Impact Data - Nyeri Youth Health Project
Date
Carried out between 1998 and 2000, the Nyeri Youth Health Project was a Kenyan reproductive and sexual health information programme for unmarried, in- and out-of-school youth aged 10 to 24 in both rural and urban areas. The objectives of the project were to delay the onset of sexual intercourse among youth who are not yet sexually active; to prevent sexually experienced youth from suffering negative consequences of sexual activity and to create a reproductive health information and service environment responsive to the needs of youth. The design of the project drew on the following six principles for youth programming:
- recognise the diversity of adolescents;
- begin with what young people want and what they are already doing to obtain sexual and reproductive health information and services;
- include skills building;
- engage adults to create a safe and supportive environment;
- use a variety of settings and providers;
- make the most of existing infrastructure.
As part of the project development process, a qualitative research study was conducted among young people, their parents and community leaders to explore preferences regarding an information and services project for youth. This study revealed that both young people and parents preferred that adults, rather than peers, deliver such information.
Methodologies
This quasi-experimental evaluation compared youth living in project sites (in Nyeri Municipality) with youth in a comparison municipality, Nyahururu. The populations in the intervention and comparison municipalities were similar in terms of ethnic and religious composition, socioeconomic status, and health and education infrastructure. Nyahururu is located more than 100 km from the project area, making contamination unlikely.
To measure the programme impact, adolescents who had not had sex at the start of the project three years prior to the endline survey were selected. To make the selection, all households in the project site were listed, using maps from the Central Bureau of Statistics. Seventy-five households with eligible adolescents were selected per counsellor area at baseline, and 100 households per area were selected at endline. As in the project area, households in the control area were listed and selected at random.
It was then determined, among young people in each district who had not had sex when the project started, what proportion went on to initiate sex during the intervention. To make a comparison, the same examination was conducted among young people who had not had sex three years prior to the baseline survey. To measure secondary abstinence, the survey included all sexually experienced adolescents and created a variable to reflect whether or not they had abstained for the previous six months. Although condom use at last intercourse is not a perfect measure of consistent condom use, it was selected to reflect the extent to which young people were currently having protected sex.
Cross-sectional surveys were carried out in the project and control sites at baseline (1997) and at endline (2001). During the baseline survey in 1997, 1544 unmarried youth, ages 10 to 24, were interviewed in Nyeri and Nyahururu. At baseline, 87% of eligible youth were interviewed and, at follow-up, 90% were interviewed. The sample at baseline was slightly younger than at follow-up: at baseline, only 16 to 20% of the sample was over age 19; at follow-up, 24 to 30% of the sample was over age 19. At follow-up in 2001, 1865 youth ages 10-26 were interviewed in the two municipalities (those who were aged 25 or 26 at endline may have benefited from the project during its first two years of implementation, but aged out of the project).
To measure the programme impact, adolescents who had not had sex at the start of the project three years prior to the endline survey were selected. To make the selection, all households in the project site were listed, using maps from the Central Bureau of Statistics. Seventy-five households with eligible adolescents were selected per counsellor area at baseline, and 100 households per area were selected at endline. As in the project area, households in the control area were listed and selected at random.
It was then determined, among young people in each district who had not had sex when the project started, what proportion went on to initiate sex during the intervention. To make a comparison, the same examination was conducted among young people who had not had sex three years prior to the baseline survey. To measure secondary abstinence, the survey included all sexually experienced adolescents and created a variable to reflect whether or not they had abstained for the previous six months. Although condom use at last intercourse is not a perfect measure of consistent condom use, it was selected to reflect the extent to which young people were currently having protected sex.
Cross-sectional surveys were carried out in the project and control sites at baseline (1997) and at endline (2001). During the baseline survey in 1997, 1544 unmarried youth, ages 10 to 24, were interviewed in Nyeri and Nyahururu. At baseline, 87% of eligible youth were interviewed and, at follow-up, 90% were interviewed. The sample at baseline was slightly younger than at follow-up: at baseline, only 16 to 20% of the sample was over age 19; at follow-up, 24 to 30% of the sample was over age 19. At follow-up in 2001, 1865 youth ages 10-26 were interviewed in the two municipalities (those who were aged 25 or 26 at endline may have benefited from the project during its first two years of implementation, but aged out of the project).
Practices
The project delayed initiation of sexual intercourse among males and increased abstinence among sexually experienced female youth. It also reduced number of sex partners among females and increased use of condoms among males.
For example, among females, between 1997 and 2001, smaller proportions initiated sex (24% vs. 21%) and reported having had three or more partners in the previous three years (14% vs. 5%), and higher proportions had abstained (40% vs. 53%) or used condoms (22% vs. 32%). In contrast, among females in the control area, five of the six indicators of sexual and reproductive health behaviour and communication changed for the worse: While the proportion who had initiated sex in the previous three years decreased (from 25% to 21%), there was also a decline in the percentage of females who had abstained from sex (39% vs. 26%) and a decrease in condom use at last sex among this group (from 28% to 25%). Furthermore, among this control group, the proportion of sexually experienced youth reporting three or more sexual partners in the last three years rose from 13% to 30%. In short, at follow-up, sexually experienced female youth from the intervention site were three times more likely to abstain from sex as females from the comparison site, a finding that was statistically significant. By follow-up, female youth in the intervention site were 90% less likely than female youth from the comparison site to have had multiple sexual partners, a statistically significant outcome.
Between 1997 and 2001, the proportion of male youth in the intervention site who had initiated sex dropped from 34% to 24% (it rose from 30% to 33% among males in the comparison site). The difference in delay was statistically significant . The proportion of sexually experienced young men from the intervention site reporting condom use at last sex rose from 39% to 45%. In contrast, condom use at last sex dropped among young men at the comparison site (from 41% to 16%). The difference in condom use was statistically significant for male youth.
For example, among females, between 1997 and 2001, smaller proportions initiated sex (24% vs. 21%) and reported having had three or more partners in the previous three years (14% vs. 5%), and higher proportions had abstained (40% vs. 53%) or used condoms (22% vs. 32%). In contrast, among females in the control area, five of the six indicators of sexual and reproductive health behaviour and communication changed for the worse: While the proportion who had initiated sex in the previous three years decreased (from 25% to 21%), there was also a decline in the percentage of females who had abstained from sex (39% vs. 26%) and a decrease in condom use at last sex among this group (from 28% to 25%). Furthermore, among this control group, the proportion of sexually experienced youth reporting three or more sexual partners in the last three years rose from 13% to 30%. In short, at follow-up, sexually experienced female youth from the intervention site were three times more likely to abstain from sex as females from the comparison site, a finding that was statistically significant. By follow-up, female youth in the intervention site were 90% less likely than female youth from the comparison site to have had multiple sexual partners, a statistically significant outcome.
Between 1997 and 2001, the proportion of male youth in the intervention site who had initiated sex dropped from 34% to 24% (it rose from 30% to 33% among males in the comparison site). The difference in delay was statistically significant . The proportion of sexually experienced young men from the intervention site reporting condom use at last sex rose from 39% to 45%. In contrast, condom use at last sex dropped among young men at the comparison site (from 41% to 16%). The difference in condom use was statistically significant for male youth.
Increased Discussion of Development Issues
The project increased communication with parents and other adults about sexual health. For example, between 1997 and 2001, more young women communicated with a parent (26% vs. 37%) or other adult (49% vs. 57%) about reproductive health. In contrast, among females in the control area, five of the six indicators of sexual and reproductive health behaviour and communication changed for the worse; for example, there was a decline in the proportion who talked to either a parent (39% vs. 19%) or another adult (54% vs. 26%) about reproductive health.
Young people's conversations with adults other than parents increased significantly among both male and female youth in the intervention community - from 39% to 47% of male youth and from 49% to 57% of female youth. In contrast, proportions dropped among youth in the comparison community (from 39% to 31% of males and from 54% to 26% of females).
Young people's conversations with adults other than parents increased significantly among both male and female youth in the intervention community - from 39% to 47% of male youth and from 49% to 57% of female youth. In contrast, proportions dropped among youth in the comparison community (from 39% to 31% of males and from 54% to 26% of females).
Source
Advocates for Youth website on February 23 2005.
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