Effect of the PREPARE intervention on sexual initiation and condom use among adolescents aged 12–14: a cluster randomised controlled trial in Dar es Salaam, Tanzania

Abstract

BackgroundUnsafe sexual practices continue to put adolescents at risk for a number of negative health outcomes in Tanzania. While there are some effective theory-based intervention packages with positive impact on important mediators of sexual behaviours, a context specific and tested intervention is urgently needed in Tanzania.PurposeTo develop and evaluate an intervention that will have a significant effect in reducing sexual initiation and promoting condom use among adolescents aged 12–14 in Dar es Salaam, Tanzania.DesignA school-based Cluster Randomised Controlled Trial was conducted during 2011–2014 in Kinondoni Municipality.MethodsA total of 38 public primary schools were randomly selected, of which half were assigned to the intervention and half to the control group based on their size and geographic location. Participants were interviewed using a self-administered questionnaire at baseline before the PREPARE intervention and then, 6 and 12 months following intervention. The primary outcomes were self-reported sex initiation and condom use during the past 6 months. Data analysis was done using Generalized Estimating Equation (GEE) modelling controlling for repeated measures and clustering of students within schools.ResultsA total of 5091 students were recruited at baseline, and interviewed again at 6 (n = 4783) and 12 months (n = 4370). Mean age of participants at baseline was 12.4 years. Baseline sociodemographic, psychometric and behavioural characteristics did not significantly differ between the two study arms. The GEE analysis indicated that the intervention had a significant effect on sexual initiation in both sexes after controlling for clustering and correlated repeated measures. A significantly higher level of action planning to use condoms was reported among female adolescent in the intervention arm than those in the control arm (p = 0.042). An effect on condom use behaviour was observed among male adolescent (p = 0.004), but not among female (p = 0.463).ConclusionsThe PREPARE intervention had an effect in delaying self-reported sexual initiation among adolescents aged 12–14 in Dar es Salaam Tanzania. The intervention positively influenced action planning to use condoms for both sexes and increased actual condom use among male adolescents only. Future interventions addressing adolescent sexual and reproductive health should focus on impacting mediators of behaviour change.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12613000900718, registered on 13 August, 2013.

Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review

“…Nineteen trials took place in Africa: one in Cameroon [50], one in Ethiopia [34], three in Kenya [32,33,36], one in Malawi [27], two in Nigeria [46], one in Senegal [31], three in South Africa [37,38,44], three in Tanzania [41,45,48], two in Uganda [49,52], one in Zimbabwe [29], and one in Zambia [70]. Five trials took place in Asia: one in China [42], three in India [30,40,47], and one in Vietnam [39].…”

“…Two trials had interventions occurring at community sites and in clinics [39,40]. Some trials took place in a combination of school and clinics [45], and finally, in the community, school, and clinics [29,31,48]. Regarding the sample size, the minimum population size was 366 participants in Ybarra 2013 [52] and the maximum population was 19,289 participants in Duflo [32].…”

“…Most trials investigated educational interventions, where 16 trials had education alone as the intervention [28][29][30][31]34,35,[37][38][39]41,43,45,47,49,50,52]. In six trials, education was combined with other strategies: provision of contraceptives [42,44,51]; peer referrals to health care providers along with the training of health care providers [46]; training of health workers and peer condom marketing [48]; referrals, family members' education, and improvement of contraceptive services [47]; skills training, referrals to micro savings and credit groups, and health care provider training [40]; and youth partnership group development and education subsidies [32].…”

“…There were a total of 14 RCTs [27][28][29]32,35,36,38,39,43,45,46,48,51,52] and the remaining were quasi-randomized studies [30,31,33,34,37,[40][41][42]44,47,49,50] (Figure 3).…”

“…A total of 23 studies compared education with no intervention [28][29][30][31][32][33][34][35][37][38][39][40][41][43][44][45][46][47][48][49][50][51][52]. Regarding unintended pregnancy, education on contraception did not have a significant impact on the risk of unintended pregnancy when compared with no education (RR = 0.42, 95% CI = 0.07-3.26; two studies, n = 490; random-effect; χ 2 p = 0.009; I 2 = 85%; low certainty of evidence using GRADE assessment).…”