The Leke project: A journey to the Isala sister project in Cameroon

The core mission of the Isala project is to spread awareness on how the vaginal microbiome is key to women’s health. Beneficial microorganisms present in the vagina, depending on their type, contribute to the prevention of certain diseases. However, data on  the specific types and taxa of vaginal bacteria that are protective and how lifestyle and other factors can promote their occurrence, is still scarce in many parts of the world. This limited availability of data is a severe hindrance for the optimal design of strategies for prevention of undesired vaginal conditions. In addition, discussing vaginal health is still taboo in many places across the world, including Cameroon, my home country. For these reasons, we are addressing some of the gaps in women’s health research by establishing the Leke project, as Isala sisterhood citizen-science project in Cameroon, Central Africa.

Meet the Leke project

Why did we choose the name ‘Leke’? We wanted to honor an inspiring women and role mode from our home country. Rose Leke is an emeritus professor of immunology and parasitology. She is among the most prominent scientific people across Africa and she is an ardent advocate of both women’s health and women in science. Her  area of research is infectious disease immunology, with a particular focus on placental malaria. She is amongst the most impactful Cameroonian scientist as she has contributed to the elimination of several vaccine preventable diseases. We strongly believe she is the right person to represent the vision of the Isala sister project in Cameroon.

In the Leke project, we aim to investigate vaginal health and raise awareness on optimal vaginal practices in Cameroon. It is part of our mission to increase knowledge on vaginal health, break taboos, and thereby encourage discussions on these intimate health topics. To the best of our knowledge, it is the first time in Cameroon that a project has been established where women are placed at the centre of the research and are encouraged to fully participate and take ownership of their health.

Women do not only provide vaginal swabs, but in return they receive knowledge on their vaginal health, so that they can hopefully take their vaginal health in their own hands in the (near) future, including timely consultations with their gynaecologist. In addition, the participating women also exchange information with the scientists on their own practices and experiences to fully grasp the citizen science aspect of it. This concept is very much in line with the current needs of the women in Cameroon, just as in other parts of the world. As we know, access to health care is limited and costly, and health insurance systems are absent in some countries such as in Cameroon. Disease prevention should be a priority, especially for women. The optimal vaginal practices we promote, will help women to protect their vaginal ecosystem and to avoid certain diseases.

Every woman involved in the Leke project is an ambassador to her community. This relates to a beautiful African proverb  saying: ”a woman you educate is a family you win’’. This translates the idea that if a woman has the correct knowledge on vaginal health, applies it, and encourages those around her to do the same, then the impact on society will be great. With this project, we try to make each woman aware of her vaginal health and that of those around her.

“A woman you educate is a family you win”

With each woman taking part in the study, we held an active discussion during which we talk about optimal vaginal practices. First, we wanted to know what women do themselves and what they know in this field. Then we gave women advice on what to avoid (for example vaginal douching, wearing wet or damp undergarments for a long period), what to maintain (for example eat a healthy diet, and drink plenty of water, wear breathable underwear preferably in cotton) and how to recognize alarm signs (for example abnormal vaginal discharge and vaginal odour). We encouraged all participating women to talk about vaginal health with their peers, so that optimal vaginal practices can be adopted and women can remain in good health. After obtaining the preliminary results of their vaginal swabs, namely the outcome of the bacterial vaginosis test, we discussed each woman’s results individually, with thorough explanations on their meaning. The same approach will be used when obtaining the results of the women’s microbiome profiles in conformity with the Isala and other sisterhood projects.

The awareness campaign

In the first phase of the Leke project, being the awareness campaign, we have targeted two towns in Cameroon: Yaounde, an urban area, and Gounougou, a rural area. These towns are dramatically different in terms of living environment, lifestyle, dietary habits and ethnic group. The city of Yaounde is the capital city of Cameroon which is a cosmopolitan harbor of people from various regions of the country (6 out of 10 regions in Cameroon) with varying dietary habits. We have enrolled about 7 ethnic groups among those found in Cameroon: Fangs, Bamileke, Bamoun, Bassas, Peuls, Beti and Bakewi. Conversly, the village of Gounougou, North Cameroon has a more homogeneous setting with people of  the same region (the Northern Region) with roughly the same lifestyle, practically the same hygiene practice, and a similar diet, mainly based on the consumption of vegetables and fish. In each setting, we recruited women who met the pre-set eligibility criteria. This includes women who gave their informed consent, do not have a known illness or complication and are not on antibiotic treatment or other medicines at the moment of sample collection. They voluntarily provided vaginal swabs, which will be analyzedto characterize their vaginal microbiome. The awareness campaign took place differently in these two settings. In Yaounde-urban area, we engaged the discussion on social media and in person.  

We engaged discussion with women in the urban areas. Here we were talking with two young girls about vaginal health.

In Gounougou-rural area, we had a different approach. Gounougou is a patriarchal society, which means that we would not have access to the women without having permission a priori from the  men. Here, topics such as sexuality or vaginal health are still very taboo. It was a challenge for the Leke team to address these topics even more, publicly.  But we definitely wanted to take up this challenge, by also involving the men in the process. We had a meeting with the men of the village, and emphasized their responsibility as heads of households in supporting women in taking care of their vaginal health. Against all fears, the message was well received. We easily discussed vaginal health-related topics. The men were open to discussion and asked lots of questions. They were interested in what we had to say, and some even took notes!

First, we met the chief of the village. We introduced the Leke project to him and the importance for his population.
We had a fruitful exchange with men of the village (picture 1).
We had a fruitful exchange with men of the village (picture 2).

Subsequently, we engaged in discussion with the women. Together with the community agent, we raised awareness on women’s health in markets, in churches, and door-to-door, and then organized a general health campaign. Community agents are generally found in villages and act as a bridge between the village community and the medical team as they are highly trusted by the former. When you want to work in a village or most rural settings, community agents are essential.

We had an intimate discussion with women of the village.
Training of hospital’s medical staff (picture 1).
Training of hospital’s medical staff (picture 2).

It was a fabulous adventure so far, the exchanges with both women and men were fruitful. For the women, it felt as if they really needed to express themselves and needed someone to talk to. Also, we noticed that they were genuinely eager to help to break taboos surrounding vaginal health. Moreover, the exchanges allowed us to understand a lot about the misinformation that was in circulation on the subject of vaginal health and some potentially harmful habits that women were adopting such as using hands to clean the vagina, prolonged use of lace underwear, and use of soap to clean the vagina.

Descent to rural Gounougou was done by this amazing team (including: students, nurse and community agent).

Stay tuned for updates on our follow-up work! 😊

Who am I?
Hi! My name is Josiane Kenfack. I am a double PhD student at the University of Yaounde I in Cameroon and at the University of Antwerp in Belgium. My passion lies in women’s health research, especially on understanding the contribution of the vaginal microbiome in women’s health. As a woman I feel concerned about women’s health issues. I would like to actively participate in improving women’s health. When I encountered Isala on Twitter, I was delighted to see a group of researchers and ambassadors who shared the same vision as me. Now, I am grateful to be part of this wonderful sisterhood, as one of the coordinators of the Isala sister project in Cameroon, called The Leke project. Our team’s aims are to characterize the vaginal microbiome of healthy women from both urban and rural areas of Cameroon and to raise awareness on vaginal health.
My passion for women’s health research partly arose from my living environment, where many factors prevent women from pursuing their studies. As the first person in my family to attend University and while I am on my way to reach the doctoral level, I am even more motivated to sensibilize women on a variety of topics, including their vaginal health. Also, I would like to motivate the girls in my community to go further into scientific education and research. Thus, I particularly like the words of Isala: ’Together we can write history’.
I like the atmosphere of the Isala team. I feel totally at home when communicating with them and I learn so much from these fabulous scientific women. Once again, special thanks to professor Sarah Lebeer, Dr. Sarah Ahannach and Dr. Sandra Condori. You are such inspiring women and role models to me. Together we will write history on women’s health research.
Our Leke team has already done a fantastic job and I am delighted to present this work to you in this blog. And guess what? We are thrilled to have our brand-new application approved to study the impact of menstrual health management on the vaginal microbiome in Cameroon. This truly is great news.😊
I cannot wait to get this amazing adventure started.