Menstrual hygiene management (MHM) has gained some attention and several literature reviews have been published. However, both original papers and reviews tend to focus on absorbent access and use and not on the disposal of menstrual waste. This review aims to fill a gap in the water, sanitation and hygiene (WASH) sector by bringing a focus specifically on menstrual hygiene safe disposal in low- and middle-income countries (LMIC). We reviewed published literature since 2002 on menstrual hygiene with a focus on menstrual waste management and menstrual absorbent disposal in LMIC. Database searches were conducted of both peer reviewed literature and grey literature, in addition to hand searching of references of relevant earlier literature reviews. In total 152 articles and reports were identified and 75 met the inclusion criteria and was included in the final review. Existing polices on MHM was also reviewed with a focus on India and South Africa. The review showed that disposal of menstrual waste is often neglected MHM and sanitation value chains, leading to improper disposal and negative impacts on users, the sanitation systems and the environment. Findings call for further research to gain better understandings of MHM waste streams, disposal behaviors, absorbent materials and waste management technologies to deliver health, safety, mobility and dignity for women and girls.

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Menstrual Hygiene Management and Waste Disposal in Low and Middle Income Countries-A Review of the Literature

Context: Family, especially the mother, has the most important role in the education, transformation of information, and health behaviors of girls in order for them to have a healthy transition from the critical stage of puberty, but there are different views in this regard. Objectives: Considering the various findings about the source of information about puberty, a meta-analysis study was conducted to investigate the extent of the mother’s role in informing girls about puberty. Data Sources: This meta-analysis study was based on English articles published from 2000 to February 2015 in the Scopus, PubMed, and Science direct databases and on Persian articles in the SID, Magiran, and Iran Medex databases with determined key words and their MeSH equivalent. Study Selection: Quantitative cross-sectional articles were extracted by two independent researchers and finally 46 articles were selected based on inclusion criteria. STROBE list were used for evaluation of studies. Data Extraction: The percent of mothers as the current and preferred source of gaining information about the process of puberty, menarche, and menstruation from the perspective of adolescent girls was extracted from the articles. The results of studies were analyzed using meta-analysis (random effects model) and the studies’ heterogeneity was analyzed using the I 2 calculation index. Variance between studies was analyzed using tau squared (Tau 2 ) and review manager 5 software. Results: The results showed that, from the perspective of teenage girls in Iran and other countries, in 56% of cases, the mother was the current source of information about the process of puberty, menarche, and menstruation. The preferred source of information about the process of puberty, menarche, and menstruation was the mother in all studies at 60% (Iran 57%, and other countries 66%). Conclusions: According to the findings of this study, it is essential that health professionals and officials of the ministry of health train mothers about the time, trends, and factors affecting the start of puberty using a multi-dimensional approach that involves religious organizations, community groups, and peer groups.

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The Role of Mother in Informing Girls About Puberty: A Meta-Analysis Study

Mapping the landscape of education research by scholars based in sub-Saharan Africa: Insights from the African Education Research Database

Background. Adolescent girls in developing countries do not have proper information, and proper information is covered up by sociocultural boundaries resulting in various morbidities. This study aimed to determine level of knowledge and its associated factors regarding menstrual hygiene amongst adolescent school girls in Dang district, Nepal. Methods. Institution-based cross-sectional study was conducted between April and October 2019 among 406 adolescent girls studying in grades 8–10 between ages of 10–19 years in Dang district, Nepal. From a total of 10 local units, 5 were selected randomly. Out of the selected 5 units, 10 schools consisting of 5 government and 5 private schools were selected through disproportionate stratified random sampling. A further 406 students were then selected randomly from the 10 selected schools. Bivariate analysis was used primarily to assess the association between dependent and independent variables. Variables which were associated with bivariate analysis were entered into a multivariable logistic regression model to identify associated factors of menstrual hygiene practice. Results. The mean age and family size were 15.13 ± 1.19 and 5.58 ± 1.81, respectively. A total of 87.7% of adolescents had good knowledge regarding menstrual hygiene. Adolescents living in rural area (AOR = 0.27, CI: 0.12–0.61, ), private schools (AOR = 6.10, CI: 1.58–23.46, ), mothers who can read and write (AOR = 0.22, CI: 0.07–0.64, ), fathers who have up-to-grade-10 education (AOR = 5.15, CI: 1.84–14.39, ), and living only with mothers (AOR = 0.29, CI: 0.12–0.69, ) were significantly associated with level of knowledge of menstrual hygiene. Conclusions. Though the majority of respondents had a good level of knowledge regarding menstrual hygiene, there was a knowledge gap in specific areas. The level of knowledge was significantly poor among adolescents in rural areas and those living only with mothers. Thus, this study concerns the need for policy makers to focus on specific education regarding menstrual hygiene in rural areas including both parents.

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Level and Associated Factors of Knowledge regarding Menstrual Hygiene among School-Going Adolescent Girls in Dang District, Nepal.

Aims: To explore the knowledge of menstrual hygiene management among adolescent girls in different domains like culture, social learning and belief. \n Methods: This review paper explored the knowledge of menstrual hygiene management under several domains. Literature published in Pub Med, Medline, Google Scholar and HINARI from 2010 to 2020 was reviewed to prepare this paper. \nResults: The studies revealed that there is a general silence about menstruation. Adequate and accurate information about menstruation and the need for good menstrual hygiene management is limited. It further revealed that girls are not provided with comprehensive information before menarche while growing up, and therefore the first experience of menstruation is without any preparation and usually comes as a shock. Menstruation is widely regarded as a curse from God or as a disease or as being impure or as a taboo. Schools are doing very little to impart education on Menstrual Hygiene Management to adolescents. A majority of the teachers themselves are least or unprepared to address this issue with the girls, even when it is part of the school curriculum. The studies provide a wealth of information for designing interventions to improve menstrual hygiene management. \nConclusions: Young girls are not well aware of the menstrual event and the hygienic measures. They are neither well informed nor properly taught by elders and teachers. Effective interventions must be contextualized, designed, and implemented to generate awareness and change the mindset of people surrounding menstruation. \nKeywords: adolescents, knowledge, menstrual hygiene management, reproductive health

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Knowledge of menstrual hygiene management among adolescent girls: what does evidence show?

A culture of silence surrounds menstruation while inadequate facilities predispose adolescents to psycho-social trauma and cyclic absenteeism from schools. This study assessed the knowledge and menstrual hygiene management (MHM) practices among in-school adolescents in an urban city in Nigeria. The descriptive, cross-sectional study identified 400 respondents through a multistage technique and collected data through validated questionnaire and observational checklist. The mean age and age-at-menarche of respondents were 15.3 ± 1.5 and 12.8 years, respectively. Most respondents (70%) were aged 10–15 years, had good knowledge of MHM (296, 74%) and knew about menstruation before menarche (85.4%). MHM knowledge was significantly associated with: mother9s education ( p = 0.029); absorbents changing frequency ( p = 0.003); and age-at-menarche ( p = 001). The number of absorbents used daily was 2.5 ± 0.7; 90% of adolescents changed absorbents at least twice daily while 24.2% had previously changed it in school. Moreover, 14.4% of respondents abstained from school during menstruation and there was a significant association between school type and menstrual absorbents used ( p = 0.0001), mothers9 education ( p = 0.0001) and disposal of used absorbents ( p = 0.004). Spent absorbents were mostly disposed of in pit latrines (35.1%) and by burning (32.6%) . A wide disparity remains between good MHM knowledge and poor practices. Therefore, gender-friendly facilities should be provided in schools to ensure retention of girls and end psycho-social trauma experienced during menstruation.

A. Adebola Olajuyin

Papers

Knowledge and menstrual hygiene practices among adolescents in senior secondary schools in Ile Ife, south-western Nigeria