Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India

Changes in the menstrual hygiene management facilities and usage among Bangladeshi school girls and its effect on school absenteeism from 2014 to 2018

BACKGROUND

The lack of menstrual hygiene management (MHM) information and facilities in schools is a major contributor to adolescent girls' school absenteeism in low- and middle-income countries like Bangladesh.

OBJECTIVES

This paper examines the changes over time in school MHM facilities, knowledge and perceptions among adolescent girls, in relation to school absenteeism between 2014 and 2018 in Bangladesh.

METHODS

We examined changes in MHM and school absenteeism among schoolgirls using nationally representative data from the Bangladesh National Hygiene Baseline Survey 2014 and National Hygiene Survey 2018. Given the repetitive nature of our data and its clustering within participants, our method included performing descriptive analysis, bivariate analysis, and multivariate Generalised Estimating Equation (GEE) modelling to analyse these changes.

RESULTS

Results showed that adolescent girls' menstruation-related absenteeism decreased between 2014 and 2018. Percentage of adolescents who missed school decreased from 25% to 14% (PD: -11; CI: -16 to -6.1), while the average number of missed days reduced from 2.8 to 2.5 (PD: -0.33; CI: -0.57 to -0.10). In the GEE model, we found that living in rural areas (coef: -5.6; CI: -10.06 to -1.14), parental restrictions on going outside (coef: 4.47; CI: 0.75 to 8.2), education levels of girls (coef: -9.48; CI: -14.17 to -4.79), girl's belief that menstruation affects school performance (coef: 23.32; CI: 19.71 to 26.93), and using old cloths (coef: -4.2; CI: -7.6 to -0.79) were significantly associated with higher absenteeism. However, participant's age, type of school, knowledge of menstruation before menarche, receiving information regarding MHM, separate place for changing absorbents, and separate latrine and urine facility were not significantly associated with the changes in absenteeism over time.

CONCLUSION

This paper emphasised the associations between changes in school absenteeism, parental restrictions on students, students' education levels, and menstruation-related misperceptions. Ongoing research, policy reviews, and targeted interventions to improve MHM perceptions among girls are required to provide long-term benefits for adolescent girls in Bangladesh.

Menstrual health inequities and "period poverty" in Canada

Period poverty is the lack of access to menstrual products, sexual and reproductive health education, safe waste management, and adequate facilities. Despite its being a public health issue and a significant concern for numerous Canadians, there is a lack of peer-reviewed research on period poverty in Canada. Existing Canadian research has primarily been conducted by non-profit organizations/charities or industry leaders for menstrual products, resulting in incomplete data. More research is needed to explore the menstrual inequities in Canada and their impact on the well-being of Canadians. This is a critical step to ensure the menstrual needs of Canadians are appropriately addressed.

Post-Toilet Wiping Style Is Associated With the Risk of Urinary Tract Infection in Women

INTRODUCTION

Urinary tract infection (UTI) has a lifetime incidence of ≥50% in women. A wide variety of clinical, physiological, and lifestyle risk factors for UTI have been identified, but the exact relationship between post-toilet anal and perineal hygiene practices, especially the wiping direction with toilet paper, and UTI risks has not been investigated yet. Therefore, this study cross-sectionally investigated the post-toilet wiping habit and lifetime UTI events in the general population.

METHODS

Individuals who visited two hospitals in Japan between April 2020 and March 2023 were initially recruited. Self-reported questionnaires regarding post-toilet wiping habits and past UTI events were collected, and their relationship was investigated in males and females. Subgroup analyses by age were further performed to estimate the impact of age on the relationship.

RESULTS

A total of 294 individuals (141 males and 153 females) agreed to participate and answered the question of post-toilet wiping direction. The number of individuals with post-toilet wiping with the arm from the front between the legs was 32 (23%) in males and 68 (44%) in females. The lifetime UTI events were more frequent in females than in males (p<0.0001). The impact of post-toilet wiping with the arm from the front between the legs on UTI events, adjusting for the age and history of diabetes mellitus, was not statistically significant both in males and females (p≥0.10 for both). Meanwhile, when the relationship was evaluated by different age groups, wiping habits from the front and UTI were significantly associated with each other in middle-aged women aged 40-59, whereas they were not in younger and older age groups.

CONCLUSION

Approximately 40-50% of women performed post-toilet wiping with the arm from the front between the legs. This post-toilet wiping habit was suggested to be a potential risk of UTI in women, especially in middle-aged subgroups, and may be better to be changed to wiping from behind.

Uncovering the linkage between sustainable development goals for access to electricity and access to safely managed drinking water and sanitation services

Efforts to improve access to electricity and access to water and sanitation often go hand in hand, as they are essential components of sustainable development. By ensuring access to electricity, communities can have improved access to safe and reliable water supply and sanitation services, leading to better health outcomes, enhanced livelihoods, and overall development. This study investigates the effects of access to electricity on access to safely managed drinking water and sanitation services in 19 African countries from 2000 to 2020. Driscoll-Kraay standard errors and IV-GMM estimation techniques are used to estimate the relationship. The results show that access to electricity is positively associated with the percentage of people using safely managed clean water and sanitation services. The results also show that access to safely managed clean water and sanitation facilities in urban and rural areas turns out to be increased as far as access to electricity increases. The findings indicate that access to electricity reduces urban-rural inequalities in access to clean water and sanitation facilities. The sub-regional analyses conducted reveal that these findings are robust across SSA countries. Lastly, the findings reveal that GDP per capita, globalization, FDI and urbanization are channels through which access to electricity contributes to increasing access to safely managed water and sanitation services. African governments should implement policies that highlight the transformative potential of reliable electricity supply in ensuring sustainable and equitable access to clean water and proper sanitation facilities to safeguard public health and well-being.

"Gender-Based Water Violence": Cross-Cultural Evidence for Severe Harm Associated With Water Insecurity for Women and Girls

We examined how study participants in Indonesia and Peru viewed the relationship between water insecurity and women's health via thematic analysis of interviews and focus groups. Participants reported that water insecurity led to vaginal infections, miscarriage, premature births, uterine prolapse, poor nutrition, restricted economic opportunities, and intergenerational cycles of poverty. Participants in both countries stated that extreme burdens associated with water insecurity should be categorized as violence. Based on these findings, we developed the concept of "gender-based water violence," defined as the spectrum of stressors associated with water insecurity that are so severe as to threaten human health and well-being, particularly that of women and girls.

Utilization of modern menstrual methods and related unmet needs among college going women in Coimbatore district: a descriptive cross-sectional study

OBJECTIVES

The primary objectives were to determine the proportion of modern menstrual method (MMM) users among college going women in Coimbatore district, Tamil Nadu; and to estimate the unmet needs associated with use of MMMs in comparison with other menstrual hygiene methods (MHMs). We also assessed the factors that determine MMM use among college going women.

METHODS

This was a descriptive cross-sectional study conducted among college going women in Coimbatore district, Tamil Nadu, India between October 2022 and January 2023 using a purpose predesigned, pretested, semi-structured proforma that included validated Menstrual Practice Needs Scale (MPNS-36).

RESULTS

Only 1.4% of the study participants used MMMs - menstrual cups (1.3%) and tampons (0.1%). Sanitary pads were the most common MHM of choice (96.3%); of which majority (98.6%) used disposable pads and more than half (50.4%) used non-biodegradable pads. Importantly, one in six (16.5%) were not aware of nature of sanitary pads (biodegradable or nonbiodegradable) used. The unmet needs associated with MMMs (menstrual cups and tampons) were significantly lower than that for other MHMs (including sanitary pads), in particular, the unmet material and home environment needs, unmet material reliability concerns, unmet reuse needs and unmet reuse insecurity. However, we found no significant difference between MMMs, sanitary pads and other MHMs in terms of unmet transport, college environment, change and disposal insecurity needs. The significant predictors of use of MMMs were age (more than 21 years of age), residence (urban), type of stay (off campus including home), socioeconomic status (upper), fathers' and mothers' education (high school and above), and presence of personal income. Discussions with friends (or peers) both before and after menarche regarding menstruation resulted in higher adoption of modern menstrual methods.

CONCLUSION

MMMs provided comparative advantage with lesser unmet needs for material reliability and reuse insecurity concerns, particularly in home environment. However, none of the MHMs fulfilled the user expectations for transport and disposal insecurity concerns, particularly outdoors.

Feasibility study of a menstrual health behaviour change intervention for women and girls with intellectual disabilities and their caregivers for Vanuatu's humanitarian responses

The Veivanua campaign is a menstrual health intervention for people with intellectual disabilities and their caregivers in Vanuatu's humanitarian setting. The campaign was adapted from the Bishesta campaign delivered in Nepal's development setting. This feasibility study is designed to assess the feasibility and acceptability of the Veivanua campaign to understand if efficacy testing is warranted. The Veivanua campaign was delivered to a preselected group of 30 young people (individuals with intellectual disabilities) and 35 caregivers (males and females). Data were collected through several qualitative tools to allow for methods triangulation: process monitoring, post-intervention in-depth interviews with caregivers and nine young people, observation of young persons, photovoice and ranking with two young people, campaign resource ranking, and key informant interviews with staff involved in the intervention. Data were analysed thematically using Nvivo 12. Results show that the Veivanua campaign is feasible. Male and female caregivers reported an increased ability to support young people's menstrual health and greater preparedness for the next emergency. Young people understood the training and applied their learning. Key informants want to scale up the intervention in their humanitarian responses. Several changes were made to the adapted campaign, but similar outcomes were recorded in Nepal and Vanuatu. All target behaviours improved, and campaign resources were used, but many caregivers found the menstrual calendar confusing. The intervention was not delivered with fidelity but responded to the context. The campaign cost more than the Bishesta campaign because procurement was more expensive in Vanuatu. In conclusion, this is the first intervention globally, so it begins to fill a substantial gap, but more must be done. As the Veivanua campaign is feasible, it requires efficacy testing in Vanuatu. It should also be adapted to humanitarian crises in other countries to support the menstrual health of this previously excluded population.

Urinary and reproductive tract infection symptoms and menstrual hygiene practices in refugee camps in Jordan: A cross-sectional study

BACKGROUND

Urinary tract infections and reproductive tract infections pose significant health risks, particularly among women living in challenging conditions. Unhygienic menstrual practices can exacerbate these risks, impacting physical and psychological well-being.

OBJECTIVES

This study assessed the association between unhygienic menstrual care and self-reported urinary tract infection/reproductive tract infection symptoms among refugee women. In addition, it explored the association between these symptoms and mental health, specifically depressive symptoms.

DESIGN

This study adopted a cross-sectional observational design.

METHODS

This study was conducted between January and March 2023, involving 387 reproductive-age refugee women. Data collected included sociodemographic information and urinary tract infection/reproductive tract infection symptoms. In addition, we used the Menstrual Practice Needs Scale to evaluate menstrual hygiene practices and the Patient Health Questionnaire-9 for depressive symptoms. Statistical analysis was performed using Python version 3.9.12.

RESULTS

Of 387 refugee women, 92.25% reported having urinary or reproductive tract infection symptoms in the previous 3 months. Factors like older age (odds ratio = 1.764, 95% confidence interval = 1.083-2.873, p-value = 0.023), lower family income (odds ratio = 0.327, 95% confidence interval = 0.138-0.775, p-value = 0.011), lower educational level (odds ratio = 0.222, 95% confidence interval = 0.068-0.718, p-value = 0.012), and being married (odds ratio = 0.328, 95% confidence interval = 0.188-0.574, p-value < 0.001) were significantly associated with urinary or reproductive tract infection risk. Difficulties obtaining menstrual products and thus reusing them increased the odds of urinary or reproductive tract infection diagnosis (odds ratio = 2.452, 95% confidence interval = 1.497-4.015, p-value < 0.001). Women with urinary or reproductive tract infection symptoms exhibited higher Patient Health Questionnaire-9 scores than those without (12.14 ± 5.87 vs 9.99 ± 5.86, p-value < 0.001, respectively).

CONCLUSION

This study highlights a high prevalence of urinary or reproductive tract infection symptoms among refugee women residing in camps in Jordan, which was associated with poor menstrual hygiene practices and depressive symptoms. To reduce the urinary tract infection/reproductive tract infection burden in marginalized communities, public health initiatives should enhance healthcare accessibility, provide reproductive education, and promote holistic well-being practices for refugee women.

Menstrual hygiene practices of adolescent secondary school girls in rural Anambra communities

BACKGROUND

Adolescent girls face numerous challenges which hinder their ability to manage menstruation in a healthy and dignified manner.

OBJECTIVES

To examine the menstrual hygiene practices of adolescent girls schooling in rural Anambra communities.

STUDY DESIGN

Cross-sectional descriptive study.

METHOD

Participants were selected using multistage stratified random sampling technique and interviewed using self-administered semi-structured questionnaire. Data were analysed using Statistical Package for Social Sciences version 22.0.

RESULTS

Mean age of all, pre-menarche and post-menarche girls were 14.7 ± 1.84, 12.8 ± 1.09 and 15.1 ± 1.73 years, respectively. About 46% of the pre-menarche girls had not received any information on menstruation. Common sources of initial menstruation information were mother (87.3%), school (52.2%) and peers (20.0%). Among the 1091 (85.0% (1091/1283)) post-menarche girls, last menstrual period, last menstrual period duration and cycle length could not be recalled by 53.9%, 34.4% and 39.3%, respectively. Majority (98.3%) who could recall last menstrual period had a cycle length of ⩽30 days and the mean duration of menses was 4.4 ± 0.84 days. Disposable sanitary pad was mostly (60%) cited as recommended product, but cloth/rags (40.6%) or tissue paper (32. 3%) were predominantly used. Majority (88.6%) took their bath ⩾twice/day, 50.9% changed sanitary product ⩽twice/day while 72.5% exhibited poor hand washing. Sanitary products were mostly discarded by burning (45.4%). Fifty-one percent could not change in school predominantly due to lack of functional toilets/changing rooms (84.2%) while 72.5% of those who changed did so in bushes or unused spaces. Challenges faced during menstruation include restriction from holy places (38.9%), waist pain (74.9%), blood stains (36.1%) and lack of money to buy pad (27.0%). Factors significantly associated with using commercial pads were age (p = 0.047), class (p = 0.006), mother's educational status (p < 0.001), social class (p < 0.001), ability to recall last menstrual period date (p = 0.029) or duration (p = 0.001).

CONCLUSION

Menstrual hygiene management was unsatisfactory among studied adolescents. Continuous education of adolescent girls on menstrual hygiene management and advocacy for adequate menstrual hygiene management support are imperative.

A Multimodal Qualitative Approach to Understanding Menstrual Health Equity among Adolescents and Young Adults

STUDY OBJECTIVE

Menstrual inequity-unequal access to menstrual health care or products-negatively affects well-being in relation to the menstrual cycle, a construct known as menstrual health. Few studies have explored menstrual inequities among adolescent and young adult populations in the United States. This multimodal qualitative research aimed to explore factors that influence the lived experience of menstruation among this population.

METHODS

This qualitative study consisted of individual interviews among menstruators ages 13-24, recruited from an urban academic medical center. Participants (N = 20) were a mean age of 19 years; 25% previously endorsed period poverty, and 90% were publicly insured. We conducted semi-structured interviews using participant video diaries in a video elicitation exercise. Data were coded by 2 investigators using thematic analysis driven by grounded theory.

RESULTS

Emergent themes included the need to normalize menstruation, the need for comprehensive menstrual health education, and the need for menstrual products to be more accessible. Twelve youth prepared video diaries, and all reported positive experiences with the video process.

CONCLUSIONS

This youth-centered, multimodal study is one of the first to qualitatively explore the lived experiences of menstruation among adolescents in the United States and identified key inequities in menstrual health from their own perspectives. Thematic findings were mapped onto a proposed framework for menstrual equity that can be applied to future research and efforts around policy change. More research is needed to assess the impacts of these policies.

Understanding the social and physical menstrual health environment of secondary schools in Uganda: A qualitative methods study

Adolescent girls face social, psychological, and physical problems managing menstruation in schools in low-resource settings. This study aimed to evaluate the social and physical menstrual health environment of secondary schools in Wakiso and Kalungu districts, Uganda, in preparation for a subsequent menstrual health intervention trial to improve education, health and wellbeing. We conducted a qualitative rapid assessment in 75 secondary schools in Uganda. This involved conducting in-depth interviews with 150 head/senior teachers and 274 students, 26 Focus Group Discussions with students, and 13 transect walks to observe school Water, Sanitation and Hygiene (WASH) facilities between May and October 2021. Due to COVID-19 related school closures, face-to-face research activities were halted and in-depth interviews were conducted over phone and replaced focus group discussions. We employed a thematic framework analysis approach using the social-ecological model (which focuses on the complex interplay between individual, interpersonal, institutional, and societal factors) to generate themes and key concepts. Participants described the social and physical menstrual health environment of secondary schools at the individual level (knowledge gaps on menstruation before menarche, negative norms and beliefs about menstrual health); interpersonal level (limited psycho-social support, myths and misconceptions about the disposal of sanitary materials and pain relief, menstrual hygiene management (MHM) support from school nurses, peers and senior teachers); institutional level (non-implementation of Government circulars on MHM, lack of school-level guidelines policies and programs on MHM and poor WASH facilities, i.e. lack of soap, safe water and unclean toilets); and societal level (MHM programmes provided by civil society groups, health workers, and students' school associations). The findings showed individual, societal and institutional burdens related to menstrual experiences. Multi-level evidence-based interventions aimed at improving the social and physical environment for menstrual health among school-going girls are needed.

Assessment of knowledge, attitudes, and practices regarding menstruation and menstrual hygiene among early-reproductive aged women in Bangladesh: a cross-sectional survey

Background

Poor menstrual hygiene practices during menstruation increases the risk of reproductive tract infections, absenteeism, and negative impact on school performance. Despite being a global problem, there is a lack of knowledge and misconceptions about menstrual hygiene among women of all ages, especially in developing countries like Bangladesh. The study aims to assess the knowledge, attitudes, and practices toward menstrual hygiene among early reproductive-aged women in Bangladesh to help policymakers and planners take effective initiatives.

Methodology

A cross-sectional survey was conducted between July and December 2022 in Dhaka, Rajshahi, Chittagong, Sylhet, and Barisal regions of Bangladesh. A convenience sampling technique was utilized to recruit a total of 1,214 participants (100% female; mean age: 22.87 ± 2.64 years). A semi-structured questionnaire including informed consent, socio-demographic information, as well as questions regarding knowledge (6-item), attitudes (7-item), and practices (6-item) toward menstruation and menstrual hygiene practices, was used to conduct the survey. All analyses were performed using the STATA (Version 15.0) and Statistical Package for the Social Sciences (SPSS version 25.0).

Result

The mean scores of the knowledge, attitudes, and practices were 4.9 ± 1.51 (out of 6), 12.58 ± 1.58 (out of 14), and 8.80 ± 1.87 (out of 12), respectively. The higher scores of knowledge, attitudes, and practices were significantly associated with several socio-demographic and menstruation-related factors (education, family type, type of menstruation, duration of menstruation, etc.).

Conclusion

This study identified several key factors associated with improved knowledge, attitudes, and practices related to menstrual hygiene, including higher education levels, student status, younger age, non-alcohol consumption, and regular menstrual cycles. To enhance menstrual hygiene practices among women, it is crucial to implement targeted interventions that address knowledge disparities and tackle social and environmental influences.

Assessing the link between hygienic material use during menstruation and self-reported reproductive tract infections among women in India: a propensity score matching approach

Background

Reproductive tract infections (RTIs) present a substantial health concern for women, especially in developing nations such as India, where inadequate access to proper sanitation and hygiene facilities frequently results in suboptimal menstrual health and hygiene (MHH), exacerbating the risk of RTIs. In this study, we analysed the self-reported prevalence of RTIs among young women in India and evaluated the impact of hygienic menstrual material usage on these RTIs.

Methods

The study used information on 27,983 women aged 15-24 years, from the National Family Health Survey (NFHS-5) (2019-21). The prevalence of RTIs was calculated for all the states and UTs of India, and propensity score matching (PSM) technique was used to evaluate the impact of hygienic material use on RTIs among women in India.

Results

Every four out of 100 women reported RTIs in India in 2019-21. Notably, RTI prevalence displayed substantial state-level disparities. West Bengal exhibited the highest RTI prevalence at 9.3%, followed by Meghalaya, Arunachal Pradesh, and Himachal Pradesh, all surpassing 6%. In contrast, the lowest RTI rates were recorded in Puducherry at 0.9%, succeeded by Andaman and Nicobar Islands, Odisha, and Jammu & Kashmir, all registering rates below 2%. The PSM analysis revealed that women who utilized hygienic materials during menstruation exhibited a reduced prevalence of RTIs (referred to as the "treated group" with an Average Treatment Effect on the Treated (ATT) of 0.0315) compared to those who did not utilize such materials (referred to as the "control group" with an ATT of 0.0416).

Conclusions

The study underscores the critical significance of using hygienic materials during menstruation as a preventive measure against RTIs among women in India. The findings suggest the need for targeted interventions focused at promoting hygienic menstrual materials to reduce the prevalence of RTIs among women in India.

Dynamics of usage of menstrual hygiene and unhygienic methods among young women in India: a spatial analysis

BACKGROUND

Menstruation, especially the menstrual cycle, is a vital sign for female adolescent health and maintaining menstrual hygiene is of utmost importance for menstruating girls and women. However, menstrual hygiene and management are issues that have not received adequate attention. Therefore, the present study aimed to explore spatial patterns of menstrual hygiene practices in India and to identify their socioeconomic and demographic determinants among women aged 15-24 years.

METHODS

The study utilized data from the fifth round of the National Family Health Survey (NFHS-5) conducted during 2019-21 in India. The analysis was limited to 241,180 women aged 15-24 years. The statistical methods range from multinomial logistic regression, spatial autocorrelation in terms of Moran's I statistics, to spatial regression in order to understand the spatial dependence and clustering in different methods of menstrual practices across the districts of India.

RESULTS

Almost half of the respondents (49.8 percent) reported using hygienic methods of bloodstain protection, while 22.7 percent still relied on unhygienic methods and 27.5 percent reported using both hygienic and unhygienic methods during their menstruation. Factors like age, place of residence, caste, religion, education, wealth index and toilet facility were found to be significantly associated with the use of unhygienic and both methods. It was also observed that the percentage of women practicing hygienic methods was predominantly higher in the Southern region. On the other hand, states like Madhya Pradesh and Bihar appeared to be hotspots for unhygienic menstrual practices. The univariate Moran's I value for unhygienic and both methods were 0.722 and 0.596, respectively, depicting high spatial autocorrelation across districts in India. In spatial regression, rural residence, illiteracy, poverty, and no toilet facility were found to be statistically significant predictors of the use of unhygienic method and both methods.

CONCLUSION

Young women should be educated about the importance of menstrual hygiene practices and the physiological consequences of unhygienic practices. Furthermore, interventions should target socio-economically disadvantaged women to increase the use of sanitary napkins.

Using intersectionality to study gender and antimicrobial resistance in low- and middle-income countries

Different sexes and genders experience differentiated risks of acquiring infections, including drug-resistant infections, and of becoming ill. Different genders also have different health-seeking behaviours that shape their likelihood of having access to and appropriately using and administering antimicrobials. Consequently, they are distinctly affected by antimicrobial resistance (AMR). As such, it is crucial to incorporate perspectives on sex and gender in the study of both AMR and antimicrobial use in order to present a full picture of AMR's drivers and impact. An intersectional approach to understanding gender and AMR can display how gender and other components 'intersect' to shape the experiences of individuals and groups affected by AMR. However, there are insufficient data on the burden of AMR disaggregated by gender and other socio-economic characteristics, and where available, it is fragmented. For example, to date, the best estimate of the global burden of bacterial AMR published in The Lancet does not consider gender or other social stratifiers in its analysis. To address this evidence gap, we undertook a scoping review to examine how sex and gender compounded by other axes of marginalization influence one's vulnerability and exposure to AMR as well as one's access to and use of antimicrobials. We undertook a gendered analysis of AMR, using intersectionality as a concept to help us understand the multiple and overlapping ways in which different people experience exposure vulnerability to AMR. This approach is crucial in informing a more nuanced view of the burden and drivers of AMR. The intersectional gender lens should be taken into account in AMR surveillance, antimicrobial stewardship, infection prevention and control and public and professional awareness efforts, both donor and government funded, as well as national and international policies and programmes tackling AMR such as through national action plans.

Assessment of Symptoms and Risk Factors as a Screening Tool of Bacterial Vaginosis Among Reproductive Age-Group Females in West Bengal, India

Background Bacterial vaginosis (BV) is a ubiquitous vaginal discomfort and has overlapping symptoms with other reproductive tract infections. The World Health Organization suggested a symptomatic approach for diagnosing BV with insufficient laboratory setup. However, due to symptom overlap, BV is often misled and ends up with injudicious drug application. Objective The study aims to identify the most relevant symptoms and behavioral risk factors associated with BV in tertiary healthcare settings in West Bengal, India. It also seeks to develop a scoring system based on clinical symptoms to screen for BV, especially when laboratory facilities are limited. Methodology The study is a retrospective case-control study involving 95 women of reproductive age. It employs both univariate and multivariate binary logistic regression models to identify risk factors and symptoms associated with BV. The study also compares these clinical symptoms with laboratory tests (Amsel's test) and attempts to create a scoring system for BV diagnosis. Key Findings Good menstrual hygiene and condom use were identified as key behavioral practices reducing the risk of BV. Four clinical symptoms, like malodor (P = 0.007), lower abdominal pain (P = 0.015), abnormal vaginal discharge (P = 0.071), and painful intercourse (P = 0.08), were identified as notable predictors. Based on these four symptoms, the scoring system showed a sensitivity of 88.2%, a specificity of 67.25%, and an overall accuracy of 74.7%. An additional diagnosis of vulvovaginal candidiasis (VVC) revealed that the odds of malodor (P= 0.006) and burning sensation (P= 0.011) increased significantly during co-infection.

Spatiotemporal change in socioeconomic inequality in hygienic menstrual product use among adolescent girls in India during 2015-2019

BACKGROUND

The use of hygienic products, such as sanitary napkins, tampons, and menstrual cups, to absorb menstrual blood is vital for the health and well-being of adolescent girls in India. However, the degree of inequity in the use of such products among this subpopulation remains inadequately explored. To fill this critical knowledge gap, this study aims to investigate the spatiotemporal dynamics of hygienic product use among adolescent girls in India from 2015 to 2020.

METHODS

In this cross-sectional study, we analyzed data from 117,749 to 114,839 adolescent girls aged 15-19, obtained from two consecutive rounds of the National Family Health Survey (NFHS) conducted in India during 2015-16 and 2019-21. Our approach involved utilizing Erreygers' Concentration Index (ECI) and Concentration Curve to quantitatively assess and visually represent socioeconomic inequality in hygienic product usage. Additionally, we investigated the spatiotemporal variation in this inequality over the study period and decomposed the ECI to identify the key contributing factors.

RESULTS

The findings reveal that hygienic product usage among adolescent girls in India has increased by 13 percentage points (PP), from 37% in 2015-16 to 50% in 2019-21. This increase is also visible across all household wealth quintiles. However, the bottom quintiles experienced a greater rise (+ 15 to 16 PP) than the top quintile (+ 8 PP). During the study period, the ECI reduced marginally, from 0.48 in 2015-16 to 0.43 in 2019-21. However, the extent of this reduction varied across different states. The greatest reduction in ECI was recorded in Punjab (-0.23 points), Telangana (-0.16 points), and West Bengal (-0.14 points). In contrast, there were a number of states with high socioeconomic inequality (ECI > 0.30) in 2015-16, where inequality reduction was minimal (< 0.05 points) over the study period. This included more developed states of Kerala, Karnataka, Maharashtra and Gujarat and relatively less developed states of Odisha, Jharkhand, Chhattisgarh, Uttar Pradesh, and Assam. Some states, such as Bihar and Madhya Pradesh, recorded an increase in socioeconomic inequality over the study period, with ECI rising to 0.31 and 0.46 (highest in the country) in 2019-21. The decomposition analysis revealed that the inequality in using hygienic products was primarily explained by place of residence, exposure to mass-media, education, and region of residence.

CONCLUSIONS

The findings suggest the need for targeted policies to reduce existing socioeconomic inequality in the usage of hygienic products among adolescent girls in India. Specifically, interventions should target regions with low use of hygienic products, economically disadvantaged groups, and poor and vulnerable populations. State-specific policies and programs are also necessary to address the disparities in socioeconomic inequality. Additionally, efforts to reduce inequality should address the underlying factors contributing to inequality.

Knowledge, Attitude and Experiences of Students Regarding Menstrual Cup Usage in a Medical College in North Kerala, India

BACKGROUND

Sanitary napkins form a major source of solid waste, the disposal of which often results in environmental pollution. Menstrual cups are an eco-friendly and cost-effective alternative to sanitary pads that have yet to gain much popularity among Indian women. The current study aims to assess the knowledge, attitude, and experiences of using the menstrual cup among medical students in a college in north Kerala, India.  Methods: This cross-sectional study was conducted among 109 female medical students. Data was collected through an online platform and analyzed using Epi Info version 7.2 (Centers for Disease Control and Prevention, Atlanta, GA).

RESULTS

Though all the participants had heard about the menstrual cup before, only 14 (12.8%) were using it either alone or in conjunction with sanitary pads. The majority of the participants had a positive attitude towards the usage of menstrual cups with 91.74% considering it a better alternative to other sanitary products, Among the several concerns expressed by the participants, 58.7% were concerned about the insertion of a foreign material into their bodies.

CONCLUSIONS

Though most of the participants displayed a positive attitude towards the menstrual cup, the number of participants who had ever tried it was very low. There are several apprehensions regarding the cup that need to be addressed before it can be expected to gain popularity.

Perceived difficulties in maintaining menstrual hygiene practices among indigenous adolescents during seasonal water scarcity periods in Bandarban hill district of Bangladesh: A cross-sectional study

BACKGROUND

Access to clean water is important for menstrual hygiene practices, an important aspect of health for adolescent girls. In Bangladesh, adolescent girls represent poor menstrual hygiene practices, whereas the practice is worse among vulnerable population groups living in areas experiencing seasonal water scarcity. This study portrays perceived difficulties in menstrual hygiene practices among indigenous adolescent girls during the period of seasonal water scarcity in Bandarban Hill District, Bangladesh.

METHOD

Data was collected from 242 indigenous adolescent girls through interviews during the period of water scarcity. Backward stepwise regression model was used to identify factors associated with perceived difficulty in maintaining menstrual hygiene (PD) practices.

RESULT

The study participants, mainly living in hard-to-reach areas, reported difficulty in getting adequate water during the water scarcity period, and the quality of water was reported to be poor. PD due to water scarcity was found to be significantly associated with water source degradation (β = 0.247, < 0.001), the need for boiling/purifying water before use for menstrual hygiene (β = 0.203, p = 0.005), and experience of water availability when it was necessary to maintain their optimal menstrual hygiene practice (β = 0.449, p < 0.001), time required to collect water (β = 0.209, p < 0.001), taking a bath every day (β = -0.228, p < 0.001), and frequency of washing genitals per day (β = - 0.094, p = 0.040).

CONCLUSION

Indigenous adolescents perceive difficulty in menstrual hygiene practices during the period of water scarcity. Further research could be carried out to observe to what extent the seasonal water scarcity could be attributable to worsen the menstrual hygiene practices and to identify the need for addressing the problems.

Menstrual hygiene management in flood-affected Pakistan: Addressing challenges and ensuring women's health and dignity

Pakistan's recent floods have worsened women's and girls' menstrual hygiene problems, compromising their health, dignity, and well-being. Supply chain issues, poor facilities, and cultural stigma limit menstrual products and hygiene management. Gender-sensitive disaster management and menstrual health education programmes can help. The Minimum Initial Service Package (MISP) can provide emergency reproductive health services. Involving men, working with religious leaders, and pre-disaster planning for menstrual hygiene management can help break the taboo and increase access to resources. Meeting ongoing needs requires timely menstrual hygiene product distribution, restocking, and renewal. By addressing these issues, Pakistan can empower post-flood women and girls through economic opportunities and legal protection.

The association between menstrual hygiene, workplace sanitation practices and self-reported urogenital symptoms in a cross-sectional survey of women working in Mukono District, Uganda

BACKGROUND

Women worldwide experience challenges managing their periods. Menstrual and genital hygiene behaviours have been linked to negative health outcomes, including urogenital symptoms and confirmed infections. However, evidence testing this association has been limited and mixed. This study aimed to (1) describe the menstrual care practices and prevalence of self-reported urogenital symptoms among working women in Mukono District, Uganda, and (2) test the associations between menstrual and genital care practices, and urogenital symptoms.

METHODOLOGY

We undertook a cross-sectional survey of women aged 18-45 working in markets, schools, and healthcare facilities in Mukono District, with 499 participants who had menstruated in the past two months included in this analysis. We developed an aggregated measure of menstrual material cleanliness, incorporating material type and laundering practices. Associations with urogenital symptoms were tested using the aggregated material cleanliness measure alongside the frequency of changing materials, handwashing before menstrual tasks, and sanitation practices.

RESULTS

Among our sample, 41% experienced urogenital symptoms in the past month. Compared to women exclusively using disposable pads, using appropriately cleaned or non-reused improvised materials (PR = 1.33, 95%CI 1.04-1.71), or inadequately cleaned materials (improvised or commercially produced reusable pads) (PR = 1.84, 95%CI 1.46-3.42) was associated with an increased prevalence of self-reported urogenital symptoms in the last month. There was no difference between those using disposable pads and those using clean reusable pads (PR = 0.98; 95%CI 0.66-1.57). Infrequent handwashing before changing materials (PR 1.18, 95%CI: 0.96-1.47), and delaying urination at work (PR = 1.37, 95%CI: 1.08-1.73) were associated with an increased prevalence of self-reported symptoms.

CONCLUSION

Prevalence of self-reported urogenital symptoms was associated with the type and cleanliness of menstrual material used as well as infrequent handwashing and urinary restriction. There is a need for interventions to enable women to maintain cleanliness of their menstrual materials and meet their menstruation, urination and hand washing needs at home and work.

Menstrual Hygiene Practices in Indian Tribal Females: A Systematic Review and Meta-Analysis

India is native to many tribal communities: Bharia (Madhya Pradesh), Bihl (Rajasthan), Santhal (Bihar, Jharkhand), Bodo (Assam, West Bengal), and many more. They reside in isolated geographical regions, which poses challenges in reaching out to them. In addition, they still have firm beliefs and taboos regarding menstruation. Knowledge about menstrual health and hygiene is one of the most important aspects of tribal health. Therefore, it is important to synthesize the results of menstrual hygiene data from the Indian tribal population. We have calculated the pooled prevalence of sanitary pad use, dustbin disposal, and hygienic reuse of menstrual materials. Online databases, namely PubMed, Cochrane Central, CINAHL, Pan African Journals, EBSCO, and Google Scholar, were searched. After the removal of duplicates, a quality check, and screening of cross-references, 19 articles were selected for final review. Statistical analysis was done by Revman 5.4 and STATA 17.0. A p-value of <0.05 was considered statistically significant. PRISMA guidelines were followed. The protocol registration number was CRD42022331376. This is a non-funded article. The pooled prevalence of sanitary pad use in Indian tribal females was 2% (95% CI 1 to 3). The pooled prevalence of dustbin disposal of menstrual material was 1% (95% CI: 0.00 to 0.02). The pooled prevalence of hygienic reuse of menstrual materials was 1%. Sanitary menstrual hygiene practices are very less prevalent in Indian tribal females. Awareness programs and tribal health policies need to be accelerated for the promotion of menstrual hygiene. Also, literature on the use, disposal, and storage of menstrual adsorbents is scarce in Indian tribes. Health research in this area needs to be emphasized.

Exploratory systematic review and meta-analysis on period poverty

BACKGROUND

Period poverty is a global health and social issue that needs to be addressed. It has been reported that many females compromise their education, employment, and social commitments during their menstruation days due to a number of reasons, including lack of access to toilets or menstrual products.

AIM

To provide a comprehensive understanding on period poverty, including outcomes associated with menstruation.

METHODS

All observational and randomised clinical trials reporting menstruation challenges, menstrual poverty and menstrual products were included. Our search strategy included multiple electronic databases of PubMed, Web of Science, ScienceDirect, ProQuest and EMBASE. Studies published in a peer review journal in English between the 30^th of April 1980 and the 30^th of April 2022 were included. The Newcastle-Ottawa Scale was used to assess the risk of bias of the systematic included studies. Pooled odds ratios (ORs) together with 95% confidence intervals (CIs) are reported overall and for sub-groups.

RESULTS

A total of 80 studies were systematically selected, where 38 were included in the meta-analysis. Of the 38 studies, 28 focused on children and young girls (i.e., 10-24 years old) and 10 included participants with a wider age range of 15-49 years. The prevalence of using disposable sanitary pads was 45% (95%CI: 0.35-0.58). The prevalence of menstrual education pre-menarche was 68% (95%CI: 0.56-0.82). The prevalence of good menstrual hygiene management (MHM) was 39% (95%CI: 0.25-0.61). Women in rural areas (OR = 0.30, 95%CI: 0.13-0.69) were 0.70 times less likely to have good MHM practices than those living in urban areas.

CONCLUSION

There was a lack of evidence, especially from low- and middle- income countries. Further research to better understand the scope and prevalence of period poverty should be considered. This will enable the development of improved policies to increase access to menstrual products and medical support where necessary.

Assessment of menstrual hygiene management practice and associated factors among prisoners in South Nation Nationalities and peoples region, Ethiopia

Introduction

Menstrual hygiene management practice is the requirements and necessities; such as the use of a sanitary pad or clean and mushy absorbents, sufficient washing of the genital area, proper disposal of the used absorbents, and other special needs for the women during menstruation.

Objective

To assess menstrual hygiene management practice and associated factors among prisoners in south Nation Nationalities and Peoples Region, Ethiopia, 2022.

Methods

An institution-based cross-sectional study was conducted from May 1 to July 30/2022. The total sample size was 605 and a simple random sampling technique was used to select prison institutions and women. The data were collected through face-to-face interviews. Data were entered using Epi data 4.6 version and analyzed by using SPSS version 26 software. Multicollinearity was checked and the goodness of fit test was done by using the Hosmer Lemeshow model of goodness fit test. Univariate analysis was done and variables with p value less than 0.25 were taken to bivariate logistic regression analysis. Adjusted odds ratio with the 95% confidence interval was considered and statistical significance was at a p-value less than 0.05 in bivariate logistic regression analysis.

Result

The prevalence of menstrual hygiene management practice was 50.6% (95% CI 47.3-54.4). Age 19-29 years old [AOR: 5.03, 95% CI 1.73-14.62], educational status; not formally educated [AOR: 0.05, 95% CI 0.02-0.13], educational status; primary level [AOR: 0.17, 95% CI 0.07-0.39], previous occupation; student [AOR: 2.56, 95% CI 1.06-6.21], previous occupation; a private employee [AOR: 4.11, 95% CI 1.48-11.42], previous occupation; government employee [AOR: 3.46, 95% CI 1.18-10.14], absence of support from family [AOR: 0.14, 95% CI 0.08-0.24] and absence of work engagement in prison [AOR: 0.44, 95% CI 0.25-0.78] were associated with MHMP.

Conclusion

In this study, about five from ten women in prison practice menstrual hygiene management. Age, educational status, previous occupation, support from family, and work engagement in prison were important risk factors for MHMP. Therefore, support from family and engaging the women to work in prison institutions may increase the MHMP in prison institutions.

Assessment of menstrual hygiene management knowledge, practice, and associated factors among girls in Boset District, Ethiopia: a school-based cross-sectional study

BACKGROUND

Adolescent girls, particularly in lower socioeconomic settings, lack adequate knowledge of menstrual hygiene management and have subpar hygiene habits. Likewise, the factors related to it have not been well addressed, and schoolgirls are facing a range of challenges. To develop effective intervention approaches, a context-specific assessment of menstrual hygiene practices is useful. Thus, this study aimed to assess menstrual hygiene management knowledge, practice, and associated factors among girls in the Boset district, Ethiopia.

METHODS

A school-based cross-sectional study was conducted at Boset district secondary schools among 629 randomly selected girls using the multi-stage sampling technique. Data were collected using a self-administered, structured questionnaire. The collected data were entered into Epi-info version 7 and analyzed by Statistical Package for Social Science (SPSS) version 26. Binary logistic regression analysis was used to model the association between dependent and independent variables. An adjusted odds ratio and 95% confidence interval were used to measure the strength of the association, and a p-value < 0.05 was used to declare statistical significance.

RESULT

Of the total study participants, 51.2% (95% CI: 46.6-55.8%) had an appropriate practice of menstrual hygiene and 57.9% (95% CI: 53.3-62.5%) had good knowledge status on menstrual hygiene management. Being an urban resident (AOR = 1.84, 95% CI: 1.20-2.80), having a mother with a secondary and above educational level (AOR = 3.4, 95% CI: 2.07-5.57), earning regular pocket money (AOR = 2.19, 95% CI: 1.45-3.313), and discussing menstrual issues with parents and friends (AOR = 3.65, 95% CI: 2.327-5.727) were associated with good practice of menstrual hygiene.

CONCLUSION

In this study, nearly half of the school girls had good practice and knowledge of menstrual hygiene management. Educating mothers and promoting discussion about menstrual hygiene management issues, especially in rural areas, should be priority actions.

Perceptions and practices related to menstruation and reproductive health in adolescent girls in an urban population - A cross sectional study

Introduction

Menarche is an important biological milestone in a woman's life as it marks the onset of the reproductive phase of her life. It is, often considered an impure phenomenon in Indian society owing to cultural taboos and insufficient and incorrect information and causes unnecessary restrictions in the day-to-day normal activities of menstruating girls.

Aim

To assess the perception and practices related to menstruation and reproductive health among school-going adolescent girls in the urban population in Kochi, Kerala.

Objectives

To elicit the practices regarding menstruation and reproductive health among the school-going, adolescent girls. i. To elicit the beliefs, perceptions, and sources of information regarding menstruation and reproductive health among the school going, adolescent girls. ii. To find out the relation between perceptions/practices and other factors.

Methodology

A cross-sectional study was conducted among 100 adolescent girls of a secondary school situated in Ernakulam, Kerala, with the help of a pre-designed and pre-tested questionnaire. Data were analyzed statistically by simple proportions.

Result

89% of the girls were aware of menstruation before menarche. A major source of information was found to be mothers. More than 70% used sanitary pads and 99% of girls knew menses as a natural phenomenon. 80% of girls with good perception had no menses-related anxiety. 54% haven't even heard of Pre-Menstrual Syndrome. 40% have inhibition talking about menses to their father or brother. Among girls with good practice, 87% had a good perception.

Conclusions

Before bringing any change in menstrual practices, Family physicians can play a role in educating the girls about the significance of menstruation and the development of secondary sexual characteristics, the selection of a sanitary menstrual absorbent, and its proper disposal. Trained personnel, school teachers, and knowledgeable parents can play a very important role in imparting menstrual health-related information to adolescent girls.

Menstrual health and hygiene among Juang women: a particularly vulnerable tribal group in Odisha, India

BACKGROUND

Menstruation is a normal biological process that all women go through, yet it is shrouded in secrecy, taboos, and even stigma in many societies. Studies have shown that women from socially disadvantaged groups are more likely to have preventable reproductive health issues and have less understanding of hygienic menstrual practices. Therefore, this study aimed to provide an insight into the most sensitive issue of menstruation and menstrual hygiene practices among the women of the Juang tribe, recognized as one of the particularly vulnerable tribal groups (PVTG) in India.

METHODS

A cross-sectional study using a mixed-method approach was carried out among Juang women in Keonjhar district of Odisha, India. Quantitative data was gathered from 360 currently married women to assess practices associated with menstruation and its management. In addition, 15 focus group discussions and 15 in-depth interviews were conducted to explore the views of Juang women on menstrual hygiene practices, cultural beliefs, menstrual problems, and treatment-seeking behaviour. Inductive content analysis was used to analyse the qualitative data, while descriptive statistics and chi-squared tests were used to analyse quantitative data.

RESULTS

Most Juang women (85%) used old clothes as absorbents during menstruation. Distance from the market (36%), lack of awareness (31%), and high cost (15%) were cited as the contributing factors to the low level of sanitary napkin usage. Around 85% of women were restricted from participating in religious activities, and 94% avoided social gatherings. Seventy-one percent of the Juang women experienced menstrual problems, while only one-third of them sought treatment for their problems.

CONCLUSION

Hygienic practices during menstruation are far from satisfactory among Juang women in Odisha, India. Menstrual problems are common, and the treatment sought is insufficient. There is a need for awareness generation on menstrual hygiene, the adverse effects of menstrual problems, and the provision of low-cost sanitary napkins among this disadvantaged, vulnerable tribal group.

Optimizing menstrual health and hygiene management in the U.S.: A mixed-methods study of the barriers and the role of healthcare professionals

OBJECTIVE

Menstrual health (MH) practices have been understudied in the U.S. This study aimed to assess patient and medical staff views of MH.

METHODS

The mixed-methods approach included medical staff and patient surveys, and patient interviews on MH experiences. Quantitative survey data generated descriptive statistics. Thematic content analysis (TCA) evaluated qualitative interviews. Convergent Parallel Triangulation Analysis (CPTA) evaluated both datasets in tandem.

RESULTS

The medical staff survey's response rate was 72% (54 participants/75 invited staff). Only 7% (4/54) of staff consistently asked patients about menstrual products (MP), while 54% (29/54) were concerned about patients affording MP. The patient survey's response rate was 90% (186/207); 22% (40/186) of respondents showed MH insecurity, which was associated with annual income <$30,000 (p < 0.01); 45% (85/186) missed commitments during menses; 53% (98/186) never discussed MP with healthcare providers. To reach thematic saturation 10/17 invited patients were interviewed. Five themes were identified through TCA: menstruation as a social barrier; menstrual education comes from a variety of sources; MP choice is a balance of comfort, cost, and convenience; patients value relationships with their providers; adolescence is the window for establishing MH. Three threads were identified through CPTA: MH insecurity is common; MH screening and education are limited; menstruation impacts patients' ability to engage in daily activities.

CONCLUSION

A holistic approach toward MH is needed; education and screening are inconsistent. Comprehensive MH can enhance a patient's understanding of and capacity to advocate for their health. These findings are specific to this population and may not be generalizable.

Persistent economic inequalities in menstrual hygiene practices in India: a decomposition analysis

Purpose

The purpose of this study is to examine the socio-economic inequalities that exist in the use of unhygienic menstrual practices in India and its states, as well as to identify the contribution of various socio-economic factors that leads to these inequalities.

Design/methodology/approach

Data from the National Family Health Survey-5 (2019–21) for 240,285 menstruating women aged 15–24 years is used to examine the above objectives. The concentration index for unhygienic menstrual practices is calculated to measure the socio-economic inequalities, which are then decomposed into their determining factors.

Findings

The state of Punjab experiencing the highest level of economic inequality, followed by Telangana and Haryana. The results from decomposition analysis suggest that rural residence (13%), illiteracy (7%), poor economic status (53%), not reading newspaper (12%) and not watching TV (14%) contribute 99% to the total socio-economic inequality in using unhygienic menstrual practices in India. The contribution of economic status to total inequalities is more in all the states except for Kerala and Mizoram, where caste and residence play an important role.

Originality/value

This paper signifies the role of economic inequality in the use of unhygienic menstrual practices in India as well as the contribution of various socio-economic factors contributing towards these inequalities. The results from decomposition analysis suggest the need for unique health intervention strategies for different states following the evidence of major contributions to total inequalities in the use of unhygienic menstrual practices.

Knowledge and peer support for increase Menstrual Hygiene Management (MHM) in adolescents

Introduction: During the transitional period of reproductive function development, adolescents require special attention, one of which is menstrual hygiene management (MHM). Teenagers dealing with menstruation have little information and understanding due to the taboo assumption of being more comfortable communicating with peers. Therefore, this study aims to explain the relationship between knowledge and peer support with MHM in adolescent girls. Design and Methods: This study adopted a correlational descriptive design with a cross-sectional approach and 122 students in apublic Junior High School in East Java were selected using proportional simple random sampling. Furthermore, the questionnaire was adopted as the study instrument to measure the variables of knowledge level, peer support, and MHM. Data were then analyzed using Spearman Rho Test with a significance level of p<0.005. Results: The results showed that there is a significant relationship between the level of knowledge (p = 0.000 r = 0.619 and peer support (p = 0.000 r = 0.534) with MHM in adolescent girls. Conclusions: Adolescent girls with adequate knowledge and peer support have better MHM. Therefore, information and education about MHM are recommended for adolescents.  

Spatial heterogeneity in the exclusive use of hygienic materials during menstruation among women in urban India

Background

Menstrual hygiene is essential for women to live with dignity. However, a large proportion of Indian women still suffer from unhygienic menstrual practices leading to reproductive tract infections. To understand the socioeconomic and bio-demographic determinants of menstrual hygiene practices, various national or local level studies have been conducted in India and around the world, however, no previous study has tried to understand the spatial heterogeneity across Indian districts in the use of hygienic materials among young urban women.

Methods

This study used data from 54,561 urban women aged 15-24 from the National Family Health Survey-5. Global Moran's I was applied to assess the degree of spatial autocorrelation and cluster and outlier analyses to locate hot-spots and clod-spots in the exclusive use of hygienic materials across the districts. Ordinary least square, spatial lag, and error models were used to identify determinants of exclusive use of hygienic materials.

Results

Approximately 66.8% of urban women exclusively use of hygienic materials which varied across districts. Global Moran's I of 0.46 indicated positive spatial autocorrelation in the outcome. Cluster and outlier analysis revealed cold-spots in central Indian districts and hotspots in south Indian districts. Results of spatial error model identified women's years of schooling, marital status, social group, and household wealth were major determinants of the exclusive use of hygienic materials among urban women across Indian districts.

Conclusion

Substantial spatial heterogeneity in the outcome among urban women in India suggests the need to design targeted and context-specific behavioural interventions and programs for women in urban India.

Spectrum of Bacterial Pathogens from Urinary Infections Associated with Struvite and Metabolic Stones

OBJECTIVE

The purposes of this multi-center study were to evaluate the rate of infection stones and to evaluate the urine cultures of patients with infection stones.

MATERIALS

Charts of adulpatients with urinary stones were reviewed and data on stone analyses and urine cultures were collected.

RESULTS

In total, 1204 renal stone formers (RSFs) from 10 countries were included (776 males, 428 females). Fifty-six patients (4.6%) had struvite stones. The highest frequency of struvite stones was observed in India (23%) and Pakistan (18%). Lower rates were reported in Canada (2%), China (3%), Argentina (3%), Iraq (3%), Italy (3.5%) and Poland (3%), and intermediate rates in Egypt (5.5%) and Bulgaria (5.4%). Urine cultures were retrieved from 508 patients. Patients with struvite stones had a positive culture in 64.3% of the samples and patients with other stones, in 26.7%. In struvite stones, the most common isolates were Escherichia coli (27.7%) and Proteus spp. (27.7%), followed by Klebsiella spp. (16.7%); in other types of stone, it was Escherichia coli (47.6%), followed by Gram-positive bacteria (14.0%) Conclusions: The struvite stone composition was associated with a urinary infection, although an infection was not demonstrable with a conventional midstream urine culture in about 30%.

Menstrual health among adolescents and young adults in rural Haiti

BACKGROUND

Adolescent and young adult (AYA) females in low- and middle-income countries often face disparities in menstrual health (MH). Poor MH and lack of sexual and reproductive health education leads to school absenteeism, increasing risk for adverse psychosocial and educational outcomes. Further, disasters (e.g., earthquakes) are linked with unsafe living environments and sanitation facilities for women. We sought to describe MH perspectives and practices among AYAs in rural Haiti.

METHODS

We conducted a cross-sectional survey in two rural communities in Haiti. AYA females aged 14-24 years completed questions on demographics, the Menstrual Practice Needs Scale (36 items; MPNS-36) and the Menstrual Practices Questionnaire (4 items). We performed descriptive statistics and Chi square or Fisher's Exact tests to compare responses among sub-groups.

RESULTS

Among 200 respondents, the median age was 20 years (IQR 17-22). 51% (95% CI 44%, 58%; 102/200) were currently attending school at least 3 days/week and 97% (94%, 99%; 193/200) were not married. According to the MPNS-36, 68% (62%, 74%; 136/200) of participants had unmet MH needs. Seventy-one (77%) reused some of their menstrual materials during their last menstruation. During their last menstruation, 44% (37%, 50%; 87/200) reported they often or always skipped school because they had their menses, and 31% (25%, 37%; 62/200) sometimes skipped. Many felt always or often worried that someone or something would harm them while they were changing their menstrual materials at home and at school.

CONCLUSIONS

Among AYAs in rural Haiti, three-quarters reported menses-related school absenteeism and two-thirds had unmet MH needs. AYA females often lacked a safe environment to change their menstrual materials. Given recent disasters in Haiti, (August 2021 earthquake), safe environments for MH are critically needed to offset risk for poor psychosocial and health outcomes. Future efforts to improve MH among AYAs in Haiti are needed to ensure access to MH resources and school attendance.

Impact of imparting knowledge and awareness on the usage of menstrual cups: A study based on project 'Thinkal' at Alappuzha Municipality in Kerala

Objectives

To assess the impact of educating and creating awareness among women on Menstrual Cups (M-Cups) as a healthy, safe, easy-to- use and affordable menstrual hygiene product with the support of medical professionals.

Study design

A two-group, non-randomized cross-sectional study.

Methods

The M-Cup awareness creation was carried out through the project 'Thinkal' and 4345 cups were distributed among the beneficiaries of Alappuzha Municipality in two separate groups. One group received awareness with the help of medical professionals and experienced users whereas the other group collected the M-Cup from the distribution centres (Municipality and Community Development Society) along with the information pamphlets without attending awareness sessions initially.

Results

Among the women who received the M-Cups without attending the awareness session, only 20.7% started using the M-Cup, where as 40.6% who received awareness, started the usage which is approximately double.

Conclusions

A well curated awareness session was the most important factor which helped in transforming a woman into an M-Cup user.

Integrating poverty alleviation and environmental protection efforts: A socio-ecological perspective on menstrual health management

Apt menstrual health management is crucial to the livelihood of low-income, bottom of the pyramid (BOP) women as well as to environmental conservation. However, knowledge is still scant about the factors underpinning women's preferences towards menstrual products, and whether and how the environmental impact of different solutions matter to women's choices. We address this gap by proposing a socio-ecological perspective to understand whether a product's low environmental impact enhances low-income women's uptake of sanitary napkins, thereby supporting poverty alleviation objectives but also efforts geared towards environmental protection. Results from a discrete-choice experiment involving 164 women (n = 1148) in two Indian slums in Delhi and Ahmedabad show that sanitary products' biodegradability is the most important attribute affecting women's preferences towards menstrual hygiene management solutions, which also significantly interacts with women's socio-economic and socio-cultural characteristics. Our findings highlight the potential for business models to find positive synergies between environmental protection and poverty alleviation goals and to situate solutions within the larger socio-ecological context of receiving communities.

A qualitative study regarding menstrual hygiene in a rural community of Haryana, India

INTRODUCTION

Adolescent girls face challenges in menstrual hygiene in routine patterns which impacts their education and health. A qualitative study was undertaken to assess the knowledge and practices regarding menstruation in a rural community of Haryana and to identify the barriers to menstrual hygiene.

METHODOLOGY

The study was conducted in the month of September 2019 among various stakeholders i.e. adolescent females, adolescent males, Accredited Social Health Activist (ASHA) workers, Anganwadi workers, school teachers and Medical Officers. The stakeholders were mapped with the help of a Multi-Purpose Health Worker and ASHA of the village. Interview guides for focus group discussion (FGD) and in-depth interview (IDI) were prepared from previous literature to understand menstrual health management among the stakeholders.

RESULTS

After IDI and FGD, we found that there is a barrier to accessibility of regular sanitary pads, a lack of education on menstrual hygiene among adolescent girls. School absenteeism was a concern due to the unavailability of mechanisms for the disposal of sanitary pads in school and poor maintenance of toilets.

CONCLUSION

Proper implementation of the Adolescent Reproductive Sexual Health program and Menstrual health education can improve the use and reduce stigma and ignorance. Free uninterrupted supply of sanitary pads through school and Anganwadi will help improving accessibility and separate toilets for girls would lead to a reduction in absenteeism.

Socio-cultural factors associated with knowledge, attitudes and menstrual hygiene practices among Junior High School adolescent girls in the Kpando district of Ghana: A mixed method study

BACKGROUND

Good menstrual hygiene practice is critical to the health of adolescent girls and women. In Ghanaian public schools, the School Health Education Program which includes menstrual health education has been instituted to equip adolescents with knowledge on menstruation and its related good hygiene practices. However, in most communities, menstruation is scarcely discussed openly due to mostly negative social and religious beliefs about menstruation. In this study, we examined socio-cultural factors associated with knowledge, attitudes and menstrual hygiene practices among Junior High School adolescent girls in the Kpando Municipality of Ghana.

MATERIALS AND METHODS

A mixed method approach was employed with 480 respondents. A survey was conducted among 390 adolescent girls using interviewer-administered questionnaires to collect data on knowledge of menstruation and menstrual hygiene practices. Focus Group Discussions (FGDs) using a discussion guide were conducted among 90 respondents in groups of 9 members. The FGD was used to collect data on socio-cultural beliefs and practices regarding menstruation. Descriptive and inferential statistics and content analysis were used to analyze the quantitative and qualitative data respectively.

RESULTS

Most (80%) of the study participants had good knowledge of menstruation. Also, most (82%) of the participants practiced good menstrual hygiene. Attending a public (AOR = 0.24, 95% CI = 0.12-0.48, p<0.001) and rural (AOR = 0.40, 95% CI = 0.21-0.75, p<0.01) school was significantly associated with reduced odds of practicing good menstrual hygiene. Good knowledge of menstruation was associated with increased odds of good hygiene practices (AOR = 4.31, 95% CI = 2.39-7.90, p<0.001). Qualitative results showed that teachers provided adolescents with more detailed biological information on menstruation than key informants (family members) did at menarche. However, both teachers and family members spoke positively of menstruation to adolescent girls. Social and religious beliefs indicate that menstruation is evil and unclean. Such beliefs influenced community members' attitudes towards adolescent girls and led to practices such as isolating menstruating girls and limiting their ability to interact and participate in certain community and religious activities.

CONCLUSION

Despite the prominence of negative social and religious beliefs about menstruation, good menstrual hygiene practice was high among study participants. Knowledge of menstruation; place of residents; and type of school were the major factors associated with good menstrual hygiene practice. It is therefore, necessary to intensify the School Health Education Program in both rural and urban public and intensively involve private schools as well to ensure equal access to accurate information on menstruation and good menstrual hygiene practices among adolescent girls.

Female-friendly toilets in schools in Burkina Faso: A mixed-methods study using photo-elicitation

Background

An absence of gender-sensitive sanitation facilities in schools and the negative effects this has on girls has been widely discussed among advocacy groups, though less examined in academic spheres. Drawing on triangulated data, we outline current challenges and respondent-driven solutions to enhance the female-friendly nature of toilets in a context of extreme poverty.

Methods

This mixed-methods study was informed by the tenets of human-centred design. We first quantitatively assessed facilities in 14 secondary schools in the Kossi Province of Burkina Faso. We then collected qualitative data, including 15 focus group discussions and 53 in-depth interviews among schoolgirls, mothers, teachers and key informants. We applied photo-elicitation, a novel method, to explore perceptions of facilities and the desirability and feasibility of interventions to improve gender-friendly sanitation facilities.

Results

No school met international water, sanitation and hygiene (WASH) standards for schools. Roughly one third of schools did not have water and, when present, there was no reliable way to use it within the toilet complex. Schoolgirls shared feelings of shame and stress when menstruating at school, and said that they would avoid using school toilets, if possible. Schoolgirls described water access as the most urgent need to address, followed by fostering privacy and facilitating cleanliness within facilities. Mothers and teachers mostly aligned with these priorities, while key informants additionally emphasised the need to raise awareness on both general and menstrual hygiene and to develop maintenance systems. Photo-elicitation engaged and empowered participants to pinpoint priorities and concrete solutions, namely a need for doors and locks, water containers and cleaning materials.

Conclusions

WASH needs in many schools remain unmet. Women and girls should be involved in decision-making across stages of intervention design and implementation. Young women's voices merit greater inclusion in academic literature. Future interventions should enhance access to water and privacy. Future research could explore maintenance and monitoring strategies to develop guidance on sustainable solutions.

Menstrual hygiene management and its determinants among adolescent girls in low-income urban areas of Delhi, India: a community-based study

Objectives

Menstrual hygiene management (MHM) in developing countries is linked to human rights, social justice, and the education and empowerment of young girls. The objective of this study was to assess menstrual hygiene practices and their determinants among adolescent girls, including school dropouts, and the effects of pad distribution programs in urban resettlement areas of Delhi, India.

Methods

A cross-sectional study was conducted from March 2019 to February 2020 in urban resettlement colonies and 2 villages of Delhi among 1,130 adolescent girls aged 10 to 19 years, who were interviewed face to face.

Results

In total, 954 participants (84.4%) used only disposable sanitary pads, 150 (13.3%) used both sanitary pads and cloths, and 26 (2.3%) used only cloths (n=1,130). Most school-going girls utilized the scheme for pad distribution, but only two-thirds of the girls who were out of school utilized the scheme. In the adjusted analysis, girls with lower educational status, those who had dropped out of school, and those from the Muslim religious community were more likely to use cloths for MHM.

Conclusion

More than 4 out of 5 adolescent girls in Delhi in low-income neighborhoods preferred sanitary pads for MHM. The government free pad scheme reached near-universal utilization among school-going girls (97%), but the subsidized pad scheme for girls who did not attend school was insufficiently utilized (75%).

A Qualitative Content Analysis of Rural and Urban School Students' Menstruation-Related Questions in Bangladesh

Nearly half of Bangladeshi girls reach menarche without knowledge of menstruation and many fear seeking support due to pervasive menstrual stigma. We aimed to explore the types of menstruation-related information and support adolescent female and male students want but may be uncomfortable verbalising. We installed a locked box in four school classrooms in rural and urban Bangladesh as part of a menstrual hygiene management pilot intervention between August 2017 and April 2018. Trained teachers provided puberty education to female and male students in classes 5-10 (ages 10-17 years) and encouraged students to submit questions anonymously to the boxes if they did not want to ask aloud. We conducted a content analysis of the 374 menstruation-related questions from a total of 834 submissions. Questions regarded experiences of menstrual bleeding (35%); menstrual symptoms and management (32%); menstrual physiology (19%); behavioural prescriptions and proscriptions (6%); concerns over vaginal discharge (4%); and menstrual stigma, fear, and social support (4%). Students wanted to understand the underlying causes of various menstrual experiences, and concern over whether particular experiences are indicative of health problems was pervasive. Ensuring comprehensive school-based menstruation education and strengthening engagement among schools, parents, and healthcare providers is important for improving access to reliable menstrual health information and may relieve adolescents' concerns over whether their menstrual experiences are 'normal'.

Puberty health intervention to improve menstrual health and school attendance among adolescent girls in The Gambia: study methodology of a cluster-randomised controlled trial in rural Gambia (MEGAMBO TRIAL)

BACKGROUND

Menstrual health (MH) is a recognised global public health challenge. Poor MH may lead to absence from school and work, and adverse health outcomes. However, reviews suggest a lack of rigorous evidence for the effectiveness of MH interventions on health and education outcomes. The objective of this paper is to describe the methods used in a cluster-randomised controlled trial to estimate the effect of a multi-component intervention to improve MH and school attendance in The Gambia.

METHODS

The design ensured half the schools (25) were randomised to receive the intervention which comprised of the following components: (i) Peer education camps and menstrual hygiene laboratories in schools, (ii) Mother's outreach sessions, (iii) Community meetings, and (iv) minor improvements of school Water Sanitation and Hygiene (WASH) facilities and maintenance. The intervention was run over a three-month period, and the evaluation was conducted at least three months after the last intervention activity was completed in the school or community. The other 25 schools acted as controls. Of these 25 control schools one Arabic school dropped out due to COVID-19. The primary outcome was the prevalence of girls missing at least one day of school during their last period. Secondary outcomes included: Urinary Tract Infection (UTI) symptoms, biochemical markers of UTI in urine, Reproductive Tract Infection symptoms, self-reported menstruation related wellbeing, social support and knowledge, perceptions and practices towards menstruation and MH in target school girls. In addition, a process evaluation using observations, routine monitoring data, survey data and interviews was undertaken to assess dose and reach (quantitative data) and assess acceptability, fidelity, context and possible mechanisms of impact (qualitative data). Cost and cost-effectiveness of the intervention package will also be assessed.

CONCLUSION

Results will add to scarce resources available on effectiveness of MH interventions on school attendance. A positive result may encourage policy makers to increase their commitment to improve operation and maintenance of school WASH facilities and include more information on menstruation into the curriculum and help in the reporting and management of infections related to adolescent menstruation. Trial Registration PACTR, PACTR201809769868245, Registered 14th August 2018, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3539.

Period poverty: The perceptions and experiences of impoverished women living in an inner-city area of Northwest England

BACKGROUND

The menstrual needs of girls and women are important to health, education, and well-being. Unmet need and harm from poor menstrual health in low-and- middle-income countries have been documented, but with little empirical research undertaken in high income countries. Continuing austerity in the UK suggests menstruators are likely more vulnerable to 'period poverty' than previously, with the COVID-19 pandemic assumed to exacerbate the situation.

AIM

To explore the menstrual experiences and perceptions of women in the UK who are living under circumstances of deprivation, alongside views of staff working in organisations supporting these women, to understand whether women's menstrual needs are met.

METHODS

A qualitative study was conducted in an inner-city in NW England. Three focus group discussions and 14 in-depth interviews were conducted across three study sites supporting impoverished women. Data was analysed thematically.

RESULTS

Themes were: reflections on menstruation; affordability of products; access to public facilities; organisational support; potential solutions. Many women perceived menstruation as a burden in three aspects: physical discomfort and pain; psychological anxiety; and shame and stigma. Managing menstruation was difficult due to cost relative to low incomes, with food, heating and lighting prioritised, leaving women improvising with materials or wearing products for longer than desired. Most suggested that products should be free, often remarking if men required similar items this would happen. Most women were unaware supporting organisations provided free products. Staff felt the small range of products offered did not meet client needs and were ill-prepared to have conversations on products and clients' menstrual needs.

CONCLUSION

Impoverished women lack the necessary resources to manage their menses well which negatively impacts their health and brings stress, embarrassment, and shame. Support, including access to free products, is needed at both local and national level to help impoverished women manage their menstrual hygiene.

Earning pocket money and girls' menstrual hygiene management in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Many adolescent girls in Ethiopia and elsewhere missed school during their monthly cycles due to a lack of affordable menstrual absorbent materials or money to buy sanitary pads. So far, few studies have looked into the relationship between earning pocket money and maintaining good menstrual hygiene. Hence, this systematic review and meta-analysis aimed to synthesize the best available evidence regarding the association between earning pocket money and menstrual hygiene management among adolescents in Ethiopia.

METHODS

We systematically searched PubMed, Hinari, Science Direct, Cochrane Library, ProQuest, POPLINE, African Journal Online, Direct of Open Access Journals, and Google Scholar for studies examining the association between earning pocket money and menstrual hygiene management among adolescent girls in Ethiopia, without restriction in a publication year. The Joanna Briggs Institute quality assessment tool for the cross-sectional studies was used to assess the quality of included studies. A prefabricated checklist, including variables: first author, publication year, sample size, type of questionnaire, and the region was used to extract data from the selected articles. A random-effect meta-analysis model was used to estimate the pooled odds ratio (OR) of the association between earning pocket money and menstrual hygiene management. The heterogeneity and publication bias was assessed by using I² test statistics and Egger's test, respectively.

RESULTS

Data from nine studies involving 4783 adolescent girls were extracted. The meta-analysis revealed that adolescent girls who earned pocket money from their parents or relative had 1.64 times higher odds of having good menstrual hygiene management than their counterparts [pooled OR = 1.64, 95% CI: 1.16-2.34, I²:66.7%, n = 7 (number of studies)]. Similarly, the likelihood of having good menstrual hygiene management was lower by 49% among adolescent girls who did not receive any pocket money from their parents compared to their counterparts (pooled OR = 0.51, 95% CI: 0.35-0.74, I²:48.4%, n = 2).

CONCLUSIONS

The findings revealed that adolescent girls who earned pocket money were more likely to practice good menstrual hygiene management. Progress toward better menstrual hygiene will necessitate consideration of this factor.

Menstrual Health and Hygiene among Adolescents in the United States

STUDY OBJECTIVE

Menstrual health in adolescents has been understudied in the United States. We aimed to assess patient and provider perspectives surrounding menstrual health management and screening.

DESIGN

Our mixed-methods approach consisted of provider surveys, patient surveys, and patient interviews.

SETTING

Participants were recruited from a pediatric gynecology practice or an adolescent medicine clinic at an urban tertiary academic center.

PARTICIPANTS

Providers were pediatrics faculty or residents. Patients aged 13-24 years were eligible.

INTERVENTION

Participants completed an anonymous survey or semi-structured interview about their experiences with menstrual health.

MAIN OUTCOME MEASURES

Descriptive statistics and thematic content analysis were used for quantitative and qualitative data, respectively. Convergent parallel analysis elucidated key findings in both data sets.

RESULTS

The provider survey response rate was 65% (69/106); 15% (9/69) of providers consistently asked patients about menstrual products, whereas 44% (27/68) were concerned patients could not afford products. The patient survey response rate was 85% (101/119); 19% (19/101) of respondents reported menstrual hygiene insecurity, 55% (55/101) missed commitments during menses, and 45% (45/101) discussed menstrual products with providers. Fifteen patients were invited for qualitative interviews; 10 were conducted, and thematic saturation occurred. Interviews highlighted the importance of comprehensive early menstrual health education and providers' role in menstrual management.

CONCLUSION

Adolescence is a crucial point of entry into health care. Because taboos surrounding menstruation could limit access to health care, menstrual health education must be emphasized. Menstrual health education is provided piecemeal by parents, schools, and providers. Current practice should be reevaluated to consider comprehensive educational approaches in which health care leads.

Correlates of bacterial vaginosis among women from North India

Background: Bacterial vaginosis (BV) is the most prevalent cause of abnormal vaginal discharge among pre-menopausal women and associated with adversities of sexual and reproductive health. The present study aimed to identify potential epidemiological and behavioural risk factors and clinical predictors of BV among women in Delhi, India. Methods: A cross-sectional study was conducted to assess 283 non-pregnant women aged 18-45 years for BV using Nugent's scoring criteria. Information on demographics, sexual behaviours, hygiene practices and clinical symptoms was obtained and evaluated for their association with Nugent-BV status. Results: A positive diagnosis for Nugent-BV was made in 69 (24.4%) participants, 55 (19.4%) were intermediate and 159 (65.2%) were negative for Nugent-BV. Infertility (p = .02) and recent unprotected sexual exposure (p = .02) were strongly associated with Nugent-BV. On the other hand, women who reported regular use of condoms during intercourse were more likely to test negative (p = .03). None of the patient complaints, however, had any significant correlation with Nugent-BV diagnosis. Conclusion: Women in their reproductive years share the highest burden of adversities associated with bacterial vaginosis. History of infertility, recent unprotected sexual exposure and frequent use of condoms were correlates having significant associations with Nugent-BV.