Évaluation d’un programme de promotion de la santé des jeunes au Cameroun

Early sexual initiation and delayed marriage are concurrently happening in most environments in Africa where traditionally early marriage and sexual initiation within marital union were more prevalent. This lengthens the time of exposure of young people to the risk of premarital sex and unwanted pregnancies as well as sexually transmitted infections including HIV/AIDS. Hence, several interventions have been carried out to promote the sexual and reproductive health of adolescents and young people. The Population Observatory in Socio-Clinical Epidemiology (POSE) designed and implemented since 1995 in Cameroon, had targeted the reproductive health promotion of adolescents and young people as one of its priorities, through the Cameroon Adolescent and Youth Reproductive Health Promotion Program (CAREH). The CAREH Program has been carrying out a series of intervention activities in the prefecture of Bandjoun since July 2000 and many other parts of Cameroon since 2003. This thesis evaluates some aspects of this intervention by examining the extent to which the intervention activities undertaken between 2000 and 2002 have contributed to: 1) delaying first sexual intercourse among adolescents aged 10 to 20 years, 2) preventing unwanted pregnancies among young people aged 10 to 29 years, and 3) preventing HIV infection among young people aged 10 to 29 years.  Data came from the 2002 Cameroon Family and Health Surveys (CFHS). A post-test design was used which divided adolescents and youth into four intervention groups (out-of-school youth unexposed to the intervention, young people enrolled in schools and unexposed to the intervention, young people exposed to the intervention in the community and young people exposed to the intervention in school settings). Descriptive analyses and multivariate logistic regression were used to assess the possible associations between intervention and outcomes variables, given the enunciated research hypotheses. Adolescents attending school who reported no exposure to the intervention (OR = 1.973; CI = 1.195 to 3.260) were more likely to have a negative perception of premarital sex than out-of-school and unexposed adolescents. However, there were no significant differences in delaying the first sexual intercourse among adolescents exposed to the intervention compared to those not exposed. Knowledge about the prevention of pregnancy was significantly higher among unexposed students (OR = 1.953, CI = 1.452-2.627), youth exposed to the intervention in the community (OR = 3.074; CI = 2.157-4.382) and youth exposed to the intervention in school (OR = 4.962, CI = 3.367 to 7.311) than among those not exposed and not in school. No statistically significant difference was found between these groups regarding the use of modern contraception. The discussion about  pregnancy prevention or contraceptive use led by a CAREH peer-educator significantly improved knowledge about pregnancy prevention for youth exposed to the intervention in school compared to their peers exposed in community where such discussion did not occur (OR = 1.549, CI = 1.056 to 2.272). Young people exposed to the intervention in community settings (OR = 2.106, CI = 1.514-2.930) and those exposed in school settings (OR = 3.117, CI = 2.192-4.433) significantly improved their knowledge about HIV prevention more than out-of-school youth unexposed to the intervention. Nevertheless, there were no significant differences between groups regarding the use of condom.  These findings should be interpreted within the limits of available data. Indeed, it was not possible to determine the level of knowledge about pregnancy prevention or HIV prevention among young people exposed to the intervention before hand.  Therefore, it is impossible to know what level of knowledge young people exposed to the intervention would have had in the absence of the intervention. However, given the results comparing the four stratified groups, it is likely that the intervention had more beneficial effects on improving knowledge than behaviours.

Keyphrases: sexuality, contraception, IST, Bandjoun, HIV, AIDS