Effects of planned education on genital hygiene behavior of adolescent females in a secondary school: A quasi-experimental study in northern Cyprus

This study was conducted as a pretest-posttest quasi-experimental design to determine the effect of planned education on the genital hygiene behaviors of secondary school female students in northern Cypurs. The research was conducted with 290 adolescents. Data were collected by using a personal information form and the Genital Hygiene Behavior Scale (GHBS). The paired sample t-test was used to analyze the data. It was determined that only 55.2 % of the adolescents received genital hygiene training, 11.7% had a genital infection and 48.6% used cosmetic products for the genital area. After education, there was a statistically significant increase in the GHBS scores and its dimensions, indicating the effectiveness and necessity of genital hygiene education. Genital hygiene education had a positive effect on the knowledge and practices of adolescent females. Therefore, planned education on genital hygiene, in which nurses play an important role, can be conducted regularly educations and home visits.

Menstrual health and hygiene amongst adolescent girls and women of reproductive age: a study of practices and predictors, Odisha, India

BACKGROUND

Menstruation is a major physiological change in a woman's life, but lack of knowledge, poor practices, socio-cultural barriers, poor access to products and their improper disposal have significant consequences on health, dignity and well-being of women and adolescent girls.

OBJECTIVES

This study aimed to assess the knowledge and practices related to menstrual health and hygiene amongst females of 10-49 years of age; explore the experiences and challenges of women during menstruation; and identify the key predictors of healthy menstrual health and hygiene.

METHODS

Using a cross-sectional study design, we adopted a mixed methods approach for data collection. For quantitative household survey, a total of 921 respondents were selected from three districts of Odisha. Qualitative findings through focus group discussions and in-depth interviews supplemented the survey findings and helped to identify the barriers affecting good menstrual practices. Epi data version 2.5 and R 4.2.2 was used for data entry and data analysis, respectively. Descriptive statistics was used to calculate proportion, mean and standard deviation; Chi square test was used to measure the association between categorical variables. Bivariate and multivariate logistics analyses were done to identify predictors of healthy menstrual health and hygiene. For qualitative data analysis, thematic analysis approach was adopted using software Atlas.ti 8.

RESULTS

For 74.3% respondents, mothers were the primary source of information; about 61% respondents were using sanitary pad. The mean age at menarche was 12.9 years and almost 46% of respondents did not receive any information about menstruation before menarche. Lower age and education up to higher secondary level or above had statistically significant associations with the knowledge about menstruation. Age, caste, respondent's education, mother's education, sanitation facility, availability of water, accessibility and affordability for sanitary pads were found to be strongly associated with good menstrual hygiene practices.

CONCLUSION

Traditional beliefs regarding menstruation still persists at the community level. Educating mothers, increasing awareness about safe menstrual hygiene, providing adequate water and sanitation facilities and ensuring proper disposal of menstruation products need priority attention.

Barriers to Women's Menstrual Hygiene Practices during Recurrent Disasters and Displacement: A Qualitative Study

Disasters that involve displacement are particularly challenging for managing personal and menstrual hygiene, which can increase the risk of toxic shock syndrome, infections and other health conditions that can endanger women's lives. This study aimed to examine the menstrual hygiene challenges experienced by internally displaced women affected by recurrent natural disasters and subsequent displacement in the context of a low-middle-income country, i.e., Pakistan. A critical ethnographic study was undertaken in disaster-relief camps in the northern region of Pakistan. Data were collected using multiple methods, including field observations, review of media reports and in-depth interviews with 18 women. The findings suggested that the key barriers to the personal and menstrual hygiene of women during recurrent disasters and displacement in the mountainous rural region of Pakistan include inadequate housing, lack of infrastructure and humanitarian aid, no waste disposal system and lack of women-friendly spaces in disaster-relief camps. Community-based collaboration is necessary for the implementation of effective interventions. A comprehensive menstrual response to promote the health and well-being of women during disasters must include menstruation supplies, supportive facilities (mainly toilets and bathing facilities), supplementary supplies for storing, washing and drying, disposal/waste management facilities, education and culturally appropriate spaces and supplies.

Utilization of modern menstrual methods and related unmet needs among college going women in Coimbatore district: a descriptive cross-sectional study

OBJECTIVES

The primary objectives were to determine the proportion of modern menstrual method (MMM) users among college going women in Coimbatore district, Tamil Nadu; and to estimate the unmet needs associated with use of MMMs in comparison with other menstrual hygiene methods (MHMs). We also assessed the factors that determine MMM use among college going women.

METHODS

This was a descriptive cross-sectional study conducted among college going women in Coimbatore district, Tamil Nadu, India between October 2022 and January 2023 using a purpose predesigned, pretested, semi-structured proforma that included validated Menstrual Practice Needs Scale (MPNS-36).

RESULTS

Only 1.4% of the study participants used MMMs - menstrual cups (1.3%) and tampons (0.1%). Sanitary pads were the most common MHM of choice (96.3%); of which majority (98.6%) used disposable pads and more than half (50.4%) used non-biodegradable pads. Importantly, one in six (16.5%) were not aware of nature of sanitary pads (biodegradable or nonbiodegradable) used. The unmet needs associated with MMMs (menstrual cups and tampons) were significantly lower than that for other MHMs (including sanitary pads), in particular, the unmet material and home environment needs, unmet material reliability concerns, unmet reuse needs and unmet reuse insecurity. However, we found no significant difference between MMMs, sanitary pads and other MHMs in terms of unmet transport, college environment, change and disposal insecurity needs. The significant predictors of use of MMMs were age (more than 21 years of age), residence (urban), type of stay (off campus including home), socioeconomic status (upper), fathers' and mothers' education (high school and above), and presence of personal income. Discussions with friends (or peers) both before and after menarche regarding menstruation resulted in higher adoption of modern menstrual methods.

CONCLUSION

MMMs provided comparative advantage with lesser unmet needs for material reliability and reuse insecurity concerns, particularly in home environment. However, none of the MHMs fulfilled the user expectations for transport and disposal insecurity concerns, particularly outdoors.

Effect of a Homestead Food Production and Food Hygiene Intervention on Biomarkers of Environmental Enteric Dysfunction in Children Younger Than 24 Months in Rural Bangladesh: A Cluster-Randomized Controlled Trial

Poor sanitation and hygiene practices and inadequate diets can contribute to environmental enteric dysfunction (EED). We evaluated the impact of a combined homestead food production and food hygiene intervention on EED biomarkers in young children in rural Bangladesh. The analysis was conducted within the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized trial in Sylhet, Bangladesh. The FAARM trial enrolled 2,705 married women and their children younger than 3 years of age in 96 settlements (geographic clusters): 48 intervention and 48 control. The 3-year intervention (2015-2018) included training on gardening, poultry rearing, and improved nutrition practices and was supplemented by an 8-month food hygiene behavior change component, implemented from mid-2017. We analyzed data on 574 children age 0 to 24 months with multilevel linear regression. We assessed fecal myeloperoxidase (MPO), neopterin (NEO), and alpha-1-antitrypsin (AAT) as biomarkers of EED, and serum C-reactive protein (CRP) and alpha-1-acid glycoprotein (AGP) as biomarkers of systemic inflammation, using ELISA. There was no intervention effect on NEO, AAT, CRP, and AGP concentrations, but, surprisingly, MPO levels were increased in children of the intervention group (0.11 log ng/mL; 95% CI, 0.001-0.22). This increase was greater with increasing child age and among intervention households with poultry that were not kept in a shed. A combined homestead food production and food hygiene intervention did not decrease EED in children in our study setting. Small-scale poultry rearing promoted by the intervention might be a risk factor for EED.

Training and career opportunities for residencies in Hygiene and Preventive Medicine: results of a survey on 39 Italian schools

INTRODUCTION

The Italian National Health Service (SSN) is currently grappling. with a complex situation, characterized by a persistent shortage of medical personnel and the divergent aspirations of young medical graduates. Additionally, recent regulatory developments concerning specialist training further contribute to the intricacies of the landscape, calling for a comprehensive analysis of the challenges and opportunities within the sector. This study aims to provide an updated overview of the current placement of medical graduates, residents and specialists in the specific hygiene and preventive medicine (Public Health) field.

METHODS

Data on admissions, withdrawals and resignations were obtained from the Ministries of Universities and Health and from the archives of the "Associazione Liberi Specializzandi" (ALS). Information regarding the professional prospects for specialists and residents in the field of Public Health was gathered through a tailored survey conducted by the "Consulta dei Medici in Formazione Specialistica" (Council of Medical Residents) of the Italian Society of Hygiene (SItI).

RESULTS

In 2022, a total of 483 specialization contracts were granted, indicating a decrease of 37% compared to the previous year. Notably, 85 positions (17.6%) remained unallocated or resulted in dropouts. Six months after completing their residency, 1.5% of hygiene residents were still actively seeking employment. On a positive note, 75.4% of fourth-year residents secured contracts under the "Decreto Calabria". Career opportunities within the Italian SSN have witnessed growth, with a significant proportion of placements in territorial services and hospital medical directorates.

DISCUSSION AND CONCLUSIONS

The updating of training programs provided by residency schools and the exploration of innovative approaches are of paramount importance to address the urgent need for high-quality training and to cater to the requirements of the national health system.

Menstrual health and hygiene among young Palestinian female university students in the West Bank: a cross-sectional study

OBJECTIVE

We investigated some aspects of menstrual health and hygiene among young female students at Birzeit University in the West Bank of the occupied Palestinian territory.

DESIGN

Cross-sectional study in a large central university.

PARTICIPANTS

Out of a total of 8473 eligible female students, a calculated sample size of 400 students aged between 16 and 27 years was obtained.SettingLarge central university, West Bank, occupied Palestinian territory (oPt).

MEASURES

An anonymous structured international research instrument consisting of 39 questions based on the Menstrual Health Questionnaire, in addition to few questions relevant to the context, was administered.

RESULTS

30.5% of participants were not informed about menstruation before menarche, and 65.3% reported that they were not ready when they got their first period. The highest reported source of information regarding menstruation was family (74.1%), followed by school (69.3%). About 66% of respondents reported that they need more information on various topics of menstruation. The most common type of menstrual hygiene products used were single-use pads (86%), followed by toilet paper (13%), nappies (10%) and reusable cloths (6%). Of the total 400 students, 14.5% reported that menstrual hygiene products are expensive, and 15.3% reported that they always/sometimes had to use menstrual products that they do not like because they are cheaper. Most (71.9%) of the respondents reported that they used menstrual products for longer time than recommended due to inadequate washing facilities at the university campus.

CONCLUSIONS

The findings provide useful evidence on the lack and the need for menstrual-related information for female university students, inadequate infrastructure to help them manage their menstruation with dignity and pointed to some menstrual poverty in accessing menstrual products. A national intervention programme is needed to increase awareness regarding menstrual health and hygiene among women in local communities and female teachers in schools and universities to enable them to disseminate information to and meet the practical needs of girls at home, at school and at the university.

Teachers' reflections on menstrual management among urban and rural schoolgirls in South Africa

Menstruation affects all aspects of an adolescent schoolgirl's life, including her educational journey. Experiences of menstruation within the school environment can either positively or negatively affect a girl's schooling career. The purpose was to investigate the role of teachers in the school setting regarding addressing young girls' experiences with menstruation in Cape Town, South Africa. We conducted a qualitative, exploratory study to purposively select six teachers from three, two urban and one rural. Six individual interviews were conducted by the researcher per school and data was transcribed and refined into themes. The main findings included, school attendance, culture, experiences and perceptions of teachers, and recommended key resources. Findings illustrate that there is a direct association between menstruation and school attendance. Challenges such as a dearth of sanitary products create a barrier for school attendance of adolescent girls. An improved understanding of culture and the challenges that menstruating adolescent schoolgirls face is needed to provide proper and adequate support. A language barrier may exist between teachers and learners, including a cultural unwillingness to speak openly about menstruation. Educational policies are needed to address the need for sanitary resources in schools to establish best practice for teachers in dealing with menstruating young schoolgirls.

Educational intervention to improve menstrual hygiene management in adolescent girls in Kalimantan, Indonesia

Objectives

To determine the effect of health education on menstrual hygiene management in adolescents.

METHODS

The quasi-experimental study was conducted from April to July 2021 in Sampit, Kalimantan, Indonesia, after approval from ethics review committee of the Nursing University of Airlangga, Surabaya, East Java, Indonesia. The sample comprised grade VII female students at a public junior high school in Sampit. The sample was divided into intervention group A and control group B. Group A was given a health education intervention through video conferences in two meetings and was given a leaflet after each meeting which lasted 90 minutes. The control group was only given a leaflet. Baseline and post-intervention data was compared. Data was analysed using SPSS 16.

RESULTS

There were 70 subjects; 35(50%) in each of the two groups. The age range was 12-14 years, with 25(71.4%) subjects in group A and 28(80%) in group B being aged 13 years. The age of menarche was 12 years for 17(48.6%) subjects in each of the two groups. Knowledge level of group A increased significantly post-intervention (p<0.05), but group B showed no significant difference (p=0.144).

CONCLUSIONS

Health education on menstrual hygiene management was found to have a beneficial influence on knowledge and attitudes among adolescents.

Development and validation of the Self-Efficacy in Addressing Menstrual Needs Scale (SAMNS-26) in Bangladeshi schools: A measure of girls' menstrual care confidence

OBJECTIVE

Qualitative studies have described girls' varying levels of confidence in managing their menstruation, with greater confidence hypothesized to positively impact health, education, and social participation outcomes. Yet, measurement of this and other psychosocial components of adolescent girls' menstrual experiences has been weak in global health research, in part due to a dearth of appropriate psychometric tools. We describe the development and validation of the Self-Efficacy in Addressing Menstrual Needs Scale (SAMNS-26).

METHODS

We conducted nine focus group discussions with girls in schools in rural and urban Bangladesh to identify tasks involved in menstrual self-care. This informed our creation of an initial pool of 50 items, which were reviewed by menstrual health experts and refined through 21 cognitive interviews with schoolgirls. Using a self-administered survey, we administered 34 refined items plus additional validation measures to a random sample of 381 post-menarcheal girls (ages 9-17) and retested a subsample of 42 girls two weeks later. We examined the measure's dimensionality using exploratory factor analysis and assessed internal consistency, temporal stability, and construct validity.

RESULTS

Exploratory factor analysis suggested a 26-item scale comprising three correlated sub-scales: the 17-item Menstrual Hygiene Preparation and Maintenance (α = 0.86), the 5-item Menstrual Pain Management (α = 0.87), and the 4-item Executing Stigmatized Tasks (α = 0.77). Sub-scales exhibited good temporal stability. SAMNS-26 scores correlated negatively with measures of anxiety, and girls who preferred to stay at home during their periods had lower SAMNS-26 scores than those who did not.

CONCLUSION

The SAMNS-26 provides a reliable measure of a schoolgirl's confidence in her capabilities to address her menstrual needs. There is initial evidence to support the measure's construct validity in the Bangladesh context as indicated by its relationships with other factors in its theorized nomological network. The tool enables incorporation of self-efficacy into multivariate models for exploring the relationships among antecedents to menstrual experiences and hypothesized impacts on health, wellbeing, and education attainment. Further testing of the tool is recommended to strengthen evidence of its validity in additional contexts.

Safe menstrual hygiene management practice and associated factors among female adolescent students at high schools in central Ethiopia: A mixed–method study

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.

Effects of Menstrual Health and Hygiene on School Absenteeism and Drop-Out among Adolescent Girls in Rural Gambia

Poor knowledge and management of menstruation impacts girls' school attendance and academic performance. This paper aims to explore how menstrual hygiene management practices and related factors influence school absenteeism and drop-out among primary and secondary school girls in rural Gambia. Mixed-method studies were conducted among students and key informants from 19 schools from July 2015-December 2017. Focus group discussions, in-depth interviews, cross-sectional surveys, menstrual diaries, and school water, sanitation and hygiene (WASH) facility observations were used. Key findings from the interviews were that menstrual pain, cultural beliefs, fear of peers knowing menstrual status, and poor school WASH facilities led to school absenteeism, however, they had no impact on school drop-out. Of the 561 girls surveyed, 27% reported missing at least one school day per month due to menses. Missing school during the most recent menstrual period was strongly associated with menstrual pain (extreme pain adjusted odds ratio (AOR) = 16.8 (95% CI: 7.29-38.74)), as was having at least one symptom suggestive of urinary tract infection (AOR = 1.71 (95% CI: 1.16-2.52)) or reproductive tract infection (AOR = 1.99 (95% CI: 1.34-2.94)). Clean toilets (AOR = 0.44 (95% CI: 0.26-75)), being happy using school latrines while menstruating (AOR = 0.59 (95% CI: 0.37-0.93)), and soap availability (AOR = 0.46 (95% CI: 0.3-0.73)) were associated with reduced odds of school absenteeism. This study suggests menstrual pain, school WASH facilities, urogenital infections, and cultural beliefs affected school attendance among menstruating girls in rural Gambia.

Menstrual health and factors associated with school absence among secondary school girls in Luang Prabang Province, Lao People's Democratic Republic: A cross-sectional study

In Lao People’s Democratic Republic (Lao PDR), information on school sanitation and menstrual health among secondary school girls is limited. This study aimed to explore knowledge and practices surrounding menstrual health and to identify factors associated with school absence due to menstruation among secondary school girls in Lao PDR. The study involved 1,366 girls from grade 9 to grade 12 in six secondary schools in Luang Prabang Province. Data on socio-demographics and menstrual health of the girls and data on school toilets was collected. Logistic regression analysis was performed to identify the factors associated with school absence due to menstruation. The mean age was 15.8 years old. The average age of menarche was 12.9 years old. Of 1,366 girls, 64.6% were shocked or ashamed when they reached menarche and 31.8% had been absent from school due to menstruation in the six months before this study was conducted. Factors associated with school absence due to menstruation were age ≥ 16 years old (AOR = 1.79, 95% CI 1.37–2.34), higher income (AOR = 2.38, 95% CI 1.16–4.87), menstrual anxiety (AOR = 1.55, 95% CI 1.09–2.20), using painkillers (AOR = 4.79, 95% CI 2.96–7.76) and other methods (AOR = 2.82, 95% CI 1.86–4.28) for dysmenorrhea, and disposing used pads in places other than the school’s waste bins (AOR = 1.34, 95% CI 1.03–1.75). Living with relatives (AOR = 0.64, 95% CI 0.43–0.95) and schools outside the city (AOR = 0.59, 95% CI 0.38–0.90) were significantly less associated with school absence. Although the association between school toilets and school absence was not examined, the results of this study suggest that school toilets should be gender-separated and equipped with waste bins in the toilet. Furthermore, menstrual education should start at elementary schools and teacher training on menstrual health should be promoted.

Menstrual characteristics, menstrual anxiety and school attendance among adolescents in Uganda: a longitudinal study

BACKGROUND

Qualitative data show negative impacts of menstruation on health and education in many settings, but there are few longitudinal quantitative studies of the impact of menstruation. We analyse associations with menstrual anxiety and school attendance in a study of Ugandan secondary school students.

METHODS

Data were from a longitudinal pilot study of a menstrual health intervention (MENISCUS), conducted in two secondary schools in Entebbe sub-district, Uganda. Self-completed menstrual-related data, including menstrual anxiety, were collected from 232 participants pre- and post-intervention. A sub-cohort of 100 randomly-selected post-menarcheal girls were asked to self-complete daily diaries during 10 months of follow-up, with data on menstrual flow, pain, and school attendance. We used multivariable logistic regression to estimate associations with menstrual anxiety among all girls at baseline, and random-effects logistic regression to estimate associations of menstrual characteristics with school non-attendance for 3 months pre-intervention in the sub-cohort, adjusting for within-girl clustering.

RESULTS

Overall, 130/222 (58.6%) of menstruating girls reported being anxious about their next period. Menstrual anxiety was higher in those not living with their mother (adjusted odds ratio (OR) = 1.91; 95% confidence interval (CI) 1.01-3.60), believing menstrual myths (aOR = 1.83; 0.95-3.50 for not agreeing that it is healthy for a girl to run, dance or cycle during her period; aOR = 1.97; 1.04-3.73 for agreeing that when a girl has her period she is unclean), lower menstrual confidence (aOR = 2.49; 1.33-4.65 for avoiding physical activity during her period; aOR = 1.68; 0.89-3.17 for not feeling comfortable to talk to other girls about her period; aOR = 2.89; 1.28-6.54 for agreeing that boys/girls tease them about their periods; and aOR = 2.27; 1.21-4.27 for worrying about being teased during her period). Those with lower knowledge about menstruation were less likely to report anxiety (aOR = 0.44; 0.23-0.84). During the pre-intervention period of the sub-cohort, school non-attendance was associated with menstrual pain, with 21.7% of girls missing school on days when they reported pain vs. 8.3% on days when no pain was reported (aOR = 3.82; 1.66-8.77).

CONCLUSIONS

Menstruation causes substantial anxiety in Ugandan schoolgirls, and menstrual pain is associated with missing school on period-days. Menstrual health interventions should address socio-cultural aspects of menstruation to reduce anxiety, and provide education on pain management strategies to support school attendance.

Drivers of menstrual material disposal and washing practices: A systematic review

Background

Disposal and washing facilities and services for menstrual materials are often designed based upon technical specifications rather than an in-depth understanding of what drives peoples’ choices of practices.

Objectives and data sources

This systematic review identified and summarised the main behavioural drivers pertaining to the choice of disposal and washing practices of menstrual materials through the thematic content analysis and study appraisal of 82 publications (80 studies) on menstrual health and hygiene published since 1999, reporting the outcomes of primary research across 26 countries.

Results

Disposal and washing behaviours are primarily driven by the physical state of sanitation facilities; however, this is intrinsically linked to taboos surrounding and knowledge of menstruation.

Implications

Using reasons given for disposal and washing practices by menstruators or those who know them well, or inferred by authors of the reviewed studies, we identify the key considerations needed to design facilities and services which best suit the desired behaviours of both planners and those who menstruate.

Inclusivity

The term menstruators is used throughout to encompass all those mentioned in the studies reviewed (girls and women); although no studies explicitly stated including non-binary or transgender participants, this review uses inclusive language that represents the spectrum of genders that may experience menstruation.

Registration

The review protocol is registered on PROSPERO: 42019140029.

Disparities in menstrual hygiene management between urban and rural schoolgirls in Northeast, Ethiopia

INTRODUCTION

Even though menstruation is a normal biological process, adolescents are facing managing their menstruation when they are at school. It causes girls to miss their class on average three days every month. Studies in some countries showed that the magnitude of menstrual hygiene management problems is higher in rural adolescent girls, but little is known in the Ethiopia context. The objective of this study was to assess and compare menstrual hygiene management practices among rural and urban schoolgirls, Northeast, Ethiopia.

METHODS

An institution-based comparative cross-sectional study was employed among 1078 schoolgirls (539 urban and 539 rural) from February to March 2020. The participants were selected using a multi-stage sampling technique. A structured self-administrative questionnaire and observational checklist were used for data collection. Bivariate and multivariable logistic regression analysis with a 95% confidence interval was employed. A P- value less than 0.05 was used to declare statistical significance.

RESULTS

Overall, the magnitude of good menstrual hygiene practice was 52.9% (95%CI: 50.3%-56.5%), which was 65.9% (95% CI: 62.8%-70.7%) among urban and 39.9% (95% CI: 36.2%-44.6%) among rural schoolgirls. Among urban schoolgirls, the odds of good menstrual hygiene management practice was higher for girls aged below 18 years (AOR = 1.58, 95%CI: 1.05-2.39), learned about menstrual hygiene at school (AOR = 1.89, 95%CI: 1.21-2.97), heard about menstrual hygiene before menarche (AOR = 4.98, 95%CI: 2.71-9.13), and discussed menstrual hygiene with parents (AOR = 2.56, 95%CI: 1.25-5.27). Whereas, the odds of good menstrual hygiene management practice was higher among those who were knowledgeable on menstrual hygiene (AOR = 5.47, 95%CI: 3.68-8.12), those who learned about menstrual hygiene at school (AOR = 1.75, 95%CI: 1.13-2.70), and girls who heard about menstrual hygiene before menarche (AOR = 3.34, 95%CI: 1.44-7.76) in rural schoolgirls.

CONCLUSIONS

Though the overall menstrual hygiene practice was low, it was relatively better among urban schoolgirls. This calls for more effort to solve these problems and achieve sustainable development goals. Therefore, education and awareness creation on menstrual hygiene for schoolgirls, even before menarche at both settings should be strengthened. Encouraging parent-adolescent discussion on menstrual hygiene would have paramount importance, particularly to urban schoolgirls.

Effectiveness of a Multicomponent Intervention to Reduce Multidrug-Resistant Organisms in Nursing Homes: A Cluster Randomized Clinical Trial

IMPORTANCE

Multidrug-resistant organisms (MDROs) can cause significant morbidity and mortality. Preventing MDROs can reduce the risk of subsequent transmission and infection.

OBJECTIVE

To determine whether a multicomponent infection prevention intervention can reduce MDRO prevalence in nursing homes (NHs).

DESIGN, SETTING, AND PARTICIPANTS

This cluster randomized clinical trial of a multicomponent intervention was conducted in 6 NHs in Michigan from September 2016 to August 2018. Three NHs adopted a multicomponent intervention, while 3 control NHs continued without investigator intervention. Study visits were conducted at baseline; days 7, 14, 21, and 30; and monthly thereafter for up to 6 months or discharge. Visits included clinical data collection and MDRO surveillance culturing of multiple body sites and high-touch surfaces in patient rooms. Any patients who provided informed consent within 14 days of admission to the NH were enrolled in this study. Non-English speakers and patients receiving hospice care were ineligible. Analysis was performed from November 2018 to February 2020.

INTERVENTIONS

Intervention NHs adopted a multicomponent intervention that included enhanced barrier precautions, chlorhexidine bathing, MDRO surveillance, environmental cleaning education and feedback, hand hygiene promotion, and health care worker education and feedback. Control nursing homes continued standard care practices.

MAIN OUTCOMES AND MEASURES

The primary outcome, presence of MDROs, was measured longitudinally in the patient and room environment and was evaluated using generalized mixed effect models. The secondary outcome, time to new MDRO acquisition, was assessed using Cox proportional hazard models.

RESULTS

A total of 6 NHs were included, with 245 patients (mean [SD] age, 72.5 [13.6] years; 134 [54.7%] women) enrolled; 3 NHs with 113 patients (46.1%) were randomized to the intervention group and 3 NHs with 132 patients (53.9%) were randomized to the control group. A total of 132 patients (53.9%) were White, and 235 patients (95.9%) were receiving postacute care. Over 808 study visits, 3654 patient cultures and 5606 environmental cultures were obtained. The intervention reduced the odds of MDRO prevalence in patients' environment by 43% (aOR, 0.57; 95% CI, 0.35-0.94), but there was no statistically significant difference on the patient level before or after adjustment (aOR, 0.57; 95% CI, 0.29-1.14). There were no significant reductions in time to new acquisition for methicillin-resistant Staphylococcus aureus (hazard ratio [HR], 0.20; 95% CI, 0.04-1.09), vancomycin-resistant enterococci (HR, 0.84; 95% CI, 0.46-1.53), or resistant gram-negative bacilli (HR, 1.14; 95% CI, 0.73-1.78).

CONCLUSIONS AND RELEVANCE

This cluster randomized clinical trial found that the multicomponent intervention reduced the prevalence of MDROs in the environment of NH patients. Our findings highlight the potential for multicomponent interventions to directly and indirectly reduce MDRO prevalence in NHs.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02909946.

Menstrual hygiene management among adolescent school girls in Taraba State, Nigeria

Background

The onset of menstruation denotes a landmark event in pubertal development of the adolescent girl. Lack of adequate knowledge and good menstrual hygiene management can have far reaching consequences on the girl's wellbeing, dignity and reproductive health.

Objectives

This study assessed the menstrual knowledge and hygiene practices of adolescent school girls in Taraba State, Nigeria.

Methods

A descriptive cross sectional study conducted among 297 adolescent school girls. Participants were selected using multistage sampling technique. A self-administered, structured questionnaire was used for data collection. The Statistical Package for Social Sciences (SPSS) version 22.0 was used for the analysis of data.

Results

The mean age at menarche was 13.7 years (± 6.7). Over three-quarter (76.1%) of the girls knew about menstruation before experiencing it. Mothers (48.1%) were the leading source of information about menstruation to the students. The study found that 207 (69.7%) of respondents had good knowledge about menstruation while 171 (57.58%) had good menstrual hygiene management. Knowledge was significantly associated with good menstrual hygiene management (p<0.001).

Conclusion

Knowledge of menstruation and hygienic practices during menstruation among the participants in the study was encouraging. Every adolescent girl should be equipped with the right knowledge and support for good menstrual hygiene management.

Examining the predictors of use of sanitary napkins among adolescent girls: A multi-level approach

Background

This paper aimed to explore various factors associated with the use of sanitary napkins among adolescent girls in Uttar Pradesh and Bihar.

Methods

The study uses information from the Understanding the Lives of Adolescents and Young Adults (UDAYA) project survey conducted in Uttar Pradesh and Bihar in 2016. The study sample consisted of 14,625 adolescent girls aged 10–19 years. The study sample was selected using a multi-stage systematic sampling design. Multilevel logistic regression (MLR) was used to identify the individual and community level factors associated with the use of sanitary napkins.

Results

The results revealed a wide variation in sanitary napkins’ use across the socio-economic and demographic factors. The use of sanitary napkins was significantly higher among girls with 8–9 (53.2%) and 10 and more (75.4%) years of schooling compared to those who had no formal education (26.4%). The use of sanitary napkins was higher among adolescent girls who were not engaged in paid work (54.7%) than those who did any paid job (40.8%). Adolescent girls reporting frequent exposure to mass media (OR = 2.10), belonging to the richest wealth quintile (OR = 3.76), and whose mothers had 10 or more years of education (OR = 2.29) had a higher propensity to use sanitary napkins than their counterparts. We did not find a significant role of community-level education of mothers on the menstrual hygiene practices of adolescents.

Conclusion

Ensuring that adolescent girls have access to hygienic means to manage their menses is critical from a public health perspective and in enabling them to realize their full potential. Programs to enhance menstrual hygiene are warranted. These programs should involve mothers, who are an important source of knowledge about menstrual hygiene. Facilitating girls’ access to education may also produce tangible menstrual hygiene benefits.

An online survey and review about the awareness, coping style, and exercise behavior during the "COVID-19 pandemic situation" by implementing the cloud-based medical treatment technology system in China among the public

To examine basic COVID-19 knowledge, coping style and exercise behavior among the public including government-provided medical cloud system treatment app based on the internet during the outbreak. Besides, to provide references for developing targeted strategies and measures on prevention and control of COVID-19. We conducted an online survey from 11th to 15th March 2020 via WeChat App using a designed questionnaire. As well as aim to diagnose COVID-19 earlier and to improve its treatment by applying medical technology, the "COVID-19 Intelligent Diagnosis and Treatment Assistant Program (nCapp)" based on the Internet of Things. Valid information was collected from 1893 responders (47.07% males and 52.93% females aged 18-80 years, with a mean age of 31.05 ± 9.86) in 20 provincial-level regions across China. From the responders, 92.90% and 34.81% were scaled pass and good and above scores for the knowledge about the novel coronavirus epidemic. 38.44% were scaled poor scores and only 5.40% were scaled good and above scores for appropriate behavior coping with the pandemic. Among the responders, 52.14% reported having active physical exercise in various places during the previous 1 week. For all the responders, appropriate behavior coping correlated positively with physical exercise (p < 0.05); the daily consumed time for getting the epidemic-related information correlated positively with the score for cognition on the epidemic's prevention measures (r = 0.111, p < 0.01) and on general knowledge about the epidemic (r = 0.087, p < 0.01). Targeted and multiple measures for guidance on the control of COVID-19 among the public should be promoted to improve the cognition on basic knowledge, behaviors and treatment.

Menstrual hygiene management practices and associated health outcomes among school-going adolescents in rural Gambia

Inadequate menstrual hygiene management (MHM) practices have been associated with adverse health outcomes. This study aimed to describe MHM practices among schoolgirls from rural Gambia and assess risk factors associated with urogenital infections and depressive symptoms. A cross-sectional study was conducted among adolescent schoolgirls in thirteen schools in rural Gambia. A questionnaire was used to collect information on socio-demographics, MHM practices and clinical symptoms of reproductive and urinary tract infections (UTIs). A modified Beck Depression Inventory-II was used to screen for depressive symptoms. Mid-stream urine samples were collected to assess for UTIs. Modified Poisson regression analysis was used to determine risk factors for symptoms of urogenital infections and depression among adolescent girls. Three hundred and fifty-eight girls were recruited. Although, 63% of the girls attended schools providing free disposable pads, reusable cloths/towels were the commonest absorbent materials used. Heavy menstrual bleeding was associated with depressive symptoms (adjusted prevalence ratio, aPR 1.4 [95% CI 1.0, 1.9]), while extreme menstrual pain (aPR 1.3 [95% CI 1.2, 1,4]), accessing sanitary pads in school (aPR 1.4 [95% CI 1.2, 1.5]) and less access to functional water source at school (aPR 1.4 [95% CI 1.3, 1.6]) were associated with UTI symptoms. Conversely, privacy in school toilets (aPR 0.6 [95% CI 0.5, 0.7]) was protective for UTI symptoms. Heavy menstrual bleeding (aPR 1.4 [95% CI 1.1, 2.0]) and taking <30 minutes to collect water at home were associated with RTI symptoms (aPR 1.2 [95% CI 1.0, 1.5]) while availability of soap in school toilets (aPR 0.6 [95% CI 0.5, 0.8] was protective for RTI symptoms. Interventions to ensure that schoolgirls have access to private sanitation facilities with water and soap both at school and at home could reduce UTI and RTI symptoms. More attention is also needed to support girls with heavy menstrual bleeding and pain symptoms.

Water, sanitation, and hygiene conditions and prevalence of intestinal parasitosis among primary school children in Dessie City, Ethiopia

BACKGROUND

Intestinal parasitosis is a major public health problem that affects the health of primary school children in low- and middle-income countries where water, sanitation, and hygiene (WASH) conditions are deficient. Since there is a paucity of information on the prevalence and associated factors of this problem among primary school children in Dessie City in Ethiopia, this study was designed to address these gaps.

METHODS

A school-based cross-sectional study was conducted among 407 stratified-sampled primary school children in five primary schools at Dessie City from April to June 2018. Data were collected using a pretested structured questionnaire, an observation checklist and laboratory analysis of stool samples. Stool specimen from each study participant was collected using clean, properly labeled and leak-proof stool cup. A portion of stool from each study participant collected sample was processed using saline wet mount technique and examined by microscope. The remaining specimens were preserved with 10% formalin and transported to Dessie Comprehensive Specialized Hospital laboratory to be processed by using formol-ether concentration technique. Then, slide smears were prepared from each processed stool specimen and finally, it was microscopically examined with 10x as well as 40x objectives for the presence or absence of intestinal parasites. Factors significantly associated with intestinal parasitosis were determined using binary logistic regression model at 95% CI (confidence interval). Thus, bivariate (COR [crude odds ratio]) and multivariable (AOR [adjusted odds ratio]) logistic regression analyses were carried out. From the multivariable analysis, variables having a p-value of less than 0.05 were declared as factors significantly associated with intestinal parasitosis among primary school children.

MAIN FINDINGS

The overall prevalence of intestinal parasitosis was found to be 16.0% (95% CI: 12.5-19.4%), of these, 50.8% were positive for protozoa, 32.2% for helminth infections and 16.9% for double co-infections. Entamoeba histolytica was the most prevalent parasite (29.2%), followed by Giardia lamblia (21.5%), Ascaris lumbricoides (18.5%), Hymenolepis nana (9.2%) and Enterobius vermicularis (4.6%). Prevalence rates were similar among government (16.3%) and private (15.7%) school children. Water consumption was less than 5 liters per capita per day in 4 of the 5 schools. Thirty-eight (9.3%) of primary school students reported that they practiced open defecation. About two-thirds (285, 70.0%) said they always washed their hands after defecation. Mother's education (illiterate) (AOR = 3.3; 95% CI: 1.20-9.37), father's education (illiterate) (AOR = 3.9; 95% CI: 1.40-10.82), fathers who could read and write (AOR = 3.3; 95% CI: 1.25-7.86), handwashing before meal (sometimes) (AOR = 2.2; 95% CI: 1.11-4.17) and poor knowledge of WASH (AOR = 9.3; 95% CI: 2.17-16.70) were statistically associated with presence of intestinal parasitic infections.

CONCLUSION

We concluded that the prevalence of intestinal parasitosis in the study area among Grades 4-8 primary school children had public health significance. Factors significantly associated with intestinal parasitosis among primary school children's were illiterate mothers and fathers, irregular handwashing of children before meals, and poor knowledge of WASH. Health education to improve students' WASH knowledge and mass deworming for parasites are recommended as preventive measures; and improvements to the quality of WASH facilities in primary schools are strongly recommended to support these measures.

Effectiveness of Mass Media Campaigns to Improve Handwashing-Related Behavior, Knowledge, and Practices in Rural Bangladesh

Water, sanitation, and handwashing interventions that use intensive interpersonal communication improve targeted behaviors, but are expensive at scale. Mass media is an alternative that could reach more people at lower cost but has rarely been rigorously evaluated. We assessed the effectiveness of a mass media campaign in improving handwashing knowledge and practices in rural Bangladesh. We conducted a cross-sectional assessment before the campaign among 8,947 households and again after 4 months of the campaign among 8,400 different households in the same areas. Trained enumerators conducted spot checks of water, sanitation, and hygiene facilities, and recorded reported knowledge and practices. We compared these outcomes after versus before the campaign using generalized linear models with robust standard errors. After the media campaign, caregivers were more likely to recall ≥ 3 messages regarding handwashing (prevalence ratio [PR] = 1.44, 1.34-1.55), sanitation (PR = 1.45, 1.35-1.55), and safe water (PR = 1.17, 1.08-1.26). After the campaign, the prevalence of using soap and water during handwashing demonstrations was higher among caregivers (PR = 1.15, 1.12-1.19) and children (PR = 1.31, 1.22-1.41). Hands were more commonly observed to be visibly clean among caregivers (PR = 1.14, 1.07-1.20) and children (PR = 1.13, 1.05-1.21). Soap and water was more commonly observed in handwashing stations near latrines (PR = 1.12, 1.06-1.19) and in cooking/eating places (PR = 1.09, 1.01-1.18). Our findings indicate improved handwashing knowledge and behaviors following a mass media campaign. This promising approach can be deployed to improve water, sanitation, and hygiene practices at scale and should be evaluated in other contexts.

Food Hygiene Practices at the Ghana School Feeding Programme in Wa and Cape Coast Cities

Objective

The integrity and the wholesomeness of the food served to school pupils cannot be overlooked, especially when one considers the magnitude of health and sanitation issues that are plaguing the West African nations. This study aimed to investigate some of the personal hygiene practices by the pupils and the hygienic conditions in which food is cooked and served to these school-going children under the Ghana School Feeding Programme (GSFP).

Design

A cross-sectional and descriptive survey research designs were used in the study. Purposive and simple random sampling techniques were employed in selecting participants. Participants. There were 720 respondents for the study, comprising 600 pupils, 60 teachers, and 60 kitchen staff members from 20 schools. Information was obtained using questionnaire, observation, and unstructured interview instruments.

Results

Findings from the study revealed that the majority of pupils (92% in Wa and 65% in Cape Coast) did not wash their hands with soap under running water. No hand washing centers for pupils were also seen in most of the schools studied. Majority of the cooks did not have health certificate, and neither had attended any in-service training in two years. In both Wa and Cape Coast municipal schools, none of the kitchen staff admitted that pupils and teachers ever complained about the meals they served to the pupils.

Conclusion

The GSFP in basic schools forms part of the integral diet of the school children; hence, provision of good quality food can affect the health, learning, and physical activities of these children. Observational checklist revealed that most of the kitchen staff do not strictly adhere to basic food hygiene practices, and this affects the wholesomeness of the food served to the children. There is, therefore, a need for kitchen staff training on hygiene and food preparation practices.

Improving Complementary Food Hygiene Behaviors Using the Risk, Attitude, Norms, Ability, and Self-Regulation Approach in Rural Malawi

The study evaluated the effectiveness of an intervention to improve complementary food hygiene behaviors among child caregivers in rural Malawi. Formative research and intervention development was grounded in the risk, attitude, norms, ability, and self-regulation (RANAS) model and targeted washing hands and kitchen utensils with soap, safe utensil storage, reheating of leftover food, and feeding of children by caregivers. Longitudinal research was applied at baseline and follow-up surveys among 320 caregivers. Determinants of selected behaviors were found, and interventions were developed based on the behavior change techniques aligned with these determinants in the RANAS model. The intervention was delivered over 9 months through group (cluster) meetings and household visits and included demonstrations, games, rewards, and songs. We randomly assigned villages to the control or intervention group. Follow-up results indicated a significant increase in three targeted behaviors (washing kitchen utensils with soap, safe utensil storage, and handwashing with soap) among intervention recipients. Several psychosocial factors differed significantly between the intervention and control groups. Mediation results showed that the intervention had a significant effect on these three targeted behaviors. For handwashing, feelings, others' behavior in the household, and remembering; for washing kitchen utensils, others' behavior in the household and difficulty to get enough soap; for safe utensils storage, others' behavior in the village and remembering mediated the effect of the intervention on the targeted behaviors. The study demonstrated that targeting food hygiene behaviors with a theory-driven behavior change approach using psychosocial factors can improve the behavior of child caregivers in rural Malawi.

Logic in the time of coronavirus

Much has happened here since the local news media trumpeted the first Australian COVID-19 fatality, and stirred up a medieval fear of contagion. We now need to take a step back to examine the logic underlying the use of our limited COVID-19 countermeasures. Emerging infectious diseases by their nature, pose new challenges to the diagnostic-treatment-control nexus, and push our concepts of causality beyond the limits of the conventional Koch-Henle approach to aetiology. We need to use contemporary methods of assessing causality to ensure that clinical, laboratory and public health measures draw on a rational, evidence-based approach to argumentation. The purpose of any aetiological hypothesis is to derive actionable insights into this latest emerging infectious disease. This review is an introduction to a conversation with medical microbiologists, which will be supported by a moderated blog.

Menstrual health intervention and school attendance in Uganda (MENISCUS-2): a pilot intervention study

OBJECTIVES

Achieving good menstrual health and hygiene (MHH) is a public health challenge and there is little evidence to inform interventions. The aim of this study was to pilot test an intervention to improve MHH and school attendance in Uganda, in preparation for a future cluster-randomised trial.

DESIGN

Longitudinal study with pre-post evaluation of a pilot intervention.

SETTING

Two secondary schools in Entebbe, Uganda.

PARTICIPANTS

Of the 473 eligible students in secondary 2 (S2) at baseline, 450 (95.1%; 232 girls and 218 boys) consented/assented. 369 students (188 girls; 81.0%; and 181 boys; 83.0%) participated in the endline survey.

INTERVENTION

The intervention comprised training teachers to improve delivery of government guidelines for puberty education, training in use of a menstrual kit and pain management, a drama skit, provision of analgesics and improvements to school water and sanitation hygiene facilities.

PRIMARY AND SECONDARY OUTCOME MEASURES

Feasibility and acceptability of delivering the intervention. Baseline and endline quantitative surveys were conducted, with qualitative interviews conducted at endline. School attendance was assessed using self-completed daily diaries among a nested cohort of 100 female students.

RESULTS

There were high levels of uptake of the individual and behavioural intervention components (puberty education, drama skit, menstrual hygiene management (MHM) kit and pain management). The proportion of girls reporting anxiety about next period decreased from 58.6% to 34.4%, and reported use of effective pain management increased from 76.4% to 91.4%. Most girls (81.4%) reported improved school toilet facilities, which improved their comfort managing menstruation. The diary data and qualitative data indicated a potential intervention impact on improving menstrual-related school absenteeism.

CONCLUSIONS

The pilot study showed that the multicomponent MHM intervention was acceptable and feasible to deliver, and potentially effective in improving menstruation knowledge and management. A cluster-randomised trial is needed to evaluate rigorously the intervention effects on MHM and school attendance.

TRIAL REGISTRATION NUMBER

NCT04064736; Pre-results.

'It's like a burden on the head': Redefining adequate menstrual hygiene management throughout women's varied life stages in Odisha, India

There has been growing recognition of menstrual hygiene management (MHM) as a significant public health issue. However, research has predominately focused on the experiences of adolescent girls in school settings. The purpose of this research is to examine detailed accounts of menstruation for women in rural Odisha, India at various life stages with a view toward improving international monitoring of MHM. Focus group discussions and in-depth interviews were conducted to understand women’s experiences of menstruation across four life stages (unmarried women, recently married women, married women, and older women). Thematic analysis was used to identify menstruation-related challenges and needs. We found women voiced needs that aligned with those captured by the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) definition for MHM: access to clean materials, privacy for changing materials, soap and water for bathing, and disposal facilities for materials. However, we also found women require materials that are not only clean but comfortable and reliable; soap and water for more than bathing; privacy for the full spectrum of menstruation-related practices, not just when changing; and disposal facilities that are private and safe, not just accessible. Additionally, we identified needs that extend beyond the existing definition: pain management, social support, and an enabling sociocultural environment. Overall, women representing all life stages discussed menstruation challenges, including bathing, pain, and washing, drying, and storing cloth materials. Cloth management challenges were most acute for unmarried and recently married women, who were concerned that practices could reveal their menstrual status and harm their reputations, thus informing their preference for disposable materials, if attainable. We propose a revised definition of adequate MHM for this population that more comprehensively captures their needs. This definition may also prove useful for other populations, future research, creating measures of assessment, and guiding interventions and program priorities.

Nutrition, Hygiene and Stimulation Education for Impoverished Mothers in Rural Uganda: Effect on Maternal Depression Symptoms and Their Associations to Child Development Outcomes

Optimal nutrition improves child development, and impaired development is associated with maternal depression symptoms, in particular in low resource settings. In this follow-up of an open cluster-randomized education trial, we examined its effects among mothers in rural Uganda on their depression symptoms and the association of these symptoms to child development. The education comprised complementary feeding, stimulation, and hygiene. We assessed 77 intervention mothers and 78 controls using Beck Depression Inventory-II (BDI-II) and Center for Epidemiologic Studies Depression Scale (CES-D) scores. Child development was assessed with Bayley Scales of Infant and Toddler Development-III (BSID-III) composite scores for cognitive, language and motor development. Compared to controls, the intervention reduced depression symptoms’ scores with mean (95% CI) differences: −8.26 (−11.49 to −1.13, p = 0.0001) and −6.54; (−8.69 to −2.99, p = 0.004) for BDI II at 20–24 and 36 months, respectively. Similar results were obtained with CES-D. There was a negative association of BDI-II scores and BSID-III cognitive and language scores at 20–24 (p = 0.01 and 0.008, respectively) and 36 months (p = 0.017 and 0.001, respectively). CES-D associations with BSID-III cognitive and language scores showed similar trends. BSID-III motor scores were associated with depression scores at 36 months for both BDI-II and CES-D (p = 0.043 and 0.028, respectively). In conclusion, the group education was associated with reduced maternal depression scores. Moreover, the depression scores were inversely associated with child cognitive and language development outcomes.

Food and Agricultural Approaches to Reducing Malnutrition (FAARM): protocol for a cluster-randomised controlled trial to evaluate the impact of a Homestead Food Production programme on undernutrition in rural Bangladesh

INTRODUCTION

Chronic undernutrition affects over 150 million children worldwide and has serious consequences. The causes are complex and include insufficient dietary diversity and poor hygiene practices. Systematic reviews of nutrition-sensitive agricultural interventions concluded that while these hold promise, there is insufficient evidence for their impact on child growth. The Food and Agricultural Approaches to Reducing Malnutrition (FAARM) project is a 1:1 cluster-randomised trial aiming to evaluate the impact of a Homestead Food Production (HFP) programme implemented by Helen Keller International on women's and children's undernutrition.

METHODS AND ANALYSIS

The HFP intervention comprises training of women's groups and asset distribution to support year-round home gardening, poultry rearing and improved nutrition and hygiene practices. Formal trainings are supplemented by behaviour change communication during household visits, and facilitated links between producer groups and market actors. The FAARM trial will examine if and how this complex intervention reduces undernutrition. In 2015, FAARM enrolled married women and their children (0-3 years) in 96 rural settlements of Habiganj district in Sylhet division, Bangladesh. Covariate-constrained randomisation was used to assign 48 settlements to receive a 3-year HFP intervention, with the other 48 acting as controls, targeting over 2700 women. To study impact pathways, a surveillance system collects data on all participants every 2 months. In late 2019, children 0-3 years of age (born during the intervention period) will be surveyed, thus capturing impact during the critical first 1000 days of life. Children's length/height-for-age z-scores will be compared between intervention and control arms using mixed-effects linear regression. Secondary outcomes include women's and children's micronutrient status, dietary intake, dietary diversity and other indicators of child growth, development and morbidity.

ETHICS AND DISSEMINATION

Ethical approval was received in Bangladesh and Germany. Results will be disseminated through peer-reviewed publications and presentations in Bangladesh and internationally.

TRIAL REGISTRATION NUMBER

NCT02505711; Pre-results.

Hygiene practices during clinical training: knowledge, attitudes and practice among a cohort of South Asian Medical students

BACKGROUND

Proper hygienic practices are important in preventing nosocomial infection. This study aimed to determine knowledge, attitudes and practices (KAP) on hand, attire and equipment hygiene during clinical training among medical students at a State Medical Institution in Sri Lanka.

METHODS

This cross-sectional study was conducted among 3rd, 4th and final (5th) year medical students of the Faculty of Medicine, University of Colombo, who had undergone at least 6 months of clinical training. KAP on hand hygiene (HH), attire hygiene (AH) and equipment hygiene (EH) were assessed using a pre-tested, self-administered questionnaire with a Likert-type scale. KAP scores were graded as follows: good ≥75; moderate:74.9-50; unsatisfactory:49.9-25; poor:< 25%. KAP based on duration of training and gender were compared using independent samples t-tests.

RESULTS

Three hundred thirty-three students participated (mean age 24 ± 1.1 years, male: female = 1: 1.2). Combined KAP scores on hand and attire hygiene were moderate (HH:73%, AH:65%) while equipment hygiene was unsatisfactory (EH:47%). Senior students (5th year) had higher combined KAP and knowledge (K) on hand hygiene (HH KAP 75% vs. 72%, p = 0.01; K:72% vs. 67%, p = 0.001) and equipment hygiene (EH KAP 50% vs. 44%, p = 0.001; K:47% vs. 35%, p = 0.001) compared to junior students (3rd/ 4th years). However, they had lower KAP and P scores on attire hygiene (AH KAP 63% vs. 67%, p = 0.006; P:60% vs. 67%, p = 0.004). Female students had better AH compared to male students (KAP:67% vs. 64% p = 0.01; K 71% vs. 66%, p = 0.048; P:66% vs. 62%, p = 0.05).

CONCLUSIONS

Overall, hand hygiene was moderate among medical students and improved with progression of training. Attire hygiene was also graded as moderate but to a lesser extent compared to hand hygiene, lower in males, and declined over time, indicating need for better reinforcement of attire hygiene practices with progression of clinical training. Equipment hygiene was unsatisfactory among most medical students and thus needs to be highlighted as a potential area to be improved during clinical training. This study suggests that knowledge, attitudes and practices on equipment and attire hygiene among medical students was less satisfactory and needs to receive greater emphasis during medical clinical training.

Water-Handling Patterns and Associated Microbial Profiles in relation to Hygiene in Babati Town, Tanzania

Introduction

In rapidly urbanizing centres in Tanzania, water supply infrastructure lags behind the speed of urbanization, affecting water availability and accessibility. We believe that inhabitants' access water using various ways which are characterizable and understanding them could inform about the risks to hygiene-related diseases. This study aimed at characterizing water-handling chains and their microbial profiles in Babati town to inform hygiene education policy and water supply planning.

Methodology

A cross-sectional study design employing a proportional sampling for each of the 8 wards was conducted between November 2016 and March 2017. A total of 564 samples of water were collected using the USA EPA procedures from 37 randomly selected households. Water samples were collected from the common sources of water as well as from the downstream points to multiple storage containers. Using EPA membrane filtration techniques, two microorganisms were tested: fecal coliforms and Salmonella typhi. Results. Three water-handling chains/patterns in Babati town were determined, and they were as follows: (i) untreated-source-to-treated-reservoir-to-households (untrS2trR2HH) chain, (ii) untreated-source-to-untreated-reservoir-to-households (untrS2untrR2HH) chain; (iii) untreated-source-straight-to-households (untrS2HH) chain. In terms of the microbial profile, the most contaminated water-handling chain was the untreated-source-straight-to-households (untrS2HH). The number of users in these three chains was not statistically significantly different (p=0.5226), meaning that all people utilized the various chains almost equally, depending on the water situation. Most households (83%) did not treat their drinking water making those using the untreated-source-to-household chain (untrS2HH) most vulnerable to waterborne diseases.

Conclusion

Determination of water-handling chains among the household is a novel approach which allows an understanding of the points at which highest fecal loading occurs. This approach therefore may inform the development of policies in the areas of household hygiene education, drinking water treatment, and water supply planning in urbanized towns in Tanzania and other developing countries.

Hygiene in medical education - Increasing patient safety through the implementation of practical training in infection prevention

Objective: Insufficient hygiene knowledge increases the risk of hospital-acquired infections through insufficient compliance and therefore poses a potential risk to patient safety. Therefore in 2015 the teaching project "OT Training" was introduced at the Faculty of Medicine (MF) Leipzig and a restructuring of the series of lectures and practical training on the topic of "Hygiene" was developed and integrated in the medical study curriculum. Methodology: The "OT Training" in the pre-clinical component and the didactic restructuring of the hygiene workshops in the hospital semester were comprehensively developed by means of the currently applicable learning objective catalogues and have already been tested in existing teaching (per year N=320 students; 2015-17: N= 960). The "OT Training" and the series of lectures and practical training are evaluated externally by the Faculty of Medicine. In addition a self-developed questionnaire (for "OT Training") and an internal evaluation (for practical stations as part of the practical training series) were used. Results: Overall the "OT Training" was evaluated as "very good" (N=492; RR=51%). Alongside the high importance of hygiene in the hospital and operating area (Overall_hospital=97% and Overall_{Operative area}=98%) the salient feature of hygiene for self-protection and in particular for patient safety was also recognised at an early stage. Through the series of lectures and practical training which were also evaluated positively, the self-reported level of knowledge and the importance of hygiene for the students improved significantly (level of knowledge M_before=2.8 vs. M_after=3.9; p>0.000; importance M_before=3.3 vs. M_after=4.2; p>0.000; 5 point Likert scale; t-Test). Conclusion: Hygiene errors constitute a potential risk to patients. Consequently the early and continuous focus on hygiene in student education makes a contribution to increasing patient safety in the healthcare sector.

Hygiene and Public Health courses in Biology curricula: the Italian scenario and the best examples from all over the world

Different longstanding and emerging challenges for public health have been identified including population ageing, migration, infectious and non-communicable diseases, the environment and climatic changes, increasing risks of misinformation and chronic underinvestment. The multi- and inter-disciplinary public health approach - including biology, epidemiology, biostatistics, anthropology and public policy - raises the need to train experienced professionals in different fields. The education on these matters is fundamental to ensure the human well-being. In the last years, education in schools of public health is changing in response to new evidence-based knowledge, opportunities for improvement and scientific discoveries. In this manuscript the current scenario of teaching Hygiene in all the Italian degree courses in Biology were reviewed and summarized and the most excellent examples of academic training offer of Public Health for Biologists worldwide were provided and discussed as a source of inspiration for novel Masters and PhD degree programmes in Italy.

Decolonization to Reduce Postdischarge Infection Risk among MRSA Carriers

BACKGROUND

Hospitalized patients who are colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at high risk for infection after discharge.

METHODS

We conducted a multicenter, randomized, controlled trial of postdischarge hygiene education, as compared with education plus decolonization, in patients colonized with MRSA (carriers). Decolonization involved chlorhexidine mouthwash, baths or showers with chlorhexidine, and nasal mupirocin for 5 days twice per month for 6 months. Participants were followed for 1 year. The primary outcome was MRSA infection as defined according to Centers for Disease Control and Prevention (CDC) criteria. Secondary outcomes included MRSA infection determined on the basis of clinical judgment, infection from any cause, and infection-related hospitalization. All analyses were performed with the use of proportional-hazards models in the per-protocol population (all participants who underwent randomization, met the inclusion criteria, and survived beyond the recruitment hospitalization) and as-treated population (participants stratified according to adherence).

RESULTS

In the per-protocol population, MRSA infection occurred in 98 of 1063 participants (9.2%) in the education group and in 67 of 1058 (6.3%) in the decolonization group; 84.8% of the MRSA infections led to hospitalization. Infection from any cause occurred in 23.7% of the participants in the education group and 19.6% of those in the decolonization group; 85.8% of the infections led to hospitalization. The hazard of MRSA infection was significantly lower in the decolonization group than in the education group (hazard ratio, 0.70; 95% confidence interval [CI], 0.52 to 0.96; P=0.03; number needed to treat to prevent one infection, 30; 95% CI, 18 to 230); this lower hazard led to a lower risk of hospitalization due to MRSA infection (hazard ratio, 0.71; 95% CI, 0.51 to 0.99). The decolonization group had lower likelihoods of clinically judged infection from any cause (hazard ratio, 0.83; 95% CI, 0.70 to 0.99) and infection-related hospitalization (hazard ratio, 0.76; 95% CI, 0.62 to 0.93); treatment effects for secondary outcomes should be interpreted with caution owing to a lack of prespecified adjustment for multiple comparisons. In as-treated analyses, participants in the decolonization group who adhered fully to the regimen had 44% fewer MRSA infections than the education group (hazard ratio, 0.56; 95% CI, 0.36 to 0.86) and had 40% fewer infections from any cause (hazard ratio, 0.60; 95% CI, 0.46 to 0.78). Side effects (all mild) occurred in 4.2% of the participants.

CONCLUSIONS

Postdischarge MRSA decolonization with chlorhexidine and mupirocin led to a 30% lower risk of MRSA infection than education alone. (Funded by the AHRQ Healthcare-Associated Infections Program and others; ClinicalTrials.gov number, NCT01209234 .).

Integrated delivery of school health interventions through the school platform: Investing for the future

School health and nutrition (SHN) programmes are recognized as a significant contributor to both health and education sector goals. The school system offers an ideal platform from which to deliver basic health interventions that target the most common health conditions affecting school-age children (SAC) in low-income countries, leading to improved participation and learning outcomes. However, governments require evidence to cost, design, and implement these programmes. In Ethiopia, prevalent health conditions affecting SAC's education participation and learning outcomes include infection with soil-transmitted helminths (STHs), hunger, and malnutrition. In recognition of the multiple issues affecting the health and education of SAC, the government has taken a proactive approach, coordinating an integrated SHN programme designed to be implemented in partnership and monitored and financed through a single, integrated mechanism. The programme, known as the Enhanced School Health Initiative (ESHI), integrates three complimentary health interventions: deworming; school feeding; and provision of a water, sanitation, and hygiene (WASH) package in schools, which in delivery aim to maximize the benefits of each of the individual components. Operational research surrounding the ESHI programme includes both qualitative and quantitative analyses. Here, we present an overview of the ESHI programme and its genesis. We also introduce three additional supporting papers that provide in-depth analyses of key findings, including the baseline situational analysis, the costs, and community perceptions of the programme. The findings from ESHI provide initial evidence to develop an understanding of the related costs and synergies of integrating multiple health interventions onto a single platform. The work has translated into strengthened institutional capacity and improved cross-sectoral coordination. The government is now committed to supporting 25 million school children in Ethiopia through SHN. The ESHI model serves as a reference point for other countries looking to scale up targeted SHN interventions.

Hymenolepis nana-An Emerging Intestinal Parasite Associated with Anemia in School Children from the Bolivian Chaco

Tropical anemia can have multiple causes, whether socioeconomic, dietary, or infectious. In the Bolivian Chaco, soil-transmitted helminthiases (STH), malaria, and Chagas disease are potential infectious causes of anemia among school-aged children (SAC). Following years of preventive chemotherapy with mebendazole, the prevalence of STH among SAC living in that area is now negligible, whereas protozoan infections are still highly prevalent (81%); Hymenolepis nana is the most frequent intestinal helminth (∼13%). We present results of hemoglobin (Hb) assessment and the association between parasitic infections and Hb levels of that SAC population. Overall, 511 SAC (girls:boys ratio 1:1, mean age 9.4 years [95% confidence interval {CI}: 9.3-9.5]) had Hb levels measured by using a point of care testing (HemoCue® Hb 301 System; HemoCue, Angelhome, Sweden). The prevalence of anemia was 23% (117/511), with mean and median Hb level = 12.2 g/dL (95% CI: 12.1-12.3; range 9.2-15.4 g/dL). By multivariate analysis, H. nana infection was associated with an increased risk of anemia (odds ratio 2.9, 95% CI: 1.5-5.7, P = 0.002). Two samples (0.5%) were positive for Trypanosoma cruzi and none for Plasmodium spp. by polymerase chain reaction of the 439 children tested. Anemia is still a concern among SAC living in the Bolivian Chaco. Our findings call for a greater attention to fecal-oral emerging pathogens, such as H. nana, and highlight the importance of water, sanitation, and hygiene improvements for disadvantaged population such as those living in the Bolivian Chaco.

Health by design: teaching cleanliness and assembling hygiene at the nineteenth-century sanitation museum

In 1878, amid a rapidly proliferating social interest in public health and cleanliness, a group of sanitary scientists and reformers founded the Parkes Museum of Hygiene in central London. Dirt and contagion knew no social boundaries, and the Parkes's founders conceived of the museum as a dynamic space for all classes to better themselves and their environments. They promoted sanitary science through a variety of initiatives: exhibits of scientific, medical and architectural paraphernalia; product endorsements; and lectures and certificated courses in practical sanitation, food inspection and tropical hygiene. While the Parkes's programmes reified the era's hierarchies of class and gender, it also pursued a public-health mission that cut across these divisions. Set apart from the great cultural and scientific popular museums that dominated Victorian London, it exhibited a collection with little intrinsic value, and offered an education in hygiene designed to be imported into visitors' homes and into urban spaces in the metropole and beyond. This essay explores the unique contributions of the Parkes Museum to late nineteenth-century sanitary science and to museum development, even as the growth of public-health policy rendered the museum obsolete.

[Employment opportunities and job satisfaction in the field of Public Health: a survey among recent graduates of the Hygiene and Preventive Medicine residency in Italy]

We conducted an on-line survey among 255 specialists in Hygiene and Preventive Medicine in Italy who completed their training between October 2014 and July 2016, to assess their training experience, employment opportunities and current job satisfaction. Response rate was 49%. Mean age was 35 years. A high employment rate within two years from obtaining specialist qualification was reported by the 125 specialists who completed the questionnaire (76% are currently employed). The three main work settings of the participating specialists are hospital health directions (37%), universities (19%) and local Prevention Departments (16%). Two thirds (66%) have temporary positions and only 6% permanent positions. Job, pay, and training satisfaction are often below expectations with geographical differences that would need to be further investigated.

Adherence to ivermectin is more associated with perceptions of community directed treatment with ivermectin organization than with onchocerciasis beliefs

BACKGROUND

The fight against onchocerciasis in Africa has boomed thanks to the Community Directed Treatment with Ivermectin (CDTI) program. However, in Cameroon, after more than 15 years of mass treatment, onchocerciasis prevalence is still above the non-transmission threshold. This study aimed to explore a possible association between people's beliefs/perceptions of onchocerciasis and of CDTI program, and their adherence to ivermectin in three regions of Cameroon.

METHODOLOGY/PRINCIPAL FINDINGS

A cross sectional survey was carried out in three health districts with persistent high onchocerciasis prevalence. Participants were randomly selected in 30 clusters per district. Adherence to ivermectin was comparable between Bafang and Bafia (55.0% and 48.8%, respectively, p>0.05) and lower in Yabassi (40.7%). Among all factors related to program perceptions and disease representations that were studied, perceptions of the program are the ones that were most determinant in adherence to ivermectin. People who had a "not positive" opinion of ivermectin distribution campaigns were less compliant than those who had a positive opinion about the campaigns (40% vs 55% in Bafang, and 48% vs 62% in Bafia, p<0.01), as well as those who had a negative appreciation of community drug distributors' commitment (22% vs 53% in Bafang, 33% vs 59% in Bafia, 27% vs 47% in Yabassi; p<0.01). The most common misconception about onchocerciasis transmission was the lack of hygiene, especially in Bafia and Yabassi. In Bafang, high proportions of people believed that onchocerciasis was due to high consumption of sugar (31% vs less than 5% in Bafia and Yabassi, p<0.001).

CONCLUSION/SIGNIFICANCE

There are still frequent misconceptions about onchocerciasis transmission in Cameroon. Perceptions of ivermectin distribution campaigns are more strongly associated to adherence. In addition to education/sensitisation on onchocerciasis during the implementation of the CDTI program, local health authorities should strive to better involve communities and more encourage community distributors' work.

Health education: Effect on knowledge and practice of workplace personal hygiene and protective measures among woodworkers in Enugu, Nigeria

BACKGROUND

There has been increasing incidence of occupational diseases among woodworkers due to exposure to preventable hazards in the workplace. The objective of this study was to determine the effects of health education on the knowledge and practice of workplace hygiene and protective measures among woodworkers in Enugu timber market.

MATERIALS AND METHODS

This was a before and after study conducted among 290 woodworkers using interviewer administered semi-structured questionnaire and manual on workplace hazards prevention. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 17 and P-value of 0.05 was set as the significance level.

RESULTS

Two hundred and ninety respondents participated in the study; 282 (97.2%) were males, most completed secondary education and had worked for less than 10 years (71% and 58.3%, respectively). The mean knowledge score of participants pre- and postintervention were 89.5% ± 9.03 and 98.5% ± 1.84, respectively (P < 0.001). Educational status had effect on knowledge of participants (P < 0.001), whereas work experience had no effect (P = 0.285). Preintervention, 37.9% of the participants used protective materials regularly, which increased to 65.8% post intervention (P < 0.001). Personal hygiene practices showed mixed responses most of which improved post intervention. The most common reason for eating in workplace was excessive workload (60.3%), while lack of PPEs (29.3%) and lack of training (23.8%) were the most common reasons for nonuse of PPEs.

CONCLUSION

Majority of the participants had good knowledge of workplace hygiene but had poor use of PPEs. Health education intervention improved the use of PPEs and should be recommended.

A self-efficacy education programme on foot self-care behaviour among older patients with diabetes in a public long-term care institution, Malaysia: a Quasi-experimental Pilot Study

OBJECTIVE

A pilot self-efficacy education programme was conducted to assess the feasibility, acceptability and potential impact of the self-efficacy education programme on improving foot self-care behaviour among older patients with diabetes in a public long-term care institution.

METHOD

A prequasi-experimental and postquasi-experimental study was conducted in a public long-term care institution in Selangor, Malaysia. Patients with diabetes aged 60 years and above who fulfilled the selection criteria were invited to participate in this programme. Four self-efficacy information sources; performance accomplishments, vicarious experience, verbal persuasion and physiological information were translated into programme interventions. The programme consisted of four visits over a 12-week period. The first visit included screening and baseline assessment and the second visit involved 30 min of group seminar presentation. The third and fourth visits entailed a 20-min one-to-one follow-up discussion and evaluation. A series of visits to the respondents was conducted throughout the programme. The primary outcome was foot self-care behaviour. Foot self-efficacy (efficacy-expectation), foot care outcome expectation, knowledge of foot care, quality of life, fasting blood glucose and foot condition were secondary outcomes. Data were analysed with descriptive and inferential statistics (McNemar's test and Wilcoxon signed-rank test) using the Statistical Package for the Social Sciences V.20.0.

RESULTS

Fifty-two residents were recruited but only 31 met the inclusion criteria and were included in the analysis at baseline and at 12 weeks postintervention. The acceptability rate was moderately high. At postintervention, foot self-care behaviour (p<0.001), foot self-efficacy (efficacy-expectation), (p<0.001), foot care outcome expectation (p<0.001), knowledge of foot care (p<0.001), quality of life (physical symptoms) (p=0.003), fasting blood glucose (p=0.010), foot hygiene (p=0.030) and anhydrosis (p=0.020) showed significant improvements.

CONCLUSION

Findings from this pilot study would facilitate the planning of a larger study among the older population with diabetes living in long-term care institutions.

TRIAL REGISTRATION NUMBER

ACTRN12616000210471; Pre-results.

Health beliefs of school-age rural children in podoconiosis-affected families: A qualitative study in Southern Ethiopia

BACKGROUND

Several studies have suggested investigation of health beliefs in children to be an important pre-condition for primary prevention of disease. However, little effort has been made to understand these in the context of podoconiosis. This study therefore aimed to explore the health beliefs of school-age rural children in podoconiosis-affected families.

METHODOLOGY/PRINCIPAL FINDINGS

A cross sectional qualitative study was conducted in March 2016 in Wolaita Zone, Southern Ethiopia. Data were collected through in-depth individual interviews (IDIs) and focus group discussions (FGDs), with a total of one hundred seventeen 9 to15-year-old children recruited from podoconiosis affected families. The study revealed various misconceptions regarding risk factors for podoconiosis. Most children believed barefoot exposure to dew, worms, snake bite, frog urine, other forms of poison, and contact with affected people to be major causes of the disease. Their knowledge about the role of heredity and that of long term barefoot exposure to irritant mineral particles was also weak. Though most participants correctly appraised their susceptibility to podoconiosis in relation to regular use of footwear and foot hygiene, others based their risk perceptions on factors they think beyond their control. They described several barriers to preventive behaviour, including uncomfortable footwear, shortage and poor adaptability of footwear for farm activities and sports, and shortage of soap for washing. Children also perceived low self-efficacy to practice preventive behaviour in spite of the barriers.

CONCLUSION/SIGNIFICANCE

Health education interventions may enhance school-age children's health literacy and be translated to preventive action. Overcoming practical challenges such as shortage of footwear and other hygiene facilities requires other forms of interventions such as livelihood strengthening activities. Linking podoconiosis-affected families with local governmental or non-governmental organizations providing socio-economic support for households may assist school-age children in those families to sustainably engage in preventive behaviours.

[Puppet shows, Mexican television and health education in the mid-twentieth century]

This article resurrects the puppet show Las calenturas de Don Ferruco (Don Ferruco's Fevers), which was televised in the late 1950s in order to help eradicate malaria in Mexico, as a useful instrument for health education. It analyzes how the spread of educational puppet shows on Mexican television showed the need to keep updating preventive healthcare pedagogy and it underlines the importance of television as an educational health-promotion production in the mid-twentieth century. The article discusses the early use of puppet shows as an especially important tool for what would later become mass-media transmission of discourses from the Secretaría de Salubridad y Asistencia (Department of Health and Healthcare).

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

OBJECTIVES

The primary objective was to describe Ugandan schoolgirls' menstrual hygiene management (MHM) practices and estimate the prevalence of inadequate MHM. Second, to assess the relative contribution of aspects of MHM to health, education and psychosocial outcomes.

DESIGN

Secondary analysis of survey data collected as part of the final follow-up from a controlled trial of reusable sanitary pad and puberty education provision was used to provide a cross-sectional description of girls' MHM practices and assess relationships with outcomes.

SETTING

Rural primary schools in the Kamuli district, Uganda.

PARTICIPANTS

Participants were 205 menstruating schoolgirls (10-19 years) from the eight study sites.

PRIMARY AND SECONDARY OUTCOME MEASURES

The prevalence of adequate MHM, consistent with the concept definition, was estimated using dimensions of absorbent used, frequency of absorbent change, washing and drying procedures and privacy. Self-reported health, education (school attendance and engagement) and psychosocial (shame, insecurity, embarrassment) outcomes hypothesised to result from poor MHM were assessed as primary outcomes. Outcomes were measured through English surveys loaded on iPads and administered verbally in the local language.

RESULTS

90.5% (95% CI 85.6% to 93.9%) of girls failed to meet available criteria for adequate MHM, with no significant difference between those using reusable sanitary pads (88.9%, 95% CI 79.0% to 94.4%) and those using existing methods, predominantly cloth (91.5%, 95% CI 85.1% to 95.3%; χ² (1)=0.12, p=0.729). Aspects of MHM predicted some consequences including shame, not standing in class to answer questions and concerns about odour.

CONCLUSIONS

This study was the first to assess the prevalence of MHM consistent with the concept definition. Results suggest that when all aspects of menstrual hygiene are considered together, the prevalence is much higher than has previously been reported based on absorbents alone. The work demonstrates an urgent need for improved assessment and reporting of MHM, and for primary research testing the links between menstrual management and health, education and psychosocial consequences.