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Costa JC, Darling AM, Shinde S, Tadesse AW, Sherfi H, Mwanyika-Sando M, Tinkasimile A, Sharma D, Baernighausen T, Fawzi WW. Estimated timing of the first menstrual period and dietary and nutritional correlates of menarche among urban school-going adolescents in four sub-Saharan African sites. MATERNAL & CHILD NUTRITION 2024:e13583. [PMID: 39094055 DOI: 10.1111/mcn.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 08/04/2024]
Abstract
Characterizing the timing of menarche and the factors that are associated with it is important for understanding a population's reproductive health needs and long-term health trajectories. We estimated the age at the menstrual onset among adolescent girls and the association between dietary and nutritional factors and menarche in four sub-Saharan African urban sites. We used cross-sectional school-based data from 2307 female adolescents aged 10-14 years collected by the Africa Research, Implementation Science, and Education (ARISE) Network in Ouagadougou, Burkina Faso; Addis Ababa, Ethiopia; Khartoum, Sudan; and Dar es Salaam, Tanzania. Logit models were used to estimate the median age at menarche at each site. Associations between menarche and BMI-for-age, stunting, dietary quality and food insecurity across settings were assessed using Poisson regression models adjusted for country and school levels. The estimated median age at menarche was 13.1 years (95% confidence interval: 12.7, 13.5) in Ouagadougou; 12.9 (12.6, 13.2) in Addis Ababa; 13.3 (12.7, 13.6) in Khartoum; and 13.2 (12.3, 14.0) in Dar es Salaam. Between 18% and 49% of the girls in each setting had already menstruated. Based on the pooled multivariable models, underweight participants were 42% less likely (adjusted prevalence ratio [PR] 0.58 [0.44, 0.77]) to have experienced menarche in comparison to normal-weight individuals. The likelihood of experiencing menarche increased for overweight [PR 1.47 (1.30,1.66)] and obese [PR 1.57 (1.35,1.82)] in comparison to normal-weight girls. Those stunted were 47% less likely to have experienced menarche [PR 0.53 (0.41, 0.69)] than their nonstunted counterparts. A lower likelihood of menarche among those experiencing moderate/severe hunger when compared to those with no/little hunger was also observed (PR 0.78 [0.63,0.96]). No evidence of association with dietary quality was found. Further research is needed to strengthen the body of evidence and inform evidence-based initiatives in low- and middle-income settings.
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Affiliation(s)
- Janaína Calu Costa
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Sachin Shinde
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Amare W Tadesse
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Huda Sherfi
- School of Health Sciences, Ahfad University for Women, Omdurman, Sudan
| | | | | | | | - Till Baernighausen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Africa Health Research Institute, Durban, South Africa
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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2
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Randall KN, Hopkins CS, Drew H. Menstrual education programs for girls and young women with intellectual and developmental disabilities: A systematic review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13264. [PMID: 38863161 DOI: 10.1111/jar.13264] [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: 08/18/2023] [Revised: 04/23/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Providing menstrual education and guidance for menstrual management for girls and young women with intellectual disabilities is recommended to ensure smooth pubertal transitions and to support menstrual self-agency. METHOD The purpose of this systematic review is to explore menstrual education interventions for girls and young women with intellectual disabilities. RESULTS Nine studies were included. Interventions were provided in small groups (n = 4) and individually (n = 5). Most studies used dolls (n = 7) and task analysis (n = 7) to teach pad-replacement skills. All reported significant improvements in participant skills and/or knowledge following the intervention. Only one study addressed self-agency and self-esteem as an outcome of the intervention. Menstrual education for girls and young women with intellectual disabilities is largely focused on pad-replacement skills. CONCLUSION Further research is needed to understand the impact of menstrual health and hygiene education on variables apart from skill improvement such as self-agency and long-term health outcomes related to menstrual health.
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Affiliation(s)
- Kristina N Randall
- Department of Special Education, Clemson University, Clemson, South Carolina, USA
| | - Casey S Hopkins
- School of Nursing, Clemson University, Clemson, South Carolina, USA
| | - Hannah Drew
- Department of Literacy, Language, and Culture, Clemson University, Clemson, South Carolina, USA
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3
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Rodríguez-Camacho MF, Sanchís-Ramón MJ, Ortiz-Barreda G, La Parra-Casado D, Gil-González D. Menarche and reproductive health in Spanish Roma women from a reproductive justice perspective: a qualitative study. Reprod Health 2024; 21:17. [PMID: 38308316 PMCID: PMC10837920 DOI: 10.1186/s12978-023-01726-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 12/13/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES This study aimed to explore the perceptions of Roma women about their experience of menarche and reproductive health considering the principles of reproductive justice. DESIGN Qualitative study based on semi-structured interviews with Roma women ages 18 through 67 in different neighborhoods in the southeast of Spain. Using a thematic analysis, we analyzed experiences related to menarche and menstruation and their significance for reproductive health, the preparation for the phase of menarche and intergenerational support. RESULTS The Roma women interviewed shared their approach to the experiences of menarche and menstruation as children in their family environments with a focus on access to information provided by other women in the family and community for reproductive health management. In their discourses we observed that the onset of menstruation supposes a rupture in the public and private spaces of girls and women. CONCLUSIONS The results of this study suggest that women and girls do not gain access to information that contributes to their reproductive wellbeing through their experience of menarche. Access to resources and skills to manage biological changes in adolescents could contribute to reducing the impact of cultural myths, false ideas and taboos that prevent advocacy and empowerment on issues of reproductive justice.
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Affiliation(s)
- María Félix Rodríguez-Camacho
- Autonomous Federation of Roma Associations of Alicante, FAGA, Alicante, Spain.
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain.
| | | | - Gaby Ortiz-Barreda
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | | | - Diana Gil-González
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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4
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Dziva Chikwari C, Dauya E, Bandason T, Tembo M, Mavodza C, Simms V, Mackworth-Young CRS, Apollo T, Grundy C, Weiss H, Kranzer K, Mavimba T, Indravudh P, Doyle A, Mugurungi O, Machiha A, Bernays S, Busza J, Madzima B, Terris-Prestholt F, McCarthy O, Hayes R, Francis S, Ferrand RA. The impact of community-based integrated HIV and sexual and reproductive health services for youth on population-level HIV viral load and sexually transmitted infections in Zimbabwe: protocol for the CHIEDZA cluster-randomised trial. Wellcome Open Res 2023; 7:54. [PMID: 38162283 PMCID: PMC10755263 DOI: 10.12688/wellcomeopenres.17530.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 03/29/2024] Open
Abstract
BACKGROUND Youth have poorer HIV-related outcomes when compared to other age-groups. We describe the protocol for a cluster randomised trial (CRT) to evaluate the effectiveness of community-based, integrated HIV and sexual and reproductive health services for youth on HIV outcomes. PROTOCOL The CHIEDZA trial is being conducted in three provinces in Zimbabwe, each with eight geographically demarcated areas (clusters) (total 24 clusters) randomised 1:1 to standard of care (existing health services) or to the intervention. The intervention comprises community-based delivery of HIV services including testing, antiretroviral therapy, treatment monitoring and adherence support as well as family planning, syndromic management of sexually transmitted infections (STIs), menstrual health management, condoms and HIV prevention and general health counselling. Youth aged 16-24 years living within intervention clusters are eligible to access CHIEDZA services. A CRT of STI screening (chlamydia, gonorrhoea and trichomoniasis) is nested in two provinces (16 of 24 clusters). The intervention is delivered over a 30-month period by a multidisciplinary team trained and configured to provide high-quality, youth friendly services.Outcomes will be ascertained through a population-based survey of 18-24-year-olds. The primary outcome is HIV viral load <1000 copies/ml in those living with HIV and proportion who test positive for STIs (for the nested trial). A detailed process and cost evaluation of the trial will be conducted. ETHICS AND DISSEMINATION The trial protocol was approved by the Medical Research Council of Zimbabwe, the Biomedical Research and Training Institute Institutional Review Board and the London School of Hygiene & Tropical Medicine Research Ethics Committee. Results will be submitted to open-access peer-reviewed journals, presented at academic meetings and shared with participating communities and with national and international policy-making bodies. TRIAL REGISTRATION https://clinicaltrials.gov/: NCT03719521.
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Affiliation(s)
- Chido Dziva Chikwari
- 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
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Mandikudza Tembo
- 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
| | - Constancia Mavodza
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Victoria Simms
- 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
| | | | - Tsitsi Apollo
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Chris Grundy
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Weiss
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Katharina Kranzer
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | | | - Pitchaya Indravudh
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Aoife Doyle
- 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
| | - Owen Mugurungi
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Anna Machiha
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Sarah Bernays
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of Sydney, Sydney, Australia
| | - Joanna Busza
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Fern Terris-Prestholt
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ona McCarthy
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Hayes
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzanna Francis
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rashida A. Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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5
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Dziva Chikwari C, Dauya E, Bandason T, Tembo M, Mavodza C, Simms V, Mackworth-Young CRS, Apollo T, Grundy C, Weiss H, Kranzer K, Mavimba T, Indravudh P, Doyle A, Mugurungi O, Machiha A, Bernays S, Busza J, Madzima B, Terris-Prestholt F, McCarthy O, Hayes R, Francis S, Ferrand RA. The impact of community-based integrated HIV and sexual and reproductive health services for youth on population-level HIV viral load and sexually transmitted infections in Zimbabwe: protocol for the CHIEDZA cluster-randomised trial. Wellcome Open Res 2023; 7:54. [PMID: 38162283 PMCID: PMC10755263 DOI: 10.12688/wellcomeopenres.17530.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/03/2024] Open
Abstract
Background Youth have poorer HIV-related outcomes when compared to other age-groups. We describe the protocol for a cluster randomised trial (CRT) to evaluate the effectiveness of community-based, integrated HIV and sexual and reproductive health services for youth on HIV outcomes. Protocol The CHIEDZA trial is being conducted in three provinces in Zimbabwe, each with eight geographically demarcated areas (clusters) (total 24 clusters) randomised 1:1 to standard of care (existing health services) or to the intervention. The intervention comprises community-based delivery of HIV services including testing, antiretroviral therapy, treatment monitoring and adherence support as well as family planning, syndromic management of sexually transmitted infections (STIs), menstrual health management, condoms and HIV prevention and general health counselling. Youth aged 16-24 years living within intervention clusters are eligible to access CHIEDZA services. A CRT of STI screening (chlamydia, gonorrhoea and trichomoniasis) is nested in two provinces (16 of 24 clusters). The intervention is delivered over a 30-month period by a multidisciplinary team trained and configured to provide high-quality, youth friendly services.Outcomes will be ascertained through a population-based survey of 18-24-year-olds. The primary outcome is HIV viral load <1000 copies/ml in those living with HIV and proportion who test positive for STIs (for the nested trial). A detailed process and cost evaluation of the trial will be conducted. Ethics and Dissemination The trial protocol was approved by the Medical Research Council of Zimbabwe, the Biomedical Research and Training Institute Institutional Review Board and the London School of Hygiene & Tropical Medicine Research Ethics Committee. Results will be submitted to open-access peer-reviewed journals, presented at academic meetings and shared with participating communities and with national and international policy-making bodies. Trial Registration https://clinicaltrials.gov/: NCT03719521.
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Affiliation(s)
- Chido Dziva Chikwari
- 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
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Mandikudza Tembo
- 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
| | - Constancia Mavodza
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Victoria Simms
- 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
| | | | - Tsitsi Apollo
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Chris Grundy
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Weiss
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Katharina Kranzer
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | | | - Pitchaya Indravudh
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Aoife Doyle
- 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
| | - Owen Mugurungi
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Anna Machiha
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Sarah Bernays
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of Sydney, Sydney, Australia
| | - Joanna Busza
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Fern Terris-Prestholt
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ona McCarthy
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Hayes
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzanna Francis
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rashida A. Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Neisani Samani L, Khanjari S, Mirmohammadi F, Maadi Esfahan M, Haghani S, Tehrani FJ. The impact of mothers and daughters health education on female adolescents' quality of life during the COVID-19 pandemic. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2023; 36:316-326. [PMID: 37434537 DOI: 10.1111/jcap.12434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 06/19/2023] [Accepted: 07/02/2023] [Indexed: 07/13/2023]
Abstract
PROBLEM Adolescence is a period of biological, cognitive, psychosocial, and emotional development. Negative experiences of Coronavirus (COVID-19) infection are associated with more changes which impacts on quality of life (QoL). However, parent-proxy and child self-reports may vary, and we have lack of knowledge about these discrepancies. The aim of this study was to identifying the impact of mother-daughter health education on female adolescents' QoL during the COVID-19 pandemic. METHODS This quasi-experimental study was conducted at two time points; before (T1) and 3 months after health education thorough blended learning (T2) from January to May of 2020. Then 196 participants were divided into intervention (N = 96) and control (N = 100) groups and Health Related QoL was assessed using the PedsQL™. RESULTS The results showed significant increase in scores of total QoL and all QoL domains in adolescents by self-reports of adolescents and mothers proxy reports (except emotional performance) compared to the control group at T2 (p < 0.05). Furthermore, mother's rated increase in social performance significantly higher in both groups at T2. CONCLUSIONS With high social anxiety due to COVID-19, adolescents may be vulnerable to various risks. Improving mothers understanding of the needs of their adolescents are an important issue; given that it is possible increase their QoL by health education, especially during COVID-19 pandemic. It is recommended to organized health education in schools to increase the knowledge of mother-daughter thorough blended learning.
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Affiliation(s)
- Leila Neisani Samani
- School of Nursing and Midwifery, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Khanjari
- School of Nursing and Midwifery, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mirmohammadi
- School of Nursing and Midwifery, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Shima Haghani
- School of Nursing and Midwifery, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Javaheri Tehrani
- School of Nursing and Midwifery, Community Health Nursing, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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7
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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. GLOBAL HEALTH, SCIENCE AND PRACTICE 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] [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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8
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Xie L, Ge T, Xiao B, Han X, Zhang Q, Xu Z, He D, Tian W. Identification of Adolescent Menarche Status Using Biplanar X-ray Images: A Deep Learning-Based Method. Bioengineering (Basel) 2023; 10:769. [PMID: 37508796 PMCID: PMC10375958 DOI: 10.3390/bioengineering10070769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
The purpose of this study is to develop an automated method for identifying the menarche status of adolescents based on EOS radiographs. We designed a deep-learning-based algorithm that contains a region of interest detection network and a classification network. The algorithm was trained and tested on a retrospective dataset of 738 adolescent EOS cases using a five-fold cross-validation strategy and was subsequently tested on a clinical validation set of 259 adolescent EOS cases. On the clinical validation set, our algorithm achieved accuracy of 0.942, macro precision of 0.933, macro recall of 0.938, and a macro F1-score of 0.935. The algorithm showed almost perfect performance in distinguishing between males and females, with the main classification errors found in females aged 12 to 14 years. Specifically for females, the algorithm had accuracy of 0.910, sensitivity of 0.943, and specificity of 0.855 in estimating menarche status, with an area under the curve of 0.959. The kappa value of the algorithm, in comparison to the actual situation, was 0.806, indicating strong agreement between the algorithm and the real-world scenario. This method can efficiently analyze EOS radiographs and identify the menarche status of adolescents. It is expected to become a routine clinical tool and provide references for doctors' decisions under specific clinical conditions.
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Affiliation(s)
- Linzhen Xie
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing 100035, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing 100035, China
| | - Tenghui Ge
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing 100035, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing 100035, China
| | - Bin Xiao
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing 100035, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing 100035, China
| | - Xiaoguang Han
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing 100035, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing 100035, China
| | - Qi Zhang
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing 100035, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing 100035, China
| | - Zhongning Xu
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing 100035, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing 100035, China
| | - Da He
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing 100035, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing 100035, China
| | - Wei Tian
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing 100035, China
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing 100035, China
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9
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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] [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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Teizazu H, Gruer C, Mandara E, Sommer M. Exploring a faith-based approach to puberty education in Tanzania. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1024550. [PMID: 36844258 PMCID: PMC9950263 DOI: 10.3389/frph.2023.1024550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/17/2023] [Indexed: 02/12/2023] Open
Abstract
Background Many adolescents in Tanzania do not receive timely and comprehensive puberty education. This study explored faith-based organizations a site for puberty education. Two puberty books, each developed through participatory research with Tanzanian adolescents and stakeholders, were promoted to 177 Christian denomination churches in Dar es Salaam, Tanzania to understand the factors that faith leaders considered in their decision to purchase puberty books, or share information about the intervention to their peers and congregants. Methods Data collection included routine monitoring via weekly reports and ethnographic observation. Data were analyzed using the Ecological Framework for Health Promotion to capture how individual, interpersonal, and institutional factors influenced leaders' decisions to purchase or promote puberty books. Results At the individual level, leaders cited their personal experiences in their support for the intervention, but leaders' time and confidence in their ability to effectively promote books to others were barriers to participation. Interpersonally, the diffusion of information between church leaders, particularly when information came from well-known or respected leaders, emerged as an important factor in leaders' willingness to promote books. At the institutional level, leaders' decisions were impacted by resources, institutional culture, and institutional hierarchy. Importantly, twelve churches in the sample purchased books. Limited financial resources and the need to receive approval from denominational leaders were discussed by leaders as barriers to purchasing books. Conclusions Despite research showing high religiosity in Tanzania, the role of religious institutions in providing puberty education has remained unexplored. Our results inform future research and practice by providing an articulation of the socioecological factors that played a role in faith leaders' decisions related to puberty education interventions in Tanzania.
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Affiliation(s)
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Elisia Mandara
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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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] [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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Ghandour R, Hammoudeh W, Giacaman R, Holmboe-Ottesen G, Fjeld HE. Coming of age: a qualitative study of adolescent girls’ menstrual preparedness in Palestinian refugee camps in the West Bank and Jordan. Sex Reprod Health Matters 2022; 30:2111793. [PMID: 36129456 PMCID: PMC9518256 DOI: 10.1080/26410397.2022.2111793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Menstrual health is important for adolescent girls and is particularly compromised in displaced communities due to restricted access to information and lack of private spaces to manage menstruation. Menarche is the biological and social milestone of girls’ adolescence, marking the onset of puberty and confirming womanhood in many communities. It also marks a difficult transitional period influenced by socio-cultural beliefs and expectations. Menstrual preparedness is critical for this transition, and the lack of accurate, timely, age-appropriate information might impact current, and future reproductive health and well-being. This paper investigates the menstrual preparedness status of adolescents living in Palestinian refugee camps in the West Bank and Jordan. These are long-term refugee camps characterised by a variety of social, economic, and political constraints affecting the health of women and girls. We conducted 39 in-depth interviews and 23 focus-group discussions with adolescent girls. The study reveals inadequate menstrual preparedness among the participants, especially in pre-menarche. Among the barriers to adequate menstrual preparedness is a predominance of practical concerns, such as the use of sanitary pads and hygienic practices, socio-cultural norms that promote secrecy and taboo around menstruation, and divergent notions of timeliness of information among girls, their mothers, and teachers. The study contends that addressing the taboo around menstruation requires joint efforts by the family, school, and social services. Menstrual preparedness should begin early and encompass biological, practical, emotional, and psychological components. The paper advocates for Comprehensive, Contextually Relevant, Timely Menstrual Preparedness (CCTMP) policies and initiatives, empowering adolescent girls, their mothers, and educators.
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Affiliation(s)
- Rula Ghandour
- Academic Researcher, Institute of Community and Public Health, Birzeit University, Said Khoury Building for Development Studies, P.O.Box 14, Birzeit, occupied Palestinian territory (oPt)
- PhD candidate, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Blindern, PB 1130, 0318 Oslo, Norway
| | - Weeam Hammoudeh
- Assistant Professor, Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory (oPt)
| | - Rita Giacaman
- Professor, Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory (oPt)
| | - Gerd Holmboe-Ottesen
- Professor, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Norway
| | - Heidi E. Fjeld
- Associate Professor, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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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] [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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14
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Hennegan J, Bukenya JN, Kibira SPS, Nakamya P, Makumbi FE, Exum NG, Schwab KJ. Revalidation and adaptation of the Menstrual Practice Needs Scale (MPNS) in a cross-sectional survey to measure the menstrual experiences of adult women working in Mukono District, Uganda. BMJ Open 2022; 12:e057662. [PMID: 35777879 PMCID: PMC9252208 DOI: 10.1136/bmjopen-2021-057662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The Menstrual Practice Needs Scale (MPNS) is a comprehensive measure of menstrual self-care experience including access to sufficient, comfortable materials to catch or absorb bleeding, supportive spaces for managing menstruation and for disposal and laundering of used materials. It addresses a critical measurement gap to improve quantitative menstrual health research and programme evaluation. The scale was validated in a population of adolescent schoolgirls. This study appraises its performance among adult women. DESIGN Cross-sectional survey. SETTING AND PARTICIPANTS Seven cognitive interviews provided insights into the interpretability of scale items. A survey of 525 working women who had menstruated in the past 6 months (435 working in markets, 45 in schools and 45 working in healthcare facilities) in Mukono District, Uganda was used to test the dimensionality, reliability and validity of the measure. RESULTS The 36 scale items were well understood by the study population. Dimensionality was tested for the 28 items relevant to women disposing of menstrual materials and 32 items relevant to those washing and reusing materials. The original subscale structure fit with the data, however, fell short of recommended thresholds for those disposing of materials (root mean squared error of approximation, RMSEA=0.069; Comparative Fit Index, CFI=0.840; Trucker-Lewis Index, TLI=0.824). An alternative subscale structure was an acceptable fit for those disposing (RMSEA=0.051; CFI=0.911; TLI=0.897) and reusing materials (RMSEA=0.053; CFI=0.915; TLI=0.904). MPNS total and subscale scores demonstrated acceptable internal consistency. Higher scores reflected more positive menstrual experiences and were associated with well-being (total score r=0.24, p<0.001), not missing work due to the last menstrual period (total score OR=2.47 95% CI 1.42 to 4.30) and confidence to manage menstruation. CONCLUSIONS The MPNS offers a valid and reliable way to assess menstrual health needs. The revised factor structure can be used for samples of adult workers. Findings also highlight challenges in assessing the variety of experiences relevant to managing menstrual bleeding.
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Affiliation(s)
- Julie Hennegan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Justine N Bukenya
- Department of Community Health and Behavioural Sciences, Makerere University, Kampala, Central, Uganda
| | - Simon P S Kibira
- Department of Community Health and Behavioural Sciences, Makerere University, Kampala, Central, Uganda
| | - Petranilla Nakamya
- Department of Community Health and Behavioural Sciences, Makerere University, Kampala, Central, Uganda
| | - Fredrick E Makumbi
- Epidemiology & Biostatistics, Makerere University, Kampala, Kampala, Uganda
| | - Natalie G Exum
- Environmental Health and Engineering, Johns Hopkins University,Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kellogg J Schwab
- Environmental Health and Engineering, Johns Hopkins University,Bloomberg School of Public Health, Baltimore, Maryland, USA
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15
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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. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL 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] [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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16
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Huseth-Zosel AL, Secor-Turner M. Teacher Perceptions of and Experiences with Student Menstruation in the School Setting. THE JOURNAL OF SCHOOL 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] [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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Austrian K, Kangwana B, Muthengi E, Soler-Hampejsek E. Effects of sanitary pad distribution and reproductive health education on upper primary school attendance and reproductive health knowledge and attitudes in Kenya: a cluster randomized controlled trial. Reprod Health 2021; 18:179. [PMID: 34465344 PMCID: PMC8406733 DOI: 10.1186/s12978-021-01223-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent girls' risk of school dropout and reproductive health (RH) challenges may be exacerbated by girls' attitudes toward their bodies and inability to manage their menstruation. We assessed effects of sanitary pad distribution and RH education on girls in primary grade 7 in Kilifi, Kenya. METHODS A cluster randomized controlled trial design was used. Eligible clusters were all non-boarding schools in three sub-counties in Kilifi County that had a minimum of 25 girls enrolled in primary grade 7. 140 primary schools, 35 per arm, were randomly assigned to one of four study arms: (1) control; (2) sanitary pad distribution; (3) RH education; or (4) both sanitary pad distribution and RH education. Outcomes were school attendance, school engagement, RH knowledge and attitudes, gender norms, and self-efficacy. For outcomes measured both at baseline and endline, difference-in-differences (DID) models were estimated and for outcomes without baseline data available, analysis of covariance models were used. RESULTS The study enrolled 3489 randomly selected girls in primary grade 7, with a mean age of 14.4 (SD 1.5). Girls in arms 2 and 4 received on average 17.6 out of 20 packets of sanitary pads and girls in arms 3 and 4 participated on average in 21 out of 25 RH sessions. Ninety-four percent of the baseline sample was interviewed at the end of the intervention with no differential attrition by arm. There was no evidence of an effect on primary school attendance on arm 2 (coefficient [coef] 0.37, 95% CI - 0.73, 1.46), arm 3 (coef 0.14, 95% CI - 0.99, 1.26) or arm 4 (coef 0.58, 95% CI - .37, 1.52). There was increased positive RH attitudes for girls in arm 3 (DID coef. 0.63, 95% CI 0.40-0.86) and arm 4 (DID coef. 0.85, 95% CI 0.64, - 1.07). There was also an increase in RH knowledge, gender norms and self-efficacy in arms 3 and 4. CONCLUSIONS The findings suggest that neither sanitary pad distribution nor RH education, on their own or together, were sufficient to improve primary school attendance. However, as the RH education intervention improved RH outcomes, the evidence suggests that sanitary pad distribution and RH education can be positioned in broader RH programming for girls. TRIAL REGISTRATION ISRCTN, ISRCTN10894523. Registered 22 August 2017-Retrospectively registered, http://www.isrctn.com/ISRCTN10894523.
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Affiliation(s)
- Karen Austrian
- Poverty, Gender and Youth Program, Population Council-Kenya, PO Box 17643-00500, Nairobi, Kenya.
| | - Beth Kangwana
- Poverty, Gender and Youth Program, Population Council-Kenya, PO Box 17643-00500, Nairobi, Kenya
| | - Eunice Muthengi
- Poverty, Gender and Youth Program, Population Council-Kenya, PO Box 17643-00500, Nairobi, Kenya
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Casola AR, Kunes B, Jefferson K, Riley AH. Menstrual Health Stigma in the United States: Communication Complexities and Implications for Theory and Practice. J Midwifery Womens Health 2021; 66:725-728. [PMID: 33619886 DOI: 10.1111/jmwh.13216] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/29/2020] [Accepted: 01/11/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Allison R Casola
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Brianna Kunes
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karen Jefferson
- Midwifery and Women's Health Programs, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Amy Henderson Riley
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania
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Wilson LC, Rademacher KH, Rosenbaum J, Callahan RL, Nanda G, Fry S, Mackenzie ACL. Seeking synergies: understanding the evidence that links menstrual health and sexual and reproductive health and rights. Sex Reprod Health Matters 2021; 29:1882791. [PMID: 33599162 PMCID: PMC8009024 DOI: 10.1080/26410397.2021.1882791] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Global efforts to improve menstrual health and sexual and reproductive health and rights (SRHR) are fundamentally intertwined and share similar goals for improving health and well-being and increasing gender equality. Historically, however, the two fields have operated independently and missed opportunities to build upon their biological and sociocultural linkages. Biological touchpoints connecting the two fields include genital tract infections, menstrual disorders, contraception, and menopause. From a sociocultural perspective, intersections occur in relation to the experience of puberty and menarche, gender norms and equity, education, gender-based violence, and transactional sex. We describe evidence linking menstrual health and SRHR and offer recommendations for integration that could strengthen the impact of both fields.
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Affiliation(s)
- Lucy C Wilson
- Independent Consultant, Rising Outcomes, Hillsborough, NC, USA. Correspondence:
| | - Kate H Rademacher
- Senior Technical Advisor, Product Development & Introduction, FHI 360, Durham, NC, USA
| | - Julia Rosenbaum
- Senior WASH Behavior Change and Integration Specialist, FHI 360, Washington, DC, USA
| | - Rebecca L Callahan
- Associate Director, Product Development & Introduction, FHI 360, Durham, NC, USA
| | - Geeta Nanda
- Scientist, Maternal and Child Health, FHI 360, Washington, DC, USA
| | - Sarah Fry
- Senior Hygiene and School WASH Advisor, USAID WASHplus Project, FHI 360, Washington, DC, USA
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Sommer M, Torondel B, Hennegan J, Phillips-Howard PA, Mahon T, Motivans A, Zulaika G, Gruer C, Haver J, Caruso BA. How addressing menstrual health and hygiene may enable progress across the Sustainable Development Goals. Glob Health Action 2021; 14:1920315. [PMID: 34190034 PMCID: PMC8253211 DOI: 10.1080/16549716.2021.1920315] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/19/2021] [Indexed: 11/16/2022] Open
Abstract
There is increasing global attention to the importance of menstrual health and hygiene (MHH) for the lives of those who menstruate and gender equality. Yet, the global development community, which focuses on issues ranging from gender to climate change to health, is overdue to draw attention to how addressing MHH may enable progress in attaining the Sustainable Development Goals (SDGs). To address this gap, we undertook a collective exercise to hypothesize the linkages between MHH and the 17 SDGs, and to identify how MHH contributes to priority outcome measures within key sectoral areas of relevance to menstruating girls in low- and middle-income countries. These areas included Education, Gender, Health (Sexual and Reproductive Health; Psychosocial Wellbeing), and Water, Sanitation and Hygiene (WASH). These efforts were undertaken from February - March 2019 by global monitoring experts, together with select representatives from research institutions, non-governmental organizations, and governments (n = 26 measures task force members). Through this paper we highlight the findings of our activities. First, we outline the existing or potential linkages between MHH and all of the SDGs. Second, we report the identified priority outcomes related to MHH for key sectors to monitor. By identifying the potential contribution of MHH towards achieving the SDGs and highlighting the ways in which MHH can be monitored within these goals, we aim to advance recognition of the fundamental role of MHH in the development efforts of countries around the world.
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Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Belen Torondel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Julie Hennegan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | | | | | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | | | - Bethany A. Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
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21
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McCammon E, Bansal S, Hebert LE, Yan S, Menendez A, Gilliam M. Exploring young women's menstruation-related challenges in Uttar Pradesh, India, using the socio-ecological framework. Sex Reprod Health Matters 2020; 28:1749342. [PMID: 32308152 PMCID: PMC7175471 DOI: 10.1080/26410397.2020.1749342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Menstruation frequently poses psychological, social, and health challenges for young women living in low- and middle-income countries. In countries such as India, where menstruation is stigmatised, it can be particularly difficult. This paper examines challenges related to menstruation for young women living in slums in Lucknow, Uttar Pradesh, India. The research was informed by the socio-ecological model. Life course interviews were conducted with 70 young women ages 15-24 living in the slums of Lucknow. Thematic analysis was used to identify salient themes regarding individual, social, and systemic challenges related to menstruation. On the individual level, young women lack knowledge about menstruation. In the social sphere, young women experience stigma around menstruation, lack opportunities to discuss menstruation, and experience limitations around mobility and other activities during menstruation. At the institutional level, for example in school, there are few resources to support menstruating young women as toilets are dirty and doors are broken. Therefore, menstruating adolescents and young women in Lucknow, Uttar Pradesh, India, face an array of challenges at multiple levels. These findings suggest that multi-level interventions are warranted to create a supportive context for menstruation.
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Affiliation(s)
- Ellen McCammon
- Research Specialist, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health at the University of Chicago, Chicago, IL, USA
| | - Suchi Bansal
- Research Specialist, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health at the University of Chicago, Chicago, IL, USA
| | - Luciana E. Hebert
- Research Specialist, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health at the University of Chicago, Chicago, IL, USA
| | - Shirley Yan
- Research Specialist, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health at the University of Chicago, Chicago, IL, USA
| | - Alicia Menendez
- Research Associate, Harris School of Public Policy, University of Chicago, Chicago, IL, USA
| | - Melissa Gilliam
- Ellen H. Block Professor of Health Justice, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health at the University of Chicago, Chicago, IL, USA
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22
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Leone T, Brown LJ. Timing and determinants of age at menarche in low-income and middle-income countries. BMJ Glob Health 2020; 5:e003689. [PMID: 33298469 PMCID: PMC7733094 DOI: 10.1136/bmjgh-2020-003689] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Understanding the timing and determinants of age at menarche is key to determining potential linkages between onset of puberty and health outcomes from a life-course perspective. Yet, we have little information in low-income and middle-income countries (LMICs) mainly due to lack of data. The aim of this study was to analyse trends in the timing and the determinants of menarche in LMICs. METHODS Using 16 World Fertility Survey and 28 Demographic and Health Surveys (DHS) from 27 countries, we analysed cohort trends and used fixed-effects models for DHS surveys to investigate sociodemographic and regional effects in the timing of age at menarche. RESULTS Trends of the mean age at menarche across time within and between countries show a declining or stalling path. Results of the determinant modelling show the relationship with wealth changes over time although not consistently across countries. We see a shift from poorer women having earlier menarche in earlier surveys to richer women having earlier menarche in later surveys in Indonesia, the Philippines and Yemen, while in Egypt, the reverse pattern is evident. CONCLUSIONS There is a considerable gap in both literature and data on menarche. We see a trend which is declining rapidly (from 14.66 to 12.86 years for the 1932 and 2002 cohorts, respectively), possibly at a faster pace than high-income countries and with a strong link to socioeconomic status. This study calls for menarche questions to be included in more nationally representative surveys and greater use of existing data because of its impact on life-course health in fast-ageing settings. Further studies will need to investigate further the use of the age at menarche as an indicator of global health.
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Affiliation(s)
- Tiziana Leone
- International Development, London School of Economics and Political Science, London, UK
| | - Laura J Brown
- International Development, London School of Economics and Political Science, London, UK
- Institute for Global Health, University College London, London, UK
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23
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Secor-Turner M, Huseth-Zosel A, Ostlund R. Menstruation Experiences of Middle and High School Students in the Midwest: A Pilot Study. J Sch Nurs 2020; 38:504-510. [PMID: 33207994 DOI: 10.1177/1059840520974234] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this pilot study was to expand understanding of the experience of menstruation for girls in the United States and its impact in the school setting. A qualitative approach was used to gather data from focus group interviews. Descriptive content analysis was used to categorize the range and types of menstruation experiences described by 12 participants aged 12-16 years. Findings revealed four main themes: (1) learning about menstruation, (2) experiencing menstruation, (3) managing menstruation, and (4) social norms and meaning of menstruation. Participants described multiple challenges faced learning about and experiencing menstruation, especially in the school setting. Participants described the limited understanding of menstruation experiences and confusion about the use of menstrual hygiene products. Challenges experienced at school included not having adequate access to menstrual hygiene products, limited time for changing products, fear of leaking menstrual blood, and impacts on school attendance. School nurses are well-positioned to contribute to creating school environments that are supportive of menstruation.
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Affiliation(s)
| | | | - Rachel Ostlund
- School of Nursing, North Dakota State University, Fargo, ND, USA
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24
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Critchley HOD, Babayev E, Bulun SE, Clark S, Garcia-Grau I, Gregersen PK, Kilcoyne A, Kim JYJ, Lavender M, Marsh EE, Matteson KA, Maybin JA, Metz CN, Moreno I, Silk K, Sommer M, Simon C, Tariyal R, Taylor HS, Wagner GP, Griffith LG. Menstruation: science and society. Am J Obstet Gynecol 2020; 223:624-664. [PMID: 32707266 PMCID: PMC7661839 DOI: 10.1016/j.ajog.2020.06.004] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/13/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022]
Abstract
Women's health concerns are generally underrepresented in basic and translational research, but reproductive health in particular has been hampered by a lack of understanding of basic uterine and menstrual physiology. Menstrual health is an integral part of overall health because between menarche and menopause, most women menstruate. Yet for tens of millions of women around the world, menstruation regularly and often catastrophically disrupts their physical, mental, and social well-being. Enhancing our understanding of the underlying phenomena involved in menstruation, abnormal uterine bleeding, and other menstruation-related disorders will move us closer to the goal of personalized care. Furthermore, a deeper mechanistic understanding of menstruation-a fast, scarless healing process in healthy individuals-will likely yield insights into a myriad of other diseases involving regulation of vascular function locally and systemically. We also recognize that many women now delay pregnancy and that there is an increasing desire for fertility and uterine preservation. In September 2018, the Gynecologic Health and Disease Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development convened a 2-day meeting, "Menstruation: Science and Society" with an aim to "identify gaps and opportunities in menstruation science and to raise awareness of the need for more research in this field." Experts in fields ranging from the evolutionary role of menstruation to basic endometrial biology (including omic analysis of the endometrium, stem cells and tissue engineering of the endometrium, endometrial microbiome, and abnormal uterine bleeding and fibroids) and translational medicine (imaging and sampling modalities, patient-focused analysis of menstrual disorders including abnormal uterine bleeding, smart technologies or applications and mobile health platforms) to societal challenges in health literacy and dissemination frameworks across different economic and cultural landscapes shared current state-of-the-art and future vision, incorporating the patient voice at the launch of the meeting. Here, we provide an enhanced meeting report with extensive up-to-date (as of submission) context, capturing the spectrum from how the basic processes of menstruation commence in response to progesterone withdrawal, through the role of tissue-resident and circulating stem and progenitor cells in monthly regeneration-and current gaps in knowledge on how dysregulation leads to abnormal uterine bleeding and other menstruation-related disorders such as adenomyosis, endometriosis, and fibroids-to the clinical challenges in diagnostics, treatment, and patient and societal education. We conclude with an overview of how the global agenda concerning menstruation, and specifically menstrual health and hygiene, are gaining momentum, ranging from increasing investment in addressing menstruation-related barriers facing girls in schools in low- to middle-income countries to the more recent "menstrual equity" and "period poverty" movements spreading across high-income countries.
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Affiliation(s)
- Hilary O D Critchley
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, United Kingdom.
| | - Elnur Babayev
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Serdar E Bulun
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Iolanda Garcia-Grau
- Igenomix Foundation-Instituto de Investigación Sanitaria Hospital Clínico, INCLIVA, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, School of Medicine, University of Valencia, Valencia, Spain
| | - Peter K Gregersen
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY
| | | | | | | | - Erica E Marsh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Kristen A Matteson
- Division of Research, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Jacqueline A Maybin
- Medical Research Council Centre for Reproductive Health, The University of Edinburgh, United Kingdom
| | - Christine N Metz
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY
| | - Inmaculada Moreno
- Igenomix Foundation-Instituto de Investigación Sanitaria Hospital Clínico, INCLIVA, Valencia, Spain
| | - Kami Silk
- Department of Communication, University of Delaware, Newark, DE
| | - Marni Sommer
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Carlos Simon
- Igenomix Foundation-Instituto de Investigación Sanitaria Hospital Clínico, INCLIVA, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, School of Medicine, University of Valencia, Valencia, Spain; Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | | | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Günter P Wagner
- Department of Ecology and Evolutionary Biology, Department of Obstetrics, Gynecology and Reproductive Sciences, Systems Biology Institute, Yale University, New Haven, CT; Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Linda G Griffith
- Center for Gynepathology Research, Massachusetts Institute of Technology, Cambridge, MA
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25
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Wall LL. Period Poverty in Public Schools: A Neglected Issue in Adolescent Health. J Adolesc Health 2020; 67:315-316. [PMID: 32829755 DOI: 10.1016/j.jadohealth.2020.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Affiliation(s)
- L Lewis Wall
- Departments of Obstetrics & Gynecology and Anthropology, Washington University in St. Louis, St. Louis, Missouri
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26
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Sommer M, Lee C, Liu D, Gruer C. The Extent to Which Menstruation-Related Issues Are Included in Graduate-Level Public Health Curricula. Front Public Health 2020; 8:442. [PMID: 32984243 PMCID: PMC7491256 DOI: 10.3389/fpubh.2020.00442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/17/2020] [Indexed: 12/01/2022] Open
Abstract
Objectives: Menstruation is increasingly recognized as an issue in domestic and global public health. Public health graduates of U.S. schools of public health must have adequate competencies to address menstruation and its implications for health and well-being in their future endeavors in research, practice and policy. This study sought to understand the extent to which U.S. schools currently integrate menstruation-related content (menstrual health, menstrual hygiene, etc.) and related competencies into their curricula. Methods: We reviewed the course directories of the top 20 US schools of public health as ranked in 2018. Courses were selected based on inclusion of menstruation and adolescent health-related search terms. Syllabi were subsequently obtained and analyzed for inclusion of specific menstruation-related terms. Syllabi including these terms were further analyzed to determine the level of inclusion of menstruation-related topics in relation to public health competencies, and the area of specialization. Results: Of an estimated 5,000 courses assessed, 28 included menstruation-related topics. Most frequently, this inclusion was minimal (e.g., a single reading or assignment), and was limited in scope. Content was typically found within global health, environmental health, and maternal and child health. Conclusions: Given growing attention to menstruation domestically and globally, and the limited current inclusion of this issue in US schools of public health curricula, graduates may not be receiving adequate training on a critically important topic of relevance within population health. Schools should consider reviewing their curricula to assess whether there are opportunities to integrate menstruation-related content in relation to the relevant public health competencies.
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Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Christina Lee
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Danting Liu
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
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27
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Sychareun V, Chaleunvong K, Essink DR, Phommavongsa P, Durham J. Menstruation practice among school and out-of-school adolescent girls, Lao PDR. Glob Health Action 2020; 13:1785170. [PMID: 32741349 PMCID: PMC7480650 DOI: 10.1080/16549716.2020.1785170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The transition from childhood to adolescence is a critical transitional period for girls, and as they experience these changes, having knowledge of, and being able to practice, good menstruation hygiene management is crucial. The objective of this study was to understand in and out of school adolescents' menstrual hygiene management practice, sources of information and attitudes towards menstruation. METHODS A cross sectional, descriptive study was conducted between November 2018 and May 2019. The sampling included adolescent girls aged 11-19 years in higher secondary schools in Khammouane and Champassak provinces and out-of-school adolescent girls. Out of the total number of 433 participants enrolled in the study, only 343 girls had reached menarche and were included in the study. Factors associated with menstruation hygiene management practice were examined with bivariate and multivariate analyses. RESULTS Out of 343 subjects who had reached menarche, 44% reported good menstrual hygiene management practice. Over half of the participants, however, were unable to access the tools of good menstruation hygiene management practice, including having somewhere to dispose of used sanitary pads in private. Being older (16-19 years) (AOR:2.4; 95%CI 1.4 to 3.9), and having primary education (AOR 0.4; 95%CI 0.2 to 0.9) were associated with good practice as was fathers' level of education (AOR 2.1; 95%CI 1.0 to 4.1) and mother-girl discussion about menstruation (AOR 2.2; 95%CI 1.0 to 5.0). No significant differences were found between in- and out-of-school adolescents. CONCLUSIONS In this study, not all participants were able to practice optimal menstruation hygiene management. This is important as good menstrual hygiene management is associated with better health and being able to participate fully in education and work. Further education is needed, but it is also important to ensure that all adolescent girls have access to the necessary tools for effective menstruation hygiene management.
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Affiliation(s)
- Vanphanom Sychareun
- Faculty of Public Health, University of Health Sciences , Vientiane, Lao PDR
| | - Kongmany Chaleunvong
- Institute of Research and Education Development, University of Health Sciences , Vientiane, Lao PDR
| | - Dirk R Essink
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit , Amsterdam, Netherlands
| | | | - Joanne Durham
- School of Public Health and Social Work, Queensland University of Technology , Brisbane, Australia
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28
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Ramaiya A, Sood S. What are the psychometric properties of a menstrual hygiene management scale: a community-based cross-sectional study. BMC Public Health 2020; 20:525. [PMID: 32306931 PMCID: PMC7168814 DOI: 10.1186/s12889-020-08627-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The last decade has highlighted how menstrual hygiene management (MHM) is a public health issue because of its link to health, education, social justice and human rights. However, measurement of MHM has not been validated across different studies. The objective of this manuscript was to test the psychometric properties of a MHM scale. METHODS An embedded mixed-method design was utilized. The girls (age 12-19) were from three districts of Uttar Pradesh (Mirzapur, Jaunpur and Sonebhadra), India. A total of 2212 girls participated in the structured questionnaire. Trained interviewers collected the data on tablets using computer assisted personal interviewing. A total of 36 FGDs were conducted among 309 girls between. Trained moderators collected the data. Factor analysis and thematic analysis was conducted to analyze and triangulate the data. RESULTS More than 90% of the girls were from a marginalized caste. Overall, 28% of the girls practiced all six MHM behaviors adequately. The factor analysis found five separate constructs corresponding to menstrual health and hygiene management (MHHM) with a variation of 84% and eigenvalue of 1.7. Preparation of clean absorbent, storage of clean absorbent, frequency of changing and disposal loaded separately, corresponding to menstrual health. Privacy to change and hygiene loaded together (eigenvalue 0.91 each), corresponding to hygiene management. An underlying theme from the FGD was menstruation as a taboo and lack of privacy for changing the absorbent. CONCLUSION MHM is multi-dimensional construct comprising of behaviors which were time-bound by menstruation (menstrual health) and behaviors not time-bound by menstruation (hygiene management). Based on these results, the author recommends that MHHM is used as an acronym in the future and proposes a revised definition for MHHM.
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Affiliation(s)
- Astha Ramaiya
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Suruchi Sood
- Department of Community Health and Prevention, Drexel University, Philadelphia, PA, USA
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29
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Crankshaw TL, Strauss M, Gumede B. Menstrual health management and schooling experience amongst female learners in Gauteng, South Africa: a mixed method study. Reprod Health 2020; 17:48. [PMID: 32293481 PMCID: PMC7158143 DOI: 10.1186/s12978-020-0896-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 03/09/2020] [Indexed: 02/05/2023] Open
Abstract
Background There has been increased attention to the menstrual health management (MHM) needs of girls and young women in Eastern and Southern Africa, relating to dignity, and to the potential link between the lack of access to sanitary products and school absenteeism. In the South Africa, there is inadequate evidence to guide appropriate national responses. This study explored the extent of access to modern sanitary products amongst female high school learners and the range of needs and challenges that they face in managing their menses in school settings in Gauteng, South Africa. Methods We collected mixed method data from 10 schools in Sedibeng district between June and August 2018. The qualitative component consisted of in-depth interviews with female learners (n = 30), educators (n = 8) and mothers of female learners (n = 9) and focus group discussions (FGDs) with male learners (n = 7) and female learners (n = 10). Five hundred and five female learners were recruited into the quantitative component consisting of a self-administered survey focussing on factors associated with access to sanitary products. Results The median age of survey participants was 17 years (interquartile range 16–18 years) and average age at menarche was 13.36 years. One in seven female learners reported not having enough sanitary products for every period in the last 3 months and this was reflected across the school quintiles. There was a complex interaction between menstrual-related challenges (physical discomfort, teasing, and feeling distracted in class) experienced by female learners, often amplified or compounded by factors in the school environment (unhygienic sanitation facilities and inadequate rest areas), and schooling participation and attendance. Girls who did not have enough products for every period in the last 3 months more likely reported missing school than those who reported sufficient products (46.27% vs 22.49% respectively, p < 0.001). However, there was no statistically significant difference between the groups in number of days missed. Conclusions Provision of sanitary products is important but only one component of a comprehensive MHM response. Ongoing attention over the link between product access and absenteeism risks overlooking complex systemic and structural factors which can negatively impact the sexual and reproductive health of learners in the school context, and more broadly.
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Affiliation(s)
- Tamaryn L Crankshaw
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa.
| | - Michael Strauss
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa
| | - Bongiwe Gumede
- Legal Resources Centre, P.O. Box 9495, Johannesburg, 2000, South Africa
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30
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Belay S, Kuhlmann AKS, Wall LL. Girls' attendance at school after a menstrual hygiene intervention in northern Ethiopia. Int J Gynaecol Obstet 2020; 149:287-291. [PMID: 32083719 DOI: 10.1002/ijgo.13127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/12/2019] [Accepted: 02/19/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the effect on school attendance of a menstrual hygiene intervention that distributes educational booklets to school children and menstrual hygiene kits to schoolgirls in northern Ethiopia. METHODS Attendance was tracked for 8839 students in grades 7-12 during the 2015-2016 academic year when the intervention was implemented. Negative binomial regression was used to test whether student sex predicted post-intervention school absences when controlling for grade-level and pre-intervention absences. Similar attendance data were analyzed for 3569 students in grades 7, 9, and 11 for the 2014-2015 academic year as a historical comparison. RESULTS Over 12 211 educational booklets were distributed to students and 5991 menstrual hygiene kits were distributed to schoolgirls. After the intervention, girls had 24% fewer school absences than boys. Sex was not a predictor of absences during a similar time-period in the prior school year. CONCLUSION This is one of the first large studies to show a positive relationship between a menstrual hygiene intervention and girls' school attendance. These positive results suggest such interventions should be expanded to other schools in northern Ethiopia. Future research should explore whether similar interventions can also decrease the rate at which girls drop out of school around menarche.
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Affiliation(s)
- Shewaye Belay
- Department of Microbiology and Parasitology, Institute of Biomedical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Anne K Sebert Kuhlmann
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - L Lewis Wall
- Department of Anthropology, College of Arts and Sciences, Washington University in St. Louis, St. Louis, MO, USA.,Department of Obstetrics & Gynecology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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31
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Canelón SP, Boland MR. A Systematic Literature Review of Factors Affecting the Timing of Menarche: The Potential for Climate Change to Impact Women's Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051703. [PMID: 32150950 PMCID: PMC7084472 DOI: 10.3390/ijerph17051703] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 01/17/2023]
Abstract
Menarche is the first occurrence of a woman’s menstruation, an event that symbolizes reproductive capacity and the transition from childhood into womanhood. The global average age for menarche is 12 years and this has been declining in recent years. Many factors that affect the timing menarche in girls could be affected by climate change. A systematic literature review was performed regarding the timing of menarche and four publication databases were interrogated: EMBASE, SCOPUS, PubMed, and Cochrane Reviews. Themes were identified from 112 articles and related to environmental causes of perturbations in menarche (either early or late), disease causes and consequences of perturbations, and social causes and consequences. Research from climatology was incorporated to describe how climate change events, including increased hurricanes, avalanches/mudslides/landslides, and extreme weather events could alter the age of menarche by disrupting food availability or via increased toxin/pollutant release. Overall, our review revealed that these perturbations in the timing of menarche are likely to increase the disease burden for women in four key areas: mental health, fertility-related conditions, cardiovascular disease, and bone health. In summary, the climate does have the potential to impact women’s health through perturbation in the timing of menarche and this, in turn, will affect women’s risk of disease in future.
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Affiliation(s)
- Silvia P. Canelón
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA ;
| | - Mary Regina Boland
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA ;
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Correspondence:
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32
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Sharma S, Mehra D, Brusselaers N, Mehra S. Menstrual Hygiene Preparedness Among Schools in India: A Systematic Review and Meta-Analysis of System-and Policy-Level Actions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E647. [PMID: 31963862 PMCID: PMC7013590 DOI: 10.3390/ijerph17020647] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/01/2020] [Accepted: 01/07/2020] [Indexed: 12/16/2022]
Abstract
With increasing girl's enrolment in schools, school preparedness to ensure a menstrual friendly environment is crucial. The study aimed to conduct a systematic review regarding the existing evidence on menstrual hygiene management (MHM) across schools in India. It further aimed to highlight the actions that have been taken by the government to improve the MHM situation in India. We conducted the systematic literature search using PubMed, EMBASE, and Web of Science for searching the peer-reviewed articles and Google Scholar for anecdotal reports published from inception until 30 October 2019. Of 1125 publications retrieved through the search, 183 papers were included in this review, using a priori created data-extraction form. Meta-analysis was used to estimate the pooled prevalence (PP) of MHM practices in schools. Less than half of the girls were aware of menstruation before menarche (PP 0.45, 0.39 to 0.51, I2= 100.0%, n = 122). Teachers were a less common source of information about menstruation to girls (PP 0.07, 0.05 to 0.08, I2 = 100.0%, n = 86). Separate toilets for girls were present in around half of the schools (PP 0.56, 0.42 to 0.75, I2 100.0%, n = 11). MHM in schools should be strengthened with convergence between various departments for explicit implementation of guidelines.
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Affiliation(s)
- Shantanu Sharma
- Researcher, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden
- MAMTA Health Institute for Mother and Child, Delhi 110048, India;
| | - Devika Mehra
- Public Health Consultant, Medeon Science Park, 21432 Malmö, Sweden;
| | - Nele Brusselaers
- Centre for Translational Microbiome Research, Department of Microbiology, Tumor and Cell biology, Karolinska Institute, SciLifeLab, 17177 Stockholm (Solna), Sweden;
| | - Sunil Mehra
- MAMTA Health Institute for Mother and Child, Delhi 110048, India;
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Krusz E, Hall N, Barrington DJ, Creamer S, Anders W, King M, Martin H, Hennegan J. Menstrual health and hygiene among Indigenous Australian girls and women: barriers and opportunities. BMC WOMENS HEALTH 2019; 19:146. [PMID: 31775735 PMCID: PMC6882156 DOI: 10.1186/s12905-019-0846-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 11/14/2019] [Indexed: 11/21/2022]
Abstract
Health inequities inhibit global development and achievement of the Sustainable Development Goals. One gendered health area, Menstrual Health & Hygiene (MHH), has received increasing attention in Low- and Middle-Income Countries as a barrier to health, wellbeing, and gender equity. Recent anecdotal evidence in Australia highlights that MHH also present challenges to High Income Countries, particularly among underrepresented populations, such as Indigenous Australian peoples, people from low socio-economic backgrounds, or communities that are remotely located. In this article, we chart the emergence of attention to MHH in the Australian context and highlight key considerations for the conduct of research with Aboriginal and Torres Strait Islander Peoples within the culturally- and gender-sensitive area of MHH. Further we draw on insights offered by a partnership between female Aboriginal and Torres Strait Islander leaders, NGO stakeholders, and non-Indigenous researchers. Through a convening (yarning circle) held in March 2018, the group identified multiple socioecological considerations for MHH research and practice, including: affordability and access to menstrual products, barriers to knowledge and culturally sensitive education, infrastructure and supply chain challenges, and the necessity of Indigenous-led research and community-driven data collection methods in addressing the sensitive topic. We draw together these insights to develop recommendations for future research, advocacy, and action in Australia.
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Janoowalla H, Keppler H, Asanti D, Xie X, Negassa A, Benfield N, Rulisa S, Nathan LM. The impact of menstrual hygiene management on adolescent health: The effect of Go! pads on rate of urinary tract infection in adolescent females in Kibogora, Rwanda. Int J Gynaecol Obstet 2019; 148:87-95. [PMID: 31560131 DOI: 10.1002/ijgo.12983] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/28/2019] [Accepted: 09/25/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the rates of urinary tract infection (UTI) in adolescent users of menstrual pads versus non-users in a rural area of Rwanda. METHODS An interventional prospective cohort study was conducted at four secondary schools in the Western Province of Rwanda from May 12, 2017 to October 20, 2017. Inclusion criteria were female students aged 18-24 who were menstruating and volunteered to participate in the study. In total, 240 adolescent participants were assigned to two cohorts; 120 received menstrual pads for 6 months and the other 120 did not use pads. Baseline symptoms and urine cultures were obtained. Symptoms and methods of menstrual hygiene management were assessed and urine cultures were obtained every 2 months. The primary outcome was the presence of UTI diagnosed by positive urine culture. Secondary outcomes were symptoms of UTI, vulvovaginal symptoms, sexual activity, dyspareunia, and self-reported sexually transmitted infection. Generalized estimating equations with nesting were used to assess associations of pad use with study outcomes. RESULTS A total of 209 participants completed the study. There was no difference in rates of positive urine culture. A decreased odds of vulvovaginal symptoms was found in self-reported "always" versus "never" pad users (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.43-0.96; P=0.031). CONCLUSIONS Despite not finding any difference in rates of UTI, the present study showed a decreased rate of vulvovaginal symptoms in users of menstrual pads. Further research investigating rates of genital infections in this population is thus necessary.
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Affiliation(s)
- Hannah Janoowalla
- Departments of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Hannah Keppler
- Departments of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel Asanti
- United Nations Multidimensional Integrated Stabilization Mission in the Central African Republic, Bangui, Mbomou Prefecture, Central African Republic
| | - Xianhong Xie
- Division of Biostatistics, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Abdissa Negassa
- Division of Biostatistics, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Nerys Benfield
- Departments of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Lisa M Nathan
- Departments of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Vulnerabilities at First Sex and Their Association With Lifetime Gender-Based Violence and HIV Prevalence Among Adolescent Girls and Young Women Engaged in Sex Work, Transactional Sex, and Casual Sex in Kenya. J Acquir Immune Defic Syndr 2019; 79:296-304. [PMID: 30113403 PMCID: PMC6203425 DOI: 10.1097/qai.0000000000001826] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescent girls and young women (AGYW) experience high rates of HIV early in their sexual life course. We estimated the prevalence of HIV-associated vulnerabilities at first sex, and their association with lifetime gender-based violence (GBV) and HIV. METHODS We conducted a cross-sectional biobehavioral survey among AGYW (14-24 years) in Mombasa, Kenya in 2015. We compared the prevalence of first sex vulnerabilities across AGYW who self-identified as engaging in sex work (N = 408), transactional sex (N = 177), or casual sex (N = 714) and used logistic regression to identify age-adjusted associations between first sex vulnerabilities and outcomes (GBV after first sex; HIV). RESULTS The median age at first sex was 16 years (interquartile range 14-18). A total of 43.6% received gifts or money at first sex; 41.2% and 11.2% experienced a coerced and forced first sex, respectively. First sex vulnerabilities were generally more common among AGYW in sex work. GBV (prevalence 23.8%) and HIV (prevalence 5.6%) were associated with first sex before age 15 [GBV adjusted odds ratio (AOR) 1.4, 95% confidence interval (CI): 1.0 to 1.9; HIV AOR 1.9, 95% CI: 1.1 to 1.3]; before or within 1 year of menarche (GBV AOR 1.3, 95% CI: 1.0 to 1.7; HIV AOR 2.1, 95% CI: 1.3 to 3.6); and receipt of money (GBV AOR 1.9, 95% CI: 1.4 to 2.5; HIV AOR 2.0, 95% CI: 1.2 to 3.4). CONCLUSIONS HIV-associated vulnerabilities begin at first sex and potentially mediate an AGYW's trajectory of risk. HIV prevention programs should include structural interventions that reach AGYW early, and screening for a history of first sex vulnerabilities could help identify AGYW at risk of ongoing GBV and HIV.
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Ramaiya A, Malhotra A, Cronin C, Stevens S, Kostizak K, Sharma A, Nagar S, Sood S. How does a Social and Behavioral Change Communication Intervention Predict Menstrual Health and Hygiene Management: A Cross-Sectional Study. BMC Public Health 2019; 19:1039. [PMID: 31375074 PMCID: PMC6679443 DOI: 10.1186/s12889-019-7359-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Interventions in India to improve menstrual health and hygiene management (MHHM) have been implemented at the national, state, district and school level. However, evaluations of these interventions have been scarce. The objective of the study was to determine if a social and behavioral change communication (SBCC) intervention (GARIMA) had a relationship with knowledge, attitudes, interpersonal communication, restrictions and MHHM using a comparison group post-test only design among 2206 adolescent girls. Methods Intervention villages and adolescent girls were selected through stratified random sampling based on where GARIMA was implemented. Villages and adolescent girls in comparison villages were matched socio-demographically to intervention villages and adolescent girls. Multi-level logistic regressions assessed the relationship between the encoded exposure, mediators and MHHM. Results The results showed that the encoded exposure predicted all behaviors corresponding to MHHM. Additionally, adolescent girls in the high encoded exposure group had significantly higher knowledge about puberty and reproductive parts (AOR: 2.03 (95% CI: 1.31 – 3.15)), positive attitudes towards gender (AOR: 1.48 (95% CI: 1.02 – 2.16)) and higher levels of some discussion and dialogue (AOR: 1.41 (95% CI: 1.04 – 1.92)). Conclusions Future programs should use SBCC to improve MHHM behavior but involve families, peers and community members to a greater extent in order to improve attitudes towards menstruation, attitudes towards restrictions, attitudes towards absorbent use and reduce restrictions within the community.
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Affiliation(s)
- Astha Ramaiya
- Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 25880, USA.
| | | | - Carmen Cronin
- Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 25880, USA
| | - Sarah Stevens
- Department of Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Kelli Kostizak
- Department of Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | | | | | - Suruchi Sood
- Department of Community Health and Prevention, Drexel University, Philadelphia, PA, USA
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MacRae ER, Clasen T, Dasmohapatra M, Caruso BA. 'It's like a burden on the head': Redefining adequate menstrual hygiene management throughout women's varied life stages in Odisha, India. PLoS One 2019; 14:e0220114. [PMID: 31369595 PMCID: PMC6675075 DOI: 10.1371/journal.pone.0220114] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/21/2019] [Indexed: 11/29/2022] Open
Abstract
There has been growing recognition of menstrual hygiene management (MHM) as a significant public health issue. However, research has predominately focused on the experiences of adolescent girls in school settings. The purpose of this research is to examine detailed accounts of menstruation for women in rural Odisha, India at various life stages with a view toward improving international monitoring of MHM. Focus group discussions and in-depth interviews were conducted to understand women’s experiences of menstruation across four life stages (unmarried women, recently married women, married women, and older women). Thematic analysis was used to identify menstruation-related challenges and needs. We found women voiced needs that aligned with those captured by the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) definition for MHM: access to clean materials, privacy for changing materials, soap and water for bathing, and disposal facilities for materials. However, we also found women require materials that are not only clean but comfortable and reliable; soap and water for more than bathing; privacy for the full spectrum of menstruation-related practices, not just when changing; and disposal facilities that are private and safe, not just accessible. Additionally, we identified needs that extend beyond the existing definition: pain management, social support, and an enabling sociocultural environment. Overall, women representing all life stages discussed menstruation challenges, including bathing, pain, and washing, drying, and storing cloth materials. Cloth management challenges were most acute for unmarried and recently married women, who were concerned that practices could reveal their menstrual status and harm their reputations, thus informing their preference for disposable materials, if attainable. We propose a revised definition of adequate MHM for this population that more comprehensively captures their needs. This definition may also prove useful for other populations, future research, creating measures of assessment, and guiding interventions and program priorities.
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Affiliation(s)
- Elizabeth R. MacRae
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Bethany A. Caruso
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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Sommer M, Schmitt M, Gruer C, Herbert A, Phillips-Howard P. Neglect of menarche and menstruation in the USA. Lancet 2019; 393:2302. [PMID: 31180028 DOI: 10.1016/s0140-6736(19)30300-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/14/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Marni Sommer
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
| | - Margaret Schmitt
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Caitlin Gruer
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Ann Herbert
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Katsuno C, Gregorio ER, Lomboy MFTC, Nonaka D, Hernandez PMR, Estrada CAM, Pimentel JMT, Bernadas RMGC, Kobayashi J. Quality of public school toilets and the frequency of changing sanitary napkins among students in public secondary schools in the City of Manila, Philippines. Trop Med Health 2019; 47:5. [PMID: 30655715 PMCID: PMC6329056 DOI: 10.1186/s41182-018-0131-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 12/20/2018] [Indexed: 11/22/2023] Open
Abstract
Background In sub-tropical countries, poor menstrual hygiene management has been reported. One cause of poor menstrual hygiene management can be poor quality toilets. However, associations between poor quality toilets and menstrual-related behaviors have been poorly understood. The present study aimed to assess the association between the quality of school toilets and the frequency of changing sanitary napkins in school toilet among Filipino students. Methods A cross-sectional study was conducted in six secondary schools of the City of Manila, Philippines, in 2017. A self-administered survey questionnaire with female students collected data on the outcome variable, self-reported daily frequency of changing sanitary napkins in school toilet, and other predictor variables. An observational survey collected data on the main predictor variable, surveyor-rated toilet quality variables. A total of 526 students were included in the analyses. Logistic regression with generalized estimating equation model was used to assess the association between the outcome and predictor variables. Results No significant association was found both between toilet quality and the outcome. Although the association was not significant, the odds ratio (OR) of “sanitary bin is available in toilet” was 2.54 compared to “sanitary bin is not available in toilet.” The results of multivariate analysis showed that participants who reported stronger perceived behavioral control or stronger subjective norm were significantly more likely to change sanitary napkins, compared to those with lower perceived control score or lower subjective norm score, respectively (adjusted OR 2.29, 95% confidence interval 1.24 to 4.25; adjusted OR 2.63, 95% confidence interval 1.45 to 4.76). Conclusions The present study showed that the quality of school toilets was not associated with the frequency of changing sanitary napkins among the studied population. However, it does not mean that the cause-effect relationship was rejected. Further studies involving more schools are necessary to confirm this relationship. Improving subjective norm and perceived behavior control might improve menstrual hygiene behavior.
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Affiliation(s)
- Chikako Katsuno
- 1Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Uehara 207, Nishihara-cho, Okinawa, 903-0215 Japan
| | - Ernesto R Gregorio
- 2Department of Health Promotion and Education, College of Public Health, University of the Philippines Manila/SEAMEO Regional Center for Public Health, Hospital Administration, Environmental & Occupational Health, 625 Pedro Gil Street, Ermita, Manila, Philippines
| | - Marian Fe Theresa C Lomboy
- 3Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila/SEAMEO Regional Center for Public Health, Hospital Administration, Environmental & Occupational Health, 625 Pedro Gil Street, Ermita, Manila, Philippines
| | - Daisuke Nonaka
- 1Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Uehara 207, Nishihara-cho, Okinawa, 903-0215 Japan
| | - Paul Michael R Hernandez
- 1Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Uehara 207, Nishihara-cho, Okinawa, 903-0215 Japan.,3Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila/SEAMEO Regional Center for Public Health, Hospital Administration, Environmental & Occupational Health, 625 Pedro Gil Street, Ermita, Manila, Philippines
| | - Crystal Amiel M Estrada
- 1Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Uehara 207, Nishihara-cho, Okinawa, 903-0215 Japan
| | - Jennel Mae T Pimentel
- 3Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila/SEAMEO Regional Center for Public Health, Hospital Administration, Environmental & Occupational Health, 625 Pedro Gil Street, Ermita, Manila, Philippines
| | - Rhea Marie Grace C Bernadas
- 3Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila/SEAMEO Regional Center for Public Health, Hospital Administration, Environmental & Occupational Health, 625 Pedro Gil Street, Ermita, Manila, Philippines
| | - Jun Kobayashi
- 1Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Uehara 207, Nishihara-cho, Okinawa, 903-0215 Japan.,3Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila/SEAMEO Regional Center for Public Health, Hospital Administration, Environmental & Occupational Health, 625 Pedro Gil Street, Ermita, Manila, Philippines
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Wall LL, Teklay K, Desta A, Belay S. Tending the 'monthly flower:' a qualitative study of menstrual beliefs in Tigray, Ethiopia. BMC WOMENS HEALTH 2018; 18:183. [PMID: 30424763 PMCID: PMC6234636 DOI: 10.1186/s12905-018-0676-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 10/28/2018] [Indexed: 11/23/2022]
Abstract
Background Menstruation is a universal aspect of human female reproductive life. Management of menstrual flow presents hygiene challenges to girls and women in low-income countries, especially when they first start their periods. As part of a project to improve menstrual hygiene management in the Tigray Region of Ethiopia, we explored the local understanding of menstruation through focus-group discussions and individual interviews. Methods A detailed ethnographic survey of menstrual beliefs was carried out through 40 focus group discussions, 64 in-depth key informant interviews, and 16 individual case histories in the Tigray Region of northern Ethiopia. A total of 240 individuals participated in six types of focus groups (pre-menarchal girls, menstruating adolescents, married women of reproductive age, post-menopausal women, adolescent males, and married men). In-depth interviews were also carried out with 80 individuals, including Orthodox Christian priests, imams from the Muslim community, principals of primary and secondary schools, teachers and nurses, as well as menstruating schoolgirls and women. Audio data were transcribed and translated, then broken down into discrete codes using Atlas Ti software (version 7.5.4, Atlas.ti Scientific Software Development Mnbh, Berlin) and further grouped into related families and sub-families based on their content. The results were then synthesized to produce a cohesive narrative concerning menstruation in Tigray. Results Recurrent themes identified by participants included descriptions of the biology of menstruation (which were sometimes fanciful); the general unpreparedness of girls for menarche; cultural restrictions imposed by menstruation on females (particularly the stigma of ritual uncleanliness in both Christian and Muslim religious traditions); the prevalence and challenges of unmet menstrual hygiene needs at schools (including lack of access to sanitary pads and the absence of acceptable toilet/washing facilities); and the stigma and shame associated with menstrual hygiene accidents in public. Conclusions Changes in the educational system in northern Ethiopia are required to improve student understanding of the biology of menstruation, to foster gender equity, to overcome the barriers to school attendance presented by poor menstrual hygiene management, and to create a society that is more understanding and more accepting of menstruation.
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Affiliation(s)
- L Lewis Wall
- Department of Anthropology, College of Arts and Sciences, Washington University in St. Louis, Campus Box 1114, One Brookings Drive, St. Louis, MO, 63130, USA. .,Department of Obstetrics & Gynecology, Ayder Comprehensive Specialist Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia. .,Department of Obstetrics & Gynecology, Washington University in St. Louis, St. Louis, MO, USA.
| | | | - Alem Desta
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Shewaye Belay
- Department of Microbiology and Parasitology, Institute of Biomedical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Cardoso LF, Clark CJ, Rivers K, Ferguson G, Shrestha B, Gupta J. Menstrual restriction prevalence and association with intimate partner violence among Nepali women. BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 45:bmjsrh-2017-101908. [PMID: 30266716 PMCID: PMC6352404 DOI: 10.1136/bmjsrh-2017-101908] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 06/27/2018] [Accepted: 08/24/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Emerging research has linked women's sanitation and menstrual hygiene experiences with increased vulnerability to violence outside the home. Few studies, however, have investigated the relationship between menstruation and violence perpetrated by family members. This type of violence may be linked specifically to restrictions placed on women during menstruation, which are common in some regions of Nepal owing to shared power differentials that disfavour women, and societal norms that stigmatise menstruation. OBJECTIVE To record the prevalence of menstrual restrictions experienced by married women and examine potential associations between intimate partner violence (IPV) in the past year and menstrual restrictions imposed by husbands and/or in-laws among women in three districts of Nepal: Nawalparasi, Kapilvastu and Chitwan. METHODS Baseline data from a larger randomised control trial aiming to reduce IPV in three districts of the Terai region of Nepal (n=1800) were used to assess the prevalence of menstrual restrictions and the association with IPV. RESULTS Nearlythree out of four women (72.3%) reported experiencing high menstrual restriction, or two or more types of menstrual restriction. When controlling for demographic variables and IPV, no type of IPV was associated with high menstrual restrictions. CONCLUSION The experience of menstrual restriction was widespread in this sample of women in Nepal. Future research should seek to identify how best to capture menstrual stigma and deviations around such norms. The global health and development community should prioritise integration with existing water and sanitation programmes to reduce stigma and ensure the well-being of menstruating women and girls. TRIAL REGISTRATION NUMBER NCT02942433.
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Affiliation(s)
- Lauren F Cardoso
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, USA
| | - Cari Jo Clark
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kelsey Rivers
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - Gemma Ferguson
- Equal Access International, San Francisco, California, USA
| | | | - Jhumka Gupta
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
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Nuccio O, Sendek B, Park MH, Mesele T, Okello FO, Gordon-Maclean C. Optimizing tubal ligation service delivery: a prospective cohort study to measure the task-sharing experience of Marie Stopes International Ethiopia. Health Policy Plan 2018; 32:163-169. [PMID: 28207063 DOI: 10.1093/heapol/czw105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 11/14/2022] Open
Abstract
The Ethiopian government implements a progressive task-sharing policy for health services as a strategy to address shortages of highly skilled providers and increase access to critical services, such as family planning. Since 2009, Marie Stopes International Ethiopia has trained health officers to provide tubal ligations, a permanent method of family planning, as part of its task-sharing strategy. The objectives of this research were to evaluate task-sharing tubal ligations to health officers at Marie Stopes International Ethiopia, specifically: (a) to investigate safety, as measured by the proportion of major adverse events; (b) to evaluate the feasibility, as measured by adherence to the standard tubal ligation procedure protocol and (c) to investigate acceptability to clients of the tubal ligation procedure provided by health officers. We established a prospective cohort of women aged ≥18 years presenting for tubal ligation at Marie Stopes International Ethiopia sites in three regions in Ethiopia (March–May 2014). Data on adverse events (incomplete procedure, pain, bleeding, infection, perforation) were collected intra-operatively; peri-operatively (1-h post-procedure); and post-operatively (7 days post-procedure). To measure feasibility, 65% of procedures were selected for ‘audit’, where a nurse observed and scored health officers adherence to standard protocol using an 18-item checklist. To assess acceptability, women were asked about their satisfaction with the procedure. In total, 276 women were enrolled in the study. 97.5% of procedures took place in rural settings. All participants were followed up 7 days post-procedure (100% response rate). The overall proportion of major adverse events was 3% (95% CI 1–6%). The most frequent adverse event was ‘failure to complete the TL’ (2.2%, n = 6). The average score on protocol adherence was 96.9%. Overall, 98.2% (n = 271) of clients would recommend the procedure to a friend. Findings from this study, indicating safety, feasibility and acceptability, are consistent with the existing literature, which indicate safety and acceptability for task-sharing tubal ligations, and other methods of contraception with non-physician health providers. This study adds to scant literature on task-sharing tubal ligations in rural and low-resource settings.
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Affiliation(s)
- Olivia Nuccio
- Research, Monitoring and Evaluation Team, Health System Department, Marie Stopes International, London, UK
| | | | - Min Hae Park
- London School of Hygiene and Tropical Medicine, London, UK
| | - Tesfaye Mesele
- Research, Monitoring and Evaluation Team, Health System Department, Marie Stopes International, London, UK
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Smiles D, Short S, Sommer M. "I Didn't Tell Anyone Because I Was Very Afraid": Girls' Experiences of Menstruation in Contemporary Ethiopia. WOMEN'S REPRODUCTIVE HEALTH (PHILADELPHIA, PA.) 2017; 4:185-197. [PMID: 31032377 PMCID: PMC6482969 DOI: 10.1080/23293691.2017.1388721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Menstrual health is central to girls' wellbeing, and is connected to their rights to health, education, safety, non-discrimination, and autonomy. This article investigates girls' experiences of menstruation in present-day Ethiopia. Results, based on data collected from 120 girls in two regions, illustrate the challenges associated with menstruation, including menstrual taboos and cultural beliefs surrounding menstruation, myths about menstruation and sex, and restrictive social expectations related to marriage, and interpersonal interaction. These challenges diminish girls' health, education, safety, and autonomy, and in so doing, underscore the relevance of menstrual health to rights' agendas that seek to advance girls' wellbeing.
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Affiliation(s)
| | | | - Marni Sommer
- Columbia University Mailman School of Public Health
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Girod C, Ellis A, Andes KL, Freeman MC, Caruso BA. Physical, Social, and Political Inequities Constraining Girls' Menstrual Management at Schools in Informal Settlements of Nairobi, Kenya. J Urban Health 2017; 94:835-846. [PMID: 28875308 PMCID: PMC5722726 DOI: 10.1007/s11524-017-0189-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Access to adequate water and sanitation is limited in informal settlements, contributing to girls' challenges managing menstruation at school, especially when they cannot access materials to absorb menstrual blood and appropriate facilities for hygiene. This study documents differences between girls' experience of menstruation at public schools (where the Kenyan government provides menstrual pads) and private schools (where pads are not provided) in two informal settlements of Nairobi, Kenya. Results showed that supply chains to public schools were not reliable, and equitable pad provision was not assured. Girls in private schools struggled to access pads because they were not provided. Sanitation facilities were physically available, but Muslim girls were unable to practice ablution due to the design of toilets in our study schools. Girls experienced fear and anxiety due to harassment from male peers and had incomplete information about menstruation from teachers. Findings suggest that practitioners and policy-makers should acknowledge the diversity of school populations and monitor programs to ensure efforts do not contribute to inequity.
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Affiliation(s)
- Candace Girod
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anna Ellis
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Karen L Andes
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Matthew C Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bethany A Caruso
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Serván-Mori E, Contreras-Loya D, Gomez-Dantés O, Nigenda G, Sosa-Rubí SG, Lozano R. Use of performance metrics for the measurement of universal coverage for maternal care in Mexico. Health Policy Plan 2017; 32:625-633. [PMID: 28453712 DOI: 10.1093/heapol/czw161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2016] [Indexed: 11/12/2022] Open
Abstract
This study provides evidence for those working in the maternal health metrics and health system performance fields, as well as those interested in achieving universal and effective health care coverage. Based on the perspective of continuity of health care and applying quasi-experimental methods to analyse the cross-sectional 2009 National Demographic Dynamics Survey (n = 14 414 women), we estimated the middle-term effects of Mexico's new public health insurance scheme, Seguro Popular de Salud (SPS) (vs women without health insurance) on seven indicators related to maternal health care (according to official guidelines): (a) access to skilled antenatal care (ANC); (b) timely ANC; (c) frequent ANC; (d) adequate content of ANC; (e) institutional delivery; (f) postnatal consultation and (g) access to standardized comprehensive antenatal and postnatal care (or the intersection of the seven process indicators). Our results show that 94% of all pregnancies were attended by trained health personnel. However, comprehensive access to ANC declines steeply in both groups as we move along the maternal healthcare continuum. The percentage of institutional deliveries providing timely, frequent and adequate content of ANC reached 70% among SPS women (vs 64.7% in the uninsured), and only 57.4% of SPS-affiliated women received standardized comprehensive care (vs 53.7% in the uninsured group). In Mexico, access to comprehensive antenatal and postnatal care as defined by Mexican guidelines (in accordance to WHO recommendations) is far from optimal. Even though a positive influence of SPS on maternal care was documented, important challenges still remain. Our results identified key bottlenecks of the maternal healthcare continuum that should be addressed by policy makers through a combination of supply side interventions and interventions directed to social determinants of access to health care.
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Affiliation(s)
| | | | | | | | | | - Rafael Lozano
- National Institute of Public Health, Cuernavaca, Mexico.,School of Medicine, State of Morelos Autonomous University, Morelos, Mexico
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Hawkey AJ, Ussher JM, Perz J, Metusela C. Experiences and Constructions of Menarche and Menstruation Among Migrant and Refugee Women. QUALITATIVE HEALTH RESEARCH 2017; 27:1473-1490. [PMID: 27742765 DOI: 10.1177/1049732316672639] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Experiences and constructions of menarche and menstruation are shaped by the sociocultural environment in which women are embedded. We explored experiences and constructions of menarche and menstruation among migrant and refugee women resettled in Sydney, Australia, and Vancouver, Canada. Seventy-eight semistructured individual interviews and 15 focus groups comprised of 82 participants were undertaken with women from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, and varying South American countries. We analyzed the data using thematic decomposition, identifying the overall theme "cycles of shame" and two core themes. In "becoming a woman," participants constructed menarche as a marker of womanhood, closely linked to marriage and childbearing. In "the unspeakable," women conveyed negative constructions of menstruation, positioning it as shameful, something to be concealed, and polluting. Identifying migrant and refugee women's experiences and constructions of menarche and menstruation is essential for culturally safe medical practice, health promotion, and health education.
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Affiliation(s)
- Alexandra J Hawkey
- 1 Centre for Health Research,Western Sydney University, Penrith, New South Wales, Australia
| | - Jane M Ussher
- 1 Centre for Health Research,Western Sydney University, Penrith, New South Wales, Australia
| | - Janette Perz
- 1 Centre for Health Research,Western Sydney University, Penrith, New South Wales, Australia
| | - Christine Metusela
- 1 Centre for Health Research,Western Sydney University, Penrith, New South Wales, Australia
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Juma J, Nyothach E, Laserson KF, Oduor C, Arita L, Ouma C, Oruko K, Omoto J, Mason L, Alexander KT, Fields B, Onyango C, Phillips-Howard PA. Examining the safety of menstrual cups among rural primary school girls in western Kenya: observational studies nested in a randomised controlled feasibility study. BMJ Open 2017; 7:e015429. [PMID: 28473520 PMCID: PMC5566618 DOI: 10.1136/bmjopen-2016-015429] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Examine the safety of menstrual cups against sanitary pads and usual practice in Kenyan schoolgirls. DESIGN Observational studies nested in a cluster randomised controlled feasibility study. SETTING 30 primary schools in a health and demographic surveillance system in rural western Kenya. PARTICIPANTS Menstruating primary schoolgirls aged 14-16 years participating in a menstrual feasibility study. INTERVENTIONS Insertable menstrual cup, monthly sanitary pads or 'usual practice' (controls). OUTCOME MEASURES Staphylococcus aureus vaginal colonization, Escherichia coli growth on sampled used cups, toxic shock syndrome or other adverse health outcomes. RESULTS Among 604 eligible girls tested, no adverse event or TSS was detected over a median 10.9 months follow-up. S. aureusprevalence was 10.8%, with no significant difference over intervention time or between groups. Of 65 S.aureus positives at first test, 49 girls were retested and 10 (20.4%) remained positive. Of these, two (20%) sample isolates tested positive for toxic shock syndrome toxin-1; both girls were provided pads and were clinically healthy. Seven per cent of cups required replacements for loss, damage, dropping in a latrine or a poor fit. Of 30 used cups processed for E. coli growth, 13 (37.1%, 95% CI 21.1% to 53.1%) had growth. E. coli growth was greatest in newer compared with established users (53%vs22.2%, p=0.12). CONCLUSIONS Among this feasibility sample, no evidence emerged to indicate menstrual cups are hazardous or cause health harms among rural Kenyan schoolgirls, but large-scale trials and post-marketing surveillance should continue to evaluate cup safety.
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Affiliation(s)
- Jane Juma
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Elizabeth Nyothach
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Kayla F Laserson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Clifford Oduor
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Lilian Arita
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Caroline Ouma
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Kelvin Oruko
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Jackton Omoto
- Siaya District Hospital, Ministry of Health, Siaya, Kenya
| | - Linda Mason
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Barry Fields
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Clayton Onyango
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Blake S, Boone M, Yenew Kassa A, Sommer M. Teaching Girls About Puberty and Menstrual Hygiene Management in Rural Ethiopia: Findings From a Pilot Evaluation. JOURNAL OF ADOLESCENT RESEARCH 2017. [DOI: 10.1177/0743558417701246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Educational interventions on menstruation and puberty have emerged as an important element of efforts to improve girls’ knowledge and confidence related to puberty, menstruation, and menstrual hygiene management (MHM). We conducted a mixed-methods evaluation of the Ethiopia Growth and Changes puberty book, developed through research with Ethiopian girls to present scientifically accurate content on MHM in a format appropriate to girls’ lives. Deploying a cluster-randomized approach, we conducted quantitative surveys with girls enrolled in Grades 6 and 7 ( n = 636) in 10 intervention and 10 control schools in two rural districts of the West Shewa Zone of Oromia, Ethiopia. We collected qualitative data from girls in intervention schools. We found that the book was associated with a statistically significant improvement in knowledge, and evidence of improvements in attitudes around menstruation. Qualitative evidence underscored a strong interest in interventions that present information on menstruation and puberty in accurate and supportive terms. Consistent with an ecological framework for adolescent health, we conclude that puberty books offer a useful individual-level intervention, whose impact would be magnified if combined with investments aimed at creating more gender equitable physical and social school environments.
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Affiliation(s)
- Sarah Blake
- University of California San Francisco School of Nursing, USA
| | - Melissa Boone
- Methodology Center at Pennsylvania State University, University Park, USA
| | | | - Marni Sommer
- Columbia University Mailman School of Public Health, New York, NY, USA
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Sveinsdóttir H. The role of menstruation in women's objectification: a questionnaire study. J Adv Nurs 2017; 73:1390-1402. [DOI: 10.1111/jan.13220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Herdís Sveinsdóttir
- University of Iceland; Faculty of Nursing; Reykjavík Iceland
- Landspitali University Hospital; Surgical Services; Reykjavík Iceland
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Montgomery P, Hennegan J, Dolan C, Wu M, Steinfield L, Scott L. Menstruation and the Cycle of Poverty: A Cluster Quasi-Randomised Control Trial of Sanitary Pad and Puberty Education Provision in Uganda. PLoS One 2016; 11:e0166122. [PMID: 28002415 PMCID: PMC5176162 DOI: 10.1371/journal.pone.0166122] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 10/18/2016] [Indexed: 11/19/2022] Open
Abstract
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. TRIAL REGISTRATION Pan African Clinical Trials Registry PACTR201503001044408.
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Affiliation(s)
- Paul Montgomery
- Centre for Evidence-Based Intervention, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Julie Hennegan
- Centre for Evidence-Based Intervention, University of Oxford, Oxford, United Kingdom
| | | | - Maryalice Wu
- Applied Technologies for Learning in the Arts and Sciences, University of Illinois, Urbana-Champaign, Illinois, United States of America
| | | | - Linda Scott
- Said Business School, University of Oxford, Oxford United Kingdom
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