Knowledge of menstruation and fertility among adults in rural Western Kenya: Gaps and opportunities for support

Diamond‐Smith, Nadia; Onyango, George O; Wawire, Salome; Ayodo, George

doi:10.1371/journal.pone.0229871

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…Our study findings support similar findings from other LMICs that note that most young women face challenges in accessing menstrual products and only learn about menstruation at menarche and even then, the information is limited and skewed by local myths and taboos [ 18 , 19 ]. These barriers then lead to feelings of isolation, shame, and fear that negatively inform how young women experience menstruation over time [ 3 ].…”

Section: Discussionsupporting

confidence: 90%

Menstrual product choice and uptake among young women in Zimbabwe: a pilot study

Tembo

Renju

Weiss

et al. 2020

Pilot Feasibility Stud

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Background Menstrual health and hygiene (MHH) is a human rights issue; yet, it remains a challenge for many, especially in low- and middle-income countries (LMICs). MHH includes the socio-political, psychosocial, and environmental factors that impact women’s menstrual experiences. High proportions of girls and women in LMICs have inadequate MHH due to limited access to menstrual knowledge, products, and stigma reinforcing harmful myths and taboos. The aim of this pilot was to inform the design of an MHH sub-study and the implementation and scale-up of an MHH intervention incorporated into a community-based cluster-randomized trial of integrated sexual and reproductive health (SRH) services for youth in Zimbabwe. The objectives were to investigate (1) uptake of a novel MHH intervention, (2) menstrual product preference, and (3) the factors that informed uptake and product choice among young women. Methods Female participants aged 16–24 years old attending the community-based SRH services between April and July 2019 were offered the MHH intervention, which included either a menstrual cup or reusable pads, analgesia, and MHH education. Descriptive statistics were used to quantitatively assess uptake and product choice. Focus group discussions and in-depth interviews with participants and the intervention team were used to investigate the factors that influenced uptake and product choice. Results Of the 1732 eligible participants, 1414 (81.6%) took up the MHH intervention at first visit. Uptake differed by age group with 84.6% of younger women (16–19 years old) compared to 79.0% of older women (20–24 years old) taking up the intervention. There was higher uptake of reusable pads (88.0%) than menstrual cups (12.0%). Qualitative data highlighted that internal factors, such as intervention delivery, influenced uptake. Participants noted the importance of access to free menstrual products, analgesics, and MHH education in a youth-friendly environment. External factors such as sociocultural factors informed product choice. Barriers to cup uptake included fears that the cup would compromise young women’s virginity. Conclusions Pilot findings were used to improve the MHH intervention design and implementation as follows: (1) cup ambassadors to improve cup promotion, sensitization, and uptake; (2) use of smaller softer cups; and (3) education for community members including caregivers and partners. Trial registration Registry: Clinicaltrials.gov Registration Number: NCT03719521 Registration Date: 25 October 2018

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Section: Discussionsupporting

confidence: 90%

Menstrual product choice and uptake among young women in Zimbabwe: a pilot study

Tembo

Renju

Weiss

et al. 2020

Pilot Feasibility Stud

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“…We found that nearly all of our study participants reported knowledge improvements in areas such as the menstrual cycle (89.0%) and pregnancy health (84.6%). This is of particular relevance given the low level of health literacy among adolescents and women about their reproductive health as reported in multiple studies [15,16,19,21,54]. These results are also in line with a study independently conducted by Karasneh at el.…”

Section: Knowledge and Health Improvements Among Flo App Userssupporting

confidence: 88%

“…There is a big knowledge gap among adolescent girls and adult women, especially in low and middle income countries, about menstrual cycle health [15,16], fertility [15,17], healthy pregnancy [18] and overall women's health and wellbeing [19][20][21]. A North Indian study has found that only 31% of respondents reported the right definition of the menstrual cycle [16].…”

Section: Introductionmentioning

confidence: 99%

Characterisation of self-reported improvements in education and health among users of Flo period tracking app: cross-sectional survey

Zhaunova¹,

Bamford²,

Radović³

et al. 2022

Preprint

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Introduction: Low health literacy among girls, women, and people who menstruate is associated with worse reproductive health outcomes. Mobile apps promise tools for improving women’s health literacy, however, there is little information about subscribers’ perceptions of app functionality and its impact on their knowledge and health. Objective: This study aimed to explore knowledge and health improvements related to menstrual cycle and pregnancy, as well as improvements in general health in Flo app users. We also investigated what components of the Flo app were associated with the above mentioned improvements, and evaluated whether those improvements differed based on education level, free or a premium subscription to the app, short or long term use of the app, and frequency of use. Methods: Flo subscribers who had been using the app for no less than 30 days completed an online survey. A total of 2214 of complete survey responses were collected. The survey included demographic questions, questions about motivations guiding usage of the Flo app, to what extent and what components of the app may have helped improve their knowledge and health (i.e., reproductive, sexual, physical, mental health, health behaviours, and communication with healthcare providers).Results: Most study participants reported menstrual cycle (89.0%) and pregnancy (84.6%) knowledge improvements from Flo app use. 62.3% of Flo users reported ‘period predictions’ and 72.2% reported ‘reading and/or watching articles and video sources in the app’ helped them feel the most informed about their cycle and pregnancy health. Higher educated, Flo Premium, frequent, and short term app users reported using the app mainly for getting pregnant and pregnancy tracking. Lower educated and long time users reported using the app to learn more about their body, sexual health, irregular cycles and related conditions, and to avoid pregnancy. Importantly, intended uses of the app for both lower and higher educated users matched areas in which they have gained knowledge and achieved their health goals upon the Flo app use. Flo Premium, frequent, and long term users were more likely to report improvements in knowledge and health in all areas they chose to use the app for and even beyond.Conclusion: There is a need to increase reproductive health literacy in the global female population. This study has shown that the use of the period tracking app, Flo, as self-reported by its users, improved their menstrual cycle and pregnancy knowledge and health. Additionally, more frequent, long-term, and Flo Premium users were more likely to report knowledge and health improvements across multiple health areas. Thus, the use of digital health apps, such as the Flo app, should be considered for integration into healthcare systems to increase women’s health literacy in the wider population.

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“…This may explain results from the Pakistan site where almost 84% of women have no formal education. A recent qualitative study of 45 men and women in rural Western Kenya reported ‘high levels of misinformation about menstruation and fertility’ and misconceptions regarding the duration of pregnancy 25. Calendar literacy appears to vary by site 26.…”

Section: Discussionmentioning

confidence: 99%

Can the date of last menstrual period be trusted in the first trimester? Comparisons of gestational age measures from a prospective cohort study in six low-income to middle-income countries

Patel,

Bann,

Thorsten

et al. 2023

BMJ Open

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ObjectivesWe examined gestational age (GA) estimates for live and still births, and prematurity rates based on last menstrual period (LMP) compared with ultrasonography (USG) among pregnant women at seven sites in six low-resource countries.DesignProspective cohort studySetting and participantsThis study included data from the Global Network’s population-based Maternal and Newborn Health Registry which follows pregnant women in six low-income and middle-income countries (Democratic Republic of the Congo, Guatemala, India, Kenya, Pakistan and Zambia). Participants in this analysis were 42 803 women, including their 43 230 babies, who registered for the study in their first trimester based on GA estimated either by LMP or USG and had a live or stillbirth with an estimated GA of 20–42 weeks.Outcome measuresGA was estimated in weeks and days based on LMP and/or USG. Prematurity was defined as GA of 20 weeks+0 days through 36 weeks+6 days, calculated by both USG and LMP.ResultsOverall, average GA varied ≤1 week between LMP and USG. Mean GA for live births by LMP was lower than by USG (adjusted mean difference (95% CI) = −0.23 (–0.29 to –0.17) weeks). Among stillbirths, a higher GA was estimated by LMP than USG (adjusted mean difference (95% CI)= 0.42 (0.11 to 0.72) weeks). Preterm birth rates for live births were significantly higher when dated by LMP (adjusted rate difference (95% CI)= 4.20 (3.56 to 4.85)). There was no significant difference in preterm birth rates for stillbirths.ConclusionThe small differences in GA for LMP versus USG in the Guatemalan and Indian sites suggest that LMP may be a useful alternative to USG for GA dating during the first trimester until availability of USG improves in those areas. Further research is needed to assess LMP for first-trimester GA dating in other regions with limited access to USG.Trial registration numberNCT01073475.

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Knowledge of menstruation and fertility among adults in rural Western Kenya: Gaps and opportunities for support

Cited by 7 publications

References 21 publications

Menstrual product choice and uptake among young women in Zimbabwe: a pilot study

Menstrual product choice and uptake among young women in Zimbabwe: a pilot study

Characterisation of self-reported improvements in education and health among users of Flo period tracking app: cross-sectional survey

Can the date of last menstrual period be trusted in the first trimester? Comparisons of gestational age measures from a prospective cohort study in six low-income to middle-income countries

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