Before and after the Ebola Virus Disease ...
Assessing the effectiveness of youth community – based sexual and reproductive health interventions in Sierra Leone: Before and after the Ebola Virus Disease Outbreak Elhassein M1; Karim A1; Alexander S2; Medina M3; Jalloh M4; Sengeh P4; Pratt S4; Dramaix M2; Weber L2; Zhang, WH2, Labat A2; Foday S1; Dickson K1
Background
Methods
Despite a high Adolescent Birth Rate in Sierra Leone 125/1,000 I women and high teenage pregnancy 28% I of girls 15-19 years, more than 86% of this age group have never used contraception Access to SRH services for adolescents is low although nearly 80% of pregnancies among adolescent girls are unwanted II The maternal mortality ratio is among the highest in the world; 1,360 per 100,000 live births III and an estimated 40% of maternal deaths are among adolescents IV I II III IV SLDHS 2013, UNICEF 2010, MMEIG2015,
Two household surveys were conducted in 2014 and 2016 to assess the effectiveness of the interventions for young people – Only two interventions were assessed in 2016 as the Saliwansai radio program was not aired in 2015 Both surveys included interviews with young people of both sexes randomly selected from 6 districts in 3 provinces n-1289 in 2014 and n= 1409 in 2016 The surveys collected data on the need and use of family planning and reproductive health services, as well as information on the youth exposure and appreciation of community-based SRH interventions Exposure was defined as “did you encounter” and appreciation as “did you like ”
MICS2010
Results Ebola Virus Disease and SRH services The Ebola Virus Disease Outbreak in 2014 seriously affected health services A 23% drop in some RH-related health services was recorded”
100664
SRH Services during EVD 79788
78933
- 14%
96928
CAG exposure increased from 15.5 % in 2014 to 21.6% in 2016 VPE exposure increased from 24% to 44% and appreciation for both interventions remained above 70% for the two surveys
81786
68278
- 16%
- 22%
Jan-Jun 2014 ANC 3rd visit
“UNDP2015
Facility delivery by SBA
PNC Visit 24-48 hrs
Jul-Dec 2014
Topics remembered differed according to intervention, however family planning and avoiding child marriage were in the top four for both CAGs and VPEs in 2016 Young people that ever had a sexual relation 72,7%
The IRMNCAH Programme In 2012, UNFPA initiated a DFID funded program (IRMNCAH) to improve awareness of, access to, and uptake of family planning, reproductive and maternal health services across Sierra Leone with a focus on young people. Three community based health interventions were implemented aimed at behaviour change: 1.Saliwansai serial radio drama 2.Placement of “Volunteer Peer Educators” (VPEs) 3.Enhancement of the Community Wellness Advocacy groups (CAGs) These interventions addressed topics such as delaying marriage, staying on at school, safe sex, giving birth in a health facility. In mid-2014, the EVD outbreak disrupted implementation.
53,5%
2014
Increased exposure to CAGs and VPE interventions
70,5% R
45,2%
2016
Boys Girls
24%
44%
21.6%
15.5%
2014
2016
Conclusions UNFPA supported interventions among young people led to increased exposure and wide appreciation even in the context of the Ebola Virus Disease The interventions probably contributed to participants’ positive SRH behaviours like delayed initiation of sexual relations It is likely there was synergy between the CAGs and the VPE interventions.
Background
Methods
Despite a high Adolescent Birth Rate in Sierra Leone 125/1,000 I women and high teenage pregnancy 28% I of girls 15-19 years, more than 86% of this age group have never used contraception Access to SRH services for adolescents is low although nearly 80% of pregnancies among adolescent girls are unwanted II The maternal mortality ratio is among the highest in the world; 1,360 per 100,000 live births III and an estimated 40% of maternal deaths are among adolescents IV I II III IV SLDHS 2013, UNICEF 2010, MMEIG2015,
Two household surveys were conducted in 2014 and 2016 to assess the effectiveness of the interventions for young people – Only two interventions were assessed in 2016 as the Saliwansai radio program was not aired in 2015 Both surveys included interviews with young people of both sexes randomly selected from 6 districts in 3 provinces n-1289 in 2014 and n= 1409 in 2016 The surveys collected data on the need and use of family planning and reproductive health services, as well as information on the youth exposure and appreciation of community-based SRH interventions Exposure was defined as “did you encounter” and appreciation as “did you like ”
MICS2010
Results Ebola Virus Disease and SRH services The Ebola Virus Disease Outbreak in 2014 seriously affected health services A 23% drop in some RH-related health services was recorded”
100664
SRH Services during EVD 79788
78933
- 14%
96928
CAG exposure increased from 15.5 % in 2014 to 21.6% in 2016 VPE exposure increased from 24% to 44% and appreciation for both interventions remained above 70% for the two surveys
81786
68278
- 16%
- 22%
Jan-Jun 2014 ANC 3rd visit
“UNDP2015
Facility delivery by SBA
PNC Visit 24-48 hrs
Jul-Dec 2014
Topics remembered differed according to intervention, however family planning and avoiding child marriage were in the top four for both CAGs and VPEs in 2016 Young people that ever had a sexual relation 72,7%
The IRMNCAH Programme In 2012, UNFPA initiated a DFID funded program (IRMNCAH) to improve awareness of, access to, and uptake of family planning, reproductive and maternal health services across Sierra Leone with a focus on young people. Three community based health interventions were implemented aimed at behaviour change: 1.Saliwansai serial radio drama 2.Placement of “Volunteer Peer Educators” (VPEs) 3.Enhancement of the Community Wellness Advocacy groups (CAGs) These interventions addressed topics such as delaying marriage, staying on at school, safe sex, giving birth in a health facility. In mid-2014, the EVD outbreak disrupted implementation.
53,5%
2014
Increased exposure to CAGs and VPE interventions
70,5% R
45,2%
2016
Boys Girls
24%
44%
21.6%
15.5%
2014
2016
Conclusions UNFPA supported interventions among young people led to increased exposure and wide appreciation even in the context of the Ebola Virus Disease The interventions probably contributed to participants’ positive SRH behaviours like delayed initiation of sexual relations It is likely there was synergy between the CAGs and the VPE interventions.
