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      Puberty and menstruation knowledge among young adolescents in low- and middle-income countries: a scoping review

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          Abstract

          Objectives

          This study presents a scoping review of evidence relating to knowledge and experiences of puberty and menstruation among females aged 10–14 years in low- and middle-income countries.

          Methods

          Forty-four items from 12 countries were identified from a systematic scoping review and screening of 8083 items. Included studies were quality assessed.

          Results

          A majority (40/44) of studies used school-based samples, and fifteen studies reported on interventions. Girls had inadequate knowledge about menstruation; menarche as a trigger for girls learning about menstruation was common. Adolescents struggled with menstrual hygiene. Negative emotions were associated with menarche and menstrual management. A minority of studies dealt explicitly with puberty. Most girls obtained information about menstruation and/or puberty from their mothers, although mothers were not necessarily girls’ preferred source for learning about these topics.

          Conclusions

          Young adolescent girls are under-prepared for puberty and menstruation. Predominantly school-based studies mean we know little about young out-of-school adolescents. The evidence base lags behind the rise in interest from practitioners as well as the development (and evaluation) of puberty and/or menstruation interventions.

          Electronic supplementary material

          The online version of this article (10.1007/s00038-019-01209-0) contains supplementary material, which is available to authorized users.

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          Most cited references55

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          What are scoping studies? A review of the nursing literature.

          Scoping studies are increasingly undertaken as distinct activities. The interpretation, methodology and expectations of scoping are highly variable. This suggests that conceptually, scoping is a poorly defined ambiguous term. The distinction between scoping as an integral preliminary process in the development of a research proposal or a formative, methodologically rigorous activity in its own right has not been extensively examined. The aim of this review is to explore the nature and status of scoping studies within the nursing literature and develop a working definition to ensure consistency in the future use of scoping as a research related activity. This paper follows an interpretative scoping review methodology. An explicit systematic search strategy included literary and web-based key word searches and advice from key researchers. Electronic sources included bibliographic and national research register databases and a general browser. The scoping studies varied widely in terms of intent, procedural and methodological rigor. An atheoretical stance was common although explicit conceptual clarification and development of a topic was limited. Four different levels of inquiry ranging from preliminary descriptive surveys to more substantive conceptual approaches were conceptualised. These levels reflected differing dimensional distinctions in which some activities constitute research whereas in others the scoping activities appear to fall outside the remit of research. Reconnaissance emerges as a common synthesising construct to explain the purpose of scoping. Scoping studies in relation to nursing are embryonic and continue to evolve. Its main strengths lie in its ability to extract the essence of a diverse body of evidence giving it meaning and significance that is both developmental and intellectually creative. As with other approaches to research and evidence synthesis a more standardized approach is required.
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            A Systematic Review of the Health and Social Effects of Menstrual Hygiene Management

            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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              Appraising the quality of qualitative research.

              In the process of undertaking a meta-synthesis of qualitative studies of free-standing midwife-led units, the authors of this paper encountered a number of methodologically and epistemologically unresolved issues. One of these related to the assessment of the quality of qualitative research. In an iterative approach to scoping this issue, we identified eight existing checklists and summary frameworks. Some of these publications were opinion based, and some involved a synthesis of pre-existing frameworks. None of them provide a clear map of the criteria used in all their reviewed papers, and of the commonalities and differences between them. We critically review these frameworks and conclude that, although they are epistemologically and theoretically dense, they are excessively detailed for most uses. In order to reach a workable solution to the problem of the quality assessment of qualitative research, the findings from these frameworks and checklists were mapped together. Using a technique we have termed a 'redundancy approach' to eliminate non-essential criteria, we developed our own summary framework. The final synthesis was achieved through reflexive debate and discussion. Aspects of this discussion are detailed here. The synthesis is clearly rooted in a subjectivist epistemology, which views knowledge as constructed and hermeneutic in intent, encompassing individual, cultural and structural representations of reality.
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                Author and article information

                Contributors
                e.coast@lse.ac.uk
                Journal
                Int J Public Health
                Int J Public Health
                International Journal of Public Health
                Springer International Publishing (Cham )
                1661-8556
                1661-8564
                10 February 2019
                10 February 2019
                2019
                : 64
                : 2
                : 293-304
                Affiliations
                [1 ]ISNI 0000 0001 0789 5319, GRID grid.13063.37, Department of International Development, , London School of Economics and Political Science, ; London, UK
                [2 ]ISNI 0000 0001 0789 5319, GRID grid.13063.37, Department of Social Policy, , London School of Economics and Political Science, ; London, UK
                Author information
                http://orcid.org/0000-0002-8703-307X
                http://orcid.org/0000-0003-0934-1488
                Article
                1209
                10.1007/s00038-019-01209-0
                6439145
                30740629
                49376cd6-022d-4a6e-a828-e89b2b28a383
                © The Author(s) 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 16 April 2018
                : 12 January 2019
                : 18 January 2019
                Funding
                Funded by: Gender and Adolescence: Global Evidence (GAGE) programme which is funded by UK Aid from the UK Department for International Development (DFID)
                Funded by: LSE Staff Research Fund
                Categories
                Review
                Custom metadata
                © Swiss School of Public Health (SSPH+) 2019

                Public health
                puberty,menarche,menstruation,adolescence,scoping review
                Public health
                puberty, menarche, menstruation, adolescence, scoping review

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