Practical Improving students ’ knowledge of puberty and menstruation in rural Zimbabwe: an evaluation of Sesame Workshop ’ s Girl Talk program

The Girl Talk initiative, a collaboration of Sesame Workshop, World Vision International and World Vision Zimbabwe, is an innovative project to address gaps in pubertal health and menstrual hygiene education among pre-adolescent and adolescent girls and boys in rural Zimbabwe. Girl Talk uses short animated videos, with accompanying print materials, that use stories about a Zimbabwean school girl, Didi, and her female and male friends growing up and helping each other deal with the challenges they face as they enter puberty. Girl Talk materials are all in the local language, Shona, and are designed to foster conversations among the students and teachers about the experiences of puberty and menstruation that are based on science. The Education Development Center (EDC) and the Zimbabwean ﬁ rm, NGO Consultancy Africa, were contracted by Sesame Workshop to evaluate of Girl Talk. Using a quasi-experimental control-group design with repeated measures to assess the impact of Girl Talk on participating students, the research found a signi ﬁ cant impact on participating students ’ knowledge about puberty and menstruation compared with the control sample.


INTRODUCTION
The WASH UP! Girl Talk initiative, a collaboration of Sesame Workshop, World Vision International (WVI), and World Vision Zimbabwe, is an innovative project to address gaps in pubertal health and menstrual hygiene education among preadolescent and adolescent girls and boys in Zimbabwe. Girl Talk is designed as an educational resource that is part of WASH UP!, a WASH (water, sanitation, and hygiene) initiative that upgrades those facilities in rural schools throughout the country. Funded by Dubai Cares, Girl Talk aims to increase students' knowledge about puberty, menstruation, Globally, few schools in low resource countries are designed to support girls' MHM needs, which is further compounded by a general lack of knowledge about menstruation and poor support available to girls (Sommer et al. ; Haver et al. ). The many challenges that girls face globally also hold true in Zimbabwe (Foulds et al. in press; Tamiru et al. ). Since menstruation is a taboo subject in Zimbabwe, girls report finding it difficult to find accurate information.
A recent study on five African countries, including Zimbabwe, found that a majority of girls report never receiving school lessons on MHM (Tamiru et al. ).  (Foulds et al. in press). Girl Talk uses short animated videos, with accompanying print materials, that use stories about a school girl, Didi, and her female and male friends growing up and helping each other deal with the challenges they face as they enter puberty.

WASH UP! GIRL TALK PROGRAM
The stories present key facts about puberty and menstruation and help the children learn about a girl's transition into womanhood while also reviewing MHM practices. Girl Talk uses these practical, age appropriate, storylines to connect the basic facts to the experiences that will happen to each girl. Furthermore, although Zimbabwean schools teach in English, Girl Talk materials are all in Shona and teachers are encouraged to teach the materials in Shona. The design research found that for this sensitive and personal topic, students' home-language was more effective (Foulds et al.). Girl Talk is comprised of printed and digital classroom educational materials and teacher trainings. Ten educational sessions are provided for use in afterschool clubs.
At each school, Girl Talk is an afterschool club offered once a week to about 60 students in Grades 4-7. Clubs run by teachers are a common part of school life in Zimbabwe and many students participate in these clubs, so the club format is already known to the students. The participants in Girl Talk include boys and girls, but participation is weighted two-to-one toward girls.
The Ministry of Health and Child Care runs a schoolbased extension program using a male teacher and a female teacher who are trained in various health topics to become 'health masters' providing support for students.
WVI trained these health masters on Girl Talk before they launched the clubs. The health masters were not specifically selected by the Girl Talk programs.

School sample
The sample included six treatment schools from Nyanga District and six control schools from Rushinga District. For the treatment schools, WVI identified ten schools each in three wards that would be implementing the WASH UP! Girl Talk program in 2019 and for each ward, the research team randomly selected two schools using an online random number generator. The control schools were picked by WVI from schools that were scheduled to start Girl Talk in 2020. The target ages fall in Grades 4-7 in the Zimbabwean school system which is the end of the primary level in Zimbabwe.

Student sample
We tested one-thirds of the students in the Girl Talk clubs, or 20 students per school. Students were randomly assigned a number between 1 and 3, one number was picked, and those students were included in the study. Since the clubs are about menstruation, the clubs are designed to have more girls than boys. The ratio of girls to boys was approximately 2:1 so this was reflected in the final sample of 20 children per school recruited for the study. At all schools, if any student did not want to participate in the questionnaire, they were excused and sampling was repeated to replace them.
The pubertal knowledge assessment was administered

FINDINGS Student demographics
All students in both samples spoke Shona at home. The gender breakdown of the sample is 65% female and 35% male. The treatment and control samples are distributed across five grades, and most of the students are in Grades 5-7 (see Table 1) but the control sample skews older having a larger share of students in Grade 6 (42%) and Grade 7 (28%).

Knowledge about menstruation and puberty
At baseline, the mean score on the pubertal knowledge assessment was 52 for the Girl Talk participants and 55 for the control students, suggesting that both groups lack a knowledge of menstruation and puberty (see Table 2).
After participating in the Girl Talk program, the mean score for participating students, 73 points, is significantly higher than the control, 54 (p < 0.0001). The success of the program draws our attention to some of the unique components of the program. Salient features in the design of Girl Talk are that the materials use a story format to present the challenges and advances of puberty in the context of the student's lives, and the materials combine short videos and printed materials in a club format to foster conversation among students and teachers about the topics. Finally, the language of instruction for the program is Shona, the students' first language, and not English, although English is used in school.

CONCLUSION
These findings suggest that MHM interventions can be very effective when they connect to the local contexts and use language and activities that present information in a format that is practical and relevant to adolescents. Girl Talk was a program specifically designed for Shona-speaking rural Zimbabwean students and their teachers. It was intended to use multimedia learning activities to foster conversations among the students and teachers about the experiences of puberty and menstruation based on science.
Even with the difficult circumstances that confront rural schools in Zimbabwe, the evaluation results suggest that the Girl Talk program was very successful at improving and clarifying young people's knowledge about puberty and menstruation.

DATA AVAILABILITY STATEMENT
Data cannot be made publicly available; readers should contact the corresponding author for details.