Table 1 Summary of included papers
Effectiveness of health education as an intervention designed to prevent female genital mutilation/cutting (FGM/C): A systematic review. | |||||||
|---|---|---|---|---|---|---|---|
Author and year | Setting and prevalence | Population | Sample type and recruitment strategy | Study design and comparison group | Method and quality of studies | Information/activities intervention offered/evaluated | Outcome/results |
Ajuwon J Ademola, Brieger R William, Oladepo Oladimeji, deniyi D Joshua (1995) | South West Nigeria FGM/C Type I | Male practitioners Males and females community leaders Males and females in focus groups Nigeria, Yoruba community | Male and female community leaders Married and unmarried men and women Practitioners/ circumcisers Leaders in community Community members Practitioners age 45 and 70Â years Community leaders and focus groups, not specified | Qualitative | Interviews 75% | General knowledge about FGM/C | There was high need for health education interventions especially for indigenous surgeries |
Allam MF, Irala-Esteves DJ, Navajas FCR, Castillo DSA, Hoashi JS, Pankovich MB, Liceaga RJ. (2001) | Universities in Cairo, Egypt | Males and females Egypt | University students mean age of 20.97Â years of medical and 20.73Â years from non-medical Belong to a community that practice FGM | Cross-sectional No comparison group | Face-to-face interviews 32-item questionnaire 100% | General information about FGM | High proportion considered discussions in the media to play an important role in banning of FGM/C People are aware of the dangers involved, are more likely to be against the practice |
Alo & Gbadebo, (2011) | Southwest Nigeria | Women Southwest Nigeria | Women who have at least one living daughter Belong to a community affected by FGM/C 15–49 years | Survey | Interviews 50% | General knowledge about FGM/C | Respondents with post-secondary education were at least likely to have their daughters cut. Only 52% of the women were aware of the health hazards associated with FGC Participants from high socio-economic status are least likely to have their daughters cut |
Asekun-Olarinmoye EO,Amusan OA (2008) | Shao community is in Kwara State Nigeria Between 60 and 70% FGM/C Type I and II | Males and females Yoruba, Nigeria | Residents of Shao town above 10 years Participants belonged to a community that practice FGM/C Modal age of 30–39 and 20–29 in pre-intervention and post intervention respectively | survey | Questionnaires 100% | Health talks in vernacular on female genital anatomy, nature and types of FGM/C,complications, beliefs that encourage it Pictures were utilised to illustrate female genitalia, different types of mutilation Questions and answer sessions utilised for further discussions | No statistical significance difference between the composition and socio-demographic characteristics Education status, age and gender were found to be statistically significant in association to those who had their daughters excised Positive impact of the health education intervention on the attitude of the respondents to FGM/C and intentions to subject their daughters |
Awuah JB (2008) | Aboabo No.1 - Suburb of Kumasi 75–85% prevalence (24.5% of women) FGM/C Type II | Females African-Ghana | Those whose address contacts could be traced to their homes Participants belong to a community that practice FGM No indicated age | Exploratory research | Face to face interviews 75% | Background, knowledge and experiences of being circumcised and facing birth complications participant Suggestions of ways to prevent FGM/C from the participants | 43% suggested health professionals should use health talks 14% suggested use of dramas and role plays by health educators 14% believe that education of females would help 4% thought use of mass media to educate the public would help |
Babalola S,Brasington A, Agbasimalo A, Helland A, Nwanguma E, Onah N. (2006) | Enugu state: 3 local government areas; i. Uzo-Uwani,ii. Isi-Uzo and iii. Enugu South FGC prevalence of Enugu −59% Ebonyi −78% Usually type I and II of FGC are performed | Males and females Africa-Enugu and Ebonyi states, Nigeria | Participants belong to communities affected by FGC a. Enugu state for intervention b.Ebonyi state for comparison c. age 18 to 59 d. men and women | cross-sectional survey Ebonyi state for comparison | Interviews 100% | Examination of knowledge, attitudes and practices surrounding women’s reproductive health Support and training in development of action plan Discussions on social and health complications of FGC | Increased knowledge leading to widespread intentions not to practice Increased self-efficacy to refuse pressure to perform Extremely religious people are less likely to abandon FGC Large number of children was associated with intentions not to practice |
Chege J, Askew I, Igras S, Mutesh JK. (2004) | Semi-arid rural in Ethiopia and Kenya Ethiopia-Awash Woredea. Kenya-Ifo in Dadaab 76% (Ethiopia) 34% (Kenya) Specific community: 91% (Ethiopia) 100% (Kenya) FGM/C Type III | Males and females African-Ethiopians and Somali in Kenya | Participants must have experienced or lived with people who have experienced FGM Ethiopia-8 to 60 years Kenya-15 to 60 years Participants belong to communities affected by FGC | Quasi-experimental Ethiopia-six villages in Amibara Woreda. Kenya-Hagadera camp | Interviews 75% | Community level education outreach activities using behaviour-communication-change Community level advocacy Training dispensary service providers in treating complications and counselling clients on FGC related areas | Percentage of those who support abandonment in Ethiopia intervention group increased by 32%-control group increased by 10%-Kenya-intervention group remained at 23%-comparison group increased by 8% Percentage of those who do not intend to cut –Ethiopia intervention group increased by 26%-control reduced by 1%-Kenya intervention group increased by 3%-comparison increased by 8% Lower levels of exposure to FGC information translates to lower increases in positive attitudes and intent behaviours. |
Diop NJ, Askew I (2009 | Kolda Region in Southern Senegal 94% prevalence FGM/C Type I and II | Men and women Senegal | Males and females from villages where TOSTAN programme had been implemented and in Older than 15 years | Survey Quasi-experimental, pre-and post-intervention longitudinal design Comparison- villages where the programme had not reached | Interviews 100% | Modules about: Human rights, Problem-solving process, Basic hygiene and Women’s health | Statistically significant differences in the proportion of girls reported to have been cut in intervention group Significant attitudinal and behavioural changes leading to mass declaration against FGM/C Education, facilitated rapid change in traditional behaviours |
Jacoby SD, Lucarelli M, Musse F, Krishnamurthy A, Salyers V (2015) | Lewiston, Maine United States. FGM/C Type I – IV | Somali Women, Individuals who had experienced perinatal health care | Somali women Living in Lewiston, Maine Participants were from countries where FGM/C is practiced 12 to 60 years | Mixed-methods | Interviews 75% | General information about women’s health including FGM/C | No participant had adequate health literacy Historietas were unanimously approved As appropriate health education tools |
Mounir G, Nehad HM, Ibtsam MF. (2003) | Alexandria University, Egypt | Female students Egypt-Middle East | Students from Alexandria University second grade Participants belong to community affected by FGM Mean-19.35 | Quasi-experiment El-Shatby hostel was the control group that did not receive the program | Questionnaire 75% | Training on Importance of premarital counselling, family planning, breastfeeding, sexually transmitted diseases Alternative methods of family planning, weaning and importance of breastfeeding, importance of antenatal care, methods of prevention of STDs Experience and precautions against FGM and early marriage, social pressure on early marriage and FGM | Statistically significant improvement in each domain of knowledge measured in intervention group and no absolute change was detected in the control group 33.3% gain scores was detected for knowledge about the term RH and FGM In regards to effects of intervention program, those of high social class had a higher post-test score The program resulted to significant improvement in most of knowledge items and a shift towards a positive attitude |
Olaitan LO (2010) | 3 State Capitals in South west Nigeria | Males and females African-Nigeria (Yoruba, Fulani, Hausa and Nupe) | Parents Participants belong to communities affected by FGC 15 to 65 and above | Survey No comparison group | Questionnaire 75% | General knowledge about FGM | No significance difference existed between males and females in the knowledge about FGM/C There was significant difference based on age in knowledge about FGM/C There was significant difference based on educational status Community health education is the best means of providing health information and education to people at every level. |
Ruiz JI, Martinez AP, Bravo PMDM. (2015) | Spain-Murcia and Eastern Morocco | Males African-Living in Spain and | Male, living in Spain and Morocco originally from countries where FGM is performed Participants lived at least 18Â years in their countries of origin and have personally being in contact with women with FGM Participants Comprehend Spanish or French Between 20 and 53Â years | Qualitative | Semi-structured interview 75% | First-hand knowledge of the practice and its foundations-from various sensitisation and personal experience | Sensitised men can change viewpoints regarding the practice Important to use visual and communication media in health education programmes There is need for new development of health education programmes. |