influence of school based sexual risk avoidance education on sexual behavior among adolescent girls in homabay
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Date
2020-09
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Abstract
Adolescent sexual and reproductive health is a priority in the global agenda because
of its associated negative reproductive health outcomes. It is estimated that Homabay
County contributes 11.5% of adolescents aged 10-19 years living with HIV in Kenya.
The fertility rate among girls aged 15-19 is also high in Homabay with a reported
teenage pregnancy rate of 33% and the age-specific fertility rate of 178 births per 1000
girls. This study aimed to determine the influence of school based sexual risk
avoidance education on sexual behavior in Homabay County. Using a cluster
randomized control trial study design 28 schools were randomly selected from a
sampling frame of 94 schools and randomly allocated to intervention and control arm
of the study at a ratio of 1:1 for a period of 12 months. Using a repeat cross-sectional
study design a total of 491 and 489 participants were proportionately and randomly
selected from a sampling frame of 2085 participated in the baseline and evaluation
surveys respectively. The data collection tools were a self-administered questionnaire,
a focused group discussion guide, and key informant interview guide. For
intervention, school-based sexual risk avoidance manual, self-assessment evaluation
checklist, and videos were used. Quantitative data was managed in SPSS while
qualitative was analyzed by thematic content analysis. Descriptive statistics was used
to determine the prevalence of high-risk sexual behavior, teenage pregnancy, level
knowledge, perception of risk and sexual self-efficacy. Logistic regression analysis
was used to determine factors associated with sexual behavior and effect of
intervention. The study found overall high-risk sexual behavior, sexual activity, early
sexual debut, inconsistent utilization of condom and multiple sexual to be
62.3%,61.7%,37.5%, 33%, and 23.1% respectively among girls. Proportion of
participants with a good level of knowledge on risky sexual behavior, pregnancy and
HIV/AIDS were found to be 39.4%,40.4%, and 82.9% respectively while those with
high perceptions of risk on pregnancy and HIV/AIDS were found to be 54.3% and
41.9% respectively and 60% had high self-sexual efficacy. Multiple sexual partner
was associated with current guardians (OR 0.327, CI 0.126-0.844, P 0.021) and
perception of risk on pregnancy (OR 0.327, CI 0.115-0.929, P 0.036)while
inconsistent utilization of condom was associated with current guardian (OR 0.477,
CI 0.242-0.940, P 0.033), position of birth (OR 0.355 CI 0.157-0.805, P 0.013) and
sexual self-efficacy (OR 0.389, CI 0.188-0.806, P 0.011).Early sexual debut was
associated with knowledge on pregnancy (OR 0.353, CI0.169-0.737, P 0.006) and
perception of risk on pregnancy (OR 0.316, CI 0.147-0.676, P 0.003). School-based
sexual risk avoidance education significantly increased knowledge on risky sexual
behavior (OR 1.525, CI 1.059-2.195, P 0.023) and strength of sexual self-efficacy
(OR 1.506, CI 1.021-2.221, P 0.039). The SRAE has a protective effect on knowledge
on risky sexual behavior and sexual self-efficacy which directly influences sexual
behavior. Therefore, Ministry of education and the stakeholders should upscal