Influence Of School-Based Sexual Risk Avoidance Education On Sexual Behavior Among Adolescent Girls In Homabay County, Kenya

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 upscale a progressive sexual risk avoidance education from primary to secondary schools.