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Phillips-Howard PA, Osire E, Akinyi C, Zulaika G, Otieno FO, Mehta SD. Water, sanitation and hygiene at sex work venues to support menstrual needs. Front Public Health 2024; 12:1305601. [PMID: 38481834 PMCID: PMC10936742 DOI: 10.3389/fpubh.2024.1305601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Adequate menstrual health and hygiene (MHH) is necessary for women's health and equity of all menstruators. Female sex workers (FSW) require good MHH to prevent discomfort and exposure to pathogens. No studies have evaluated water, sanitation, and hygiene (WASH) conditions of FSW. We report on a cross-sectional WASH assessment at FSW venues in Kisumu, western Kenya. Methods Stakeholders identified 77 FSW venues in Kisumu, of which 47 were randomly sampled and visited between April-May 2023. A standardized structured survey of WASH conditions was deployed by trained research staff using Android tablets after proprietor's consent. WASH scores ranging 0-3 were computed based on point each for direct observation of water available, soap available, and acceptable latrine. MHH scores ranging between 0-4 were computed (one point each) for direct observation of: currently available soap and water, locking door on a usable latrine, functional lighting, and a private area for changing clothes or menstrual materials, separate from the latrine(s). WASH and MHH scores were compared by venue type using non-parametric Kruskal-Wallis tests, and non-parametric Spearman rank tests. Results Full WASH criteria was met by 29.8% of venues; 34.0% had no adequate WASH facilities; 46.8% had no female latrine; and 25.5% provided soap and water in private spaces for women. While 76.6% had menstrual waste disposal only 14 (29.8%) had covered bins. One in 10 venues provided adequate MHM facilities. Poorest WASH facilities were in brothels and in bars, and three-quarters of bars with accommodation had no MHH facilities. Discussion WASH and MHH services were sub-optimal in the majority of FSW venues, preventing menstrual management safely, effectively, with dignity and privacy. This study highlights the unmet need for MHH support for this population. Poor MHH can deleteriously impact FSW health and wellbeing and compound the stigma and shame associated with their work and ability to stay clean. Acceptable and cost-effective solutions to sustainably improve WASH facilities for these populations are needed. Trial registration Clinicaltrial.gov NCT0566678.
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Affiliation(s)
| | - Edyth Osire
- Nyanza Reproductive Health Society, Kisumu, Kenya
| | | | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Supriya D. Mehta
- Department of Internal Medicine, Division of Infectious Diseases, Rush Medical College, Chicago, IL, United States
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
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Donkoh R, Lee WO, Ahoto AT, Donkor J, Twerefoo PO, Akotey MK, Ntim SY. Effects of educational management on quality education in rural and urban primary schools in Ghana. Heliyon 2023; 9:e21325. [PMID: 38027794 PMCID: PMC10663754 DOI: 10.1016/j.heliyon.2023.e21325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
To ensure inclusive, equitable quality education, and encourage educational opportunities for lifelong learning worldwide; the United Nations set sustainable development goals (SDG) to achieve quality education. Thus, using SDG 4 quality education and system theory, this research seeks to identify the effects of educational management on quality education in rural and urban primary schools in Ghana. Moreover, the mediating role of internet facilities in educational management and quality education relationhsip has been discussed. Thus, 745 urban and 471 rural head teachers and teachers from Ghana participated in an online survey. The data was compiled and executed by structural equation model using SPSS-AMOS. The result reveals that educational management has a positive effect on quality education in urban and rural schools. In addition, urban schools have more quality education than rural schools. Although internet facilities have a positive effect on quality education their absence weakens the quality of education in urban and rural schools. Moreover, it is recommended that the Ministry of Education should arrange professional training for supervisors and head teachers to boost their monitoring and supervision strategies. Furthermore, Parents Teacher Associations can provide funding to support the monitoring and supervision activities to achieve success. Lastly, quality internet facilities should be built with limited charges in rural and urban schools.
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Affiliation(s)
- Ruth Donkoh
- Department of Education, Zhengzhou University, China
| | - Wing On Lee
- Institute of Adult Learning, Singapore University of Social Sciences, Singapore
| | | | | | - Portia Oware Twerefoo
- Department of Public Administration and Management, University of South Africa, South Africa
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Proff AA, Fatima S, Limón MLS. Becoming women: period. Perceptions of barriers and facilitators to menstrual hygiene management programs for Pakistani girls. Front Public Health 2023; 11:1083688. [PMID: 37637817 PMCID: PMC10457679 DOI: 10.3389/fpubh.2023.1083688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/08/2023] [Indexed: 08/29/2023] Open
Abstract
Discussions on and around menstruation are often considered a cultural taboo in many parts of Pakistan. Mostly, individuals avoid discussing menstruation and lack awareness about its related health and hygiene issues. Sexual health education is entangled in a complex myriad of social and cultural stigmas. Limited knowledge and lack of access to menstrual health management (MHM) resources decrease the self-confidence of girl students and lead to reluctance to seek help or advice. This quantitative study aimed to gain a deeper understanding of the intersectionality of the influences leading to barriers and facilitators of access to the MHM program in a public school in the Hyderabad district and utilize this information to construct a framework for evaluation of the Water, Sanitation, and Hygiene (WASH) in Schools program. This study sampled all girls' elementary and higher secondary schools in the Hyderabad district. Due to the limitations of time and access during the global COVID-19 pandemic, the researchers collected data from more than 100 school leaders and teachers regarding the MHM facilities in their schools through an online self-administered survey. The data were then analyzed in SPSS for frequencies, mean scores, and standard deviation. The results suggest that school leaders and teachers of the Hyderabad district perceive MHM facilities to be significantly low in terms of both resources and policies. Schools worldwide are introducing life skills, hygiene, good health, and wellness subjects. Pakistan needs to change its educational policy for the welfare of women, who comprise a magnanimous 48.54% of its population. Moreover, with the planning and implementation of programs such as WASH in Schools (WinS), the perceptions of barriers and facilitators to MHM facilities in Pakistan must be studied to fight the taboo and raise awareness about the same.
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Affiliation(s)
- Alexandria Alisa Proff
- Department of Humanities and Social Sciences, American University of Ras Al Khaimah, Ras Al-Khaimah, United Arab Emirates
| | - Surhan Fatima
- Department of Mathematics and Social Sciences, Sukkur Institute of Business Administration (IBA) University, Sukkur, Pakistan
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Melaku A, Addis T, Mengistie B, Kanno GG, Adane M, Kelly-Quinn M, Ketema S, Hailu T, Bedada D, Ambelu A. Menstrual hygiene management practices and determinants among schoolgirls in Addis Ababa, Ethiopia: The urgency of tackling bottlenecks - Water and sanitation services. Heliyon 2023; 9:e15893. [PMID: 37180900 PMCID: PMC10172776 DOI: 10.1016/j.heliyon.2023.e15893] [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: 10/02/2022] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/16/2023] Open
Abstract
Background Menstrual hygiene management (MHM) service provision and improving schoolgirls' hygienic practices in schools are among the major challenges for low and middle income countries, including Ethiopia, in meeting the 2030 Sustainable Development Goals. This study was conducted to assess schoolgirls' MHM practices and what influences those practices in Addis Ababa, the capital city of Ethiopia. Methods A cross-sectional study was conducted on 401 adolescent schoolgirls and 98 school directors that were selected using a multistage sampling method. Pretested semi-structured interviewer-administered questionnaires and observational checklists were used to collect data. Results During menstruation, about 90% of schoolgirls used commercially made disposable sanitary pads. However, only 45.9% of girls had access to emergency pads from their schools. Of the 98 directors, 79 (80.6%) responded that they had MHM provisions for schoolgirls. However, 42 (42.9%) schools had no water and soap in the pad changing rooms/toilets, and 70% lacked a covered dustbin for disposal/storage of soiled sanitary pads. Besides, more than 55% of the schools practiced open burning and dumping to dispose of used menstrual materials. More than half of the schools had no sanitary pad changing rooms, three-quarters of them lack MHM education, and only 2.5% had a bathing area. The location of schools (AOR = 5.44, 95% CI: (2.34-12.66)), health club availability (AOR = 3.14, 95% CI: (1.53, 6.42)), being informed about MHM before menarche (AOR = 2.04, 95% CI: (1.04, 4.00)), and availability of emergency sanitary pad at schools (AOR = 2.59, 95% CI: (1.36, 4.91)) were significantly associated with the status of schoolgirls menstrual hygiene practices. Conclusions About one-quarter of the schoolgirls had poor menstrual hygiene practices. Being a student in inner-city schools, attending a school that had a health club, being informed about MHM before menarche, and having access to emergency pads from schools were the determinant factors for good menstrual hygiene practices. However, most schools lack water, soap, and a covered dustbin in the pad changing rooms/toilets. Moreover, only a few schools provided MHM education and emergency pads. Improving water and sanitation services along with tailored MHM education are urgently needed to circumvent unsafe MHM practices among adolescent schoolgirls.
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Affiliation(s)
- Abayneh Melaku
- Ethiopian Institute of Water Resources, Addis Ababa University, P.O.Box 1176, Addis Ababa, Ethiopia
| | - Taffere Addis
- Ethiopian Institute of Water Resources, Addis Ababa University, P.O.Box 1176, Addis Ababa, Ethiopia
- Corresponding author. Ethiopian Institute of Water Resources, Addis Ababa University, P.0.Box 1176, Addis Ababa, Ethiopia.
| | - Bezatu Mengistie
- Ethiopian Institute of Water Resources, Addis Ababa University, P.O.Box 1176, Addis Ababa, Ethiopia
| | - Girum Gebremeskel Kanno
- Department of Environmental Health, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mary Kelly-Quinn
- School of Biology and Environmental Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Sisay Ketema
- Mizan Aman Health Science Collage, Mizan, Ethiopia
| | | | - Dinaol Bedada
- School of Public Health, Selale University, Selale, Ethiopia
| | - Argaw Ambelu
- Ethiopian Institute of Water Resources, Addis Ababa University, P.O.Box 1176, Addis Ababa, Ethiopia
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Buitrago-García T, Sawadogo NH, Souares A, Koulidiati JL, Sié A, Bärnighausen T, Langlotz S, McMahon SA. Female-friendly toilets in schools in Burkina Faso: A mixed-methods study using photo-elicitation. J Glob Health 2022; 12:04057. [PMID: 36073661 PMCID: PMC9454237 DOI: 10.7189/jogh.12.04057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background An absence of gender-sensitive sanitation facilities in schools and the negative effects this has on girls has been widely discussed among advocacy groups, though less examined in academic spheres. Drawing on triangulated data, we outline current challenges and respondent-driven solutions to enhance the female-friendly nature of toilets in a context of extreme poverty. Methods This mixed-methods study was informed by the tenets of human-centred design. We first quantitatively assessed facilities in 14 secondary schools in the Kossi Province of Burkina Faso. We then collected qualitative data, including 15 focus group discussions and 53 in-depth interviews among schoolgirls, mothers, teachers and key informants. We applied photo-elicitation, a novel method, to explore perceptions of facilities and the desirability and feasibility of interventions to improve gender-friendly sanitation facilities. Results No school met international water, sanitation and hygiene (WASH) standards for schools. Roughly one third of schools did not have water and, when present, there was no reliable way to use it within the toilet complex. Schoolgirls shared feelings of shame and stress when menstruating at school, and said that they would avoid using school toilets, if possible. Schoolgirls described water access as the most urgent need to address, followed by fostering privacy and facilitating cleanliness within facilities. Mothers and teachers mostly aligned with these priorities, while key informants additionally emphasised the need to raise awareness on both general and menstrual hygiene and to develop maintenance systems. Photo-elicitation engaged and empowered participants to pinpoint priorities and concrete solutions, namely a need for doors and locks, water containers and cleaning materials. Conclusions WASH needs in many schools remain unmet. Women and girls should be involved in decision-making across stages of intervention design and implementation. Young women's voices merit greater inclusion in academic literature. Future interventions should enhance access to water and privacy. Future research could explore maintenance and monitoring strategies to develop guidance on sustainable solutions.
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Affiliation(s)
- Teresa Buitrago-García
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- La Paz University Hospital, Madrid, Spain
| | | | - Aurélia Souares
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Jean-Louis Koulidiati
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Ali Sié
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Nouna Health Research Centre, Nouna, Burkina Faso
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Africa Health Research Institute, Nelson R. Mandela Medical School, Umbilo, Durban, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sarah Langlotz
- Chair of Development Economics (Prof. Fuchs), Georg-August-Universität Göttingen, Göttingen, Germany
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Deriba BS, Garedew G, Gemeda D, Geleta TA, Jemal K, Bala ET, Mekuria M, Nigussie T, Dirirsa DE, Legesse E. Safe menstrual hygiene management practice and associated factors among female adolescent students at high schools in central Ethiopia: A mixed–method study. Front Public Health 2022; 10:913262. [PMID: 35958860 PMCID: PMC9360541 DOI: 10.3389/fpubh.2022.913262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background Menstrual Hygiene Management (MHM) is a much-neglected issue in developing countries, including Ethiopia. Menstruating women and girls are forced into isolation, prevented from movement, dietary restrictions, and can be prevented from participating in daily routine activities. Furthermore, the way almost all previous studies conducted in Ethiopia measured the practice of MHM did not meet standard definition of safe MHM. This study aimed to assess safe management of menstrual hygiene practice and associated factors among female adolescent students in public high schools in central Ethiopia. Methods A mixed-methods approach was employed in this study. Systematic random sampling technique was used to select 846 study participants. The collected data were entered through EPI INFO version 7 and exported to SPSS version 23 for cleaning and analysis. Bivariate and multivariate logistic regression analysis were performed to identify the association between MHM and independent variables. Finally, AOR, 95% CI, and p-value < 0.05 were considered statistically significant. The qualitative data was analyzed by ATLAS.ti in order to extract the main themes and categories. Direct quotations were presented with a thick description of the findings. Results The safe management of menstrual hygiene was 28.20%. Living with parents (AOR = 2.51, 95% CI:1.11–5.68), living with relatives (AOR = 7.41, 95% CI:2.55–21.54), having a merchant mother (AOR = 1.81, 95% CI:1.14–2.9), having a mother who has private work (AOR = 4.56, 95% CI:1.31–5.90), having a farmer father (AOR = 1.53, 95% CI:1.1–2.31), rural resident (AOR = 1.61, 95% CI: 1.17–2.21) and realizing the absence of container for storing sanitary napkins in the toilet of the school latrine (AOR = 1.44, 95% CI: 1.1–0.94) were factors associated with MHM. Findings from a qualitative study were discussed under four themes to explore barriers to menstrual hygiene management, and three themes emerged as enablers to menstrual hygiene management. Conclusions The safe management of menstrual hygiene was low among adolescent girls. People with whom adolescent girls live, the occupational status of mother and father, residence, the availability of a container to dispose of sanitary napkins in school toilets were factors associated with menstrual hygiene management. Behavioral change communications must be provided to female students about menstrual hygiene.
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Affiliation(s)
- Berhanu Senbeta Deriba
- Department of Public Health Fitche, College of Medicine and Health Sciences, Salale University, Fiche, Ethiopia
- *Correspondence: Berhanu Senbeta Deriba
| | - Girma Garedew
- Department of Public Health Fitche, College of Medicine and Health Sciences, Salale University, Fiche, Ethiopia
| | - Diriba Gemeda
- Department of Public Health Fitche, College of Medicine and Health Sciences, Salale University, Fiche, Ethiopia
| | - Tinsae Abeya Geleta
- Department of Public Health Fitche, College of Medicine and Health Sciences, Salale University, Fiche, Ethiopia
| | - Kemal Jemal
- Department of Nursing, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia
| | - Elias Teferi Bala
- Department of Public Health, Ambo University College of Medicine and Health Sciences, Ambo, Ethiopia
| | - Mulugeta Mekuria
- Department of Public Health, Ambo University College of Medicine and Health Sciences, Ambo, Ethiopia
| | - Tadesse Nigussie
- Department of Public Health Fitche, College of Medicine and Health Sciences, Salale University, Fiche, Ethiopia
| | - Dejene Edosa Dirirsa
- Department of Midwifery, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia
| | - Elsabeth Legesse
- Department of Public Health Fitche, College of Medicine and Health Sciences, Salale University, Fiche, Ethiopia
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Long JL, Haver J, Mendoza P, Vargas Kotasek SM. The More You Know, the Less You Stress: Menstrual Health Literacy in Schools Reduces Menstruation-Related Stress and Increases Self-Efficacy for Very Young Adolescent Girls in Mexico. Front Glob Womens Health 2022; 3:859797. [PMID: 35496727 PMCID: PMC9047952 DOI: 10.3389/fgwh.2022.859797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Improving the menstrual health literacy of girls and boys is a key strategy within a holistic framework of Save the Children's school health and comprehensive sexuality education programming. As menstrual health is an emerging area of study and programming, Save the Children continues to learn and adjust its interventions using program evaluations and rigorous monitoring. This paper will examine program-monitoring data from three cohorts, representing 47 public schools in Mexico City, Puebla, and Mérida, Mexico. The study focuses on female students in 5th and 6th grade who participated in We See Equal, a school-based program centered on gender equality and puberty education, between September 2018 and December 2019. This study used a cross-sectional quantitative cohort approach to document changes in girls' experiences and perceptions around managing menstruation in school. The analysis compares girls' knowledge and experiences before and after participation in We See Equal to understand how knowledge changes over the program and how those changes may contribute to menstruation-related school engagement, stress, and self-efficacy (MENSES) outcomes. Multivariate regression models explored relationships between MENSES outcomes, knowledge and socioeconomic status (SES). Overall, results show that the more knowledge girls acquired, the higher their self-efficacy score and the lower their stress score, however, certain MHH knowledge was more predictive of MENSES outcomes and varied by SES. Among girls from lower SES, we observed significant relationships between knowing what their period was prior to menarche and the three MENSES outcomes. Decreases in menstruation-related stress were driven by items related to the practical knowledge of how to dispose of sanitary pads and reduced feelings of nervousness on days they had their period at school. Increases in self-efficacy were primarily driven by girls' confidence in their ability to track their period from month to month, feelings that they could still do well on an exam if they had their period at school, and security that they could ask a friend to lend them a pad if they needed one. Implications for future menstrual health literacy programming and targeting populations for menstrual health education, as well as priorities for future research will be discussed.
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Affiliation(s)
- Jeanne L. Long
- Department of Education and Child Protection, Save the Children, Washington, DC, United States
| | - Jacquelyn Haver
- Department of Education and Child Protection, Save the Children, Washington, DC, United States
| | - Pamela Mendoza
- Department of Education and Child Protection, Save the Children, Washington, DC, United States
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Poague KIHM, Blanford JI, Anthonj C. Water, Sanitation and Hygiene in Schools in Low- and Middle-Income Countries: A Systematic Review and Implications for the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3124. [PMID: 35270814 PMCID: PMC8910349 DOI: 10.3390/ijerph19053124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/21/2022] [Accepted: 03/03/2022] [Indexed: 12/26/2022]
Abstract
The global COVID-19 pandemic has revealed the extent to which schools are struggling with the provision of safe drinking water, sanitation and hygiene (WASH). To describe the WASH conditions in schools and discuss the implications for the safe reopening of schools during the ongoing COVID-19 pandemic, a systematic review of peer-reviewed literature on WASH in schools in low- and middle-income countries was performed. In April 2021, five databases, including MEDLINE (via PubMed), Web of Science, Scopus, AJOL, and LILACS, were used to identify studies. Sixty-five papers met the inclusion criteria. We extracted and analyzed data considering the Joint Monitoring Programme (JMP) definitions and the normative contents of Human Rights to safe drinking water and sanitation. Publications included in this systematic review considered 18,465 schools, across 30 different countries. Results indicate a lack of adequate WASH conditions and menstrual hygiene management requirements in all countries. The largely insufficient and inadequate school infrastructure hampers students to practice healthy hygiene habits and handwashing in particular. In the context of the COVID-19 pandemic, being hindered to implement such a key strategy to contain the spread of SARS-CoV-2 in the school environment is of major concern.
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Affiliation(s)
- Kasandra I. H. M. Poague
- Faculty of Geo-Information Science and Earth Observation–ITC, University of Twente, Hengelosestraat 99, P.O. Box 217, 7500 AE Enschede, The Netherlands; (J.I.B.); (C.A.)
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OUP accepted manuscript. Health Promot Int 2022:6586597. [DOI: 10.1093/heapro/daac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sanni UA, Offiong UM, Anigilaje EA, Airede KI, Imam A. A pre-COVID-19 assessment of aspects of the school health programme in some selected Nigerian primary schools: implications for school re-opening during the COVID-19 pandemic in developing country contexts. BMC Public Health 2021; 21:1214. [PMID: 34167515 PMCID: PMC8223233 DOI: 10.1186/s12889-021-11258-x] [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: 12/21/2020] [Accepted: 06/10/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Following the COVID-19 pandemic, school closures were part of the global public health response to limit community spread of the virus. In recent times, there has been an emphasis on safe school re-opening. This concept is likely to differ between developed and developing country settings. There are however no published studies on barriers hindering safe school re-opening within developing country contexts. This study evaluates aspects of the school health program (SHP) in some selected Nigerian schools that might relate to the pandemic control during school re-opening. METHODS In 2017, we conducted a cross-sectional survey of the SHP of 146 registered primary schools in Gwagwalada Area Council in Abuja, Nigeria. These schools provided services to about 54,562 students. We used direct observational methods and interviewer-administered questionnaires to assess the SHP of each school. We compare SHP characteristics that might relate to COVID-19 control in schools across government-owned (public) and privately-owned (private) schools using a pre-defined framework. RESULTS Public school to pupil ratios was more than six times that of private schools. Only 6.9% of all surveyed schools employed qualified health personnel. Although 8 in every 10 schools conducted health talks for communicable disease control, the use of temporary isolation and school-based immunization were low at 1.4 and 2.7% respectively. Pipe-borne water access was present in 4 of 10 schools, with public schools having more limited access than private schools (p = 0.009). Similarly, less proportion of public schools had access to soap for handwashing (p < 0.001). Adequate classroom ventilation was present in 63% of surveyed schools, with private schools having more limited ventilation (p < 0.001). CONCLUSIONS Overcrowding and infrastructural deficits within developing country contexts represent barriers to safe school re-opening during the COVID-19 pandemic. In these settings, there needs to be tailored and innovative strategies which consider local practical realities when designing the COVID-19 control programs during school re-opening.
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Affiliation(s)
- Usman A Sanni
- Department of Paediatrics, Federal Medical Centre, Birnin-Kebbi, Kebbi, Nigeria
| | - Uduak M Offiong
- Department of Paediatrics, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Emmanuel A Anigilaje
- Department of Paediatrics, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.,Department of Paediatrics, University of Abuja, Gwagwalada, P.M.B 117, Abuja, Nigeria
| | - Kareem I Airede
- Department of Paediatrics, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.,Department of Paediatrics, University of Abuja, Gwagwalada, P.M.B 117, Abuja, Nigeria
| | - Abdulazeez Imam
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, P.O. Box 273, Fajara, Gambia.
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Jauhari S, Singh N, Kumari R, Agarwal D. Comparison of awareness and perception of menstrual hygiene between pre and postmenarchal adolescents of North India: A cross-sectional study. J Family Med Prim Care 2021; 10:4168-4175. [PMID: 35136784 PMCID: PMC8797133 DOI: 10.4103/jfmpc.jfmpc_672_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022] Open
Abstract
Context: Menstruation is a normal physiologic phenomenon. Due to lack of awareness regarding menstrual hygiene among adolescent girls in India, majority have unhygienic practices which make them vulnerable to various adverse health and social outcomes. Aims and Objective: The aim of this study was to compare the awareness and perception of pre- and postmenarchal adolescent girls regarding menstrual hygiene. Settings and Design: A hospital-based cross-sectional study was conducted by the Department of Obstetrics and Gynaecology and Paediatrics of a Government tertiary care center, Lucknow, Uttar Pradesh for 6 months from 1 July 2019 to 31 December 2019. Material and Methods: The study was undertaken among 120 adolescent girls between 09 and 19 years of age. Premenarchal age group was from 9 to 12 years and postmenarchal was 13–19 years. All the adolescent girls who fulfilled the inclusion criteria were subjected to a pretested prevalidated semi-structured questionnaire assessing their awareness and perceptions regarding menstrual hygiene. Result: Of 120 respondents, 43 girls were aware of menstruation prior to attainment of menarche. Mother was the first informant regarding menstruation in the case of 49 (49.65%) girls. A total of 57 girls believed it as a physiological process. 32 (53.3%) girls knew the use of sanitary pads during menstruation. Regarding restrictions practiced, 136 (85%) girls practiced different restrictions during menstruation. Conclusion: Adolescent girls, being vulnerable, need to have adequate and correct awareness regarding menstrual hygiene. This will protect them from risk of developing reproductive or sexually transmitted infections (RTI/STI) which is a burden on our society and render many females infertile and cause other adverse health outcomes.
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Ssewanyana D, Newton CR, van Baar A, Hassan AS, Stein A, Taylor HG, Van De Vijver F, Scerif G, Abubakar A. Beyond Their HIV Status: the Occurrence of Multiple Health Risk Behavior Among Adolescents from a Rural Setting of Sub-Saharan Africa. Int J Behav Med 2020; 27:426-443. [PMID: 32215858 PMCID: PMC7359141 DOI: 10.1007/s12529-020-09877-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Health risk behaviors during adolescence may cluster into patterns that might be predicted by specific factors, among which HIV may have an important role. Method In a cross-sectional study conducted between 2017 and 2018, clustering of HRB and its associated factors was investigated in rural Kenya among 588 adolescents (36% perinatally HIV infected; 28% perinatally HIV exposed but uninfected; and 36% HIV unexposed/uninfected). Latent class analysis of 22 behaviors followed by multinomial logistic regression were conducted. Four risk behavior classes were identified. Results No significant differences were found in behavioral class membership across the three HIV groups (p = 0.366). The risk of membership to the higher risk behavioral classes relative to class 1 (the substance and drug abstinent low risk takers) increased with older adolescent age (p = 0.047), increased among adolescent who experienced mental distress (p < 0.001), and those who felt unsafe in their neighborhood (p < 0.002). Better working memory (p = 0.0037) was found to be protective. Conclusion The results highlight a need to include screening and interventions for internalizing mental health problems and deficits in executive functioning, as well as steps to involve family members and communities to address psychosocial risk factors in adolescents in Kenya.
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Affiliation(s)
- Derrick Ssewanyana
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), P. O Box 230, Kilifi, 80108, Kenya.
- Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands.
| | - Charles R Newton
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), P. O Box 230, Kilifi, 80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Anneloes van Baar
- Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Amin S Hassan
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), P. O Box 230, Kilifi, 80108, Kenya
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - H Gerry Taylor
- Department of Pediatrics, Center for Biobehavioral Health, Nationwide Children's Hospital Research Institute, The Ohio State University, Columbus, OH, USA
| | - Fons Van De Vijver
- Department of Culture Studies, Tilburg University, Tilburg, The Netherlands
| | - Gaia Scerif
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Amina Abubakar
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), P. O Box 230, Kilifi, 80108, Kenya
- Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Public Health, Pwani University, Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
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Onyango EO, Elliott SJ. Bleeding Bodies, Untrustworthy Bodies: A Social Constructionist Approach to Health and Wellbeing of Young People in Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7555. [PMID: 33080818 PMCID: PMC7589892 DOI: 10.3390/ijerph17207555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 12/23/2022]
Abstract
The Sustainable Development Goals provide a global development agenda that is meant to be inclusive of all people. However, the development needs for vulnerable populations such as youth are not reflected within the policy agenda of some developing countries. One of the reasons for this is that research that explores health and wellbeing concerns for young people are sparse in the region and where they exist, the focus has been on marginalized subgroups. To address this gap, this cross-sectional study explored the health and wellbeing of youth in Kenya. We conducted 10 focus group discussions and 14 in-depth interviews with youth ages 15 to 24 years. A thematic analysis of the data revealed that structural factors are important influencers of youth perceptions and their social constructions of health and wellbeing. Kenyan youth are concerned about the health status and healthcare services in their communities, as well as issues of community trust of youths and perceived risks of political misuse and emotional suffering. Our findings suggest that youth transitioning into adulthood in resource-constrained areas experience feelings of powerlessness and inability to take charge over their own life. This impacts how they perceive and socially construct health and wellbeing.
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Affiliation(s)
- Elizabeth Opiyo Onyango
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, ON N2N 1N2, Canada;
- School of Nursing and Midwifery, Masinde Muliro University of Science and Technology, Kakamega 50100, Kenya
| | - Susan J. Elliott
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, ON N2N 1N2, Canada;
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Connecting Female Genital Schistosomiasis and Menstrual Hygiene Initiatives. Trends Parasitol 2020; 36:410-412. [PMID: 32298628 DOI: 10.1016/j.pt.2020.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 11/20/2022]
Abstract
Effective future control of female genital schistosomiasis (FGS) requires an integrated and multisectoral approach, bringing together HIV, sexual and reproductive health, and reproductive rights sectors. In this article, an underappreciated but important connection between FGS and menstrual hygiene initiatives in Africa is highlighted.
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Iselin Ertzgaard S, Kristin N, Sofie T, Giske Sindberg H, Tobias Bang H, Cosmas M, Tron Vedul T, Aslam N, Jon Ø. Prevalence of hearing impairment among primary school children in the Kilimanjaro region within Tanzania. Int J Pediatr Otorhinolaryngol 2020; 130:109797. [PMID: 31816514 DOI: 10.1016/j.ijporl.2019.109797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Hearing impairment is becoming a public health concern and a widespread problem. The World Health Organization estimates that globally there are about 466 million people with hearing impairment, of which 34 million represent children. We examined the prevalence and etiology of hearing impairment among primary school children in the Kilimanjaro region within Tanzania. METHOD A cross-sectional study of primary school children aged 6-17 was conducted to determine the prevalence of hearing impairment. Tanzanian primary school children were screened for hearing loss and an otoscopy was performed on those who failed the screening. RESULTS There were 403 children screened from three schools in rural areas of Tanzania. The prevalence of hearing loss was found to be 7.1%, 10.8% and 16.7% in the different schools. Cerumen was proven to be the most common possible cause of hearing impairment. Other possible causes of hearing impairment were found to be (in descending order) otitis (all types), no abnormalities, and perforation of the tympanic membrane. CONCLUSIONS These results show a need for better identification of hearing impairment in school-going children and implementation of prevention and treatment options in Tanzania and other developing countries. This can further improve children's potential for language development, communication and academic achievement.
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Affiliation(s)
- Solvang Iselin Ertzgaard
- The Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Tungasletta 2, 7047, Trondheim, Norway
| | - Naalsund Kristin
- The Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Tungasletta 2, 7047, Trondheim, Norway
| | - Tønder Sofie
- The Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Tungasletta 2, 7047, Trondheim, Norway
| | - Hansen Giske Sindberg
- The Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Tungasletta 2, 7047, Trondheim, Norway
| | - Hagan Tobias Bang
- The Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Tungasletta 2, 7047, Trondheim, Norway
| | - Mnyanyi Cosmas
- Open University of Tanzania, Department of Psychology and Special Education, Dar Es Salaam, Tanzania
| | - Tronstad Tron Vedul
- SINTEF Digital, Connectivity Technologies and Platforms, Strindvegen 4, 7034, Trondheim, Norway.
| | - Nkya Aslam
- Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Øygarden Jon
- The Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Tungasletta 2, 7047, Trondheim, Norway; SINTEF Digital, Connectivity Technologies and Platforms, Strindvegen 4, 7034, Trondheim, Norway
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Zulaika G, Kwaro D, Nyothach E, Wang D, Zielinski-Gutierrez E, Mason L, Eleveld A, Chen T, Kerubo E, van Eijk A, Pace C, Obor D, Juma J, Oyaro B, Niessen L, Bigogo G, Ngere I, Henry C, Majiwa M, Onyango CO, Ter Kuile FO, Phillips-Howard PA. Menstrual cups and cash transfer to reduce sexual and reproductive harm and school dropout in adolescent schoolgirls: study protocol of a cluster-randomised controlled trial in western Kenya. BMC Public Health 2019; 19:1317. [PMID: 31638946 PMCID: PMC6805471 DOI: 10.1186/s12889-019-7594-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 09/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Adolescent girls in sub-Saharan Africa are disproportionally vulnerable to sexual and reproductive health (SRH) harms. In western Kenya, where unprotected transactional sex is common, young females face higher rates of school dropout, often due to pregnancy, and sexually transmitted infections (STIs), including HIV. Staying in school has shown to protect girls against early marriage, teen pregnancy, and HIV infection. This study evaluates the impact of menstrual cups and cash transfer interventions on a composite of deleterious outcomes (HIV, HSV-2, and school dropout) when given to secondary schoolgirls in western Kenya, with the aim to inform evidence-based policy to improve girls’ health, school equity, and life-chances. Methods Single site, 4-arm, cluster randomised controlled superiority trial. Secondary schools are the unit of randomisation, with schoolgirls as the unit of measurement. Schools will be randomised into one of four intervention arms using a 1:1:1:1 ratio and block randomisation: (1) menstrual cup arm; (2) cash transfer arm, (3) cups and cash combined intervention arm, or (4) control arm. National and county agreement, and school level consent will be obtained prior to recruitment of schools, with parent consent and girls’ assent obtained for participant enrolment. Participants will be trained on safe use of interventions, with all arms receiving puberty and hygiene education. Annually, the state of latrines, water availability, water treatment, handwashing units and soap in schools will be measured. The primary endpoint is a composite of incident HIV, HSV-2, and all-cause school dropout, after 3 years follow-up. School dropout will be monitored each term via school registers and confirmed through home visits. HIV and HSV-2 incident infections and risk factors will be measured at baseline, mid-line and end-line. Intention to treat analysis will be conducted among all enrolled participants. Focus group discussions will provide contextual information on uptake of interventions. Monitoring for safety will occur throughout. Discussion If proved safe and effective, the interventions offer a potential contribution toward girls’ schooling, health, and equity in low- and middle-income countries. Trial registration ClinicalTrials.gov NCT03051789, 15th February 2017.
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Affiliation(s)
- Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Daniel Kwaro
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Elizabeth Nyothach
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Emily Zielinski-Gutierrez
- Center for Global Health, Division of Global Health HIV and TB, U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Linda Mason
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Alie Eleveld
- Safe Water and AIDS Project (SWAP), Kisumu, Kenya
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Emily Kerubo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Annemieke van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Cheryl Pace
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - David Obor
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Jane Juma
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Boaz Oyaro
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Louis Niessen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Godfrey Bigogo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Carl Henry
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Maxwell Majiwa
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Feiko O Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Penelope A Phillips-Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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Mumtaz Z, Sivananthajothy P, Bhatti A, Sommer M. "How can we leave the traditions of our Baab Daada" socio-cultural structures and values driving menstrual hygiene management challenges in schools in Pakistan. J Adolesc 2019; 76:152-161. [PMID: 31487579 DOI: 10.1016/j.adolescence.2019.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite the growing attention to the relationship between menstruation and girls schooling, there remain many challenges to addressing the issue. Current interventions, which mostly focus on developing WASH infrastructure and sanitary hygiene management products, while necessary, may not be sufficient. This paper aimed to identify the root causes of poorly maintained WASH infrastructure, and understand the deeply embedded socio-cultural values around menstrual hygiene management that need to be addressed in order to provide truly supportive school environments for menstruating girls. METHODS Qualitative data were collected in rural and urban sites in three provinces in Pakistan using participatory activities with 312 girls aged 16-19 years, observations of 7 School WASH facilities, 42 key informant interviews and a document review. RESULTS Three key themes emerged from our data: (1) a poorly maintained, girls-unfriendly School WASH infrastructure was a result of gender-insensitive design, a cultural devaluation of toilet cleaners and inadequate governing practices; (2) the design of WASH facilities did not align with traditionally-determined modes of disposal of rag-pads, the most common used absorbents; (3) traditional menstrual management practices situate girls in an 'alternate space' characterised by withdrawal from many daily routines. These three socio-culturally determined practices interacted in a complex manner, often leading to interrupted class engagement and attendance. CONCLUSIONS To be truly effective, current menstrual hygiene management strategies need to address the root causes of poor WASH infrastructure and ensure facility design is sensitive to the gendered and deeply embedded local socio-cultural values and beliefs around menstrual hygiene management.
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Affiliation(s)
- Zubia Mumtaz
- School of Public Health, University of Alberta, 3-309 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada.
| | - Priatharsini Sivananthajothy
- School of Public Health, University of Alberta, 3-309 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada
| | - Afshan Bhatti
- Real Medicine Foundation, House 328, Main Service Road, E11/3, Islamabad, Pakistan
| | - Marni Sommer
- Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 537, New York, NY, 10032, USA
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van Eijk AM, Zulaika G, Lenchner M, Mason L, Sivakami M, Nyothach E, Unger H, Laserson K, Phillips-Howard PA. Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis. Lancet Public Health 2019; 4:e376-e393. [PMID: 31324419 PMCID: PMC6669309 DOI: 10.1016/s2468-2667(19)30111-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/15/2019] [Accepted: 06/17/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Girls and women need effective, safe, and affordable menstrual products. Single-use products are regularly selected by agencies for resource-poor settings; the menstrual cup is a less known alternative. We reviewed international studies on menstrual cup leakage, acceptability, and safety and explored menstrual cup availability to inform programmes. METHODS In this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Web of Science, Popline, Cinahl, Global Health database, Emerald, Google Scholar, Science.gov, and WorldWideScience from database inception to May 14, 2019, for quantitative or qualitative studies published in English on experiences and leakage associated with menstrual cups, and adverse event reports. We also screened the Manufacturer and User Facility Device Experience database from the US Food and Drug Administration for events related to menstrual cups. To be eligible for inclusion, the material needed to have information on leakage, acceptability, or safety of menstrual cups. The main outcome of interest was menstrual blood leakage when using a menstrual cup. Safety outcomes of interest included serious adverse events; vaginal abrasions and effects on vaginal microflora; effects on the reproductive, digestive, or urinary tract; and safety in poor sanitary conditions. Findings were tabulated or combined by use of forest plots (random-effects meta-analysis). We also did preliminary estimates on costs and environmental savings potentially associated with cups. This systematic review is registered on PROSPERO, number CRD42016047845. FINDINGS Of 436 records identified, 43 studies were eligible for analysis (3319 participants). Most studies reported on vaginal cups (27 [63%] vaginal cups, five [12%] cervical cups, and 11 [25%] mixed types of cups or unknown) and 15 were from low-income and middle-income countries. 22 studies were included in qualitative or quantitative syntheses, of which only three were of moderate-to-high quality. Four studies made a direct comparison between menstrual cups and usual products for the main outcome of leakage and reported leakage was similar or lower for menstrual cups than for disposable pads or tampons (n=293). In all qualitative studies, the adoption of the menstrual cup required a familiarisation phase over several menstrual cycles and peer support improved uptake (two studies in developing countries). In 13 studies, 73% (pooled estimate: n=1144; 95% CI 59-84, I2=96%) of participants wished to continue use of the menstrual cup at study completion. Use of the menstrual cup showed no adverse effects on the vaginal flora (four studies, 507 women). We identified five women who reported severe pain or vaginal wounds, six reports of allergies or rashes, nine of urinary tract complaints (three with hydronephrosis), and five of toxic shock syndrome after use of the menstrual cup. Dislodgement of an intrauterine device was reported in 13 women who used the menstrual cup (eight in case reports, and five in one study) between 1 week and 13 months of insertion of the intrauterine device. Professional assistance to aid removal of menstrual cup was reported among 47 cervical cup users and two vaginal cup users. We identified 199 brands of menstrual cup, and availability in 99 countries with prices ranging US$0·72-46·72 (median $23·3, 145 brands). INTERPRETATION Our review indicates that menstrual cups are a safe option for menstruation management and are being used internationally. Good quality studies in this field are needed. Further studies are needed on cost-effectiveness and environmental effect comparing different menstrual products. FUNDING UK Medical Research Council, Department for International Development, and Wellcome Trust.
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Affiliation(s)
- Anna Maria van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Madeline Lenchner
- Population Health Sciences, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Linda Mason
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Muthusamy Sivakami
- Centre for Health and Social Sciences, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
| | - Elizabeth Nyothach
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Holger Unger
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK; Department of Obstetrics and Gynaecology, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Kayla Laserson
- Bill & Melinda Gates Foundation, India Country Office, New Delhi, India
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Use of menstrual cups among school girls: longitudinal observations nested in a randomised controlled feasibility study in rural western Kenya. Reprod Health 2018; 15:139. [PMID: 30119636 PMCID: PMC6098596 DOI: 10.1186/s12978-018-0582-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 08/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A menstrual cup can be a good solution for menstrual hygiene management in economically challenged settings. As part of a pilot study we assessed uptake and maintenance of cup use among young school girls in Kenya. METHODS A total of 192 girls between 14 to 16 years were enrolled in 10 schools in Nyanza Province, Western Kenya; these schools were assigned menstrual cups as part of the cluster-randomized pilot study. Girls were provided with menstrual cups in addition to training and guidance on use, puberty education, and instructions for menstrual hygiene. During repeated individual visits with nurses, girls reported use of the menstrual cup and nurses recorded colour change of the cup. RESULTS Girls were able to keep their cups in good condition, with only 12 cups (6.3%) lost (dropped in toilet, lost or destroyed). Verbally reported cup use increased from 84% in the first 3 months (n = 143) to 96% after 9 months (n = 74). Colour change of the cup, as 'uptake' indicator of use, was detected in 70.8% of 192 participants, with a median time of 5 months (range 1-14 months). Uptake differed by school and was significantly higher among girls who experienced menarche within the past year (adjusted risk ratio 1.29, 95% CI 1.04-1.60), and was faster among girls enrolled in the second study year (hazard ratio 3.93, 95% CI 2.09-7.38). The kappa score comparing self-report and cup colour observation was 0.044 (p = 0.028), indicating that agreement was only slightly higher than by random chance. CONCLUSIONS Objective evidence through cup colour change suggests school girls in rural Africa can use menstrual cups, with uptake improving with peer group education and over time. TRIAL REGISTRATION ISRCTN17486946 . Retrospectively registered 09 December 2014.
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Alexander KT, Zulaika G, Nyothach E, Oduor C, Mason L, Obor D, Eleveld A, Laserson KF, Phillips-Howard PA. Do Water, Sanitation and Hygiene Conditions in Primary Schools Consistently Support Schoolgirls' Menstrual Needs? A Longitudinal Study in Rural Western Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081682. [PMID: 30087298 PMCID: PMC6121484 DOI: 10.3390/ijerph15081682] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/01/2018] [Accepted: 08/04/2018] [Indexed: 11/16/2022]
Abstract
Many females lack access to water, privacy and basic sanitation—felt acutely when menstruating. Water, sanitation and hygiene (WASH) conditions in schools, such as access to latrines, water, and soap, are essential for the comfort, equity, and dignity of menstruating girls. Our study was nested within a cluster randomized controlled pilot feasibility study where nurses provided menstrual items to schoolgirls. We observed the WASH conditions of 30 schools from June 2012–October 2013 to see if there were any changes in conditions, to compare differences between study arms and to examine agreement between observed and teacher-reported conditions. Data came from study staff observed, and school teacher reported, WASH conditions. We developed scores for the condition of school facilities to report any changes in conditions and compare outcomes across study arms. Results demonstrated that soap availability for students increased significantly between baseline and follow-up while there was a significant decrease in the number of “acceptable” latrines. During the study follow-up period, individual WASH indicators supporting menstruating girls, such as locks on latrine doors or water availability in latrines did not significantly improve. Advances in WASH conditions for all students, and menstrual hygiene facilities for schoolgirls, needs further support, a defined budget, and regular monitoring of WASH facilities to maintain standards.
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Affiliation(s)
- Kelly T Alexander
- Liverpool School of Tropical Medicine, Liverpool L35QA, UK.
- Cooperative for Assistance and Relief Everywhere (CARE), 151 Ellis St NE, Atlanta, GA 30303, USA.
| | - Garazi Zulaika
- Liverpool School of Tropical Medicine, Liverpool L35QA, UK.
| | | | - Clifford Oduor
- Kenya Medical Research Institute, Kisumu 1578-40100, Kenya.
| | - Linda Mason
- Liverpool School of Tropical Medicine, Liverpool L35QA, UK.
| | - David Obor
- Kenya Medical Research Institute, Kisumu 1578-40100, Kenya.
| | - Alie Eleveld
- Safe Water and AIDS Programme, Kisumu 3323-40100, Kenya.
| | - Kayla F Laserson
- Kenya Medical Research Institute, Kisumu 1578-40100, Kenya.
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Kaur R, Kaur K, Kaur R. Menstrual Hygiene, Management, and Waste Disposal: Practices and Challenges Faced by Girls/Women of Developing Countries. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2018; 2018:1730964. [PMID: 29675047 PMCID: PMC5838436 DOI: 10.1155/2018/1730964] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/12/2017] [Indexed: 11/18/2022]
Abstract
Menstruation and menstrual practices still face many social, cultural, and religious restrictions which are a big barrier in the path of menstrual hygiene management. In many parts of the country especially in rural areas girls are not prepared and aware about menstruation so they face many difficulties and challenges at home, schools, and work places. While reviewing literature, we found that little, inaccurate, or incomplete knowledge about menstruation is a great hindrance in the path of personal and menstrual hygiene management. Girls and women have very less or no knowledge about reproductive tract infections caused due to ignorance of personal hygiene during menstruation time. In rural areas, women do not have access to sanitary products or they know very little about the types and method of using them or are unable to afford such products due to high cost. So, they mostly rely on reusable cloth pads which they wash and use again. Needs and requirements of the adolescent girls and women are ignored despite the fact that there are major developments in the area of water and sanitation. Women manage menstruation differently when they are at home or outside; at homes, they dispose of menstrual products in domestic wastes and in public toilets and they flush them in the toilets without knowing the consequences of choking. So, there should be a need to educate and make them aware about the environmental pollution and health hazards associated with them. Implementation of modern techniques like incineration can help to reduce the waste. Also, awareness should be created to emphasize the use of reusable sanitary products or the natural sanitary products made from materials like banana fibre, bamboo fibre, sea sponges, water hyacinth, and so on.
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Affiliation(s)
- Rajanbir Kaur
- Department of Botanical and Environmental Sciences, Guru Nanak Dev University, Amritsar, Punjab 143005, India
| | | | - Rajinder Kaur
- Department of Botanical and Environmental Sciences, Guru Nanak Dev University, Amritsar, Punjab 143005, India
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Khan SM, Bain RES, Lunze K, Unalan T, Beshanski-Pedersen B, Slaymaker T, Johnston R, Hancioglu A. Optimizing household survey methods to monitor the Sustainable Development Goals targets 6.1 and 6.2 on drinking water, sanitation and hygiene: A mixed-methods field-test in Belize. PLoS One 2017; 12:e0189089. [PMID: 29216244 PMCID: PMC5720699 DOI: 10.1371/journal.pone.0189089] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 11/17/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Sustainable Development Goals (SDGs) require household survey programmes such as the UNICEF-supported Multiple Indicator Cluster Surveys (MICS) to enhance data collection to cover new indicators. This study aims to evaluated methods for assessing water quality, water availability, emptying of sanitation facilities, menstrual hygiene management and the acceptability of water quality testing in households which are key to monitoring SDG targets 6.1 and 6.2 on drinking Water, Sanitation and Hygiene (WASH) and emerging issues. METHODS As part of a MICS field test, we interviewed 429 households and 267 women age 15-49 in Stann Creek, Belize in a split-sample experiment. In a concurrent qualitative component, we conducted focus groups with interviewers and cognitive interviews with respondents during and immediately following questionnaire administration in the field to explore their question comprehension and response processes. FINDINGS About 88% of respondents agreed to water quality testing but also desired test results, given the potential implications for their own health. Escherichia coli was present in 36% of drinking water collected at the source, and in 47% of samples consumed in the household. Both questions on water availability necessitated probing by interviewers. About one quarter of households reported emptying of pit latrines and septic tanks, though one-quarter could not provide an answer to the question. Asking questions on menstrual hygiene was acceptable to respondents, but required some clarification and probing. CONCLUSIONS In the context of Belize, this study confirmed the feasibility of collecting information on the availability and quality of drinking water, emptying of sanitation facilities and menstrual hygiene in a multi-purpose household survey, indicating specific areas to improve question formulation and field protocols. Improvements have been incorporated into the latest round of MICS surveys which will be a major source of national data for monitoring of SDG targets for drinking water, sanitation and hygiene and emerging issues for WASH sector programming.
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Affiliation(s)
- Shane M. Khan
- Division of Data, Research and Policy, UNICEF, New York City, New York, United States of America
| | - Robert E. S. Bain
- Division of Data, Research and Policy, UNICEF, New York City, New York, United States of America
| | - Karsten Lunze
- School of Medicine, Boston University, Boston, Massachusetts, United States of America
| | - Turgay Unalan
- Division of Data, Research and Policy, UNICEF, New York City, New York, United States of America
| | - Bo Beshanski-Pedersen
- Division of Data, Research and Policy, UNICEF, New York City, New York, United States of America
| | - Tom Slaymaker
- Division of Data, Research and Policy, UNICEF, New York City, New York, United States of America
| | - Richard Johnston
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Attila Hancioglu
- Division of Data, Research and Policy, UNICEF, New York City, New York, United States of America
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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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Alam MU, Luby SP, Halder AK, Islam K, Opel A, Shoab AK, Ghosh PK, Rahman M, Mahon T, Unicomb L. Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: results from a cross-sectional survey. BMJ Open 2017; 7:e015508. [PMID: 28694347 PMCID: PMC5541609 DOI: 10.1136/bmjopen-2016-015508] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/08/2017] [Accepted: 05/10/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Many adolescent girls in low-income and middle-income countries lack appropriate facilities and support in school to manage menstruation. Little research has been conducted on how menstruation affects school absence. This study examines the association of menstrual hygiene management knowledge, facilities and practice with absence from school during menstruation among Bangladeshi schoolgirls. METHODS We conducted a nationally representative, cross-sectional study in Bangladeshi schools from March to June 2013 among girls 11 to 17 years old who reached menarche. We sampled 700 schools from 50 urban and 50 rural clusters using a probability proportional to size technique. We interviewed 2332 schoolgirls and conducted spot checks in each school for menstrual hygiene facilities. To assess factors associated with reported school absence, we estimated adjusted prevalence difference (APD) for controlling confounders' effect using generalised estimating equations to account for school-level clustering. RESULTS Among schoolgirls who reached menarche, 41% (931) reported missing school, an average of 2.8 missed days per menstrual cycle. Students who felt uncomfortable at school during menstruation (99% vs 32%; APD=58%; CI 54 to 63) and who believed menstrual problems interfere with school performance (64% vs 30%; APD=27; CI 20 to 33) were more likely to miss school during menstruation than those who did not. School absence during menstruation was less common among girls attending schools with unlocked toilet for girls (35% vs 43%; APD=-5.4; CI -10 to -1.6). School absence was more common among girls who were forbidden from any activities during menstruation (41% vs 33%; APD=9.1; CI 3.3 to 14). CONCLUSION Risk factors for school absence included girl's attitude, misconceptions about menstruation, insufficient and inadequate facilities at school, and family restriction. Enabling girls to manage menstruation at school by providing knowledge and management methods prior to menarche, privacy and a positive social environment around menstrual issues has the potential to benefit students by reducing school absence.
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Affiliation(s)
- Mahbub-Ul Alam
- Environmental Interventions Unit, Infectious Disease Division, International Center for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Stephen P Luby
- Environmental Interventions Unit, Infectious Disease Division, International Center for Diarrheal Disease Research, Dhaka, Bangladesh
- Stanford Woods Institute for the Environment, Stanford University, Stanford, California, USA
| | - Amal K Halder
- Environmental Interventions Unit, Infectious Disease Division, International Center for Diarrheal Disease Research, Dhaka, Bangladesh
| | | | | | - Abul K Shoab
- Environmental Interventions Unit, Infectious Disease Division, International Center for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Probir K Ghosh
- Environmental Interventions Unit, Infectious Disease Division, International Center for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Disease Division, International Center for Diarrheal Disease Research, Dhaka, Bangladesh
| | | | - Leanne Unicomb
- Environmental Interventions Unit, Infectious Disease Division, International Center for Diarrheal Disease Research, Dhaka, Bangladesh
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25
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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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27
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Economic Analysis and Feasibility of Rainwater Harvesting Systems in Urban and Peri-Urban Environments: A Review of the Global Situation with a Special Focus on Australia and Kenya. WATER 2016. [DOI: 10.3390/w8040149] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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28
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van Eijk AM, Sivakami M, Thakkar MB, Bauman A, Laserson KF, Coates S, Phillips-Howard PA. Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis. BMJ Open 2016; 6:e010290. [PMID: 26936906 PMCID: PMC4785312 DOI: 10.1136/bmjopen-2015-010290] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To assess the status of menstrual hygiene management (MHM) among adolescent girls in India to determine unmet needs. DESIGN Systematic review and meta-analysis. We searched PubMed, The Global Health Database, Google Scholar and references for studies published from 2000 to September 2015 on girls' MHM. SETTING India. PARTICIPANTS Adolescent girls. OUTCOME MEASURES Information on menarche awareness, type of absorbent used, disposal, hygiene, restrictions and school absenteeism was extracted from eligible materials; a quality score was applied. Meta-analysis was used to estimate pooled prevalence (PP), and meta-regression to examine the effect of setting, region and time. RESULTS Data from 138 studies involving 193 subpopulations and 97,070 girls were extracted. In 88 studies, half of the girls reported being informed prior to menarche (PP 48%, 95% CI 43% to 53%, I(2) 98.6%). Commercial pad use was more common among urban (PP 67%, 57% to 76%, I(2) 99.3%, n=38) than rural girls (PP 32%, 25% to 38%, I(2) 98.6%, n=56, p<0.0001), with use increasing over time (p<0.0001). Inappropriate disposal was common (PP 23%, 16% to 31%, I(2) 99.0%, n=34). Menstruating girls experienced many restrictions, especially for religious activities (PP 0.77, 0.71 to 0.83, I(2) 99.1%, n=67). A quarter (PP 24%, 19% to 30%, I(2) 98.5%, n=64) reported missing school during periods. A lower prevalence of absenteeism was associated with higher commercial pad use in univariate (p=0.023) but not in multivariate analysis when adjusted for region (p=0.232, n=53). Approximately a third of girls changed their absorbents in school facilities (PP 37%, 29% to 46%, I(2) 97.8%, n=17). Half of the girls' homes had a toilet (PP 51%, 36% to 67%, I(2) 99.4%, n=21). The quality of studies imposed limitations on analyses and the interpretation of results (mean score 3 on a scale of 0-7). CONCLUSIONS Strengthening of MHM programmes in India is needed. Education on awareness, access to hygienic absorbents and disposal of MHM items need to be addressed. TRIAL REGISTRATION NUMBER CRD42015019197.
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Affiliation(s)
- Anna Maria van Eijk
- Department of Clinical Sciences, Liverpool school of Tropical Medicine, Liverpool, UK
| | - M Sivakami
- Tata Institute of Social Sciences, School of Health Systems Studies, Mumbai, Maharashtra, India
| | | | - Ashley Bauman
- Department of Clinical Sciences, Liverpool school of Tropical Medicine, Liverpool, UK
| | - Kayla F Laserson
- Centers for Disease Control and Prevention (CDC) India, Atlanta, Georgia, USA
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Sommer M, Caruso BA, Sahin M, Calderon T, Cavill S, Mahon T, Phillips-Howard PA. A Time for Global Action: Addressing Girls' Menstrual Hygiene Management Needs in Schools. PLoS Med 2016; 13:e1001962. [PMID: 26908274 PMCID: PMC4764363 DOI: 10.1371/journal.pmed.1001962] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Marni Sommer and colleagues reflect on priorities needed to guide global, national, and local action to address girls' menstrual hygiene management needs in schools.
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Affiliation(s)
- Marni Sommer
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
- * E-mail:
| | - Bethany A. Caruso
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Murat Sahin
- UNICEF Headquarters, New York, New York, United States of America
| | | | - Sue Cavill
- UNICEF Headquarters, New York, New York, United States of America
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30
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Kerubo E, Laserson KF, Otecko N, Odhiambo C, Mason L, Nyothach E, Oruko KO, Bauman A, Vulule J, Zeh C, Phillips-Howard PA. Prevalence of reproductive tract infections and the predictive value of girls' symptom-based reporting: findings from a cross-sectional survey in rural western Kenya. Sex Transm Infect 2016; 92:251-6. [PMID: 26819339 PMCID: PMC4893088 DOI: 10.1136/sextrans-2015-052371] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 12/30/2015] [Indexed: 11/30/2022] Open
Abstract
Objectives Reproductive tract infections (RTIs), including sexually acquired, among adolescent girls is a public health concern, but few studies have measured prevalence in low-middle-income countries. The objective of this study was to examine prevalence in rural schoolgirls in Kenya against their reported symptoms. Methods In 2013, a survey was conducted in 542 adolescent schoolgirls aged 14–17 years who were enrolled in a menstrual feasibility study. Vaginal self-swabbing was conducted after girls were interviewed face-to-face by trained nurses on symptoms. The prevalence of girls with symptoms and laboratory-confirmed infections, and the sensitivity, specificity, positive and negative predictive values of symptoms compared with laboratory results, were calculated. Results Of 515 girls agreeing to self-swab, 510 answered symptom questions. A quarter (24%) reported one or more symptoms; most commonly vaginal discharge (11%), pain (9%) or itching (4%). Laboratory tests confirmed 28% of girls had one or more RTI. Prevalence rose with age; among girls aged 16–17 years, 33% had infections. Bacterial vaginosis was the most common (18%), followed by Candida albicans (9%), Chlamydia trachomatis (3%), Trichomonas vaginalis (3%) and Neisseria gonorrhoeae (1%). Reported symptoms had a low sensitivity and positive predictive value. Three-quarters of girls with bacterial vaginosis and C. albicans, and 50% with T. vaginalis were asymptomatic. Conclusions There is a high prevalence of adolescent schoolgirls with RTI in rural Kenya. Public efforts are required to identify and treat infections among girls to reduce longer-term sequelae but poor reliability of symptom reporting minimises utility of symptom-based diagnosis in this population. Trial registration number ISRCTN17486946.
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Affiliation(s)
- Emily Kerubo
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI) Kisumu, Kisumu, Kenya
| | - Kayla F Laserson
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Newton Otecko
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI) Kisumu, Kisumu, Kenya
| | - Collins Odhiambo
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI) Kisumu, Kisumu, Kenya
| | - Linda Mason
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Elizabeth Nyothach
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI) Kisumu, Kisumu, Kenya
| | - Kelvin O Oruko
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI) Kisumu, Kisumu, Kenya
| | - Ashley Bauman
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - John Vulule
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI) Kisumu, Kisumu, Kenya
| | - Clement Zeh
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Penelope A Phillips-Howard
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI) Kisumu, Kisumu, Kenya Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Oruko K, Nyothach E, Zielinski-Gutierrez E, Mason L, Alexander K, Vulule J, Laserson KF, Phillips-Howard PA. 'He is the one who is providing you with everything so whatever he says is what you do': A Qualitative Study on Factors Affecting Secondary Schoolgirls' Dropout in Rural Western Kenya. PLoS One 2015; 10:e0144321. [PMID: 26636771 PMCID: PMC4670214 DOI: 10.1371/journal.pone.0144321] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 11/15/2015] [Indexed: 11/19/2022] Open
Abstract
Education is an effective way to improve girls’ self-worth, health, and productivity; however there remains a gender gap between girls’ and boys’ completion of school. The literature around factors influencing girls’ decision to stay in school is limited. Seven focus group discussions took place among 79 girls in forms 2 to 4 at secondary schools in rural western Kenya, to examine their views on why girls absent themselves or dropout from school. Data were analysed thematically. Lack of resources, sexual relationships with boyfriends, and menstrual care problems were reported to lead directly to dropout or school absence. These were tied to girls increased vulnerability to pregnancy, poor performance in school, and punishments, which further increase school absence and risk of dropout. Poverty, unmet essential needs, coercive sexual relationships, and an inequitable school environment collude to counter girls’ resolve to complete their schooling. Lack of resources drive girls to have sex with boyfriends or men who provide them with essentials their family cannot afford, such as sanitary pads and transport to school. While these improve quality of their school life, this dynamic increases their exposure to sexual risk, pregnancy, punishment, and dropout. Evaluation of interventions to ameliorate these challenges is warranted, including provision of pocket money to address their needs.
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Affiliation(s)
- Kelvin Oruko
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | - Elizabeth Nyothach
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | - Emily Zielinski-Gutierrez
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Linda Mason
- Department of Clinical Studies, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kelly Alexander
- Department of Clinical Studies, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - John Vulule
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | - Kayla F. Laserson
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Penelope A. Phillips-Howard
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
- Department of Clinical Studies, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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32
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King N, Dewey C, Borish D. Determinants of Primary School Non-Enrollment and Absenteeism: Results from a Retrospective, Convergent Mixed Methods, Cohort Study in Rural Western Kenya. PLoS One 2015; 10:e0138362. [PMID: 26371885 PMCID: PMC4570670 DOI: 10.1371/journal.pone.0138362] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/27/2015] [Indexed: 11/18/2022] Open
Abstract
Background Education is a key element in the socioeconomic development required to improve quality of life in Kenya. Despite the introduction of free primary education, primary school enrollment and attendance levels remain low. Drawing on qualitative and quantitative data, this study explores the determinants of non-enrollment and absenteeism in rural western Kenya and potential mitigation strategies to address these issues. Methods The study was conducted in Bwaliro village in rural western Kenya. A random sample of 64 students was obtained by blocking the village primary school’s student population according to grade level, gender, and orphan status. Qualitative and quantitative data were collected through interviews with parents, guardians, and key informants, and focus group discussions with students. Quantitative data were compared using chi-square tests, Student’s T-test, and Poisson regressions. Qualitative data were analyzed using thematic content analysis. Results Malaria, menstruation, and lack of money were among the most notable determinants of primary school dropout and absenteeism, and these factors disproportionately impacted orphans and female students. Potential mitigation strategies suggested by the community included provision of malaria treatment or prevention, reduction in education costs, expansion of the established school-feeding program, and provision of sanitary pads. Conclusion Despite free primary education, numerous factors continue to prevent children in rural western Kenya from attending primary school. The findings suggest that interventions should primarily target orphaned and female students. Prior to implementation, suggested mitigation strategies should be assessed for cost-effectiveness.
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Affiliation(s)
- Nia King
- Department of Population Medicine, Ontario Veterinary College, Guelph, Ontario, Canada
- * E-mail:
| | - Cate Dewey
- Department of Population Medicine, Ontario Veterinary College, Guelph, Ontario, Canada
- Centre for Public Health and Zoonoses, University of Guelph, Guelph, Ontario, Canada
| | - David Borish
- Department of Population Medicine, Ontario Veterinary College, Guelph, Ontario, Canada
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33
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Phillips-Howard PA, Otieno G, Burmen B, Otieno F, Odongo F, Odour C, Nyothach E, Amek N, Zielinski-Gutierrez E, Odhiambo F, Zeh C, Kwaro D, Mills LA, Laserson KF. Menstrual Needs and Associations with Sexual and Reproductive Risks in Rural Kenyan Females: A Cross-Sectional Behavioral Survey Linked with HIV Prevalence. J Womens Health (Larchmt) 2015; 24:801-11. [PMID: 26296186 PMCID: PMC4624246 DOI: 10.1089/jwh.2014.5031] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Females in low and middle income countries (LMICs) have difficulty coping with menstrual needs, but few studies have examined the social or health implications of these needs. Methods: Responses from 3418 menstruating females aged 13–29 years were extracted from an HIV and behavioral risks cross-sectional survey conducted in rural western Kenya. We examined sanitary products used, provision of products from sexual partners or from transactional sex, and demographic and sexual exposures. Results: Overall, 75% of females reported using commercial pads and 25% used traditional materials such as cloth or items like paper or tissue, with 10% of girls <15 years old depending on makeshift items. Two-thirds of females with no education relied on traditional items. Having attended secondary school increased the odds of using commercial pads among married (adjusted odds ratios [AOR] 4.8, 95% confidence interval [CI] 3.25–7.12) and single females (AOR 2.17, 95% CI 1.04–4.55). Married females had lower odds of pad use if they reported early (<12 years of age) compared with later (≥18 years) sexual debut (64% vs. 78%, AOR 0.45, 95% CI 0.21–0.97). Two-thirds of pad users received them from sexual partners. Receipt was lower among married females if partners were violent (AOR 0.67, 95% CI 0.53–0.85). Receipt among single females was higher if they had two or more sexual partners in the past year (AOR 2.11, 95% CI 1.04–4.29). Prevalence of engaging in sex for money to buy pads was low (1.3%); however, 10% of 15-year-olds reported this, with girls ≤15 having significantly higher odds compared with females over 15 (AOR 2.84, 95% CI 0.89–9.11). The odds of having transactional sex for pads was higher among females having two or more partners in the past 12 months (AOR 4.86, 95% CI 2.06–11.43). Conclusions: Menstrual needs of impoverished females in rural LMICs settings likely leads to increased physical and sexual harms. Studies are required to strengthen knowledge and to evaluate interventions to reduce these harms.
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Affiliation(s)
- Penelope A Phillips-Howard
- 1 Department of Clinical Sciences, Liverpool School of Tropical Medicine , Liverpool, United Kingdom .,2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | - George Otieno
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | - Barbara Burmen
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | - Frederick Otieno
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya .,3 Nyanza Reproductive Health Society , Kisumu, Kenya
| | - Frederick Odongo
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | - Clifford Odour
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | - Elizabeth Nyothach
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | - Nyanguara Amek
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | | | - Frank Odhiambo
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | - Clement Zeh
- 5 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Kisumu, Kenya
| | - Daniel Kwaro
- 2 Kenya Medical Research Institute , Centre for Global Health Research, Kisumu, Kenya
| | - Lisa A Mills
- 5 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Kisumu, Kenya
| | - Kayla F Laserson
- 6 Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention , Atlanta, Georgia
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Jordanova T, Cronk R, Obando W, Medina OZ, Kinoshita R, Bartram J. Water, sanitation, and hygiene in schools in low socio-economic regions in Nicaragua: a cross-sectional survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:6197-217. [PMID: 26035665 PMCID: PMC4483696 DOI: 10.3390/ijerph120606197] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/25/2015] [Indexed: 11/16/2022]
Abstract
Water, sanitation, and hygiene (WaSH) in schools contributes to better health and educational outcomes among school-aged children. In 2012, UNICEF Nicaragua and partners conducted a cross-sectional survey of WaSH in 526 schools in 12 low socio-economic status municipalities in Nicaragua. The survey gathered information on: school characteristics; teacher and community participation; water and sanitation infrastructure; and hygiene education and habits. Survey results were analyzed for associations between variables. WaSH coverage was significantly higher in urban than rural areas. Presence of drinking water infrastructure (43%) was lower than sanitation infrastructure (64%). Eighty-one percent of schools had no hand washing stations and 74% of schools lacked soap. Sanitation facilities were not in use at 28% of schools with sanitation infrastructure and 26% of schools with water infrastructure had non-functional systems. Only 8% of schools had budgets to purchase toilet-cleaning supplies and 75% obtained supplies from students’ families. This study generates transferable WaSH sector learnings and new insights from monitoring data. Results can be used by donors, service providers, and policy makers to better target resources in Nicaraguan schools.
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Affiliation(s)
- Tania Jordanova
- Department of Environmental Sciences and Engineering, The Water Institute, University of North Carolina, Chapel Hill, NC 27599, USA.
| | - Ryan Cronk
- Department of Environmental Sciences and Engineering, The Water Institute, University of North Carolina, Chapel Hill, NC 27599, USA.
| | - Wanda Obando
- The United Nations Children's Fund (UNICEF), Managua 10000, Nicaragua.
| | | | - Rinko Kinoshita
- The United Nations Children's Fund (UNICEF), Managua 10000, Nicaragua.
| | - Jamie Bartram
- Department of Environmental Sciences and Engineering, The Water Institute, University of North Carolina, Chapel Hill, NC 27599, USA.
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