Sexual and reproductive health among primary and secondary school pupils in Mwanza, Tanzania: need for intervention

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.