School-Based Sexual Health Education Interventions in Sub-Saharan Africa: A Multiple Case Study

School-based sexual health education is one of the most comprehensive and effective ways of promoting young people’s sexual health, reducing risky sexual behaviours and preventing sexually transmitted infections. This study investigated the design, implementation and evaluation of seven school-based sexual health education interventions in five sub-Saharan African countries, to identify features that may be associated with effectiveness or ineffectiveness on self-reported condom use and preventing sexually transmitted infections. A multiple case study design was employed. Data from each intervention were collected through documents review and interviews with key investigators. Data were analysed using a combination of case study methods. The findings confirmed that interventions that had greater numbers of features recommended by previous evidence synthesis studies were more likely to be effective. Findings suggested that young people’s sexual health needs assessment could be improved by applying ethnography, and Sexual Script research, which, in turn, could make interventions more effective. School-based interventions should consider environmental factors by incorporating community-based approaches and using ecological models as theories underpinning interventions. Interventions were also more likely to be effective if delivered by both teachers and peer educators. Finally, optimum impact is likely if young people are exposed to interventions for at least two years/academic sessions. Future intervention design should consider these features to optimise effectiveness of school-based sexual health education in sub-Saharan Africa