School-based sexual health education interventions to prevent STI/HIV in sub-Saharan Africa: a systematic review and meta-analysis

Abstract

BackgroundSchool-based sexual health education has the potential to provide an inclusive and comprehensive approach to promoting sexual health among young people. We reviewed evaluations of school-based sexual health education interventions in sub-Saharan Africa to assess effectiveness in reducing sexually transmitted infections and promoting condom use.MethodsWe searched ten electronic databases, hand-searched key journals, and reference lists of included articles for potential studies. Data were extracted on outcomes, intervention characteristics, methods and study characteristics indicative of methodological quality. Where possible, data were synthesized using random effect meta-analysis. Intervention features found predominantly in effective interventions were noted.ResultsThe initial search retrieved 21634 potentially relevant citations. Of these, 51 papers reporting on 31 interventions were included. No evaluation reported statistically significant effects on the incidence or prevalence of Human Immunodeficiency Virus and Herpes Simplex Virus 2 infections. However, intervention participants reported statistically significant greater condom use in both randomised controlled trials and non-randomised trials for short (less than 6 months) follow-up periods (OR = 1.62, 95 % CI = 1.03–2.55 and OR = 2.88, 95 % CI = 1.41–5.90 respectively). For intermediate (6–10 months) and long-term (more than 10 months) follow-up periods, the effect was statistically significant (OR = 1.40, 95 % CI = 1.16–1.68) and marginally significant (OR = 1.22, 95 % CI = 0.99–1.50) among the randomised trials respectively. Only 12 of the 31 interventions reported implementation details, out of which seven reported on fidelity.ConclusionSchool-based sexual health education has the potential to promote condom use among young people in sub-Saharan Africa. However, further work is needed to develop and evaluate interventions that have measurable effects on sexually transmitted infections.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3715-4) contains supplementary material, which is available to authorized users.

A Cross-Sectional Study on the Knowledge of Sexually Transmitted Diseases among Young Adults Living in Albaha, Saudi Arabia

“…Currently there is no evidence-based health educational program, with a focus on men and women's health, which applies to and targets the young or adolescents in Saudi. Whereas, evidence in literature suggests a high positive impact associated with applying educational programs for promoting healthy practice for minimizing STD transition [21][22][23]. Sex education is compulsory in several countries; however, there are still countries, such as Saudi, that have not yet applied such educational material at any education level.…”

Recommendations for cervical cancer prevention and control in Ghana: public education and human papillomavirus vaccination

“…Systematic reviews of school-based education programs in Africa have shown that significant change in adolescents' knowledge and altitude towards HIV/AIDS and other sexually transmitted infections (STIs) can be achieved. 20,21 School-based sexual and reproductive health education is one way to help adolescents recognise risk and improve their sexual and reproductive health. 22 A well-developed program including cervical cancer prevention can influence adolescents' altitude, knowledge and behaviour on sexual and reproductive health greatly.…”

Ubudoda Abukhulelwa – Responsible Manhood

“…These interventions include voluntary male circumcision, prevention from mother to child transmission, curbing risky behaviours and tackling some of the environmental, economic and socio-political issues which leave people vulnerable to HIV infection (UNAIDS, 2016). In sub Saharan Africa specifically there are interventions to increase ART adherence , to reduce HIV stigma in PMTCT (Peltzer et al, 2018), to link HIV infected people to care (Mavegam, Pharr, Cruz, & Ezeanolue, 2017), school-based interventions to prevent STIs and HIV (Sani, Abraham, Denford, & Ball, 2016), and interventions that target the reduction of alcohol and drug use which in turn lead to risky sexual behaviours (Carney et al, 2018;Wechsberg et al, 2013). As much as all these interventions contribute to the fight against HIV, more interventions focussing on sexual context need to be developed.…”

“…When looking at school-based interventions, it is clear that these programmes are best placed to reach young people, who are currently among the highest-infected groups. The evidence however further suggests that school-based interventions only have a positive effect on condom use and not on STIs (Sani et al, 2016). Interventions which sought to reduce alcohol and drug use reported decreased incidents of engaging in sex while intoxicated and a reduction in the number of sexual partners (Carney et al, 2018;Wechsberg et al, 2013).…”

“…In Sub-Saharan Africa several STI/HIV-focused interventions covering different aspects of HIV prevention have been tested, which include but are not limited to: school-based interventions (Mason-Jones et al, 2016;Sani et al, 2016), interventions to increase antiretroviral therapy (ART) adherence , interventions to increase male participation in prevention of motherto-child transmission (PMTCT) (Weiss et al, 2014) and to reduce HIV stigma in PMTCT (Peltzer et al, 2018), interventions that reduce the use of alcohol and other drugs (Carney et al, 2018;Parry, Carney, & Petersen Williams, 2017;Wechsberg et al, 2013), and interventions that link HIV-infected people to care, therefore opening room to initiate ART (Mavegam et al, 2017). These latter interventions showed that home-based HIV testing and counselling, together with a proper referral plan, aid considerably in reducing the time it takes to successfully start people on care protocols.…”