Knowledge of safe motherhood
Although the study was not intended to assess in detail knowledge of reproductive health, some basic questions indicate that knowledge of many aspects of reproductive health and sexuality among pupils was low. For example, concerning signs of puberty, 28% of boys and 14.2% of girls could not cite any sign. Only 44% of boys and 33.3% of girls were able to mention three or more signs of puberty such as menstruation, sexual desire, hair growing in private parts and ejaculation. There was no marked difference in knowledge between children from lower and higher classes. During group interview it was learned that pupils felt shy and feared to discuss sexuality, but boys felt freer than girls. One girl in a FGI said,
"Naogopa kusema matusi" which means "I fear to talk about immoral things"
In the knowledge test many girls, especially from lower classes, did not answer some questions which required writing the signs of puberty or reproductive organs. Later during the FGIs we found that they knew the answers but felt shy to write them.
The results of the knowledge test showed that only 33% of pupils could accurately identify the age at which a woman can conceive. Out of 90 (67%) who couldn't mention age at which a woman can conceive, 49 (54.4%) proposed eight to ten years and 41 (46%) cited over twenty years. There was very little difference between boys and girls; only 40% of the boys and 33.3% of the girls got the question right.
Regarding the duration for pregnancy, a total of 104 (77.3%) of the respondents were able to correctly answer nine months, while others suggested longer periods any where from 10 to 20 months. In this question, the girls' knowledge was found to be slightly better (81%) compared to the boys (76%).
Maternal risk behavior and etiology of pregnancy complications
School children are not well-informed about risk behaviors. For example, when asked to list three risky maternal practices, only 37% mentioned early marriage and early pregnancy and 28% mentioned lack of child spacing. In the FGIs, in discussing the consequences of early marriage, the majority mentioned failure to continue with studies or inability to take care of children or family. After further probing on risk practices very few mentioned heavy work, and unsafe sex. Abortion, smoking, alcoholism and violence were never mentioned. Nothing was known about post-partum complications or care. The few pregnancy complications and danger signs, which were known and repeatedly mentioned in all FGIs, were difficulties in delivery and anaemia.
On birth preparedness, the majority of pupils were aware and they mentioned the need to save money, for food and transport. Other preparedness issues such as early antenatal care (ANC) visits, identification of skilled birth attendants, birth plan and the identification of blood donors were not mentioned. A question regarding where they would prefer to deliver in the future, the whole group loudly replied "Kituo cha Afya" (health center). When asked why, they said, "because there is reliable medical help"
Pregnancy, traditional beliefs and practices
It is very interesting that school children, especially those who have gone through initiation rites, are well informed about traditions related to pregnancy and childbirth. Strikingly, as seen in Table , the majority of pupils (63.4%) often associated pregnancy complications, difficult labour and negative pregnancy outcome with non-observance of traditional rules and taboos. During a FGI a standard seven girl said,
Knowledge Test: Children's knowledge on maternal health aspects
"My mother told me that most women in our village get difficult labour because one spouse or both had sex with another person during pregnancy".
Others supported this statement. From the KIIs, it was noted that this belief is popular among community members. Another belief mentioned was, if a husband is traveling he should not inform his pregnant wife who is expecting to deliver soon. If he does, the child will refuse to come out until the father reaches the destination. Several taboos that restrict pregnant women from eating certain types of food were also mentioned. Few pupils doubted these beliefs and practices and were eager to get more clarifications.
Knowledge on STI and HIV/AIDS in pregnancy
When asked to state any three STIs that they know, 23 out of 77 boys (30%) and 14 out of 58 girls (24.1%) mentioned only one STI respectively. The majority, over 60% of all respondents were able to mention more than two STIs; only 27% were able to mention three. Most pupils mentioned syphilis, gonorrhea and HIV/AIDS, and some included schitosomiasis. FGIs revealed that, the majority was aware that STIs can be transmitted through sexual contact, but no one mentioned the possibility of transmission during childbirth.
Almost all school children have heard about HIV/AIDS. However, very few reported to have seen anyone suffering from AIDS. When asked to list five ways HIV is transmitted, only 50% were able to mention three or more ways and 24% stated only one way. Generally, pupils from older classes were more knowledgeable than those from younger classes. We noted some misconceptions about the disease. When answering the question whether they think school children can be infected with HIV, in two FGIs, the statement was made "We are still very young, we cannot be infected" and themajority in the group seemed to support this statement. In some of the groups HIV/AIDS was seen as an urban problem.
Knowledge about the signs of AIDS was found to be higher; seventy six percent the school children stated more than three signs. Again more boys (84%) were able to volunteer more than three HIV/AIDS signs compared to girls (66.6%). Commonly mentioned signs were loss of weight, prolonged coughing and diarrhea. About 41% were able to mention three or more ways of HIV/AIDS prevention. The commonly cited prevention measure was abstinence. A small proportion of children, mainly being boys, mentioned condom use. In FGIs, children mentioned traditional night dances, alcoholism, unsafe sex, and urban life to be major influencing factors for HIV/AIDS transmission.
The majority of children, 126 (93.3%) are aware that the virus can be transmitted from mother to child but the ways to prevent transmission from mother to child was almost unknown to the majority of the pupils. Quite a large percentage of children, 103 (76.3%) mentioned avoidance of extra-marital sex with high risk groups like prostitutes as the major way of preventing transmission from mother to child. Out of 135 respondents, only 24 (17.8%) were aware that HIV/AIDS can be transmitted during birth and through breastfeeding. In most aspects regarding HIV/AIDS transmission, boys overall were slightly more knowledgeable than girls.
With regard to the sources of health information, over 68% of school children said their main sources of reproductive health and safe motherhood information are friends, out of school youths, parents and schoolteachers. Only 17% mentioned media and about 11% mentioned health staffs and village health workers.