Protocol for the Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study in Khulna, Bangladesh: A Prospective cohort to quantify the influence of menstrual health on adolescent girls’ health and education outcomes.

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Abstract

Background

Menstrual health is essential for gender equity and the well-being of women and girls. Qualitative research has described the burden of poor menstrual health on health and education; however, these impacts have not been quantified, curtailing investment. The Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study aims to describe menstrual health and its trajectories across adolescence, and quantify the relationships between menstrual health and girls’ health and education in Khulna, Bangladesh.

Methods and analysis

AMEHC is a prospective longitudinal cohort of 2016 adolescent girls recruited at the commencement of class 6 (secondary school, mean age=12) across 101 schools selected through a proportional random sampling approach. Each year, the cohort will be asked to complete a survey capturing (1) girls’ menstrual health and experiences, (2) support for menstrual health, and (3) health and education outcomes. Survey questions were refined through qualitative research, cognitive interviews and pilot survey in the year preceding the cohort. Girls’ guardians will be surveyed at baseline and wave 2 to capture their perspectives and household demographics. Annual assessments will capture schools’ water, sanitation and hygiene, and support for menstruation and collect data on participants’ education, including school attendance and performance (in maths, literacy). Cohort enrolment and baseline survey commenced in February 2023. Follow-up waves are scheduled for 2024, 2025 and 2026, with plans for extension. A nested subcohort will follow 406 post-menarche girls at 2-month intervals throughout 2023 (May, August, October) to describe changes across menstrual periods. This protocol outlines a priori hypotheses regarding the impacts of menstrual health to be tested through the cohort.

Ethics and dissemination

AMEHC has ethical approval from the Alfred Hospital Ethics Committee (369/22) and BRAC James P Grant School of Public Health Institutional Review Board (IRB-06 July 22-024). Study materials and outputs will be available open access through peer-reviewed publication and study web pages.

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Most cited references 72

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The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample.

Julie D Henry, John R Crawford (2005)

To test the construct validity of the short-form version of the Depression anxiety and stress scale (DASS-21), and in particular, to assess whether stress as indexed by this measure is synonymous with negative affectivity (NA) or whether it represents a related, but distinct, construct. To provide normative data for the general adult population. Cross-sectional, correlational and confirmatory factor analysis (CFA). The DASS-21 was administered to a non-clinical sample, broadly representative of the general adult UK population (N = 1,794). Competing models of the latent structure of the DASS-21 were evaluated using CFA. The model with optimal fit (RCFI = 0.94) had a quadripartite structure, and consisted of a general factor of psychological distress plus orthogonal specific factors of depression, anxiety, and stress. This model was a significantly better fit than a competing model that tested the possibility that the Stress scale simply measures NA. The DASS-21 subscales can validly be used to measure the dimensions of depression, anxiety, and stress. However, each of these subscales also taps a more general dimension of psychological distress or NA. The utility of the measure is enhanced by the provision of normative data based on a large sample.

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The Body Appreciation Scale-2: item refinement and psychometric evaluation.

Nichole L Wood-Barcalow, Tracy Tylka (2015)

Considered a positive body image measure, the 13-item Body Appreciation Scale (BAS; Avalos, Tylka, & Wood-Barcalow, 2005) assesses individuals' acceptance of, favorable opinions toward, and respect for their bodies. While the BAS has accrued psychometric support, we improved it by rewording certain BAS items (to eliminate sex-specific versions and body dissatisfaction-based language) and developing additional items based on positive body image research. In three studies, we examined the reworded, newly developed, and retained items to determine their psychometric properties among college and online community (Amazon Mechanical Turk) samples of 820 women and 767 men. After exploratory factor analysis, we retained 10 items (five original BAS items). Confirmatory factor analysis upheld the BAS-2's unidimensionality and invariance across sex and sample type. Its internal consistency, test-retest reliability, and construct (convergent, incremental, and discriminant) validity were supported. The BAS-2 is a psychometrically sound positive body image measure applicable for research and clinical settings.

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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: 2024

Publication date (Electronic): 10 April 2024

Volume: 14

Issue: 4

Electronic Location Identifier: e079451

Affiliations

[1 ]departmentMaternal, Child and Adolescent Health Program , Ringgold_104125Burnet Institute , Melbourne, Victoria, Australia

[2 ]departmentSchool of Population and Global Health , Ringgold_50066The University of Melbourne , Melbourne, Victoria, Australia

[3 ]departmentMelbourne School of Population and Global Health , University of Melbourne , Melbourne, VIC, Australia

[4 ]departmentBRAC James P Grant School of Public Health , Ringgold_246826BRAC University , Dhaka, Bangladesh

[5 ]departmentSchool of Population Health and Preventive Medicine , Ringgold_2541Monash University , Clayton, Victoria, Australia

[6 ]Ringgold_34361Murdoch Children's Research Institute , Parkville, Victoria, Australia

[7 ]departmentDepartment of Public Health Sciences , Ringgold_47810Clemson University College of Behavioral Social and Health Sciences , Clemson, South Carolina, USA

[8 ]departmentDepartment of International Health , Ringgold_25802Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland, USA

[9 ]departmentSydney School of Public Health , The University of Sydney , Sydney, NSW, Australia

[10 ]WaterAid Bangladesh , Dhaka, Bangladesh

[11 ]departmentSchool of Social and Political Sciences , University of Melboune , Melbourne, Victoria, Australia

[12 ]departmentDepartment of Epidemiology and Preventive Medicine , Ringgold_2541Monash University , Clayton, Victoria, Australia

[13 ]departmentMRC International Statistics and Epidemiology Group , Ringgold_4906London School of Hygiene and Tropical Medicine , London, UK

[14 ]departmentMyanmar Country Program , Ringgold_104125Burnet Institute , Yangon, Myanmar

[15 ]departmentFaculty of Health and Life Sciences , Ringgold_3286University of Exeter , Exeter, UK

[16 ]departmentDisease Elimination Program , Ringgold_104125Burnet Institute , Melbourne, Victoria, Australia

[17 ]departmentDepartment of Paediatrics , Ringgold_569523The University of Melbourne , Parkville, Victoria, Australia

[18 ]Ringgold_117610Telethon Kids Institute , Adelaide, South Australia, Australia

Author notes

[Correspondence to ] Dr Julie Hennegan; julie.hennegan@ 123456burnet.edu.au

MTH, SFR and PA are joint senior authors.

Author information

Julie Hennegan http://orcid.org/0000-0003-2011-1595

Abdul Jabbar http://orcid.org/0000-0001-7105-2412

Erin Hunter http://orcid.org/0000-0001-6073-8646

Adrita Kaiser http://orcid.org/0000-0003-0006-5587

Laura Dunstan http://orcid.org/0000-0001-7053-2908

Alexandra Head http://orcid.org/0000-0002-6518-6550

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

Thin Mar Win http://orcid.org/0000-0002-6804-278X

Kyu Kyu Than http://orcid.org/0000-0003-0567-9334

Article

Publisher ID: bmjopen-2023-079451

DOI: 10.1136/bmjopen-2023-079451

PMC ID: 11015194

PubMed ID: 38604626

SO-VID: af20af59-809e-4095-a130-615db74471ed

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 01 September 2023

Date accepted : 06 March 2024

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;

Award ID: GNT2004222

Award ID: GNT2008574

Award ID: GNT2008600

Funded by: Victorian Operational Infrastructure Support Program;

Award ID: NA

Funded by: Reckitt Global Hygiene Institute (RGHI);

Award ID: NA

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ScienceOpen disciplines: Medicine

Keywords: adolescent,dysmenorrhea,epidemiology,health equity,health policy,public health

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ScienceOpen disciplines: Medicine

Keywords: adolescent, dysmenorrhea, epidemiology, health equity, health policy, public health

Protocol for the Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study in Khulna, Bangladesh: A Prospective cohort to quantify the influence of menstrual health on adolescent girls’ health and education outcomes.

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Climate Change and Human Health

Most cited references 72

The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample.

The Body Appreciation Scale-2: item refinement and psychometric evaluation.

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

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