Medium term impact of school-based interventions for girls transitioning into adulthood

This research will follow-up adolescent girls and young women (AGYW) enrolled in a prior 4-arm (investigating menstrual cups, cash, cups plus cash, against controls) school-based randomised-controlled trial (SERU #3215) to measure if prior interventions provided to secondary schoolgirls have a sustained, complementary, or lag effect on sexual and reproductive health (SRH), mental health, and social equity as AGYW transition into adulthood after trial closure. It will examine if gains are lost or if outcomes converge to those of AGYW who received no prior interventions. The follow-up will evaluate if positive lag effects occur. Additional outcomes such as mental health, community perceptions of trial outcomes, continued use and safety of menstrual cups, and COVID-19 impacts will be evaluated. We aim to re-enrol ~90% of original cohort of 4137 participants and conduct two biomarker, socio-behavioural and mental health surveys, between July 2022 and December 2024. Measures will evaluate if prior interventions effect the incidence of HIV, HSV-2, gender-based violence, mental health, age at first marriage, age-equitable partners/husbands, age at first birth, contraceptive use and fertility, maternal, neonatal and child outcomes, e.g. proportion of low birth weight, stillbirth, and neonatal mortality, and health decision-making (e.g. health care seeking, vaccination status). Facility records will be interrogated to capture and validate outcomes.

Where does the project lie on the Translational Pathway?

T2 (Human/Clinical Research)

Expected Outputs

Publications – PhD candidate can negotiate area of interest, leading on subject of choice – we would anticipate at least 5 publications as 1st/2nd author, and numerous others as a co-author

Funding – MRC funder remain interested in this area of study, with potential of next stage grant evaluating longer-term impact; findings from this study will also contribute toward other grants on girls and young women’s health (and their children) across the life-course.

Impact – data from study will feed into policy on health of adolescent girls and young women, and their babies, to menstrual health, sexual and reproductive health, mental health, and to deliberations by international agencies on provision of menstrual cup, and cash transfer for social equity.

Training Opportunities

Field epidemiology, managing large-scale projects, qualitative methods, statistical analyses. Other courses TBD

Skills Required

Basic statistical skills

Key Publications associated with this project

Mason L, Zulaika G, van Eijk AM, Fwaya E, Obor D, Phillips-Howard PA, Nyothach E. You don’t have to sleep with a man to get how to survive’ Girls perceptions of an intervention study aimed at improving sexual and reproductive health and schooling outcomes, PLoS Global Health, 2(10): e0000987, 2022.

Zulaika G, Bulbarelli M, Nyothach E, van Eijk AM, Mason L, Obor D, Ngere I, Mehta SD, Phillips-Howard PA. Impact of COVID-19 school shutdowns on adolescent pregnancy and school dropout among Kenyan secondary schoolgirls, BMJ Global Health, 7:e007666, 2022.

Zulaika G, Nyothach E, van Eijk AM, Obor D, Mason L, Wang D, Oyaro B, Opollo V, Owino S, Ngere I, Chen T, Kerubo E, Kwaro D, Phillips-Howard PA. Factors associated with the prevalence of HIV, HSV-2, pregnancy, and reported sexual activity among adolescent girls in rural western Kenya: A cross-sectional analysis of baseline data in a cluster randomized controlled trial. PLoS Med 18(9): e1003756, 2021.

Mehta SD, Zulaika G, Otieno F, Nyothach E, Agingu W, Bhaumik R, Green SJ, van Eijk AM, Kwaro D, Phillips-Howard PA. High Prevalence of Lactobacillus crispatus Dominated Vaginal Microbiome Among Kenyan Secondary School Girls: Negative Effects of Poor Quality Menstrual Hygiene Management and Sexual Activity Frontiers Cellular and Infection Microbiology, 11:716537, 2021.

van Eijk AM, Zulaika G, Lenchner M, Mason L, Sivakami M, Nyothach E, Unger H, Laserson KF, Phillips-Howard PA. Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis. Lancet Public Health; 4(8), e376-393,  2019.

LSTM Themes and Topics – Key Words

Maternal, Newborn, and Child Health

Public Health



Application Portal closes: Thursday 9th February 2023 (12:00 noon UK time)

Shortlisting complete by: End Feb/early March 2023

Interviews by: Late March/early April 2023

Further information on the MRC CASE/DTP 2023/24 programme and how to apply can be found here