A cross-sectional questionnaire survey was conducted among 892 randomly selected pupils, aged 12 and above, attending 18 primary schools (PS) and five secondary schools (SS) in four communities of Mwanza Region in Tanzania. The goals were to assess the level of knowledge adolescents have about sexual and reproductive health (SRH), to assess the magnitude of SRH problems and to help design appropriate interventions. Median age of respondents was 15 years (range 12-20 years) and 14 years (range 12-19 years) for PS boys and girls, respectively, and 19 years (range 16-24 years) and 17 years (range 14-19 years) for SS boys and girls. Eighty per cent of PS boys and 68% of PS girls were already sexually active; the corresponding figures were 89% for SS boys and 48% for SS girls. Vaginal sex was the most common first sexual act reported by SS pupils, but 40% of PS pupils reported orogenital sex and 9% of PS pupils reported anal sex as their first sexual act. Almost half of PS girls have had sex with adults, including teachers and relatives. 'Forced sex' was reported by nearly half of PS and SS girls. Fourteen per cent of PS girls had already been pregnant, and over half of these pregnancies ended in illegally induced abortions. Despite a rather high (30%) lifetime rate of condom use, 33% and 25% of PS boys and girls, respectively, reported past experience of sexually transmitted diseases (STDs). STD rates were lower among SS pupils who had a better knowledge of STDs/HIV and fertility issues and reported higher condom use. The survey demonstrated the great vulnerability of school-going adolescents of Mwanza Region to consequences of sexual intercourse. The response should urgently come in the from of comprehensive adolescent SRH programmes.
PIP: Sexual and reproductive health knowledge and behaviors were investigated in a baseline cross-sectional survey of 892 randomly selected students 12-19 years of age attending 18 primary and 5 secondary schools in Tanzania's Mwanza Region. Among primary school students, 80% of boys and 68% of girls were already sexually active; in the secondary school group, these rates were 89% and 48%, respectively. 9% of primary school students reported anal sex as their first sexual act. The main reasons cited for not having sex were, for boys, fear of HIV/AIDS and other sexually transmitted diseases (STDs) and, among girls, fear of pregnancy and parents. Forced sex was reported by 47% of sexually active primary school girls and 37% of experienced secondary school girls. 50% of primary school females had previously had sex with adults, including teachers and relatives. 14% of primary school girls had been pregnant, and over 50% of these pregnancies were terminated through illegal abortion. 33% of primary school boys and 25% of girls reported a history of at least one STD. The lifetime rate of condom use was 30%. The STD rate was lower among secondary school students who were well informed about STDs and HIV/AIDS and used condoms. Discussions about sex were restricted almost exclusively to peers. The Tanzanian Ministry of Education and Culture has designed a family life education program for primary schools that focuses on AIDS prevention. The African Medical and Research Foundation has developed a regional adolescent sexual and reproductive health program to support and complement this initiative; it will be implemented in rural Mwanza starting in 1996 and evaluated in 1999. The findings of the present survey underscore the urgent need for such programming to reduce the grave consequences of early sexual activity.