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Jahan F, Shuchi NS, Shoab AK, Alam MU, Bashar SMK, Islam K, Jahan H, Hasan M, Alam MM, Rahman M. Changes in the menstrual hygiene management facilities and usage among Bangladeshi school girls and its effect on school absenteeism from 2014 to 2018. Glob Health Action 2024; 17:2297512. [PMID: 38230656 PMCID: PMC10795776 DOI: 10.1080/16549716.2023.2297512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/12/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The lack of menstrual hygiene management (MHM) information and facilities in schools is a major contributor to adolescent girls' school absenteeism in low- and middle-income countries like Bangladesh. OBJECTIVES This paper examines the changes over time in school MHM facilities, knowledge and perceptions among adolescent girls, in relation to school absenteeism between 2014 and 2018 in Bangladesh. METHODS We examined changes in MHM and school absenteeism among schoolgirls using nationally representative data from the Bangladesh National Hygiene Baseline Survey 2014 and National Hygiene Survey 2018. Given the repetitive nature of our data and its clustering within participants, our method included performing descriptive analysis, bivariate analysis, and multivariate Generalised Estimating Equation (GEE) modelling to analyse these changes. RESULTS Results showed that adolescent girls' menstruation-related absenteeism decreased between 2014 and 2018. Percentage of adolescents who missed school decreased from 25% to 14% (PD: -11; CI: -16 to -6.1), while the average number of missed days reduced from 2.8 to 2.5 (PD: -0.33; CI: -0.57 to -0.10). In the GEE model, we found that living in rural areas (coef: -5.6; CI: -10.06 to -1.14), parental restrictions on going outside (coef: 4.47; CI: 0.75 to 8.2), education levels of girls (coef: -9.48; CI: -14.17 to -4.79), girl's belief that menstruation affects school performance (coef: 23.32; CI: 19.71 to 26.93), and using old cloths (coef: -4.2; CI: -7.6 to -0.79) were significantly associated with higher absenteeism. However, participant's age, type of school, knowledge of menstruation before menarche, receiving information regarding MHM, separate place for changing absorbents, and separate latrine and urine facility were not significantly associated with the changes in absenteeism over time. CONCLUSION This paper emphasised the associations between changes in school absenteeism, parental restrictions on students, students' education levels, and menstruation-related misperceptions. Ongoing research, policy reviews, and targeted interventions to improve MHM perceptions among girls are required to provide long-term benefits for adolescent girls in Bangladesh.
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Affiliation(s)
- Farjana Jahan
- Environmental Health and WASH, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Noshin Sayiara Shuchi
- Environmental Health and WASH, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abul Kasham Shoab
- Environmental Health and WASH, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahbub-Ul Alam
- Environmental Health and WASH, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- School of Civil Engineering, University of Leeds, Leeds, UK
| | - Sk. Md. Kamrul Bashar
- Environmental Health and WASH, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Khairul Islam
- WaterAid, South Asia Region Bangladesh, Dhaka, Bangladesh
| | - Hasin Jahan
- WaterAid, South Asia Region Bangladesh, Dhaka, Bangladesh
| | - Mahadi Hasan
- WaterAid, South Asia Region Bangladesh, Dhaka, Bangladesh
| | - Md. Masud Alam
- Demography and Health Wing, Bangladesh Bureau of Statistics, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Environmental Health and WASH, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Czekalski Lobascz B, Reis MBDF, Mendes GDPMET, Cruz DCDO, Damaceno MJCF, Sartorao Filho CI. Determinants of menstrual cup use among undergraduate medical students: A cross-sectional study. Int J Gynaecol Obstet 2023; 160:1007-1011. [PMID: 36087018 DOI: 10.1002/ijgo.14450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/14/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To identify the determinants of menstrual cup use among medical students in Brazil. METHODS A cross-sectional study with an online survey regularly applied to matriculate women from Medical School in January 2021. RESULTS Of 277 women, 164 participated. The mean age was 22.26 ± 3.21 years. In all 136 women preferred external pads, 60 internal pads, 28 menstrual cups, and 11 did not use. Using a 1-10 scale, price, efficacy, sustainability, practice, vaginal health status, hygiene, and importance of internal genital integrity were investigated. Thirty-seven (22.56%) women related the use of menstrual cups in the last year. Using any method to reduce menstruation had an adjusted odds ratio (aOR) of 0.310 (95% confidence interval [CI] 0.122-0.787). Concern about the environmental biodegradation had an aOR of 6.369 (95% CI 1.372-29.562); concern about intimal health had an aOR 1.996 (95% CI 1.183-3.368); and concern about internal genital integrity had an aOR of 0.824 (95% CI 0.682-0.995) for menstrual cup use. CONCLUSION The significant independent factors for the use or adherence to menstrual cups were: women using a method to reduce their menstrual flow; concerning biodegradation; concerning vaginal health; with no concerns about manipulating their genitalia. The menstrual cup was used by 22.56% of a medical school in Brazil among undergraduate women.
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Affiliation(s)
| | | | | | | | | | - Carlos Izaias Sartorao Filho
- Educational Foundation of Municipality of Assis, Medical School, Assis, Sao Paulo, Brazil
- Educational Foundation of Municipality of Assis, Physiotherapy School, Assis, Sao Paulo, Brazil
- University Hospital, Botucatu Medical School, University of Sao Paulo State-UNESP, Botucatu, Sao Paulo, Brazil
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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] [Abstract] [Key Words] [MESH Headings] [Grants] [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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Affiliation(s)
- Mahbub-Ul Alam
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
| | - Farhana Sultana
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Erin C Hunter
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Leanne Unicomb
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Supta Sarker
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Mehjabin Tishan Mahfuz
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Abdullah Al-Masud
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Stephen P Luby
- Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, USA
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Poague KIHM, Blanford JI, Anthonj C. Water, Sanitation and Hygiene in Schools in Low- and Middle-Income Countries: A Systematic Review and Implications for the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3124. [PMID: 35270814 PMCID: PMC8910349 DOI: 10.3390/ijerph19053124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/21/2022] [Accepted: 03/03/2022] [Indexed: 12/26/2022]
Abstract
The global COVID-19 pandemic has revealed the extent to which schools are struggling with the provision of safe drinking water, sanitation and hygiene (WASH). To describe the WASH conditions in schools and discuss the implications for the safe reopening of schools during the ongoing COVID-19 pandemic, a systematic review of peer-reviewed literature on WASH in schools in low- and middle-income countries was performed. In April 2021, five databases, including MEDLINE (via PubMed), Web of Science, Scopus, AJOL, and LILACS, were used to identify studies. Sixty-five papers met the inclusion criteria. We extracted and analyzed data considering the Joint Monitoring Programme (JMP) definitions and the normative contents of Human Rights to safe drinking water and sanitation. Publications included in this systematic review considered 18,465 schools, across 30 different countries. Results indicate a lack of adequate WASH conditions and menstrual hygiene management requirements in all countries. The largely insufficient and inadequate school infrastructure hampers students to practice healthy hygiene habits and handwashing in particular. In the context of the COVID-19 pandemic, being hindered to implement such a key strategy to contain the spread of SARS-CoV-2 in the school environment is of major concern.
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Affiliation(s)
- Kasandra I. H. M. Poague
- Faculty of Geo-Information Science and Earth Observation–ITC, University of Twente, Hengelosestraat 99, P.O. Box 217, 7500 AE Enschede, The Netherlands; (J.I.B.); (C.A.)
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Robinson HJ, Barrington DJ. Drivers of menstrual material disposal and washing practices: A systematic review. PLoS One 2021; 16:e0260472. [PMID: 34860828 PMCID: PMC8641861 DOI: 10.1371/journal.pone.0260472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022] Open
Abstract
Background Disposal and washing facilities and services for menstrual materials are often designed based upon technical specifications rather than an in-depth understanding of what drives peoples’ choices of practices. Objectives and data sources This systematic review identified and summarised the main behavioural drivers pertaining to the choice of disposal and washing practices of menstrual materials through the thematic content analysis and study appraisal of 82 publications (80 studies) on menstrual health and hygiene published since 1999, reporting the outcomes of primary research across 26 countries. Results Disposal and washing behaviours are primarily driven by the physical state of sanitation facilities; however, this is intrinsically linked to taboos surrounding and knowledge of menstruation. Implications Using reasons given for disposal and washing practices by menstruators or those who know them well, or inferred by authors of the reviewed studies, we identify the key considerations needed to design facilities and services which best suit the desired behaviours of both planners and those who menstruate. Inclusivity The term menstruators is used throughout to encompass all those mentioned in the studies reviewed (girls and women); although no studies explicitly stated including non-binary or transgender participants, this review uses inclusive language that represents the spectrum of genders that may experience menstruation. Registration The review protocol is registered on PROSPERO: 42019140029.
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Affiliation(s)
| | - Dani Jennifer Barrington
- University of Leeds, Leeds, West Yorkshire, United Kingdom
- The University of Western Australia, Crawley, Western Australia, Australia
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Mahfuz MT, Sultana F, Hunter EC, Jahan F, Akand F, Khan S, Mobashhara M, Rahman M, Alam MU, Unicomb L, Luby SP, Winch PJ. Teachers' perspective on implementation of menstrual hygiene management and puberty education in a pilot study in Bangladeshi schools. Glob Health Action 2021; 14:1955492. [PMID: 34338160 PMCID: PMC8330768 DOI: 10.1080/16549716.2021.1955492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To assess the perspectives of Bangladeshi teachers on the feasibility of delivery and potential for long-term sustainability of puberty and menstruation education in urban and rural schools. METHOD We developed a multi-module puberty and menstrual hygiene management education curriculum that teachers piloted for six months in four urban and rural government and private schools in Bangladesh. We conducted monthly assessments during piloting, discussion for manual revision and four group discussions with 20 participating teachers to understand perceived benefits, barriers, and sustainability of puberty and menstruation education among school children. RESULTS Teachers acknowledged the importance of school-based puberty and menstruation education to improve students' perception and preparedness. They found that the training and instructors' manual they received were useful tools for effectively communicating with students. Teachers noted school and community pressure to de-emphasize educational content not included on nationally standardized examinations, and insufficient time and pre-service training for teaching sensitive topics served as barriers to implementing the pilot curriculum. CONCLUSION Pressure from school authorities and community may hinder the successful long-term delivery of school-based puberty and menstruation education programs that are external to the national curriculum. Our findings indicate that feasibly and sustainably improving education on these topics in Bangladeshi classrooms should be achieved through 1) revision of the current national curriculum to incorporate more comprehensive puberty and menstruation information including its physiology, management, and social context, 2) adequate training and support for teachers to deliver the content, and 3) incorporation of puberty and menstruation content into students' national examinations which may better ensure teachers are given the tools and opportunity to prioritize teaching this content.
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Affiliation(s)
- Mehjabin Tishan Mahfuz
- Environmental Interventions Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Bangladesh
| | - Farhana Sultana
- Environmental Interventions Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Bangladesh
| | - Erin C Hunter
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Farjana Jahan
- Environmental Interventions Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Bangladesh
| | - Farhana Akand
- Environmental Interventions Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Bangladesh
| | - Shifat Khan
- Environmental Interventions Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Bangladesh
| | - Mosammat Mobashhara
- Environmental Interventions Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Bangladesh
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Bangladesh
| | - Mahbub-Ul Alam
- Environmental Interventions Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Bangladesh
| | - Leanne Unicomb
- Environmental Interventions Unit, Infectious Disease Division, International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Bangladesh
| | | | - Peter J Winch
- John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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