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Botswana Youth Risk Behaviour Surveillance Survey
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Botswana Youth Risk Behaviour Surveillance Survey

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  1. Botswana Youth Risk Behaviour Surveillance Survey BY THE Byrbss twg 14 MARCH 2013 Gaborone SUN

  2. Outline Background Methods Results SUMMARY recommendations

  3. Youth Health Surveys in Botswana • Multiple Indicator Survey (2000) focusing on 15-49 years women in 14 districts • Main focus was HIV/AIDS exposure, knowledge, attitudes • Botswana AIDS Impact Survey (2001, 2004, 2008) focusing on men & women 10-64 years • Knowledge, attitudes & sexual behaviours associated with HIV • Antenatal Care Sentinel Surveillance (periodically since 1992) among pregnant women 15-49 years • Monitor trends in HIV and syphilis prevalence LIMITATIONS: • Number of young people captured in these surveys is relatively small and surveys are generally HIV focused

  4. Rationale for BYRBSS Youth are a group at risk (3.5% HIV prevalence among 10-19yrs) Youth form a large proportion of the Botswana population (45% Batswana below 19 years) Most of the youth can easily be accessed in schools (70% enrolled in schools) BYRBSS is a comprehensive risk behaviour survey covering a wide variety of topics at once

  5. Survey Objectives BYRBSS developed to: • Assess awareness on health risk behaviours among students • Establish baseline data of risk factors at National and Educational Region level • Assess student exposure to health prevention in schools

  6. Focus of the Survey • Tobacco, Drug and Alcohol use • Sexual behaviour, Sexually transmitted infections, HIV testing • HIV knowledge, attitudes and health risk behaviours • Knowledge of prevention interventions • Nutrition, Hygiene, Mental health

  7. Methods (1) • Multi-stage stratified cross-sectional survey in 145 schools in 10 MOESD Education Regions • Data collected September to October 2010 • Eligibility: • Students aged 10-19 years in upper primary and secondary schools in Botswana • Parent/guardian consent and student assent before participation in the survey

  8. Methods (2) Students using PDAs to complete the questionnaire Self-administered questionnaire using personal digital assistants (PDAs) Data weighted to adjust for school and student non-response rates Survey protocol approved for research ethics Analysis done using SPSS complex samples Module

  9. Demographics • 4,289 students in 145 schools approached for the survey • 3,374 received parent/guardian consent to participate and completed the survey questionnaire • Response rate of 78.7% • 56% were girls and 44% boys • Mean age was 14.1 years for boys and 13.8 years for girls.

  10. Use of Alcohol, tobacco and Alcohol, Tobacco and Drug Use

  11. Percent distribution of students who ever had alcohol by age category and gender

  12. Percent distribution of students who had ever smoked a cigarette

  13. Percent distribution of students who had ever used drugs by type of drug used

  14. Sexual Behaviour

  15. Percent distribution of respondents who ever had sexual intercourse by age category Overall 21% ever had sex Older students more likely to have had sex than younger ones (32% vs 13%) No difference by gender

  16. Among the 21% who ever had sex: • 55% used a condom the first time they had sex • Higher prevalence among older students than younger ones (67% vs 35%). No difference by gender • 19% reported sex with more than 1 partner in the past 12 months • No difference by age category or gender • 21% exchanged sex for money, drugs, or gifts • Higher prevalence among younger students than older ones (28% vs 19%). No difference by gender • 27% reported symptoms of STI • No difference by age category or gender

  17. HIV Testing

  18. Percent distribution of students who know a place for HIV testing, ever been tested for HIV, tested for HIV in the previous 12 months by gender

  19. Percent distribution of students who report having an HIV positive test result by age category and gender

  20. Nutrition, Physical Activity & Hygiene

  21. Percent distribution of students who reported being taught in school about benefits of healthy eating & weight and non-participation in physical activity outside school by gender

  22. Percent distribution of students who went hungry because there was not enough food in their homes during the past 30 days by gender

  23. Percent distribution of students who reported always washing hands before eating, always using soap when washing hands and brush teeth everyday by gender

  24. Physical & Sexual Violence

  25. Percent distribution of students who have been involved in physical fight in the past 12 months and had to be treated by a doctor/nurse by age category and gender

  26. SEXUAL VIOLENCE • Among the 21% who ever had sex: • 13% reported being forced to have sex in the past 12 months • No statistical difference between males and females • Younger students were more likely to have been forced to have sex than older students (18% vs 9%)

  27. Summary Encouraging signs • Health education • Know where to get HIV test • Healthy eating • Weight loss • Physical activity • Dental hygiene Areas for concern • Alcohol, tobacco use • Illicit drug use • Low HIV testing • Transactional sex • Multiple partners • Physical and sexual Violence • Food security

  28. Limitations • Findings not representative of all youth in Botswana as Private schools and out of school youth are excluded • Under-representation of some forms (std 7, Form 3 and 5) due to overlap with examination period • Upper primary students had challenges with comprehension of some questions (suicide, emotional abuse) • Questions asked in English

  29. Recommendations RECOMMENDATIONS

  30. Recommendations to inform future surveys and research • Repeat YRBSS every 3-4 years to monitor changes in risk behaviour • Due to comprehension problems among upper primary students, consider: • Limiting the respondents to secondary students, or • Using a separate questionnaire that is easier to understand • Conduct the survey outside the examination period to allow all grades to fully participate. • Conduct HIV testing as part of YRBSS to directly measure prevalence • Additional research is needed to fully understand why young people engage in risky behaviours.

  31. Recommendations specific to objectives of the study • Intensify education on prevention to help students to protect themselves from exposure to health risks and infections. • Enforce existing legislations on alcohol, cigarettes and drugs advertisement, accessibility and consumption by minors. • In collaboration with public health agencies and parents, MoESD’s educational programmes on personal hygiene should be strengthened.

  32. Acknowledgements Students & Parents MOESD (HQ, Regions, schools) United States Government Technical Working Group