REPUBLIC OF KENYA

Ministry of Health

UNDERSTANDING
ADOLESCENCE
A guide for adolescents

2022
 REPUBLIC OF KENYA

Ministry of Health

UNDERSTANDING
ADOLESCENCE
A guide for adolescents

© Copyright Ministry of Health, Kenya 2021

This document is a publication of the Division of Reproductive and Maternal Health, Ministry of Health Kenya. No part of this
publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying or
recording, without the prior written permission of the Division of Reproductive and Maternal Health (DRMH), Ministry of
Health Kenya, except for non-commercial uses permitted by copyright law.

This publication: UNDERSTANDING ADOLESCENCE: A GUIDE FOR ADOLESCENTS, is a tool for use primarily by
adolescents; and also by parents, caregivers and health care providers to help adolescents navigate the complexities of
adolescence.

For clarifications, contact:

Head, Department of Family Health, Division of Reproductive and Maternal Health, Ministry of Health, Kenya.
Old Mbagathi Road, P. O. Box 43319 - 00100, Nairobi, Kenya.
Telephone: +254 20 272510 | Fax: +254 20 2716814
Email: [Link]@[Link] | Website: [Link]

The recommended citation for this document is:

Ministry of Health, DRMH; Understanding Adolescence: A Guide for Adolescents 2021 Edition. Nairobi, Kenya.
FOREWORD
‘Yoh What’s up? Let me holla at you real quick!’ That is
my attempt to sound like you, old man has to try. On a
serious note, though, I know you face many issues at
your age and you might believe that many people do
not understand. Believe me, I do because I was once
your age. What I have learned in the last five decades is
captured in this book: Understanding Adolescence.
Consider this your ‘Mwaks’ or a guide to life.
First of all, you have rights and you need to know them
to avoid any kind of violation from any person. By
reading this guide you will increase your knowledge
about your body growth and development. You will also
find information about the unique challenges and
solutions that come with growth. The challenges may be emotional, social, or even

relationship issues, Health related problems and the world of drugs and substance abuse.
Additionally, you will get exciting information, education and communication on
Nutrition, personal hygiene and physical activity which will help you become a healthier
and responsible individual who is in control of what takes place in your life.
This guide has been written in a simple language that also resonates with the daily
experiences of adolescents in various contexts. Remember that we live in an
environment keeps on changing rapidly and in the same manner, information also
changes. Therefore, you are encouraged to discuss some of the topics at depth with
parents, teachers, religious leaders, specialists and other adolescents. This will help all
everyone to make the right and informed choices.
Finally, the book has included content that will help in making appropriate career choices.
Notice that each career path has benefits to individuals and the society in their own ways.
A doctor is as important as a footballer, a mechanic, writer, actor or preacher. A farmer
can change the world just as a hairdresser. What matters is focus and ensuring you
remain healthy.
This guide can be read chronologically but you can pick any topic of interest and read
through at your convenient time. Finally, it is often tempting to always rely on the internet
for information, but that should be done with caution. The internet can guide but it can
also misguide. The topic of Social Media provides some pointers on how to navigate the
virtual space responsibly.
By the way, it’s only 60 pages and free of charge, how about that from an old man? That’s
what’s up, read on and see you when you are my age.

Hon. Mutahi Kagwe, EGH

Cabinet Secretary
Ministry of Health
i
 PREFACE
Inadequate access to comprehensive and correct
information on Sexual and Reproductive Health by
adolescents and young people has been identified as
one of the main drivers of teenage pregnancies, new
HIV infections, Gender-Based-Violence and other
Sexual and Reproductive Health Rights risks. Most
children approach adolescence and even adulthood
with little or no information about Sexual and
Reproductive Health while others are forced to rely on
uninformed peers and the internet for this life saving
information. This debacle is further exacerbated by
embarrassment, silence and disapproval of open
discussion of issues around sexuality with adults,
including parents and teachers.
The current reality is that the Sexual and Reproductive Health context and needs of
the current Gen-Z adolescents are not the same as those of the millenials of our time.
Kenyan adolescents are not a homogeneous population. It is this insight that
provided our innovative approach in developing and designing this resource-rich
document targeted towards the current adolescent in Kenya.

I am particularly proud that the Kenyan adolescent, from all corners of the country
was placed at the centre of the development of this critical guide. Covering a wide
range of topics including Sexual & Gender-Based Violence, Social Media, Healthy
Relationships & Communication, Abstinence, Life Skills and Career Choices among
others, this guide is set to provide vital information to the adolescent to enable them
become productive members of society and empower them to navigate the
complexities of adolescence in the 21st century.

Enjoy the read!

Susan Mochache, CBS

Principal Secretary
Ministry of Health

ii
ACKNOWLEDGMENTS
The development of this Adolescent Sexual
and Reproductive Health Guide (2022) in Kenya
was a result of concerted efforts spearheaded by
the Ministry of Health through the Division
of Reproductive and Maternal Health (DRMH)
with several stakeholders through consultative
meetings, literature review, and reviews of the
various drafts of the Guide.
The Ministry of Health through DRMH wishes to
thank the following individuals whose
insights and dedication made it possible to
develop this manual. Specifically, the Ministry
would like to thank the leadership of Dr. Issak
Bashir (Head, Department of Family Health) and
Dr. Stephen Kaliti (Head, Division of Reproductive and Maternal Health) for their
guidance and policy direction during the development process of this guide.
We are highly indebted to Ms. Mary Magubo (ASRH /ACSM Program Coordinator)
for leading the development process of this valuable document supported by
the competent SRH team who provided expert technical assistance led by Dr.
Rose Wafula (SRH Gender Manager), Mary Gathitu (IPV/FGM Lead), Elizabeth
Washika (SGBV Lead), Joseph Baraza (GBV/FGM), ASRH CoE Members; Peter
Onyancha (ASRH Advocacy Expert) Grace Wasike (ACSM Manager DNCH), Dr.
Christine Wambugu (DASH), Martin Mburu (M&E/ SRH), Catherine Chacha (M&E
FELTP), Job Mwanga (Communications Expert), Hezron Kizito (HIV/ AIDS
Expert), Sarah Nditika (MoE, Kenya High School), Violet Munyasi (MoE Nairobi
County), Gordon Ochieng’ (TICAH) Dorothy Okemo (Meta) and Kigen Korir
(UNFPA) who gave their invaluable inputs and guided the process to its successful
completion.
We further wish to extend our gratitude to the counties Adolescent/ Reproductive
Health Coordinators for supporting the document pretesting who included;
Amina Falana (Isiolo), Milsane Kilpai (Bungoma), Jacktone Okeyo (Kisumu), Leah
Ogega (Kisii), Kenneth Miriti (Kilifi) and Faith Kinuthia (Nairobi).
Special appreciation to the German Cooperation who provided financial support
through KfW for the development of the guide.
Lastly, we also wish to thank the consulting firm, Crestwood Marketing &
Communications for compiling, collating and curating the content in this guide.

Dr. Patrick Amoth, EBS

Ag. Director General for Health
Ministry of Health

iii
 ABBREVIATIONS
ACSM Advocacy Communication & Social Mobilization
AIDS Acquired Immunodeficiency Syndrome
ANC Ante-Natal Care
AYSRH Adolescent Youth Sexual Reproductive Health
COE Committee of Experts
DASH Division of Adolescent and School Health
DNCH Division of Nutrition and Child Health
DRMH Divison of Reproductive & Maternal Health
FGM Female Genital Mutilation
GBV Gender Based Violence
HIV Human Immunodeficiency Virus
HPV Human Papilloma Virus
PEP Post Exposure Prophylaxis
RTC Reproductive Tract Cancer
SGBV Sexual and Gender-Based Violence
SRH Sexual & Reproductive Health
STI Sexually Transmitted Infection
UTI Urinary Tract Infection
WHO World Health Organization

iv
TABLE
TABLE
OFOF
CONTENTS
CONTENTS
1 1
Adolescent
Adolescent
Growth
Growth
& Development
& Development

• What
• What
is adolescence?
is adolescence?
• Rights
• Rights
of adolescents
of adolescents• Anatomy
• Anatomy
of theofFemale
the Female
Reproductive
Reproductive
SystemSystem
• Anatomy
• Anatomy
of theofMale
the Male
Reproductive
Reproductive
SystemSystem
• Stages
• Stages
of of
Adolescent
Adolescent
GrowthGrowth
and Development
and Development • Summary
• Summaryof adolescent
of adolescent
physical
physical
development/puberty
development/puberty • Tanner
• Tanner
staging
staging
in boys
in boys
• Tanner
• Tanner
staging
staging
in girls
in girls
• Social
• Social
and and
Emotional
Emotional
Changes
Changes
During
During
Adolescence
Adolescence • Social
• Social
and emotional
and emotional
problems
problems
experienced
experienced
during
during adolescence
adolescence • Menstrual
• Menstrual
Health
Health
• Facts
• Facts
aboutabout
Menstruation
Menstruation
• The• Menstrual
The Menstrual
CycleCycle
• Menstrual
• Menstrual
Hygiene
Hygiene
• Semenarche
• Semenarcheand Wet
and Dreams
Wet Dreams• Personal
• Personal
Hygiene
Hygiene
and and
Sanitation
Sanitation
• How • How
do wet
dodreams
wet dreams
occur?occur?

2 2
Personal
Personal
Hygiene
Hygiene
andand
• Personal
Sanitation
• Personal
Sanitation
hygiene
hygiene
and sanitation
and sanitation

3 3
Healthy
Healthy
Relationships
Relationships
andand
Communication
Communication
• Healthy
• Healthy
Relationships
Relationships
• Benefits
• Benefits
of Healthy
of Healthy
Relationships
Relationships
• How • How
to identify
to identify
unhealthy
unhealthy
relationships
relationships
with others
with others
• Coping
• Coping
with broken
with broken
relationships
relationships

4 4
Abstinence
Abstinence
• Delaying
• Delaying
sexual
sexual
debutdebut
is possible
is possible
if adolescents
if adolescents
• Abstinence
• Abstinence
• Early
• Early
Pregnancies
Pregnancies
and Prevention
and Prevention• Why • Why
should
should
I abstain?
I abstain?

5 5
Sexually
Sexually
Transmitted
Transmitted
Infections
Infections
(STIs)
(STIs)
• Signs
• Signs
And Symptoms
And SymptomsOf STIs
Of STIs
• How
• How
STI can
STIbe
can
prevented
be prevented
• How• How
STI can
STIbe
can
treated
be treated

v
 6 6
HIV/HIV/
AIDSAIDS
• How
• How
HIV isHIV
Spread
is Spread
• How
• How
HIV can
HIVbe
can
Prevented
be Prevented
• HIV•Testing
HIV Testing
• Supporting
• Supporting
Adolescents
Adolescents
Living
Living
WithWith
HIV HIV

7 7
Urinary
Urinary
Tract
Tract
Infections
Infections
(UTIs)
(UTIs)

• Some
• Some
of theofcommon
the common
causes
causes
of UITs
of include
UITs include
• Symptoms
• Symptoms
of UTIs
of UTIs
• How
• How
UTIs can
UTIs be
canprevented
be prevented

8 8
Cancers
Cancers
of the
of the
reproductive
reproductive
organs
organs

• Reproductive
• Reproductive
organorgan
cancers
cancers
in females
in females
• Symptoms
• Symptomsof female
of female
reproductive
reproductive
organorgan
cancers
cancers
• Reproductive
• Reproductive
organorgan
cancers
cancers
in females
in females
• How • How
to identify
to identify
cancers
cancers
of reproductive
of reproductive
organs
organs
in females
in females
• Breast
• Breast
Self-Test
Self-Test
for Adolescents
for Adolescents
• Reproductive
• Reproductive
organorgan
cancers
cancers
in males
in males
• How • How
to identify
to identify
cancers
cancers
of reproductive
of reproductive
organs
organs
in males
in males
• How • How
to to
prevent
prevent
reproductive
reproductive
organorgan
cancers
cancers
in males
in males

9 9
Mental
Mental
Health
Health
• Stress
• Stress
and stress
and stress
management
management • What
• What
causes
causes
stress?
stress?
• How • How
to know
to know
someone
someone
is stressed
is stressed
• How• How
to avoid
to avoid
stressstress

10 10
Drugs
Drugs
& Substance
& Substance
UseUse
• Commonly
• Commonlyabusedabused
drugsdrugs
and substances
and substances
• How• How
to know
to know
whenwhen
one isone
abusing
is abusing
drugsdrugs
• How• How
to avoid
to avoid
drug drug
and and
substance
substance
abuse abuse
• Consequences
• Consequences
of abusing
of abusing
drugsdrugs

vi
 11 11
Harmful
Harmful
Cultural
Cultural
Practices
Practices
• Child
• Child
Labour
Labour
• What
• What
is FGM
is FGM
• Child
• Child
Marriage
Marriage
• Addressing
• Addressing
Harmful
Harmful
Cultural
Cultural
Practices
Practices

12 12
Sexual
Sexual
andand
Gender-Based
Gender-Based
Violence
Violence
• What
• What
is defilement?
is defilement?
• What
• What
is RAPE?
is RAPE?
• Look
• Look
out for
outthe
forbelow
the below
as potential
as potential
perpetrators
perpetrators
• What
• What
to doto
indo
theinevent
the event
of defilement
of defilement
or rape
or rape
• Care
• Care
givengiven
after after
defilement
defilement
or rape
or rape
(post(post
rape rape
care)care)
• What
• What
to Expect
to Expect
at theatHospital
the Hospital

13 13
Nutrition
Nutrition
andand
Physical
Physical
Activity
Activity
• Benefits
• Benefits
of good
of good
nutrition
nutrition
• Unhealthy
• Unhealthy
eating
eating
habits
habits
• Physical
• Physical
activity
activity

14 14
LifeLife
Skills
Skills
• What
• What
are life
areskills?
life skills?
• Core
• Core
life skill
lifestrategies
skill strategies
and techniques
and techniques

15 15
Social
Social
Media
Media

• Common
• Common
SocialSocial
Media Media
Platforms
Platforms
• To be
• To
onbe
the
onsafer
the safer
side, side,
consider
consider
thesethese
important
important
tips tips

16 16
Career
Career
Choices
Choices

• What
• What
do youdowant
you want
to beto
inbe
lifeinwhen
life when
donedone
with school?
with school?
• Factors
• Factors
influencing
influencing
career
career
choiceschoices
vii
 1 Adolescent Growth &
Development
What is adolescence?
Adolescence is a period of transition from childhood to adulthood.
During this period, boys and girls undergo physical, behavioural,
cognitive, social, intellectual and emotional growth and change. An
Adolescent is a person between 10 and 19 years of age.

Rights of adolescents
All adolescents, including those punishment, and hazardous
with disability, have the right to or exploitative labour;
access quality health care • To parental care and
services. Caregivers in schools, protection, which includes
communities and religious equal responsibility of the
institutions have a responsibility mother and father to provide
to protect children and for the child, whether they
adolescents. are married to each other or
According to the Constitution of not; and
Kenya, every child and • Not to be detained, except
adolescent has a right: as a measure of last resort,
and when detained, to be
• To a name and nationality
held:
from birth;
- for the shortest appropriate
• To free and compulsory basic period of time; and
education;
- separate from adults and in
• To basic nutrition, shelter and conditions that take account
health care; of the child’s sex and age.
• To be protected from abuse,
neglect, harmful cultural Adolescents have rights like any
practices, all forms of violence, other Kenyan. A right is something
that one is allowed to have or to do
inhuman treatment and according to the law.
Chapter 4 of the Constitution of Kenya (2010)
1
 How to know when rights
are violated
• If a service provider refuses
to attend to you
• If a health care provider
displays negative attitude
towards you
• If parents or caregivers deny
the adolescent access to
healthcare

What to do when rights

are violated
• Report to the relevant
authority e.g. the person in-
charge of the health facility
• Discuss with the counsellor,
parents, friend or caregiver
• Be persistent in asking for
your rights respectfully
2
 Anatomy of the Female
Reproductive System
Uterus Fallopian Tube
This is an internal organ These are the thin tubes that connect the
where a fertilized egg grows ovaries to the uterus. Once an egg is
and develops into a foetus. It released it travels down the fallopian tubes
is also called the womb. to the uterus. Fertilization usually happens
in the fallopian tubes.

Cervix
Ovary This is the lower part of
the uterus, which extends
Where the ova or eggs are into the upper part of the
produced vagina.

Vagina
This is the opening that
connects the uterus to
the outside of the body.
The walls of the vagina
are made of muscles
which can expand to
allow a penis to be
inserted or a foetus to be
delivered.

Clitoris

Outer Labia
Urethra

Inner Labia
Vaginal Opening

Hymen

3
 Anatomy of the Male
Reproductive System

Bladder

Seminal Vescicles

Vas Deferens
This is the tube that
carries sperm from
the epididymis to
the urethra.

Urethra
This is a tube through which
urine and semen exit the
body. The opening of the
urethra is located in the
glans of the penis.

Prostate

Testicles Epididymis
Also known as testes, these
are the two oval shaped sex This is a tube at the back of
organs located just below the scrotum that stores
the penis. The testicles sperm for two to three
produce sperm and male months while they develop.
hormones.
Penis
This is the external male sex Scrotum
organ. It is made of spongy
tissue. When a man This is a pouch of thin loose
becomes sexually excited, skin that holds the testicles.
this tissue fills with blood
and the penis becomes
erect.

4
 Stages of Adolescent Growth
and Development
According to WHO, an Adolescent is a person between 10 and
19 years of age. Adolescence is a period of transition from
childhood to adulthood during which a boy or a girl develops
physically, socially, emotionally and mentally and moves
towards independence.

Early Adolescence Mid Adolescence Late Adolescence

(10-13 years) (14-16 years) (17 -19 years)

Stages of Stages of Stages of

Emotional Development Emotional Development Emotional Development
• Mood swings, • Sense of • Sense of
Intense feelings, low invulnerability, Risk responsibility for
impulse control taking behaviour one’s health,
increasing sense of
Stages of Stages of vulnerability, Able to
Cognitive Development Cognitive Development think of others and
• Concrete thinking, • Able to conceptu- suppress ones
little ability to alize abstract ideas needs, less risk
anticipate long term such as love, justice, taking
consequences of truth and spirituality Stages of
their action Cognitive Development
• Literal • Ability to
interpretation of understand and set
ideas limits
• Understands other’s
thoughts and feelings

Please don't be shy to discuss these experiences

with a teacher from your school, a parent, a
guardian, a caregiver and other trusted adults.

5
 Summary of adolescent physical
development/puberty

Boys Girls Boys &Girls

• Voice changes • Breast enlargement • Development of pubic and
• Shoulders broaden • Hip enlargement armpit hair
• Facial hair • Monthly period/ • Growth of body height
menstruation and weight gain
• Sperm production and (adolescent growth spurt)
Ejaculation • Perspiration increases
and body odour may • Genital organs
• Wet dreams and erection enlargement
occurs frequently appear
• Pimples (acne) may
• Muscular and skeletal develop on the face
growth • Body shape takes on a
• Perspiration increases characteristic adult
and body odour may pattern
appear

Common Problems
When to seek medical opinion
During Puberty For Girls
• Delayed puberty
• Delayed menstruation • Abnormal vaginal discharge such as foul smell,
• Vaginal discharge itching and discomfort
• Abdominal cramps • Severe cramps that affects normal activities
• Pain in the breasts • Heavy menstrual bleeding
• Acne • When the menstrual period does not occur by 18
years
• Increase in weight/ weight gain
• Delayed or early onset of
puberty

Common Problems
When to seek a doctor’s opinion
During Puberty For Boys
• Pain and swelling of the glans penis and prepuce
• Undescended testicles • Delayed puberty beyond 18 years
• Delayed puberty • Enlarged breasts also called gynecomastia
• Severe acne • Abnormal penile discharge such as foul smell,
• Enlarged breasts also called itching and discomfort
gynecomastia • Pain when passing urine
6
 Tanner staging in boys
Adolescents do not always develop in the same way and
manner. It is normal to have delays in development (of testes,
pubic hair, breasts and hips for girls etc) and it should be a cause
for worry.
These diagrams show development at various stages.

1.

2. 3.

4. 5.

7
 Tanner staging in girls

1.

2.

3.

4.

5.

8
 Social and Emotional Changes During
Adolescence
• Sudden changes in mood also called mood swings
• Shyness for some adolescents
• Feeling closer to friends and peers than family.
• Attention seeking behavior and recognition
• Struggling with a sense of identity and questions
about oneself
• Need for more independence and privacy
• Experimenting new things
• Being conscious about physical appearance
• Worry about the future (school, family, job)
• Becoming more expressive of their ideas and
opinions
• Attraction to opposite sex
• Brain development
• Decision making process is starting

Social and emotional

problems
experienced during ado-
lescence
maintaining new
relationships
• Peer pressure.
• Delinquency (involvement in crime and
breaking the rules)
• Argumentative and aggressive behaviour
is seen more
• Moodiness, anger, stress and depression
• Low self Esteem
If you are going through such problems, talk to someone you trust for
9
guidance such as a teacher, a religious leader, a guardian or a parent
 Menstrual Health
Every female experiences changes in her body as she grows
and develops. One of the important changes that adolescent
girls go through is menstruation, which is a natural process of
the females’ reproductive cycle. Once menstruation starts,
each month thereafter one of her ovaries releases an egg
(ovum). At this stage, two things are likely to happen:
1. The lining of the womb breaks down, creating the blood
that passes through the vagina and this is referred as the
monthly period.
2. If the egg (ovum) is fertilized, pregnancy will occur and
Menstruation will not occur. It is important to abstain
from sexual intercourse.
During the monthly period, the girl needs to maintain high
menstrual hygiene that involves using menstrual items to
absorb or collect blood such as pads, clothes or menstrual
cups.

Facts about Menstruation

• The first menstrual cycle is called
‘menarche’
• Periods in the first few years of
menstruation are not very regular
• Some girls have their first period
as early as eight or nine years of age
• Some women menstruate every
28days, while others have longer
cycles (35days) or shorter cycles (21
days)
• Periods usually last between 2 -7
days, with five days being the
average length of menstrual flow.
10
 Menstruation is Menstruation is NOT

• The shedding of tissue and • Sickness

blood from the lining of the • Illness
womb through a woman’s
vagina • Disease
• Also called ‘menses’, • Infection
‘menstrual period’, ‘monthly • Harmful, dirty, shameful,
bleeding’ and ‘period’. unclean or otherwise
• The blood and tissue that ‘negative
comes from the uterus when
fertilization does not occur
• The monthly self-cleaning Menstrual Hygiene is
action of a healthy uterus important because it:
• It is an important • Prevents infection
developmental milestone for
girls, the same way wet dreams • Prevents body odour
are for boys • Enables females to remain
• It is an indication that a girl is healthy
approaching maturity. • Enables females to feel
comfortable, confident and
stay fresh all day
• Boost self esteem

Common problems that occur before or at the

onset of menstruation
• General weakness of the body or body feels
heavy
• Dizziness, nausea, cramps(lower abdominal 1 2 3 4 5 6 7 8

pain) 9

17
10

18
10

19
12

20
13

21
14

22
15

23
16

24

• Headache, enlarged and painful breasts,

25 26 27 28 29 30 31

fever
• Backache, irritability, mood swings,
cravings, tiredness, pimples etc.
In case you need
calrification, talk
to a TRUSTED
teacher, parent,
sibling or
guardian.
11
 The Menstrual Cycle

Hormonal changes
occurs during ovulation
If fertilization has not
taken place, the uterine
lining fades away

Growth & development for adolescents occurs

• Some girls will experience pain during their menstruation

• Some girls have their first period as early as 8 or 9 years of age while In case you need
others at 17 or 18 years of age. calrification, talk
• Some girlsmenstruate every 28 days, while others have longer cycles (35 to a TRUSTED
days) or shorter cycles (21 days) teacher, parent,
• Periods usually last between 2 -7 days, with five days being the average sibling or
length of menstrual flow. guardian. 12
 MENSTRUAL HYGIENE

HOW TO • Don’t be afraid. It can be scary to see

MANAGE YOUR or feel the blood on your underwear,
but it is normal and natural
FIRST MONTH-
LY PERIOD • Talk to other girls and women or any
other person you trust in your
community
• If you are at school, tell the matron, a
teacher or a fellow student
• Feel proud! Your body is developing
into that of a young woman.
• Change sanitary materials every few
hours or when it is soaked with blood

• Unwrap the pad from its package HOW TO USE A

• Stick the pad in your underwear PAD DURING
using the sticky strip on the back. MONTHLY
(Some reusable pads are held in place
with snaps or the elastic in your
PERIOD
underwear)
• Change your pad every few hours, or
when it's soaked with blood Important Information
• Wrap used pads in the wrapper or NEVER insert any foreign
toilet paper and throw them in the objects inside your vagina
designated trash.
• Place a cloth, pad, cotton on your
underwear

13
 HOW TO • If you are re-using a cloth, put it into a
DISPOSE OF paper bag until you can wash it with
THE CLOTH, water and soap and then dry it in the
PAD OR sunshine
COTTON • If you are using a pad, or cotton, or
want to dispose of your cloth, wrap it in
paper to make a clean package and put
it in the designated bin so it can be
burned later
• If there is no other option, drop it
straight in a pit latrine.

• Every day (morning and evening if HOW TO

possible) bathe with soap and water KEEP
• Keep unused cloths and pads clean YOURSELF
(wrapped in tissue or paper bag) for CLEAN
further use DURING
• Pat the vagina dry with a cloth, and put a YOUR
fresh cloth, pad or cotton on your under- MONTHLY
wear PERIOD
• Always wipe from front to back after a
long call
• Wash opening of the vagina with water
only (do not use soap).

HOW TO • Use hot water bottle on your lower

MANAGE THE stomach area. Ensure the water is not too
hot to burn you. This can relieve the pain.
STOMACH
PAIN FROM • Try to do some exercises and keep your
body active
YOUR
• On the most painful days, take painkiller
MONTHLY medicines every four to six hours as advised
PERIOD by the doctor.
• Regular check-up is important to monitor
your blood levels

Important Information
It is normal to have menstrual pain during your monthly period but if it is
too much and interfers with your normal daily activities it is advisable to
seek medical attention

14
 Semenarche and Wet Dreams
During adolescence and with the start of puberty, important
changes occur in a boy’s body and they experience
semenarche or the first ejaculation. At the onset of puberty,
thick white fluid called semen comes out of the penis. This is
commonly known as a wet dream. Lots of semen is formed
inside the body and when there is too much, some of it
released. During adolescence boys sometimes experience wet
dreams. Wet dreams occur when a boy ejaculates during sleep.
Wet dreams are a normal part of growing up and should not be
a cause for worry.

Semenarche refers to Wet dreams is the seminal

the first ejaculation by a fluid that comes out of a penis
boy while a boy is asleep

How do wet dreams occur?

• During ejaculation, semen (the fluid containing sperm)
comes out of the penis and this is what you notice on your
underwear or pajama pants
• You may also notice it when you wake up to find your
bed sheet or blanket wet and sticky
• Wet dreams are not necessarily caused by sexual
fantacies or desires

How To Manage Wet Dreams

If you are feeling uncomfortable about having a wet
dream, talk with an adult you trust e.g. a parent, teacher,
caregiver or your health care provider to help you feel
more comfortable about this natural part of your
development
NOTE: It is also normal
not to have wet dreams.
15
2 Personal Hygiene
and Sanitation
Adolescence causes several changes in the body. Sweat
glands are more active during this stage, which causes

places especially in the public region and armpits. The skin

and scalp may also suddenly get oily very easily.
Sometimes the adolescent may seem to sweat for no
reason and may notice odors where there was none
before. It is important to understand that all these changes
are normal. They are caused due to the hormonal changes
in the body.
To help deal with these changes, adolescents must
maintain cleanliness and proper sanitation. This is done by:

Regular hand Regular brushing

washing or bathing teeth
sanitizing

Keeping Proper Changing washing and

short nails grooming inner wear, ironing of
socks and clothes
bedding

16
 Poor hygiene can also lead to peers undermining
your worthiness leading to low self esteem.
Poor Hygiene can lead to conditions such as:

Some of these can

1. Ringworms be infections from
2. Athlete’s Foot other individuals or
symptoms of other
3. Scabies issues
4. Skin Rash
3

17
3 Healthy Relationships
and Communication
A relationship is
an interaction/ connection
between two or more people
based on mutual trust.

Types of Relationships
These include:
• Parent/ Caregiver - daughter and/or son
relationships
• Peer-to-peer relationships
• Siblings relationships

18
 HEALTHY RELATIONSHIPS
CHARACTERISTICS OF PEOPLE IN
HEALTHY RELATIONSHIPS:
• Listen to each other
• Communicate openly and without judgment
• Trust and respect each other
• Consistently make time for each other
• Remember details about each other’s lives
• Engage in healthy activities together
• Forgive and ask for forgiveness
• Support each other

HOW ADOLESCENTS CAN BUILD

AND MAINTAIN GOOD
RELATIONSHIPS WITH THEIR PEERS
• Respect each other
• Understand each others personalities
• Listen attentively to each others’ challenges
• Learn to be more understanding to others
• Learn to give constructive feedback
• Do not harm others
• Love and treat people fairly, as you would
like to be treated

ADOLESCENTS CAN BUILD AND MAINTAIN

GOOD RELATIONSHIPS WITH THEIR
CAREGIVERS/ PARENTS/ GUARDIANS BY
DOING THE FOLLOWING:
• Being respectful to them
• Obeying instructions
• Being honest, open and truthful
• Being friendly
• Seeking guidance

19
 Benefits of Healthy Relationships
• Helps develop self-esteem and a sense of belonging.
• Promotes academic success with positive
teacher–student relationship.
• Helps shape good behavior
• Helps one to feel needed and loved by relatives, friends
and community
• Helps to reduce stress
• Helps you in becoming the person you want to be
• Strengthens family ties and togetherness

How to identify unhealthy

relationships with others
• You feel threatened around them
• They are always jealous and do not want you to stay
around other people.
• They convince you to do things you would not normally
feel comfortable doing
• They ignore you until they get their way, and use gifts
and apologies to influence your decisions
• They divert your attention from achieving your goals. For
example, they make you miss school or practice or keep
you from getting schoolwork done
• They make you feel bad about yourself. For example,
they call you names, make rude remarks about your
friends or your family
• They make you feel guilty or responsible for their actions.
For example, they make you feel responsible for their
happiness.
• They intimidate and frigthen you in order to control you.

20
 Coping
Coping
with
with
broken
broken
relationships
relationships
Sometimes
Sometimes relationships
relationshipsbreak
break
andand
individuals
individuals
havehave
to to
adjust
adjust
to new
to newrealities.
realities.
It might
It might
of help
of help
to do
to the
do the
following:
following:
• Give
• Give
yourself
yourself
timetime
to deal
to deal
withwith
thethe
painpain
of the
of the
broken
broken
relationship
relationship
• If this
• If this
is overwhelming,
is overwhelming, talktalk
to ato
counsellor
a counsellor
or someone
or someone youyou
trusttrust
e.g.e.g.
parent,
parent,
teacher,
teacher,
guardian
guardian
or sibling
or sibling
• Do • Do
notnotspread
spread
rumors
rumorsor bad
or bad
stories
stories
because
becauseyouyouare are
hurthurt
• Seek
• Seek
ways ways
to focus
to focuson achieving
on achieving
youryour
goals
goals
such such
as as
reading
readingandandrevising
revising
for your
for your
exams
exams
• Find
• Find
a hobby
a hobbythatthat
will will
keepkeep
youryour
mindmind
occupied
occupiedwhenwhenyouyou
are are
[Link].

21
4 Abstinence
Delaying the start of sexual activity has numerous benefits. This

prevention of early pregnancy, prevention of STIs (Sexually

Transmitted Infections) and HIV (Human Immunodeficiency
Virus), promotion of self-esteem and self-worth.

Delaying sexual debut is possible

if adolescents;
• Avoid peer pressure
• Avoid the use of alcohol, tobacco and recreational drugs
• Seek help/counselling for mental health issues
• Build and maintain healthy relationships with parents or
guardians
• Regularly attend school/classes and avoid being unruly
• Seek assistance for socio-economic challenges from the
community or government agencies where possible
• Engage in physical activity and avoid sedentary behavior
• Avoid interaction with pornographic material
• Only visit age appropiate websites and interact with
age-appropiate media.

In Kenya having sex with a minor (a

person below 18 years) is illegal and is
punishable by law regardless of the age
of the person having sex with minor.
Minors cannot consent to sex thus
consensual sex among minors is also not
acceptable.

22
 Abstinence
Sexual abstinence means choosing not to have sex. Practicing
abstinence ensures that a girl will not become pregnant because
there is no chance for the sperm to fertilize an egg.

Why should I abstain?

preventing pregnancy
• By abstaining from sexual activity, you also avoid the risk of STIs
including HIV
• Reduces exposure to Human Papilloma Virus (HPV) which
causes cervical cancer
• Adolescents who practice abstinence are much less likely to
experience a physically or emotionally abusive relationship, drop
out of school, engage in substance abuse or feel pressured into
having sex

• Abstinence boosts a sense of self-worth and self-esteem

SAY N TO SEX!
Counselling on Sexual Reproductive
Health amongst Adolescents
• Counselling should be done for both girls and boys
• In case of rape, pregnancy and STIs, seek counselling and
guidance from a trusted teacher, parent or pastor

23
 Early Pregnancies
and Prevention
Causes of Early Pregnancies
• Engaging in sexual activities
• Rape or defilement which can be perpetrated by a
stranger or by a person known to the victim
• Use of alcohol and drugs may lead you into engaging in
risky sexual behavior
• Early marriages

Consequences of Early
Pregnancies

early sexual activities which lead to

teenage pregnancy include the
following:
• Dropping out of school
• Premature child birth
• Early or forced marriages in some
communities
• Complications in child bith which
may result in death
• Socio-economic challenges e.g.
lower chance of getting
employment
• Social isolation because of stigma

24
 5 Sexually Transmitted
Infections (STIs)
Sexually Transmitted
Infections (STIs) are transmitted
from one infected person to another
through sex. These infections
include; Gonorrhoea, chlamydia,
syphilis, herpes simplex, HIV etc.

Signs and Symptoms of STIs

Boys Girls

• Discharge from the penis • Abnormal discharge from

• Sores or rashes on the penis the vagina which may be
smelly
or anal area
• Sores or rashes on vagina
• Pain while passing urine or anal area
• Itching of private parts • Pain while passing urine
• Lower abdominal pain • Itching of private parts
• Lower abdominal pain

How STIs can be prevented

STIs can be prevented by abstaining from sex

What to do when you have an STI

• Go to any health facility near you and follow the doctor’s
instructions .
• STIs can be cured

25
 6 HIV and AIDS
Human Immunodeficiency Virus (HIV) is a virus that
attacks the immune system thereby weakening the
body’s ability to fight diseases.
Acquired Immune Deficiency Syndrome (AIDS) is a
disease that can develop in people with HIV when the

This makes the person vulnerable to a wide range of

illnesses.

How HIV is Spread

The virus is contained in body fluids like semen, vaginal
fluids, blood and breast milk .
The virus can be passed from one infected person to
another through:
• Sexual intercourse
• Mother to child while in the womb or during delivery or
when breastfeeding
• Blood transfusion with HIV infected blood
• Sharing of contaminated sharp objects such as needles
and razors.

26
 HIV DOES NOT Spread Through:
• Sharing the same desk in • Sharing a toilet, towels, or
school bedding
• Sitting close to other people • Bites from mosquitoes or
• Hugging, shaking hands or other insects
kissing • Swimming in the same
• Breathing the same air water or playing sports
• Sharing food or drinks
• Tears or sweat

How HIV can be Prevented

• Abstinence from sex is the best way to prevent
acquiring HIV infection. Delay sex until appropriate and
acceptable time. Avoiding drugs, alcohol and
pornography
• Self-control: Be alert and know when to walk away from
sexual advances
• Avoiding sharing sharp objects such as razors
• Your cuts and wounds should be covered well at all
times to avoid infection from environment and people
you meet.
• Screening of blood before transfusion to avoid
transfusion of infected blood
• Take Post Exposure Prophylaxis (PEP) immediately
after any exposure. This is medicine taken by uninfected
persons after exposure to body fluids from an infected
person (For instance, after defilement, rape or being
injected/cut by potentially infected objects)
27
 HIV Testing
• HIV Testing is very important for oneself
• A health care worker will talk to you before
and after HIV test at a HIV Testing Services

T
Centre or a health facility

TES
HIV
• If you are HIV positive, the health care
worker will talk to you on how to take care
of yourself and lead a healthy life as soon as
possible
• If you are HIV negative, the health care
worker will talk to you on how to take care of yourself and remain HIV
negative
• HIV has no cure, however, there are drugs that are available to help
boost immunity and help you live a long healthy life

Supporting Adolescents Living With HIV

Take • Adolescents living with HIV
medication as
directed by are encouraged to join a group
the doctor.
of other adolescents who are
also living with HIV so as to
Eat a
balanced share experiences and
diet
encourage each other to
continue taking drugs and take
Join support care themselves.
groups for
psychosocial • Take medication as directed
support.
by the doctor.

• Eat a balanced diet

• Exercise regularly
• Remember to go for clinic appointments
• There are adolescents who are living with HIV on medication in
boarding school. These adolescents need to identify a person whom
they feel free and comfortable around to disclose their status
• You can lead a normal life and do well in school

28
 77 Urinary
UrinaryTract
Infections
Tract
Infections(UTIs)
(UTIs)
Some Someof theof common
the common This isThis
an infection
is an infection
(mostly(mostly
causes
causesof UTIs
of UTIs
include:
include:
urinaryurinary
tract system
tract system
• Wiping
• Wipingoneselfoneself
fromfromthe the (urethra
(urethra
and bladder).
and bladder).
UTI’s UTI’s
backbackto theto front
the frontafterafter
a a occuroccur
when whenbacteria,
bacteria,
often often
longlong
call call from the
from skin
theorskin
rectum,
or rectum,
enter enter
the urethra
the urethra
and infect
and infect
• Holding
• Holdingurineurine
for aforlonga long the urinary
the urinary
tract. tract.
timetime
without
withouturinating
urinating
• Poor
• Poor
hygiene.
hygiene.
HowHowUTIsUTIs can be canprevented
be prevented
• Not• Not
washing
washinghands hands
beforebefore
• Drink
• Drink
lots oflots water
of waterand and
and and
afterafter
changing
changingsanitary
sanitary
urinate
urinate
frequently
frequently
towels
towels
• Keep
• Keep
genitalgenitalareaareaclean clean
several
several
partsparts
of the of urinary
the urinary • Wipe
• Wipe
from from
front front
to back
to back
tract,tract,
but the
but most
the mostcommoncommon afterafter
passing
passing urine urine
and and
stool stool
typetype
is a bladder
is a bladder infection
infection for girls
for girls
(cystitis).
(cystitis). • Avoid
• Avoid
inserting
inserting fingersfingers
into into
vagina vagina
Symptoms
Symptoms of UTIsof UTIs
• Avoid
• Avoid
douching
douching (spraying
(spraying
• Pain
• Pain
or burning
or burning sensation
sensation
or washing
or washing inside inside
the the
whilewhile
urinating
urinating
vagina
vagina
withwith water) water)
• Frequent
• Frequent urination
urination
• Wear
• Wear
cotton cotton underwear
underwear
• Feeling
• Feeling
the need
the needto to and and
avoid avoid
tighttightunderwear
underwear
urinate
urinate
despite
despite
having having
an an and and g-strings
g-strings
emptyemptybladder
bladder
• Use• Use
clean clean
toilets toilets
• Blood
• Blood
in urine
in urine
• Change
• Change padspads frequently
frequently
• Pressure
• Pressureor cramping
or cramping in in during during
menstruation.
menstruation.
the groin
the groin
or loweror lower
abdomen
abdomen
• Abstaining
• Abstaining fromfrom sexual sexual
In case
Inof
case
anyofsigns
any and
signs and
activity
activity
symptoms
symptoms
visit the
visit
nearest
the nearest
healthhealth
facilityfacility
and follow
and follow AvoidAvoid
douching.
douching.
Douching
Douching
doctors’
doctors’
instructions
instructions interferes
interferes
with the
with
normal
the normal
vaginal
vaginal
pH environment
pH environment

29
8 Cancers of the
Reproductive Organs
Cancer is a disease that results
from uncontrolled growth and
division of body cells.

Reproductive organ cancers in females

These include:
• Cervical cancer:
of the uterus
• Ovarian cancer:
• Uterine cancer:
• Vulval cancer:
the opening of the vagina
• Vaginal cancer:
• Breast cancer:

Symptoms of female reproductive organ

cancers
• Pressure or pain in the abdomen
The common symptoms of the
(belly) or back
organs are summarized below: Uterine cancer
Breast Cancer • Bleeding or discharge from the
vagina that is not normal
• An abnormal painless lump in the
breast (you can feel on touch) • Pressure or pain in the pelvic area
Cervical Cancer • Bleeding after menopause
• Bleeding or discharge from the Vaginal Cancer
vagina that is not normal • Bleeding or discharge from the
Ovarian Cancer vagina that is not normal
• Bleeding or discharge from the Vulval Cancer
vagina that is not normal • Itching, bleeding, burning or sores
• Pressure or pain in the pelvic area around the opening of vagina that
do not go away. 30
 Risk factors of female Reproductive
Tract Cancers
system e.g. due to conditions
Breast Cancer such as HIV
• Someone in your family • Early sexual activity
having had breast cancer (for
example, mother or a sister) i.e Vaginal and Vulval Cancer
hereditary/ genetic • Having HPV
• Smoking tobacco e.g. • Having a weak immune
cigarettes system e.g. due to conditions
• Excessive drinking of alcohol such as HIV
• Smoking tobacco
Cervical Cancer
• Persistence of infection with Visit the nearest health
Human Papilloma Virus (HPV) facility if you identify any
• Smoking tobacco e.g. of these symptoms
cigarettes
• Having a weak immune

How to prevent reproductive organ

cancers in females
Cervical Cancer prevention
• HPV vaccination for cervical cancer. This is available as a routine
vaccine in the health facilities for all girls from age 9 years. It is given
as two doses 6 months apart
• Delayed sexual activity
• Avoid smoking tobacco e.g. cigarette Have you
Breast Cancer prevention received your
• Breast self-examination – a person HPV vaccine?
checks their breasts for lumps at least This is available as a
once every month routine vaccine in the
• Clinical breast examination – done by health facilities for all
a health care provider girls from age 9 years.
• Other hospital investigations It is given as two doses
6 months apart

31
 Breast
Breast
Self-Examination
Self-Examination

StepStep
1 1 StepStep
4 4
BeginBegin
by standing
by standing
with your
with your
Next, Next,
feel your
feel breasts
your breasts
shoulders
shoulders
straight
straight
and your
and your
while while
lying down,
lying down,
using using
arms on
arms
your
on hips
your hips
your right
your hand
right hand
to feelto feel
Here isHere
whatisyou
whatshould
you should
look look
for: for:
your left
yourbreast
left breast
and then
and then
• Breasts
• Breasts
that arethat
their
areusual
their usual your left
yourhand
left hand
to feelto feel
size, shape,
size, shape,
and color
and color your right
your breast.
right breast.
• Breasts
• Breasts
that arethat
evenly
are evenly
shapedshaped
without without
distortion
distortion
or swelling
or swelling • Use a• firm,
Use asmooth
firm, smoothtouch with touch thewith
first
the first
few finger
few pads
fingerofpads yourofhand,
yourkeeping
hand, keeping
the fingers
the fingers
flat and flat
together.
and together.
Use a Use a
circularcircular
motion,motion,
about the about size theof size
a of a
[Link].
• Cover• the
Cover entire
the breast
entire breast
from top fromto top to
bottom, bottom,
side toside sideto —side
from—your from your
StepStep
2 2 collarbone
collarbone
to the top to theof top
yourofabdomen,
your abdomen,
and fromandyourfromarmpit
your armpit
to yourtocleavage.
your cleavage.
• Follow• Follow
a pattern a pattern
to be sureto be that
sureyouthat you
cover the
cover
wholethe whole
[Link].
• You can
• You
begincan atbeginthe nipple,
at the nipple,
movingmoving in in
Now, Now,
raise raise
your arms
your arms
and and larger and
larger and circles
larger larger circles
until you until
reach
you reach
look for
lookthe
forsame
the same
changes.
changes. the outer
theedge
outerof edgethe breast.
of the breast.
• You can
• You
also canmove
also your
movefingersyour fingers
up andup and
down vertically,
down vertically,
in rows,inas rows,
if you aswere
if you were
mowing mowing
a [Link] lawn. up-and-down
This up-and-down
approachapproach
seems seems to work tobest
work forbest
most for most
women. women.
Be sureBe tosure
feel toall feel
the tissue
all the from
tissue from
the front
thetofront
the back
to theofback yourofbreasts:
your breasts:
for for
the skinthe
andskintissue
and justtissuebeneath,
just beneath,
use light use light
pressure;
pressure;
use mediumuse medium pressure pressure
for tissuefor tissue
StepStep
3 3 in the middle
pressure
in the middle
of yourofbreasts;
for thefor
pressure deep
your breasts;
thetissue
deep in
use firm
tissue
use firm
the back.
in the back.
• When• you've
When you'vereached reached
the deep thetissue,
deep tissue,
you should
you should
be ablebe toable
feel todownfeel todownyourto your
Look Look
for anyforsigns
any signs
of fluidof fluid rib cage.
rib cage.
coming
coming
out ofoutoneoforone
both
or both
nipples
nipples
(this could
(this could
be a be a
watery,
watery,
milky,milky,
yellowyellow
fluid or
fluid or StepStep
5 5
blood).
blood).

Finally,
Finally,
feel your
feel your
breasts
breasts
while while
you areyou are
Important
Important
Information
Information standing
standing
or sitting.
or sitting.
• Some• girls
Some have
girlslumps
have lumps
or lumpy
or lumpy
areas in
areas
theirin their
breastsbreasts
all the time,
all theand
time,
most
andbreast
most breast
lumps lumps
turn turn
out to out
be benign
to be benign
(not cancerous).
(not cancerous).
There are
Therea are a
number number
of possible
of possible
causescauses
of non-cancerous
of non-cancerous
breast breast
lumps,lumps,
includingincluding
normalnormal
hormonal
hormonal
changes,
changes,
a benign a benign
breast breast
condition
condition
or an injury.
or an injury.
• Do not• Do
panic
notcall
panic
your
calldoctor
your doctor
if you’veif you’ve
noticednoticed
a lumpaor lump
any or breast
any breast
changechangethat is that
new is and
new and If you If
seeyou
any
see
ofany
theoffollowing
the following
changes,
changes,
worrisome.
worrisome.
This is This
especially
is especially
true fortruechanges
for changes bring them
bring to
them
yourtodoctor's
your doctor's
attention
attention
that last
that
more
lastthan
moreone
than fullone
menstrual cycle or
full menstrual cycle or
seem to get to
seem bigger or more
get bigger orprominent
more prominent in somein some • Dimpling,
• Dimpling,
puckering
puckering
or bulging
or bulging
of the skin
of the skin
way. If way.
you menstruate, you may
If you menstruate, you want
mayto waitto wait
want • A nipple
• A nipple
that has
that
changed
has changed
positionposition
or an or an
until after
untilyour
afterperiod to see to
your period if the
seelump
if theor other
lump or other inverted
inverted
nipple nipple
(pushed(pushed
inwardinward
insteadinstead
of of
breast breast
changes disappears
changes on its own
disappears on itsbefore
own before sticking
sticking
out) out)
calling calling
your doctor.
your doctor. • Redness,
• Redness,
soreness,
soreness,
rash orrash
swelling
or swelling
• Some• girls
Some will produce
girls fluid from
will produce fluidtheir
frombreasts
their breasts
as partas
ofpart
theirofnormal growthgrowth
their normal and development.
and development.
32
 Reproductive Tract organ cancers
in males
• Testicular cancer: • Breast cancer:
testes breast though not common in
• Penile cancer: men
penis
• Prostate cancer:
prostate gland, a gland inside
the pelvis.

How to identify cancers of reproductive

organs in males
• Testicular cancer: Pain, discomfort, lump, or swelling in the
testis, aching in the lower abdomen (belly)
• Penile cancer: discomfort, sore, or lump on the penis
• Prostate cancer: Weak flow of urine, pain in the back, hips or
pelvis (lower belly between the hips) or needing to pass urine
often.

Testicular Cancer: Penile cancer: Prostate cancer:

Risk factors include Risk factors include Risk factors include
• Uncorrected • Having Human • Being aged 50 years
undescended testicle(s) Papilloma Virus (HPV) old or older
• Having a family history • Being uncircumcised • Having a family history
of testicular cancer • Early sexual activity of prostate cancer
• Having a testicle that is • Using tobacco • Early sexual activity
not normal products

How to prevent reproductive organ

cancers in males
• Visit the nearest health facility if you identify any symptoms
• Physical exercise and eating balanced diet.
• Delay sexual activity
• Self-examination for testicular cancer by feeling for lumps

33
9 Mental Health
Mental health refers to emotional, psychological,

and act. It also helps determine how we handle

challenges, relate to others, and make choices.

An adolescent needs good mental health to develop in a healthy

way, build strong relationships and adapt to change and deal with
life challenges.

What causes stress?

Stress is a normal part of life • Discrimination or
where the body reacts to harassment at home or in
any change that requires a school
response. • Natural disasters, theft,
Some stress in life can be rape, or violence against you
positive, but extreme, or a loved one
ongoing stress can cause • Worrying about things
problems in young people’s
• Unrealistic expectations
health, behaviour and ability
to develop and grow. • Giving a talk in front of
peers
Some of the causes of stress
are: • Failing exams
• Rejection
• Sudden change in personal
thoughts or environment

34
 Stress management
• Identify the issue that is causing the stress
• Reflect about how to overcome/ solution to the problem
• Identify opportunities that would resolve the matter
completely
• Consider sharing the problem with a trusted person

• Listen to people’s opinions and evaluate them

• In some instances, you might be refered for medical help
• Speak up in case of any form of violation or abuse whether
sexual or stigmatization
• Adapt mental health positive habits such as having enough
sleep, physical exercise, avoiding drugs and alcohol, positive social
networking and positive meditation and planning your time

Signs of stress
• Isolation • Fatigue
• Disrupted sleeping patterns • Feeling rejected by family,
• Little interest in doing your friends, colleagues
normal duties • Self-worthlessness
• Change in eating habits • Irritability
• Negative thoughts of harm to • Headache
self including death

How to avoid stress

• Keep positive attitude • Eat healthy
• Exercise regularly • Avoid conflicts with
• Get enough rest parents, teachers, peers
• Spend time with loved ones and authority
• Express your challenges
• Avoid alcohol and drugs

In case you experience any of the signs and

• Trained counselor • Religious leaders

• Parents/guardians • Teachers
• Trusted friends

35
10 Drugs & Substance
Use

Drugs are any chemical substances

(legal or illegal) when ingested,
injected or inhaled can cause a

body functioning.

Commonly abused drugs and

substances
• Alcohol • Tobacco • Miraa
• Bhang • Nicotine • Cocaine
• Shisha • Codeine • Painkillers

Consequences of abusing drugs

Substance use among adolescent ranges
from experimental to severe substance use
disorder. putting them in problems such as
• Fights
• Accidents
• Mental health disorders e.g. Stress and
suicide
• Impaired judgment
• One is highly likely to engage in crime and
violence
• Dropping out of school
• One is likely to engage in risky sexual
behavior that can result in teenage
pregnancy and contracting HIV and STIs
• Addiction
36
 How to know when one is
abusing drugs
• Unusual body smell and breath
• Poor personal grooming
• Changes in appetite
• Change in sleep patterns
• Low or lack of interest in their normal duties
• Injection marks
• Change in behavior patterns e.g. borrowing or stealing
money to buy drugs, engage in school fights, lying
• Drop in attendance and performance in school
• Sudden mood swings and irritability
• Isolation and withdrawal
• Sudden change of friends
• Identifying with drug-related personalities and symbols

NOTE: Experiencing just one or two signs

and symptoms does not mean that one is
abusing drugs.

How to avoid drug and

substance abuse
• Keep positive attitude
• Exercising regularly and naturing of talents
• Spend time with loved ones
• Express your challenges
• Eat healthy
• Avoid conflicts with parents, teachers, peers and
authority

If you need help on drug and

substance abuse, talk to:
• Trained counselor
• Religious leaders
• Parents/guardians
• Teachers
• Trusted friends
37
 11 Harmful Cultural
Practices
Harmful cultural practices are behaviours and/or
Human rights are the
basic rights and
the rights of adolescents. freedoms that belong to
every person in the
Examples of harmful cultural practices include child world, from birth until
death e.g right to life,
labour, female circumcision also called Female right to happiness, right
to freedom
Genital Mutilation (FGM) and child marriage.
Every adolescent has the right to be protected from

and social wellbeing. It’s illegal and punishable by

law in Kenya if found practicing

Child labour such outdated cultures

Child labour is considered as work

undertaken by children between
the ages of 5 and 17 years for
wages and prevents them from
normal growth and development.
As an adolescent, you need to be
in school and focus on your
studies.

While at home you need to assist

doing some house chores given to
you by your parents or guardians.
If someone wants to take you
away from school to give you
work do not accept. Report them
to your teachers, parent, guardian.

If your parent sends you away to

One day you will grow up to be an adult work so that they are paid do talk
who will be able to work and get paid, yo! to your teacher.

You can call the toll free line 116 to

report any case of child abuse.

38
 What is FGM? into adulthood or to be
Female Genital Mutilation (FGM) admitted into the community.
refers to the removal of part or all of Instead of undergoing FGM,
the female private part for non girls can be taken through
medical reasons. Girls who undergo Alternative Rites of Passage to
FGM can be injured and lose a lot of mark transition period to be
blood , become sick with infection, trained about and to celebrate
have a risk of getting HIV and in adolescence, puberty and
future they may experience
problems during child birth.
A girl does not have to undergo FGM DID YOU KNOW?
to mark transition from childhood That FGM can result to
death
Child Marriage
Marriage before the age of 18 is illegal in Kenya. Marriage at the right
time allows your body to grow and to complete your education.
For girls, if you get married as a child you will start giving birth early and
may not be adequately prepared to face the challenges of bringing up
children even as you grow and develop as an adolescent.
Child marriage is associated with dropping out of school, increased risk
of HIV infection and Gender-Based Violence (GBV).

Addressing Harmful Cultural Practices

• Initiate discussions on harmful cultural practises with people in authority
such as parents and teachers in order to find solutions that apply in your
context
• Report any of these practises to local community leaders such as the chief
or police (you can also call the toll-free lines 911, 1190, 1195 or 999)
Encourage your peers to educate others about harmful cultural practices
• Participate in alternative rites of passage that are made available by
community programmes
• In some communities, the male circumcision event is a rite of passage into
adulthood, but it does not mean that they should have sex right away
• After circumcision, adolescents are not ready to father children yet
because they have not fully matured psychologically and emotionally.
39
 Sexual and
12 Gender-Based
Violence
Gender-Based Violence (GBV) is any harmful act
carried out to someone based on them being males or
females. It includes physical, mental torture, sexual
violence, verbal abuse and denying someone a necessi-
ty (deprivation).

In most cases, the

What is defilement? person doing the
harmful act (perpetra-
An act which causes penetration of a child’s tor) is known to the
survivor and could be
genital organs (private parts). A child is any one a parent, care giver,
below the age of 18 years. sibling, close relative,
friend, neighbor or
domestic worker
What is RAPE?
It is the penetration of one person’s genital The term rape is used
organs into the genital organs of another person for persons above
18years and defilement
without their permission or where the permission is referred to persons
is obtained by force, threats or intimidation of any below 18 years
kind.

Look out for the below as potential

perpetrators
• Ignores when the adolescent
• Someone who touches you doesn’t want to be hugged or
inappropriately (touching your tickled
private parts)
• Gives you money and gifts she likes being with
without any occasion
• Doesn’t respect your privacy in
• Prefers to spends more time the toilet or bathroom
with you when adults are not
• Asks the adolescent to discuss
around
about sexual issues
• Strangers on social media who
STOP shopping or a walk when parents
are not there
are overly friendly

40
 What to do in the event of defilement
or rape
Tell a family Do not change your Visit the nearest
member or Do not wash or
bath yourself clothes, if you hospital where you
someone else you change clothes, put will be examined by
trust who can be a nurse/clinical
with you and help
step
2 them in a non
plastic bag officer /doctor
you
step
1 step
3 step
4
1190
You can also call
1195 these numbers at no
999 cost (the call is free)
0800 722 022

Care given after defilement or rape

(post rape care)
This is care that is given to any collected timely and preserved
person who has gone through correctly
any form of sexual violence. It is • To provide psychosocial
recommended to seek for support for the survivor
medical care as soon as possible
or within 72 hours for the • To ensure the survivor gets
following benefits: immediate medical or surgical
care.
• To prevent pregnancy
• Help get justice
• To prevent infection of
HIV/AIDS and STI’s
• To ensure that evidence is

What to Expect at the Hospital

• You will be required to willingly • Collection of rape evidence for
give permission for care after court
defilement or rape • Documents will be given to you/
• There will be a physical parent/care giver by the doctor
examination and collection of which will need to be kept safely
samples of blood, urine, vaginal (Post Rape Care Forms and the P3
and anal fluids taken for laboratory Forms)
tests. • You maybe referred to lawyers,
• Treatment for physical injuries police and counsellors.
• You will be given drugs for pain, • Follow up appointments
prevention of HIV, pregnancy and
41 STIs
 13 Nutrition and
Physical Activity

Growth during adolescence is faster than at any other time in a

child’s lifetime. Iron requirements also increase dramatically as a
result of the increase in total blood volume, increase in body
muscle and onset of menses in young females.
Healthy eating during adolescence is important as these body

normal to have an increased appetite and it is okay to feel hungrier

and eat more than how you are used to.
It is also important to have a balanced diet. This means your daily
meals should include vitamins, proteins and carbohydrates. Eat at
least three nutritious meals every day and two snacks
Additionally, because of loss of iron during menstruation, girls
should ensure they eat iron rich food to prevent
anaemia. Iron-rich foods include meat, fish, poultry,
iron-fortified foods, legumes, fruits and dark green
vegetables. Vitamin C (found in many fruits and
vegetables) enhances the absorption of iron from
plant food sources.

Benefits of good nutrition

• Helps in proper growth and development
• Ensures adequate normal bone development
• Helps in strengthening immunity
• Helps in prevention of lifestyle diseases such as
diabetes, hypertension, athritis among others
• Improves memory

Take time to identify locally available foods

and classify them into the nutritional
requirements
42
 Unhealthy eating habits
• Selecting food based mainly on availability, convenience and
time, rather than food value
• Being influenced by peers, mass media, prevalent body
image to guide food choice
• Poor eating habits due to low self-esteem and negative body
image
• Missing meals and excessive snacking on foods that are not
nutritious
• Choosing fast food joints over home prepared meals. These
spoil the appetite for regular meals and are high on calories
and low on nutrients.

DID YOU KNOW?

It is recommended to take 8

Physical activity glasses of water per day

Physical activity will activities such as:

strengthen your immunity, • dancing
DID YOU builds their self-esteem, • sporting activities
KNOW? reduces symptoms of (volleyball, football,
It is depression and improves
advisable to basketball, swimming,
social behaviour and walking and running etc)
be involved
in physical learning.
This will help you to
activities at It is advisable to be maintain a healthy body
least three involved in physical
times a weight, and improve your
week activities at least three fitness, body composition,
times a week. Take part in muscle and skeletal fitness.
active play and other
physically demanding
43
14 Life Skills
What are life skills?
Life skills are the abilities for adaptive and positive behavior that

challenges of everyday life.

Core life skill strategies and techniques

Self-awareness building skills
This involves being aware of one’s emotions, likes
and dislikes. It also involves viewing yourself as a
worthy human being (self-esteem) and as such
being confident in one’s thoughts and actions
which are essential tools for understanding one’s
strengths and weaknesses.

Critical thinking
Adolescents should be able evaluate the future
consequences of their present actions and the
actions of others. They need to be able to
determine alternative solutions and to analyze
the influence of their own values and the values
of those around them.

Communication/interpersonal
relationship skills
This skill includes verbal and non-verbal
communication, active listening, and the ability
to express feelings and give feedback.
Adolescents should learn how to negotiate, and
compromise or refuse when appropriate. These

ones’ ability to manage conflict.

44
 Empathy
Is the ability to listen and understand others’ needs.
Teamwork, and the ability to cooperate include
expressing respect for those around us, are part of
empathy skills. Development of this skill set enables
the adolescent to be accepted in society.

Problem solving
This skill, enables one to explore alternatives,
weigh the good sides and bad sides of every
situation and make good decisions in solving
each problem or issue as it arises.

Coping and self-control skills

Refers to skills that help you to respond to your
emotion in stressful situations and strengthen the

to set goals as well as coping with stress, anxiety,

anger, grief, loss, and trauma. Time management is
also a key life skill to learn under self-management.
Adolescents should also learn positive thinking and
relaxation techniques.
Self-control is the ability to restrain an individual’s
desires, emotions and actions.
Planning
Being able to make good plans and to carry them
out to meet your goals/purpose.

Career decisions
When deciding on a career, the adolescent should
consider what skills they have in terms of academic
skills, artistic skills, creative skills, musical skills. They
should also consider what they love doing. Finally,
they should also consider what can generate them a
source of income in future.
Refer to the topic on Career Choices for more information
45
15 Social Media

Do you chat with your

friends on WhatsApp?
You are in the social media
space.

Common Social Media Platforms

While, there are many other Social Media platforms, some of the
most popular platforms in Kenya include:

Facebook Twitter Instagram Youtube

WhatsApp Tik Tok Snapchat

With every social media account you sign up for, every picture
you post and status you update, you are sharing information
about yourself with these social media platforms and the world.
How can you make sure you and your information stay safe
online? This Chapter on Social Media Guide provides some tips to
help you safely explore the social media world.

As an adolescent, you are likely to interact with computers,

phones, tablets and other electronic devices in your everyday life
at home and in the school environment. With this, there are risks

46
 To be on the safer side, consider
these important tips
There is no ‘Delete’ button on the share it with the world.
Internet. Speak up if you’re uncomfortable.
• Think before you post, because • If a friend posts something about
even if you delete a post or picture you that makes you uncomfortable
from your profile only seconds after or you think is inappropriate, let him
posting it, chances are someone still or her know.
saw it. • Respect other people and remove
any posts that makes them become
Be mindful about sharing your uncomfortable. Also, stay open
location. minded if a friend approaches you
• Location or geo-tagging features on because something you’ve posted
social networks is not the safest makes him or her uncomfortable.
feature to activate. You could be
telling a stalker exactly where to find for how much the world knows
you or telling a thief that you are not about them, and it is important to
home.
• Connect only with people you trust.
• keep your connections to people Think about your online reputation.
you know and trust. • Start early in building a positive
online reputation. From the very first
Keep certain things private from post you make on a new social
everyone.
• Certain information should be kept

While it’s fun to have everyone wish

you a happy birthday, listing your
date of birth with your full name and
address exposes you to potential
thieves.
• Other things to keep private
includes sensitive pictures or
information about friends and family.
Just because you think something is
funny does not mean you should

47
media platform, think about how it friend or follow you)
will impact on your image and • Go through your friends and
followers lists regularly and take the
create and maintain an online time to delete those you do not
identity that strongly demonstrates trust.
integrity and maturity.
Don’t hang out with the wrong
Don’t hang out with the wrong
crowd online. • You may be careful about your
• Resist accepting every friend and posting on social media. However, if
follower request that comes your you hang out with the wrong crowd,
way. Having a lot of followers isn’t your friend may end up posting and
the status symbol some people tagging you.
make it out to be, and can just
increase your risk of victimization.
Watch out what you share.
• Giving strangers access to your
• It is important to be careful about
personal information opens you up
what you share on social media
to potential problems. It’s also true,
platforms. Before sharing content
though, that those who are most
created from other sources, be
likely to take advantage of you will
careful that it does not violate rules
be those you’ve let into your life just
and regulations.
a little bit (like allowing them to

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Like

48
 16 Career Choices
Which career would you like to pursue
after your education?
When choosing a career, it is also important ot consider your
interests, abilities, skills, academic performance, personality
traits, values, dreams and aspirations, gifts, natural talent and
future ambitions.

Career: is an occupation or profession, especially one requiring

education and special training
Talent: is an ability or strength that come naturally to an individual
resulting from learning, development and disciplined practice
Career choice: is an ongoing lifelong process of making decisions that
complement your personal attributes and help you to realize your basic
life values

Factors influencing career choices

• Academic performance
• Abilities and Talents: abilities and talents may fit a particular career
path which comes out as one of the earliest career development fields
• Social and Economic Conditions: All of our career choices take place
within the context of society and the economy
• Personality Type: Understanding your Personality can help you select
a career field that is a good fit for your personality make-up

Career guidance and counseling is given to individuals to help them

acquire the knowledge, information, and experience necessary to identi-
fy career options and narrow them down to make one career decision.

• Career counselors
• Teachers • Siblings
• Parents/guardians
49
 CROSSWORD
CROSSWORD
PUZZLE
PUZZLE
1 1

2 2

3 43 4

5 5

6 6

7 7

8 8 9 9 10 10

11 11 12 12 13 13

14 14

15 15

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that causes
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to thetobody to
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when consumed enable enable
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and guidance
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particular
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in matters that affect 2. A person
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9. The 9.
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The abdominal
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pains
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tensiontension 10. The10.
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15. A constant
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feelingfeeling
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behaviorbehavior
or usingorausing
substance
a substance

50
 List of contributors
County ASRH /RH coordinators
1. Amina Falana (Isiolo)
2. Milsane Kilpai (Bungoma)
3. Jacktone Okeyo (Kisumu)
5. Leah Ogega (Kisii)
6. Jane Owuor (Kisumu)
7. Katra Lelesiit (Samburu)
8. Clara Kerich Mitei (Nakuru)
9. Esther Kiambati (Nairobi)
10. Daniel Muli (Machakos)
11. Alice Sipidayo Kholbokha (Marsabit)
12. Catherine W. Gachanja (Murang’a)
13. George Wanzala (Bungoma)
14. Edward Mumbo (Kwale)

Adolescents

Bungoma County
1. Nkhumicha Waswa (17yrs)
2. Schemith Achieng (17yrs)
3. Melvin Nyongesa (17yrs)
4. Stella Simiyu (17yrs)
5. Stacy Kavulani (17yrs)
6. Shoune Amunga (17yrs)
7. Riziki Hillary (17yrs)

9. Maureen Kemundo (17yrs)

Isiolo County
1. Galgalo Halake (16yrs)
2. Shukri Diba (15yrs)
3. Casmir Eewoi (15yrs)
4. Agga Abdinasir (16yrs)
5. Verrarosa Ebongon (13yrs)
6. Maria Elailor (13yrs)
7. Fatuma Abdi (16yrs)
8. Jackline Wangechi (14yrs)

51
List of contributors
Nairobi county
1. Vanessa Mokeira (17yrs)
2. Talia Wanjiru (16yrs)
3. Jewel Santa (10yrs)
4. Joseph Gweth (17yrs)
5. Rose Ng’wono (17yrs)
6. Levin thuo murage
7. Mitchell brown
8. Angel Talia
9. Eddy Ngaruiya
10. Randy odhiambo
11. Mitchele Pendo
12. Miguela Pambo

Kisumu county
1. Kimberly achieng (10yrs)
2. Zainalo shaban (13yrs)
3. Hazdoline Atieno (14yrs)
4. Abdul Biko (14yrs)
5. Salwa Akinyi (14yrs)
6. John Brian Onyango (12yrs)
7. Cedrick Erocho (17yrs)
8. Benedict Omondi (13yrs)
9. Robinson Kamazu (11yrs)

Kisii county
1. Irene Nyakoi (11yrs)
2. Margaret Maubi (14yrs)
3. Jerusha Keuku (16yrs)
4. Bridgit Isaboke (15yrs)
5. Julius M Matai (13yrs)
6. Paul Moindi (11yrs)
7. Glen Mokua (15yrs)
8. Angela Ondari (16yrs)
9. Angela Kwamboka
10. Nixon ogega
11. Oigoro Emmanuel Nyamweya
12. Peter O. Mangesa
13. Glenn mokua

52
 My Notes
Machakis
MachakosCounty
County
1. Bridget ngusye Mukuma
2. Davis Kimanzi
3. Stacey Nthamba
4. Brian Mutua
5. Patricia Ngati
6. Philomena muthoka

Murang’a County
1. Dennis Kinuthia
2. Mercy Nyokabi
3. Solomon Nganga
4. Tanisha Wahura

Marsabit County
1. Biftu Hussein
2. Princess matimu
3. Leah Lentoror
4. Brian Safo

Samburu County
1. Jessica Lekirau
2. Humphrey Meitekini
3. Sylvia Lekoomet
4. Anthony Laanyu

we
appreciate
you !
Mary Magubo
Ministry of Health, Kenya.

53
My Notes
My Notes
REPUBLIC OF KENYA

Ministry of Health

For more information or additional copies, please contact:

Head, Division of Reproductive and Maternal Health,
Ministry of Health,
Old Mbagathi Road P. O. Box 43319, Nairobi, KENYA
Telephone: +254-20-272510 Fax: 254-20-2716814
Website: [Link]
Email: [Link]@[Link]

With support from: