Assessment of the Impact of a Short-Term Intervention on Menstrual Hygiene Practices of Adolescent Girls in Rural Parts of Central India

Introduction Menstruation affects many young girls in a negative way in relation to their physical and psychological health despite being a reasonably common issue in daily life. Their health relies on their learning about fundamental menstruation hygiene. They have a significant risk of developing ailments due to their lack of education in this area. Young girls can avoid several preventable illnesses by being educated about menstruation hygiene and practices. Therefore, our study aimed to assess the impact of a health education intervention on the knowledge, attitude, and practice of teenage girls about menstrual hygiene. Materials and methods The current educational interventional study design evaluates the impact of an educational intervention on menstrual hygiene in teenage females. Adolescent girls were educated about the practices and taboos related to menstruation. They were assessed using a pretest and post-test after the intervention. The results of the pre- and post-study tests were compared, and the effect of the intervention was determined. Result A noteworthy observation of the study was that only 87 (34.8%) teenage girls were aware of hygienic practices before menarche. The didactic lecture had a favorable impact, and after two months, 2.40% of the 6.80% of females who changed their reusable pads just once a week began replacing them every two days. Additionally, a shift in hygiene behaviors was noted; 17.20% of the 33.60% of individuals started washing their hands with soap and water after changing their menstruation pads, which was significant (p=0.05). Conclusion The study assessed the impact of a short-term intervention on the menstrual habits practiced by adolescent girls. We concluded that an intervention in the form of educational counseling can significantly impact the menstrual hygiene practices of adolescent girls. Teaching teenage females resulted in a considerable improvement in their menstruation habits, which has a beneficial overall effect.

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

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

Study of Menstrual Hygiene Practices Among Adolescent Girls in a Tribal Area of Central India

Introduction Menstruation is an essential phenomenon in an adolescent girl's life. In India, females who are menstruating are considered impure and teenage girls are not allowed to undertake home chores or engage in religious or cultural events during their period. Up-to-date knowledge about menstruation, beginning in early adolescence, would improve safe practices and relieve the distress of millions of women. Material and methods A cross-sectional study was conducted among adolescent girls (10-19 years) residing in a tribal area of Nagpur District from January to March 2022. Three tribal residential schools (Ashram Shala) were selected from a total of six in Hingana Taluka of Nagpur District, using simple random sampling to fulfill the required sample size of 272. Demographic details, age at menarche, awareness of menstruation, sources of information about menstruation, menstrual hygiene practices, and restrictions observed during menstruation were assessed. Results The average age at menarche was 13.04+0.96 years (range 11-16 years). Only 45.17% of girls were aware of the menarche and menstrual cycle before its onset. The duration of the menstrual cycle ranged from 21-35 days in most of the girls (90.69%), and it was regular in 85.86% of girls. Duration of bleeding was two to six days for the majority of the girls (87.93%). Around 73.79% of girls were using sanitary pads, while 26.21% of girls were using clothes. The most important restrictions imposed on the girls during menstruation were not being allowed to attend religious functions (97.93%), followed by not being allowed to attend classes (65.86%). The use of sanitary pads was significantly more in late adolescent girls than in early adolescent girls (ꭓ²=14.97, p=0.0001), girls who have literate mothers than girls with illiterate mothers (ꭓ²=5.17, p=0.02), and girls belonging to higher socioeconomic classes (class I, II, III) than lower ones (class IV, V) (ꭓ²=44.23, p<0.0001). Conclusion The tribal adolescent girls still don't exercise proper hygiene throughout their periods. During menstruation, the majority of girls are still subjected to various restrictions.

Cost-Effectiveness and Cost-Benefit Analyses of Providing Menstrual Cups and Sanitary Pads to Schoolgirls in Rural Kenya

Objective

To analyze the relative value of providing menstrual cups and sanitary pads to primary schoolgirls.

Design

Cost-effectiveness and cost-benefit analyses of three-arm single-site open cluster randomized controlled pilot study providing menstrual cups or sanitary pads for 1 year.

Participants

Girls 14-16 years of age enrolled across 30 primary schools in rural western Kenya.

Methods

Cost-effectiveness analysis was conducted based on the health effects (reductions in disability-adjusted life years [DALYs]) and education effects (reductions in school absenteeism) of both interventions. The health and education benefits were separately valued and compared with relative program costs.

Results

Compared with the control group, the cost of menstrual cups was estimated at $3,270 per year for 1000 girls, compared with $24,000 for sanitary pads. The benefit of the menstrual cup program (1.4 DALYs averted, 95% confidence interval [CI]: -4.3 to 3.1) was higher compared with a sanitary pad program (0.48 DALYs averted, 95% CI: -4.2 to 2.3), but the health effects of both interventions were not statistically significant likely due to the limited statistical power. Using point estimates, the menstrual cup intervention was cost-effective in improving health outcomes ($2,300/DALY averted). The sanitary pad intervention had a cost-effectiveness of $300/student-school year in reducing school absenteeism. When considering improvements in future earnings from reduced absenteeism, the sanitary pad program had a net benefit of +$68,000 (95% CI: -$32,000 to +$169,000).

Conclusions

The menstrual cup may provide a cost-effective solution for menstrual hygiene management in low-income settings. This study outlines a methodology for future analyses of menstrual hygiene interventions and highlights several knowledge gaps that need to be addressed. Trial registration: ISRCTN17486946.

Working Alone, Limited Restroom Accessibility, and Poor Menstrual Health Among Cosmetics Saleswomen in South Korea

Menstrual hygiene management (MHM) at work has been neglected in occupational health research despite its importance for female workers' health. This study investigated the association between hours of working alone and poor menstrual health among 740 cosmetics saleswomen in South Korea. Hours of working alone in a day were classified into 4 categories. MHM was measured by asking "Over the past six months, have you ever experienced that you could not change your sanitary pad when you need to change it at work?" We also measured the experience of dermatopathy due to unchanged sanitary pads. Cosmetics saleswomen who worked alone for 3 h or more in a day reported a higher prevalence of ever being unable to change the sanitary pads (prevalence ratio [PR] 1.84, 95% confidence interval [CI]: 1.37-2.46) and dermatopathy due to unchanged sanitary pads (PR 2.06, 95% CI: 1.18-3.59) than those who worked alone less than 1 h in a day.

Waste management and environmental impact of absorbent hygiene products: A review

Absorbent hygiene products (AHP) have received much interest due to the notion that their end-of-life (EoL) stage has high environmental impacts. Since the use of AHP will continue to rise in the foreseeable future, information that helps with a reduction in the environmental impacts of AHP through their life cycle is needed. This research presents an estimation of AHP in municipal waste, and it also reviews and discusses waste management options, available treatments at bench, pilot or full scale, and life cycle assessments (LCAs) available in the literature. Municipal waste of countries belonging to the Organization for Economic Co-operation and Development contains on average 2.7% of baby nappies, 4.8% of adult nappies and 0.5% of sanitary pads (in weight), whereas that of Latin-American countries have 7.3%, 3.3%, and 0.9%, respectively. Management options for AHP waste in developed countries are landfilling and incineration, while in developing countries AHP are disposed of in dumpsites and landfills. Most LCAs identify significant environmental impacts in the production of raw materials, while EoL scenarios involving incineration and landfill were found to have a significant contribution to global warming potential. Substitution with alternative products has been suggested as a way of decreasing environmental impacts; however, their use frequently causes a trade-off on different impact categories. Municipalities could use a wide range of policy tools, such as extended producer responsibility systems, bans, levies, ecolabelling, or a combination of these, to reduce the environmental and economic burden of AHP waste.

Understanding Period Poverty: Socio-Economic Inequalities in Menstrual Hygiene Management in Eight Low- and Middle-Income Countries

Menstrual hygiene management and health is increasingly gaining policy importance in a bid to promote dignity, gender equality and reproductive health. Effective and adequate menstrual hygiene management requires women and girls to have access to their menstrual health materials and products of choice, but also extends into having private, clean and safe spaces for using these materials. The paper provides empirical evidence of the inequality in menstrual hygiene management in Kinshasa (DRC), Ethiopia, Ghana, Kenya, Rajasthan (India), Indonesia, Nigeria and Uganda using concentration indices and decomposition methods. There is consistent evidence of wealth-related inequality in the conditions of menstrual hygiene management spaces as well as access to sanitary pads across all countries. Wealth, education, the rural-urban divide and infrastructural limitations of the household are major contributors to these inequalities. While wealth is identified as one of the key drivers of unequal access to menstrual hygiene management, other socio-economic, environmental and household factors require urgent policy attention. This specifically includes the lack of safe MHM spaces which threaten the health and dignity of women and girls.

MR-guided focused ultrasound surgery: A novel non-invasive technique in the treatment of adenomyosis -18 month's follow-up of 12 cases

Background:

Adenomyosis is a gynecological condition of the uterus, characterized by the presence of ectopic endometrial tissue in the myometrium. Hysterectomy, uterine artery embolization, and endometrial ablation therapy are the various surgical treatment options available for adenomyosis. A novel and globally upcoming technique is MR-guided focused ultrasound surgery “MRgFUS,” which is a promising non-invasive surgical treatment option. This study was carried out to determine the effectiveness of MRgFUS in the symptomatic management of adenomyosis.

Subjects and Methods:

This study was carried out as a long-term follow-up study among 12 cases of adenomyosis, which were treated by MR-guided focused ultrasound. In all these participant's, three parameters – symptom severity score (SSS), menstrual pain score accessed using visual analogue score (VAS), and number of approximate pads used during menstruation were recorded prior to the treatment and on follow-up at 3, 9, and 18 months, respectively. The Friedman's test was used to test the difference in the values of scores before and after treatment.

Results:

There was a significant improvement in the SSS, VAS, and the numbers of sanitary napkins used after surgery and sustained during the long-term follow-up. These values were statistically significant (P < 0.05).

Conclusion:

MRgFUS can be used in successful treatment of adenomyosis/focal adenomyoma by careful selection of the participant, good planning, and proper monitoring of the technique during ablation.

Risk assessment of volatile organic compounds (VOCs) detected in sanitary pads

Disposable sanitary pads are a necessity for women's health, but safety concerns regarding the use of these products have created anxiety. The aim of this study was to conduct a risk assessment of 74 volatile organic compounds (VOCs), which were expected to be contained within sanitary pads. Of the 74 VOCs, 50 were found in sanitary pads retailed in Korea at concentrations ranging from 0.025 to 3548.09 µg/pad. In order to undertake a risk assessment of the VOCs, the toxicological database of these compounds in the United States Environmental Protection Agency (USEPA), Agency for Toxic Substances and Disease Registry (ATSDR), National Toxicology Program (NTP) and World Health Organization (WHO) was searched. Ethanol was found to exhibit the highest reference dose (RfD) while 1,2-dibromo-3-chloro-propane displayed the lowest RfD. Consequently, a worst-case exposure scenario was applied in this study. It was assumed that there was the use of 7.5 sanitary napkins/day for 7 days/month. In the case of panty liners or overnight sanitary napkins, the utilization of 90 panty liners/month or 21 overnight sanitary napkins/month was assumed, respectively. In addition, 43 kg, the body weight of 12 to 13-year-old young women, and 100% VOCs skin absorption were employed for risk assessment. The systemic exposure dose (SED) values were calculated ranging from 1.74 (1,1,2-trichloroethane) ng/kg/day to 144.4 (ethanol, absolute) µg/kg/day. Uncertainty factors (UFs) were applied ranging from 10 to 100,000 in accordance with the robustness of animal or human experiments. The margin of exposure (MOE) of 34 VOCs was more than 1 (acceptable MOE > 1). Applicable carcinogenic references reported that the cancer risk of five VOCs was below 10^-6. Based on our findings, evidence indicates that the non-cancer and cancer risks associated with VOCs detected in sanitary pads currently used in South Korea do not pose an adverse health risk in women.

Knowledge and awareness regarding menstruation and HIV/AIDS among schoolgoing adolescent girls

Introduction:

Menstruation in our country is associated with various myths and restrictions leading to lack of awareness among adolescent girls. Insufficient menstrual hygiene practices are the cause of stress associated with menstruation and reproductive tract infections. Sexually transmitted infections and HIV/AIDS are not openly discussed in our society making adolescents vulnerable to them.

Aim:

To assess the knowledge of school going adolescent girls regarding menstrual hygiene and HIV/AIDS.

Materials and Methods:

Girls studying in class 8^th-12^th standard and who have attained menarche were included in the study. A predesigned questionnaire, which consisted of questions related to menstrual awareness and knowledge about HIV/AIDS was used for data collection. Data was analysed using SPSS software and results were interpreted into percentages.

Results:

282 girls took part in the study. Mean age of girls was 14.70 ± 1.5 years. Median age of girls was 15 years. Knowledge regarding menstrual hygiene and HIV/AIDS was found to be only satisfactory leaving a scope of improvement. Mother was the main source of information regarding both menstruation and HIV/AIDS.

Conclusion:

A comprehensive health education programme involving mothers is required to remove various misconceptions and taboos associated with menstruation and make it a pleasant experience for adolescent girls. Information, education and awareness programmes need to be strengthened to spread awareness regarding HIV/AIDS.

Assessment of menstrual hygiene among reproductive age women in South-west Delhi

Background:

The issue of menstrual hygiene is inadequately acknowledged in our nation. The use of sanitary pads and washing the genital area are essential practices for good menstrual hygiene. Poor menstrual hygiene may lead to itching or rashes in the perineal region, bad odor, and sometimes, major complications such as pelvic inflammatory disease and toxic shock syndrome. Therefore, the objective of this study was to assess the knowledge and practice of menstrual hygiene among reproductive age group women.

Methods:

A Community-based cross-sectional study design was employed. Study was conducted from January 2012 to April 2013. Data were collected using a pretested semi-structured structured questionnaire. The data were entered and analyzed into a computer using SPSS version 20.

Results:

In this study, 584 (81.7%) respondents had good practice of menstrual hygiene. The findings of the study showed a significant positive association between good practices of menstrual hygiene and years of education of the study subject (adjusted odds ratio [AOR] =9.3, 95% confidence interval [CI]: 4.4–19.5), having a higher socioeconomic status (AOR = 9.27, 95% CI: 4.7–18.03).

Conclusions:

Awareness of good menstrual practices is of utmost importance. Health education regarding menstrual hygiene should be a part of school curriculum and health institutes. Social marketing of good quality, low-cost sanitary napkins at accessible outlets, provision for adequate water supply, vending machines for low-cost sanitary napkins, privacy and wall-mounted incinerators for disposal in schools, workplaces, and public places would go a long way in improving the menstrual hygiene and help them in securing healthy lifestyle.

Menstrual Hygiene Practices in Context of Schooling: A Community Study Among Rural Adolescent Girls in Varanasi

INTRODUCTION

Up until now, poor menstrual hygiene in developing countries has been an insufficiently acknowledged problem. The lack of attention to this issue is striking as we cannot achieve several Millennium Development Goals (MDGs), that is, 2, 3 4,5, and 5B. This study aimed to assess the level of awareness about menarche and hygienic practices during menstruation in context of schooling.

MATERIALS AND METHODS

Community-based cross-sectional study using a mix method approach (qualitative and quantitative). It was conducted among 650 adolescent girls in the field practice area of Rural Health and Training Centre, Chiraigaon block of district Varanasi between January and June2011. Pretested, semistructured interview schedule was used. Data were analyzed statistically by using Statistical Package for Social Sciences (SPSS) software.

RESULTS

Out of the total 650 respondents, 590 (90.78%) had attained menarche at the time of interview and only one-third of the respondents (29.4%) were aware of menstruation before menarche and sisters (55%) played the key role in providing information to them. Only 31% respondents were using sanitary pads during menstruation. Self-reported reproductive tract infection (RTI) was observed more in respondents not maintaining hygienic practices (6.6%) as compared to those maintaining hygiene (2.6%).

CONCLUSION AND RECOMMENDATIONS

From the Focus Group Discussions (FGDs) as well as quantitative survey it was observed that the awareness about menarche before its onset was still poor in rural areas. Significant association (P < 0.05) was observed between respondent education and their awareness about menarche before its onset. Therefore, it is recommended that teachers can play an influential role in informing them about changes during adolescence, especially about menarche and other issues related to menstruation. As per the present study, sisters and mothers were the major source of information. Therefore, there is a need for the provision of comprehensive family life education for the parents also.