Even after the launch of family planning program in Kenya, in 1967, contraceptive use among adolescents has remained below 10 percent while child bearing has increased from 2 percent at age 15 to 36 percent at age 19. To understand the roles of perceptions and barriers on contraceptive use, a mixed method study design was applied to a conceptual framework that operationalized these concepts using data from different sources of social interactions in Nairobi, Kenya. Quantitative data were collected from 1119 adolescents aged 15 -19 years. Qualitative data were collected from adolescents, adolescents' parents and their school teachers. The later were analyzed and interpreted together with the results from cross-tabulations and logistic regression in order to understand the roles of perceptions and barriers. Contraceptive use was found to be 8.6 percent among the adolescents. Overall, unfavourable perceptions among adolescents, parents and teachers seemed to have contributed to low contraceptive use. Unfavourable perceptions played greater role compared to barriers such as sexual partner communication, opinion on adolescents to use a contraceptives and ability to seek contraceptives. Qualitative data show that teachers and parents lack adequate information and skills to discuss sexuality issues. Linking data among adolescents, parents and teachers help to understand the roles of perceptions and barriers to contraceptive use in Kenya. The findings suggest capacity building of teachers and parents on accurate sexuality information for adolescents while services should be youth-friendly. KeywordsContraceptive Use, Perceptions and Barriers, Sexuality Information J. Kinaro et al. 86

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The World Health Organization lists Kenya among African countries experiencing health workforce crisis catalysed through immigration, underproduction, inconsistent quality of production and unequal distribution. Strengthening health training institutions to increase production of high-quality health workers is acknowledged as a measure to mitigate the crisis.IntraHealth International’s USAID-funded FUNZOKenya Project (2012–2017) undertook an assessment to identify the bottlenecks to increasing the number and quality of pre-service graduates in Kenya. The assessment, a cross-sectional descriptive study, collected data through structured respondent interviews among faculty, students in health training institutions, key informants and desk review. The assessment purposively selected 14 institutions from 18 institutions identified for initial collaboration with the project towards strengthening health workforce training. The statistical package for social sciences (SPSS) application helped analyse quantitative data and quotes used to illustrate perceptions on the quality of curricula.The findings revealed major gaps in quality and adequacy of curricula in the training institutions. A national standard framework to guide curricula review process is lacking. Further, curricula did not adequately prepare students for clinical placement, as most failed to directly respond to national health needs. The study recommended reviews of curricula to ensure their responsiveness to emerging issues in the health sector, the formation of curriculum committees to review curricula, development of official curricula review standards and an integrated mechanism to disseminate policies and guidelines.Electronic supplementary materialThe online version of this article (doi:10.1186/s12960-015-0048-9) contains supplementary material, which is available to authorized users.

As in other developing countries, contraceptive use among adolescents is low and only one in twenty adolescents is reported to use contraceptives in Kenya. Pregnancies early in life expose adolescents to health complications. Establishing perceptions that affect contraception and factors that influence those perceptions is important in developing appropriate programs and policies to increase contraceptive use prevalence among adolescents. We used primary data from a household survey using a systematic random sampling in eight administrative divisions in Nairobi County in 2010. The study utilized information collected using structured interviews, focus group discussions (FGDs) and in-depth interviews (IDIs). The findings revealed that perceptions on parental approval, adolescent approval, ability to get contraceptives for self, knowledge of how to use contraceptives and sexual partner communication had significant effect on contraception. The narratives showed that parents, teachers and service providers had negative perceptions and discouraged contraception among adolescents thereby influencing use. Parents and teachers had inadequate knowledge and skills to communicate sexuality messages creating potential environment likely to have indirect negative influence on adolescents' perceptions on contraception.

Context: Despite a high number of unwanted pregnancies in Kenya, contraceptive use among adolescents is very low. Establishing the nature of sexuality discussions is critical to determine perceptions and barriers affecting contraceptive use among adolescents. Methods: The study used systematic random sampling to collect data to examine sexuality information and knowledge that affect perception and barriers on contra-ceptive use among 1119 adolescents aged 15 - 19 years in Nairobi. The survey was conducted using the 2009 Kenya Demographic and Health Survey enumeration areas and projections based on the 1999 population census. Data were collected using structured interviews, focus group discussions (FGDs) and in-depth interviews (IDIs) among adolescents, parents and teachers. Quantitative data were analyzed using Statistical Package for Social Sciences (SPSS) software while qualitative information was analyzed using iT Atlas. Results: Although teachers were identified as a primary source of sexuality information, they were poorly prepared to teach the subject. While the study found negative perceptions on sexuality education, most FGDs and IDIs supported the need for its integration in the school curriculum. Most adolescents who used con- traceptives had perceptions that their parents approved. Source of sexuality information, living arrangement and perceptions on contraceptives for unmarried adolescents were statistically associated with contraceptive use. Conclusion: The study showed that sexuality information from parents and teachers was biased against adolescents using contraceptives. There is need to address attitudes in discussing contraceptive use for adolescents by parents and teachers to enhance positive perceptions and increase contraceptive use by adolescents.