Are schools a good setting for adolescent sexual health promotion in rural Africa? A qualitative assessment from Tanzania

Abstract

African adolescents are at high risk of poor sexual health. School-based interventions could reach many adolescents in a sustainable and replicable way, if enrolment, funding and infrastructure are adequate. This study examined pupils', recent school leavers', parents' and teachers' views and experiences of rural Tanzanian primary schools, focusing on the implications for potential sexual health programmes. From 1999 to 2002, participant observation was conducted in nine villages for 158 person-weeks. Half of Year 7 pupils were 15-17 years old, and few went on to secondary school, suggesting that primary schools may be a good venue for such programmes. However, serious challenges include low enrolment and attendance rates, limited teacher training, little access to teaching resources and official and unofficial practices that may alienate pupils and their parents, e.g. corporal punishment, pupils being made to do unpaid work, forced pregnancy examinations, and some teachers' alcohol or sexual abuse. At a national level, improved teacher training and supervision are critical, as well as policies that better prevent, identify and correct undesired practices. At a programme level, intervention developers need to simplify the subject matter, introduce alternative teaching methods, help improve teacher-pupil and teacher-community relationships, and closely supervise and appropriately respond to undesired practices.

High prevalence of sexually transmitted infections in pregnant adolescent girls in Tanzania: a multi-community cross-sectional study

“…Important teaching topics highlighted by our study findings include signs, symptoms and side effects of STIs and methods of both STI and pregnancy prevention. As others have suggested, for this to be successful, teachers will need to be empowered to discuss sensitive health topics 31. Increasing adolescents’ knowledge of STI symptoms and sequelae may lead those with symptoms (who, in our study, were the majority of infected girls) to be more bold in admitting their symptoms and seeking treatment.…”

School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents

“…As many young people spend a substantial amount of time in school, it is also an arena for peer connections and the development of relationships that influence individual and group behaviour within the school, and beyond into local communities; although it is important to recognize that schools are not always supportive or safe social environments for young people (Abrahams 2006; Kaplan 2007; Plummer 2007). It is known that dropping out of school can result in adverse health outcomes for young people (Freudenberg 2007).…”

Evaluation of knowledge levels amongst village AIDS committees after undergoing HIV educational sessions: results from a pilot study in rural Tanzania

“…This imbalance may reduce opportunities for dissemination of HIV education, as opportunities to interact with youths and women within these communities may not be available. In addition, the absence of teachers among the committees in Kisesa may lead to missed opportunities for HIV education within schools, as primary school teachers can be trained to deliver HIV education messages [27]. The MKV programme rolled out in rural Mwanza implemented peer-assisted methods of education in addition to teacher-led education.…”