Measuring the prevalence and impact of poor menstrual hygiene management: a quantitative survey of schoolgirls in rural Uganda

Objectives The primary objective was to describe Ugandan schoolgirls’ menstrual hygiene management (MHM) practices and estimate the prevalence of inadequate MHM. Second, to assess the relative contribution of aspects of MHM to health, education and psychosocial outcomes. Design Secondary analysis of survey data collected as part of the final follow-up from a controlled trial of reusable sanitary pad and puberty education provision was used to provide a cross-sectional description of girls’ MHM practices and assess relationships with outcomes Setting Rural primary schools in the Kamuli district, Uganda. Participants Participants were 205 menstruating schoolgirls (10–19 years) from the eight study sites. Primary and secondary outcome measures The prevalence of adequate MHM, consistent with the concept definition, was estimated using dimensions of absorbent used, frequency of absorbent change, washing and drying procedures and privacy. Selfreported health, education (school attendance and engagement) and psychosocial (shame, insecurity, embarrassment) outcomes hypothesised to result from poor MHM were assessed as primary outcomes. Outcomes were measured through English surveys loaded on iPads and administered verbally in the local language. Results 90.5% (95% CI 85.6% to 93.9%) of girls failed to meet available criteria for adequate MHM, with no significant difference between those using reusable sanitary pads (88.9%, 95% CI 79.0% to 94.4%) and those using existing methods, predominantly cloth (91.5%, 95% CI 85.1% to 95.3%; χ2 (1)=0.12, p=0.729). Aspects of MHM predicted some consequences including shame, not standing in class to answer questions and concerns about odour. Conclusions This study was the first to assess the prevalence of MHM consistent with the concept definition. Results suggest that when all aspects of menstrual hygiene are considered together, the prevalence is much higher than has previously been reported based on absorbents alone. The work demonstrates an urgent need for improved assessment and reporting of MHM, and for primary research testing the links between menstrual management and health, education and psychosocial consequences

Schoolgirls’ experience and appraisal of menstrual absorbents in rural Uganda: a cross-sectional evaluation of reusable sanitary pads

BACKGROUND: Governments, multinational organisations, and charities have commenced the distribution of sanitary products to address current deficits in girls’ menstrual management. The few effectiveness studies conducted have focused on health and education outcomes but have failed to provide quantitative assessment of girls’ preferences, experiences of absorbents, and comfort. Objectives of the study were, first, to quantitatively describe girls’ experiences with, and ratings of reliability and acceptability of different menstrual absorbents. Second, to compare ratings of freely-provided reusable pads (AFRIpads) to other existing methods of menstrual management. Finally, to assess differences in self-reported freedom of activity during menses according to menstrual absorbent. // METHODS: Cross-sectional, secondary analysis of data from the final survey of a controlled trial of reusable sanitary padand puberty education provision was undertaken. Participants were 205 menstruating schoolgirls from eight schools in rural Uganda. 72 girls who reported using the intervention-provided reusable pads were compared to those using existing improvised methods (predominately new or old cloth). // RESULTS: Schoolgirls using reusable pads provided significantly higher ratings of perceived absorbent reliability across activities, less difficulties changing absorbents, and less disgust with cleaning absorbents. There were no significant differences in reports of outside garment soiling (OR 1.00 95%CI 0.51–1.99), or odour (0.84 95%CI 0.40–1.74) during the last menstrual period. When girls were asked if menstruation caused them to miss daily activities there were no differences between those using reusable pads and those using other existing methods. However, when asked about activities avoided during menstruation, those using reusable pads participated less in physical sports, working in the field, fetching water, and cooking. // CONCLUSIONS: Reusable pads were rated favourably. This translated into some benefits for self-reported involvement in daily activities, although reports of actual soiling and missing activities due to menstruation did not differ. More research is needed comparing the impact of menstrual absorbents on girls’ daily activities, and validating outcome measures for menstrual management research

Menstruation and the cycle of poverty: a cluster quasi-randomised control trial of sanitary pad and puberty education provision in Uganda

BACKGROUND: Poor menstrual knowledge and access to sanitary products have been proposed as barriers to menstrual health and school attendance. In response, interventions targeting these needs have seen increasing implementation in public and private sectors. However, there has been limited assessment of their effectiveness. // OBJECTIVES: Assess the impact of providing reusable sanitary pads and puberty education on girls’ school attendance and psychosocial wellbeing outcomes. // METHODS: A cluster quasi-randomised controlled trial was conducted across 8 schools, including 1124 girls, in rural Uganda. Schools were allocated to one of four conditions: the provision of puberty education alone; reusable sanitary pads alone; puberty education and reusable sanitary pads; and a control (no intervention). The primary outcome was school attendance. Secondary outcomes reflected psychosocial wellbeing. // RESULTS: At follow-up, school attendance had worsened for girls across all conditions. Per-protocol analysis revealed that this decline was significantly greater for those in the control condition d = 0.52 (95%CI 0.26–0.77), with those in control schools having a 17.1% (95%CI: 8.7–25.5) greater drop in attendance than those in any intervention school. There were no differences between the intervention conditions. High rates of school drop-out and transfer meant the trial suffered from substantial participant drop-out. Intention-to-treat analyses using two different imputation strategies were consistent with the main results, with mean differences of 5.2% attendance in best-case and 24.5% in worst-case imputations. Results were robust to adjustments for clustering. There was no impact of the interventions on girls’ self-reported shame or insecurity during menstruation. // CONCLUSION: Results of the trial support the hypothesised positive impact of providing sanitary pads or puberty education for girls’ school attendance in a developing country context. Findings must be interpreted with caution in light of poor participant retention, intervention fidelity, and the attendance measures used

A Comparison of Certified Nurse-Midwives in Two Locations: The Freestanding Birth Center and the Hospital

268 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2004.The analyses of the birth certificate data show that all medical procedures have a higher likelihood of being used in hospitals than in FSBCs. Despite these significant differences in the use of medical technology across work location, the insights garnered from the interviews imply that midwives have a common childbirth philosophy no matter what their work location and that the divergent practices in the hospital and the FSBC are therefore linked to the different work environments. The interviews also indicate that midwives share some common national/state and community social constraints; although there are also some unique challenges directly affecting the practice of midwifery in free standing birth centers versus hospital environments. For example, CNMs in hospitals may find it difficult to act as advocates for their clients because they work in an environment inundated by a medical approach to childbirth. However, midwives in FSBCs struggle to find and utilize backup services from physicians and hospitals.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD

Additional file 2: of Schoolgirls’ experience and appraisal of menstrual absorbents in rural Uganda: a cross-sectional evaluation of reusable sanitary pads

Intervention Survey Oct 2014. (PDF 236 kb

Mean percentage attendance at baseline and follow-up for all interventions combined, and each condition, compared to control.

<p>Presented for the sample of girls retained in schools at follow-up (n = 580).</p

Psychosocial wellbeing across intervention conditions (n = 356).

<p>Psychosocial wellbeing across intervention conditions (n = 356).</p

Mean percentage attendance at baseline, follow-up and change scores across conditions (n = 580).

<p>Mean percentage attendance at baseline, follow-up and change scores across conditions (n = 580).</p

School status at follow-up according to condition (%) (n = 1008)

<p>School status at follow-up according to condition (%) (n = 1008)</p

Mean baseline and follow-up percentage attendance according to girls’ menstrual status at study conclusion (n = 356)

<p>Mean baseline and follow-up percentage attendance according to girls’ menstrual status at study conclusion (n = 356)</p