference
among control
group
(F1-Baseline)
Intervention
Effect
Knowledge
HIV knowledge
(mean difference)
Protection
knowledge (mean
difference)
Myths
0.000
-0.072**
0.083**
0.001
-0.048**
0.039
-0.013
-0.052*
0.099**
-0.002
-0.026*
0.068**
Myths – HIV
(mean difference)
0.022
-0.010
-0.119**
-0.045
-0.022
-0.056
Myths – 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
Interventi
Difference among control on Effect
(I-C)
group
(F1-Baseline)
Baseline
Difference
(I-C)
Difference
Interventi
among control on Effect
group
(F1-Baseline)
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
Intervention
Difference
among
Effect
(I-C)
control group
(F1-Baseline)
Norms
Delaying sex
(mean difference)
Condom use
(mean difference)
Self-Efficacy
Baseline
Difference
(I-C)
Difference
Intervention
among control
Effect
group (F1Baseline)
0.036
-0.014
0.207*
-0.005
-0.032
0.089
-0.076
-0.056*
0.230**
-0.057
-0.104*
0.124
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
Intervention
Difference
among
Effect
(I-C)
control group
(F1-Baseline)
Baseline
Difference
(I-C)
Difference
among
control group
(F1-Baseline)
Intervention
Effect
Communication
With parents
(mean difference)
With friends
(mean difference)
0.029
-0.031
0.094*
0.017
-0.016
-0.009
0.012
-0.030
0.213**
0.044
0.045
0.005
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
Intentions
* <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 (Chisquare; 127.99, df;2 p;<0.01)
• There was no intervention effect on sexual activity, immediately
post intervention.
Intervention effects: Condom Use
At 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