This paper summarises pilot work by Irise International to develop an acceptable and replicable solution to menstrual hygiene management (MHM) in East Africa based around the manufacture of a reusable pad. The paper presents a theoretical justification for the approach and the results of pilot work used to develop it, including baseline menstrual hygiene practices and their relationship to school absenteeism in schoolgirls in western Kenya, the short-term impact of training girls to make a reusable product on school absenteeism using a partial preference, parallel group randomised control trial, and an assessment of the acceptability of the approach.Cet article résume des activités pilotes entreprises par Irise International pour mettre au point une solution acceptable et reproductible en matière de gestion de l'hygiène menstruelle (GHM) en Afrique de l'Est, basée sur la fabrication d'une serviette hygiénique réutilisable. Cet article présente une justification théorique pour cette approche et les résultats des activités pilotes mises en oeuvre pour la mettre au point, y compris des pratiques d'hygiène menstruelle de référence et leur rapport avec l'absentéisme des écolières de l'ouest du Kenya, l'impact sur l'absentéisme que peut avoir à court terme la formation des filles à la fabrication d'un produit réutilisable en utilisant une préférence partielle, un essai contrôlé randomisé effectué sur un groupe parallèle et une évaluation de l'acceptabilité de l'approche.El presente artículo realiza una síntesis del trabajo pionero de Irise International en África Oriental, el cual se orienta a desarrollar una solución aceptable y replicable del manejo de la higiene menstrual (MHM) centrada en la producción de una toalla sanitaria reutilizable. Se presenta la justificación teórica de este enfoque, explicando luego los resultados del trabajo pionero que lo produjo. Se establece una línea de base en torno a las prácticas de higiene menstrual, su relación con el ausentismo escolar de las jóvenes educandas en Kenia occidental y con el impacto que la capacitación de las jóvenes en la elaboración de un producto reutilizable tendrá a corto plazo sobre dicho ausentismo. Para efectos del estudio, se usó un ensayo controlado aleatorio de preferencia parcial y de grupo paralelo. Asimismo, el artículo evalúa el grado de aceptación de dicho enfoque.

ObjectivesIncreased rates of illicit drug inhalation are thought to expose opiate misusers (OMUs) to an enhanced risk of respiratory health problems. This pilot study aimed to determine the feasibility of undertaking respiratory screening of OMUs in a community clinic.SettingSingle-centre UK community substance misuse clinic.ParticipantsAll clinic attendees receiving treatment for opiate misuse were eligible to participate. 36 participants (mean age=37) were recruited over a 5-week period. The sample included 26 males and 10 females.Outcome measuresSpirometry without bronchodilation; health related quality of life EQ-5D-3L; Asthma Control Test; Mini Asthma Quality of Life; Clinical COPD Questionnaire and the Treatment Outcome Profile were used to assess the respiratory health of participants. Findings were discussed with staff and service users in 2 patient and public involvement events and feedback was analysed thematically.Results34 participants reported that they had smoked heroin. 8 participants diagnosed with asthma, scored under 13 on the Asthma Control Test, suggesting poorly controlled asthma. Participants (n=28), without a diagnosis of asthma completed the Lung Function Questionnaire. Of these, 79% produced scores under 18, indicating symptoms associated with the development of chronic obstructive pulmonary disease. Spirometry showed 14% of all participants had forced expiratory volume in 1 s/forced vital capacity <0.7 (without bronchodilator), indicating potential obstructive lung disease. Feedback from service users and staff suggested a willingness and capacity to deliver respiratory health screening programmes. Insight towards the difficulties service users have in accessing services and the burden of respiratory health was also provided.ConclusionsIt is feasible to undertake respiratory health screening of OMUs in a community clinic. Larger screening studies are warranted to determine the prevalence of respiratory health problems in this population. Research regarding asthma medicines adherence and access to healthcare among OMUs is also required.

IntroductionMDTs promote harm reduction in the care of opiate misusers (OMUs) through the prescription of opiate substitute medication and by encouraging smoking rather than injecting (to reduce the risk of blood-bourne virus transmission and venous thromboembolism). The average life expectancy for a male OMU is 41 years and whilst evidence suggests that the current cohort of older OMUs are dying prematurely from non-drug related deaths, all-cause mortality studies rarely report the prevalence of chronic health problems. A recent case-controlled study reported a higher prevalence of asthma and COPD in OMUs after adjusting for tobacco consumption and other factors.The study objective was to investigate the prevalence and illness burden of respiratory problems (asthma, COPD, symptomatic but undiagnosed lung disease) in patients with a history of current and/or past opiate misuse.MethodsOpportunistic clinic-based participant recruitment. Resting spirometry and researcher administered socio-demographic, inhaled drug use and validated respiratory patient reported outcome questionnaires: 1) prior diagnosis of asthma (ACT; mini-ARQoL) or COPD (CCQ); 2) respiratory health screening if no prior diagnosis (LFQ).ResultsThere were 36 participants (26 male; 10 female; aged 24–53). Only 8 had a diagnosis (all asthmatics); 35/36 smoked tobacco; 34/36 smoked heroin; 33/36 smoked cocaine; and 31/36 smoked cannabis. All asthmatics had poor control (<13) on the ACT (median score 8) and frequent beta-agonist use (none used inhaled corticosteroids). Of the others, 22/28 scored ≤18 on LFQ suggesting high symptom burden and three of these had obstructive resting spirometry increasing the possibility of COPD.ConclusionsChronic respiratory health in drug users is an under-researched area with few screening or high quality intervention studies evident. We identified a significant respiratory symptom burden within this OMU cohort. Most smoked tobacco, heroin, cocaine and cannabis. Asthmatics reported poor control and were potentially at risk of severe exacerbations, hospital admission and early progression to COPD.Four further LHOp studies are planned: a pharmacy based intervention to improve asthma control/uptake of preventive interventions (smoking cessation; vaccinations); a case control study of GP asthma medication prescribing; prospective prognostic respiratory health cohort studies; and a qualitative study of asthmatic OMUs’ perspectives on respiratory health and inhaler use.