School-based and animation-based comprehensive sexuality education in Kenya: protocol for a quasiexperimental study

Adolescents in Kenya face a high burden of sexual and reproductive health (SRH) challenges, including early pregnancy, sexually transmitted infections and limited access to accurate sexuality education. While school-based comprehensive sexuality education (SBCSE) has shown promise globally, its implementation in Kenya has faced significant barriers, including cultural resistance and lack of trained personnel. To address these gaps, the Afya Kesho ('Health for Tomorrow') programme introduces an innovative, animation-based, school-integrated and community-integrated comprehensive sexuality education curriculum aimed at enhancing adolescent SRH knowledge, attitudes and behaviours in rural and periurban Kenya. This manuscript presents the protocol of the Afya Kesho programme.

This quasiexperimental study will employ a preintervention and postintervention design to evaluate the effectiveness of the Afya Kesho programme. The intervention, delivered in three schools across Nairobi and Kiambu counties, includes 17 animated episodes structured into eight interactive SBCSE sessions facilitated by trained school health teachers and community health promoters. A total of 422 adolescents aged 10-19 will be recruited using multistage sampling. 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. Primary outcomes include SRH knowledge, gender norms and intimacy, while secondary outcomes include physical and mental health, dietary behaviours and healthcare utilisation. Statistical analysis using STATA V.17 will include descriptive, inferential and multivariate regression analyses. The final protocol is available on Open Science Forum (https://osf.io/fx38c).

Ethical approval has been 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 and adheres to ethical standards of adolescent research. 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.