About the Author(s)


Aimable Nkurunziza Email symbol
School of Nursing, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda

Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada

School of Nursing, Faculty of Education and Professional Studies, Nipissing University, North Bay, Canada

Michael Habtu symbol
School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda

Germaine Tuyisenge symbol
Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom

Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada

Nadja Van Endert symbol
Department of Midwifery, University Colleges Leuven-Limburg (UCLL), Genk, Belguim

Godfrey Katende symbol
School of Nursing, Aga Khan University, Kampala, Uganda

Assumpta Yamuragiye symbol
School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda

Justine Bagirisano symbol
Department of Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda

Jean B.H. Hitayezu symbol
Department of Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda

Olive Tengera symbol
Department of Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda

Edward Rwagasore symbol
Health Development Initiative, Kigali, Rwanda

Citation


Nkurunziza A, Habtu M, Tuyisenge G, et al. Peer education programme to improve adolescent sexual and reproductive health in Rwanda. J Public Health Africa. 2025;16(1), a1342. https://doi.org/10.4102/jphia.v16i1.1342

Original Research

Peer education programme to improve adolescent sexual and reproductive health in Rwanda

Aimable Nkurunziza, Michael Habtu, Germaine Tuyisenge, Nadja Van Endert, Godfrey Katende, Assumpta Yamuragiye, Justine Bagirisano, Jean B.H. Hitayezu, Olive Tengera, Edward Rwagasore

Received: 25 Feb. 2025; Accepted: 30 June 2025; Published: 08 Oct. 2025

Copyright: © 2025. The Author(s). Licensee: AOSIS.
This work is licensed under the Creative Commons Attribution 4.0 International (CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/).

Abstract

Background: A peer education programme was developed in response to the tendency of high school students in Rwanda to seek sexual and reproductive health information from peers who are often inadequately informed.

Aim: To assess the effect of Sexual and Reproductive Health Peer Education Programme (SRH PEP) on knowledge and the attitudes of SRH among high school adolescents in Rwanda.

Setting: The study was conducted at selected high schools in Rwanda.

Methods: This pre-test and post-test design study was conducted in two selected high schools. The pre-test data were collected in February 2020, followed by the post-test data in May 2022. A total of 536 students participated in this study. The effect on SRH knowledge and attitudes was measured using a paired t-test.

Results: Of the total 536 questionnaires administered, only 508 were well completed (response rate of 94.7%). After the intervention, there was an increase in knowledge and attitude regarding SRH (M = 15.87 vs 19.9, p < 0.001; M = 7.95 vs 10.66, p < 0.001, respectively). The proportion of correct responses to knowledge and attitude was also significantly improved after the intervention (p < 0.05).

Conclusion: This study underscored the pivotal role of peer-led SRH education programmes as an effective modality for educating adolescents and young adults about SRH. There is a need for integrating structured peer education initiatives into school-based programmes to ensure adolescents receive accurate and reliable SRH information.

Contribution: This study contributes to the field of adolescent SRH by demonstrating the effectiveness of peer education programmes (PEPs) in enhancing knowledge and attitudes among high school students.

Keywords: high school; adolescents; peer education programme; sexual and reproductive health; Rwanda.

Introduction

Background

Sexual and reproductive health and rights (SRHR) is an essential and integral component of universal health coverage that countries around the globe need to consider for attainment of the sustainable development goals (SDGs). Limited access to sexual and reproductive health (SRH) among adolescents has been reported as a challenge in many countries worldwide.1 Lack of or inadequate SRH knowledge among adolescents has severe consequences, including but not limited to increased teenage pregnancies, early marriage and poor decision-making.2

Worldwide, teenage pregnancy remains a major concern with variations in different countries, including sub-Saharan Africa (SSA) as the most affected.3,4,5,6,7,8 The East African region accounts for 25% of the SSAs prevalence.9 In Rwanda, one of the East African countries, pregnancies among young girls between 10 years and 18 years continue to be reported, with the eastern province having the highest prevalence.10 Teenage pregnancy consequently leads to school dropouts, extreme poverty, complicated pregnancies and associated risks, malnutrition as well as mental health consequences.11

A recent study conducted in Rwanda about adolescent reproductive health and sources of information revealed that sexuality as a topic is considered taboo in Rwandan culture.12 However, another study that was conducted to explore enabling and preventive factors to access to the SRH among adolescents revealed that 5% of female and 11% of male adolescents became engaged in sexual activity before the age of 15 years.13 This high prevalence of teenage pregnancies and adolescents’ behaviour of engaging in sexual activities suggests a need to address the problem but also calls for implementing different interventions to provide and increase access to quality sex education.

Since 2016, Rwanda has been implementing a comprehensive SRH education in primary and secondary schools together with other different interventions such as teaching in and out schooling and mobile for reproductive health (m4RH) that delivered reliable SRH information to early adolescents.11 However, from statistics, it appears that most of these interventions seem to be less effective with little or no significant outcomes.14 This might be argued that many of the adolescents seek information from their peers, who might also be equipped with little or incorrect knowledge about SRH.15 This, therefore, led to the development and implementation of a Sexual and Reproductive Health Peer Education Programme (SRH PEP) conducted in the selected district of Rwanda. The selection of the district was based on the current country’s highest prevalence of teenage pregnancies in Eastern Province.16 The SRH PEP was implemented to equip adolescents with knowledge and the right attitudes about SRH in schools but also to contribute to addressing the problem. The outcomes of implementing the SRH PEP were also evaluated.

Research methods and design

Study design

This study utilised both pre-intervention and post-intervention designs. A baseline (pre-test) survey was conducted on SRH knowledge and attitudes among adolescents before the implementation of the intervention. A post-test survey was conducted after 26 months of the implementation of the intervention.

Description of the intervention

The SRH PEP Manual was developed in 2019 in collaboration with the University of Rwanda (UR) and University College Leuven-Limberg (UCLL) staff.16 The development of the Manual undertook several steps to the final implementable Manual. The literature review process was conducted to understand the available evidence around the implementation of the SRH PEP. A local needs assessment was then conducted to ensure that the intervention was tailored to the local and adolescents’ needs. A networking event was also organised with different stakeholders, including schools’ leadership, teachers, community leaders, religious people and healthcare providers among others. The purpose of this event was to gain a comprehensive understanding of existing SRH programmes in the district or schools, the challenges faced during their implementation in the schools and the communities. The networking event was also used as an opportunity to connect with the stakeholders for programme sustainability. Baseline surveys were then conducted using mixed methods. The quantitative approach was used to examine adolescents’ knowledge and their attitudes regarding SRH, while the qualitative approach was conducted through six focus group discussions (FGDs) to obtain a deeper understanding of adolescents’ SRH needs. These were analysed and used to inform the development of the SRH PEP Manual. Lastly, the team from UR visited UCLL to discuss SRH issues and outreach programmes in Rwanda.

During the implementation of the SRH PEP, the empowerment model developed by the research team guided the process.16 With the use of the SRH PEP Manual, a 6-day workshop was conducted to train selected students to become peer educators (PEs). The goal of the workshop was to equip PEs with enough SRH knowledge and improve their personal development and group communication skills. During the workshop, evidence-based experimental learning and interactive methodologies were used. These strategies were also used to help PEs discover new information about themselves. To ensure that PEs were actively involved and retained information, active learning strategies such as role plays, simulations and educational games were utilised.17

We conducted two different trainings (training module A for UR midwifery students as facilitators and train-the-trainer module B for PEs).18 Six of the trained facilitators (midwifery students) and three staff members of UR midwifery trained the selected students at three secondary schools. In each school, we selected 12 students as PEs (six males and six females). In addition, we trained their teachers who, at the time, showed interest in learning more about SRH issues and also in implementing the SRH Module. This was not previously planned but, in the end, added value to the project for sustainability. These teachers then took up the mentorship role of the students during the project implementation. After we completed the training, we then embarked on creating a WhatsApp group among the project team, trained teachers and schools’ authorities to ensure constant communication. The project team contacted the trained peers by phone through their teachers and authorities at least twice a month to monitor any challenges and propose immediate solutions. Focus group discussions were conducted with PEs to explore their experiences as evidence that PEs improved the programme.18 After 26 months of implementing the SRH PEP, we again assessed their knowledge and attitudes.

Study participants

The SRH PEP was implemented in three secondary-level high schools. However, due to unforeseen challenges faced by one school in the implementation of the project – with mentors’ relocation to other schools and repatriation of PEs to Burundi from the refugee camp,19 the post-intervention was only conducted in two schools. Therefore, 536 students aged between 13 years and 24 years from secondary school levels 2, 3, 5 and 6 participated in both the pre-survey and the post-survey. Students from secondary levels 1 and 4 were excluded because they were new to the schools and programme from primary level and other schools, respectively. The findings from the pre-test evaluations from the third school were not considered in this manuscript. After excluding the incomplete data from the total 536 students who had participated in the baseline, 508 students enrolled in the programme were included in the analysis.

Data collection instrument and procedures

A self-administered questionnaire, the World Health Organisation’s (WHO) ‘Illustrated Questionnaire for Interview Surveys with Young People’ was adapted and utilised as a data collection tool for this study.20 The questionnaire consisted of 23 questions/statements on knowledge with different subscales such as four items for sexual health, eleven items on contraceptive methods and eight items on human immunodeficiency virus (HIV) and/or acquired immunodeficiency syndrome (AIDS) and sexually transmitted diseases (STDs). A score of one (1) was allocated to the correct response, whereas a score of zero (0) was given to the incorrect response. Similarly, there were 13 items for the attitudes, and a Score 1 was assigned for the positive attitude, whereas a Score 0 for the negative attitude. Higher total scores implied better knowledge and attitudes. Six students from each school were recruited for the pilot of the instrument. The findings from the pilot study yielded Cronbach’s alpha of 0.85. The students also provided their feedback to make the tool easier to complete. During the pilot study, the students were not included in the study. The final corrected tool was developed from the feedback obtained from the assessed students. Before the implementation of the project, the questionnaire was administered to all (N = 536) students.

Data analysis

Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 25 (SPSS Inc., Chicago, IL, United States). Descriptive statistics were conducted, with frequencies and percentages used for categorical variables, and means with standard deviations calculated for continuous variables. McNemar test was used to compare categorical knowledge and attitude variables between pre-test and post-test intervention. The score changes of knowledge and attitudes as continuous variables between pre-test and post-test interventions were evaluated using paired t-test. A p-value of less than 0.05 was considered as statistically significant.

Ethical considerations

Ethical clearance to conduct this study was obtained from the University of Rwanda College of Medicine and Health Sciences Institutional Review Board (No. 158/CMHS IRB/2019). Participants aged less than 18 years old signed assent forms, and their legal guardians signed the informed consents, while those aged 18 years and more signed the informed consents.

Results

Demographic attributes of respondents

Slightly more than half (53.7%) of the respondents were in the age range of 16 years to 18 years, with significantly more females in this age group (p = 0.001). There was nearly an equal distribution of participants for all the classes involved. Large proportion (49.0%) of students were from Protestants’ religious affiliation. About 9% were taking alcohol with more among males (p < 0.001), while smoking was only 0.4%. Approximately half of the participants (48.9%) had never engaged in conversations with their fathers about sexual matters, compared with 30.5% who had not discussed such topics with their mothers. Among the respondents, 13.8% reported having had sexual intercourse and, of these, the majority (70.6%) indicated that they had used contraceptives (Table 1).

TABLE 1: Selected attributes of respondents (N = 508).
Knowledge on sexual health, contraceptives and HIV and/or AIDS and STDs according to pre- and post-Sexual and Reproductive Health Peer Education Programme

Table 2 demonstrates the responses of adolescents to knowledge questions provided pre-education and post-education interventions. The knowledge was divided into three subscales: sexual health, contraceptive methods and HIV and/or AIDS and STDs. The knowledge had significantly improved (p < 0.01) for all statements except for two questions under the subscale of HIV and/or AIDS and STDs, which were cure of HIV and/or AIDS and availability of simple test for HIV (Table 2).

TABLE 2: Knowledge on sexual health, contraceptives and HIV and/or AIDS and STDs according to pre- and post-Sexual and Reproductive Health Peer Education Programmes.
Attitudes towards contraceptive methods according to pre- and post-Sexual and Reproductive Health Peer Education Programmes

Table 3 provides the responses of adolescents to the attitudes on contraceptive methods during the pre-education and post-education interventions. The respondents demonstrated significant increase in the positive attitudes to all the statements after implementing the SRH PEP (p < 0.001).

TABLE 3: The attitudes towards contraceptive methods according to pre- and post-Sexual and Reproductive Health Peer Education Programme.
Effect of Sexual and Reproductive Health Peer Education Programme on knowledge and the attitudes towards sexual health, contraceptives and HIV and/or AIDS and STDs

Table 4 indicates that the mean overall knowledge scores among adolescent students had significantly increased from 15.87 before the intervention to 19.59 after the intervention (p < 0.001). Similarly, the mean knowledge score for each subscale had improved significantly after the SRH PEP (p < 0.001). A similar result was also observed for the mean attitude scores, where it significantly improved from 7.95 in the pre-intervention to 10.66 in the post-intervention (p < 0.001).

TABLE 4: Effect of Sexual and Reproductive Health Peer Education Programme on knowledge and the attitudes towards sexual health, contraceptives and HIV and/or AIDS and STDs.
Knowledge and the attitude scores based on socio-demographic characteristics

The attitude score on contraceptive was significantly higher among male students than female students (p = 0.005) before intervention; however, this difference was not significant after the intervention (p = 0.986). Students from Seniors 5 and 6 had significantly (p < 0.001) higher knowledge scores compared to those in Seniors 3 and 4 in both the pre-intervention and the post-intervention. After the intervention, the overall knowledge score was significantly higher among adolescents aged from 22 years to 24 years (p = 0.022), but there were no significant differences before the intervention (Table 5).

TABLE 5: Knowledge and the attitude scores based on socio-demographic characteristics.

Discussion

The purpose of this study was to evaluate the effect of the SRH PEP on knowledge and the attitudes of SRH among high school adolescents. The findings from the current study revealed that the knowledge on sexual health, contraceptive methods and HIV and/or AIDS and STDs had significantly improved after implementing SRH PEP. Young students’ mean overall knowledge score of SRH significantly rose from 15.87 prior to intervention to 19.59 following the SRH PEP. Similar findings were seen for the mean attitude score, which revealed a considerable increase from 7.95 prior to intervention to 10.66 following intervention.

Despite the prolific implementation of peer education programmes (PEPs) globally, reviews found that there is a mixture of the PEP outcomes – some lead to positive outcomes and others do not.21,22 However, a recent study found that PEP can contribute to even more than expected outcomes.23 Other studies have found that PEPs are well perceived by students to increase their knowledge about SRH.17 In the present study, the SRH PEP had significantly improved knowledge among school adolescents. These findings are consistent with other studies conducted in other countries.24,25,26,27 This may be the case because when young people are taught in classrooms with their peers, they may learn more since they feel more at ease discussing ideas with their peers.28

Based on our findings, the mean attitude score on contraceptive methods was significantly improved after the intervention. These results are consistent with other studies which were conducted in other settings.26,27,29 In contrast, findings from a study which has been conducted in Malaysia revealed that there was a decrease of participants with positive attitudes toward sexuality with an increase of participants with positive attitudes toward SRH.30 Even though there is a mixture of findings, SRH PEP may be a promising strategy to improve the SRH attitudes among the schools’ adolescents.

Most significantly, peer education may provide a safe environment for young people to discuss significant life concerns without fear or outside pressure. This approach is considered advantageous since it makes it easier for people of similar ages to share sensitive information. Similar to this, the theory of social awareness proposes that peers frequently imitate the behaviour of those they hold up as role model.31 Therefore, our findings support the usefulness of peer education in raising young people’s knowledge and the attitude of SRH-related issues. Thus, the prevention of risky behaviours can benefit greatly from peer education.

Students from Seniors 5 and 6 had significantly higher knowledge scores compared to those in Seniors 3 and 4 in both the pre-intervention and the post-intervention. Lower secondary school has been determined to contribute to poor knowledge regarding SRH in Cameroon.32 This may be because young people who stay in school longer may have more exposure to SRH information through their curricula. Following the intervention, adolescents aged from 22 years to 24 years demonstrated a significantly higher overall knowledge score; however, no significant differences were observed between age groups prior to the intervention. These findings are in contrast with a study which found that age was not associated with an increase in knowledge and attitudes after a PEP in Nigeria.33 Increased knowledge among upper years and those aged between 22 years and 24 years in this study might be related to the significant exposure of SRH information in biological courses as they are in options with biology as a principal subject. However, contrary to other studies, there was no association between gender and knowledge of SRH in both before and after the interventions.24,34

The key strength of this study is that the intervention was designed in collaboration with several stakeholders to assess the local needs and contexts. As a result, we developed a manual which is tailored to adolescents’ needs. The implementation was well monitored with series of qualitative surveys. Constant communication between the project team and the schools helped to address any challenges which could hinder the implementation as soon as possible. However, this study has limitations. Firstly, in post-test we did not consider the third school because of the challenges faced during the implementation, including relocation of mentors to other schools and repatriation of PEs to their country of origin. Students from this school might have different responses. Secondly, the sample size was small to the extent that findings could not be generalised.

Conclusion

This study showed that SRH PEP is a crucial method for educating adolescents and young adults about sexual and reproductive health. Significant positive changes in knowledge and attitudes were observed following SRH PEP intervention. In order to provide teenagers enrolled in schools with accurate and trustworthy SRH information, a well-designed SRH PEP is a successful approach. Further study is also recommended to investigate the effect of the SRH PEP on reducing risky sexual practices.

Acknowledgements

The authors would like to acknowledge the stakeholders who provided their inputs towards the development of the PEP, PEs for executing their tasks and the school’s administration for allowing PEs to participate and support.

Competing interests

The authors reported that they have received funding from the Vlaamse Interuniversitaire Raad – Universitaire Ontwikkelingssamenwerking [Flemish Interuniversity Council – University Cooperation for Development] (VLIR UOS) grant, which may be affected by the research reported in the enclosed publication. The authors have disclosed those interests fully and have implemented an approved plan for managing any potential conflicts arising from their involvement. The terms of these funding arrangements have been reviewed and approved by the affiliated university in accordance with its policy on objectivity in research.

Authors’ contributions

A.N., N.V.E., J.B., J.B.H.H. and O.T. contributed to the study conception, study design and data collection of this article. A.N., M.H., G.T., A.Y., G.K. and E.R. contributed to the data analysis and interpretation of the results. A.N., M.H., J.B.H.H., A.Y., J.B., O.T., G.K. and E.R. were involved in drafting the article. A.N., N.V.E., G.T., M.H., G.K. and E.R. have contributed to the writing, reviewing and editing of the article. All authors read and approved the article.

Funding information

This project’s development and implementation was supported by VLIR UOS grant (RW2019SI259B140 – 76956). The project had no role in the study’s design, data collection, analysis and interpretation of results or manuscript preparation.

Data availability

The raw data that support the findings of this study are available from the corresponding author, A.N., upon fair and reasonable request.

Disclaimer

The views and opinions expressed in this article are those of the authors and are the product of professional research. It does not necessarily reflect the official policy or position of any affiliated institution, funder, agency or that of the publisher. The authors are responsible for this article’s results, findings and content.

References

  1. UNFPA. Teen pregnancies a barrier to fulfil youth potential [homepage on the Internet]. UNFPA; 2018 [cited 2023 June 10]. Available from: https://rwanda.unfpa.org/en/news/teen-pregnancies-barrier-fulfil-youth-potential
  2. Ahinkorah BO, Aboagye RG, Okyere J, et al. Correlates of repeat pregnancies among adolescent girls and young women in sub-Saharan Africa. BMC Pregnancy Childbirth. 2023;23:93. https://doi.org/10.1186/s12884-023-05361-7
  3. Ameyaw EK. Prevalence and correlates of unintended pregnancy in Ghana: Analysis of 2014 Ghana demographic and health survey. Matern Heal Neonatol Perinatol. 2018;4:1–6. https://doi.org/10.1186/s40748-018-0085-1
  4. Habitu YA, Yalew A, Bisetegn TA. Prevalence and factors associated with teenage pregnancy, Northeast Ethiopia, 2017: A cross-sectional study. J Pregnancy. 2018;2018:1–7. https://doi.org/10.1155/2018/1714527
  5. Human Rights Watch. Leave no girl behind in Africa: Discrimination in education against pregnant girls and adolescent mothers [homepage on the Internet]. Human Rights Watch, 2018 [cited 2020 Dec 15]. Available from: https://www.hrw.org/report/2018/06/14/leave-no-girl-behind-africa/discrimination-education-against-pregnant-girls-and
  6. Kaphagawani NC, Kalipeni E. Sociocultural factors contributing to teenage pregnancy in Zomba district, Malawi. Glob Public Health. 2017;12(6):694–710. https://doi.org/10.1080/17441692.2016.1229354
  7. Omoro T, Gray SC, Otieno G, et al. Teen pregnancy in rural western Kenya: A public health issue. Int J Adolesc Youth. 2018;23:399–408.
  8. Yakubu I, Salisu WJ. Determinants of adolescent pregnancy in sub-Saharan Africa: A systematic review. Reprod Health. 2018;15:1–11. https://doi.org/10.1186/s12978-018-0460-4
  9. Kassa GM, Arowojolu AO, Odukogbe AA, et al. Prevalence and determinants of adolescent pregnancy in Africa: A systematic review and Meta-analysis. Reprod Health. 2018;15:1–17. https://doi.org/10.1186/s12978-018-0640-2
  10. National Institute of Statistics of Rwanda, Ministry of Health (Rwanda), ICF. Rwanda demographic and health survey 2019-20: Key indicators report. Kigali: National Institute of Statistics of Rwanda (NISR); 2020.
  11. Rwanda Ministry of Health. National family planning and adolescent sexual and reproductive health. Kigali: MoH.
  12. Mbarushimana V, Goldstein S, Conco DN. ‘Not just the consequences, but also the pleasurable sex’: A review of the content of comprehensive sexuality education for early adolescents in Rwanda. BMC Public Health. 2023;23:1–14. https://doi.org/10.1186/s12889-022-14966-0
  13. Mbarushimana V, Conco DN, Goldstein S. ‘Such conversations are not had in the families’: A qualitative study of the determinants of young adolescents’ access to sexual and reproductive health and rights information in Rwanda. BMC Public Health. 2022;22:1–26. https://doi.org/10.1186/s12889-022-14256-9
  14. Michielsen K, Remes P, Rugabo J, et al. Rwandan young people’s perceptions on sexuality and relationships: Results from a qualitative study using the ‘mailbox technique’. SAHARA J J Soc Asp HIV/AIDS Res Alliance. 2014;11(1):51–60. https://doi.org/10.1080/17290376.2014.927950
  15. Collectif des Ligues et Associations de Défense des Droits de l’Homme au Rwanda. Report on early/ unwanted pregnancy for under 18 years in 10 districts of Rwanda. Kigali: CLADHO; 2016.
  16. Nkurunziza A, Endert N Van, Bagirisano J, et al. Breaking barriers in the prevention of adolescent pregnancies for in-school children in Kirehe district (Rwanda): A mixed-method study for the development of a peer education program on sexual and reproductive health. Reprod Health. 2020;17:1–8. https://doi.org/10.1186/s12978-020-00986-9
  17. Montalti M, Longobucco Y, Celani C, et al. Perceptions of and satisfaction with sexual and reproductive health interventions in pre-adolescent and adolescent students in UE/EEA countries: A systematic review. Healthcare. 2023;11(7):1–13. https://doi.org/10.3390/healthcare11070939
  18. Nkurunziza A, Tuyisenge G, Habtu M, et al. Experiences of peer educators in a high school sexual and reproductive health peer education programme in Rwanda. Health Educ J. 2024;83(8):1–12. https://doi.org/10.1177/00178969241282797
  19. Nkurunziza A, Van Endert N, Bagirisano J, et al. Lessons learned from a sexual and reproductive health and rights peer education program to prevent adolescent pregnancies in high schools in Rwanda Adolescent pregnancy continues to be a major Development of the program. Afr J Reprod Health. 2023;27:16–23.
  20. Cleland J, Roger I, Nicole S. Asking young people about sexual and reproductive behaviours: Illustrative core instruments [homepage on the Internet]. World Health Organization; 2001 [cited 2019 Feb 13]. Available from: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Asking+young+people+about+sexual+and+reproductive+behaviours+:+Illustrative+Core+Instruments#0
  21. Siddiqui M, Kataria I, Watson K, et al. A systematic review of the evidence on peer education programmes for promoting the sexual and reproductive health of young people in India. Sex Reprod Heal Matters. 2020;28(1):129–159. https://doi.org/10.1080/26410397.2020.1741494
  22. Dodd S, Widnall E, Russell AE, et al. School-based peer education interventions to improve health: A global systematic review of effectiveness. BMC Public Health. 2022;22:1–14. https://doi.org/10.1186/s12889-022-14688-3
  23. Evelia H, Watson K, Billowitz M, et al. Measured and unmeasured contributions of peer education: Experiences from the Get Up, Speak Out for Youth Rights! (GUSO) programme in Kisumu and Siaya Counties, Kenya. Sex Educ. 2022;23(1):96–113. https://doi.org/10.1080/14681811.2022.2031148
  24. Akuiyibo S, Anyanti J, Idogho O, et al. Impact of peer education on sexual health knowledge among adolescents and young persons in two North Western states of Nigeria. Reprod Health. 2021;18:1–8. https://doi.org/10.1186/s12978-021-01251-3
  25. Krugu JK, Mevissen FEF, Van Breukelen G, et al. SPEEK: Effect evaluation of a Ghanaian school-based and peer-led sexual education programme. Health Educ Res. 2018;33(4):292–314. https://doi.org/10.1093/her/cyy017
  26. Hatami M, Kazemi A, Mehrabi T. Effect of peer education in school on sexual health knowledge and attitude in girl adolescents. J Educ Health Promot. 2015;4(1):1–6. https://doi.org/10.4103/2277-9531.171791
  27. Phulambrikar RM, Kharde AL, Mahavarakar VN, et al. Effectiveness of interventional reproductive and sexual health education among school going adolescent girls in Rural Area. Indian J Community Med. 2019;44(4):378–382. https://doi.org/10.4103/ijcm.IJCM_155_19
  28. Menna T, Ali A, Worku A. Effects of peer education intervention on HIV/AIDS related sexual behaviors of secondary school students in Addis Ababa, Ethiopia: A quasi-experimental study. Reprod Health. 2015;12:1–8. https://doi.org/10.1186/s12978-015-0077-9
  29. De Castro F, Rojas-Martínez R, Villalobos-Hernández A, et al. Sexual and reproductive health outcomes are positively associated with comprehensive sexual education exposure in Mexican high-school students. PLoS One. 2018;13(3):1–15. https://doi.org/10.1371/journal.pone.0193780
  30. Ujang F, Sutan R. The effects of short health messages intervention in improving knowledge and attitude on sexual and reproductive health among late adolescents at colleges in Malaysia. Open J Prev Med. 2018;8(8):207–228. https://doi.org/10.4236/ojpm.2018.88019
  31. Karwalajtys T, Mcdonough B, Hall H, et al. Development of the volunteer peer educator role in a Community Cardiovascular Health Awareness Program (CHAP): A process evaluation in two communities. J Community Heal. 2009;34:336–345. https://doi.org/10.1007/s10900-009-9149-5
  32. Fubam RM, Tendongfor N, Olayemi O, et al. Sexual and reproductive health knowledge of secondary school adolescents in Fako, Cameroon. Pan Afr Med J. 2022;41:340.
  33. Adeomi AA, Adeoye OA, Asekun-Olarinmoye EO, et al. Evaluation of the effectiveness of peer education in improving HIV knowledge, attitude, and sexual behaviours among in-school adolescents in osun state, Nigeria. AIDS Res Treat. 2014;2014:131756. https://doi.org/10.1155/2014/131756
  34. Nair MKC, Leena ML, George B, et al. ARSH 2 : Reproductive and sexual health knowledge, attitude and practices: Comparison among boys and girls (10–24 y). Indian J Pediatr. 2013;80:199–202. https://doi.org/10.1007/s12098-013-1139-z


Crossref Citations

No related citations found.