On International Women’s Day, we celebrate women in science who dedicate their knowledge and expertise to improve the health of women throughout all stages of life. Women and girls can build a healthier future for generations to come and it is important nourish, educate, and empower them. Today, we are pleased to feature a story of one researcher’s journey to self-empowerment through her research explorations.
In March and September of 2017, Global WACh highlighted Dr. Linnet Masese (then a Postdoctoral Fellow at the UW Department of Medicine and Clinic Section Head at the UW/University of Nairobi Research) and three published manuscripts from her study supported by Global WACh seed grant funding in 2011. The grant award marked her entry into adolescent reproductive health research, a field she has grown to love despite the challenges accompanying clinical research on adolescents. These include long waits for ethical committee review approvals, low participant recruitment and retention, and issues around consent, confidentiality, and parental roles in supporting in the research protocol. The challenges she faced and overcame have only fueled her passion in this field.
“I had always worked with adolescents through my church but working on adolescent reproductive health provided a distinctive avenue through which I could impact and train the girls on reproductive health matters. Besides talking about reproductive health issues, visiting high schools and universities provided a mentorship avenue. I have been able to reach out to and inspire many girls and young women. This has turned out to be an immensely rewarding experience.”
As part of her doctoral research at UW under the mentorship of Dr. Scott McClelland, Dr. Masese conducted a study to assess the incidence and correlates of chlamydia in a cohort of high-risk women in Mombasa, Kenya. Their research demonstrated that the incidence of chlamydia infection among young women under 25 years in Mombasa who reported transactional sex was 27.6/100 person-years, meaning 1 in every 4 young women acquired chlamydia during the study period. They presented their findings to visiting faculty from the University of Nairobi (UoN) in 2011. One of the faculty members, Dr. Grace Omoni asked if she had ever considered expanding her research to the general population of adolescents and young women, given the startlingly high incidence among high-risk women. Because young women in Kenya bear the greatest burden of sexually transmitted infections (STIs), Dr. Masese took this question to heart.
“Luckily, this was around the time Global WACh put out its first call for the Integrated Health Seed Grant proposals!”
With Dr. McClelland’s help, she drafted a full proposal to conduct a study employing qualitative and quantitative methods to understand the feasibility of screening for STIs among female students (age 15-24 years) in high schools and colleges. The qualitative component included in-depth interviews and focus group discussions among adolescents, young women, parents of adolescents, and institutional leaders. The quantitative component involved STIs urine screenings of young women. After the proposal was awarded, Dr. Masese initiated the qualitative work as soon as ethical approval was granted.
Complexities around parental notification, confidentiality, and stigma soon arose. Dr. Masese demonstrated her ability to listen, understand, and consider everyone’s viewpoints and still meet her research goals. In brief, she found that young women were willing to be screened for STIs and parents were willing to allow their adolescent daughters to be screened. School settings, however, were not a preferred testing location, due to stigma. Therefore, sample collection and testing were conducted at the UW/UoN Clinic at Ganjoni and the UW Research Laboratory in Mombasa respectively. With some adolescents and young women divided on their willingness to share test results with their parents, Dr. Masese worked with the Kenyatta National Hospital Ethics and Research Committee to determine the best, straightforward approach—to share results with parents only if their daughters gave verbal consent to do so.
Following the qualitative phase, she helped developed a school-based recruitment strategy linked to a clinic-based intervention, which successfully screened 451 girls and young women for STIs using a urine nucleic acid amplification test. The overall prevalence of STIs in this population was 5.8%. Self-reported unprotected sex was associated with a 6-fold higher odds of having an STI. Overall, Dr. Masese’s study and subsequent publications suggest that expanded school-based interventions are possible and can be a way to encourage adolescents and young women to seek STI screening, care, and support. The results also suggest that STI screening interventions are feasible and acceptable when conducted in collaboration with students, parents, and influential members of the community.
Following the success of the study and gain of valuable research experience, Dr. Masese received funding in 2014 from the Fogarty International Center through the Northern Pacific Global Health Fellowship for a new adolescent study. In this study, she used a method called “capture-recapture” to estimate the population size of girls 9-13 years who were not enrolled in school. This population is important to follow in vaccination planning, as they would be missed by a school-based HPV vaccination program. To further inform vaccine preparedness, Dr. Masese and her team will also quantify prevalence and correlates of high-risk HPV infection in 13-17 year old girls, both in and out of school.
Dr. Masese says she is excited about adolescent reproductive health research and hopes to continue working and impacting young people in Kenya and other parts of the world. As she offers gratitude to Global WACh for helping her start her research career path, we show gratitude to her and all extraordinary women researchers for striving to improve life for themselves and for all women.