1. Shoo T, Kamala B, Rosecrans K, Miller K, Al-Alawy H, Rwezahura P
Families Matter! Program Increases Parent-Preadolescent Communication about Sex in Tanzania An Outcome Evaluation in Mtwara and Ruvuma
Shoo T, Kamala B, Rosecrans K, Miller K, Al-Alawy H, Rwezahura P

2. Attribution and Disclaimer
This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of Cooperative Agreement No.1U2GGH
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the CDC. 

3. Background
Young Tanzanians are at risk of HIV infection (THMIS )
HIV prevalence among women
1.1% (15-17 years old)
6.6% (23-24 years old)
Comprehensive HIV knowledge (15-24 years old)
40% women
47% men
About half men & women aged reported having sex before age 18
Studies from many countries, including Tanzania, suggest parents play an important role in preventing their children from engaging in risky sexual behavior
(Kajula et al, 2014, Mlunde et al,2012, Mmbaga et al,2012)

4. Families Matter! Program Curriculum1
Getting to know you and steps to understanding your child 2
Effective parenting 3
Sexuality education, sexual Health and parents as sex educators 4
Increasing comfort and skills in discussing sexuality issues 5
Discussing sexuality and handling peer pressure
Evidence-based intervention
promote positive parenting practices and effective parent-child communication on sexuality and sexual risk reduction
parents and other caregivers of 9-12 year olds
Ultimate goal: reduce sexual risk behaviors and delay onset of sexual debut.
FMP was implemented in Ruvuma (Subira ward) and Mtwara (Nanyamba ward)

5. Objective
To evaluate whether Families Matter! Program (FMP) increases parent-preadolescent communication about sex in the two wards
Sexual education
Heterosexual friendship
Puberty
Menstruation
Sexual risk reduction
Abstinence
Peer pressure
Condoms
Sex
Reproduction
Maturity required for sex
Family planning
HIV/AIDS
Other sexually transmitted infections (STIs)

6. Methodology Pre-post program evaluation 1-3 weeks before FMP
3 months after FMP
Structured questionnaire
Face-to-face interview
Administered separately to parent/ guardian and 9-12 year-old child
Six questions in each domain
Each question scored 0-2
0 “No, never”
1 “Yes, once”
2 “Yes, more than once”
Approved by the National Health Research Ethics Review Committee at the National Institute for Medical Research (Tanzania) and Centers for Disease Control and Prevention.

7. Data Analysis Analysis using SPSS v22
Descriptive statistics calculated to describe the study population
Frequency of answers to each item calculated
For each domain, score calculated
Cronbach’s alpha calculated
>0.7 considered internally consistent
McNemmers test and Wilcoxon signed-rank test (a non-parametric test) were used to compare baseline and post-intervention scores
797 parent-preadolescent pairs enrolled at baseline
658 (83%) completed post-intervention questionnaire

8. Results

9. Parent Socio-Demographic Characteristics
Mtwara
Ruvuma
Total 
N (%)
Sex
Male
101 (30.7)
84 (25.5)
185 (28.1)
Female
228 (69.3)
246 (74.5)
474 (71.9)
Age
25-34
98 (29.8)
86 (26.1)
184 (27.9)
35-44
136 (41.3)
119 (36.1)
255 (38.7)
45-54
64 (19.5)
71 (21.5)
135 (20.5)
55+
31 (9.4)
54 (16.4)
85 (12.9)
Relationship
Parent
271 (81.9)
247 (74.8)
518 (78.6)
Other
58 (18.1)
83 (25.2)
141 (21.4)
Education
None
40 (12.1)
94 (14.3)
Primary
260 (79.0)
276 (83.6)
536 (81.3)
Secondary+
15 (4.6)
14 (4.2)
29 (4.4)
Occupation
Farmer
317 (96.4)
322 (97.6)
639 (97.0)
Others
12 (3.6)
8 (2.4)
20 (3.0)
Total
329 (100.0)
330 (100.0)
659 (100.0)
More female than men
Mostly in the age group 35-44
Most were biological parents
More caretakers/guardians in Ruvuma than Mtwara

10. Preadolescent Socio-Demographic Characteristics
Mtwara
Ruvuma
Total 
N (%)
Sex
Male
152 (46.2)
167 (50.6)
319 (48.4)
Female
177 (53.8)
163 (49.4)
340 (51.6)
Age
9-10
204 (62.0)
176 (53.3)
380 (57.7)
11-12
125 (38.0)
154 (46.7)
279 (42.3)
Total
329 (100.0)
320 (100.0)
659 (100.0)

11. Ever Talked about Sexual Education Topics

12. Ever Talked about Sexual Risk Reduction Topics

13. Baseline and Post-Intervention Communication Scores
 Baseline score
Post-intervention score
Score difference
Participants with score improvements
Test for significance
Median (Q1,Q3)
Mean % 
P-value 
Sexual education
Parent
0 (0,1) 
4 (1,10)
4.6 58
<0.0001
Preadolescent
2 (0,6)
2.9 54
Sexual risk reduction
2 (0,2) 
8 (4,8)
5.2 81
1 (0,2) 
4 (2,8)
3.2 56

14. Conclusions FMP increases parent-child communication Sexual education
Sexual risk reduction
May influence children to
Delay sexual debut
Reduce risky sexual behaviors and hence HIV new infections among youth

15. Acknowledgements FMP Participants MOHSW (NACP) TACAIDS
RAS Ruvuma and Mtwara
DED Songea
WEO and VEO
Head teachers
Enumerators and supervisors
T-MARC partners