Water, sanitation and hygiene (WASH) programs in African schools have received increased attention, particularly around the potential impact of poor menstrual

BackgroundA menstrual cup can be a good solution for menstrual hygiene management in economically challenged settings. As part of a pilot study we assessed uptake and maintenance of cup use among young school girls in Kenya.MethodsA total of 192 girls between 14 to 16 years were enrolled in 10 schools in Nyanza Province, Western Kenya; these schools were assigned menstrual cups as part of the cluster-randomized pilot study. Girls were provided with menstrual cups in addition to training and guidance on use, puberty education, and instructions for menstrual hygiene. During repeated individual visits with nurses, girls reported use of the menstrual cup and nurses recorded colour change of the cup.ResultsGirls were able to keep their cups in good condition, with only 12 cups (6.3%) lost (dropped in toilet, lost or destroyed). Verbally reported cup use increased from 84% in the first 3 months (n = 143) to 96% after 9 months (n = 74). Colour change of the cup, as ‘uptake’ indicator of use, was detected in 70.8% of 192 participants, with a median time of 5 months (range 1–14 months). Uptake differed by school and was significantly higher among girls who experienced menarche within the past year (adjusted risk ratio 1.29, 95% CI 1.04–1.60), and was faster among girls enrolled in the second study year (hazard ratio 3.93, 95% CI 2.09–7.38). The kappa score comparing self-report and cup colour observation was 0.044 (p = 0.028), indicating that agreement was only slightly higher than by random chance.ConclusionsObjective evidence through cup colour change suggests school girls in rural Africa can use menstrual cups, with uptake improving with peer group education and over time.Trial registrationISRCTN17486946. Retrospectively registered 09 December 2014.Electronic supplementary materialThe online version of this article (10.1186/s12978-018-0582-8) contains supplementary material, which is available to authorized users.

Many females lack access to water, privacy and basic sanitation—felt acutely when menstruating. Water, sanitation and hygiene (WASH) conditions in schools, such as access to latrines, water, and soap, are essential for the comfort, equity, and dignity of menstruating girls. Our study was nested within a cluster randomized controlled pilot feasibility study where nurses provided menstrual items to schoolgirls. We observed the WASH conditions of 30 schools from June 2012–October 2013 to see if there were any changes in conditions, to compare differences between study arms and to examine agreement between observed and teacher-reported conditions. Data came from study staff observed, and school teacher reported, WASH conditions. We developed scores for the condition of school facilities to report any changes in conditions and compare outcomes across study arms. Results demonstrated that soap availability for students increased significantly between baseline and follow-up while there was a significant decrease in the number of “acceptable” latrines. During the study follow-up period, individual WASH indicators supporting menstruating girls, such as locks on latrine doors or water availability in latrines did not significantly improve. Advances in WASH conditions for all students, and menstrual hygiene facilities for schoolgirls, needs further support, a defined budget, and regular monitoring of WASH facilities to maintain standards.

ObjectiveExamine the safety of menstrual cups against sanitary pads and usual practice in Kenyan schoolgirls.DesignObservational studies nested in a cluster randomised controlled feasibility study.Setting30 primary schools in a health and demographic surveillance system in rural western Kenya.ParticipantsMenstruating primary schoolgirls aged 14–16 years participating in a menstrual feasibility study.InterventionsInsertable menstrual cup, monthly sanitary pads or ‘usual practice’ (controls).Outcome measures Staphylococcus aureus vaginal colonization, Escherichia coli growth on sampled used cups, toxic shock syndrome or other adverse health outcomes.ResultsAmong 604 eligible girls tested, no adverse event or TSS was detected over a median 10.9 months follow-up. S. aureusprevalence was 10.8%, with no significant difference over intervention time or between groups. Of 65 S.aureus positives at first test, 49 girls were retested and 10 (20.4%) remained positive. Of these, two (20%) sample isolates tested positive for toxic shock syndrome toxin-1; both girls were provided pads and were clinically healthy. Seven per cent of cups required replacements for loss, damage, dropping in a latrine or a poor fit. Of 30 used cups processed for E. coli growth, 13 (37.1%, 95% CI 21.1% to 53.1%) had growth. E. coli growth was greatest in newer compared with established users (53%vs22.2%, p=0.12).ConclusionsAmong this feasibility sample, no evidence emerged to indicate menstrual cups are hazardous or cause health harms among rural Kenyan schoolgirls, but large-scale trials and post-marketing surveillance should continue to evaluate cup safety.

Introduction There is emerging data on HIV ‐1 incidence among MSM in sub‐Saharan Africa ( SSA ), but no known estimate of HIV ‐1 incidence among transgender women ( TGW ) in the region has yet been reported. We assessed HIV ‐1 incidence and pre‐exposure prophylaxis (Pr EP ) interest in men who have sex with men exclusively ( MSME ), men who have sex with men and women ( MSMW ) and TGW in coastal Kenya. Methods HIV ‐1‐seronegative individuals who had participated in an HIV testing study in 2016 were traced and retested in 2017 according to Kenyan guidelines. All participants were assigned male sex at birth and had male sex partners; additional data on gender identity and sexual orientation were obtained. We assessed the factors associated with HIV ‐1 acquisition using Poisson regression and calculated HIV ‐1 incidence in MSME , MSMW and TGW . Pr EP interest was assessed through focus group discussions to characterize subcategories’ perceived Pr EP needs. Results Of the 168 cohort participants, 42 were classified as MSME , 112 as MSMW and 14 as TGW . Overall, HIV ‐1 incidence was 5.1 (95% confidence interval ( CI ): 2.6 to 9.8) per 100 person‐years ( PY ): 4.5 (95% CI : 1.1 to 17.8] per 100 PY among MSME , 3.4 (95% CI : 1.3 to 9.1) per 100 PY among MSMW and 20.6 (95% CI : 6.6 to 63.8] per 100 PY among TGW . HIV ‐1 acquisition was associated with exclusive receptive anal intercourse ( aIRR 13.0, 95% CI 1.9 to 88.6), history of an STI in preceding six months ( aIRR 10.3, 95% CI 2.2 to 49.4) and separated/divorced marital status ( aIRR 8.2 (95%: 1.1 to 62.2). Almost all (98.8%) participants were interested in initiating Pr EP . MSME and TGW felt that Pr EP would lead to increases in condomless anal or group sex. Conclusions ...