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Hennegan J, Hasan MT, Jabbar A, Jalil T, Kennedy E, Hunter E, Kaiser A, Akter S, Zaman A, Rahman MU, Dunstan L, Head A, Scott N, Weiss HA, Win TM, Melendez-Torres GJ, Than KK, Hughes CL, Grover S, Hasan M, Rashid SF, Azzopardi P. Protocol for the Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study in Khulna, Bangladesh: A Prospective cohort to quantify the influence of menstrual health on adolescent girls' health and education outcomes. BMJ Open 2024; 14:e079451. [PMID: 38604626 PMCID: PMC11015194 DOI: 10.1136/bmjopen-2023-079451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/06/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Menstrual health is essential for gender equity and the well-being of women and girls. Qualitative research has described the burden of poor menstrual health on health and education; however, these impacts have not been quantified, curtailing investment. The Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study aims to describe menstrual health and its trajectories across adolescence, and quantify the relationships between menstrual health and girls' health and education in Khulna, Bangladesh. METHODS AND ANALYSIS AMEHC is a prospective longitudinal cohort of 2016 adolescent girls recruited at the commencement of class 6 (secondary school, mean age=12) across 101 schools selected through a proportional random sampling approach. Each year, the cohort will be asked to complete a survey capturing (1) girls' menstrual health and experiences, (2) support for menstrual health, and (3) health and education outcomes. Survey questions were refined through qualitative research, cognitive interviews and pilot survey in the year preceding the cohort. Girls' guardians will be surveyed at baseline and wave 2 to capture their perspectives and household demographics. Annual assessments will capture schools' water, sanitation and hygiene, and support for menstruation and collect data on participants' education, including school attendance and performance (in maths, literacy). Cohort enrolment and baseline survey commenced in February 2023. Follow-up waves are scheduled for 2024, 2025 and 2026, with plans for extension. A nested subcohort will follow 406 post-menarche girls at 2-month intervals throughout 2023 (May, August, October) to describe changes across menstrual periods. This protocol outlines a priori hypotheses regarding the impacts of menstrual health to be tested through the cohort. ETHICS AND DISSEMINATION AMEHC has ethical approval from the Alfred Hospital Ethics Committee (369/22) and BRAC James P Grant School of Public Health Institutional Review Board (IRB-06 July 22-024). Study materials and outputs will be available open access through peer-reviewed publication and study web pages.
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Affiliation(s)
- Julie Hennegan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Md Tanvir Hasan
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abdul Jabbar
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Tasfiyah Jalil
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Elissa Kennedy
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Population Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Erin Hunter
- Department of Public Health Sciences, Clemson University College of Behavioral Social and Health Sciences, Clemson, South Carolina, USA
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Adrita Kaiser
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sabina Akter
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Afreen Zaman
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Laura Dunstan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- School of Social and Political Sciences, University of Melboune, Melbourne, Victoria, Australia
| | - Alexandra Head
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nick Scott
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Helen Anne Weiss
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Thin Mar Win
- Myanmar Country Program, Burnet Institute, Yangon, Myanmar
| | | | - Kyu Kyu Than
- Myanmar Country Program, Burnet Institute, Yangon, Myanmar
| | - Chad L Hughes
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Sonia Grover
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Peter Azzopardi
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Telethon Kids Institute, Adelaide, South Australia, Australia
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Dalai S, Malini DS, Satapathy DM, Patro S. A Qualitative Analysis of Urbanization and Menstrual Health Among Young Women. Cureus 2024; 16:e56390. [PMID: 38633924 PMCID: PMC11022980 DOI: 10.7759/cureus.56390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
This qualitative study, grounded in theory, employed inductive coding for analysis, focusing on menstrual health among urban women aged 10-25. The research aims to explore the menstrual health status, practices, and beliefs of participants. The research delves into the impact of recent government initiatives on menstrual health and assesses the role of urbanization in shaping evolving menstrual health practices among young girls. Employing in-depth qualitative methods such as interviews and focus group discussions, the study seeks a comprehensive understanding of participants' experiences and perceptions related to menstrual health. The dynamics of women's menstrual experiences are significantly influenced by urbanization, heightened exposure to social media, evolving lifestyles, and government initiatives like the distribution of menstrual products in schools and the enhancement of water, sanitation, and hygiene (WASH) facilities in government institutions. Positive shifts have been observed, including reduced restrictions on menstruating individuals, enhanced access to affordable hygiene products, and improved disposal facilitated by municipal garbage collection services. However, notable gaps persist in basic knowledge about menstruation, hygienic practices, effective interpersonal communication with schoolteachers or community health care workers, and compliance with government programs promoting weekly iron-folic acid supplementation and biannual Albendazole intake, calling for substantial improvement.
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Affiliation(s)
- Sithal Dalai
- Community Medicine, Maharaja Krishna Chandra Gajapati Medical College and Hospital, Berhampur, IND
| | - D Shobha Malini
- Community Medicine, Jajati Keshari Medical College & Hospital (JKMCH), Jajpur, IND
| | - Durga M Satapathy
- Community Medicine, Maharaja Krishna Chandra Gajapati Medical College and Hospital, Berhampur, IND
| | - Sithun Patro
- Community Medicine, Maharaja Krishna Chandra Gajapati Medical College and Hospital, New Delhi, IND
- Epidemiology Research, JHPIEGO, New Delhi, IND
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Phillips-Howard PA, Osire E, Akinyi C, Zulaika G, Otieno FO, Mehta SD. Water, sanitation and hygiene at sex work venues to support menstrual needs. Front Public Health 2024; 12:1305601. [PMID: 38481834 PMCID: PMC10936742 DOI: 10.3389/fpubh.2024.1305601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Adequate menstrual health and hygiene (MHH) is necessary for women's health and equity of all menstruators. Female sex workers (FSW) require good MHH to prevent discomfort and exposure to pathogens. No studies have evaluated water, sanitation, and hygiene (WASH) conditions of FSW. We report on a cross-sectional WASH assessment at FSW venues in Kisumu, western Kenya. Methods Stakeholders identified 77 FSW venues in Kisumu, of which 47 were randomly sampled and visited between April-May 2023. A standardized structured survey of WASH conditions was deployed by trained research staff using Android tablets after proprietor's consent. WASH scores ranging 0-3 were computed based on point each for direct observation of water available, soap available, and acceptable latrine. MHH scores ranging between 0-4 were computed (one point each) for direct observation of: currently available soap and water, locking door on a usable latrine, functional lighting, and a private area for changing clothes or menstrual materials, separate from the latrine(s). WASH and MHH scores were compared by venue type using non-parametric Kruskal-Wallis tests, and non-parametric Spearman rank tests. Results Full WASH criteria was met by 29.8% of venues; 34.0% had no adequate WASH facilities; 46.8% had no female latrine; and 25.5% provided soap and water in private spaces for women. While 76.6% had menstrual waste disposal only 14 (29.8%) had covered bins. One in 10 venues provided adequate MHM facilities. Poorest WASH facilities were in brothels and in bars, and three-quarters of bars with accommodation had no MHH facilities. Discussion WASH and MHH services were sub-optimal in the majority of FSW venues, preventing menstrual management safely, effectively, with dignity and privacy. This study highlights the unmet need for MHH support for this population. Poor MHH can deleteriously impact FSW health and wellbeing and compound the stigma and shame associated with their work and ability to stay clean. Acceptable and cost-effective solutions to sustainably improve WASH facilities for these populations are needed. Trial registration Clinicaltrial.gov NCT0566678.
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Affiliation(s)
| | - Edyth Osire
- Nyanza Reproductive Health Society, Kisumu, Kenya
| | | | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Supriya D. Mehta
- Department of Internal Medicine, Division of Infectious Diseases, Rush Medical College, Chicago, IL, United States
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
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Wilbur J, Crow CL, Poilapa R, Morrison C. Feasibility study of a menstrual health behaviour change intervention for women and girls with intellectual disabilities and their caregivers for Vanuatu's humanitarian responses. PLOS Glob Public Health 2024; 4:e0002244. [PMID: 38241243 PMCID: PMC10798467 DOI: 10.1371/journal.pgph.0002244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Abstract
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.
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Affiliation(s)
- Jane Wilbur
- International Centre for Evidence in Disability (ICED), London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Casey-Lynn Crow
- International Centre for Evidence in Disability (ICED), London School of Hygiene & Tropical Medicine, London, United Kingdom
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Plesons M, Torondel B, Caruso BA, Hennegan J, Sommer M, Haver J, Keiser D, van Eijk AM, Zulaika G, Mason L, Phillips-Howard PA. Research priorities for improving menstrual health across the life-course in low- and middle-income countries. Glob Health Action 2023; 16:2279396. [PMID: 38010372 PMCID: PMC10795652 DOI: 10.1080/16549716.2023.2279396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Research on menstrual health is required to understand menstrual needs and generate solutions to improve health, wellbeing, and productivity. The identification of research priorities will help inform where to invest efforts and resources. OBJECTIVES To identify research priorities for menstrual health across the life-course, in consultation with a range of stakeholder groups from a variety of geographic regions, and to identify if menstrual health research priorities varied by expertise. METHODS A modified version of the Child Health and Nutrition Research Initiative approach was utilized to reach consensus on a set of research priorities. Multisector stakeholders with menstrual health expertise, identified through networks and the literature, were invited to submit research questions through an online survey. Responses were consolidated, and individuals were invited to rank these questions based on novelty, potential for intervention, and importance/impact. Research priority scores were calculated and evaluated by participants' characteristics. RESULTS Eighty-two participants proposed 1135 research questions, which were consolidated into 94 unique research questions. The mean number of questions did not differ between low- and middle-income country (LMIC) and high-income country (HIC) participants, but significantly more questions were raised by participants with expertise in mental health and WASH. Sixty-six participants then ranked these questions. The top ten-ranked research questions included four on 'understanding the problem', four on 'designing and implementing interventions', one on 'integrating and scaling up', and one on 'measurement'. Indicators for the measurement of adequate menstrual health over time was ranked the highest priority by all stakeholders. Top ten-ranked research questions differed between academics and non-academics, and between participants from HICs and LMICs, reflecting differences in needs and knowledge gaps. CONCLUSIONS A list of ranked research priorities was generated through a consultative process with stakeholders across LMICs and HICs which can inform where to invest efforts and resources.
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Affiliation(s)
- Marina Plesons
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Belen Torondel
- Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Bethany A. Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Julie Hennegan
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jacquelyn Haver
- School Health and Nutrition, Department of Education and Children Protection, Save the Children US, Washington, DC, USA
| | | | - Anna M. van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Linda Mason
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Francis L, Meraj S, Konduru D, Perrin EM. An Update on State Legislation Supporting Menstrual Hygiene Products in US Schools: A Legislative Review, Policy Report, and Recommendations for School Nurse Leadership. J Sch Nurs 2023; 39:536-541. [PMID: 36217851 DOI: 10.1177/10598405221131012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Access to menstrual products is important to support adolescent health. Advocacy to increase access to menstrual products in schools is growing; however, ideal access requires policies that will require schools to support the menstrual health of menstruating students. We conducted a legislative review on the existence and status of state legislation related to the provision of menstrual products in US schools and categorized by state's political control (political party affiliation of governors and state legislature). Of 50 states and 6 territories, 21 had legislation to support menstrual products in schools, 7 had bills pending, 10 had bills failed, and 18 states had no policies introduced in the state legislature. States with Democrat control have significantly more menstrual product state laws compared to states with Republican control [z = 2.54, p = 0.01]. There is a need, especially in Republican states, to accelerate efforts to pass laws that will support menstrual product access in schools.
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Affiliation(s)
- Lucine Francis
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA
- Center for Community Programs, Innovation, and Scholarship, Johns Hopkins School of Nursing, Baltimore, MD 21205, USA
- Johns Hopkins Consortium for School-Based Health Solutions, Baltimore, MD, USA
| | - Shafkat Meraj
- Johns Hopkins University Homewood Campus, Baltimore, MD, USA
| | - Divya Konduru
- Johns Hopkins University Homewood Campus, Baltimore, MD, USA
| | - Eliana M Perrin
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hennegan J, Caruso BA, Zulaika G, Torondel B, Haver J, Phillips-Howard PA, Valdez J, Gruer C, Okwaro N, Mahon T, Sommer M. Indicators for National and Global Monitoring of Girls' Menstrual Health and Hygiene: Development of a Priority Shortlist. J Adolesc Health 2023; 73:992-1001. [PMID: 37737755 PMCID: PMC10654045 DOI: 10.1016/j.jadohealth.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/28/2023] [Accepted: 07/07/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Despite the importance of menstrual health and hygiene (MHH) for adolescent girls' health, education, and gender equality, few countries monitor MHH. MHH needs remain underprioritized, and progress achieved through policies, programs, or investments go unmeasured. This article reports the systematic development of an indicator shortlist to monitor adolescent girls' MHH at the national and global levels across low- and middle-income countries. METHODS A core group of MHH researchers and practitioners collaborated with stakeholders from three countries with demonstrated commitment to monitoring MHH (Bangladesh, Kenya, and the Philippines), measures experts, and a global advisory group. The approach included the following: (1) define domains for monitoring MHH; (2) review and map existing indicators and measures; (3) iteratively shortlist indicators through appraising quality, feasibility, and stakeholder input; and (4) refine the shortlist and develop guidance for use. RESULTS The shortlist comprises 21 indicators across seven domains covering menstrual materials, water, sanitation, and hygiene facilities, knowledge, discomforts and disorders, supportive social environments, menstrual health impacts, and policies. Indicators are accompanied by measures that have been tested or are expected to provide reliable data, alongside justification for their selection and guidance for use. DISCUSSION The shortlisted indicators reflect the multisectoral collaboration necessary for ensuring girls' MHH. Uptake requires integration into monitoring systems at national and global levels. Future work remains to evaluate the performance of the indicators over time and to support their widespread use. Governments and stakeholders can use these indicators to track the progress of programs and policies, monitor unmet MHH needs, identify disparities, and set targets for improvement.
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Affiliation(s)
- Julie Hennegan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Bethany A Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Belen Torondel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jacquelyn Haver
- Department of Education and Child Protection, School Health and Nutrition Program, Save the Children US, Washington, D.C
| | | | - Jonathan Valdez
- Department of Education and Child Protection, School Health and Nutrition Program, Save the Children US, Washington, D.C
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Therese Mahon
- International Programmes Department, WaterAid, London, United Kingdom
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York.
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Sanders SL, Douglas LD, Sill TE, Stewart K, Pieniazek N, Li C, Walters E, Al-Hashimi M, Fang L, Davidson RD, Banerjee S. Tetrapodal textured Janus textiles for accessible menstrual health. iScience 2023; 26:108224. [PMID: 38107878 PMCID: PMC10725076 DOI: 10.1016/j.isci.2023.108224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/15/2023] [Accepted: 10/12/2023] [Indexed: 12/19/2023] Open
Abstract
Menstruating individuals without access to adequate hygiene products often improvise with alternatives that pose health risks and limit their participation in society. We describe here a menstrual hygiene product based on low-cost materials, which are integrated onto fabrics to imbue unidirectional permeability. A body-facing "Janus" fabric top layer comprising ZnO tetrapods spray-coated onto polyester mosquito netting imparts hierarchical texturation, augmenting the micron-scale texturation derived from the weave of the underlying fabric. The asymmetric coating establishes a gradient in wettability, which underpins flash spreading and unidirectional permeability. The hygiene product accommodates a variety of absorptive media, which are sandwiched between the Janus layer and a second outward-facing coated densely woven fabric. An assembled prototype demonstrates outstanding ability to wick saline solutions and a menstrual fluid simulant while outperforming a variety of commercially alternatives. The results demonstrate a versatile menstrual health product that provides a combination of dryness, discretion, washability, and safety.
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Affiliation(s)
- Sarah L. Sanders
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Lacey D. Douglas
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Tiffany E. Sill
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Kaylyn Stewart
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Noah Pieniazek
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Chenxuan Li
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
| | - Eve Walters
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | | | - Lei Fang
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
| | - Rachel D. Davidson
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Sarbajit Banerjee
- Department of Chemistry, Texas A&M University, College Station, TX 77842-3012, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX 77843-3003, USA
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Meher T, Sahoo H. Dynamics of usage of menstrual hygiene and unhygienic methods among young women in India: a spatial analysis. BMC Womens Health 2023; 23:573. [PMID: 37932760 PMCID: PMC10629021 DOI: 10.1186/s12905-023-02710-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 10/15/2023] [Indexed: 11/08/2023] Open
Abstract
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.
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Affiliation(s)
- Trupti Meher
- International Institute for Population Sciences (IIPS), Deonar, Mumbai, India, 400088.
| | - Harihar Sahoo
- International Institute for Population Sciences (IIPS), Deonar, Mumbai, India, 400088
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Hoppes E, Rademacher KH, Wilson L, Mahajan TD, Wilson K, Sommer M, Solomon M, Lathrop E. Strengthening Integrated Approaches for Family Planning and Menstrual Health. Glob Health Sci Pract 2023; 11:e2300080. [PMID: 37903573 PMCID: PMC10615238 DOI: 10.9745/ghsp-d-23-00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/29/2023] [Indexed: 11/01/2023]
Abstract
FP and menstrual health integration has the potential to improve individuals' health and well-being. The authors describe potential ways to integrate FP and menstrual health, outlining steps that stakeholders can take in designing integrated approaches.
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Affiliation(s)
| | | | | | | | | | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, NY, USA
| | | | - Eva Lathrop
- Population Services International, Washington, DC, USA
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Gupta A, Aravindakshan R, Sharmila V, Reddy BV, Marimuthu Y, Naidu NK. Menstrual cup webinar series: A developing model of modified pre- and post-tests in the online teaching-learning of primary health care workers. J Educ Health Promot 2023; 12:322. [PMID: 38023077 PMCID: PMC10670881 DOI: 10.4103/jehp.jehp_1825_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/21/2023] [Indexed: 12/01/2023]
Abstract
Menstrual hygiene management, especially in resource-limited settings, is challenging. The acceptability of the menstrual cup is increasing recently in western countries whereas, in developing countries like India, the awareness, acceptability, and use of menstrual cups are very limited. We assessed the effectiveness of modified pre-post-test teaching-learning methodology in an online webinar series on menstrual cups using Moore's outcome assessment. An online webinar series on menstrual hygiene and the menstrual cup was conducted to raise awareness about the usage of menstrual cups among the health care workers like Auxiliary Nurse Midwife (ANMs), Accredited Social Health Activist (ASHAs), and Anganwadi Workers (AWWs) of the Guntur district, Andhra Pradesh, India. The questions of modified pre- and post-test were displayed. The questions were displayed to participants using the polling option in zoom. A total of 1597 health care workers participated in the menstrual cup webinar series. Of the total, 72.7% of participants responded to the job title question of which ASHA, ANMs, and AWWs were 16.8%, 34.2%, and 41.9%, respectively. The baseline knowledge of menstrual cups among primary health care workers for "heard of the menstrual cup" and "ever used/know anyone using menstrual cup" was 36.89% and 11.67%, respectively. After the webinar among the primary health care workers, the maximum gain in knowledge was seen for "menstrual cup can be cleaned in the home," 94.53%, and the minimum gain in knowledge was on "unmarried girls can use menstrual cups," 50.42%. The modified pre- and post-test model predicted an overall 50 percent rise in the knowledge of primary health care workers by the webinar series about a different aspect of the menstrual cup.As online webinar providers aim to provide more performance-based learning activities, current approaches to continuing medical education may become obsolete. The single most essential shift in online webinar planners can make is to incorporate modified pre-and post-test to allow for interactive and formative assessment during webinar activities.
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Affiliation(s)
- Arti Gupta
- Department of Community and Family Medicine, All India Institute of Medical Sciences Mangalagiri, Andhra Pradesh, India
| | - Rajeev Aravindakshan
- Department of Community and Family Medicine, All India Institute of Medical Sciences Mangalagiri, Andhra Pradesh, India
| | - Vijayan Sharmila
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences Mangalagiri, Andhra Pradesh, India
| | - B Venkatashiva Reddy
- Department of Community and Family Medicine, All India Institute of Medical Sciences Mangalagiri, Andhra Pradesh, India
| | - Yamini Marimuthu
- Department of Community and Family Medicine, All India Institute of Medical Sciences Mangalagiri, Andhra Pradesh, India
| | - Navya Krishna Naidu
- Department of Community and Family Medicine, All India Institute of Medical Sciences Mangalagiri, Andhra Pradesh, India
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12
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Moreno Gómez A, Guo P, de la Llave Rincón AI, Efstathiou N. Women's experiences of primary dysmenorrhea symptoms: a systematic review of qualitative evidence and meta-aggregation. Women Health 2023; 63:658-668. [PMID: 37726871 DOI: 10.1080/03630242.2023.2255289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Abstract
Primary dysmenorrhea (PD) has a significant impact on women's lives, especially among young women who miss school and work due to painful periods. Experiences and how women manage PD have been explored to some extent, but the evidence has not been systematically collated and reviewed to allow health professionals to better understand women's experiences of and perceptions about PD. Hence, we aim to synthesize the qualitative evidence related to women's experiences of PD and associated symptoms. For this purpose, seven databases (Ovid MEDLINE®, PubMed, Embase, APA PsycINFO, Web of Science, CINAHL and OpenGrey) were searched for relevant papers published in English, Spanish, Greek and Chinese between January 1997 and May 2021. All studies investigating women's experiences with PD were included; besides, The Critical Appraisal Skills Programme (CASP) tool for qualitative studies was used to critically appraise the papers. A data extraction form was developed using JBI template and findings from the papers were analyzed and synthesized using meta-aggregation. Sixteen articles were included and during the analysis five themes were identified: Experiencing pain and associated symptoms, the psychological dimension of PD, knowledge and support, day-to-day living with PD, and coping strategies. We concluded taboos and deeply rooted beliefs around menstruation can potentially lead to gender inequalities; hence, women's common concerns and their experiences with PD need to be considered. Training and treatment protocols for health practitioners are needed. Future research should focus on development and testing of protocols for diagnosis, pharmacological and non-pharmacological management and men's perceptions of menstruation of their lovers.
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Affiliation(s)
- Ana Moreno Gómez
- Student in Health Sciences, Universidad Rey Juan Carlos, Alcorcón (Madrid), Spain
| | - Ping Guo
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ana Isabel de la Llave Rincón
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Nikolaos Efstathiou
- College of Medical and Dental Sciences, Institute of Clinical Sciences, School of Nursing, University of Birmingham, Birmingham, UK
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13
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Casola AR, Luber K, Riley AH. Period Poverty: an Epidemiologic and Biopsychosocial Analysis. Health Promot Pract 2023:15248399231192998. [PMID: 37605547 DOI: 10.1177/15248399231192998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
In the United States, approximately one in five persons experience period poverty, defined as the inability to obtain resources needed for healthy, safe, and dignified menstrual management. Limited access to an inadequate number of menstrual supplies may lead to longer-than-recommended use, which can increase skin chafing, disruption of vaginal flora, and intravaginal toxin overgrowth. However, period poverty goes beyond simply having enough menstrual products and can encompass the embarrassment, stigma, shame, and barriers in conversation surrounding menstruation. Discussion and critical examination of the multilayered attributes surrounding period poverty have been intermittent in academic literature, particularly from a domestic lens. Thus, this narrative review and theoretical analysis aimed to describe the epidemiology of period poverty and analyze its biological, socio-emotional, and societal implications. We applied a descriptive epidemiology approach of person, place, and time, and employed a social-ecological lens to examine risk factors. Our findings describe the incidence, distribution, and possible ways to alleviate period poverty. Practitioners, medical providers, and public health professionals may have limited knowledge of period poverty, what it entails, and who it impacts, but they have great potential to address it and associated menstrual inequities in their work. With its widespread implications for psychosocial and community-level health, this phenomenon needs urgent attention to promote menstrual equity as an issue of human rights and social justice. We conclude with research and policy recommendations for alleviating period poverty.
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Affiliation(s)
| | - Kierstin Luber
- Thomas Jefferson University, Philadelphia, PA, USA
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
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14
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Proff AA, Fatima S, Limón MLS. Becoming women: period. Perceptions of barriers and facilitators to menstrual hygiene management programs for Pakistani girls. Front Public Health 2023; 11:1083688. [PMID: 37637817 PMCID: PMC10457679 DOI: 10.3389/fpubh.2023.1083688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/08/2023] [Indexed: 08/29/2023] Open
Abstract
Discussions on and around menstruation are often considered a cultural taboo in many parts of Pakistan. Mostly, individuals avoid discussing menstruation and lack awareness about its related health and hygiene issues. Sexual health education is entangled in a complex myriad of social and cultural stigmas. Limited knowledge and lack of access to menstrual health management (MHM) resources decrease the self-confidence of girl students and lead to reluctance to seek help or advice. This quantitative study aimed to gain a deeper understanding of the intersectionality of the influences leading to barriers and facilitators of access to the MHM program in a public school in the Hyderabad district and utilize this information to construct a framework for evaluation of the Water, Sanitation, and Hygiene (WASH) in Schools program. This study sampled all girls' elementary and higher secondary schools in the Hyderabad district. Due to the limitations of time and access during the global COVID-19 pandemic, the researchers collected data from more than 100 school leaders and teachers regarding the MHM facilities in their schools through an online self-administered survey. The data were then analyzed in SPSS for frequencies, mean scores, and standard deviation. The results suggest that school leaders and teachers of the Hyderabad district perceive MHM facilities to be significantly low in terms of both resources and policies. Schools worldwide are introducing life skills, hygiene, good health, and wellness subjects. Pakistan needs to change its educational policy for the welfare of women, who comprise a magnanimous 48.54% of its population. Moreover, with the planning and implementation of programs such as WASH in Schools (WinS), the perceptions of barriers and facilitators to MHM facilities in Pakistan must be studied to fight the taboo and raise awareness about the same.
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Affiliation(s)
- Alexandria Alisa Proff
- Department of Humanities and Social Sciences, American University of Ras Al Khaimah, Ras Al-Khaimah, United Arab Emirates
| | - Surhan Fatima
- Department of Mathematics and Social Sciences, Sukkur Institute of Business Administration (IBA) University, Sukkur, Pakistan
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15
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Shenkman JL, Neubauer LC, Mason L, Oruko K, Alexander K, Phillips-Howard PA, Nyothach E. Building menstrual health and hygiene-supportive environments: exploring teachers' experience in rural Western Kenya. Front Public Health 2023; 11:1206069. [PMID: 37559733 PMCID: PMC10407083 DOI: 10.3389/fpubh.2023.1206069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/10/2023] [Indexed: 08/11/2023] Open
Abstract
Introduction Existing school environments and staff play a critical role in Menstrual Health and Hygiene (MHH) for school aged girls in middle and low-income countries. This paper leverages teachers' perspectives on menstruation and the impact of the Menstrual Solutions (MS) study, an open cluster randomized controlled feasibility study to determine the impact of puberty education, nurses support, and menstrual product provision on girls' academic performance and emotional well-being. Methods Seventeen focus group discussions were conducted from October 2012 through November 2013 with teachers at six participating schools, held at three different time points during the study period. Results Key themes that emerged were emotions and blood, absenteeism, the role of teachers in MHH, and the impact of sensitization. Teachers noted that poor MHH had an impact on school attendance, transparency and openness with teachers, and student behavior in class. It was reported that adolescent girls would absent themselves for 3-5 days during their menstrual cycle depending on what materials they could use, and they would often shy away from teachers, when possible, only speaking to them about their menses if it was urgent or they needed to go home. Emotions such as fear and embarrassment were commonly associated with bleeding. At the midpoint and end of the study, teachers noted that the puberty education and menstrual product provision (where applicable) had a positive impact on girls' attendance, attention, and comfort in the classroom. Girls became more open with both male and female teachers about their menses, and more comfortable and confident in the classroom among all classmates. Discussion This research highlights the importance of building an MHH-supportive environment with multiple school personnel within schools to develop a gender-equitable environment for girls to learn confidently without undue interference. Teachers are key adults in adolescent girls' lives, having the potential to foster an environment that empowers girls with greater autonomy to manage their menses. This highlights a need to consider their perspectives in intervention development. Sensitization of teachers and puberty education across both genders are key components to developing the MHH-supportive environment in schools.
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Affiliation(s)
- Julia L. Shenkman
- Division of Public Health Practice, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Leah C. Neubauer
- Division of Public Health Practice, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Linda Mason
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kelvin Oruko
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Kenya Medical Training College, Nairobi, Kenya
| | - Kelly Alexander
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Water + Team, Care International, Atlanta, GA, United States
| | | | - Elizabeth Nyothach
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
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Rawat M, Novorita A, Frank J, Burgett S, Cromer R, Ruple A, DeMaria AL. "Sometimes I just forget them": capturing experiences of women about free menstrual products in a U.S. based public university campus. BMC Womens Health 2023; 23:351. [PMID: 37403058 DOI: 10.1186/s12905-023-02457-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Studies have proven that lack of access to menstruation products negatively affects school attendance, academic performance, and individual health. Implementing "period policies," or programs offering free menstruation products, are becoming popular in schools, businesses, and communities in high-income countries. U.S.-based Purdue University announced in February 2020 that free pads and tampons would be stocked in all women's and gender-neutral restrooms in campus buildings. This study aimed to capture the experiences of menstruators about free menstrual products and the impact of a university-wide free menstruation management product policy and program. A second purpose was to understand how access to menstrual management products is intertwined with broader socio-cultural experiences of a menstruator. METHODS As part of a larger study, virtual focus group discussions (n = 32 across 5 focus groups) were conducted in February 2021. Eligible participants were student-menstruators attending Purdue University. We used thematic analysis techniques for data analysis, allowing for a constant comparative approach to data contextualization and theme identification. RESULTS Focus group discussions revealed vivid menarche and menstruation experiences, shifting period culture, recollections of shame and stigma, and use of various technologies to manage menstruation. Recommendations for community-based programs offering free products included maintaining stock, making informed product choices, and broadly distributing program information to increase awareness of free product placements. CONCLUSIONS Findings offer practical recommendations that will contribute to menstruation management and period poverty solutions for university communities.
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Affiliation(s)
- Meghana Rawat
- Department of Communication, College of Humanities and Social Sciences, Utah Valley University, 800 W University Parkway, Orem, UT, 84058, USA.
| | - Allison Novorita
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Jaclyn Frank
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Stevie Burgett
- Weldon School of Biomedical Engineering, College of Engineering, Purdue University, West Lafayette, IN, USA
| | - Risa Cromer
- Department of Anthropology, College of Liberal Arts, Purdue University, West Lafayette, IN, USA
| | - Audrey Ruple
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Andrea L DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
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Degefu S, Tadesse A, Ashagir K, Ezo E. Assessment of menstrual hygiene management practice and associated factors among prisoners in South Nation Nationalities and peoples region, Ethiopia. Heliyon 2023; 9:e16224. [PMID: 37274653 PMCID: PMC10238586 DOI: 10.1016/j.heliyon.2023.e16224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 06/06/2023] Open
Abstract
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.
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Affiliation(s)
- Sindu Degefu
- Department of Nursing College of Medicine and Health Science, Wolaita Sodo University, Ethiopia
| | - Aster Tadesse
- Department of Nursing College of Health Sciences, Debre Markos University, Ethiopia
| | - Kidist Ashagir
- Department of Nursing College of Medicine and Health Science, Wolaita Sodo University, Ethiopia
| | - Elias Ezo
- Department of Comprehensive Nursing School of Nursing College of Medicine and Health Science, Wachemo University, Ethiopia
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18
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Yang YT, Chen DR. Effectiveness of a menstrual health education program on psychological well-being and behavioral change among adolescent girls in rural Uganda. J Public Health Afr 2023; 14:1971. [PMID: 37197264 PMCID: PMC10184177 DOI: 10.4081/jphia.2023.1971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/04/2022] [Indexed: 05/19/2023] Open
Abstract
Objectives. Menstrual hygiene management is one of the main barriers to girls' education attainment in low-and middle-income countries. Poor access to sanitary products and lack of menstrual knowledge affect students' performance at school compared to the opposite sex. Limited evidence is available to provide solutions for schoolgirls. This study examines the effectiveness of menstrual health education programs on well-being and behavioral change among adolescent girls in rural Uganda. Methods. A cluster randomized controlled trial was conducted across 3 schools, including 66 girls aged 13-17 years, in a rural village in Mukono District, Uganda. Schools were randomly allocated to 2 groups: i) health education program intervention and ii) control group (no intervention). Results. After 5 weeks of the Health Education Program, the schoolgirls in experiment groups showed significantly less fear of sharing the menstruation-related concern with parents and pupils [Mean Difference (MD)=0.87, P=0.029) (MD=2.02, P=0.000), and the sense of shameful feelings during menstruation (MD=1.65, P= 0.004); conversely, the fear to go to school during menstruation did not differ between experiment and control groups (MD=-0.04, P=0.94). However, the changes in feeling comfortable having a period at school were significantly different between the experiment and control groups (P=0.001). Conclusions. The study demonstrated promising results of a low-cost intervention for enhancing girls' menstrual health education in a low-income context. Puberty education and reusable pad sewing provision were strongly associated with improving schoolgirls' psychosocial wellbeing related to menstrual management.
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Affiliation(s)
- Yi-Ting Yang
- Master of Public Health, College of Public Health, National Taiwan University, Taipei
| | - Duan-Rung Chen
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan, No. 17, Xu-Zhou Road, Taipei, Taiwan. +886-2-3366-8066.
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Tembo M, Weiss HA, Larsson LS, Bandason T, Redzo N, Dauya E, Nzanza T, Ishumael P, Gweshe N, Ndlovu P, Dziva Chikwari C, Mavodza CV, Renju J, Francis SC, Ferrand R, Mackworth-Young CRS. A mixed-methods study measuring the effectiveness of a menstrual health intervention on menstrual health knowledge, perceptions and practices among young women in Zimbabwe. BMJ Open 2023; 13:e067897. [PMID: 36894201 PMCID: PMC10008401 DOI: 10.1136/bmjopen-2022-067897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVES While integral to women's physical and mental well-being, achieving good menstrual health (MH) remains a challenge for many women. This study investigated the effectiveness of a comprehensive MH intervention on menstrual knowledge, perceptions and practices among women aged 16-24 years in Harare, Zimbabwe. DESIGN A mixed-methods prospective cohort study with pre-post evaluation of an MH intervention. SETTING Two intervention clusters in Harare, Zimbabwe. PARTICIPANTS Overall, 303 female participants were recruited, of whom 189 (62.4%) were seen at midline (median follow-up 7.0; IQR 5.8-7.7 months) and 184 (60.7%) were seen at endline (median follow-up 12.4; IQR 11.9-13.8 months). Cohort follow-up was greatly affected by COVID-19 pandemic and associated restrictions. INTERVENTION The MH intervention provided MH education and support, analgesics, and a choice of menstrual products in a community-based setting to improve MH outcomes among young women in Zimbabwe. PRIMARY AND SECONDARY OUTCOMES Effectiveness of a comprehensive MH intervention on improving MH knowledge, perceptions, and practices among young women over time. Quantitative questionnaire data were collected at baseline, midline, and endline. At endline, thematic analysis of four focus group discussions was used to further explore participants' menstrual product use and experiences of the intervention. RESULTS At midline, more participants had correct/positive responses for MH knowledge (adjusted OR (aOR)=12.14; 95% CI: 6.8 to 21.8), perceptions (aOR=2.85; 95% CI: 1.6 to 5.1) and practices for reusable pads (aOR=4.68; 95% CI: 2.3 to 9.6) than at baseline. Results were similar comparing endline with baseline for all MH outcomes. Qualitative findings showed that sociocultural norms, stigma and taboos around menstruation, and environmental factors such as limited access to water, sanitation and hygiene facilities affected the effect of the intervention on MH outcomes. CONCLUSIONS The intervention improved MH knowledge, perceptions and practices among young women in Zimbabwe, and the comprehensive nature of the intervention was key to this. MH interventions should address interpersonal, environmental and societal factors. TRIAL REGISTRATION NUMBER NCT03719521.
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Affiliation(s)
- Mandikudza Tembo
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen A Weiss
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Nicol Redzo
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tafadzwa Nzanza
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Nancy Gweshe
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Precious Ndlovu
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Constancia Vimbayi Mavodza
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, London, UK
| | - Jenny Renju
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzanna C Francis
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rashida Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene and Tropical Medicine Department of Clinical Research, London, London, UK
| | - Constance R S Mackworth-Young
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
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Macura B, Foggitt E, Liera C, Soto A, Orlando A, Del Duca L, Carrard N, Hannes K, Sommer M, Dickin S. Systematic mapping of gender equality and social inclusion in WASH interventions: knowledge clusters and gaps. BMJ Glob Health 2023; 8:bmjgh-2022-010850. [PMID: 36693669 PMCID: PMC9884933 DOI: 10.1136/bmjgh-2022-010850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/29/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Poor access to water, sanitation and hygiene (WASH) services threatens population health and contributes to gender and social inequalities, especially in low-resource settings. Despite awareness in the WASH sector of the importance of promoting gender equality and social inclusion (GESI) to address these inequalities, evaluations of interventions focus largely on health outcomes, while gender equality and other social outcomes are rarely included. This review aimed to collate and describe available research evidence of GESI outcomes evaluated in WASH intervention studies. METHODS We applied a systematic mapping methodology and searched for both academic and grey literature published between 2010 and 2020 in 16 bibliographic databases and 53 specialist websites. Eligibility screening (with consistency checking) was conducted according to predetermined criteria, followed by metadata coding and narrative synthesis. RESULTS Our evidence base comprises 463 intervention studies. Only 42% of studies measured transformative GESI outcomes of WASH interventions, referring to those that seek to transform gender relations and power imbalances to promote equality. A majority of studies disaggregated outcome data by sex, but other forms of data disaggregation were limited. Most included studies (78%) lacked a specific GESI mainstreaming component in their intervention design. Of the interventions with GESI mainstreaming, the majority targeted women and girls, with very few focused on other social groups or intersectional considerations. CONCLUSION The review points to various areas for future primary and secondary research. Given the potential contribution of WASH to GESI, GESI considerations should be incorporated into the evaluation of WASH interventions. Regular collection of data and monitoring of GESI outcomes is needed as well as developing new and testing existing methods for monitoring and evaluation of such data.
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Affiliation(s)
| | - Ella Foggitt
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
| | - Carla Liera
- Stockholm Environment Institute, Stockholm, Sweden
| | - Adriana Soto
- Stockholm Environment Institute, Stockholm, Sweden
| | - Arianna Orlando
- Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
| | | | - Naomi Carrard
- Institute for Sustainable Futures, University of Technology Sydney, Broadway, Sydney, Australia
| | - Karin Hannes
- Research Group SoMeTHin’K, Faculty of Social Sciences, KU Leuven, Leuven, Belgium
| | - Marni Sommer
- Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Sarah Dickin
- Stockholm Environment Institute, Stockholm, Sweden,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Anbesu EW, Asgedom DK. Menstrual hygiene practice and associated factors among adolescent girls in sub-Saharan Africa: a systematic review and meta-analysis. BMC Public Health 2023; 23:33. [PMID: 36604734 PMCID: PMC9817285 DOI: 10.1186/s12889-022-14942-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/26/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Menstrual hygiene has not received adequate attention in Sub-Saharan Africa, and there is a lack of regional representative data. Therefore, this study aimed to estimate the pooled prevalence of good menstrual hygiene practices and associated factors among adolescent girls in sub-Saharan Africa. METHODS In this study, the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to develop the review manuscript. Online electronic databases, such as PubMed/Medline, Google Scholar, and CINAHL, were searched to retrieve available studies. The database search was conducted from January 1 to May 17, 2022. The selection, quality assessment, and data extraction of the studies were performed. Quality assessment of the studies was performed using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Subgroup analysis and meta-regression were performed based on country, study area, and sample size. Publication bias was examined by funnel plots and Egger's test. The statistical analysis was conducted using STATA version 14 software and RevMan software, and statistical significance was declared at a p value of less than 0.05. PROTOCOL REGISTRATION NUMBER CRD42020165628. RESULTS A total of 229 studies were retrieved, and 14 studies were included in the final meta-analysis. The pooled prevalence of good menstrual hygiene practices was 45% (95% CI, (37, 53). Adolescents from urban residences (OR = 3.03, 95% CI (2.3, 3.97)), able to afford menstrual sanitary products (OR = 2.17, 95% CI (1.42, 3.3)), and from educated mothers (OR = 2.33, 95% CI (1.32, 4.12)) were associated with increased odds of good menstrual hygiene practice. CONCLUSION The pooled prevalence of menstrual hygiene practices was low compared to the SDG 6.2 target by 2030. "Achieve access to adequate and equitable sanitation and hygiene for all, paying special attention to the needs of women and girls and those in vulnerable situations". Therefore, improving the accessibility of a safe water supply, hygiene, sanitation facilities and affordability of menstrual products and promoting maternal education are mandatory and should be part of government-level public health policy to prevent related health issues, loss of economic output and education opportunities.
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Affiliation(s)
- Etsay Woldu Anbesu
- grid.459905.40000 0004 4684 7098Department of Public Health, College of Medical and Health Sciences, Samara University, Samara, Ethiopia
| | - Dejen Kahsay Asgedom
- grid.459905.40000 0004 4684 7098Department of Public Health, College of Medical and Health Sciences, Samara University, Samara, Ethiopia
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22
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Rupe ER, Rodean J, Hurley EA, Miller MK, Boncoeur MD, Masonbrink AR. Menstrual health among adolescents and young adults in rural Haiti. Reprod Health 2022; 19:227. [PMID: 36539795 PMCID: PMC9764460 DOI: 10.1186/s12978-022-01533-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Emily R. Rupe
- grid.266515.30000 0001 2106 0692University of Kansas School of Medicine, 1010 N Kansas St., Wichita, KS 67214 USA
| | - Jonathan Rodean
- grid.429588.aChildren’s Hospital Association, Lenexa, KS USA
| | - Emily A. Hurley
- grid.239559.10000 0004 0415 5050Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO USA ,grid.266756.60000 0001 2179 926XUniversity of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Melissa K. Miller
- grid.239559.10000 0004 0415 5050Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO USA ,grid.266756.60000 0001 2179 926XUniversity of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | | | - Abbey R. Masonbrink
- grid.239559.10000 0004 0415 5050Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO USA ,grid.266756.60000 0001 2179 926XUniversity of Missouri-Kansas City School of Medicine, Kansas City, MO USA
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Hunter EC, Murray SM, Sultana F, Alam MU, Sarker S, Rahman M, Akter N, Mobashara M, Momata M, Winch PJ. Development and validation of the Self-Efficacy in Addressing Menstrual Needs Scale (SAMNS-26) in Bangladeshi schools: A measure of girls' menstrual care confidence. PLoS One 2022; 17:e0275736. [PMID: 36201478 PMCID: PMC9536616 DOI: 10.1371/journal.pone.0275736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 09/22/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Qualitative studies have described girls' varying levels of confidence in managing their menstruation, with greater confidence hypothesized to positively impact health, education, and social participation outcomes. Yet, measurement of this and other psychosocial components of adolescent girls' menstrual experiences has been weak in global health research, in part due to a dearth of appropriate psychometric tools. We describe the development and validation of the Self-Efficacy in Addressing Menstrual Needs Scale (SAMNS-26). METHODS We conducted nine focus group discussions with girls in schools in rural and urban Bangladesh to identify tasks involved in menstrual self-care. This informed our creation of an initial pool of 50 items, which were reviewed by menstrual health experts and refined through 21 cognitive interviews with schoolgirls. Using a self-administered survey, we administered 34 refined items plus additional validation measures to a random sample of 381 post-menarcheal girls (ages 9-17) and retested a subsample of 42 girls two weeks later. We examined the measure's dimensionality using exploratory factor analysis and assessed internal consistency, temporal stability, and construct validity. RESULTS Exploratory factor analysis suggested a 26-item scale comprising three correlated sub-scales: the 17-item Menstrual Hygiene Preparation and Maintenance (α = 0.86), the 5-item Menstrual Pain Management (α = 0.87), and the 4-item Executing Stigmatized Tasks (α = 0.77). Sub-scales exhibited good temporal stability. SAMNS-26 scores correlated negatively with measures of anxiety, and girls who preferred to stay at home during their periods had lower SAMNS-26 scores than those who did not. CONCLUSION The SAMNS-26 provides a reliable measure of a schoolgirl's confidence in her capabilities to address her menstrual needs. There is initial evidence to support the measure's construct validity in the Bangladesh context as indicated by its relationships with other factors in its theorized nomological network. The tool enables incorporation of self-efficacy into multivariate models for exploring the relationships among antecedents to menstrual experiences and hypothesized impacts on health, wellbeing, and education attainment. Further testing of the tool is recommended to strengthen evidence of its validity in additional contexts.
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Affiliation(s)
- Erin C. Hunter
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Farhana Sultana
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mahbub-Ul Alam
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Supta Sarker
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Nazrin Akter
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Moshammot Mobashara
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Marufa Momata
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Peter J. Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Kansiime C, Hytti L, Nelson KA, Torondel B, Francis SC, Tanton C, Greco G, Belfield S, Nakalema S, Matovu F, Ssemata AS, Alezuyo C, Neema S, Jerrim J, Bonell C, Seeley J, Weiss HA. Menstrual health interventions, schooling, and mental health problems among Ugandan students (MENISCUS): study protocol for a school-based cluster-randomised trial. Trials 2022; 23:759. [PMID: 36071530 PMCID: PMC9449307 DOI: 10.1186/s13063-022-06672-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Menstrual health is an increasingly recognised public health issue, defined as complete physical, mental, and social well-being in relation to the menstrual cycle. The MENISCUS trial aims to assess whether a multi-component intervention addressing physical and emotional aspects of menstrual health improves educational attainment, mental health problems, menstrual management, self-efficacy, and quality of life among girls in secondary school in Uganda. METHODS The study is a parallel-arm cluster-randomised controlled trial with 60 schools (clusters) in Wakiso and Kalungu districts, with a mixed-methods process evaluation to assess intervention fidelity and acceptability and economic and policy analyses. The schools will be randomised 1:1 to immediate intervention or to optimised usual care with delayed intervention delivery. The intervention includes creation of a Menstrual Health Action Group at schools and NGO-led training of trainers on puberty education, development of a drama skit, delivery of a menstrual health kit including reusable pads and menstrual cups, access to pain management strategies including analgesics, and basic improvements to school water, sanitation, and hygiene facilities. Baseline data will be collected from secondary 2 students in 2022 (median age ~15.5 years), with endline after 1 year of intervention delivery (~3600 females and a random sample of ~900 males). The primary outcomes assessed in girls are (i) examination performance based on the Mathematics, English, and Biology curriculum taught during the intervention delivery (independently assessed by the Uganda National Examinations Board) and (ii) mental health problems using the Total Difficulties Scale of the Strengths and Difficulties 25-item questionnaire. Secondary outcomes are menstrual knowledge and attitudes in girls and boys and, in girls only, menstrual practices, self-efficacy in managing menstruation, quality of life and happiness, prevalence of urogenital infections, school and class attendance using a self-completed menstrual daily diary, and confidence in maths and science. DISCUSSION The trial is innovative in evaluating a multi-component school-based menstrual health intervention addressing both physical and emotional aspects of menstrual health and using a "training of trainers" model designed to be sustainable within schools. If found to be cost-effective and acceptable, the intervention will have the potential for national and regional scale-up. TRIAL REGISTRATION ISRCTN 45461276 . Registered on 16 September 2021.
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Affiliation(s)
- Catherine Kansiime
- grid.415861.f0000 0004 1790 6116MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe, Uganda
| | - Laura Hytti
- grid.8991.90000 0004 0425 469XLSHTM, London, UK
| | | | - Belen Torondel
- grid.8991.90000 0004 0425 469XFaculty of Infectious and Tropical Diseases, LSHTM, London, UK
| | | | | | | | | | | | - Fred Matovu
- grid.11194.3c0000 0004 0620 0548PADRI, Makerere University, Kampala, Uganda
| | - Andrew Sentoogo Ssemata
- grid.415861.f0000 0004 1790 6116MRC/UVRI and LSHTM Uganda Research Unit, P.O. Box 49, Plot 51-59 Nakiwogo Road, Entebbe, Uganda
| | - Connie Alezuyo
- grid.466898.d0000 0004 0648 0949Education Response Plan Secretariat, Ministry of Education and Sports, Kampala, Uganda
| | - Stella Neema
- grid.11194.3c0000 0004 0620 0548Makerere University, Kampala, Uganda
| | - John Jerrim
- grid.83440.3b0000000121901201UCL Institute of Education, University College London, London, UK
| | | | - Janet Seeley
- grid.8991.90000 0004 0425 469XLSHTM, London, UK
- Social Science Programme, MRC/UVRI and LSHTM, Entebbe, Uganda
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25
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Wasan Y, Baxter JAB, Rizvi A, Shaheen F, Junejo Q, Abro MA, Hussain A, Ahmed I, Soofi SB, Bhutta ZA. Practices and predictors of menstrual hygiene management material use among adolescent and young women in rural Pakistan: A cross-sectional assessment. J Glob Health 2022; 12:04059. [PMID: 35908217 PMCID: PMC9339234 DOI: 10.7189/jogh.12.04059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background In low- and middle-income countries (LMICs), women often use inappropriate materials to manage menstruation, which can threaten their health. Improper practices can also have critical downstream consequences beyond physiologic health, including restricting adolescent girls’ access to academic pursuits. Methods We used cross-sectional data collected through a structured questionnaire from the menstruating adolescents and young women 15-23 years of age living in rural Pakistan (n = 25 305). We aimed to describe menstrual hygiene management (MHM) practices and generate a predictive model of the socioeconomic and demographic factors related to the use of MHM materials. Beliefs and barriers around MHM were also summarized. The outcome variable included: those who practiced appropriate and inappropriate MHM practices. Logistic regression was used to generate the predictive model, with results presented as odds ratios (OR) and 95% confidence interval (CI). Results Inappropriate MHM practices were reported by 75% (n = 19 006) of participants. The majority 61.9% (n = 15 667) reported using old cloths, 12.6% (n = 3191) used nothing, and 0.5% (n = 136) used old cloth with a sanitary pad. One-fourth of participants reported appropriate MHM material use, including 16.2% (n = 4087) sanitary pads, 8.6% (n = 2167) new cloth, and a few reported using sanitary pads with new cloth 0.2% (n = 45). Inappropriate MHM practices were more common in lowest wealth quintile (OR = 4.41; 95% CI = 2.77-7.01, P < 0.0001), followed by those with no education (OR = 3.9; 95% CI = 3.36-4.52, P < 0.0001). Conclusions The study indicates the need for multi-sectoral efforts to introduce MHM-specific and MHM-sensitive interventions to improve MHM practices, ranging from the availability of low-cost MHM materials to the inclusion of MHM education in school curriculums and within the community platforms.
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Affiliation(s)
- Yaqub Wasan
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Jo-Anna B Baxter
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Arjumand Rizvi
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Fariha Shaheen
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Qamaruddin Junejo
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Mansoor A Abro
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Amjad Hussain
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Imran Ahmed
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Sajid B Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan.,Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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Asumah MN, Abubakari A, Aninanya GA, Baig AA. Determinants of Menstrual Hygiene Management Practices among Schoolgirls: A Cross-Sectional Study in the Savannah Region of Ghana. Infect Dis Obstet Gynecol 2022; 2022:1-10. [PMID: 35978966 PMCID: PMC9377905 DOI: 10.1155/2022/7007117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/27/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction. Menstruation is crucial in the reproductive lives of all women. The advent of menses in most settings is accompanied by physical and psychological health, religious, social, and cultural implications. The research intends to identify determinants of menstrual hygiene management (MHM) practices among adolescent girls in Junior High Schools in the West Gonja Municipality of the Savannah Region of Ghana. Methods. The study employed an analytical cross-sectional design with 430 adolescent schoolgirls selected through multistage sampling techniques. A structured questionnaire was used to collect data and analyzed using STATA version 14. A logistic regression model was run to determine the predictors of MHM practices. Results. The study discovered that 63.7% of the girls had sufficient knowledge of menstruation and menstrual hygiene. Almost all girls (97%) used some form of absorbent materials during menses, with over half of these girls (58.6%) using commercial sanitary pads, 30.5% using cloth, 3.7% using cotton, and 4.2% using tissue papers with 3.0% reported not using any absorbent material. Only 44.4% reported reusing their absorbent materials. Out of which, the majority (88.5%) of the schoolgirls cleaned their reusable absorbent material using soap and water with 77.5% drying absorbent materials in the sun. Overall, 84.9% practiced good MHM. Type of school [Adjusted Odds Ratio (AOR) =6.0; 95% Confidence Interval (CI) (2.64-13.59)], pocket money [AOR =2.5; 95% CI (1.27-4.86)], and residence [AOR =2.8 95% CI (1.55-5.18)] were the most significant determinants of menstrual hygiene management practice. Conclusion. About two-thirds of the schoolgirls are knowledgeable in menstrual hygiene but access to management materials is problematic whereas approximately half of the girls have access to sanitary pads and the rest resort to the use of cloth and cotton. Pocket money and residential status were the most important predictors of the menstrual hygiene management. The government initiative to provide schoolgirls with sanitary pads could go a long way to improve menstrual hygiene management if implemented across all schools in Ghana, particularly in rural areas.
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Malima G, Mshida H, Machunda R, Moyo F, Banzi J, Gautam OP, Mbeguere M, Smith K, Cairncross S, Njau KN. What influences individuals to invest in improved sanitation services and hygiene behaviours in a small town? A formative research study in Babati, Tanzania. PLoS One 2022; 17:e0270688. [PMID: 35862380 PMCID: PMC9302730 DOI: 10.1371/journal.pone.0270688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 06/16/2022] [Indexed: 11/19/2022] Open
Abstract
Sub-Sahara African countries face immense challenges in ensuring adequate sanitation and hygiene behaviours to the rapidly growing populations. Attempts to address these challenges require empirical evidence to inform policy and planning. We contribute toward that goal by unveiling findings of formative research conducted in Babati, a rapidly growing town in Tanzania. We conducted a cross-sectional study involving 486 households, to unwind motives and barriers for individuals to invest in improved sanitation services and hygiene behaviour change. We used several methods including household survey, focus group discussions, behaviour observations and spot checks. The findings revealed that households derive their motivation to invest in improved sanitation and hygiene practices from comfort, raising social status, and the need for personal safety and privacy. Other motives include fear of penalties and fines and fear of disease outbreaks, whilst the barriers include, limited water availability and accessibility, environmental factors, property rights, cultural issues, financial constraints, and a person’s attitude. Quantitative data were subjected to multivariate analysis to identify determinants of households to invest in sanitation and hygiene practices. The logistic regression analyses revealed that sources of water, property rights, and education level were the main determinants of households to invest in sanitation and hygiene facilities, while household income was the main determinant for households to invest in both construction of handwashing facility and water treatment. We argue that the initiative to promote sanitation and hygiene behaviour change in small towns should focus on promoting motivation factors and abating the determinant factors identified in this study.
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Affiliation(s)
- Gabriel Malima
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- * E-mail:
| | - Hoyce Mshida
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Revocatus Machunda
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Francis Moyo
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | | | | | | | | | - Sandy Cairncross
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Karoli N. Njau
- Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
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Shah V, Phillips-Howard P, Hennegan J, Cavill S, Sonko B, Sinjanka E, Camara Trawally N, Kanteh A, Mendy F, Bah AB, Saar M, Ross I, Schmidt W, Torondel B. 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). Emerg Themes Epidemiol 2022; 19:6. [PMID: 35842700 PMCID: PMC9287699 DOI: 10.1186/s12982-022-00114-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Vishna Shah
- Environmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Penelope Phillips-Howard
- grid.48004.380000 0004 1936 9764Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - Julie Hennegan
- grid.1056.20000 0001 2224 8486Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | | | - Bakary Sonko
- grid.415063.50000 0004 0606 294XNutrition Theme, MRCG Keneba, Medical Research Council Unit, Banjul, The Gambia
| | - Edrisa Sinjanka
- grid.415063.50000 0004 0606 294XNutrition Theme, MRCG Keneba, Medical Research Council Unit, Banjul, The Gambia
| | - Nyima Camara Trawally
- grid.415063.50000 0004 0606 294XNutrition Theme, MRCG Keneba, Medical Research Council Unit, Banjul, The Gambia
| | - Abdou Kanteh
- Nova Scotia Gambia Association (NSGA), Banjul, The Gambia
| | - Francois Mendy
- Nova Scotia Gambia Association (NSGA), Banjul, The Gambia
| | - Amadou B. Bah
- Nova Scotia Gambia Association (NSGA), Banjul, The Gambia
| | - Momodou Saar
- Nova Scotia Gambia Association (NSGA), Banjul, The Gambia
| | - Ian Ross
- grid.8991.90000 0004 0425 469XEnvironmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Wolf Schmidt
- grid.8991.90000 0004 0425 469XEnvironmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Belen Torondel
- grid.8991.90000 0004 0425 469XEnvironmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Alor SK, Anaba EA, Adongo PB. Correlates of absenteeism at work, school and social activities during menstruation: Evidence from the 2017/2018 Ghana Multiple Indicator Cluster Survey. PLoS One 2022; 17:e0270848. [PMID: 35771899 PMCID: PMC9246230 DOI: 10.1371/journal.pone.0270848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Menstruation is a biological process which is crucial for human reproduction. Menstruation is a source of absenteeism, yet the subject matter has not been well explored. This study aimed to assess the correlates of absenteeism at school, work and social activities during menstruation among Ghanaian women of reproductive age.
Methods
This study was an analysis of secondary data from the 2017/18 Ghana Multiple Indicator Cluster Survey. Data were analysed using descriptive statistics, Chi-square and Binomial Logistic Regression with the aid of Stata/SE, version 16.
Results
The majority of the participants were aged 25–49 years (63%), married/in union (55%) and resided in urban areas (52%). Nine in ten participants had access to privacy at home and 98% used menstrual materials during their last period. Eight in ten participants used disposable menstrual materials. Exactly 19% of the participants missed school, work or social activities during their last period. Participants who used disposable menstrual materials (AOR = 0.67; 95% CI: 0.52–0.85) were less likely to miss school, work or social activities during menstruation compared to those who used reusable menstrual materials.
Conclusion
This study demonstrated that a significant minority of women in Ghana miss academic, economic or social activities during menstruation. Therefore, there is a need for effective interventions to help reduce menstruation-related absenteeism among women and girls in Ghana.
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Affiliation(s)
- Stanley Kofi Alor
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Emmanuel Anongeba Anaba
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
- * E-mail:
| | - Philip Baba Adongo
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
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Alam MU, Sultana F, Hunter EC, Winch PJ, Unicomb L, Sarker S, Mahfuz MT, Al-Masud A, Rahman M, Luby SP. Evaluation of a menstrual hygiene intervention in urban and rural schools in Bangladesh: a pilot study. BMC Public Health 2022; 22:1100. [PMID: 35655267 PMCID: PMC9161596 DOI: 10.1186/s12889-022-13478-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
Girls’ menstrual experiences impact their social and educational participation, physical and psychological health. We conducted a pilot study to assess the acceptability and feasibility of a multi-component intervention intended to support menstruating girls; improve menstrual care knowledge, practices, and comfort; and increase school attendance. We conducted a pre/post evaluation of a 6-month pilot intervention in four schools (2 urban, 2 rural) in Dhaka, Bangladesh. We selected 527 schoolgirls (grades 5 to 10; aged 10 to 17 years) for a baseline survey and 528 girls at endline. The intervention included: 1) Menstrual Hygiene Management (MHM) packs– reusable cloth pads, underwear, carry bags and menstrual cycle tracking calendars, 2) education curriculum- pictorial flipcharts, puberty related-booklets, and teachers’ training to deliver puberty and MHM sessions, 3) maintenance- improvements to school sanitation, provision of disposable pads in the school office, provision of chute disposal systems for disposable pads, and gender committees to promote a gender-friendly school environment and maintenance of intervention facilities. We estimated intervention uptake and intervention effect by calculating prevalence differences and 95% confidence intervals using fixed-effects logistic regression. The intervention uptake was more than 85% for most indicators; 100% reported receiving puberty education, 85% received MHM packs, and 92% received booklets. Reusable cloth pads uptake was 34% by endline compared with 0% at baseline. Knowledge about menstrual physiology and knowledge of recommended menstrual management practices significantly improved from baseline to endline. Reported improvements included more frequent changing of menstrual materials (4.2 times/day at endline vs. 3.4 times/day at baseline), increased use of recommended disposal methods (prevalence difference (PD): 8%; 95% Confidence Interval: 1, 14), and fewer staining incidents (PD: − 12%; 95% CI: − 22, − 1). More girls reported being satisfied with their menstrual materials (59% at endline vs. 46% at baseline, p < 0.005) and thought school facilities were adequate for menstrual management at endline compared to baseline (54% vs. 8%, p < 0.001). At endline, 64% girls disagreed/strongly disagreed that they felt anxious at school due to menstruation, compared to 33% at baseline (p < 0.001). Sixty-five percent girls disagreed/strongly disagreed about feeling distracted or trouble concentrating in class at endline, compared to 41% at baseline (p < 0.001). Self-reported absences decreased slightly (PD: − 8%; 95% CI: − 14, − 2). Uptake of cloth pads, improved maintenance and disposal of menstrual materials, and reduced anxiety at school suggest acceptability and feasibility of the intervention aiming to create a supportive school environment.
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Maulingin-Gumbaketi E, Larkins S, Whittaker M, Rembeck G, Gunnarsson R, Redman-MacLaren M. Socio-cultural implications for women's menstrual health in the Pacific Island Countries and Territories (PICTs): a scoping review. Reprod Health 2022; 19:128. [PMID: 35655221 DOI: 10.1186/s12978-022-01398-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, experiences of menarche and subsequent menstruation are embedded in social and cultural beliefs, norms and practices. Menarche is an important developmental milestone in sexual and reproductive health (SRH) for females. Menarche is intertwined with socio-cultural norms, beliefs and practices, which can impact on women's ability to manage menstruation with dignity. This paper reviews the social and cultural factors that affect women's ability to effectively manage their menstrual health and hygiene (MHH) in Pacific Island Countries and Territories (PICTs). METHODS A scoping review was conducted following PRISMA scoping review guidelines and inclusion/exclusion criteria. An online search was conducted for peer-reviewed publications in Medline/OVID; Medline/PubMED; PsycINFO; CINAHL; Scopus and JSTOR, and Google Scholar. A search for grey literature was conducted in Google Scholar and websites of international and local organizations. Experts in the field also contributed additional references. Extracted data were summarised in an Excel spreadsheet. Searches were conducted between May and June, 2019, and then repeated in July, 2020. RESULTS A total of 11 studies were included; 10 qualitative and one mixed methods study. Studies were conducted in Melanesian (n = 9), Polynesian (n = 1) and Micronesian (n = 1) PICTs. All 11 studies reported elements of societal and personal factors; ten studies reported evidence relating to interpersonal factors; nine studies reported elements relating to environmental factors; and two studies presented evidence linked to biological factors. Managing menstrual health with dignity is challenging for many women and girls because menstruation is associated with menstrual taboos and shame. CONCLUSION This review found that the MHH experiences of women in PICTs are affected by social and cultural beliefs, norms and practices. Beliefs, norms and practices about menarche need to be incorporated in SRH planning, programs and education in order to be relevant to diverse village and urban settings.
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Altundağ S. Imparting genital hygiene skills to adolescents with intellectual disabilities attending a special education Centre: a quasi-experimental study on effect of short education. Int J Dev Disabil 2022; 70:127-136. [PMID: 38456142 PMCID: PMC10916902 DOI: 10.1080/20473869.2022.2070421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/20/2022] [Indexed: 03/09/2024]
Abstract
Objective: The study aimed to evaluate the short-term effects of education given on genital hygiene to female students attending a special education center. Methods: We interviewed 52 girls selected by meeting the inclusion criteria, using a quasi-experimental method, the single group pre-test post-test model in a special education institution located in the Aegean region in Turkey. Results: The results of the programme the genital hygiene knowledge of the participants had significantly improved. Significantly positive changes were observed in genital hygiene knowledge compared to pre-training (p < .001). Conclusion: It is recommended that the program training and practices to be carried out simultaneously be implemented by healthcare professionals for adolescents with intellectual disability and their parents.
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Affiliation(s)
- Sebahat Altundağ
- Department of Pediatric Nursing, Pamukkale University Faculty of Health Sciences, Denizli, Turkey
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Long JL, Haver J, Mendoza P, Vargas Kotasek SM. The More You Know, the Less You Stress: Menstrual Health Literacy in Schools Reduces Menstruation-Related Stress and Increases Self-Efficacy for Very Young Adolescent Girls in Mexico. Front Glob Womens Health 2022; 3:859797. [PMID: 35496727 PMCID: PMC9047952 DOI: 10.3389/fgwh.2022.859797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Improving the menstrual health literacy of girls and boys is a key strategy within a holistic framework of Save the Children's school health and comprehensive sexuality education programming. As menstrual health is an emerging area of study and programming, Save the Children continues to learn and adjust its interventions using program evaluations and rigorous monitoring. This paper will examine program-monitoring data from three cohorts, representing 47 public schools in Mexico City, Puebla, and Mérida, Mexico. The study focuses on female students in 5th and 6th grade who participated in We See Equal, a school-based program centered on gender equality and puberty education, between September 2018 and December 2019. This study used a cross-sectional quantitative cohort approach to document changes in girls' experiences and perceptions around managing menstruation in school. The analysis compares girls' knowledge and experiences before and after participation in We See Equal to understand how knowledge changes over the program and how those changes may contribute to menstruation-related school engagement, stress, and self-efficacy (MENSES) outcomes. Multivariate regression models explored relationships between MENSES outcomes, knowledge and socioeconomic status (SES). Overall, results show that the more knowledge girls acquired, the higher their self-efficacy score and the lower their stress score, however, certain MHH knowledge was more predictive of MENSES outcomes and varied by SES. Among girls from lower SES, we observed significant relationships between knowing what their period was prior to menarche and the three MENSES outcomes. Decreases in menstruation-related stress were driven by items related to the practical knowledge of how to dispose of sanitary pads and reduced feelings of nervousness on days they had their period at school. Increases in self-efficacy were primarily driven by girls' confidence in their ability to track their period from month to month, feelings that they could still do well on an exam if they had their period at school, and security that they could ask a friend to lend them a pad if they needed one. Implications for future menstrual health literacy programming and targeting populations for menstrual health education, as well as priorities for future research will be discussed.
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Affiliation(s)
- Jeanne L. Long
- Department of Education and Child Protection, Save the Children, Washington, DC, United States
| | - Jacquelyn Haver
- Department of Education and Child Protection, Save the Children, Washington, DC, United States
| | - Pamela Mendoza
- Department of Education and Child Protection, Save the Children, Washington, DC, United States
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Asumah MN, Abubakari A, Gariba A. Schools preparedness for menstrual hygiene management: a descriptive cross-sectional study in the West Gonja Municipality, Savannah Region of Ghana. BMJ Open 2022; 12:e056526. [PMID: 35365528 PMCID: PMC8977809 DOI: 10.1136/bmjopen-2021-056526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to investigate schools' preparedness for menstrual hygiene management in the West Gonja Municipality of Ghana. DESIGN This was a cross-sectional study with a mixed-methods approach. SETTING Junior high schools in the West Gonja Municipality. PARTICIPANTS Twenty-six schools were randomly selected, and 13 schoolgirls were purposively chosen for qualitative interviews. ANALYSIS OF DATA The quantitative and qualitative data were analysed using Microsoft Excel and thematic content analysis, respectively. The transcriptions were printed out and read repeatedly to identify similar wordings, phrases, concept and meanings. OUTCOMES Presence of menstrual hygiene facilities in basic schools. RESULTS Majority (69.2%) of the schools were poorly prepared towards menstrual hygiene management. Only 38.5% schools had water, most schools (61.5%) did not have waste bins, 30.8% of the schools had designated places for changing of menstrual materials. No school had menstrual hygiene materials available for emergency use. All participants acknowledged inadequate hygiene facilities in their schools. During menses, adolescent girls often absent themselves from school. Girls tend to be very inactive during their menstrual period for fear of embracement from their male counterparts. The following themes were obtained 'unavailability of hygiene material', 'involvement in class during menses' and 'absence from school'. CONCLUSION Schools in West Gonja Municipality have inadequate menstrual hygiene management facilities that could be a major setback to the health and educational attainment of young girls. The Ministry of Sanitation and Water Resources should expand menstrual hygiene and its management to reach the West Gonja Municipality as part of the National Sanitation and Hygiene Strategy.
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Affiliation(s)
- Mubarick Nungbaso Asumah
- Department of Global and International Health, University for Development Studies, Tamale, Northern Region, Ghana
- Kintampo Municipal Hospital, Ghana Health Service, Kintampo, Bono East Region, Ghana
| | - Abdulai Abubakari
- Department of Global and International Health, University for Development Studies, Tamale, Northern Region, Ghana
| | - Ayishetu Gariba
- Students Affairs, C K Tedam University of Technology and Applied Sciences, Navrongo, Upper East Region, Ghana
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Tembo M, Renju J, Weiss HA, Dauya E, Gweshe N, Ndlovu P, Nzombe P, Chikwari CD, Mavodza CV, Mackworth-Young CRS, A Ferrand R, Francis SC. Integration of a menstrual health intervention in a community-based sexual and reproductive health service for young people in Zimbabwe: a qualitative acceptability study. BMC Health Serv Res 2022; 22:421. [PMID: 35354445 PMCID: PMC8966602 DOI: 10.1186/s12913-022-07818-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite being fundamental to the health and well-being of women, menstrual health is often overlooked as a health priority and access to menstrual health education, products, and support is limited. Consequently, many young women are unprepared for menarche and face challenges in accessing menstrual health products and support and in managing menstruation in a healthy and dignified way. In this paper, we examine the acceptability of a comprehensive menstrual health and hygiene (MHH) intervention integrated within a community-based sexual and reproductive health (SRH) service for young people aged 16-24 years in Zimbabwe called CHIEDZA. METHODS We conducted focus group discussions, that included participatory drawings, with CHIEDZA healthcare service providers (N = 3) and with young women who had attended CHIEDZA (N = 6) between June to August 2020. Translated transcripts were read for familiarisation and thematic analysis was used to explore acceptability. We applied Sekhon's thematic framework of acceptability that looks at seven key constructs (affective attitudes, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy). Data from FGDs and meeting minutes taken during the study time period were used to triangulate a comprehensive understanding of MHH intervention acceptability. RESULTS The MHH intervention was acceptable to participants as it addressed the severe prevailing lack of access to menstrual health education, products, and support in the communities, and facilitated access to other SRH services on site. In addition to the constructs defined by Sekhon's thematic framework, acceptability was also informed by external contextual factors such as sociocultural norms and the economic environment. Providers highlighted the increased burden in their workload due to demand for MHH products, and how sociocultural beliefs around insertable menstrual products compromising virginity can negatively affect acceptability among young people and community members. CONCLUSIONS MHH interventions are acceptable to young women in community-based settings in Zimbabwe as there is great unmet need for comprehensive MHH support. The integration of MHH in SRH services can serve as a facilitator to female engagement with SRH services. However, it is important to note that contextual external factors can affect the implementation and acceptability of integrated SRH and MHH services within communities. TRIAL REGISTRATION Registry: Clinicaltrials.gov, Registration Number: NCT03719521 , Registration Date: October 25, 2018.
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Affiliation(s)
- Mandikudza Tembo
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK. .,Biomedical Research and Training Institute, Harare, Zimbabwe.
| | - Jenny Renju
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen A Weiss
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Nancy Gweshe
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Precious Ndlovu
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Portia Nzombe
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Constancia Vimbayi Mavodza
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Constance R S Mackworth-Young
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rashida A Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanna C Francis
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
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Ha MAT, Alam MZ. Menstrual hygiene management practice among adolescent girls: an urban-rural comparative study in Rajshahi division, Bangladesh. BMC Womens Health 2022; 22:86. [PMID: 35321715 PMCID: PMC8943920 DOI: 10.1186/s12905-022-01665-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Adolescence is a critical period characterized by significant physical, emotional, cognitive, and social changes, including the monthly occurrence of menstruation of adolescent girls. Despite being an inevitable natural event, most societies consider menstruation and menstrual blood as taboos and impure. Such consideration prevents many adolescent girls from proper health education and information related to menstrual health, which forces them to develop their ways of managing the event. This study attempted to explore the pattern, the urban–rural differences, and the determinants of menstrual hygiene management practices (MHMP) among adolescent girls in the Rajshahi division, Bangladesh. Methodology Using a cross-sectional study design with multistage random sampling, we collected data from 586 adolescent girls (aged 14–19 years) from the Rajshahi division of Bangladesh. The MHMP was measured using eight binary items, where the value from zero to five as ‘bad,’ six as ‘fair,’ and seven-eight as ‘good’ practices. Finally, we employed bivariate analysis and multinomial logistic regression analysis. Findings Only 37.7% continuously used sanitary pads. Among the cloth users, nearly three-fourths reused cloths, and about 57% used water and soap to wash them. About 49% changed menstrual absorbent, and 44% washed their genitalia three times daily. About 41% used water only to wash genitalia, and 55% buried sanitary materials under the soil. Around 36.9% of the girls practiced bad, 33.4% fair, and 29.7% good menstrual management. We found significant differences in MHMP among adolescent girls between urban and rural areas (32.3% vs. 27.7% good users, p ≤ 0.05). Multinomial logistic regression found that place of residence, age, family size, parental education, and age at first menstruation were the significant determinants of MHMP. Conclusion Although there are some cases of sanitary pad use, still menstrual hygiene management is unhealthy in most cases. The continuous supply of sanitary pads at affordable cost, change in existing social norms about menstruation, proper education, information, and services are essential for achieving health-related SDG goals in both rural and urban areas of Bangladesh.
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Affiliation(s)
- Md Abu Tal Ha
- Department of Population Sciences, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Md Zakiul Alam
- Department of Population Sciences, University of Dhaka, Dhaka, 1000, Bangladesh.
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Sood S, Stevens S, Okumura M, Hauer M, Ramaiya A. A Systematic Review of Menstrual Health and Hygiene Management (MHHM) as a Human Right for Adolescents Girls. Int J Sex Health 2022; 34:483-502. [PMID: 38596276 PMCID: PMC10903676 DOI: 10.1080/19317611.2022.2050874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 04/11/2024]
Abstract
Despite its relationship with several development issues and sexual health, menstrual health and hygiene management among adolescents have until recently been ignored by practitioners and researchers. This paper is a systematic review of existing literature and argues that menstrual health and hygiene management is a human rights issue. 28,745 articles were screened, with 84 articles included in the full-text review and quality assessment. The results indicate that using a cross-cutting, human rights framework to address inadequate menstrual health and hygiene management is fundamental to promoting menstrual health and hygiene management with dignity among girls and women across the globe.
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Affiliation(s)
- Suruchi Sood
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Sarah Stevens
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Maho Okumura
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Michael Hauer
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Astha Ramaiya
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Shah V, Nabwera H, Sonko B, Bajo F, Faal F, Saidykhan M, Jallow Y, Keita O, Schmidt WP, Torondel B. Effects of Menstrual Health and Hygiene on School Absenteeism and Drop-Out among Adolescent Girls in Rural Gambia. Int J Environ Res Public Health 2022; 19:3337. [PMID: 35329020 PMCID: PMC8954348 DOI: 10.3390/ijerph19063337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 12/04/2022]
Abstract
Poor knowledge and management of menstruation impacts girls' school attendance and academic performance. This paper aims to explore how menstrual hygiene management practices and related factors influence school absenteeism and drop-out among primary and secondary school girls in rural Gambia. Mixed-method studies were conducted among students and key informants from 19 schools from July 2015-December 2017. Focus group discussions, in-depth interviews, cross-sectional surveys, menstrual diaries, and school water, sanitation and hygiene (WASH) facility observations were used. Key findings from the interviews were that menstrual pain, cultural beliefs, fear of peers knowing menstrual status, and poor school WASH facilities led to school absenteeism, however, they had no impact on school drop-out. Of the 561 girls surveyed, 27% reported missing at least one school day per month due to menses. Missing school during the most recent menstrual period was strongly associated with menstrual pain (extreme pain adjusted odds ratio (AOR) = 16.8 (95% CI: 7.29-38.74)), as was having at least one symptom suggestive of urinary tract infection (AOR = 1.71 (95% CI: 1.16-2.52)) or reproductive tract infection (AOR = 1.99 (95% CI: 1.34-2.94)). Clean toilets (AOR = 0.44 (95% CI: 0.26-75)), being happy using school latrines while menstruating (AOR = 0.59 (95% CI: 0.37-0.93)), and soap availability (AOR = 0.46 (95% CI: 0.3-0.73)) were associated with reduced odds of school absenteeism. This study suggests menstrual pain, school WASH facilities, urogenital infections, and cultural beliefs affected school attendance among menstruating girls in rural Gambia.
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Affiliation(s)
- Vishna Shah
- Environmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (W.-P.S.); (B.T.)
| | - Helen Nabwera
- Department of Education and Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK;
| | - Bakary Sonko
- The Medical Research Council Unit the Gambia, London School of Hygiene & Tropical Medicine, Banjul P.O. Box 273, The Gambia; (B.S.); (F.B.); (F.F.); (M.S.); (Y.J.)
| | - Fatou Bajo
- The Medical Research Council Unit the Gambia, London School of Hygiene & Tropical Medicine, Banjul P.O. Box 273, The Gambia; (B.S.); (F.B.); (F.F.); (M.S.); (Y.J.)
| | - Fatou Faal
- The Medical Research Council Unit the Gambia, London School of Hygiene & Tropical Medicine, Banjul P.O. Box 273, The Gambia; (B.S.); (F.B.); (F.F.); (M.S.); (Y.J.)
| | - Mariama Saidykhan
- The Medical Research Council Unit the Gambia, London School of Hygiene & Tropical Medicine, Banjul P.O. Box 273, The Gambia; (B.S.); (F.B.); (F.F.); (M.S.); (Y.J.)
| | - Yamoundaw Jallow
- The Medical Research Council Unit the Gambia, London School of Hygiene & Tropical Medicine, Banjul P.O. Box 273, The Gambia; (B.S.); (F.B.); (F.F.); (M.S.); (Y.J.)
| | - Omar Keita
- Regional Education Directorate Four, Ministry of Basic and Secondary Education, Mansakonko Lower River Region, Banjul P.O. Box 989, The Gambia;
| | - Wolf-Peter Schmidt
- Environmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (W.-P.S.); (B.T.)
| | - Belen Torondel
- Environmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (W.-P.S.); (B.T.)
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Psaki S, Haberland N, Mensch B, Woyczynski L, Chuang E. Policies and interventions to remove gender-related barriers to girls' school participation and learning in low- and middle-income countries: A systematic review of the evidence. Campbell Syst Rev 2022; 18:e1207. [PMID: 36913193 PMCID: PMC8770660 DOI: 10.1002/cl2.1207] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Gender disparities in education continue to undermine girls' opportunities, despite enormous strides in recent years to improve primary enrolment and attainment for girls in low- and middle-income countries (LMICs). At the regional, country and subnational levels gender gaps remain, with girls in many settings less likely to complete primary school, less likely to complete secondary, and often less likely to be literate than boys. The academic and policy literatures on the topic of gender-related barriers to girls' education are both extensive. However, there remain gaps in knowledge regarding which interventions are most likely to work in contexts with different combinations of barriers. OBJECTIVES This systematic review identified and assessed the strength of the evidence of interventions and exposures addressing gender-related barriers to schooling for girls in LMICs. SEARCH METHODS The AEA RCT Registry, Africa Bibliography, African Education Research Database, African Journals Online, DEC USAID, Dissertation Abstracts, EconLit, ELDIS, Evidence Hub, Global Index Medicus, IDEAS-Repec, Intl Clinical Trials Registry, NBER, OpenGrey, Open Knowledge Repository, POPLINE, PsychINFO, PubMed, Research for Development Outputs, ScienceDirect, Sociological Abstracts, Web of Science, as well as relevant organization websites were searched electronically in March and April of 2019. Further searches were conducted through review of bibliographies as well as through inquiries to authors of included studies, relevant researchers and relevant organizations, and completed in March 2020. SELECTION CRITERIA We included randomized controlled trials as well as quasi-experimental studies that used quantitative models that attempted to control for endogeneity. Manuscripts could be either published, peer-reviewed articles or grey literature such as working papers, reports and dissertations. Studies must have been published on or after 2000, employed an intervention or exposure that attempted to address a gender-related barrier to schooling, analyzed the effects of the intervention/exposure on at least one of our primary outcomes of interest, and utilized data from LMICs to be included. DATA COLLECTION AND ANALYSIS A team of reviewers was grouped into pairs to independently screen articles for relevance, extract data and assess risk of bias for each included study. A third reviewer assisted in resolving any disputes. Risk of bias was assessed either through the RoB 2 tool for experimental studies or the ROBINS-I tool for quasi-experimental studies. Due to the heterogeneity of study characteristics and reported outcome measures between studies, we applied the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach adapted for situations where a meta-analysis is not possible to synthesize the research. RESULTS Interventions rated as effective exist for three gender-related barriers: inability to afford tuition and fees, lack of adequate food, and insufficient academic support. Promising interventions exist for three gender-related barriers: inadequate school access, inability to afford school materials, and lack of water and sanitation. More research is needed for the remaining 12 gender-related barriers: lack of support for girls' education, child marriage and adolescent pregnancy, lack of information on returns to education/alternative roles for women, school-related gender-based violence (SRGBV), lack of safe spaces and social connections, inadequate sports programs for girls, inadequate health and childcare services, inadequate life skills, inadequate menstrual hygiene management (MHM), poor policy/legal environment, lack of teaching materials and supplies, and gender-insensitive school environment. We find substantial gaps in the evidence. Several gender-related barriers to girls' schooling are under-examined. For nine of these barriers we found fewer than 10 relevant evaluations, and for five of the barriers-child marriage and adolescent pregnancy, SRGBV, inadequate sports programs for girls, inadequate health and childcare services, and inadequate MHM-we found fewer than five relevant evaluations; thus, more research is needed to understand the most effective interventions to address many of those barriers. Also, nearly half of programs evaluated in the included studies were multi-component, and most evaluations were not designed to tease out the effects of individual components. As a result, even when interventions were effective overall, it is often difficult to identify how much, if any, of the impact is attributable to a given program component. The combination of components varies between studies, with few comparable interventions, further limiting our ability to identify packages of interventions that work well. Finally, the context-specific nature of these barriers-whether a barrier exists in a setting and how it manifests and operates-means that a program that is effective in one setting may not be effective in another. AUTHORS' CONCLUSIONS While some effective and promising approaches exist to address gender-related barriers to education for girls, evidence gaps exist on more than half of our hypothesized gender-related barriers to education, including lack of support for girls' education, SRGBV, lack of safe spaces and social connections, inadequate life skills, and inadequate MHM, among others. In some cases, despite numerous studies examining interventions addressing a specific barrier, studies either did not disaggregate results by sex, or they were not designed to isolate the effects of each intervention component. Differences in context and in implementation, such as the number of program components, curricula content, and duration of interventions, also make it difficult to compare interventions to one another. Finally, few studies looked at pathways between interventions and education outcomes, so the reasons for differences in outcomes largely remain unclear.
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Chang DH, Dumanski SM, Ahmed SB. Female Reproductive and Gynecologic Considerations in Chronic Kidney Disease: Adolescence and Young Adulthood. Kidney Int Rep 2022; 7:152-64. [PMID: 35155855 PMCID: PMC8820991 DOI: 10.1016/j.ekir.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/21/2022] Open
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Huseth-Zosel AL, Secor-Turner M. Teacher Perceptions of and Experiences with Student Menstruation in the School Setting. J Sch Health 2022; 92:194-204. [PMID: 34806189 DOI: 10.1111/josh.13120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/24/2021] [Accepted: 06/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Menstrual hygiene management is an important public health issue for adolescents. The objective of this study was to explore teacher perceptions and experiences addressing adolescent menstruation experiences at school and examine their perception of the impact of menstruation on student learning. METHODS Teachers in a Midwest school district participated in an online survey about their perceptions of adolescent school-based menstruation experiences, including: experience and comfort-level with providing menstruation assistance, presence of menstrual products in classroom/office for students, perceptions about adolescent school-based menstruation experiences, and perceptions on the impact of menstruation on student learning. RESULTS Two hundred and nine teachers participated in this study. Teachers perceived students' school-based menstruation experiences to be mostly negative, stressful, embarrassing, and focused on concealment. Teachers described school-based menstruation events as a distraction to learning and responded by offering emotional support and menstrual products, typically purchased by teachers. CONCLUSION Teachers' negative perception of about menstruation and distractions in the classroom are amplified by social norms associated with overall menstruation-related stigma. Findings emphasize the importance of educating teachers on how to more positively address student menstruation experiences to foster a more supportive environment conducive to learning for these students.
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Affiliation(s)
- Andrea L Huseth-Zosel
- Department of Public Health, North Dakota State University, Dept. 2662, PO Box 6050, Fargo, ND, 58108-6050, USA
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Wunsch N, Green SJ, Adam S, Hampton J, Phillips-Howard PA, Mehta SD. In Vitro Study to Assess Effective Cleaning Techniques for Removing Staphylococcus aureus from Menstrual Cups. Int J Environ Res Public Health 2022; 19:1450. [PMID: 35162481 DOI: 10.3390/ijerph19031450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/04/2022]
Abstract
Background: We sought to determine the effectiveness of common cleaning procedures in eliminating S. aureus from silicone menstrual cups. Methods: In this in vitro study, we tested four cleaning techniques: (1) cold water; (2) cold water and liquid soap; (3) cold water followed by steeping the cup in boiled water for 5 min in a ceramic mug covered with a small plate; and (4) cold water and soap followed by steeping the cup in boiled water as in (3). Human blood was coated to the inner and outer surface of each cup, dried, and incubated with 106S. aureus colony-forming units (CFU/mL). All tests were performed in triplicate. Viable bacterial abundance was measured with decadic dilution and drop plate or surface plating. Results: Bacteria were most effectively eliminated by cleaning cups with soap and water and then steeping in boiled water (0 CFU/cup vs. 2.075 × 108/cup no cleaning, p = 0.005). This was not statistically significantly different from washing cups with water only and steeping 5 min in boiled water (14 CFU/cup). Raised lettering on the outer surface of the menstrual cups resulted in more bacterial recovery from pieces with lettering than without lettering. Conclusions: These results advance knowledge of between-period menstrual cup cleaning recommendations, suggesting that the logistical challenges of continuous boiling may be eliminated with steeping at least 5 min.
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Wilbur J, Morrison C, Iakavai J, Shem J, Poilapa R, Bambery L, Baker S, Tanguay J, Sheppard P, Banks LM, Mactaggart I. "The weather is not good": exploring the menstrual health experiences of menstruators with and without disabilities in Vanuatu. Lancet Reg Health West Pac 2022; 18:100325. [PMID: 35024657 DOI: 10.1016/j.lanwpc.2021.100325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Menstrual health is essential for gender equality and achieving the sustainable development goals. Though currently lacking, understanding and addressing menstrual health and social related inequalities requires comparison of experiences between menstruators with and without disabilities. Methods We completed a mixed-methods population-based study of water, sanitation and hygiene, disability and menstrual health in TORBA and SANMA Provinces, Vanuatu. Methods included a census, nested case-control study, in-depth interviews (IDIs), focus group discussions (FGDs), PhotoVoice and structured observations. We undertook a population census of 11,000+ households and recruited 164 menstruators with and 169 without disabilities (aged 10-45) into a nested case-control study. 20 menstruators across both groups were selected for the qualitative component. Findings Menstruators with disabilities were five times (adjusted Odds Ratio [aOR] 5.5, 95% Confidence Interval 1.8 - 16.5) more likely to use different bathing facilities to others in the household, nearly twice as likely (1.8, 1.1 - 3.1) to miss social activities, and three times (3.0, 1.6 - 5.7) more likely to eat alone during menstruation. Menstrual restrictions were widespread for all, but collecting water and managing menstrual materials was harder for menstruators with disabilities, particularly those requiring caregivers' support. These factors negatively impacted menstruators with disabilities' comfort, safety and hygiene, yet they reported less interference of menstruation on participation. Interpretation Negative factors affecting all menstruators disproportionately impact those with disabilities, compounding existing inequalities. Menstruators with disabilities may have reported less interference because they are accustomed to greater participation restrictions than others. Funding Australian Government's Water for Women fund and public donations.
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Affiliation(s)
- Jane Wilbur
- International Centre for Evidence in Disability (ICED), London School of Hygiene & Tropical Medicine, Keppel Street, London WCE 7HT, UK
| | - Chloe Morrison
- World Vision Vanuatu, Rue Artoi M/S, P.O Box 247, Port Vila, Vanuatu
| | - Judith Iakavai
- Vanuatu Society for People with Disability, PO Box 373, Port Vila, Vanuatu
| | - Jeanine Shem
- World Vision Vanuatu, Rue Artoi M/S, P.O Box 247, Port Vila, Vanuatu
| | - Relvie Poilapa
- World Vision Vanuatu, Rue Artoi M/S, P.O Box 247, Port Vila, Vanuatu
| | - Luke Bambery
- World Vision Vanuatu, Rue Artoi M/S, P.O Box 247, Port Vila, Vanuatu
| | - Sally Baker
- Melbourne School of Population Health, University of Melbourne, 207 Bouverie St, Carlton, VIC 3053, Australia
| | - Jamie Tanguay
- Vanuatu National Statistics Office, Port Vila, Vanuatu
| | - Philip Sheppard
- International Centre for Evidence in Disability (ICED), London School of Hygiene & Tropical Medicine, Keppel Street, London WCE 7HT, UK
| | - Lena Morgon Banks
- International Centre for Evidence in Disability (ICED), London School of Hygiene & Tropical Medicine, Keppel Street, London WCE 7HT, UK
| | - Islay Mactaggart
- International Centre for Evidence in Disability (ICED), London School of Hygiene & Tropical Medicine, Keppel Street, London WCE 7HT, UK
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Hussein J, Gobena T, Gashaw T. The practice of menstrual hygiene management and associated factors among secondary school girls in eastern Ethiopia: The need for water, sanitation, and hygiene support. Womens Health (Lond) 2022; 18:17455057221087871. [PMID: 35323073 PMCID: PMC8958694 DOI: 10.1177/17455057221087871] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND During menstruation, school girls face obstacles connected to menstrual hygiene management in schools. Due to their monthly period, up to 20% of girls miss school globally, and one in ten will drop out entirely. Three hundred thirty-five million girls attended school without access to running water or soap. In Ethiopia, 67% of girls have no access to education on puberty and menstrual health; menstrual hygiene management continues to be one of the major problems among school girls. Thus, context-specific assessment of the practice may be useful in developing customized intervention approaches. Thus, the objective of the study was to assess practices of menstrual hygiene management and associated determinants among secondary school girls in East Hararghe, Ethiopia from 1 to 30 December 2020. METHODS A school-based cross-sectional survey was undertaken with 486 randomly selected female students. Data were collected by pretested self-administered questionnaire. Descriptive statistical tests and multivariate logistic regression were used to describe the study variables and to examine the association. Statistical package for social science version 23 was used for data analysis, and a p-value of 0.05 was considered as a cut-off point for statistical significance. RESULTS Of the total, 328 (68%) of the study participants practiced appropriate menstrual hygiene. Besides, 350 (72.6%) had a good level of understanding about menstrual hygiene. A higher level of knowledge (adjusted odds ratio = 2.12, 95% confidence interval = 1.28, 3.53), a greater wealth indexed family (adjusted odds ratio = 7.14, 95% confidence interval = 3.98, 12.88), earning permanent pocket money (adjusted odds ratio = 0.495, 95% confidence interval = 0.299, 0.821), and being in grade level (11-12) (adjusted odds ratio = 3.45, 95% confidence interval = 1.75, 4.501) were significant predictors of the good menstrual hygiene practice. CONCLUSION One-third of the school girls had poor menstrual hygiene practices which may affect their school performance and the reproductive health. Hence, tailored menstrual hygiene information should be given to school girls and parents. Besides, efforts ought to be made for the provision of affordable sanitary materials in schools.
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Affiliation(s)
| | - Tesfaye Gobena
- Department of Environmental Health Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tigist Gashaw
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Munro AK, Keep M, Hunter EC, Hossain SZ. Confidence to manage menstruation among university students in Australia: Evidence from a cross-sectional survey. Womens Health (Lond Engl) 2022; 18:17455065211070666. [PMID: 35001743 PMCID: PMC8744198 DOI: 10.1177/17455065211070666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: There has been increased attention to university students’ experiences of menstrual disorders, and access to menstrual products, in high-income countries. Less attention has been directed to other aspects of their menstrual experience, including confidence for menstrual management. This study aimed to understand the factors affecting university students’ confidence to manage menstruation at university. Methods: An online survey was completed by 410 participants (age range: 16–46 years, mean = 20.1 years) who menstruate and study at an Australian university. Participants reported demographic characteristics, confidence to manage menstruation at university, and personal, physical and environmental factors. A Mann–Whitney U-test analysed differences in confidence between groups of students. Pearson’s correlation coefficient and bivariate linear regressions determined associations between factors and confidence. Statistically significant associations were inputted into a multiple linear regression model. P-values less than 0.05 were considered significant. Results: A minority of students (16.2%) felt completely confident to manage their menstruation at university. Menstrual knowledge, positive perceptions of menstruation and comfort to discuss menstruation with others positively predicted confidence. Physical menstrual symptoms, negative perceptions of menstruation, perceived stigma and using a menstrual cup or period underwear predicted lower confidence. In multiple regression, private and clean and sanitary university bathroom facilities, changing menstrual products at university, perceived stigma and negative perceptions of menstruation remained significant predictors. Conclusion: Most students did not have complete confidence to manage their menstruation at university. Several personal, physical and environmental factors were related to students’ confidence to manage menstruation. Assessment of these factors in future research with university students is recommended to enable a comprehensive understanding of their menstrual needs, and inform interventions aimed at improving their menstrual management confidence at university.
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Affiliation(s)
- Alana K Munro
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Melanie Keep
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Erin C Hunter
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Syeda Z Hossain
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Stoilova D, Cai R, Aguilar-Gomez S, Batzer NH, Nyanza EC, Benshaul-Tolonen A. Biological, material and socio-cultural constraints to effective menstrual hygiene management among secondary school students in Tanzania. PLOS Glob Public Health 2022; 2:e0000110. [PMID: 36962274 PMCID: PMC10021794 DOI: 10.1371/journal.pgph.0000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022]
Abstract
Menstrual hygiene management is an important determinant for girls' educational outcomes. We develop a method of cross-sectional analysis that quantifies the relative importance of four distinct mechanisms: material, biological, social and informational constraints and consider four main schooling outcomes: absenteeism, early departure, concentration and participation. We use survey data from 524 female students enrolled in four co-educational secondary schools in Northern Tanzania. Average age at first period is 14.2 years (standard deviation = 1.1, range 9-19). Information is the least binding constraint: 90-95% of girls report they received information about menstruation and how to manage it. In contrast, biological constraints are hindering: (i) the distribution of menstrual cramps and pain is bifurcated: most girls report very light or very strong pain (rather than moderate) with considerable educational impacts for girls in the latter group, (ii) irregular cycles (62%) and difficulty predicting the cycle (60%) lead to stress and uncertainty. Socio-cultural constraints are binding as 84% would feel shame if male peers knew their menstrual status, and 58% fear being teased over periods. Material constraints include prohibitive costs: girls spending between 12-70% of the daily national poverty line (6,247 TSH per day) on pads during their period. However, we discern no statistically significant relationship between access to pads and absenteeism. In contrast, biological and socio-cultural constraints as well as lack of sanitary infrastructure have significant effects on absenteeism. The results have several implications. First, sanitary pad interventions should consider participation and concentration as main outcomes, in addition to absenteeism. Second, biological (menstrual cramps and pain) and socio-cultural (fear, stigma) constraints are drivers of menstruation-related absenteeism and participation in the classroom and need to be evaluated in trials. We suggest exploring analgesic use, alternative pain-management techniques, menstrual cycle tracking technologies, and social programming in future trials.
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Affiliation(s)
- Dani Stoilova
- Department of Economics, Barnard College, Columbia University, New York City, NY, United States of America
| | - Rebecca Cai
- Columbia University, New York City, NY, United States of America
| | | | | | - Elias Charles Nyanza
- Department of Environmental and Occupational Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Anja Benshaul-Tolonen
- Department of Economics, Barnard College, Columbia University, New York City, NY, United States of America
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Daniels G, MacLeod M, Cantwell RE, Keene D, Humprhies D. Navigating fear, shyness, and discomfort during menstruation in Cambodia. PLOS Glob Public Health 2022; 2:e0000405. [PMID: 36962410 PMCID: PMC10022126 DOI: 10.1371/journal.pgph.0000405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/05/2022] [Indexed: 11/18/2022]
Abstract
While increased attention has been given to girls' menstrual hygiene management (MHM) experiences in schools as they relate to managerial challenges, research exploring girls' psychosocial experiences during menstruation and their needs in non-school environments remains limited. This study investigates the knowledge, attitudes, and practices regarding menstruation and MHM (M&MHM) among rural Cambodian girls (at least 14 years old, post-menarche; n = 130), mothers (n = 93), fathers (n = 15), teachers (n = 37; 54.1% female), and boys (at least 14 years old; n = 59) in both the home and school environments. Qualitative and quantitative data were collected through structured interviews, focus groups, and latrine surveys in eight secondary schools and villages from two rural provinces, Banteay Meanchey and Kratie. Findings indicated that although 95% of girls felt capable of managing their menses each month, many girls experienced fear, shyness, and discomfort (FSD) during menstruation. Identified M&MHM challenges and FSD in both the home and school environments influenced all participant groups' decision-making, social interactions, and varied based on their knowledge of M&MHM and emphasized the need for comprehensive interventions that reduce the impact of MHM challenges on psychosocial experiences and FSD to promote girls' well-being during menstruation, particularly in income limited settings.
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Affiliation(s)
- Gabrielle Daniels
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Marin MacLeod
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Raymond E Cantwell
- Water, Sanitation, and Hygiene Program, Samaritan's Purse, Phnom Penh, Cambodia
| | - Danya Keene
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Debbie Humprhies
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
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Tanton C, Nakuya K, Kansiime C, Hytti L, Torondel B, Francis SC, Namirembe P, Nakalema S, Nalugya R, Musoke SN, Neema S, Ross DA, Bonell C, Seeley J, Weiss HA. Menstrual characteristics, menstrual anxiety and school attendance among adolescents in Uganda: a longitudinal study. BMC Womens Health 2021; 21:410. [PMID: 34895210 PMCID: PMC8665501 DOI: 10.1186/s12905-021-01544-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/18/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Qualitative data show negative impacts of menstruation on health and education in many settings, but there are few longitudinal quantitative studies of the impact of menstruation. We analyse associations with menstrual anxiety and school attendance in a study of Ugandan secondary school students. METHODS Data were from a longitudinal pilot study of a menstrual health intervention (MENISCUS), conducted in two secondary schools in Entebbe sub-district, Uganda. Self-completed menstrual-related data, including menstrual anxiety, were collected from 232 participants pre- and post-intervention. A sub-cohort of 100 randomly-selected post-menarcheal girls were asked to self-complete daily diaries during 10 months of follow-up, with data on menstrual flow, pain, and school attendance. We used multivariable logistic regression to estimate associations with menstrual anxiety among all girls at baseline, and random-effects logistic regression to estimate associations of menstrual characteristics with school non-attendance for 3 months pre-intervention in the sub-cohort, adjusting for within-girl clustering. RESULTS Overall, 130/222 (58.6%) of menstruating girls reported being anxious about their next period. Menstrual anxiety was higher in those not living with their mother (adjusted odds ratio (OR) = 1.91; 95% confidence interval (CI) 1.01-3.60), believing menstrual myths (aOR = 1.83; 0.95-3.50 for not agreeing that it is healthy for a girl to run, dance or cycle during her period; aOR = 1.97; 1.04-3.73 for agreeing that when a girl has her period she is unclean), lower menstrual confidence (aOR = 2.49; 1.33-4.65 for avoiding physical activity during her period; aOR = 1.68; 0.89-3.17 for not feeling comfortable to talk to other girls about her period; aOR = 2.89; 1.28-6.54 for agreeing that boys/girls tease them about their periods; and aOR = 2.27; 1.21-4.27 for worrying about being teased during her period). Those with lower knowledge about menstruation were less likely to report anxiety (aOR = 0.44; 0.23-0.84). During the pre-intervention period of the sub-cohort, school non-attendance was associated with menstrual pain, with 21.7% of girls missing school on days when they reported pain vs. 8.3% on days when no pain was reported (aOR = 3.82; 1.66-8.77). CONCLUSIONS Menstruation causes substantial anxiety in Ugandan schoolgirls, and menstrual pain is associated with missing school on period-days. Menstrual health interventions should address socio-cultural aspects of menstruation to reduce anxiety, and provide education on pain management strategies to support school attendance.
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Affiliation(s)
- Clare Tanton
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Kevin Nakuya
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Catherine Kansiime
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Belen Torondel
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanna C Francis
- MRC International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Prossy Namirembe
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Ruth Nalugya
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Stella Neema
- College of Humanities and Social Science, Makerere University, Kampala, Uganda
| | - David A Ross
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Bonell
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Janet Seeley
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Helen A Weiss
- MRC International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Shibeshi BY, Emiru AA, Asresie MB. Disparities in menstrual hygiene management between urban and rural schoolgirls in Northeast, Ethiopia. PLoS One 2021; 16:e0257853. [PMID: 34591900 PMCID: PMC8483289 DOI: 10.1371/journal.pone.0257853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/10/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Even though menstruation is a normal biological process, adolescents are facing managing their menstruation when they are at school. It causes girls to miss their class on average three days every month. Studies in some countries showed that the magnitude of menstrual hygiene management problems is higher in rural adolescent girls, but little is known in the Ethiopia context. The objective of this study was to assess and compare menstrual hygiene management practices among rural and urban schoolgirls, Northeast, Ethiopia. METHODS An institution-based comparative cross-sectional study was employed among 1078 schoolgirls (539 urban and 539 rural) from February to March 2020. The participants were selected using a multi-stage sampling technique. A structured self-administrative questionnaire and observational checklist were used for data collection. Bivariate and multivariable logistic regression analysis with a 95% confidence interval was employed. A P- value less than 0.05 was used to declare statistical significance. RESULTS Overall, the magnitude of good menstrual hygiene practice was 52.9% (95%CI: 50.3%-56.5%), which was 65.9% (95% CI: 62.8%-70.7%) among urban and 39.9% (95% CI: 36.2%-44.6%) among rural schoolgirls. Among urban schoolgirls, the odds of good menstrual hygiene management practice was higher for girls aged below 18 years (AOR = 1.58, 95%CI: 1.05-2.39), learned about menstrual hygiene at school (AOR = 1.89, 95%CI: 1.21-2.97), heard about menstrual hygiene before menarche (AOR = 4.98, 95%CI: 2.71-9.13), and discussed menstrual hygiene with parents (AOR = 2.56, 95%CI: 1.25-5.27). Whereas, the odds of good menstrual hygiene management practice was higher among those who were knowledgeable on menstrual hygiene (AOR = 5.47, 95%CI: 3.68-8.12), those who learned about menstrual hygiene at school (AOR = 1.75, 95%CI: 1.13-2.70), and girls who heard about menstrual hygiene before menarche (AOR = 3.34, 95%CI: 1.44-7.76) in rural schoolgirls. CONCLUSIONS Though the overall menstrual hygiene practice was low, it was relatively better among urban schoolgirls. This calls for more effort to solve these problems and achieve sustainable development goals. Therefore, education and awareness creation on menstrual hygiene for schoolgirls, even before menarche at both settings should be strengthened. Encouraging parent-adolescent discussion on menstrual hygiene would have paramount importance, particularly to urban schoolgirls.
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Affiliation(s)
- Bikis Yaynie Shibeshi
- Department of Obstetrics and Gynecology Nefasmewucha Hospital, Amhara Regional State, Bahir Dar, Ethiopia
| | - Amanu Aragaw Emiru
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Melash Belacehew Asresie
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Mehta SD, Zulaika G, Otieno FO, Nyothach E, Agingu W, Bhaumik R, Green SJ, van Eijk AM, Kwaro D, Phillips-Howard PA. High Prevalence of Lactobacillus crispatus Dominated Vaginal Microbiome Among Kenyan Secondary School Girls: Negative Effects of Poor Quality Menstrual Hygiene Management and Sexual Activity. Front Cell Infect Microbiol 2021; 11:716537. [PMID: 34621690 PMCID: PMC8490761 DOI: 10.3389/fcimb.2021.716537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/30/2021] [Indexed: 01/05/2023] Open
Abstract
The vaginal microbiome (VMB) impacts numerous health outcomes, but evaluation among adolescents is limited. We characterized the VMB via 16S rRNA gene amplicon sequencing, and its association with Bacterial vaginosis (BV) and sexually transmitted infections (STIs; chlamydia, gonorrhea, trichomoniasis) among 436 schoolgirls in Kenya, median age 16.9 years. BV and STI prevalence was 11.2% and 9.9%, respectively, with 17.6% of girls having any reproductive tract infection. Three community state types (CST) accounted for 95% of observations: CST-I L.crispatus-dominant (N=178, BV 0%, STI 2.8%, sexually active 21%); CST-III L.iners-dominant (N=152, BV 3.3%, STI 9.7%, sexually active 35%); CST-IV G.vaginalis-dominant (N=83, BV 51.8%, STI 25.3%, sexually active 43%). In multivariable adjusted analyses, sexually active girls had increased odds of CST-III and CST-IV, and use of cloth to manage menses had 1.72-fold increased odds of CST-IV vs. CST-I. The predominance of L.crispatus-dominated VMB, substantially higher than observed in prior studies of young adult and adult women in sub-Saharan Africa, indicates that non-optimal VMB can be an acquired state. Interventions to maintain or re-constitute L.crispatus dominance should be considered even in adolescents.
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Affiliation(s)
- Supriya D. Mehta
- Division of Epidemiology & Biostatistics, University of Illinois at Chicago, Chicago, IL, United States,*Correspondence: Supriya D. Mehta,
| | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Elizabeth Nyothach
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Runa Bhaumik
- Division of Epidemiology & Biostatistics, University of Illinois at Chicago, Chicago, IL, United States
| | - Stefan J. Green
- Department of Internal Medicine and Genomics and Microbiome Core Facility, Rush University, Chicago, IL, United States
| | - Anna Maria van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Daniel Kwaro
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
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