Adolescent Girls In Kenya Research Articles

The Case for Rights-Based Investments in Adolescent Girls in Kenya: An Economic Modelling Study

The Case for Rights-Based Investments in Adolescent Girls in Kenya: An Economic Modelling Study

Diverse policy maker perspectives on the mental health of pregnant and parenting adolescent girls in Kenya: Considerations for comprehensive, adolescent-centered policies and programs.

The pregnancy rate in Kenya among adolescent girls is among the highest in the world. Adolescent girls experience increased risk of anxiety and depression during pregnancy and postpartum which can result in poor health outcomes for both mother and baby, and negatively influence their life course. Mental health is often given low priority in health policy planning, particularly in Sub-Saharan Africa (SSA). There is an urgent need to address the treatment gap and provide timely mental health promotion and preventative services, there is a need to focus on the shifting demographic of SSA-the young people. To understand perspectives on policymakers on the mental health prevention and promotion needs of pregnant and parenting adolescent girls, we carried out a series of interviews as part of UNICEF funded helping pregnant and parenting adolescents thrive project in Kenya. We interviewed 13 diverse health and social policy makers in Kenya to understand their perspectives on the mental health experiences of pregnant and parenting adolescent girls and their ideas for optimizing mental health promotion. Six principal themes emerged including the mental health situation for adolescent girls, risk factors for poor mental health and barriers to accessing services for adolescent girls, health seeking behavior effect on maternal and child health outcomes, mental health promotion, protective factors for good mental health, and policy level issues. Examination of existing policies is required to determine how they can fully and effectively be implemented to support the mental health of pregnant and parenting adolescent girls.

Effects of a single cash transfer on school re-enrollment during COVID-19 among vulnerable adolescent girls in Kenya: Randomized controlled trial

COVID-19 related school closures in Kenya were among the longest in Africa, putting older adolescent girls nearing the end of secondary school at risk of permanent dropout. Using a randomized-controlled trial we evaluated a logistically simple cash transfer intervention in urban areas designed to promote their return to school. There were no required conditions for receiving the transfer and the intervention is interpreted as a labeled cash transfer. It had substantial significant effects on re-enrollment of adolescent girls, with greater effectiveness for older girls and even for some not enrolled earlier in the school year. The program effectiveness demonstrates feasibility of the approach and underscores the potential importance of additional resources for schooling during the pandemic, when a large majority of households had suffered income losses.

It's not just about pads! Adolescent reproductive health views in Kenya: A qualitative secondary analysis.

Many adolescents face barriers to accessing reproductive health care even though quality reproductive health care is a fundamental human right. The objective of this study is to understand the requests of quality reproductive health among high school girls in Kenya. We conducted a secondary analysis of qualitative data from a sub-sample of adolescent girls in Kenya who participated in the What Women Want global campaign and analyzed interview data from key informants involved in the survey. We used pre-existing codes and current literature to design the coding framework and thematic analysis to describe emerging themes. Atlas. ti 8 was used to organize and analyze codes. Over 4,500 high school girls, ages 12 and 19 years, were included in the analysis, with 61.6% from all-girls boarding schools and 13.8% from mixed-day schools. Data from nine key informants complemented findings from the survey. Emerging themes included: 1) The need for improved menstrual health and hygiene: Sanitary towels and cleaner toilets; 2) Prevention of adolescent pregnancy: Access to contraception; 3) Respect and dignity: Participants want privacy and confidentiality; and 4) The need to address social determinants of health: Economic stability and a safe physical environment. This study indicated that adolescent high school girls have varied requests for reproductive health care and services. While menstrual health and hygiene are key issues, reproductive needs are beyond just sanitary products. The results suggest a need for targeted reproductive health interventions using a multi-sectoral approach.

Ramifications of Covid-19 pandemic mitigation measures on sexual reproductive health services utilization among women and adolescent girls in Kenya

Background: Women and the adolescents girls in low-middle income countries continue to be the most vulnerable individuals in times of disasters such as the ongoing COVID-19 pandemic with emphasis on their Sexual Reproductive Health (SRH); yet hardly many studies choose to identify gaps that could improve and bring about well-informed interventions during crisis that do not affect other essential services. Hence, this study aimed to identify the effect of the Covid-19 pandemic mitigation measures on access and utilization of sexual reproductive health services and its related SRH outcomes among women and female adolescents in Kenya. Methods: A systematic literature review was performed to collate findings on the given study using 8 databases. Total of 1352 presumably pertinent publication were retrieved of which 20 studies met the study’s inclusion criteria which included studies with quantitative, qualitative and mixed methods study designs in full text and in English without duplicates. Using a data extraction table, thematic analysis was carried out to yield the study findings. Results: Two themes were identified including; service access related outcomes with the sub-themes of maternal health services and HIV/AIDS services and pandemic specific stressors with the sub-themes of Covid-19 mitigation stressors and socio-economic stressors. The findings implied that, women of reproductive age SRH access and utilization was affected by the COVID-19 pandemic’s mitigation responses with adverse SRH adverse health outcomes. Conclusion: In conclusion, the Covid-19 pandemic adversely affected sexual reproductive health services among women and female adolescents in Kenya. The given main findings indicated and recognized the existence of improper set policies and mitigative measures during crisis management, affecting essential services such as SRH.

Access to Oral Fluid-Based Human Immunodeficiency Virus Self-Tests Increases Testing Among Male Partners of Adolescent Girls in Kenya: A Randomized Controlled Trial

PurposeThe risk of human immunodeficiency virus (HIV) among adolescent girls (AGs) may be reduced if they know the HIV status of their male partners. We assessed the ability of AGs in Siaya County, Kenya, to offer HIV self-tests to their partners to promote partner and couples testing. MethodsEligible AGs were 15–19 years old, self-tested HIV-negative, and had a male partner not tested in the past 6 months. Participants were randomly assigned to receive two oral fluid-based self-tests (intervention arm) or a referral coupon for facility-based testing (comparison arm). The intervention included counseling on ways to safely introduce self-tests to partners. Follow-up surveys were conducted within 3 months. ResultsAmong 349 AGs enrolled, median age was 17 years (interquartile range 16–18), 88.3% of primary partners were noncohabiting boyfriends, and 37.5% were unaware if their partner had ever tested. At 3 months, 93.9% of the intervention arm and 73.9% of the comparison arm reported that partner testing occurred. Compared to the comparison arm, partner testing was more likely in the intervention arm (risk ratio = 1.27; 95% confidence interval 1.15–1.40; p < .001). Among participants whose partners got tested, 94.1% and 81.5% in the intervention and comparison arms, respectively, reported that couples testing occurred; couples testing was more likely in the intervention than comparison arm (risk ratio = 1.15; 95% confidence interval 1.15–1.27; p = .003). Five participants reported partner violence, one study-related. DiscussionProvision of multiple self-tests to AGs for the purpose of promoting partner and couples testing should be considered in Kenya and other settings where AGs face a high risk of HIV acquisition.

Improving oral health of adolescent girls in Kenya through education - An observational study.

Dental caries and periodontal diseases are significant health concerns in developing nations. This study assessed the impact of a comprehensive oral health education program on adolescent girls in rural Kenya. Eighty-seven girls aged 13-18 years attending school in rural Nanyuki, Kenya, were enrolled in the study. The comprehensive program included personalized oral hygiene training, education and health advocacy coaching. Dental caries, gingival inflammation and dental plaque biofilm were assessed at baseline, 1- and 2.5-year post-implementation. The intervention was highly effective in arresting pre-existing carious lesions and preventing the formation of new ones in this population. The data revealed that there was a significant remineralization of incipient caries lesion, as shown by decreases in modified ICCMS™ scores from baseline to 1-year post-implementation. From baseline to the 2.5-year post-implementation assessment, only six new carious lesions developed. Dental plaque biofilm was reduced by 83.6%, and gingival inflammation was reduced by 81.6%. A comprehensive oral health program, which included behavioural awareness and educational approaches, resulted in significant positive oral health outcomes in caries, dental plaque biofilm and gingival inflammation.

Sexual and reproductive health service utilization among adolescent girls in Kenya: A cross-sectional analysis.

We examined the association between adolescents' sexual and reproductive health (SRH) service utilization in the past 12 months and structural, health facility, community, interpersonal, and individual level factors in Kenya. This cross-sectional analysis used baseline data collected in Homa Bay and Narok counties as part of the In Their Hands intervention evaluation from September to October 2018. In total, 1840 adolescent girls aged 15 to 19 years were recruited to complete a baseline survey. We used unadjusted and adjusted logistic regression to model factors associated with SRH utilization across the social-ecological framework levels. Overall, 36% of participants reported visiting a health facility for SRH services in the past 12 months. At the structural level being out-of-school (AOR: 2.12 95% CI: 1.60-2.82) and not needing to get permission to go (AOR: 1.37 95%CI: 1.04-1.82) were associated with SRH service utilization. At the interpersonal level, participants who reported being able to ask adults for help when they needed it were more likely to report using SRH services in the past 12 months (AOR: 1.98, 95% CI: 1.09-3.78). At the individual level, having knowledge about where to obtain family planning (AOR = 2.48 95% CI: 1.74-3.57) and receiving information on SRH services in the past year (AOR: 1.44 95% CI:1.15-1.80) were associated with SRH service utilization. Our findings demonstrate the need for interventions, policies, and practices to be implemented across structural, health facility, community, interpersonal, and individual levels to comprehensively support adolescent girls to access and use SRH services.

Robust Designs for Prospective Randomized Trials Surveying Sensitive Topics.

We consider the problem of designing a prospective randomized trial in which the outcome data will be self-reported and will involve sensitive topics. Our interest is in how a researcher can adequately power her study when some respondents misreport the binary outcome of interest. To correct the power calculations, we first obtain expressions for the bias and variance induced by misreporting. We model the problem by assuming each individual in our study is a member of one "reporting class": a true-reporter, false-reporter, never-reporter, or always-reporter. We show that the joint distribution of reporting classes and "response classes" (characterizing individuals' response to the treatment) will exactly define the error terms for our causal estimate. We propose a novel procedure for determining adequate sample sizes under the worst-case power corresponding to a given level of misreporting. Our problem is motivated by prior experience implementing a randomized controlled trial of a sexual-violence prevention program among adolescent girls in Kenya.

School attendance and sexual and reproductive health outcomes among adolescent girls in Kenya: a cross-sectional analysis

BackgroundGiven the high burden of adverse sexual and reproductive health outcomes (SRH) and low levels of school attendance among adolescent girls in Kenya, this study sought to elucidate the association between school attendance and SRH outcomes among adolescent girls in Homa Bay and Narok counties.MethodsThis study uses baseline quantitative data from the mixed-methods evaluation of the In Their Hands (ITH) program which occurred between September to October 2018 in Homa Bay and Narok counties. In total, 1840 adolescent girls aged 15–19 years participated in the baseline survey, of which 1810 were included in the present analysis. Multivariable logistic regression models were used to assess the association between school attendance (in- versus out-of-school) and ever having sex, condom use during last sex, and ever pregnant, controlling for age, orphan status, income generation, religion, county, relationship status, and correct SRH knowledge.ResultsAcross the 1810 participants included in our study, 61.3% were in-school and 38.7% were out-of-school. Compared to adolescent girls who were in-school, those out-of-school were more likely (AOR 5.74 95% CI 3.94, 8.46) to report ever having sex, less likely (AOR: 0.21, 95% CI 0.16, 0.31) to have used a condom during their last sexual intercourse, and more likely (AOR: 6.98, 95% CI 5.04, 9.74) to have ever been pregnant.ConclusionsSchool attendance plays an integral role in adolescent girls’ SRH outcomes, and it is imperative that policy actors coordinate with the government and community to develop and implement initiatives that support adolescent girls’ school attendance and education.

The impact of Menstrual Hygiene Management and gender on psychosocial outcomes for adolescent girls in Kenya

ABSTRACT This research measures the psychosocial impact of a Menstrual Hygiene Management (MHM) program in Kenya by assessing change in self-efficacy, authenticity, and hope in adolescent girls. Trained researchers administered baseline and end-line assessments, 16 weeks apart, to 311 participants in the Always Keeping Girls in School Program. The schools were assigned to one of three program versions: only period products, only menstrual health education, or both menstrual health education and period products; in all-girls or coed classes. When girls received MHM education and pads in coed classes, there was no change in their self-efficacy or hope scores, but in all-girls classes, self-efficacy and hope scores significantly increased. Authenticity in girls decreased in coed classes unless period products were distributed, and then girl’s authenticity scores increased. The role of gender in assessing change in self-efficacy, authenticity and hope has provided a useful frame for evaluating MHM programming.

Political prioritization and the competing definitions of adolescent pregnancy in Kenya: An application of the Public Arenas Model.

Approximately one in every five adolescent girls in Kenya has either had a live birth or is pregnant with her first child. There is an urgent need to understand the language and symbols used to represent adolescent pregnancy, if the current trend in adolescent pregnancy is to be reversed. Agreement on the definition of a societal problem is an important precursor to a social issue's political prioritization and priority setting. We apply the Public Arenas Model to appraise the environments, definitions, competition dynamics, principles of selection and current actors involved in problem-solving and prioritizing adolescent pregnancy as a policy issue. Using a focused ethnographic approach, we undertook semi-structured interviews with 14 members of adolescent sexual reproductive health networks at the national level and conducted thematic analysis of the interviews. We found that existing definitions center around adolescent pregnancy as a "disease" that needs prevention and treatment, socially deviant behaviour that requires individual agency, and a national social concern that drains public resources and therefore needs to be regulated. These competing definitions contribute to the rarity of the topic achieving traction within the political agenda and contribute to conflicting solutions, such as lowering the legal age of consenting to sex, while limiting access to contraceptive information and services to minors. This paper provides a timely theoretical approach to draw attention to the different competing definitions and subsequent divergent interpretations of the problem of adolescent pregnancy in Kenya. Adolescent reproductive health stakeholders need to be familiar with the existing definitions and deliberately reframe this important social problem for better political prioritization and resource allocation. We recommend a definition of adolescent pregnancy that cuts across different arenas, and leverages already existing dominant and concurrent social and economic issues that are already on the agenda table.

Tu'Washindi na PrEP: Adolescent Girls in Kenya Taking Control of Their Health

Tu'Washindi na PrEP: Adolescent Girls in Kenya Taking Control of Their Health

Providers, Unmarried Young Women, and Post-Abortion Care in Kenya.

Young women and girls in Kenya face challenges in access to abortion care services. Using in‐depth and focus group interviews, we explored providers’ constructions of these challenges. In general, providers considered abortion to be commonplace in Kenya; reported being regularly approached to offer abortion‐related care and services; and articulated the structural, contextual, and personal challenges they faced in serving young post‐abortion care (PAC) patients. They also considered induced abortion among young unmarried girls to be especially objectionable; stressed premarital fertility and out‐of‐union sexual activity among unmarried young girls as transgressive of respectable femininity and proper adolescence; blamed young women and girls for the challenges they reported in obtaining PAC services; and linked these challenges to young women's efforts to conceal their failures related to gender and adolescence, exemplified by pre‐marital pregnancy and abortion. This study shows how providers’ distinctive emphasis that young abortion care‐seekers are to blame for their own difficulties in accessing PAC may add to the ongoing crisis of post‐abortion care for young women and adolescent girls in Kenya.

Parents\u2019 and teachers\u2019 views on sexual health education and screening for sexually transmitted infections among in-school adolescent girls in Kenya: a qualitative study

BackgroundTo successfully develop and implement school-based sexual health interventions for adolescent girls, such as screening for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, it is important to understand parents’ and teachers’ attitudes towards sexual health education and acceptability of sexually transmitted infection (STI) screening interventions.MethodsIn this qualitative study, we approached parents and teachers from three high schools to participate in in-depth interviews (IDIs) and focus-group discussions (FGDs). Parents and teachers were asked about their general knowledge of STIs and sexual health education. In addition, they were asked whether they would support utilizing outreach to schools to facilitate provision of sexual health education and screening for STIs in adolescent girls. Data were audio-recorded, transcribed, and translated into English. An initial coding matrix was developed and refined throughout the coding process. Transcripts were coded by two researchers and analyzed using the content analysis approach.ResultsWe conducted 10 IDIs (5 parents and 5 teachers) and 4 FGDs (2 with parents, 2 with teachers, total of 26 participants). Most parents reported few or no discussions regarding STIs with their adolescent girls. Parents were more comfortable discussing consequences of sexual activity including loss of virginity and the potential for pregnancy. Parents tended to place responsibility for sexual health education with teachers. The teachers, in turn, provided basic sexual and reproductive health education including puberty, abstinence, and overview of STIs. Both parents and teachers found the idea of screening for STIs in adolescent girls to be acceptable, and were comfortable with research staff contacting girls through informational meetings at schools. Parents felt that adolescents’ STI screening results should be shared with their parents.ConclusionIn this African setting, parents and teachers provide limited sexual health education, with a focus on negative consequences including loss of virginity, pregnancy, and risk for STIs. Nonetheless, both parents and teachers were supportive of STI screening for adolescent girls, beginning with school-based informational meetings for the girls. Research and programs that aim to provide STI screening in this setting must offer treatment and address the issue of whether results will be disclosed to parents.

The Adolescent Girls Initiative-Kenya (AGI-K): study protocol.

BackgroundMany adolescent girls in Kenya and elsewhere face considerable risks and vulnerabilities that affect their well-being and hinder a safe, healthy, and productive transition into early adulthood. Early adolescence provides a critical window of opportunity to intervene at a time when girls are experiencing many challenges, but before those challenges have resulted in deleterious outcomes that may be irreversible. The Adolescent Girls Initiative-Kenya (AGI-K) is built on these insights and designed to address these risks for young adolescent girls. The long-term goal of AGI-K is to delay childbearing for adolescent girls by improving their well-being.InterventionAGI-K comprises nested combinations of different single-sector interventions (violence prevention, education, health, and wealth creation). It will deliver interventions to over 6000 girls between the ages of 11 and 14 years in two marginalized areas of Kenya: 1) Kibera in Nairobi and 2) Wajir County in Northeastern Kenya. The program will use a combination of girl-, household- and community-level interventions. The violence prevention intervention will use community conversations and planning focused on enhancing the value of girls in the community. The educational intervention includes a cash transfer to the household conditioned on school enrollment and attendance. The health intervention is culturally relevant, age-appropriate sexual and reproductive health education delivered in a group setting once a week over the course of 2 years. Lastly, the wealth creation intervention provides savings and financial education, as well as start-up savings.Methods/DesignA randomized trial will be used to compare the impact of four different packages of interventions, in order to assess if and how intervening in early adolescence improves girls’ lives after four years. The project will be evaluated using data from behavioural surveys conducted before the start of the program (baseline in 2015), at the end of the 2-year intervention (endline in 2017), and 2 years post-intervention (follow-up in 2019). Monitoring data will also be collected to track program attendance and participation. Primary analyses will be on an intent-to-treat basis. Qualitative research including semi-structured interviews of beneficiaries and key adult stakeholders in 2016 and 2018 will supplement and complement the quantitative survey results. In addition, the cost-effectiveness of the interventions will be assessed.DiscussionAGI-K will provide critical evidence for policy-makers, donors and other stakeholders on the most effective ways to combine interventions for marginalized adolescent girls across sectors, and which packages of interventions are most cost-effective.Trial registrationISRCTN77455458, December 24, 2015Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2888-1) contains supplementary material, which is available to authorized users.

Overcoming Barriers to Contraceptive Uptake among Adolescents: The Case of Kiambu County, Kenya

Despite high sexual activity among adolescent girls in Kenya, contraceptive uptake is very low with only about 26 percent sexually active adolescent girls currently using a contraceptive method. This exposes them to HIV infections and unplanned pregnancies which consequently lead to school dropouts, unsafe abortions, and lack of employment opportunities. This cross-sectional study aimed at assessing the utilization of contraceptives among secondary school adolescent girls in Karuri Town Council, Kiambu County. Overall, 421 girls aged between 13.0 to 19.0 years took part in the study. Findings showed that despite majority (77.5%) of the adolescent girls having had sexual debut by the age of 15 years, contraceptive utilization was very low at 43%. The results revealed that age of the adolescent, knowledge of contraceptives options, perception and accessibility of the contraceptives had positive significant effect on contraceptive utilization. Adolescents aged 18 years and above were more likely to utilize contraceptives as compared to those of a lesser age (p ≤ 0.001; OR: 9.870 (95% CI: 3.781 - 25.763)). Those with knowledge on contraceptives were OR 3.2 times more likely to use contraceptives (p = 0.025), similarly, accessibility was significantly associated with increased contraceptive utilization (p = 0.34, 95% CI: 1.054 - 4.187). Adolescents who perceived use of contraceptives as wise were more likely to use a contraceptive than those of a divergent opinion (OR: 2.053 (95% CI: 1.024 - 4.115), p = 0.041). This revealed that high level of knowledge on contraceptives did not always amount to practice. There is therefore a need to develop age specific reproductive health messages to guide school education curriculum as well as parent or guardian-child communication.

Rape prevention through empowerment of adolescent girls.

Sexual assault is a major cause of injury, unplanned pregnancy, HIV infection, and mental health problems worldwide. In parts of sub-Saharan Africa, sexual assault has reached epidemic proportions. This study evaluated the efficacy of an empowerment and self-defense intervention for adolescent girls to decrease the incidence of sexual assault and harassment in Nairobi's large informal settlements. A prospective cohort of 1978 adolescents from 4 neighborhoods near Nairobi were taught empowerment, deescalation, and self-defense skills in six 2-hour sessions. The standard-of-care (SOC) group (n = 428) received a life skills class. Self-reported, anonymous survey data were collected at baseline and 10.5 months after intervention. Annual sexual assault rates decreased from 17.9/100 person-years at baseline to 11.1 at follow-up (rate ratio = 1.61; 95% confidence interval [CI], 1.26-1.86; P < .001); there was no significant change in the SOC group (14.3 to 14.0, rate ratio = 1.02; 95% CI, 0.67-1.57, P = .92). Sexual assault disclosure in the intervention group increased from 56% to 75% (P = .006), compared with a constant incidence of disclosure (53%) in the SOC group. The majority (52.3%) of adolescents in the intervention group reported using skills learned to stop an assault. This intervention decreased sexual assault rates among adolescent girls in Kenya. The intervention was also associated with an increase in the disclosure of assaults, thereby enabling survivors to seek care and support and possibly leading to the identification and prosecution of perpetrators. This model should be adaptable to other settings both in Africa and globally.

Front and Back Covers, Volume 28, Number 4. August 2012

Front and back cover caption, volume 28 issue 4Front cover: OLYMPIC LEGACY: FOODOver the last decades, the Olympic Games have increasingly claimed to deliver a social and economic ‘legacy’ to the host city. The 2012 Olympic Games in London have set out to deliver a legacy of better food for east London, an area perceived as ‘deprived’, with higher than average rates of obesity and significant ‘food deserts’ in its midst. Various Olympic organizations have considered the issue, resulting in the publication of a Food vision for the first time ever in Olympic history.However, with companies such as Coca‐Cola and McDonald's having been appointed official suppliers to the Games, and with an extremely limited time frame, will the Games be able to deliver on this promise?Allotments have been demolished and plans are afoot for Queen's Market, Upton Park, to be replaced by a supermarket. In response, Queen's Market traders and customers protest that demolition of their market goes against the Olympic spirit. Indeed, the Games could be used instead to help improve access to London's ethnically diverse markets far beyond the borough limits, as suggested in this postcard distributed by campaigners.As Freek Janssens argues in his guest editorial in this issue, the 2012 Games provide the opportunity to more critically assess how food serves the marginalized in our ethnically diverse inner cities. Also in this issue, Johan Fischer deals with halal, another topic that impacts athletes and spectators at the Games, with sporting events taking place during ramadan.Back cover: POVERTY AND GRASSROOTS COMMERCEAisha, a door‐to‐door entrepreneur in CARE Bangladesh’ s Rural Sales Programme (RSP), is one of 3,000 previously ‘destitute’ women who now earns an income by selling branded consumer goods across rural villages under a partnership between CARE and global multinationals such as Danone, Bic, and Unilever. Similar female distribution systems are now popping up across the world. From Procter and Gamble's distribution of sanitary pads to ‘poor’ adolescent girls in Kenya and Malawi, to Unilever's Shakti ammas distributing soap village‐to‐village in rural India, companies aim to expand their bottom line by fostering entrepreneurial opportunities among the poor through so‐called ‘bottom of the pyramid’ (BoP) initiatives.Such initiatives reflect the changing nature of international development where new development actors – celebrities, philanthrocapitalists, multinational corporations, social entrepreneurs etc. – spearhead efforts to reduce poverty, replacing the role long occupied by states and aid agencies. Today some of the world's largest corporations have become key players in global development by selling ‘socially beneficial’ products to the ‘poor’, and by drawing them into global commodity chains as entrepreneurs. These efforts are now widely endorsed as part of a pro‐market development agenda that looks to the perceived ‘efficiency’ of the private sector to do what billions of aid dollars have been unable to do.BoP distribution systems can offer ‘poor’ women like Aisha an opportunity to earn an income and contribute to the food security of their family. But these engagements pose risks as well as rewards, and raise pressing questions for anthropologists about how, under what terms, and with what effects, global capital is linking up with informal economies in the name of development.

An Integrative Review of Comprehensive Sex Education for Adolescent Girls in Kenya

The purposes of this article are to identify and review comprehensive sex education programs (CSEPs) available to adolescent females in Kenya, East Africa, to discuss barriers to implementing CSEPs in Kenya, and to highlight the role of nurses in improving and institutionalizing available CSEPs in Kenya. Integrative review. A systematic search of six databases and other Internet sources was conducted to identify CSEPs currently available to adolescent girls in Kenya. Five CSEPs were identified. The CSEPs were evaluated using established criteria. All of the CSEPs were well designed and almost all were implemented with fidelity. Four of the five CSEPs met all of the criteria for well-designed CSEPs with only one showing lack of sustainability. Tuko Pamoja (We Are One) shows promise for wider implementation. CSEPs are a valid intervention leading to the reduction of teenage pregnancy, HIV/AIDS, and sexually transmitted infections. The reach of the identified CSEPs varies, and sustainability is challenging due to lack of government and community support, lack of funding, and unsustainable teaching modalities. Nurses can serve as liaisons between adolescents, the community, and the Kenyan government in promoting CSEPs. Nurses should be more readily utilized in educating community members and policy makers about the need for CSEPs in all Kenyan high schools. Nursing students can also be utilized in their community health role to teach curricula of CSEPs. Nurses should advocate for all adolescents to access reproductive health services and for all healthcare providers to provide comprehensive reproductive health care to them.