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.
Highlights
School-based sexual health education has the potential to provide an inclusive and comprehensive approach to promoting sexual health among young people
The Mema Kwa Vijana (MkV) intervention was reported in six included papers [35,36,37,38,39,40], Ross et al [35] is cited when referring to this intervention because most data were extracted from that report
Across 31 interventions meeting our inclusion criteria, we found no evidence of effectiveness in reducing Sexually transmitted infection (STI), including Human Immunodeficiency Virus (HIV), one study [55] reported a reduction in curable STIs (Chlamydia, Gonorrhoea and Trichomonas) at one follow-up period
Summary
School-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. Several types of interventions have been employed to reduce the vulnerability of adolescents to STIs, including HIV These include: preventive education in schools; services delivered in youth centres, including condom distribution; adolescent-friendly health centres that encourage utilisation of prevention services; school-based health services; conditional cash transfers to encourage young people to remain in school or to avoid risky sexual behaviours; various community-based interventions; and unconditional cash transfers [6]. School-based sexual health education (SBSHE) is arguably the most inclusive and potentially comprehensive of these approaches and has the potential to effectively promote population-level sexual health among adolescents and young adults [7], so reducing the spread of STIs, including HIV [8]. SBSHE was defined as any intervention delivered wholly or partially in a school setting aiming to reduce risky sexual behaviours, STIs and unplanned pregnancy, and promote positive sexual health
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