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Health Education Research Advance Access originally published online on October 3, 2006
Health Education Research 2007 22(4):483-499; doi:10.1093/her/cyl099
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© The Author 2006. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Are schools a good setting for adolescent sexual health promotion in rural Africa? A qualitative assessment from Tanzania

Mary L. Plummer1,2,*, D Wight2, J Wamoyi3, K Nyalali3, T Ingall4, G Mshana5, Z. S. Shigongo3, A. I. N. Obasi6 and D. A. Ross1

1 Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
2 Social and Public Health Sciences Unit, Medical Research Council, Glasgow G12 8RZ, UK
3 NIMR/AMREF/LSHTM Collaborative Projects, Mwanza, Tanzania
4 Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
5 National Institute for Medical Research, Mwanza, Tanzania
6 Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK

* Correspondence to: M. L. Plummer. E-mail: mary.plummer{at}lshtm.ac.uk

African adolescents are at high risk of poor sexual health. School-based interventions could reach many adolescents in a sustainable and replicable way, if enrolment, funding and infrastructure are adequate. This study examined pupils', recent school leavers', parents' and teachers' views and experiences of rural Tanzanian primary schools, focusing on the implications for potential sexual health programmes. From 1999 to 2002, participant observation was conducted in nine villages for 158 person-weeks. Half of Year 7 pupils were 15–17 years old, and few went on to secondary school, suggesting that primary schools may be a good venue for such programmes. However, serious challenges include low enrolment and attendance rates, limited teacher training, little access to teaching resources and official and unofficial practices that may alienate pupils and their parents, e.g. corporal punishment, pupils being made to do unpaid work, forced pregnancy examinations, and some teachers' alcohol or sexual abuse. At a national level, improved teacher training and supervision are critical, as well as policies that better prevent, identify and correct undesired practices. At a programme level, intervention developers need to simplify the subject matter, introduce alternative teaching methods, help improve teacher–pupil and teacher–community relationships, and closely supervise and appropriately respond to undesired practices.

Received on December 25, 2005; accepted on August 7, 2006


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M. L. Plummer, D Wight, A. I. N. Obasi, J Wamoyi, G Mshana, J Todd, B. C. Mazige, M Makokha, R. J. Hayes, and D. A. Ross
A process evaluation of a school-based adolescent sexual health intervention in rural Tanzania: the MEMA kwa Vijana programme
Health Educ. Res., August 1, 2007; 22(4): 500 - 512.
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