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

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Abstract

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.

Related collections

Most cited references 36

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Rigor in qualitative research: the assessment of trustworthiness.

L Krefting (1991)

Despite a growing interest in qualitative research in occupational therapy, little attention has been placed on establishing its rigor. This article presents one model that can be used for the assessment of trustworthiness or merit of qualitative inquiry. Guba's (1981) model describes four general criteria for evaluation of research and then defines each from both a quantitative and a qualitative perspective. Several strategies for the achievement of rigor in qualitative research useful for both researchers and consumers of research are described.

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The World Health Organization’s Health Promoting Schools framework: a Cochrane systematic review and meta-analysis

Rebecca Langford, Christopher Bonell, Hayley Jones … (2015)

Background Healthy children achieve better educational outcomes which, in turn, are associated with improved health later in life. The World Health Organization’s Health Promoting Schools (HPS) framework is a holistic approach to promoting health and educational attainment in school. The effectiveness of this approach has not yet been rigorously reviewed. Methods We searched 20 health, education and social science databases, and trials registries and relevant websites in 2011 and 2013. We included cluster randomised controlled trials. Participants were children and young people aged four to 18 years attending schools/colleges. HPS interventions had to include the following three elements: input into the curriculum; changes to the school’s ethos or environment; and engagement with families and/or local communities. Two reviewers identified relevant trials, extracted data and assessed risk of bias. We grouped studies according to the health topic(s) targeted. Where data permitted, we performed random-effects meta-analyses. Results We identified 67 eligible trials tackling a range of health issues. Few studies included any academic/attendance outcomes. We found positive average intervention effects for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small. On average across studies, we found little evidence of effectiveness for zBMI (BMI, standardized for age and gender), and no evidence for fat intake, alcohol use, drug use, mental health, violence and bullying others. It was not possible to meta-analyse data on other health outcomes due to lack of data. Methodological limitations were identified including reliance on self-reported data, lack of long-term follow-up, and high attrition rates. Conclusion This Cochrane review has found the WHO HPS framework is effective at improving some aspects of student health. The effects are small but potentially important at a population level.

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A Systematic Review of the Health and Social Effects of Menstrual Hygiene Management

Colin Sumpter, Belen Torondel (2013)

Background Differing approaches to menstrual hygiene management (MHM) have been associated with a wide range of health and psycho-social outcomes in lower income settings. This paper systematically collates, summarizes and critically appraises the available evidence. Methods Following the PRISMA guidelines a structured search strategy was used to identify articles investigating the effects of MHM on health and psycho-social outcomes. The search was conducted in May 2012 and had no date limit. Data was extracted and quality of methodology was independently assessed by two researchers. Where no measure of effect was provided, but sufficient data were available to calculate one, this was undertaken. Meta-analysis was conducted where sufficient data were available. Results 14 articles were identified which looked at health outcomes, primarily reproductive tract infections (RTI). 11 articles were identified investigating associations between MHM, social restrictions and school attendance. MHM was found to be associated with RTI in 7 papers. Methodologies however varied greatly and overall quality was low. Meta-analysis of a subset of studies found no association between confirmed bacterial vaginosis and MHM (OR: 1.07, 95% CI: 0.52–2.24). No other substantial associations with health outcomes were found. Although there was good evidence that educational interventions can improve MHM practices and reduce social restrictions there was no quantitative evidence that improvements in management methods reduce school absenteeism. Conclusion The management of menstruation presents significant challenges for women in lower income settings; the effect of poor MHM however remains unclear. It is plausible that MHM can affect the reproductive tract but the specific infections, the strength of effect, and the route of transmission, remain unclear. There is a gap in the evidence for high quality randomised intervention studies which combine hardware and software interventions, in particular for better understanding the nuanced effect improving MHM may have on girls’ attendance at school.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2020

Publication date (Electronic): 4 February 2020

Volume: 10

Issue: 2

Electronic Location Identifier: e031182

Affiliations

[1 ] departmentResearch Unit , Medical Research Council/Uganda Virus Research Institute & London School of Hygiene & Tropical Medicine Uganda , Entebbe, Uganda

[2 ] WoMena Uganda , Kampala, Uganda

[3 ] departmentCollege of Humanities and Social Science , Makerere University , Kampala, Uganda

[4 ] departmentEpidemiology and Population Health , London School of Hygiene and Tropical Medicine , London, UK

[5 ] Palm Tree Academy Uganda , Kampala, Uganda

[6 ] Uganda Virus Research Institute , Entebbe, Uganda

[7 ] departmentFaculty of Infectious and Tropical Diseases , London School of Hygiene and Tropical Medicine , London, UK

[8 ] departmentMRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health , London School of Hygiene and Tropical Medicine , London, UK

[9 ] departmentDepartment of Maternal, Newborn, Child and Adolescent Health , World Health Organization , Geneve, Switzerland

[10 ] departmentFaculty of Public Health and Policy , London School of Hygiene & Tropical Medicine , London, UK

Author notes

[Correspondence to ] Dr Helen Anne Weiss; helen.weiss@ 123456lshtm.ac.uk

Author information

Christopher Bonell http://orcid.org/0000-0002-6253-6498

Helen Anne Weiss http://orcid.org/0000-0003-3547-7936

Article

Publisher ID: bmjopen-2019-031182

DOI: 10.1136/bmjopen-2019-031182

PMC ID: 7044877

PubMed ID: 32024786

SO-VID: 0a68b82a-ff0a-4e36-b64c-7f7a9b1083c0

License:

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

History

Date received : 20 April 2019

Date revision received : 05 December 2019

Date accepted : 13 January 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000265, Medical Research Council;

Award ID: MR/P020283/1

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ScienceOpen disciplines: Medicine

Keywords: menstrual health,school attendance,menstrual hygiene,adolescent health,education

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ScienceOpen disciplines: Medicine

Keywords: menstrual health, school attendance, menstrual hygiene, adolescent health, education

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

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Abstract

Objectives

Design

Setting

Participants

Intervention

Primary and secondary outcome measures

Results

Conclusions

Trial registration number

Related collections

Chinese Journal of School Health

Most cited references 36

Rigor in qualitative research: the assessment of trustworthiness.

The World Health Organization’s Health Promoting Schools framework: a Cochrane systematic review and meta-analysis

A Systematic Review of the Health and Social Effects of Menstrual Hygiene Management

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