Interventions

MEMA kwa Vijana is one of the first studies in Africa to evaluate an adolescent reproductive health intervention programme using both behavioural and biomedical markers within a randomised controlled trial.

The first phase of MEMA kwa Vijana (MkV1) ran from 1997-2002. During this phase, the interventions were developed and pilot tested over a 12 month period (1997-1998), and then introduced into 10 randomly chosen intervention communities, with 10 similar communities acting as comparison communities (1998-2002). A trial community was roughly equivalent to an administrative ward within the Tanzanian local government system, and had an average of 5-6 villages. Overall, there were a total of 62 primary schools and the 18 health facilities in the 10 intervention communities, and 59 primary schools and 21 health facilities in the 10 comparison communities.

The intervention package

1. During MkV1, the package of adolescent sexual and reproductive health interventions included:
2. Teacher-led, peer-assisted in-school sexual and reproductive health education to pupils in the last three years (Standards 5, 6 & 7) of primary school. These were taught within science lessons.
3. Training and supervision of health workers in government health facilities to provide youth-friendly sexual and reproductive health services.
4. Training and supply of youth community-based condom promoters and distributors.
5. Related community-wide activities, to create a supportive environment for the adolescent sexual health interventions. These included a team spending one week in each community prior to the launch of the interventions, an annual youth health week, and biannual youth health days at the local health facilities.

The interventions in the schools and health facilities are led by government teachers and health workers, and were explicitly designed to be affordable by the Government of Tanzania with realistic levels of external funding support, and to be replicable on a very large scale. Over 150 teachers, 2000 peer educators, 62 head teachers, 14 ward education co-ordinators, 10 district inspectors of schools and 70 health workers were trained during the first Phase of the project. Three innovative teacher guides with accompanying pupil drama guides, a teacher’s resource book and flip chart were developed for use in years 5, 6 and 7 of primary school, and locally available question and answer booklets developed by another group in Tanzania were introduced into all intervention primary schools. Training and supervision manuals for teachers, class and community peer educators, health workers, youth condom promoters and distributors, and community advisory committees were also developed. All the materials used in the interventions were further improved in the light of experience and detailed process evaluation over the initial four years of implementation of the project (MkV1, 1998-2002). These materials are available in both Swahili or English on request.