Mmbaga Elia John, Kajula Lusajo, Aarø Leif Edvard, Kilonzo Mrema, Wubs Annegreet Gera, Eggers Sander Matthijs, de Vries Hein, Kaaya Sylvia
Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, PO Box 65015, Dar es Salaam, Tanzania.
Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
BMC Public Health. 2017 Apr 17;17(1):322. doi: 10.1186/s12889-017-4245-4.
Unsafe 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.
To 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.
A school-based Cluster Randomised Controlled Trial was conducted during 2011-2014 in Kinondoni Municipality.
A 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.
A 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).
The 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.
Australian New Zealand Clinical Trials Registry ACTRN12613000900718 , registered on 13 August, 2013.
在坦桑尼亚，不安全的性行为持续使青少年面临一系列负面健康后果的风险。虽然有一些基于有效理论的干预方案对性行为的重要调节因素产生了积极影响，但坦桑尼亚迫切需要一种针对当地情况且经过测试的干预措施。
开发并评估一种干预措施，该措施将对减少坦桑尼亚达累斯萨拉姆12 - 14岁青少年的首次性行为并促进其使用避孕套产生显著效果。
2011 - 2014年在基农多尼市进行了一项基于学校的整群随机对照试验。
总共随机选择了38所公立小学，根据学校规模和地理位置，其中一半被分配到干预组，另一半被分配到对照组。在进行“准备”干预之前，参与者在基线时使用自填式问卷进行访谈，然后在干预后的6个月和12个月再次进行访谈。主要结果是在过去6个月内自我报告的首次性行为和避孕套使用情况。使用广义估计方程（GEE）模型进行数据分析，该模型控制了重复测量以及学校内学生的聚类情况。
基线时共招募了5091名学生，在6个月时（n = 4783）和12个月时（n = 4370）再次进行了访谈。基线时参与者的平均年龄为12.4岁。两个研究组在基线时的社会人口统计学、心理测量学和行为特征没有显著差异。GEE分析表明，在控制聚类和相关重复测量后，该干预对两性的首次性行为都有显著影响。干预组中的女性青少年报告的使用避孕套的行动计划水平显著高于对照组（p = 0.042）。在男性青少年中观察到对避孕套使用行为的影响（p = 0.004），但在女性中未观察到（p = 0.463）。
“准备”干预措施对坦桑尼亚达累斯萨拉姆12 - 14岁青少年自我报告的首次性行为延迟产生了效果。该干预对两性使用避孕套的行动计划产生了积极影响，并且仅增加了男性青少年的实际避孕套使用。未来针对青少年性与生殖健康的干预应侧重于影响行为改变的调节因素。
澳大利亚新西兰临床试验注册中心ACTRN12613000900718，于2013年8月13日注册。
