Effects of economic support and community dialogue on adolescent sexual behaviour: findings from a cluster RCT in Zambia

Background: With a HIV prevalence twice that of their male counterparts and a high incidence of adolescent pregnancies, girls and young women in Sub-Saharan Africa are disproportionately affected by sexual and reproductive health problems (SRH). The objective of this study was to measure the effectiveness of economic support alone or in combination with a community intervention, on sexual activity, contraceptive knowledge and contraceptive behaviour of adolescent girls. Methods: Data come from a cluster-randomised trial in rural Zambia. Recruitment was conducted between March and July 2016, and all girls from grade 7 in 157 selected schools were eligible to participate. Schools were randomised to either economic support, combined economic support and community dialogue, or control. Economic support consisted of cash transfers to girls and their parents, and payment of school fees for girls continuing to grade 8 and 9. The community dialogue consisted of community and youth meetings that aimed to enhance SRH knowledge and supportive community norms. The interventions lasted from 2016 to 2018, and outcomes were measured at the end of the intervention period. Comparisons between the arms were made using generalised estimating equations. All analyses were by intention-to-treat. Results: In total 4922 girls assented to participate. The mean age was 13.6 years at baseline and 16.1 years at the end of the intervention period. The response rate at the end of the intervention period was 89.4%. The proportion of girls reporting recent sexual activity was markedly lower in the combined arm (RR 0.73; 95% C.I. 0.60 – 0.89) and slightly lower in the economic arm (0.85; 95% CI 0.69 – 1.05) than in the control arm. Knowledge of modern contraceptives was higher in the combined than in the other two arms, but only significantly different from the economic arm (combined vs. economic RR 1.17; 95% C.I. 1.00 – 1.36; combined vs. control RR 1.16; 95% C.I. 0.95 – 1.43). No intervention effect was found on reported current use of modern contraceptives. Conclusions: Economic support combined with community dialogue increased contraceptive knowledge and reduced sexual activity more than economic support alone, and may in turn reduce the risk of SRH problems. However, contraceptive use was not affected.