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Menstrual cups and cash transfer to reduce sexual and reproductive harm and school dropout in adolescent schoolgirls: study protocol of a cluster-randomised controlled trial in western Kenya

Zulaika, Garazi, Kwaro, Daniel, Nyothach, Elizabeth, Wang, Duolao ORCID:, Zielinski-Gutierrez, Emily, Mason, Linda, Eleveld, Alie, Chen, Tao ORCID:, Kerubo, Emily, vanEijk, Anna ORCID:, Pace, Cheryl, Obor, David, Juma, Jane, Oyaro, Boaz, Niessen, Louis ORCID:, Bigogo, Godfrey, Ngere, Isaac, Henry, Carl, Majiwa, Maxwell, Onyango, Clayton O, terKuile, Feiko ORCID: and Phillips-Howard, Penelope ORCID: (2019) 'Menstrual cups and cash transfer to reduce sexual and reproductive harm and school dropout in adolescent schoolgirls: study protocol of a cluster-randomised controlled trial in western Kenya'. BMC Public Health, Vol 19, Issue 1, e1317.

PUBH-D-19-00698_R3_FinalDecision_BMC PH_GZ.pdf - Accepted Version
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Adolescent girls in sub-Saharan Africa are disproportionally vulnerable to sexual and reproductive health (SRH) harms. In western Kenya, where unprotected transactional sex is common, young females face higher rates of school dropout, often due to pregnancy, and sexually transmitted infections (STIs), including HIV. Staying in school has shown to protect girls against early marriage, teen pregnancy, and HIV infection. This study evaluates the impact of menstrual cups and cash transfer interventions on a composite of deleterious outcomes (HIV, HSV-2, and school dropout) when given to secondary schoolgirls in western Kenya, with the aim to inform evidence-based policy to improve girls’ health, school equity, and life-chances.

Single site, 4-arm, cluster randomised controlled superiority trial. Secondary schools are the unit of randomisation, with schoolgirls as the unit of measurement. Schools will be randomised into one of four intervention arms using a 1:1:1:1 ratio and block randomisation: (1) menstrual cup arm; (2) cash transfer arm, (3) cups and cash combined intervention arm, or (4) control arm. National and county agreement, and school level consent will be obtained prior to recruitment of schools, with parent consent and girls’ assent obtained for participant enrolment. Participants will be trained on safe use of interventions, with all arms receiving puberty and hygiene education. Annually, the state of latrines, water availability, water treatment, handwashing units and soap in schools will be measured. The primary endpoint is a composite of incident HIV, HSV-2, and all-cause school dropout, after 3 years follow-up. School dropout will be monitored each term via school registers and confirmed through home visits. HIV and HSV-2 incident infections and risk factors will be measured at baseline, mid-line and end-line. Intention to treat analysis will be conducted among all enrolled participants. Focus group discussions will provide contextual information on uptake of interventions. Monitoring for safety will occur throughout.

If proved safe and effective, the interventions offer a potential contribution toward girls’ schooling, health, and equity in low- and middle-income countries.

Item Type: Article
Subjects: WA Public Health > WA 20.5 Research (General)
WA Public Health > Health Problems of Special Population Groups > WA 309 Women's health
WP Gynecology > WP 100 General works
WP Gynecology > Anatomy. Diseases. Injuries > WP 400 General works
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
Depositing User: Cheryl Giddings
Date Deposited: 04 Nov 2019 16:23
Last Modified: 13 Mar 2020 16:12


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