/pdf/treating-tb-in-people-with-hiv-45po9049i7.pdf

Treating TB in people with HIV

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Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation

Objectives To assess the status of menstrual hygiene management (MHM) among adolescent girls in India to determine unmet needs. Design Systematic review and meta-analysis. We searched PubMed, The Global Health Database, Google Scholar and references for studies published from 2000 to September 2015 on girls’ MHM. Setting India. Participants Adolescent girls. Outcome measures Information on menarche awareness, type of absorbent used, disposal, hygiene, restrictions and school absenteeism was extracted from eligible materials; a quality score was applied. Meta-analysis was used to estimate pooled prevalence (PP), and meta-regression to examine the effect of setting, region and time. Results Data from 138 studies involving 193 subpopulations and 97 070 girls were extracted. In 88 studies, half of the girls reported being informed prior to menarche (PP 48%, 95% CI 43% to 53%, I2 98.6%). Commercial pad use was more common among urban (PP 67%, 57% to 76%, I2 99.3%, n=38) than rural girls (PP 32%, 25% to 38%, I2 98.6%, n=56, p Conclusions Strengthening of MHM programmes in India is needed. Education on awareness, access to hygienic absorbents and disposal of MHM items need to be addressed. Trial registration number CRD42015019197.

https://bmjopen.bmj.com/content/bmjopen/6/3/e010290.full.pdf

Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis

Background 
Lack of menstrual knowledge, poor access to sanitary products and a non-facilitating school environment can make it difficult for girls to attend school. In India, interventions have been developed to reduce the burden of menstruation for school girls by government and non-governmental organizations (NGOs). We sought to identify challenges related to menstruation, and facilitators of menstrual management in schools in three states in India.

Methods 
Surveys were conducted among menstruating school girls in class 8-10 (above 12 years of age) of 43 government schools selected through stratified random sampling in three Indian states (Maharashtra, Chhattisgarh, Tamil Nadu) in 2015. For comparison, ten model schools supported by NGOs or UNICEF with a focussed menstrual hygiene education program were selected purposely in the same states to represent the better-case scenario. We examined awareness about menarche, items used for menstruation, and facilitators on girls’ experience of menstruation in regular schools and compared with model schools. Factors associated with school absence during menstruation were explored using multivariate analysis.

Findings 
More girls (mean age 14.1 years) were informed about menstruation before menarche in model schools (56%, n=492) than in regular schools (36%, n=2072, p<0.001). Girls reported menstruation affected school attendance (6% vs. 11% in model vs. regular schools respectively, p=0.003) and concentration (40% vs. 45%, p=0.1) and was associated with pain (31% vs. 38%, p=0.004) and fear of stain or smell (11% vs. 16%, p=0.002). About 45% of girls reported using disposable pads in both model and regular schools, but only 55% and 29% of pad-users reported good disposal facilities, respectively (p<0.001). In multivariate analysis, reported absenteeism during menstruation was significantly lower in Tamil Nadu (adjusted prevalence ratio [APR] 95% CI 0.24, 0.14-0.40) and Maharashtra (APR 0.56, 0.40-0.77) compared to Chhattisgarh, and halved in model compared to regular schools (APR 0.50, 0.34-0.73). Pain medication in school (APR 0.71, 0.51-0.97) and use of disposable pads (APR 0.57, 0.42-0.77) were associated with lower absenteeism and inadequate sanitary facilities with higher absenteeism during menstruation.

Conclusions 
Menstrual hygiene education, accessible sanitary products, pain relief, and adequate sanitary facilities at school would improve the schooling-experience of adolescent girls in India.

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Effect of menstruation on girls and their schooling, and facilitators of menstrual hygiene management in schools: surveys in government schools in three states in India, 2015.

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.

/pdf/menstrual-hygiene-management-and-waste-disposal-in-low-and-4wt3diyvib.pdf

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

Menstrual hygiene practices and its association with reproductive tract infections and abnormal vaginal discharge among women in India.

India is rapidly undergoing an epidemiological transition with a sudden change in the disease profile of its population. It is important to understand the changing nature of the burden of disease across the states of India for adequate policy intervention. We analyzed the trend and pattern of self-reported morbidity across states of India using three rounds of (52nd, 60th and 71st) National Sample Survey Organization (NSSO) data. Descriptive analysis was carried out to understand the prevalence of self-reported morbidity variation over a period of two decades (1995-2014) and multivariate analysis was performed to identify the significant determinants of various types of self-reported morbidities. The results indicated an increasing trend of infectious disease, Cardio Vascular Diseases (CVDs) and Non-Communicable Diseases (NCDs) over the last two decades (1995-2014). CVDs increased by a whopping eight-fold and the NCDs increased by three times during this period. A higher prevalence of self-reported morbidity was observed among the elderly and female, particularly in the urban locality. The growing incidence of CVDs and NCDs, especially among the elderly were reported from Kerala, Tamil Nadu, Punjab and West Bengal. The already constrained public health system in India is likely to face serious challenges with a double burden of communicable and non-communicable diseases. An effective and responsive public health system needs to be in place to make health care services available for NCDs and CVDs at the primary level. In order to ameliorate caregiving, the involvement of family will be critical. Informing the people inculcate healthy habits may be an effective health promotion measure.

/pdf/emerging-trends-and-patterns-of-self-reported-morbidity-in-32fdg1w1cq.pdf

Emerging trends and patterns of self-reported morbidity in India: Evidence from three rounds of national sample survey.

This study examined the relationship between Intimate Partner Violence (IPV) and unintended pregnancy among young women in South Asia using Demographic and Health Survey data from India (2005-2006), Bangladesh (2007) and Nepal (2011). The respondents were adolescent and young adult married women aged 15-24 years who had at least one childbirth in the five years preceding the survey. Bivariate and stepwise multivariate logistic regression analyses were performed to assess the relationship between IPV and unintended pregnancy. Thirty-eight per cent of the respondents in India, 52% in Bangladesh and 28% in Nepal reported having experienced physical or sexual IPV. Those who reported physical or sexual IPV had higher odds of unintended pregnancy (1.36 in India and 1.99 in Bangladesh). The findings indicate that IPV is a risk factor for unintended pregnancy among adolescent and young adult married women. Along with violence prevention programmes, a more responsive and youth-friendly health system needs to be in place to provide health care services to young women in these countries.

Intimate partner violence and unintended pregnancy among adolescent and young adult married women in south asia.

Menstruation among women is an integral part and a natural process that starts with menarche and stops at menopause. Women use sanitary pad, clothes and other methods to prevent blood stains from becoming evident. This paper examines the prevalence and discrepancies in the use of hygienic method during menstruation among unmarried women in India using nationally representative District Level Household and Facility Survey data (2007-08). The findings suggest that only one-third of the studied population used hygienic method during menstruation. Rural-urban and poor-non poor disparity persists across all background characteristics in use of hygienic method. Women with high school and above education (OR=8.8, p<0.001), from richest wealth quintile (OR=5.2, p<0.001) and women following Christian religion (OR=3.6, p<0.001) are more likely to use hygienic method as compared with women with no education, poor household and Hindu women respectively. Locally prepared low cost sanitary pads can be promoted across the country for easy accessibility and affordability. Effort should be made to produce them in bulk and supply them through female health workers such as ANM and Anganwadi worker across the country.

Menstrual Hygiene Management among Young Unmarried Women in India

Menstrual health problems are a largely neglected priority within the sexual and reproductive health domain in most low-income countries. We examined the prevalence of menstrual health problems and...

Jayakant Singh

Papers

Menstrual hygiene practices and its association with reproductive tract infections and abnormal vaginal discharge among women in India.

Emerging trends and patterns of self-reported morbidity in India: Evidence from three rounds of national sample survey.

Intimate partner violence and unintended pregnancy among adolescent and young adult married women in south asia.

Menstrual Hygiene Management among Young Unmarried Women in India

Neglect of Menstrual Disorders in Reproductive Health Care in India: A Population-Based Survey