Assessing the effectiveness of a comprehensive menstrual health intervention program in Ugandan schools (MENISCUS): process evaluation of a pilot intervention study

Abstract

Background: Poor menstrual health and hygiene (MHH) is a globally recognised public health challenge. A pilot study of an MHH intervention was conducted in two secondary schools in Entebbe, Uganda, over 9 months. The intervention included five components delivered by the implementing partner (WoMena Uganda) and the research team: (i) training teachers to implement government guidelines for puberty education, (ii) a drama skit to reduce stigma about menstruation, (iii) training in use of a menstrual kit (including re-usable pads), (iv) guidance on pain relief methods including provision of analgesics and (v) improvements to school water, sanitation and hygiene (WASH) facilities. The aim of the process evaluation was to examine implementation, context and possible causal pathways. Methods: We collected information on fidelity, dose, reach, acceptability, context and mechanisms of impact using (i) quantitative survey data collected from female and male students in year 2 of secondary school (ages 13-21; 450 at the baseline and 369 at endline); (ii) qualitative data from 40 in-depth interviews with parents, teachers and female students, and four focus group discussions with students, stratified by gender; (iii) data from unannounced visits checking on WASH facilities throughout the study; and (iv) routine data collected as part of the implementation. Quantitative data were used primarily to assess fidelity, dose and reach. Qualitative data were used primarily to assess acceptability, context and possible mechanisms.

A comparative study of direct health intervention and peer-led intervention on menstrual hygiene management of adolescent girls in rural India

“…There are various studies which have demonstrated the impact of educational intervention on menstrual hygiene, but comparison of direct and peerled intervention is not to be found. 8,[20][21][22][23]35,36 In recent intervention studies conducted at Uganda, the investigators observed a significant improved in knowledge (reduce anxiety to menstruation) and practices (effective pain management) following intervention. 35,36 A study conducted in western Nigeria by Ademola evaluated the role of school-based education involving teacher-led and peer-led intervention on reproductive health of adolescents but not specifically on menstrual hygiene.…”

“…8,[20][21][22][23]35,36 In recent intervention studies conducted at Uganda, the investigators observed a significant improved in knowledge (reduce anxiety to menstruation) and practices (effective pain management) following intervention. 35,36 A study conducted in western Nigeria by Ademola evaluated the role of school-based education involving teacher-led and peer-led intervention on reproductive health of adolescents but not specifically on menstrual hygiene. 37 In study conducted by Ramaiya et al in India emphasis that social and behavioural change communication (SBCC) intervention plays a positive role in influencing the knowledge, attitudes, interpersonal communication, restrictions and MHM of adolescent girls.…”

Water, Sanitation, and Women’s Empowerment: A systematic review and qualitative metasynthesis

“…Multiple factors influence this ability, including conditions of water and sanitation facilities. Women and girls have described sanitation conditions as undesirable, dirty, disgusting, and nauseating 99,121,130,154,156,157,159,171,174,203,205,206,[208][209][210]212,213,215,[221][222][223]226,227,230,233,237 and lacking resources like disposal bins, soap, sufficient water, and buckets for washing or bathing, which are also needed during menstruation. 99,130,157,171,176,189,193,201,207,208,212,213,215,232,[238][239][240] Women used less preferred locations and sources for sanitation 116,156,159,…”

“…2,121,160,165,167 Research describing perceptions of improved safety all focuses on sanitation. 125,208,213,243,253 Women in Nigeria with lockable latrines were significantly more likely to indicate that their latrine was safe than women without. 253 Women and girls in Maharashtra, India, particularly when pregnant, menstruating, or adolescent, reported reduced fear when using toilets rather than open defecating.…”

Grand Challenges in Adolescent Sexual and Reproductive Health

“…Menstrual health is an area which has focused attention on the reproductive health needs of girls and young women (20), with a growing body of literature documenting successful interventions in schools (21)(22)(23). There is also a recognition of the importance of support for menstruation support and management which includes boys and young men to heighten their awareness and sensitivity to the issues (24), so that their attitudes and behavior do not promote the exclusion from school of girls experiencing their periods. The inclusion in policy discussions and interventions that the reproductive health concerns of girls and boys, young women and young men, are interlinked beyond males being viewed as sexually dominant, helps in the recognition of the sexual health uncertainties that boys as well as girls face in adolescence and beyond.…”