Increasing high school students’ knowledge of reproductive health in Hanoi and Hai Duong province through the use of extra-curricular activities

Abstract. The study was conducted on 928 high school students at two schools, one in Hanoi and one in Hai Duong Province, to assess the effectiveness of extra-curricular activities in improving knowledge about reproductive health. At each school, the students were divided into two groups: the control group which did not participate in the extra-curricular activities on reproductive health, and the experimental group which did participate in extra-curricular activities on reproductive health. The results showed that students in the control group knew relatively little about reproductive health while those in the experimental group increased their knowledge of reproductive health markedly. The results also suggest that besides the need to integrate reproductive health content with other subjects, providing extra-curricular activities also increases high school student‟s knowledge of reproductive health.

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JOURNAL OF SCIENCE OF HNUE DOI: 10.18173/2354-1059.2015-00092 Chemical and Biological Sci. 2015, Vol. 60, No. 9, pp. 154-160 This paper is available online at Received November 30, 2015. Accepted December 24, 2015. Contact Nguyen Phuc Hung, e-mail address: phuchungch10@yahoo.com 154 INCREASING HIGH SCHOOL STUDENTS’ KNOWLEDGE OF REPRODUCTIVE HEALTH IN HANOI AND HAI DUONG PROVINCE THROUGH THE USE OF EXTRA-CURRICULAR ACTIVITIES Nguyen Phuc Hung1 and Ha Manh Linh2 1 Centre for Reproductive Health Education and Family Planning Education, Hanoi National University of Education 2 Faculty of Biology and Chemistry, Tay Bac University Abstract. The study was conducted on 928 high school students at two schools, one in Hanoi and one in Hai Duong Province, to assess the effectiveness of extra-curricular activities in improving knowledge about reproductive health. At each school, the students were divided into two groups: the control group which did not participate in the extra-curricular activities on reproductive health, and the experimental group which did participate in extra-curricular activities on reproductive health. The results showed that students in the control group knew relatively little about reproductive health while those in the experimental group increased their knowledge of reproductive health markedly. The results also suggest that besides the need to integrate reproductive health content with other subjects, providing extra-curricular activities also increases high school student‟s knowledge of reproductive health. Keywords: Reproductive health, extra-cur icular activity, student, high school 1. Introduction The age of adolescence is an important stage in the development of the body, characterized by major changes both psychological and physiological [1]. During this period, juveniles are affected by factors which include individual factors, their family, the community and society. Minors tend to become more precocious at the age of puberty and the age having sexual intercourse for the first time has been falling. However, most juveniles do not have an adequate understanding of reproductive health [2-4]. This leads to an increase in premarital sex, an increase in unwanted pregnancies, increased abortions and the spread of sexually transmitted diseases, including HIV/AIDS. Using the reported number of 300,000 ab rtions per world (according to one report) Vietnam has one of the highest abortion rates in the world. With 20% involving juveniles, Vietnam has the highest juvenile abortion rate in Southeast Asia and ranks fifth in the world [3, 5, 6]. Of this number, It is also thought that 800,000 to 1,00,000 Vietnamese people are infected with a sexually transmitted disease each year and juveniles account for 40% of these [6, 7]. Increasing high school students’ knowledge of reproductive health in Hanoi and Hai Duong... 155 Almost all young people experience the onset of puberty while attending high school. I recent years, reproductive health education in high school is said to be carried out as „an integration of disciplines‟. It has been shown that this method is not effective [3, 8]. This method is not effective because there is actually very little integrat on of reproductive health issues in other subjects, there is no obligation on the part of the teachers to include reproductive health as a part of the curriculum, and the subject of reproductive health is avoided because in the culture the subject has always been avoided and is still an uncomfortable subject. Therefore, other methods are sought which would bring reproductive health issues to the attention of students. The aim of this study is to evaluate the need for and effectiveness of high school extra-curricular activities that focus on reproductive health and to compare urban and rural students‟ awareness of reproductive health. 2. Content 2.1. Materials and methods * Study population The study population consisted of 928 high school students (453 at the Hoai Duc B High School, Hoai Duc District, Hanoi, and 475 at the Doan Thuong High School, Doan Thuong District, Hai Duong Province). All of these students seemed to be of normal health and mentality. * Methods Study design: At each school, the students were divided into two groups, the control group and the experimental group, insuring a similar mix of study results and grades in each group. The control group took part in no extra-curricular reproductive health activities. The experimental group did take part in extra-curricular eproductive health activities. The extra- curricular activity n this study was a specialized seminar. The students were given one lecture about reproductive health after which they could ask questions and discuss the subject matter with other members of the group. This extra-curricular activity lasted 45 minutes, a time period similar to their normal one-hour class. Two weeks later, all of the students were given a written test to see what they knew about reproductive health. Data collection: The questionnaire given to each student was approved by the Center for Reproductive Health, Education and Family Planning Education, Hanoi National University of Education. The questions were only about reproductive health. It was a multiple choice test, each question having four possible answers with only one correct answer. Participants were instructed to circle one answer and they were not to speak to each other or use reference materials while taking the test. Data analysis: The completed questionnaires were assessed and analyzed using Microsoft Excel 2010 and EPI-INFO 6.04. The significance is based on a 5% level of probability. 2.2. Results and discussion 2.2.1. Reproductive health knowledge of student * Knowledge about the signs of puberty Table 1 shows that the percentage of control students that knew more than 5 signs of puberty at Hoai Duc and Doan Thuong High School was 59.29% and 74.07%, respectively. However, 7.08% of the students at Hoai Duc B High School and 4.12% of the students at Doan Thuong High School knew not one sign of puberty in spite of the fact that they were at that time experiencing puberty. Other studies have also been done which also showed that there are some students who are at that time experiencing puberty but know not one sign of puberty. A study conducted by Nguyen Van Nghi found that 16.5-30% of the students in Chi Linh District, Hai Duong Province knew not one sign of puberty [9]. Hoang Thi Tam found Nguyen Phuc Hung and Ha Manh Linh 156 that about 20% of high school students in Hue d d not know that pubic hair growth or acne was a sign of puberty, 33.1% did not k ow that menstruation in females was a sign of puberty and 49.5% of them did not know that male ejaculation was a sign of puberty [10]. Table 1. Knowledge of students about the signs of puberty Group Knowledge of students Hoai Duc B Doan Thuong Control group Experimental group Control group Experimenta l group n % n % n % n % Know more than 5 signs 134 59.29a* 199 87.67b 180 74.07c** 203 87.50d Know 4 signs 28 12.38a 15 6.61b 31 12.76d 17 7.33c Know from 1 to 3 signs 48 21.24b* 11 4.85a 22 9.05d** 10 4.31c Know none of the signs 16 7.08b 2 0.89a 10 4.12d 2 0.86c The values of each school in the same row with different superscripts are significantly different (P < 0.05). The values of the same group design in the same row with different asterisks are significantly different (P < 0.05). By attending the extra-cu ricular activity,, students‟ knowledge of the signs of puberty increased significantly (P < 0.05). The percentage of students at Hoai Duc B and Doan Thuong High School who knew more than 5 signs of puberty increased from 59.29% to 87.67% and from 74.07% to 87.5%, respectively, after the extra-curricular activity. In addition, there was a significant decrease in the percentage of students who k new fewer than 5 signs of puberty or none at all (P < 0.05). The present study shows that although it is said that reproductive health, including the signs of puberty, have been integrated into school subje ts such as Biology, Geography and Citizen Education, some students now know not one sign of puberty signs. The results of this study results suggest that extra-curricular activities relating to reproductive health would make students more knowledgeable about the signs of puberty. * Knowledge about pregnancy Table 2. Knowledge of how a female gets pregnant Group Knowledge of students Hoai Duc B Doan Thuong Control group Experimental group Control group Experimental group n % n % n % n % Sexual intercourse between males and females 186 82.3a 219 96.48b 213 87.65c 222 95.69d Thought wrongly or did not know 40 17.7 b 8 3.52a 30 12.35d 10 4.31c Values of each school in the same row with different superscripts are significantly different (P < 0.05). Table 2 shows that 82.3% of the control students at Hoai Duc B and 86.75% at Doan Thuong understood what it is that makes a female pregnant. Although insemination is relatively easy to understand, more than 15% of the control students at each school did not know that Increasing high school students’ knowledge of reproductive health in Hanoi and Hai Duong... 157 fucking can make a baby. The studies of Ton That Chieu and Hoang Thi Tam also found that 15% to 20% of the students did not know how a female gets pregnant [10, 11]. When attending an extra-curricular activity related to reproductive health, the percentage of students who did not know how a female got pregnant decreased from 17.7% to 3.52% at Hoai Duc B school and 12.35% to 4.31% at Doan Thuong school. In addition, the percentage of students who knew that semen must go in the vagina, and it‟s usually a penis that puts it in there, increased to 96.48% and to 95.69% at these two high schools. The differences between the control group and the experimental group are statistically significant (P < 0.05). This shows that the extra-cu ricular activity was useful in teaching most of the students what causes pregnancy. * Knowledge of students about time of greater and lesser fertility during the menstrual cycle At Hoai Duc B High School, the percentage of students who knew that there were some days during the m nstrual cycle in which pregnancy is more likely was 30.97% while at Doan Thuong High School only 26.75% knew of this (Table 3). That leaves 69.03% at Hoai Duc B High School and 73.25% at Doan Thuong High School who knew nothing about this. Th t shows a severe lack of reproductive health knowledge among Vietnamese juveniles, urban and rural. Research done by Nguyen Van Truong at Dai Tu High School in Thai Nguyen Province revealed that only 33% of pupils knew about these „easier to get pregnant‟ days [12]. In Hue, Hoang Thi Tam found that it was 45.6% of the students [10]. In the SAVY1 survey, the percentage of students who were aware of this was 9.1% among the males and 19.1% among the females [6]. This lack of knowledge could be part of the reason for the high rate of pregnancies and abortion among Vietnamese juveniles. This does provide a welcome source of income for abortion providers. Table 3. Knowledge of students about the days during the menstrual cycle on which conception is most likely to occur Group Knowledge of pupils Hoai Duc B Doan Thuong Control group Experimental group Control group Experimental group n % n % n % n % Understood for the most part 70 30.97a 166 73.13b* 65 26.75c 150 64.66d** Thought wrongly or did not know 156 69.03 b 61 26.87a* 178 73.25d 82 35.34c** Values of each school in the same row with different superscripts are significantly different (P < 0.05). Values of the same group design in the same row with different asterisks are significantly different (P < 0.05). After participating in an extra-cur icular activity related to reproductive health, the knowledge of students at both schools improved significantly (to 73.13% at Hoai Duc B and to 64.66% at Doan Thuong high schools) (P < 0.05). This implies that such an extra- curricular activity is effective in teaching students about the days on which it‟s most likely to get pregnant during the menstrual cycle. If students knew this, they could have unprotected sex on the other days with the result that the number of unwanted teenage pregnancies would fall. Nguyen Phuc Hung and Ha Manh Linh 158 * Knowledge of contraceptive methods Table 4. Knowledge of students about contraceptive methods Group Knowledge of pupils Hoai Duc B Doan Thuong Control group Experimental group Control group Experimental group n % n % n % n % Know more than 5 methods 49 21.68 a 149 65.64b* 65 26.75c 110 47.41d** Know 4 methods 38 16.81 25 11.01* 45 18.52 55 23.71** Know 1-3 methods 88 38.94b 45 19.82a 96 39.50d 54 23.28c Know of no method 51 22.57b* 8 3.52a 37 15.23d** 13 5.60c Values of each school in the same row with different superscripts are significantly different (P < 0.05). Values of the same group design in the same row with different asterisks are significantly different (P < 0.05). No significant difference in students‟ knowledge of contraceptive methods was found between the control groups of the two schools (Table 4). Although a relatively high percentage of students knew one or more method of contraception, there were some who knew not one method. However, after taking part in a reproductive health-orient d xtra- curricular activity, the knowledge of students about contraceptive methods was significantly improved. About three times more students at Hoai Duc B High School knew more than 5 methods compared to the students who did not participate in the extra-curricular activity. There was a similar tendency at Doan Thuong High School with twice as many in the experimental group learning 5 or more methods of contraception. The diff rence between the control group and the experimental group was statistically significant at both schools (P < 0.05). At the same time the percentage of students who knew no contraceptive method dropped to 3.52% at Hoai Duc B High School and 5.6% at Doan Thuong High School. The difference between the two groups was also statistically significant (P < 0.05). The implication is that this form of extra-curricular activity can make high school students more knowledgeable about contraceptive methods. * Knowledge of students about the health risks of abortion Students in both schools who did not take part in the extra-curricular ctivity knew little about the potential for physical damage that accompanies abortion (Table 5). Only 26.55% of the students at Hoai Duc B High School and 30.87% from Doan Thuong High School were aware of more than 4 possible harmful effects while 13.72% at Hoai Duc B High School and 8.64% at Doan Thuong High School were aware of any risk. There was no big difference in awareness of the potential harmful effects of abortion between the control groups of the two high schools. The results of this study show the general lack of knowledge about the harmful effects of abortion in juveniles. Hoang Thi Tam noted that 20.9% of adolescents did not know one potential harmful effect of abortion while less than 50% were aware [10]. The lack of knowledge about the potential damage of abortion is one reason why so many juveniles and adolescents are having abortions done. It is, however, more likely that an abortion will be done for reason of maintaining marriageability and protecting the honor/face of the girl‟s family. The findings of this study indicate that in addition to integrated teaching, other means are needed if high school students are to me made m re aware of reproductive health. Increasing high school students’ knowledge of reproductive health in Hanoi and Hai Duong... 159 Table 5. Knowledge of students of the potential harmful effects of abortion Group Knowledge of pupils Hoai Duc B Doan Thuong Control group Experimental group Control group Experimental group n % n % n % n % Know more than 4 harmful effects 60 26.55 a 101 44.49b* 75 30.87c 135 58.19d** Know 1-3 harmful effects 135 59.73 116 51.1* 147 60.49d 94 40.52c** Know of no harmful effect 31 13.72 b 10 4.41a* 21 8.64d 3 1.29c** Values of each school in the same row with different superscripts are significantly different (P < 0,05). Values of the same group desigin the same row with different asterisks are significantly different (P < 0,05). In present study, student awareness of the harmful effects of abortion increased dramatically after they attended the extra-curricul r activity. The percentage of students who knew 4 or more harmful effects was 44.49% at Hoai Duc B High School and 58/19% at Doan Thuong High School (P < 0.05). At the same time, 4.41% at Hoai Duc B High School and 1.29% at Doan Thuong High School knew nothing about this (P < 0.05). This proves that the extra-curricular activities in the present study did teach the high school students something about reproductive health. * Knowledge of students about sexually transmitted disease Table 6. Knowledge of students about sexually transmitted disease Group Knowledge of students Hoai Duc B Doan Thuong Control group Experimental group Control group Experimental group n % n % n % n % Know of more than 3 diseases 85 37.61 a 197 86.78b* 102 41.98c 131 56.47d** Know of 1- 2 diseases 105 46.46b 18 7.93a* 118 48.56d 87 37.50c** Know of no disease 36 15.93b* 12 5.29a 23 9.46** 14 6.03 Values of each school in the same row with different superscripts are significantly different (P < 0.05). Values of the same group design in the same row with different asterisks are significantly different (P < 0.05). Table 6 shows that of those in the control group at Hoai Duc B High School, only 37.61% of them knew of more than 3 sexually transmitted diseases while 15.93% did not know of one sexually transmitted disease. A similar situation was found with the Doan Thuong High School control group students. Only 41.98% knew of more than 3 diseases and 9.46% did not know of one disease. Hoang Thi Tam found the situation to be similar in Hue. In that study, the percentage of students who knew of not one sexually transmitted Nguyen Phuc Hung and Ha Manh Linh 160 disease was 24.6% [10]. In addition, the SAVY1survey noted that about 20% of juveniles did not know anything about sexually transmitted disease [6]. After participating in the extra-cur icular activity on reproductive health, students knew more about sexually transmitted diseases. The percentage knowing more than 3 diseases was 86.78% at Hoai Duc B High School and 56.47% at Doan Thuong High School. The differences between the control group and the experimental group are statistically significant (P < 0.05). The percentage of students who knew not one sexually transmitted disease decreased from 15.93% to 5.29% at Hoai Duc B High School and this difference is statistically significant (P < 0.05). At Doan Thuong High School, the percentage of students who knew nothing of sexually transmitted disease decreased slightly with no significant difference. These results indicate that the extra-curricular activity served to teach students at both high schools something about sexually transmitted disease. 3. Conclusion Student awareness of reproductive health at both Hoai Duc B and at Doan Thuong High Schools was found to be low. An extra