Effectiveness of peer-led education interventions on contraceptive use, unmet need, and demand among adolescent girls in Gedeo Zone, South Ethiopia. A cluster randomized controlled trial

ABSTRACT

Background

Peer-led education interventions are assumed to be an effective means of increasing contraceptive utilization and demand in adolescents. However evidence is lacking on whether peer-led education is effective in promoting the demand for and use of contraceptives in adolescent girls, especially in resource-limited settings.

Objective

The present study evaluated the effectiveness of peer-led education interventions in improving contraceptive use, unmet needs, and demand among sexually active secondary school adolescent girls in Gedeo Zone, South Ethiopia.

Methods

A single-blinded cluster randomised controlled trial study was performed in six randomly selected secondary schools in the Gedeo Zone, southern Ethiopia. A total of 224 participants were recruited and randomly assigned to the intervention and control groups. The intervention group received peer-led education intervention for six months. A pre-tested and validated questionnaire was used to measure contraceptive use, unmet need, and contraceptive demand. A generalised estimating equation (GEE) model was used to examine the effectiveness of the intervention.

Result

After six months of intervention, the Differences-in-difference in contraceptive use, unmet need, and contraceptive demand between the intervention and control groups were 25.1%, 7.4%, and 17.7%, respectively. There was a statistically significant difference in contraceptive use [AOR = 8.7, 95% CI: (3.66, 20.83), unmet need for contraceptives [AOR = 6.2, 95% CI: (1.61, 24.36)] and contraceptive demand [AOR = 6.1, 95% CI: (2.43, 15.11)] between the intervention and control groups.

Conclusions

School-based peer education intervention effectively improved contraceptive use and unmet needs in a low-resource setting and created demand in sexually active adolescent girls. These results support the potential utility of this approach in similar settings for the promotion of contraception use and demand.

KEYWORDS:

• Peer-led education
• contraceptive use
• unmet need
• contraceptive demand
• student
• high school

Responsible Editor Jennifer Stewart Williams

Responsible Editor Jennifer Stewart Williams

Acknowledgments

All authors thank Jimma University and Dilla University for ethical approval and funding. We also thank the study participants for their thoughtful responses and involvement in this study and the assigned personnel involved in the data collection process for their outstanding commitment.

Authors’ contributions

YAW interpreted the data, wrote the methodology, and prepared and reviewed the manuscript. ZBK and GTD wrote the methods, reviewed the manuscript, performed data cleaning and analyses, and carefully revised the contents.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

The Institutional Review Board of Jimma University gave ethical clearance with the reference number IHRPG995/20/11/2020. Written informed consent was obtained from a parent or legal guardian for study participation after providing detailed information on study objectives and benefits. The procedure used in this study adhered to the principles of the Helsinki Declaration [40].

Paper context

Pregnancy and childbirth among adolescents are major global health concerns. Adolescents in resource-poor settings have limited or no access to sexual and reproductive health education and contraception. School-aged adolescents are a significant target population for health promotion programs, particularly programs addressing sexual behaviours. School-based peer education intervention effectively improves contraceptive use, unmet needs, and demand among students. Similar programs should be implemented in areas where coverage of contraception use and demand is low.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by Jimma University and Dilla University Research grant. This trial was registered under ClinicalTrials.gov with identifier number PACTR 202109586981531.