Utilization of Adolescent-Friendly Health Services in Mathare Informal Settlement, Nairobi, Kenya: Cross-sectional Study

Abstract

Adolescent-friendly health services are essential for addressing the unique health needs of young people, particularly in informal settlements where access to quality healthcare is often limited. This study examined the utilization of AFHS among adolescents in the Mathare informal settlement, Nairobi, Kenya, with a focus on socio-demographic characteristics, health system factors, and adolescents' perceptions of service quality. A cross-sectional study design was employed, utilizing a structured questionnaire administered to a randomly selected sample of adolescents aged 15-19 years. Descriptive statistics were used to summarize the data, while logistic regression identified factors associated with AFHS utilization. Results showed significant associations between adolescent education level (χ2 = 4.54, p=0.033), type of school attended (χ2 = 24.05, p=0.001), religion (χ2 = 16.32, p=0.001), parent’s living status (χ2 = 28.71, p=0.001), and parent’s occupation (χ2 = 24.76, p=0.0001), as well as father’s (Fisher's exact p=0.001) and mother’s education levels (Fisher's exact p=0.001) with AFHS utilization. Health system factors, including waiting time (Fisher's exact p=0.049) and staff communication (χ2 = 63.22, p=0.0001), were also significantly associated with AFHS use. Additionally, the opportunity to ask questions in nearby health facilities was linked to higher utilization (χ2 = 20.42, p=0.0001). Perceived health risks among adolescents were significantly associated with AFHS use (Fisher's exact = 0.004). Key barriers identified included limited accessibility, insufficient healthcare worker training, and concerns about confidentiality. The findings underscore the need for targeted interventions, comprehensive policies by the MOH, improved resource allocation, and specialized training for healthcare workers. The study recommends the use of mobile clinics, awareness campaigns, and peer education programs to enhance service utilization. Collaborative efforts between AFHS centers, community leaders, schools, and youth organizations are essential for improving access and addressing socio-economic barriers in informal settlement