Effects of a randomized health education intervention on aspects of reproductive health knowledge and reported behaviour among adolescents in Zimbabwe.

Unwanted teenage pregnancy and the attendant morbidity and mortality necessitate an understanding of the factors influencing adolescent sexuality and the implementation of programmes designed to improve their knowledge and reproductive behaviour. A randomized controlled study on reproductive health knowledge and behaviour was undertaken among adolescent pupils drawn from a multi-stage random cluster sample. A self-administered questionnaire was used to assess aspects of reproductive health knowledge and behaviour at baseline followed by a health education intervention, except for control schools. Results are based on 1689 responses made up of 1159 intervention and 530 control respondents. There was a significant increase in correct knowledge about aspects of menstruation in intervention as compared with control schools [odds ratio (OR) = 4.5, 95% confidence interval (CI) = 3.4-6.1). Significantly, (OR = 2.0, 95%CI = 1.1-3.9) more pupils from intervention than control schools scored correctly on practice relating to menstruation. Pupils from intervention schools were more likely (P < 0.001) to know that a boy experiencing wet dreams could make a girl pregnant and that a girl could get pregnant at her first sexual intercourse (OR = 1.4, 95%CI = 1.1-1.9). Knowledge of family planning was low in both groups at baseline but was high at five months follow-up in the intervention schools. The findings point to the need for early school-based reproductive health education programmes, incorporating correct information on reproductive biology and the subsequent prevention of reproductive ill health.

Zimbabwean teenagers' knowledge of AIDS and other sexually transmitted diseases.

A cross sectional anonymously administered questionnaire was used amongst 1689 secondary school girls and boys to determine their knowledge of AIDS and other sexually transmitted diseases (STDs). Their knowledge was found to be very low. While 80% could name an STD in an open question, only 16% could recognise the important symptoms of the common and treatable diseases such as gonorrhoea and syphilis. This finding is worrying in view of the fact that these common STDs facilitate transmission of HIV/AIDS. The awareness of AIDs was high but when it came to the mode of transmission of AIDS the large majority were not aware of the risk of intercourse with an infected person. Furthermore, despite an intensive AIDS awareness campaign programme mounted by the government of Zimbabwe a large number of students thought that one can contract HIV/AIDS by shaking hands, sharing a toilet and witchcraft. Misconceptions on transmission abound. The data show that there is a need to review strategies of disseminating information to teenagers regarding STD, including AIDS, reproductive biology, sexuality and contraception. The best strategy may be the introduction of a reproductive health education curriculum in all schools starting at an early age.

Trends in reproductive health knowledge following a health education intervention among adolescents in Zimbabwe.

BACKGROUND: Unwanted teenage pregnancy, sexually transmitted infections and the attendant morbidity and mortality necessitate the need for understanding factors influencing adolescent sexuality and the implementation of programmes designed to improve their knowledge, reproductive behaviour, sexual and reproductive health. OBJECTIVE: To determine the impact of an intervention package on knowledge levels of various reproductive health issues through trend analysis. DESIGN: Randomized controlled trial of a health education intervention in schools stratified for representativeness. SETTING: Rural and urban secondary schools in Zimbabwe. SUBJECTS: 1,689 students recruited from 11 secondary schools in Mashonaland Central. MAIN OUTCOME MEASURE: Knowledge level before and after intervention. RESULTS: The demographic characteristics of the pupils at baseline, five months and nine months were comparable between the two groups. There was an overall increase in knowledge on menstruation. Students from the intervention schools were more likely to have correct knowledge over time on aspects of reproductive biology. A significant linear trend (p = 0.017) was observed in the area of family planning and contraception. A linear decreasing trend (p = 0.001) was observed on pregnancy risk. Though not significantly linear, the general trend of knowledge levels in all the areas of reproductive health, pregnancy risk, STDs and HIV/AIDS showed an upward trend, from 20% to 96%. Worth noting was that in all the areas the intervention group had knowledge above that in the control group. CONCLUSION: The reproductive health education intervention had an impact on aspects of reproductive biology and contraception as measured by the increased scoring at follow up when comparing intervention and control schools. The overall findings point to the need for early school based reproductive health education programmes incooperating correct information on reproductive biology and the prevention of subsequent reproductive morbidity by imparting information on non-risk behaviour during the early developmental years.

PIP: Evaluation of a secondary school-based reproductive health education intervention in Zimbabwe indicated that such a program should be introduced at the primary school level to have maximum impact. A total of 1689 rural and urban students (mean age, 13.5 years) from 11 secondary schools completed a baseline questionnaire. 1159 (68.7%) were randomly allocated to the intervention schools and 530 (31.3%) to control schools; evaluations were conducted after 5 and 9 months. At baseline, few students in either group had correct information on when a girl was likely to get pregnant during the menstrual cycle. Although follow-up revealed improved knowledge in this area, the intervention effect was significant only among the youngest students. Students in the intervention schools were more likely than controls to know that menarche is associated with the ability to become pregnant, but fewer were knowledgeable about the association between wet dreams in boys and the capability of making a girl pregnant. Attendance at family life education lectures had the most significant positive impact on both knowledge and use of contraception. Knowledge increases in other areas of reproductive health, sexually transmitted diseases, and AIDS increased to a greater extent among exposed than non-exposed youth (20-96% gains), but the trend was not significantly linear. The provision of information on reproductive biology and pregnancy prevention during an earlier developmental stage is recommended.

Reproductive biology knowledge, and behaviour of teenagers in East, Central and Southern Africa: the Zimbabwe case study.

Sexuality in the teenager is often complicated by unplanned/unwanted pregnancy, abortion and the risks of STDs including AIDS. There is therefore a need for improved understanding of factors affecting adolescent sexuality and the implementation of programmes designed to improve their knowledge, risk awareness and subsequent behavioural outcomes. A multicentre study of reproductive health knowledge and behaviour followed by a health education intervention was undertaken amongst teenagers in selected countries of East, Central and Southern Africa. Reported here are findings at baseline derived from the Zimbabwe component on reproductive biology knowledge and behavior. A self-administered questionnaire was used among 1 689 adolescent pupils drawn from rural, urban, co-education, single sex, boarding and day secondary schools in Zimbabwe. Correct knowledge on reproductive biology as measured by the meaning and interpretation of menstruation and wet dreams varied by school from 68 pc to 86 pc, with a significant trend (p < 0,01) based on level of education at baseline. The reported mean age at which menarche took place was 13,5 years +/- 1,3 (mean +/- SD). First coitus was reported to have taken place at the mean age of 12 years for boys and 13,6 years for girls. Seventeen pc of the adolescent pupils reported that they were sexually experienced and 33,2 had relationships. There were misconceptions reported on menstruation with 23 pc reporting that it was an illness. Peers, followed by magazines were the first sources of information on various aspects of reproductive biology, both of which might not provide the correct first information. Among pupils reporting that they were sexually experienced, the largest proportion (56 pc) had unprotected sex. The findings point to the need for targeting the adolescent pupils for information on reproductive biology and increased awareness on the risks of pregnancy, STDs and HIV.

PIP: A multicenter study of reproductive health knowledge and behavior followed by a health education intervention was undertaken among teenagers in selected countries of eastern, central, and southern Africa. Baseline findings are reported from the Zimbabwe component of the study. 1689 adolescents from rural, urban, coeducational, single sex, boarding, and day secondary schools in Zimbabwe participated in the study. 789 were aged 10-14 years, 872 were aged 15-19, 10 were older than 19, and 18 did not offer their age. 48.4% of participants were male. Correct knowledge on reproductive biology was measured by the meaning and interpretation of menstruation and wet dreams as indicated by responses to self-administered questionnaires. That knowledge varied by school from 68% to 86%, with a significant trend based upon the level of education at baseline. Menarche occurred at the reported mean age of 13.5 years, with first coitus occurring at the mean ages of 12 years for boys and 13.6 years for girls. 17% reported being sexually experienced and 33.2% were involved in relationships. 23% believed menstruation to be an illness. Peers, followed by magazines, were the main sources of information on reproductive biology. 56% of the respondents who reported being sexually experienced had unprotected sex. These findings point to the need to target adolescent students with information on reproductive biology and increased awareness on the risks of pregnancy, sexually transmitted diseases, and HIV.