Implementation and evaluation of a curriculum to teach reproductive health to adolescents in northern Madagascar

Abstract

Background: In Madagascar, prevalence of sexually transmitted infections (STIs) and unplanned pregnancies are high among adolescents. Limited reproductive health education is available.

Methods: In northern Madagascar, in 2014, we assessed the baseline knowledge, attitudes and self-efficacy regarding STIs/HIV and family planning among 155 adolescents, and designed and implemented a 6-week reproductive health curriculum for adolescents using complementary teaching methods. We evaluated the curriculum through pre- and post-curriculum surveys of adolescents using paired t-tests.

Results: Pre-test survey revealed a general lack of knowledge regarding different types of STIs. Post-curriculum, there was a significant improvement in the following educational domains: general knowledge of HIV/AIDS, other STIs and family planning (49%±17% to 65%±15%) (p<0.001), self-efficacy and use of contraceptives (57%±26% to 70%±26%) (p<0.01), and the overall combined scores of knowledge, attitude and self-efficacy (53%±14% to 68%±14%) (p<0.001). Open-ended questions revealed significant misconceptions and stigma regarding oral and anal sex and usage of condoms.

Conclusions: Important misconceptions and knowledge gaps regarding reproductive health exist among adolescents. The comprehensive reproductive health curriculum with complementary teaching methods was feasible, well-received and effective, and could be considered for integration into the schools' curricula.

Keywords: Adolescents; Contraception; Curriculum; Family planning; Madagascar; Reproductive health.