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      Assessing the link between hygienic material use during menstruation and self-reported reproductive tract infections among women in India: a propensity score matching approach

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          Abstract

          Background

          Reproductive tract infections (RTIs) present a substantial health concern for women, especially in developing nations such as India, where inadequate access to proper sanitation and hygiene facilities frequently results in suboptimal menstrual health and hygiene (MHH), exacerbating the risk of RTIs. In this study, we analysed the self-reported prevalence of RTIs among young women in India and evaluated the impact of hygienic menstrual material usage on these RTIs.

          Methods

          The study used information on 27,983 women aged 15–24 years, from the National Family Health Survey (NFHS-5) (2019-21). The prevalence of RTIs was calculated for all the states and UTs of India, and propensity score matching (PSM) technique was used to evaluate the impact of hygienic material use on RTIs among women in India.

          Results

          Every four out of 100 women reported RTIs in India in 2019–21. Notably, RTI prevalence displayed substantial state-level disparities. West Bengal exhibited the highest RTI prevalence at 9.3%, followed by Meghalaya, Arunachal Pradesh, and Himachal Pradesh, all surpassing 6%. In contrast, the lowest RTI rates were recorded in Puducherry at 0.9%, succeeded by Andaman and Nicobar Islands, Odisha, and Jammu & Kashmir, all registering rates below 2%. The PSM analysis revealed that women who utilized hygienic materials during menstruation exhibited a reduced prevalence of RTIs (referred to as the “treated group” with an Average Treatment Effect on the Treated (ATT) of 0.0315) compared to those who did not utilize such materials (referred to as the “control group” with an ATT of 0.0416).

          Conclusions

          The study underscores the critical significance of using hygienic materials during menstruation as a preventive measure against RTIs among women in India. The findings suggest the need for targeted interventions focused at promoting hygienic menstrual materials to reduce the prevalence of RTIs among women in India.

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          Most cited references59

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          Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies

          In a study comparing the effects of two treatments, the propensity score is the probability of assignment to one treatment conditional on a subject's measured baseline covariates. Propensity-score matching is increasingly being used to estimate the effects of exposures using observational data. In the most common implementation of propensity-score matching, pairs of treated and untreated subjects are formed whose propensity scores differ by at most a pre-specified amount (the caliper width). There has been a little research into the optimal caliper width. We conducted an extensive series of Monte Carlo simulations to determine the optimal caliper width for estimating differences in means (for continuous outcomes) and risk differences (for binary outcomes). When estimating differences in means or risk differences, we recommend that researchers match on the logit of the propensity score using calipers of width equal to 0.2 of the standard deviation of the logit of the propensity score. When at least some of the covariates were continuous, then either this value, or one close to it, minimized the mean square error of the resultant estimated treatment effect. It also eliminated at least 98% of the bias in the crude estimator, and it resulted in confidence intervals with approximately the correct coverage rates. Furthermore, the empirical type I error rate was approximately correct. When all of the covariates were binary, then the choice of caliper width had a much smaller impact on the performance of estimation of risk differences and differences in means. Copyright © 2010 John Wiley & Sons, Ltd.
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            Balance diagnostics after propensity score matching

            Propensity score matching (PSM) is a popular method in clinical researches to create a balanced covariate distribution between treated and untreated groups. However, the balance diagnostics are often not appropriately conducted and reported in the literature and therefore the validity of the findings from the PSM analysis is not warranted. The special article aims to outline the methods used for assessing balance in covariates after PSM. Standardized mean difference (SMD) is the most commonly used statistic to examine the balance of covariate distribution between treatment groups. Because SMD is independent of the unit of measurement, it allows comparison between variables with different unit of measurement. SMD can be reported with plot. Variance is the second central moment and should also be compared in the matched sample. Finally, a correct specification of the propensity score model (e.g., linearity and additivity) should be re-assessed if there is evidence of imbalance between treated and untreated. R code for the implementation of balance diagnostics is provided and explained.
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              Constructing a Control Group Using Multivariate Matched Sampling Methods That Incorporate the Propensity Score

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                Author and article information

                Contributors
                Journal
                PeerJ
                PeerJ
                peerj
                PeerJ
                PeerJ Inc. (San Diego, USA )
                2167-8359
                17 November 2023
                2023
                : 11
                : e16430
                Affiliations
                [1 ]Department of Geography, Banaras Hindu University , Varanasi, Uttar Pradesh, India
                [2 ]Girl Innovation, Research, and Learning (GIRL) Center, Population Council , New York, NY, USA
                Article
                16430
                10.7717/peerj.16430
                10658888
                2f731aff-a1d8-4e23-b14a-a46aadf73201
                ©2023 Chakrabarty and Singh

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ) and either DOI or URL of the article must be cited.

                History
                : 22 February 2023
                : 18 October 2023
                Funding
                Funded by: Banaras Hindu University’s Institute of Eminence (IOE)
                Award ID: R/Dev/D/IoE/Equipment/Seed Grant II/2022-23/48726
                Funded by: University Grants Commission, India
                Award ID: 200510082749
                This research was supported by the Banaras Hindu University’s Institute of Eminence (IOE) Seed Grant awarded to Dr. Aditya Singh (Grant No. R/Dev/D/IoE/Equipment/Seed Grant II/2022-23/48726), while Mahashweta Chakrabarty received support in the form of a Junior Research Fellowship from the University Grants Commission, India (Reference Number: 200510082749). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Epidemiology
                Global Health
                Health Policy
                Public Health
                Women’s Health

                reproductive tract infections,menstrual hygiene management,hygienic materials,menstruation,abnormal genital discharge,quasi-experimental method,propensity score matching,women’s health,public health,sexually transmitted infections

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