Attitude and prevalence of early sexual debut and associated risk sexual behavior among adolescents in Tanzania; Evidence from baseline data in a Randomized Controlled Trial.

BACKGROUND: Unsafe sexual behaviours and associated sexual ideas among adolescents may contribute to adverse health consequences for sexual health in adulthood. The patterns of sexual ideology and sociodemographic factors profiles on adolescents' sexual behaviours have not been the subject of a definite consensus in research. The purpose of this study was to investigate the attitude and prevalence of early sexual debut and associated risk sexual behavior among adolescents in Tanzania as the evidence from baseline data in a Randomized Controlled Trial. METHODS: The study included 647 randomly chosen in-school adolescents from Tanzania and used an analytical cross-section survey in a quantitative research approach. Sexual-risk Behaviour Beliefs and Self-esteem Scale from previous studies were the main data collection tool. According to the Statistical Analysis Software (SAS), computer software version 9.4 descriptive analysis established respondents' socio-demographic profiles, attitudes, prevalence, and determinants linked to teenagers' early sexual debut. The link between the variables was established via multivariate logistic regression at a 5% significance level and a 95% confidence interval. RESULTS: The mean age was 15 ± 1.869 years while 57.5% of adolescents were females. 69.7% of adolescents were sexually active whereas 44.8% of them practised sexual behaviours willingly against 24.9% who practised coerced sexual behaviours. The majority (44.4%) and 16.2% of them initiated sexual behaviours during the early and middle adolescence stages respectively. Most adolescents had the ideology that sex was okay to them even before the age of 18 years. Their odds of practicing sexual behaviours were significantly high with the ideology that sex was okay to them even before 18 years of age (AOR = 1.293; p < 0.05; 95%CI: 0.689, 2.989), exposure to drug abuse (AOR = 1.210; p < 0.05; 95%CI: 0.803, 2.130), using media (AOR = 1.006; p < 0.05; 95%CI: 0.748, 2.667) and/or exposure to social groups [Jogging, Gym, health clubs, betting, Games] (AOR = 1.032; p < 0.05; 95%CI: 0.889, 2.044). CONCLUSION: Findings suggest that holding a positive attitude towards early sexual debut is a precursor to early sexual activity among adolescents. Unsafe sex, coercive sex, and other risky sexual behaviors are not uncommon among adolescents starting sex before the age of 18 years. Exposure to drug abuse, online sexual content, and/or social groups significantly influenced early sexual debut irrespective of other known factors. Age-appropriate school-based sexuality education programs should be promoted and implemented to address the most prevalent positive attitude towards early sexual debut and associated risk sexual behaviour among adolescents in Tanzania and other similar settings.

The effect of educational intervention on shaping safe sexual behavior based on problem-based pedagogy in the field of sex education and reproductive health: clinical trial among adolescents in Tanzania.

BACKGROUND: The majority of adolescents are currently becoming sexually active before their 18th birthday having to battle with unsafe sexual behaviors, teenage pregnancies, sexually transmitted infections, and school dropouts. The study designed and tested the effect of integrated reproductive health lesson materials in a Problem-Based pedagogy (PBP) to enhance safe sexual behaviors among adolescents in Tanzania. METHODS: Clustered Randomized Controlled Trial was adopted among 660 adolescents in Tanzania. The study consisted of three research arms including pure PBP, Hybrid PBP, and Lecture-Based Pedagogy (LBP). Sexual-risk Behavior Beliefs and Self-esteem Scale adopted from previous studies measured adolescents' sexual behaviors. A Statistical Analysis Software (SAS) version 9.4 was used to analyze data. Descriptive analysis established adolescents' socio-demographic profiles. Generalized Estimating Equation (GEE) determined the effect of interventions on adolescents' intentions to practice safe sexual behaviors at a 95% confidence interval and a significance level of 5%. RESULTS: Adolescents' mean age was 15 ± 1.869 years. Sums of 57.5% (n = 380) were females. 39.5% of adolescents were sexually active whereas 44.8% of them initiated sexual intercourse by the age between 10 and 12 years. The end-line findings showed that 54.9% of adolescents in the LBP group demonstrated a significant intention to unsafe sexual behaviors against 26.3% and 30.9% of adolescents in the pure PBP and Hybrid PBP groups respectively. The Difference-In-Difference odds ratio for unsafe sexual behavior among adolescents in the Hybrid PBP and pure PBP was less (AOR = 0.30; p < 0.0001; 95%CI: 0.1398, 0.5559) and (AOR = 0.30, p < 0.0002; 95%CI: 0.1386, 0.5487) contrary to a control group respectively. CONCLUSION: The integrated RH lesson materials in a PBP can change a spectrum of sexual behavior among adolescents in Tanzania. This study suggests school teachers and health workers work together to facilitate RH lessons using PBP to enhance safe sexual behaviors among adolescents for their healthy adulthood and future investment.Trial registration: Pan African Clinical Trial Registry identifier: PACTR202009656160779.

Effect of integrated reproductive health lesson materials in a problem-based pedagogy on soft skills for safe sexual behaviour among adolescents: A school-based randomized controlled trial in Tanzania.

BACKGROUND: Adolescents are currently becoming sexually active before their 18th birthday during which they have to battle with unsafe sexual behaviours, teenage pregnancies, sexually transmitted infections (STIs), and school dropouts. The trend is linked with low soft skills (self-esteem and assertiveness skills) for them to make informed, reasoned, and responsible decisions over sexual activities. This study designed and tested the effect of integrated reproductive health (RH) lesson materials in a problem-based pedagogy (PBP) to enhance soft skills for safe sexual behaviour among adolescents in Tanzania. METHODS: A double-blinded clustered randomized controlled trial was conducted between September 2019 and September 2020 among 660 randomly selected adolescents. A Sexual-risk Behaviour Beliefs and Self-esteem Scale adopted from previous studies measured soft skills for safe sexual behaviour. A descriptive statistical analysis was performed by using the statistical analysis software programme version 9.4. The effect of the intervention was determined using Linear Mixed Model set at α error probability = 5% significance level (95% confidence interval) and a ß error probability = 0.80. FINDINGS: Adolescents' mean age was 15±1.869 with 57.5% females. The end-line findings indicated that the coefficient of soft skills was significantly higher among adolescents in the hybrid PBP (ß=9.0986, p<0.01; 95%CI: 4.7772, 14.2311) and pure PBP (ß =8.7114, p<0.01; 95%CI: 3.9990, 10.1208) than in the control group. The retention rate of soft skills was still significantly higher at 3-months follow-up (ß=2.0044; p<0.01; 95%CI: 1.0234, 4.1182) and at 6-months follow-up (ß=1.9803; p<0.01; 95%CI: 0.8399, 3.1099) compared to the baseline and immediate post-intervention assessments. CONCLUSION: The intervention substantially enhanced soft skills for safe sexual behaviour among adolescents of both sex. Despite the fact that scores for soft skills varied across the study timelines, adolescents demonstrated significant intentions to abstain from sexual intercourse, delay sexual relationships, negotiate condom use, and withstand sexual coercions. The PBP may need to be incorporated in ordinary level secondary school curricula as a formal guide to teachers and or health workers to optimally prepare adolescents for their healthy adulthood.