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

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.