This paper presents the protocol for a quasiexperimental study evaluating the Afya Kesho ('Health for Tomorrow') programme, an innovative animation-based, school-integrated and community-integrated comprehensive sexuality education curriculum aimed at enhancing adolescent sexual and reproductive health knowledge, attitudes and behaviours in rural and periurban Kenya.
Key Findings
Background
Adolescents in Kenya face a high burden of sexual and reproductive health challenges including early pregnancy, sexually transmitted infections, and limited access to accurate sexuality education.
Cultural resistance and lack of trained personnel have been identified as significant barriers to implementing school-based comprehensive sexuality education (SBCSE) in Kenya.
The study targets rural and periurban settings across Nairobi and Kiambu counties.
The programme is designed to address gaps left by existing global SBCSE approaches that have faced implementation challenges in Kenya.
Methods
The Afya Kesho programme uses an animation-based, school-integrated and community-integrated curriculum delivered through 17 animated episodes structured into eight interactive sessions.
Sessions are facilitated by trained school health teachers and community health promoters.
The intervention is delivered across three schools in Nairobi and Kiambu counties.
The curriculum integrates both school-based and community-based components to address SRH knowledge, attitudes, and behaviours.
Methods
The study will recruit a total of 422 adolescents aged 10-19 using multistage sampling.
A preintervention and postintervention quasiexperimental design will be used to evaluate programme effectiveness.
Quantitative data will be collected at baseline and endline using a structured questionnaire adapted from the Global School-based Student Health Survey and the Global Diet Quality Score.
Multistage sampling is the recruitment methodology employed.
Methods
Primary outcomes of the study include SRH knowledge, gender norms and intimacy, while secondary outcomes include physical and mental health, dietary behaviours and healthcare utilisation.
The study uses a structured questionnaire adapted from validated tools including the Global School-based Student Health Survey and the Global Diet Quality Score.
Statistical analysis will use STATA V.17 and will include descriptive, inferential and multivariate regression analyses.
The broad outcome framework reflects an intention to assess comprehensive wellbeing beyond traditional SRH metrics.
Methods
The study has received ethical approval and incorporates specific ethical safeguards for adolescent research.
Ethical approval was granted by the Kenyatta National Hospital-University of Nairobi Ethics and Research Committee (P854/12/2024).
Informed consent will be obtained from all participants and their guardians.
The study prioritises minimal disruption to school activities and adheres to ethical standards of adolescent research.
The final protocol is registered and available on Open Science Forum (https://osf.io/fx38c).
Methods
Dissemination of findings will occur through multiple open-access channels, and anonymised datasets will be made publicly available upon study completion.
Findings will be disseminated through open-access publications, infographics, school-based brochures and digital platforms.
Anonymised datasets will be made publicly available on the Innovation for Health Equity in Africa website on completion.
This open-data approach is intended to support future research and programme replication.
What This Means
This paper describes the design and protocol for a study testing a new sexual health education programme called Afya Kesho ('Health for Tomorrow') in Kenya. The programme is aimed at adolescents aged 10 to 19 in rural and semi-urban areas around Nairobi and Kiambu counties. What makes it distinctive is its use of animated video episodes — 17 in total — delivered across eight structured sessions by trained school teachers and community health workers. The study will involve 422 young people across three schools and will measure changes in knowledge about sexual and reproductive health, attitudes toward gender and relationships, and broader health behaviours such as diet and mental health, before and after the programme is delivered.
This research suggests that animation-based education delivered in both school and community settings may offer a practical solution to longstanding barriers in Kenya's sexual health education landscape, such as cultural resistance and a shortage of trained educators. By combining entertaining visual content with guided interactive sessions, the programme aims to reach adolescents in a way that is engaging and culturally sensitive. The study is carefully designed to meet international ethical standards for research with young people, including obtaining consent from both participants and their guardians.
This research matters because Kenya, like many sub-Saharan African countries, has high rates of adolescent pregnancy and sexually transmitted infections, and existing education efforts have struggled to gain traction. If the Afya Kesho programme is shown to be effective, it could serve as a scalable model for other low-resource settings facing similar challenges. The researchers plan to share all findings and data openly so that other communities and researchers can build on the results.
Gao Y, Zhao S, Okenyoru D, Lu Y, Zhang R. (2025). School-based and animation-based comprehensive sexuality education in Kenya: protocol for a quasiexperimental study.. BMJ open. https://doi.org/10.1136/bmjopen-2025-103510