Adijah Research

DETERMINANTS OF UTILIZATION OF YOUTH FRIENDLY
REPRODUCTIVE HEALTH SERVICES AMONG SCHOOL AND

COLLEGE YOUTHS (10-24 YEARS) IN OGEMBO SUB
COUNTY HOSPITAL, KISII COUNTY
BY ADIJAH MORAA OGANDA
REG.NO:D/NURS/16030/015
RESEARCH SUBMITTED TO THE DEPARTMENT OF

NURSING IN PARTIAL FULFILLMENT OF THE
REQUIREMENT FOR THE AWARD OF DIPLOMA IN
COMMUNITY HEALTH NURSING
KENYA MEDICAL TRAINING COLLEGE,
KAPKATET CAMPUS,
P.O BOX 35
KAPKATET
YEAR 2018
DECLARATION
I declare that this research is my own original mind work, not duplicate on of similarly published
work of any other scholar
I further declare that all the materials which may be cited in this paper which are not mine they are
dully acknowledged
NAME; ADIJAH MORAA OGANDA
SIGNATURE………………………………………………...
DATE………………………………………………………...
SUPERVISOR
NAME: MR.NGENO
SIGNATURE……………………………………...
DATE………………………………………………….
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DEDICATION
This research is being dedicated to my parents for their support in my education, to my siblings
for their perseverance and motivation for these three years away from home to study at KMTC
Kapkatet.
Lastly to my friends and colleagues whom with a lot of love and caring stood with me during my
studies and all well-wishers in my home who helped me both in thought and talks. May God bless
them.
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ACKNOWLEDGEMENT
My sincere acknowledgement goes to God through his power who made me to pursue and excel
in this medical course.
Also my appreciation to the principal Kapkatet medical training college Mr. Korir and the deputy
for the protection and encouragement for us students as we explore our professionalism.
My gratitude also goes to the head of nursing department Mr. Ngeno
My sincere appreciation also goes to Mr.Kandie whose efforts and motivation provided me with
relevant guidance to ensure I gained relevant concept and experience
Much appreciation also goes to the nursing officer in charge of Kapkatet sub county hospital and
the entire staff who assisted me to obtain relevant information required to facilitate my analysis,
findings of research project successfully.
Lastly my appreciation goes to my parents and siblings who supported me spiritually, socially,
financially and most encouraging to excel in my studies.
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CONTENTS
DECLARATION ........................................................................................................................ ii
DEDICATION ........................................................................................................................... iii
ACKNOWLEDGEMENT ......................................................................................................... iv
CONTENTS ................................................................................................................................ v
LIST OF FIGURES AND TABLES........................................................................................ viii
ABBREVATIONS AND ACRONYMS ................................................................................... ix
DEFINITION OF TERMS ......................................................................................................... x
ABSTRACT ............................................................................................................................... xi
CHAPTER ONE ............................................................................................................................. 1
1.0 INTRODUCTION ................................................................................................................ 1
1.1Background of the study ........................................................................................................ 1
1.2 Problem Statement ................................................................................................................ 2
1.3 Hypothesis............................................................................................................................. 3
1.4 Research questions ................................................................................................................ 4
1.5 STUDY OBJECTIVES......................................................................................................... 4
1.6 Justification of the study ....................................................................................................... 4
1.7 Limitation of the study .......................................................................................................... 5
CHAPTER TWO ............................................................................................................................ 6
2.0 LITERATURE REVIEW ................................................................................................. 6
CHAPTER THREE ...................................................................................................................... 13
3.0 RESEARCH METHODOLOGY........................................................................................ 13
3.1 Introduction ......................................................................................................................... 13
3.2 Study design ........................................................................................................................ 13
3.3 Variables......................................................................................................................... 13
3.4 Study area............................................................................................................................ 14
3.5 Target Population ................................................................................................................ 14
3.6 Sampling Criteria ........................................................................................................... 14
3.7 Sampling......................................................................................................................... 14
3.7.1 Sample Size determination .............................................................................................. 14
3.7.2 Sampling Technique ........................................................................................................ 15
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3.8 DATA ............................................................................................................................. 16
3.9 Data collection procedures .................................................................................................. 16
3.10 Data Analysis and presentation ......................................................................................... 16
3.11 Ethical considerations ....................................................................................................... 16
CHAPTER FOUR ......................................................................................................................... 18
STUDY FINDINGS AND INTERPRETATIONS ................................................................... 18
Figure 4.1: Background characteristics..................................................................................... 18
Figure 4.2: Gender .................................................................................................................... 19
Figure 4.3: Level of education .................................................................................................. 19
Figure 4.4: Religion utilization of YFRHS ............................................................................... 20
Figure 4.5 Religious affiliation ................................................................................................. 20
Figure 4.6: Ethnicity ................................................................................................................. 21
Figure 4.7: Parental employment status .................................................................................... 21
Figure 4.8:Reproductive health service utilized by youth ........................................................ 22
Table 4.0 Demographic factors and utilization of YRHS ......................................................... 23
Table 4.1: Socioeconomic and school factors and utilization of counseling services .............. 24
Table 4.2; Socio-economic and school factors and utilization of VCT services ...................... 25
Table 4.3: socio-economic and school factors and utilization of STI treatment services ......... 25
Table 4.4: Socio-cultural factors and utilization of family planning services .......................... 26
Table 4.5: socio-cultural factors and utilization of counseling services ................................... 26
Table 4.6: Socio-cultural factors and utilization of VCT services ............................................ 27
Table 4.7: Socio-cultural factors and utilization of STI treatment services ............................. 27
Figure 4.9 Source of information on RHS ................................................................................ 28
Figure 4.10: Persons consulted about reproductive health services ......................................... 29
Health system factors and utilization of YFRHS ...................................................................... 29
Fig 4.11 Availability of reproductive health facility ................................................................ 30
Fig 4.12: Distance of YRHS and Utilization of YFRHS .......................................................... 30
Table 4.8: Distance of YFRH facility ....................................................................................... 31
Figure 4.13: Displays the reasons for missing the services as stated by the youth................... 31
Figure 4.14: Reasons for not receiving the services required ................................................... 32
Fig 4.15: Health service provider attitude................................................................................. 32
CHAPTER FIVE .......................................................................................................................... 35
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5.0 DISCUSSION ..................................................................................................................... 35
CHAPTER SIX ............................................................................................................................. 39
6.0 CONCLUSION AND RECOMMENDATION ............................................................. 39
6.1 CONCLUSION ................................................................................................................... 40
6.2 RECOMMENDATION ...................................................................................................... 40
REFERENCES ......................................................................................................................... 42
APPENDIX I: QUESTIONNAIRE .......................................................................................... 43
APPENDIX II: BUDGET ......................................................................................................... 47
APPENDIX III: WORK PLAN ................................................................................................ 48
APPENDIX IV: LETTER OF AUTHORIZATION................................................................. 49
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LIST OF FIGURES AND TABLES
Figure 4.1: Background characteristics……………………………….………….………….18

Figure 4.2: Gender………………………………………………….……………….………19
Figure 4.3: Level of education……………………………….………………………..…….19
Figure 4.4: Religion utilization of YFRHS………………..………………….….………….20
Figure 4.5 Religious affiliation……………………………..………………….……………20
Figure 4.6: Ethnicity………………………………….……………………..………………21
Figure 4.7: Parental employment status…………………………….……………………….21
Figure 4.8:Reproductive health service utilized by youth…………………………………..22
Table 4.0 Demographic factors and utilization of YRHS……………………………….…..24
Table 4.1: Socioeconomic and school factors and utilization of counseling services….……24
Table 4.2; Socio-economic and school factors and utilization of VCT services………….…25
Table 4.3: socio-economic and school factors and utilization of STI treatment services…...25
Table 4.4: Socio-cultural factors and utilization of family planning services………….…...26
Table 4.5: socio-cultural factors and utilization of counseling services…………..….……..26
Table 4.6: Socio-cultural factors and utilization of VCT services…………..….….……….27
Table 4.7: Socio-cultural factors and utilization of STI treatment services…….….………..27
Figure 4.9 Source of information on RHS……………………………………….………….28
Figure 4.10: Persons consulted about reproductive health services…………….…………..29
Health system factors and utilization of YFRHS…………………………….……………..29
Fig 4.11 Availability of reproductive health facility…………………………..……………30
Fig 4.12: Distance of YRHS and Utilization of YFRHS……………………………………30
Table 4.8: Distance of YFRH facility……………………………………………………….31
Figure 4.13: Displays the reasons for missing the services as stated by the youth………….31
Figure 4.14: Reasons for not receiving the services required……………………………….31
Fig 4.15: Health service provider attitude…………………………………………………..32
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ABBREVATIONS AND ACRONYMS
AIDS -Acquired Immune Deficiency Syndrome
ARH&D -Adolescent Reproductive Health and Development
GOK -Government of Kenya
HIV -Human Immunodeficiency Virus
HS -Health System
ICPD -International Conference on Population and Development
IEC -Information, Education and Counseling
KDHS -Kenya Demographic and Health Survey
KEPH -Kenya Essential Package of Health
KNBS -Kenya National Bureau of Statistics
KSPA Kenya Service Provision Assessment
MOH -Ministry of Health
NPPSD -National Population Policy for Sustainable Development
STIs -Sexually Transmitted Infections
VCT -Voluntary Counseling &Testing
WHO -World Health Organization
YFRHS -Youth Friendly Reproductive Health Services
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DEFINITION OF TERMS
Utilization –The ability to consume services and incorporates economics, geographic location,
abundance of health services, physical and social resources or usage of the youth friendly
reproductive health services
Determinants of Health -These are a range of personal, social, economic and environmental
factors which determine the health status of individuals or populations
Health System -The health structure or organizations whose primary purpose and activities
is to promotes, restore or maintain health (WHO, 2007) Youth-Persons aged 10-24 years in this
study
Youth Friendly Reproductive Health Service: services that is accessible, acceptable and
appropriate for the youth. They are in the right place at the right price (free where necessary) and
delivered in the right style to be acceptable to young people and are effective, safe and affordable.
They include counseling, family planning, voluntary counseling and testing and treatment of
sexually transmitted infections (WHO,2004)
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ABSTRACT
This study was on determinants of utilization of youth friendly health services (YFRHS) among
school and college youth in Ogembo Sub-county of Kisii County. The reproductive and sexual
health of the youth remains relatively new and sensitive area mainly due to restrictive norms and
policies guiding the services.Sex and sexuality among the young people have remained a sacred
area and few structures were in place to address it.After the International Conference on
population and Development in 1994,countries started implementing adolescent reproductive
health issues. The government of Kenya together with partners in an attempt to address the
reproductive health challenges came up with the Adolescent Reproductive Health and
Development Policy (ARH&D) in 2003 whose guidelines were finalized in July 2005 and released
for use by service providers. Despite these guidelines, the access and utilization of YFRHS among
the school youth are dependent on many factors which include demographic, economic, school,
socio-cultural and health system factors .The study examined how those factors determined or
affected the utilization patterns of YFRHS by the youth. The study further explored ways of
mitigating or addressing the barriers to scale up utilization of those services. The study used both
quantitative and qualitative approaches to collect data. The study utilized survey research adapting
descriptive cross-sectional design and semi-structured questionnaire to interview 390 school and
college youth in Ogembo sub-county. The key informants were mainly nurses who were working
at the reproductive health service delivery area at the time of study and were interviewed using an
interview guide. Quantitative data was analyzed using Statistical Package for Social Sciences
(SPSS) Version 18.0.Descriptive statistics and chi-square tests were performed to determine
significant associations. The study established that sex,age,level of education, type of school and
youth’s awareness about existence of reproductive health facility and services offered were
significantly associated with utilization at while religion and parental employment status had
association only to a few services. Ethnicity had no association to utilization of all YFRHS.Long
queues, unfavorable working hours, mixing out of school youth and the school going youth and
lack of money negatively affected utilization of YFRHS.Parents and teachers involvement in
passing RH (Reproductive Health) information was found to be low as majority of the youth
reported that they got information of these services from friends. The study concluded that the
utilization of reproductive health services among the school and college youth was low largely due
to unfriendliness of the reproductive health facilities to the youth and lack of awareness of RH
services. In view of the findings, this study recommends need for the government through the
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Ministry of Health and partners in health service provision to increase the number of YFRHS and
ensure that the recommendations of Adolescent Health Policy guidelines are implemented fully
with good evaluation strategies in place. Rigorous awareness drives to sensitize the youth about
the available RHS through rigorous health education and increased involvement of both
parents/guardians and teachers to scale up utilization are also recommended.
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CHAPTER ONE
1.0 INTRODUCTION
1.1Background of the study
Globally, there are 1.7 billion people aged 10-24 years, representing one-quarter of the world’s
population, with over 85% living in developing countries(Population Reference Bureau),2006).In
Kenya, statistics from Kenya National Bureau of Statistics (KNBS) census report estimate the
youth to be about 40% of the population and youth aged 10-24 years make up to 36% of the
population (KNBS,2010).International Conference on Population and Development (ICPD) 1994
identified and recommended that,Adolescent,sexual and reproductive health issues are addressed
through the promotion of responsible and healthy reproductive and sexual behavior, including
voluntary abstinence and the provision of appropriate services and counseling specifically suitable
for that age group (WHO,2002a).Countries were encouraged to ensure that programmes and
attitudes of health care providers do not restrict youth access to and utilization of the services and
information they need. These services must safeguard the right of adolescents to privacy,
confidentiality, respect and informed consent, while respecting cultural values and religious
beliefs, as well as the rights, duties and responsibilities of parents (ICPD), 1994).
In pursuit of reproductive health agenda which was deliberated in ICPD,1994,the government

adopted the National Reproductive Health Strategy (NRHS) for Kenya 1997-2010 whose strategy
identified reproductive health priority areas as; family planning and unmet needs; safe motherhood
and child survival initiatives; promotion of adolescent and youth health; gender and reproductive
health issues. Within the context of the strategy, standards for reproductive health service providers
were released in 1997 and implementation plans were developed to guide reproductive health
needs in the country. Ministry of health in Kenya formally approved the country’s first National
Reproductive Health Policy(NRHP) was formally approved by the Kenya’s Ministry of Health to
provide a framework for equitable ,efficient and effective delivery of quality reproductive health
services to the population especially those considered vulnerable such as the youth. The aim of the
policy is to guide planning, standardization, implementation and monitoring and evaluation of
reproductive health care provided by various stakeholders. It focuses on; safe motherhood,
maternal and neonatal health, family planning and adolescent/youth sexual and reproductive health
and gender issues. But despite these initiatives, reproductive health service utilization among the
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youth still faces a lot of challenges related to the sensitive nature of adolescent sex and sexuality
and poor evaluation policy structures hence underutilization. The ministry of Public health and
sanitation (MOPHS) and Ministry of Medical Services (MOMS) started a review to the process
through a study on reproductive health communication (MOPHS &MOMS,2010-2012).
The health care services given to youth in schools mainly focus on services such as school physical
environment and sanitation, nutritional status, immunization and treatment of common childhood
illness. Reproductive health needs get little attention (Kenya National School Health Policy, 2009)
1.2 Problem Statement
As a response to the reproductive health needs of youth, the Ministry of Public Health and
Sanitation initiated integration process of priority concerns into the Kenya Essential Package for
Health (KEPH) programme at especially the community level of health care. The government
further adopted the Adolescent Reproductive health and Development Policy (ARH&D) in 2003
with a commitment to address adolescent reproductive health issues raised by the National
Population Policy for Sustainable Development and the Kenya Health Policy Framework of 1994
(MOH,2005).The policy was meant to address; adolescent sexual health and reproductive rights;
harmful practices, including early marriage, female genital cutting and gender-based violence;
drug and substance abuse; socio-economic factors; and the special need of adolescents and young
people with disabilities. The target of this policy was to increase the proportion of facilities offering
youth-friendly services to 85% ,up from 7% as at that time and reduction of the proportion of
women aged below 20 with a first birth from 45% in 1998 to 22% (NCPD,2010).This was far
below expectation in meeting the reproductive health needs of the 40% youth population of Kenya
(KDHS,2009/10)
The adolescent Reproductive Health and Development Plan of Action 2005-2015 was developed
to guide the implementation of the policy and later a National Guideline for Provision of youth-
friendly services has been developed and funds have been provided all in the effort of meeting the
sexual and reproductive health needs of the youth. Other than the government of Kenya, on-
governmental Organizations (NGOs) have also tried to increase access to reproductive health
services by the youth through various initiatives. For example, Family Health Options of Kenya
(FHOK) has started various YFRHS in different parts of Kenya like
2
Meru,Murang’a,Nairobi,Nakuru,Eldoret,Kisumu and latest in 2013 in Kitale.Pathfinder
International on the other hand came up with University Based Peer Education in 1988 which
aimed at addressing the social, reproductive health and information needs of the youth in Kenyan
Universities namely Jomo Kenyatta University of Science Technology and Kenyatta University
and colleges, Kenya medical training colleges. These effects of all these efforts have not been felt
across the Kenyan learning institutions as is evidenced by persistent reproductive health problems
and challenges of the youth such as unwanted pregnancy and its consequences, Sexually
Transmitted Infections (STIs) and HIV/AIDs (MOH,2003;SChueller et
al,2006;Tilahun,2010).The success and benefits of these initiatives and services cannot be
quantified as they are not well documented (Godia,2010).Ogembo sub-county like other regions
in Kenya has recorded high reproductive health problems mentioned above, girls being mostly
affected as shown by the Kenya Demographic Health Survey (KDHS) of 2009/2010 which
revealed that 26 percent and 8 percent of girls with only primary and secondary school education
were already mothers (KNBS and ICF Macro,2010).The study explore whether the youth are
aware of the availability of youth friendly reproductive health services and whether they are
utilizing them as well as the reasons behind under /non utilization.
1.3 Hypothesis
The persistence of reproductive health challenges among the school and college youth as revealed
from literature therefore prompted this study. Moreover there is scanty information concerning
any study on utilization of reproductive health services done in Ogembo sub-county focusing on
school and college youth despite the fact that the district is well endowed with health facilities
offering clinic- based reproductive health services for adolescents as envisioned in the essential
package. The access to and utilization of YFRHS services is primary concern surrounding the
promotion of sexual and reproductive health and rights. This is attributed to sensitive nature of sex
and sexuality issues among youth which have not been fully addressed and to a large extent the
way the reproductive health services are being offered to them (MOH,2005)
The need to have a healthy youth is of great value to nation`s socioeconomic development because
if they use YFRHS promptly, a lot of health problems will be reduced better performance at school
and better future adults population (MOH, 2005). Studies by family health international (FHI) in
2006 further showed that attracting the youth to the clinic services has remained a challenge and
3
that there is need to create demand and improve health seeking behavior of the youth. It is this
revelation that prompted this study
1.4 Research questions
The study attempted to answer the following research questions:
1. Which demographic, socioeconomic and socio-cultural factors determine school youth

utilization of youth friendly reproductive health services
2. Do knowledge factors influence utilization of youth friendly reproductive health services?
3. What are the system factors that influence the utilization of youth friendly reproductive
health services?
4. What are the strategies that can be put in place to scale up utilization of reproductive health
services?
1.5 STUDY OBJECTIVES
1.5.1 Broad study objectives

The main objective of the study was to explore the determinants of utilization of youth friendly
reproductive health services (YFRHS) among school going youth in Ogembo sub-county.
1.5.2 Specific objectives

 To established demographic, socioeconomic and social-cultural and knowledge factors
influencing utilization of reproductive health services by the school youth.
 To determine health system factors influencing the utilization of reproductive health services
by the school youth.
 To explore strategies that can scale up utilization of reproductive health services by the school
youth in Kenya.
1.6 Justification of the study
The study on utilization of reproductive health services is key to improvement in the quality of life
of the youth. The knowledge acquired from this study will ultimately facilitate the understanding
of pattern of demand and uptake of reproductive health services among the school going youth in
4
Ogembo sub-county. Health care planners may utilize information generated from the study to
improve service delivery to school going youth. The school youth too may benefit from awareness
drive by the health care providers targeting them and this in turn may equip them with adequate
information to help them make informed reproductive health choices. The teachers may also utilize
the information about reproductive health needs of the school and college youth so that they can
support them adequately.
1.7 Limitation of the study
The study focused on the school going youth therefore generalization of the findings for out of the
school youth may not be feasible. The study outcome depended on the truthfulness and openness
of respondents as the information sought was considered personal and sensitive. The economic
aspect could not come out clearly given financial matters are so sensitive and most parents are not
able to share with children salaries. It could have been assessed more effective if the youth were
asked the family income/earning, other possession like owning television, refrigerator, computer,
a car and so on but since most youth may not know the actual income it was assumed that parental
employment status could have shed some light on economic issues of the school.
5
CHAPTER TWO
2.0 LITERATURE REVIEW
2.1 Introduction
Youth friendly reproductive health services (YFRHS) must be accessible, acceptable and
appropriate for the youth people to effective attract them respond comfortably to their needs and
retain them for continued care. The service offered should include family planning (fp), sexual
information, pregnancy testing, treatment of sexual transmitted infection (STI) and counseling
(international Planned Parenthood federation (IPPF), 2007). Literature reviewed utilization of
YFRHS globally, regionally, Kenya and Ogembo sub-county scrutinizing
demographic,economic,social cultural factors of the youth and health system factors that are likely
to influence access and utilization of RHS will be reviewed.
2.2 Reproductive Health Services

2.2.1 Barriers to Utilization of friendly Reproductive Health Services (YFRHS) Globally
Globally, existing barriers to access and utilization include poor access, availability and
acceptability of the services (WHO,2004).Lack of clear directions and services on
offer,crowding,lack of privacy, appointment times that do not accommodate young people’s work
and school schedules, little or no accommodation for walk-in patients and limited services and
contraceptive supplies and options calling for referral are also impediments
(WHO,2004).Senderowitz and others (2003) in a study on rapid assessment of reproductive health
services reported that significant barriers posted by the current state of most RH services are
perceived unwelcoming to the youth. A study in Cambodia showed that the barriers to youth access
to reproductive health services included lack of confidentiality, shyness, and poor relations with
health staff, illiteracy and low prioritization by parents for reproductive health services
(Adra,2007).PATH (2001) in a study to evaluate youth friendly services (YFS) in shanghai found
that although there was good infrastructure,equipment,staff and good environment at the city, sub-
county and school level, few youths used YFS due to insufficient publicity, insufficient full time
and skilled professional health service proviers,poor services and a weak referral system. In the
Russian federation, while the government has identified young people’s reproductive health needs
as a priority, health care and education systems are not yet properly equipped to address the youth’s
6
specific reproductive health systems (WHO,2010).The youth aged 15-18 year olds in Russia are
served by pediatricians but health reports show that thes young people who had a long relationship
with pediatricians are often embarrassed to discuss difficult issues such as contraception or
sexually transmitted infection (STIs) and may slow worry about breaches of confidentiality
(WHO,2010)
2.2.2 Barriers to Utilization of Youth Friendly Reproductive Health Services in Africa
Most African countries as a follow up to ICPD(1994) have put up youth friendly health services
with the combined partnership between the United Nations Population Fund (UNFPA),Pathfinder
International through the African Youth Alliance (AYA) program in Botswana,Uganda,Tanzania
and Ghana (Senderowitz,2003)but despite these efforts, most countries in sub-Saharan Africa
,youth still encounter significant obstacles to receiving sexual and reproductive health services to
obtaining effective, modern contraception and condoms to protect against sexually transmitted
infections (STIs),including HIV.In South African activities geared towards the youth are being
implemented but are still limited (Erlker,2001).A study to evaluate factors that discouraged the
youth from using youth friendly reproductive services in South Africa found that inconvenient
hours or locations, unfriendly staff and lack of privacy were among the reasons adults gave for not
using YFRHS (FHI,200).The country in conjunction with Pathfinder International is working hard
through a project, FOCUS on Youth adults to put processes in place to remove those obstacles
(Pathfinder International,2005).In Nigeria, the realization of the magnitude of reproductive health
problems the youth face prompted the government to make it an issue of national health priority.
Association for Reproduction and Family Health (ARFH) in conjunction with Ford Foundation
Office in Nigerian states is collaborating with NGOs to expand Adolescent Reproductive Health
programs. A study conducted by one World UK to assess facilities providing Youth-Friendly
Services (YFS) found out that gaps existed in provision of YFS and that few facilities qualified to
be called youth friendly as they did not meet universally acceptable standards for youth friendly
services and such were run by Non-governmental (NGOs) Universities and colleges. There was
inadequate staffing, lack of clear policies and guidelines on YFS provision and inadequate
information Education Communication (IEC) materials (Osanyin, 2009).
A study conducted in Zimbabwe on factors affecting Africans on reproductive health found that
12% if the youth did not visit RH because the distance was too great,11% were too busy while
7
11% were shy (Annabel & others,2004).In Zanzibar, the policy on reproductive health does not
allow unmarried youth to get reproductive health services (Pathfinder Internationsl,2005).Another
study in Zambia on vulnerability and sexual reproductive health among Zambian secondary school
students concluded that boys and girls lacked adequate information about human reproduction and
STIs including HIV (Werenius et al,2007).A study done by Motuma (2012) on youth-friendly
services (YFS) utilization and factors in Harar,Ethiopia concluded that most youth had positive
attitude towards YFS but had poor knowledge on the services. The same study also reported that
only one facility provided YFS in Harar thus pointing the limitations in offering YFRHS in that
region.
2.2.3 Reproductive health service provision in Kenya
In Kenya, there are new efforts and reforms in the health sector which are captured in Second
National Health Sector Strategic Plan II(2005-2010), which provide framework for addressing the
reproductive challenges in National Reproductive Health Policy of 2007. The national guideline
for provision of youth friendly service in Kenya document further articulates reproductive health
issues such as providing information and service which are accessible, affordable and acceptable
and made available (MOH, 2005. This service are geared toward meeting unmet reproductive
needs of youth
Other initiative include Adolescent Reproductive Health and Development policy plan of Action
2005-2015 which seeks to spearhead the need to provide and accelerate access and utilization of
youth friendly service by young people (NCAPD/MOH,2005). Godia (2010) conclude that
utilization of youth friendly sexual and reproductive service in Kenya still faces multiple
challenges from youth who have little or lack information on youth friendly reproductive health
service, community negative perception where there is no ownership of the service, limited
management support and poor funding as well as poor staff attitude. Family Health Option Kenya
(FHOK) is an organization partnering with other organization such as IPPF, FHI and DANIDA
among others with a strategic objectives of strengthening the commitment on support for sexual
and reproductive health and rights and needs of adolescent /young people .
To achieve this strategic area, FHOK uses various strategies, provision of youth friendly integrated
service, sexuality education, peer education advocacy and empowerment of young people.
8
Through outreach activities, 477,901adolecences were reached with Adolescents Sexual
Reproductive Health (ASRH) information, 23,536 with clinical service, and 19,483 with VCT
services while 1,574 received counseling service. The Youth centers are located in Nairobi,
Mombasa, Eldoret, Nakuru, Kitale and Kisumu and lately in Bondo.intergrated outreach activities
include VCT/SRH mobile and moonlight provide an avenue for young people to access the service
with reduced barriers (FHOK, 2013).
2.2.4 Reproductive Health Service in Ogembo sub-county
Youth friendly health reproductive service are offered using the integrate model of service delivery
both in public, faith-base and private health facilities within the district (NCAPD2005). Kwanza
is one of the districts in Kenya which has a stand-alone youth friendly facility in Entebes
commissioned in 2008 and offers youth friendly reproductive health service although this service
are available, Ogembo sub-county strategic plan 2005-2010 identified that there was inadequate
access to affordable and quality RH service and low access to Reproductive Health information
and service by the youth and adolescence (NCAPD, 2005).
2.3 Demographic Factors that influence Utilization of YFRHS
2.3.1. Age
Age is demographic factors that affect utilization of health service. Report from KDHS 2008/2009
revealed an increased uptake of family planning service among age 20-24 years as compared to
10-19 years old youth. The youth hardly perceive the seriousness of sickness or health need and
this is the major impediment to the youth in accessing and utilizing health service. A study by
Senderowitz et al (2003) on rapid assessment reproductive health service
concluded that youth are unwilling to seek care due to the national laws and policies restricting
care based on age and or marital status, poor understanding of their changing bodies and
insufficient awareness of risk associated with early sexual debut,STI/HIV and pregnancy.
2.4 Socio-economic and socio-cultural factors that influence utilization of YFRHS
9
The economic costs of health care seeking include not only payment for treatment but also loss of
productive or school time for the pupil/student and the travelling expenses. This means that persons
of low-income economic status can have difficulty in affording the costs associated with
utilization of healthcare making utilization unlikely unless they are provided with subsidized costs
(Taylor,2003).Poverty has led some school youth to engage in pre-marital sex in exchange for gift
or economic support further exposing them to RH risks. User fee charged at the health facilities
may hinder the youth from utilizing youth friendly services (MOH,2005;ncapd ET AL,2005).Lack
of political will has led to a corresponding lack of financial commitment to sexual reproductive
health to both international donors and national governments thus further complicating access for
the youths who may not have funds for the services (Global Fund,PEPFAR and World Banks
MAP).
2.4.1 Education and Awareness of YFRHS
Studies have revealed that the more educated youth are more likely to seek youth friendly health
services as they possess better understanding of their health needs (KDHS,2008/09).A study done
in Burkina Faso,Ghana,Malawi and Uganda in 2004 showed that contraceptive,STI and VCY
services are still under-utilized by the youth due to lack of knowledge about the service.Godia
(2010) also found out that lack of understanding of the importance of sexual health care or
knowledge of where to go for care may discourage young people from using the services and
therefore health education is a major component in passing health information and which in turn
can increase utilization of services.
2.4.2 Religion
Most religious groups have stringent rules and norms that tend to view use of family planning
among unmarried youth as sinful and believe that engaging in pre-marital sex is sin.These religious
norms to some extent have played a role in controlling the youth from involving themselves in
indiscriminate sex in Kenya but these efforts have been eroded by increased urbanization which
has led to most youth living on their own without religious guidance and control
(MOH,2005).Squealer et al (2006) in an assessment of youth reproductive health and HIV/AIDS
progress in Kenya concluded that young people’s health is influenced by parents, religious leaders,
teachers and peers.
10
2.4.3 Traditional Beliefs and Ethnicity
The youth sexuality problems are worsened by lack of adequate information since in the olden
days this was given by grandparents and aunts and this is no longer the case due to increased
Urbanization.(Warenius, 2008).Senderowitz (2003) reported that breakdown in traditional

communication channels through which adults used to pass information and guidance to the young
has broken down due to urbanization thus leaving the youth vulnerable to sexually related
problems, most ethnic moral/traditional codes prohibit premarital sex and pregnancy and any youth
discovered to be using family planning services is reprimanded thus fear is instilled among the
youth especially on family planning use. When there is community involvement whereby
communities are engaged in positive dialogue to promote the value of health services and
encourage parental and wider support for the provision of quality services to the youth, utilization
is likely to increase (WHO, 2010).
2.5 The Health System Factors that Determine Youth Utilization of RHS
2.5.1 The Health Facility Organization
Provision of good quality health services to the youth can be achieved through favorable policy
environment, improved clinical and communication skills of providers and their supportive
attitude (WHO, 2004).The National Guidelines for provision of YFS in Kenya categorizes
qualities of a facility which make it youth friendly and which are likely to increase utilization by
the youth. These includes; the services should be in a place that is easily accessible, have flexible
working hours, offer privacy, offers wide range of services at affordable cost or free and friendly
health service providers (MOH,2005),
2.5.2 Health Worker’s Attitude
Negative provider’s attitude have been identified as a major barrier as it discourages young people
from seeking or returning for care (MOH, 2005; Warenius et al, 2005; Godia, 2010).A study by
Warenius et al (2006) among Kenyan and Zambian midwives revealed that reproductive health
services are underutilized due to judgmental attitude of health providers and lack of competence
coupled with lack of knowledge in youth friendly service provision irrespective of training. A
study in Ethiopia on health workers attitude towards sexual and reproductive health services for
11
unmarried youth concluded that some health workers were setting up penal rules and regulations
against premarital sex (Tilahun et al, 2010).
2.6 Summary of Literature review
Literature revealed that despite the initiatives put in place towards improving YFRHS of the youth,
barriers still exist which affect the utilization of services by the youth. Studies across the globe
point to the ways the services are given and the youth unfriendliness of the facilities. This is
evidenced in factors such as services delivery hours, cost of services and lack of confidentiality
and facility organization. Others are individual factors such as lack of knowledge and attitude
Literature also revealed that there is concerted effort by many countries to reach the youth with
reproductive health services and though little has been achieved. A lot more need to be done to
reach a good threshold to rid the youth from reproductive health problems. Kenya is among the
countries a lot of effort is going on in the area of reproductive health service delivery but little
evidence is shown for the school youth.
12
CHAPTER THREE
3.0 RESEARCH METHODOLOGY
3.1 Introduction
This chapter includes study design, variables, area, sampling criteria and study instruments used
in the study, data collection, data analysis and interpretation and lastly ethical considerations for
the study.
3.2 Study design
This study adopted a descriptive cross-sectional design that aimed at describing the demographic,
socio-economic, school and socio-cultural factors that influenced utilization of youth friendly
reproductive health service (YFRHS) among the youth friendly reproductive health services
(YFRHS) among the youth.
3.3 Variables
3.3.1 Independent variables
These were factors which literature review revealed that had significant on the utilization of
YFRHS by the youth. These were; demographic factors such as age and sex, socio economy and
school factors such as, level of education and awareness about existence of youth friendly
reproductive health facilities and services, employment status of the parents and type of school.
Socio- cultural factors studied included religion and ethnicity. Health system factors included
health facility organization and service delivery, health provider attitude and availability of youth
friendly health services within the school and the district.
3.3.2 Dependent variables
The dependent variable in this study was utilization of youth-friendly reproductive health services
measured through the dichotomous response of yes or no. The utilization of youth friendly
reproductive health services availed in the reproductive health center such as family planning,
counseling services, VCT and treatment of STIs were considered.
13
3.4 Study area
Ogembo sub-county formerly Ogembo district is one of six sub-counties in kisii county.
3.5 Target Population
The study focused on school youth aged 10-24 years in sampled primary, secondary schools and
tertiary/colleges whose population was 1984
3.6 Sampling Criteria
3.6.1 Inclusion Criteria
This comprised the youth in school, key informants being health service providers who were
working at reproductive health facilities at the time of study
3.6.2 Exclusion Criteria
The youth who declined to give informed consent and those below 10 years or above 24 years
were excluded. The youth in lower primary school also excluded.
3.7 Sampling
3.7.1 Sample Size determination
Formula for sample size determination. (Mugenda and Mugenda formula)
Where n = Z2pq
d2
n =desired sample size (N=10,000)
z = is the standard normal deviate of required confidence interval, set at 1.96 which
Corresponds to 95% confidence interval
P =Proportion in the targeted population estimate to have characteristics being measured
q =1-p
14
d =level of statistical significance set degree of accuracy set as at 0.005
Therefore;
N=1.96*1.96*0.5*0.5
0.052
N=384
Target population
Nf=n/1 + (n/N)
N=300
N=384
1+ (384/300)
Nf=384/1+1.28
Nf=384/2.28
=168
But the researcher considered 80 respondents due to time and precise including resources.
3.7.2 Sampling Technique
Cluster sampling was used to select primary, secondary schools and tertiary learning
institutions/colleges using a list of school in the district provided by the District Education Officer
as a sampling frame. The youth in the sampled schools were further listed according to age group
to enable variability and equal inclusion. Systematic random sampling technique using random
numbers was used to pick the first respondent in each cluster, followed by every 5th person from
the group to ensure randomness until 80 respondents were picked. Each school received 65
questionnaires.
15
3.8 DATA
3.8.1 Primary Data
The study employed the following instruments which were carefully designed, pretested and
revised before final data collection.
1. Self-administered structured questionnaires to collect data from the school youth in

secondary and tertiary learning institutions
2. Self-administered questionnaire with partial assistance from research assistants for primary
school youth who needed clarification
3. Two self-administered questionnaires for key informants from health facilities and parents
4. An interview guide for key informants
3.8.2 Secondary data
Those were collected from government documents including KDHS 2008/9 report, the Adolescent
Reproductive Health Policy of 2007,census report of 2009,Ogembo sub-county health
records,subcounty education records, journals and books.Informaion from these sources was used
during literature review and for discussion.
3.9 Data collection procedures
Structured questionnaire was given to the respondents and respondents answered the questions as
asked in the questionnaire. Privacy and confidentiality was highly maintained.
3.10 Data Analysis and presentation
Data collected was analyzed using descriptive statistics and percentages calculated by scientific
calculator. Results were presented by use of frequency tables, bar graphs and pie charts
3.11 Ethical considerations
Permission to conduct the study was sought from Kenya medical Training College, Ogembo sub-
County education office and school principals, medical officer of health/medical superintendent
of Kapkatet sub-county hospital. Informed consent was sought from the study participants above
18 years. The youth who were under 18 years old were asked for their assent to be involved in the
study. Confidentiality was maintained throughout the study by use of code numbers rather than
16
names. Respondents did not receive any incentives to participate in this study and no participant
was forced to answer questions they did not wish to answer.
17
CHAPTER FOUR
STUDY FINDINGS AND INTERPRETATIONS
4.1 Introduction
This chapter displays results and analysis of the study findings. It is organized as follows,
descriptive information of the variables, factors significantly associated to utilization of YFRHS,
perceptions of YFRHS providers and discussion of findings.
Descriptive Information of study variables
The study involved participants aged between 10-24 years and 10 key informants who were health
care providers working at a youth friendly reproductive health service area at the time of study.
Figure 4.1 summarizes the descriptive information of the study participants.
Figure 4.1: Background characteristics
Figure 4.1 shows that there were (43.3%) 10-14 years,the youth aged 15-19 years were (32.8%)
and 20-24 years were (23.9%).
50.00%
45.00%
40.00%
35.00%
30.00%
25.00%
Age
20.00%
15.00%
10.00%
5.00%
0.00%
10-14 years 15-19 years 20-24 years
Descriptive information of participants .10-14 years was 43.3%,15-19 years were 32.8% and 20-
24 years were 23.9%
18
Figure 4.2: Gender
Gender
45% Female
55% Male
The pie chart findings showed that females and males who participated in the interview were
54.9% and 45.1% respectively.
Figure 4.3: Level of education
Level of education
60.00%
40.00%
20.00%
0.00%
Boarding Day
Boarding Day
The study covered youth in primary, secondary and tertiary levels of education and each level was
covered equally. Of the youth studied, 57.2% were in boarding schools while 42.8% were in day
schools.
19
Figure 4.4: Religion utilization of YFRHS
Religion utilization of YFRHS
70.00%
60.00%
50.00% Religion restrict
40.00%
Not restricted
30.00%
20.00%
10.00%
0.00%
Religion restrict Not restricted
When asked whether their religion restricted utilization of the YFRHS, 62.1% said that their
religion restricted use of some of the reproductive health services by the youth while 37.9% said
there was no restriction.
Figure 4.5 Religious affiliation
On religious affiliation 87.7% of those interviewed were Christians 5.6% were Muslims and 6.7%
belonged to various religions which were not falling under either Christianity or Muslims
Religious affiliations
100.00%
80.00%
60.00% Christians
40.00% Muslims
20.00% Others
0.00%
Religious affiliations
Christians
Muslims
Others
20
Figure 4.6: Ethnicity
Majority of the youth interviewed were from Kisii community forming 50% followed by Luhya
who were 10%, Luo 9.7% and Kamba 7.0% while other ethnic groups were 23.3%
Ethnicity
50%
0%
Kalenjin Luhya
Luo
Kamba
Others
Kalenjin Luhya Luo Kamba Others
Figure 4.7: Parental employment status
On parental employment 76.2% said their parents were employed while the rest 23.8% were not.
Of those employed, were in formal employment like civil service, teaching,NGO among others.
Some parents were self-employed and farming.
Parental employment
Not employed
24%
Employed
76%
Demographic, Socio-economic, school and socio-cultural factors and YFRH
The main youth-friendly reproductive health services utilized by the youth were family planning,
counseling services, CT and STI treatment.
21
Figure 4.8:Reproductive health service utilized by youth
Reproductive health service utilized by

youth
Family planning Counselling services VCT
47.90% 38.70%
29.50%
Family planning Counselling VCT

services
The results indicate that 47.9% of youth utilized counseling services, 38.7% utilized VCT, 29.5%
utilized family planning and no student reported having used antenatal or pregnancy services. Age
was also associated with utilization of counseling services, younger age group 10-14 years utilized
them more than the older ones. Age was significantly associated with knowledge of YFRHS and
their utilization. Youth aged 20-24 years had higher knowledge of YFRHS and utilization of
YFRHS than those aged 15-19 years and 10-14 years respectively
22
Age and sex that utilized family planning services % utilized
Age in years 10-14 8.7
15-19 30.4
20-24 60.9
Sex Male 56.5

Female 43.5
VCT Services
Age 10-14 years 21.9
15-19 years 27.1
20-24 years 51.0
Sex Male 51.0

Female 49.0
Knowledge on YFRHS
Age 10-14 years 17.9
15-19 years 32.1
20-24 years 50.0
Sex Male 53.7
Female 46.3
Table 4.0 Demographic factors and utilization of YRHS
On sex and utilization, significance was noted in sex and utilization of family planning, more
females than males utilized this service.Sex of the individual had significant relationship to
treatment of STIs.Male have been treated more than females.However,there was no significant
relationship between sex of an individual and utilization of VCT services. Type of school on the
other hand had significant association to family planning utilization. Youth in boarding schools
indicated higher utilization of family planning (75%) while those in day school were (25%)
23
Table 4.1: Socioeconomic and school factors and utilization of counseling services
Utilization of counseling services % utilization % not utilized Total

Education level Primary 6.4 27 33.4
Secondary 10.8 22.6 33.4
Tertiary 21.5 11.7 33.2
Type of school Boarding 24.9 32.3 57.2

Day 13.8 29.0 42.8
Parents status
Employed 29.2 47.0 76.2
Not employed 9.5 14.3 23.8
Table 4.1 shows that there was significant association between level of education and type of
school to utilization of counseling services. More youth in tertiary learning institutions utilized the
services as compared to those in secondary and primary school respectively. On the other hand
youth in boarding schools had higher utilization compared to those in day schools. Parent’s
employment status showed no significance to counseling.
24
Table 4.2; Socio-economic and school factors and utilization of VCT services
% utilized % not utilized Total

Education level Primary 6.4 27 33.4
Secondary 10.8 22.6 33.4
Tertiary 21.5 11.7 33.2
Day 13.8 13.8 42.8
Status Employed 29.2 47.0 76.2
Table 4.2 shows that there was significant relationship between level of education and utilization
of VCT services. The youth in tertiary level of education utilized VCT more than those in lower
levels of education. Similarly type of school had significant relationship to VCT utilization. But
parent’s employment status had no significance to VCT utilization
Table 4.3: socio-economic and school factors and utilization of STI treatment services
STI treatment % utilized % not utilized Total

Education level Primary 2.6 64.1 667
Secondary 6.4 26.9 33.3
Tertiary 6.4 26.9 33.3
Day 4.9 38.0 42.9
Parents employment Employed 5.4 70.7 76.1
status
Table 4.3 displays how treatment for STIs in relationship to education level, type of school and
parent’s employment status. Education level and parent’s employment status were significant
25
respectively. More youth in tertiary learning level were found to have been treated for STIs than
those in primary and secondary schools.
Table 4.4: Socio-cultural factors and utilization of family planning services
Family planning services % utilized % not utilized Total

Religion Christian 26.5 61.3 87.8
Muslims 1.5 4.1 5.6
Others 1.5 5.1 6.6
Ethnicity Kisii 13.6 36.7 50.3
Luo,Kamba &Luhya 3.6 6.1 9.7
Other ethnic group 2.8 5.1 9.7
9.0 13.3 22.3
The table 4.4 above shows that religion was significantly associated to utilization of family
planning services with Christian youth utilizing more than Muslims and other religious groups. On
whether religion restricted utilization, significance was found. The youth were asked whether their
religion prohibited utilization of YFRHS.Analysis showed that the odds whose religion did not
prohibit utilization of YFRHS were most likely to have used a family planning service than those
whose religion prohibited.
Table 4.5: socio-cultural factors and utilization of counseling services
Family planning services % utilized % not utilized Total

Muslims 1.5 4.0 5.5
Others 2.4 4.4 6.8
Ethnicity
Kisii 13.6 36.7 50.3
Luo,Kamba,Luhya 3.6 6.1 9.7
Others 9.0 13.3 22.3
26
2.8 5.1 9.7
Table 4.5 indicates significant association between religion of the youth and utilization of
counseling services. Youth of Christian faith utilized counseling services more than those of other
religions. There was no association between ethnicity and utilization of counseling services.
Table 4.6: Socio-cultural factors and utilization of VCT services
VCT services % utilized % not utilized Total

Muslims 2.8 9.5 12.3
Ethnicity
Kisii 18.5 31.5 50
Luo,Kamba,Luhya 4.9 4.9 9.8
Kamba 2.5 5.4 7.9
Luhya 5.1 4.9 10.0
Others 7.7 14.6 22.3
There was no association between religion and ethnicity to utilization of VCT services.
Table 4.7: Socio-cultural factors and utilization of STI treatment services
STI treatment % utilized % not utilized Total

Muslims & others 1.6 10.7 12.3
Ethnicity
Kisii 5.1 44.9 50
Luo,Kamba,Luhya 3.9 46.1 50
There was no association between religion and ethnicity to utilization of STI treatment
Health knowledge and awareness of YFRHS
27
The school and college youth knowledge on YFRHS was assessed by asking them whether they
knew about any facility offering reproductive health services and the services being offered as
reproductive health services.
Those who knew about the YFRHS services were further asked to state their source of information
and the responses are reflected in figure 4.9
Figure 4.9 Source of information on RHS
Information on youth friendly services
From
friends
23% Teachers
Other 9%
19% Parents
10%
Not yet received
any information on
YFRHS
58%
Figure 4.9 shows that majority of the school and college youth (74%) had not received any
information of YFRHS.However, among those who knew about YFRHS,14.4% and got the
information from their friend, while 5.1% and 4.1% asked their parent and teacher respectively.
In investigating whether the youth got support when they needed any YFRHS, they were asked to
state whom they consulted before going for the services and the results are shown below.
28
Column1
Parent Siblings Friends Teacher Self decision
29%
46%
3%
20%
2%
Figure 4.10: Persons consulted about reproductive health services
Siblings
2%Teachers Persons consulted
3%
Friends
20%
Parents
46%
Made their own

decisions
29%
Majority 46% of the youth consulted their parents while 29% decided on their own and 20%
consulted their friends. A few youth, that is 3% and 2% consulted their teacher and sibling
respectively.
Health system factors and utilization of YFRHS
29
Health facility factors that encouraged or discourage the school going youth from utilizing YFRHS
were investigated. Factors such as availability of reproductive health services within the school,
distance to reproductive health service, health facility organization and staff treatment/handling of
the youth and cost of the services were assessed. The youth were asked whether there was a
reproductive health facility within the school and the distance to a nearest facility in case there as
none at school.
Fig 4.11 Availability of reproductive health facility
Availability of reproductive health facility

100.00%
80.00%
60.00% Reproductive health facility
within the school
40.00%
No RHF within the school
20.00%
0.00%
Reproductive health facility No RHF within the school
within the school
The youth were asked whether they had a reproductive health facility within the school and 82.3%
said they had no YFRH facility while 17.7% said they had the facilities.
Fig 4.12: Distance of YRHS and Utilization of YFRHS
Distance of YRHS facility and utilization of

YFRHS
Walking distance YFRHF within school Nearest facility req 20/= Far from HF
14%
39%
18%
29%
30
The respondents were further asked to estimate the distance from the nearest facility using
transport fare as an estimate. The above table shows that most youth resided far from a health
facility as suggested by 39.5% of the youth who said that it required them transport fare of 20
Kenya shillings.Others,that is 17.6% said that there was YFRHS facility within their school while
14.4% said it was a walking distance. Fare/money was used as an estimate for distance because it
was difficult to do the estimate of distances in terms of kilometers as the roads within the district
are not all marked showing distances.
Table 4.8: Distance of YFRH facility
Category Frequency(n) Percentage (%)

Walking distance 15 18.75%
Near, require 20/=fare 26 32.5%
Far, requires 50/=fare 24 30%
Available 15 18.75%
Health facility organization and staff handling of youth and cost of services assessed
The youth were asked if they had ever south for YFRHS but did not get them and 52.1% of the
youth indicated that they actually did not get the services. Those who sought but did not get the
services were asked to state the reasons that made them miss the services.
Figure 4.13: Displays the reasons for missing the services as stated by the youth
reasons for missing the services

I had no money
Found neighbours and felt ashamed
The service provider refused to offer services 4%
the clinic was closed 27%
39% 24%
0% 9%
28%
Figure 4.13: Reasons for missing YFRHS
31
23% of the youths said had no money,9% got or met their relatives and neighbors at the health
facility,4% when they reached at the facility the service providers refused to offer services,27%
got the clinic closed where as 37% complained of long queue.
Figure 4.14: Reasons for not receiving the services required
Resons for not receiving services

40%
30% Long queues
20% Facility
Lack of money
10%
Meet
0% Turned back
Long queues Facility Lack of Meet Turned back
money
Long queues at the facility37% ,facility closure at the time of arrival at the facility 27%,lack of
money to pay for services 23% while 9% said they met neighbors/relatives at the facility and felt
embarrassed. Some 4% of the youth
Fig 4.15: Health service provider attitude
Health service provider attitude
50.00%
Pleasant
Fair
0.00%
Health service provider attitude Harsh
Pleasant Fair
Harsh No coment
No
coment
The attitude of health service providers was captured by asking the school youth who had utilized
reproductive health services how they were handled by the staff when they sought reproductive
health services. Majority 29.7% who had utilized the services said the providers were
32
pleasant,23.8% felt they were fairly pleasant but asked too many questions.However,5.9% felt that
the service providers were bad and harsh to them while 40.5% had no comment on this.
Perception of healthcare providers regarding utilization of YFRHS
The healthcare service providers were involved in the study to find out their views about
reproductive health service delivery to the youth. The themes that were discussed were perceptions
of the service providers on youth and utilization of health system factors that determined the youths
utilization of YFRHS.The youth factors included their age,sex and type of services most preferred
by the youth. On the health system factors were the knowledge of health service providers on
YFRHS and their perception on provision of the same to the youth. The health service providers
were also asked to give their suggestions on how YFRHS delivery to the youth can be scaled up.
Most health service providers alluded to the fact that most youth who visited the facilities were
aged 18 years and above. When asked what their view about offering services such as family
planning to school youth,70% of the service providers felt uncomfortable to give the services to
the youth below 18 years.30% however said that they had no problem with giving the youth the
services as it was the right of everyone to get the services so long as there was no contradiction
and proper information offered to them. When asked which gender of the school youth accesses
their services, 60% said the females visited more than males. Majority of the service providers said
that the females tend to come for contraceptive pills but usually it is hard to identify them as school
going youth do not wear school uniform neither do they have any school identification when they
visit the facility This was further confirmed by clinic register which had no data on whether the
clients were students or not. On operation time and the hours, all the health providers said that
YFRHS services operate from 8:00 am to 4:00 pm daily Monday to Friday. They also said that all
services were integrated within the same area and no separate area isolated for the school youth.
On challenges facing the service providers, majority said that the youth hardly identified
themselves and were many times not open to say what exactly they wanted. Some cheated about
their age and said they were married and men and women. Other than personal problems the
service providers cited too much workload which makes them not have quality time with the youth
to enable them counsels them adequately.
33
The service providers suggested that to mitigate on the barriers, the government and employees
need to add staff, train them on how to handle the youth and separate an area specifically for the
school youth to enable them be handled without feeling ashamed or intimidated. They suggested
that reproductive health should be taught actively in the primary school and secondary school
curriculums and that reproductive health specialists or lecturers be engaged in teaching the youth
instead of the regular school teachers who may not be well versed with the area of reproductive
health. They also said that the reproductive health component be strengthened in school health
curriculum.Generally,the interviews pointed to the services provided to the school and college
youth not to be completely youth friendly and this is the most possible reason for low uptake of
reproductive services
34
CHAPTER FIVE
5.0 DISCUSSION
5.1 Demographic factors and utilization of YFRHS
Both descriptive and statistical test showed that age and sex of an individual were greatly
associated with utilization of almost all reproductive health services by the youth. Except for
counseling services, utilization for all the reproductive health services increased with age. The
older youth in age group of 20-24 years utilized all the YFRHS more than those who were younger.
This finding is normal and expected because younger youth have lower knowledge of reproductive
health issues and this is in agreement with a study by Sendowitz (2003) which reported low
utilization of RHS among young people due to poor understanding of their changing bodies and
insufficient awareness of risks associated with early sexual debut, STI/HIV and pregnancy and
shyness. The findings also agree with KDHS 2010/12 which revealed an increased uptake of
family planning services among older youth, 20-24 years compared to 10-19 year olds.
This is further supported by key informants who when asked the common age group, they tended
to serve most, majority of health service providers answered that, majority of the youth who sought
services were above 18 years as suggested by 80% of the respondents. This therefore means that
the younger youth in the age below 18 years rarely utilize reproductive health services. This finding
therefore reveal a need to reach the younger youth with age appropriate YFRHS message to
enlighten and help them make right decisions as some are already sexually active as reported that
the adolescent get into sexual debut early and that many have sex by age 15 years (KDHS
2010/12).The older youth are sexually active and have freedom to make their choices as was found
out by this study that majority of youth aged 20-24 made self-decisions when they needed the
services. The study also found out that the youth aged 20-24 years had a tendency to trust and
consult their peers more than parents as compared to the younger ones. The older youths are in
colleges and therefore are free from parent’s control and are more sexually active therefore the
reason for higher likelihood to have utilized YFRHS especially FP,VCT and treatment for STIs as
per this study findings. This is in agreement with KDHS, 2010/12 which pointed out that youth
aged 20-24 years had higher utilization of contraceptives as compared with those younger ones.
5.2 Socioeconomic and school factors and utilization of YFRHS
35
The employment/occupation of the youth’s parents showed no significant association to utilization
of YFRHS.The employment status only showed significant association to treatment of sexually
transmitted infection. This confirms the finding that there is a cost attached to treatment as was
mentioned by some youth.STI management a lot of time involves laboratory investigations that
are charged for irrespective of whether the individual is a school youth or not, thus explaining the
connection between employment status and this utilization. This means that without money, the
youth might not access and utilize the service.
This finding is in agreement with a study that was done by NCAPD (2005) which showed that
generally health service utilization including RHS was tied to economic aspects of an individual.
This finding was also brought out when a big percentage of the youth said that they missed the
services due to cost/fee charged on some services. The implication of this finding is that majority
of the youth are likely not to seek medical care and treatment for these infections in time and this
can lead to serious reproductive health complications such as infertility in future. The
implementation of YFRHS should be done in totality such that no fee charged at all for all services
offered at YFRH facility.
5.3 Socio-cultural factors and utilization of YFRHS
Religion had association to some services mainly family planning, CT and counseling services. It
was established that some religions prohibited the youth from utilizing YFRHS.This was evidently
brought out when descriptive, chi-square and odd statistics all showed significant relationships.
The finding creates a need for religious forums to be used to pass YFRHS messages to the youth
and to teach them to be responsible over sexual issues and to make informed and safe choices.
Ethnic group had no significant association to utilization of all services thus disagreeing with a
study report in Youth and Health World Youth Report 2003 which stated most ethnic groups
prohibit premarital sex and pregnancy and youth were reprimanded for using family planning.
5.4 Health Knowledge and Awareness factors and utilization of YFRHS
36
School youth at all levels had generally low knowledge on YRFHS services a fact that led to low
utilization of these services. The ones who reported knowing of the specific services given and
the YFRHS facility registered increased utilization than those who did not know as was also
confirmed by the chi square and odds analysi.These findings agree with studies by Biddlecom,et
al.(2007) and Godia (2010) which reported that lack of knowledge by the youth was a major factor
that caused underutilization of youth friendly reproductive/sexual services.Godia(2010) and
Transgrud (2001) further stated that lack of understanding of the importance of sexual health care
or knowledge of where to go for care may discourage the youth from using YFRHS.This is
contrary to one of the goals set out in Adolescent Reproductive policy 2007 which intended that
reproductive information should be made available to the youth. This shows massive ignorance
among the school going youth about YFRHS despite these services being in place in almost all
health facilities through comprehensive/combined mode. Chi square analysis showed significant
association between awareness and knowledge of RHS and services to utilization and his therefore
mean that increasing the knowledge base of the youth by creating awareness concerning the
services can greatly improve or scale up utilization. On sources of RH information, majority 14.1%
of the school going youth sought information from their friend with very few 5.4% and 4.1%
asking parent or teacher respectively. This implies and confirms the literature that the youth due
to the sensitive nature of reproductive health issues trust their peers more than the adult population
whom they fear might raise judgment of early sexual debut. This finding is in agreement with a
study done by Senderowitz (2003) and Tilahun et al (2010).
5.5 Health System factors and Utilization of YFRHS
On health system factors, the study established that utilization of YFRHS were affected by health
facility organization, key among them were; long queues, facility closure at the time of arrival at
the facility. Others were that the youth met neighbors/relatives at the facility and felt ashamed and
being turned back by service provider respectively. Lack of money to pay for the services also
featured. The findings point to the fact that the reproductive health services were not youth friendly
because the long queues resulting from serving out of school and school youth at the same point,
early facility closure and charging a fee for the services is against the recommendations contained
in Adolescent Health and Development policy which requires all the aspects of reproductive
services to be free for the youth (MOH,2005).The findings are also in agreement with other studies
37
which pointed out similar reasons such as unfavorable operation hours which do not accommodate
the youth’s school schedules, lack of clear directions and services on overcrowding, lack of privacy
as the main impediments to utilization of reproductive health services by the youth
(IPPF,2008;FHI,2006;WHO,2004).This finding reveals persistence of prohibitive issues to
utilization of YFRHS which have been extensively studied but strategies to solve them by the
concerned persons seem not to be quickly forthcoming.
5.6 Implications of the findings
The study findings show that utilization of YFRHS by youth is still very low and this has serious
implications on the youth sexuality and growth. It further signifies the failure of adolescent health
policy from meeting its objectives. The school youth in particular are at a great risks of suffering
the consequence of poor reproductive health such as sexually transmitted infections,HIV and ADS,
unwanted pregnancy and abortions and high levels of school dropout rate especially among
females, the very problems which the Adolescent Health policy sought to reverse
(GOK,2005;GOK,2007).The suggestions brought forth by health service providers that the
services need to be made accessible to the school youth through adjustment of operation hours are
valid if success in having the school youth fully utilize the YFRHS is to be achieved. The low level
of awareness of YFRHS among the school youth means that there is a big gap between policy
makers and the community which needs to be bridged by improving on the structures of YFRHS
information dissemination to the youth and indeed to the whole nation
5.7 Suggestions to overcome barriers to utilization of YFRHS
The health service providers were asked what they thought could be done to enable school going
youth and college youth to increase access and utilization of reproductive health services.
1. They unanimously agreed that reproductive service delivery for the youth needs to be given
in a separate area of the facility as most of them are shy and may not be willing to be served
together with adults.
2. Training of the service workers on how to handle the school youth
3. The government to improve on staffing so that reproductive health service delivery is
delivered effectively and efficiently to avoid unnecessary delays leading to crowding and
long waiting time.
38
4. School health services to include reproductive health sessions.
CHAPTER SIX
6.0 CONCLUSION AND RECOMMENDATION
39
6.1 CONCLUSION
Age, sex, level of education, knowledge of YFRHS had significant influence on utilization of
almost all YFRHS such as family planning, counseling, voluntary counseling and testing for HIV
and treatment of sexually transmitted infections while religious affiliation showed significant
relationship to utilization of family planning, ethnicity did not have any influence on utilization of
all the above services.
Parents and teachers had minimal participation in educating the youth about youth friendly
reproductive health services.
The facility factors found significant was mainly organization whereby both the school youth and
the adults were being given service in the same area thereby causing long queues and also
unfavorable operation hours which led to the youth missing services due to closure of the facility.
6.2 RECOMMENDATION
The recommendations arising from this study are; The study has revealed lack of knowledge, this
study recommends active sensitization of the youth in schools through youth forums such as
seminars, rallies, chief’s barazas and any other gathering that creates an opportunity where such
information can be shared to scale up their knowledge on the YFRHS and the facilities that are
available, this will in turn increase utilization of the services. There is need to train more school
and college peer educators to complement the health service providers in passing the youth friendly
reproductive health information to their peers.
The integrated model adopted by most government facilities have not favored the youth therefore
efforts by the government and partners should be geared towards increasing the number of
facilities offering exclusive youth friendly services. This will increase the confidence of the youth
and at the same time bridge the distances and bring these services nearer to the school youth for
easier accessibility and in turn enhance utilization by the school and college youth. The
government and partners should try mobile clinic approach and in cooperating them in school
health services so that these services are taken to the schools on specific days as a temporary
measure as they look for modalities of increasing the number of YFRHS facilities .The government
and partners should increase funding towards YFRHS to enable service providers to offer these
services completely free of charge to enable the school and college youth access them without any
40
constraints. The health care service providers should be mandated to adjust the working days and
hours, that is the facilities should remain open for longer hours up to 6:30 pm and be operated on
weekends too to accommodate the school youth schedules.
41
REFERENCES
42
APPENDICES
APPENDIX I: QUESTIONNAIRE
DETERMINANTS OF UTILIZATION OF YOUTH FRIENDLY REPRODUCTIVE

HEALTH SERVICES AMONG SCHOOL AND COLLEGE YOUTH (10-24 YEARS) IN
OGEMBO SUB-COUNTY, KISII COUNTY
PARTICIPANTS’ INSTRUCTIONS
Do not write your name; tick only one correct response and multiple responses where applicable.
Only youth aged 10-24 years are eligible for this study. The acronym YFRHS stands for youth-
friendly reproductive health services, Part one-demographic, economic, and school and socio –
cultural information
PART A: SOCIO-DEMOGRAPHIV INFORMATION
1. What is your Sex/Gender?

a) Male
b) Female
2. What is your age in years?
a) 10-24 years
b) 15-19 years
c) 20-24 years
3. What is your current level of education?
a) Primary school
b) Secondary school
c) College/Tertiary institution
4. What is the type of school you attend?
Boarding school
Day school
5. What is your religious status?
Christian (catholic/protestant)
Muslim
43
6. Does your religion restrict utilization of YFRHS?
a) Yes
b) No
7. What is your ethnicity?
a) Kisii
b) Luo
c) Kamba
d) Luhya
8. Is there any part of your culture that prohibits utilization of YFRHS?
a) Yes
b) No
9. Is your parent(s) employed?
a) Yes
b) No
If employed, what is his/her occupation?
a) Formal employment(teacher, civil servant,NGO worker etc)

b) Casual laborer
c) Self-employment/business
d) Farmer
PART 2: KNOWLEDGE AND UTILIZATION OF YOUTH-FRIENDLY

REPRODUCTIVE SERVICES (YFRHS)
10. Do you know of any reproductive health facility?

a) Yes
b) No
If yes, who told you about it?
a) Parent/Guardian
b) Friend/Peer
44
c) Teacher
d) I read on notice board
e) I do not know of any
11. Which services are being offered in reproductive health facility? Tick all correct
answers
i. Family planning services(contraceptive, condoms)
ii. Voluntary counseling and testing (VCT)
iii. Treatment of all the disease
iv. Treatment of sexually transmitted infections/diseases
v. Care of pregnant young persons
vi. General health information/counseling
vii. Sports and recreational activities
PART B: UTILIZATION OF YFRHS, HAVE YOU EVER USED ANY OF THIS

SERVICES
12. Counseling services

a) Yes
b) No
13. Family planning
a) Yes
b) No
14. VCT services
a) Yes
b) No
15. Treatment of STI
a) Yes
b) No
16. Antenatal services
a) Yes
b) No
45
PART C: HEALTH SYSTEM FACTORS
17. I s there youth-friendly reproductive health (YFRHS) facility in your school?

a) Yes
b) No
18. How far is YFRH facility from your school?
a) Near, short walking distance
b) Near but requires about ksh.20 transport
c) Far, requires ksh.50 and above for transport
19. If you have ever used a reproductive health service facility, how would you describe
how you were handled by service provider?
a) Good-friendly,welcoming,handled me well and gave me the service I required
b) Moderate-welcomed me but asked too many unnecessary questions before giving
me services
c) Bad, he/she was harsh rude and denied me service
20. Have you ever visited YFRHS but missed the service you required?
a) Yes
b) No
46
APPENDIX II: BUDGET
STATIONERY/ QUANTITY COST(KSH.) AMOUNT(KSH.)

ACTIVITY
foolscaps 1 ream 400 400
Pens 4 20 80
File 1 50 50
Flash disc 1 800 800
Typing and printing 3500
binding 300
internet 1000
travelling 1000
pencils 1 30 30
rubber 1 10 10
miscellaneous 500
TOTAL 7670
47
APPENDIX III: WORK PLAN
ACTIVITY MONTH
Survey activities Jan
Research topic Feb-May
Literature review May-June
Proposal writing June-July
Identifying research tools August
Budget September
Data collection October
Data analysis November
Report writing and presentation December
48
APPENDIX IV: LETTER OF AUTHORIZATION
KENYA MEDICAL TRAINING COLLEGE,

KAPKATET CAMPUS,
P.O BOX 35,
KAPKATET
Date: 12th JAN 2018
TO WHOM IT MAY CONCERN
REF: RESEARCH AUTHORISATION LETTER
The following student Adijah Moraa Oganda is a third year nursing student, KMTC Kapkatet
campus.She seeks to collect data from your Location for study purposes
Please accord her any assistance required .
Assistance accorded is highly appreciated.
Thank you,
Yours faithfuly,
Mr.Grossvenor Ngeno,
H.O.D Nursing Department
49

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DETERMINANTS OF UTILIZATION OF YOUTH FRIENDLY

REPRODUCTIVE HEALTH SERVICES AMONG SCHOOL AND

BY ADIJAH MORAA OGANDA

RESEARCH SUBMITTED TO THE DEPARTMENT OF

KENYA MEDICAL TRAINING COLLEGE,

NAME; ADIJAH MORAA OGANDA

My gratitude also goes to the head of nursing department Mr. Ngeno

Figure 4.1: Background characteristics……………………………….………….………….18

AIDS -Acquired Immune Deficiency Syndrome

ARH&D -Adolescent Reproductive Health and Development

GOK -Government of Kenya

HIV -Human Immunodeficiency Virus

ICPD -International Conference on Population and Development

IEC -Information, Education and Counseling

KDHS -Kenya Demographic and Health Survey

KEPH -Kenya Essential Package of Health

KNBS -Kenya National Bureau of Statistics

KSPA Kenya Service Provision Assessment

MOH -Ministry of Health

NPPSD -National Population Policy for Sustainable Development

STIs -Sexually Transmitted Infections

VCT -Voluntary Counseling &Testing

WHO -World Health Organization

YFRHS -Youth Friendly Reproductive Health Services

1.1Background of the study

In pursuit of reproductive health agenda which was deliberated in ICPD,1994,the government

1.2 Problem Statement

1.4 Research questions

The study attempted to answer the following research questions:

1. Which demographic, socioeconomic and socio-cultural factors determine school youth

1.5 STUDY OBJECTIVES

1.5.1 Broad study objectives

1.5.2 Specific objectives

1.6 Justification of the study

1.7 Limitation of the study

2.2 Reproductive Health Services

2.2.2 Barriers to Utilization of Youth Friendly Reproductive Health Services in Africa

2.2.3 Reproductive health service provision in Kenya

2.2.4 Reproductive Health Service in Ogembo sub-county

2.3 Demographic Factors that influence Utilization of YFRHS

2.4 Socio-economic and socio-cultural factors that influence utilization of YFRHS

2.4.1 Education and Awareness of YFRHS

Urbanization.(Warenius, 2008).Senderowitz (2003) reported that breakdown in traditional

2.5.2 Health Worker’s Attitude

2.6 Summary of Literature review

3.2 Study design

3.3.1 Independent variables

3.3.2 Dependent variables

3.5 Target Population

3.6 Sampling Criteria

3.6.1 Inclusion Criteria

3.6.2 Exclusion Criteria

3.7.1 Sample Size determination

Formula for sample size determination. (Mugenda and Mugenda formula)

n =desired sample size (N=10,000)

Corresponds to 95% confidence interval

P =Proportion in the targeted population estimate to have characteristics being measured

3.7.2 Sampling Technique

3.8.1 Primary Data