Knowledge, Perceptions and Acceptability to Strengthening Adolescents’ Sexual and Reproductive Health Education amongst Secondary Schools in Gulu District

Authors: Lule Herman, E. Ovuga, M. Mshilla, S. Ojara, G. Kimbugwe, A. P. Adrawa, N. Mahuro

Abstract:

Adolescents in Northern Uganda are at risk of teenage pregnancies, unsafe abortions and sexually transmitted infections (STIs). There is silence on sex both at home and school. This cross sectional descriptive analytical study interviews a random sample of 827 students and 13 teachers on knowledge, perception and acceptability to a comprehensive adolescent sexual and reproductive health education in “O” and “A” level secondary schools in Gulu District. Quantitative data was analyzed using SPSS 16.0. Directed content analysis of themes of transcribed qualitative data was conducted manually for common codes, sub-categories and categories. Of the 827 students; 54.3% (449) reported being in a sexual relationship especially those aged 15-17 years. Majority 96.1% (807) supported the teaching of a comprehensive ASRHE, citing no negative impact 71.5% (601). Majority 81.6% (686) agreed that such education could help prevention of STIs, abortions and teenage pregnancies, and that it should be taught by health workers 69.0% (580). Majority 76.6% (203) reported that ASRHE was not currently being taught in their schools. Students had low knowledge levels and misconceptions about ASRHE. ASRHE was highly acceptable though not being emphasized; its success in school settings requires multidisciplinary culturally sensitive approaches amongst which health workers should be frontiers.

Keywords: Acceptability, ASRHE, Knowledge, Perception.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1087406

References:

[1] Kearney (2008). http://www.doctors.am/en/announcments/Sexeducation- and-human-sexuality/4821
[2] UNFPA-Adolescents and Youth. (2012). http://www.unfpa.org/public/adolescents/
[3] United Nations Population Fund, UNFPA. (2003). State of the World Population: Investing Adolescents’ Health and Rights, New York:
[4] The International Conference on Population and Development, ICPD (1994). Identifying Sexuality education as a human right, essential to development and human well-being. The ICPD POA, Para 7.37-7.47. Cairo
[5] Joint United Nations Programme on HIV/AIDS, UNAIDS (2004). HIV and young people: the threat for today's youth. Report on the Global AIDS Epidemic, fourth ed., Geneva, Switzerland: pp. 93-98.
[6] Pettifor AE, Straten V, Ariane, Dunbar, Megan S, Shiboski, Stephen C; Padian, Nancy S. (2004). Early age of first sex: A risk factor for HIV infection among women in Zimbabwe, AIDS, 18(10); 1435-1442.
[7] Uganda AIDS indicator survey. (2011). Available at [email protected]
[8] Uganda Bureau of Statistics (2010).Uganda National Household Survey Findings 2009/2010. UBOS Plot 9 Coleville Street, P.O. Box 7186, Kampala, Uganda; Telephone: (256-41) 706000; Fax: (256-41) 237553/230370; Email: [email protected]; Internet: www.ubos.org.
[9] UNICEF.(2005).Study highlights of rape in Northern Uganda's largest IDP camp GULU, UGANDA, 15 JUNE 2005,UNICEFChulho Hyun, Communication Officer, UNICEF Uganda, +256 (0)77 222 347, [email protected]
[10] Ocowun Chris (2008). Cited in the new vision Uganda. Monday, 16th June, 2008.
[11] United Nations (UN) General assembly (2001). Declaration of commitment on HIV/AIDS. Special session on HIV/AIDS, 25-27 June 2001
[12] Alan Guttmacher Institute (2004).Adolescent Sexual and Reproductive Health in Uganda: A Synthesis of Research Evidence; http://www.agiusa. org/pubs/2004/12/20/or14.pdf
[13] Macro International. (2002). Reproductive Health of Young Adults in Uganda: Available at http://www.measuredhs.com/pubs/pdf/OD23/OD23.pdf
[14] Myagmar E. (2000). Mongolian adolescents’ needs assessment survey report. Ulaanbaatar: s.n., 126 p
[15] Kibombo R, Neema S, Moore A and Humera AF. (2008).Adults’ Perceptions of Adolescents’ Sexual and Reproductive Health: Qualitative Evidence from Uganda. Occasional Report No. 35 February (2008)
[16] Amone J. (2004). Reproductive health status of adolescents in the Internally Displaced People's (IDP) camps in Gulu District, Uganda: International Conference on AIDS, 15th: 2004: Bangkok, Thailand). Int Conf AIDS. 2004 Jul 11-16; 15: abstract no. MoPeC3505.
[17] World Population Foundation, WPF (2003).Computer-based sexuality and life skills education in secondary schools in Indonesia, Thailand, Kenya and Uganda. http://schoolnetuganda.sc.ug/projects/ongoingprojects/ the world start with me
[18] Monibiot G. (2004).Joy of sex education: The Guardian, 111 may 2004
[19] Finn Friis Lauszus, Aiste Ozeraityte Kloster, Jacob Lauesgaard Nielsen, Jane Boelskifte, Jørgen Falk, Kjeld Leisgård Rasmussen .(2006). Gender-specific knowledge on sex. Arch Gynecol Obste.; 12;200, 66452
[20] Lewin, K & Caillords, F. (2001). Financing secondary Education in Development
[21] Nsubuga, Y.K.K. (2003). Development and examination of secondary school education in Uganda
[22] Namirembe, G. (2005). Status of education for rural people in Uganda Paper presented at the ministerial seminar on education for rural people in Africa. Addis Ababa, Ethiopia
[23] Oyat C. (2009). The Challenges of Sustained HIV/AIDS Education in Uganda: A case study in Northern Uganda. Gulu University Medical Journal (GUMJ) Vol 4 2008/2009 pgs 13-18
[24] Straight Talk Foundation. (2007).The straight talk foundation in Uganda: Impact of mass media initiatives (Full report) p.64.USAID, Kampala
[25] Uganda DISH II- Research on Adolescent Sexual and Reproductive Health in Uganda http://www.ugandadish.org/resource/aa/aa6.shtml
[26] Ali MM & Cleland J. (2005). Sexual and reproductive behaviour among single women aged 15-24 in eight Latin American countries: a comparative analysis, Social Science & Medicine; 60(6): 1175-1185.
[27] Wellings K, Collumbien M, Slaymaker E, Singh S, Hodges Z, Patel D, Bajos N.(2006). Sexual behaviour in context: a global perspective, Lancet, 368(9548): 1706-1728.
[28] Glasier A, Gülmezoglu AM, Schmid GP, Schmid GP, Moreno CG, Van Look. (2006). Sexual and reproductive health: a matter of life and death, Lancet; 368(9547): 1595-1607.
[29] Khan S & Mishra V. (2008). Youth Reproductive and Sexual Health, DHS Comparative Reports, Calverton, MD, USA: Macro International, Inc., No. 19
[30] DiCenso .A, Gordon G. Willan.A &Griffith. L. (2002). Interventions to Reduce Unintended Pregnancies among Adolescents: Systematic Review of Randomized Controlled Trials. British Medical Journal; 324:1426.
[31] Bersamin MM, Fisher DA, Walker S, Douglas LH, Joel WG. (2007). Defining virginity and abstinence: adolescents' interpretations of sexual behaviours. Journal of Adolescent Health; 41(2)182-188.
[32] Masatu MC, Kazaura MR, Ndeki S, Mwampambe R. (2009). Predictors of risky sexual behaviour among adolescents in Tanzania, AIDS and Behavior; 13(1):94-99. (17.)
[33] Kawai K, Kaaya, S. F., Kajula, L., Mbwambo, J., Kilonzo, G. P., & Fawzi, W. W. (2008). Parents’ and teachers’ communication about HIV and sex in relation to the timing of sexual initiation among young adolescents in Tanzania. Scandinavian Journal of Public Health; 36(8), 879-888.
[34] Guttmacher Institute. (2008).Protecting the next generation in Uganda: New evidence on Adolescent Sexual and Reproductive health needs.
[35] United Nations. (2008). Human Development Report, New York
[36] IOM. (2003). International Organization for Migration, p.30, Gulu District IDP Camps survey, Kampala
[37] Okurut Nathan., Jonathan J.A.O. Odwee, Asaf Adebua (2002). Determinants of Regional Poverty in Uganda, The African Economic Research Consortium, Nairobi Kenya ISBN 9966-944-89-3 http://www.aercafrica.org/documents/rp122.pdf
[38] Hargreaves JR, Morison LA, Kim JC, Bonell CP, Porter1 JDH, Watts C, Busza J, Phetla G, Pronyk PM.(2008).The association between school attendance, HIV infection and sexual behaviour among young people in rural South Africa, Journal of Epidemiology and Community Health; 62(2): 113-119.
[39] Bearinger L.H, Sieving RE, Ferguson J, Sharma V. (2009). Global perspectives on the sexual and reproductive health of adolescents: patterns, prevention, and potential, Lancet; 369(9568): 1220-1231
[40] UNFPA Timor-Leste- Adolescent Sexual and Reproductive Health Curriculum for Tomor-Leste; http://countryoffice.unfpa.org/timorleste/2012/03/23/4725/adolescent_se xual_and_reproductive_health_carriculum_for_timor_leste/
[41] Akpabio II, Asuzu MC, Fajemilehin BR, Ofi AB. (2009). Effects of school health nursing education interventions on HIV/AIDS-related attitudes of students in Akwa Ibom State, Nigeria, Journal of Adolescent Health; 44(2): 118-123.
[42] Thato R. Jenkins RA & Dusitsin N. (2008). Effects of the culturallysensitive comprehensive sex education programme among Thai secondary school students, Journal of Advanced Nursing, 62(4): 457- 469.
[43] Minaya J, Owen-Smith A and Herold J. (2008). The impact of sex education on HIV knowledge and condom use among adolescent females in the Dominican Republic, International Journal of Adolescent Medicine and Health, 20(3):275-282
[44] Givaudan M, Leenen I, Fons J. R, Van De V, Ype H. Poortinga P. S. (2008). Longitudinal study of a school based HIV/AIDS early prevention program for Mexican adolescents, Psychology, Health and Medicine; 13(1):98-110.
[45] Pick S, Givaudan M, Sirkin J, Ortega I. (2007). Communication as a protective factor: evaluation of a life skills HIV/AIDS prevention program for Mexican elementary-school students, AIDS Education and Prevention, 19(5): 408-421.
[46] Lumuli M & Kayombo JK. (2008). Assessing acceptability of parents/guardians of adolescents towards introduction of sex and reproductive health education in schools at Kinondoni Municipal in Dar es Salaam city. School of Medicine, Muhimbili University of Health & Allied Sciences (MUHAS), Dar es Salaam, Tanzania. East Afr J Public Health;5 (1):26-31 18669120 Cit:1
[47] Kirby DB. Laris BA and Rolleri LA. (2007). Sex and HIV education programs: their impact on sexual behaviors of young people throughout the world, Journal of Adolescent Health; 40(3): 206-217.
[48] Nair MKC, Leena ML, Mini KP, Vijayan H, Babu G, Russell PS,Thankachi Y.(2012) Attitudes of parents and teachers towards adolescent reproductive and sexual health education. Indian J Pediatr. ; 79 Suppl 1:S60-3 21614606.
[49] Mwambete DK & Mtaturu Z. (2006). Knowledge of sexually transmitted diseases among secondary school students in Dar es Salaam, Tanzania. Afr Health Sci.; 6(3): 165–169. PMCID: PMC1831885
[50] Thankachi Y, M K C Nair, Mini K Paul, M L Leena, Babu George, P S Russell, H Vijayan Pillai. (2012). Effectiveness of a reproductive sexual health education package among school going adolescents. Indian J Pediatr; 79 Suppl 1:S64-8 21617909
[51] Katoanga SF. (2000). Situation analysis of adolescent reproductive health in selected Pacific Island countries. Paper presented at the Intercountry Workshop on Adolescent Reproductive Health for East and South East and the Pacific Island Countries, 27 April to 3 May 2000. 20p.
[52] McManus Alexandra & Lipi Dhar. (2008). Knowledge, perception and attitude of adolescent girls towards STIs/HIV, safer sex and sex education: A cross sectional survey of urban adolescent school girls in South Delhi, India. Published online 2008 July 23. doi: 10.1186/1472- 6874-8-12PMCID: PMC2490677
[53] Valley Research Group. (1999). Reproductive health awareness, attitudes and behaviour of adolescents in Nepal. Kathmandu: UNFPA, 1999. 110p