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Journal ArticleDOI

Menstrual Hygiene Management—Knowledge, Attitudes, and Practices Among Female College Students in Bhutan

TL;DR: In this article, the authors explored knowledge, attitudes, and practices (KAP) of female college students from all ten government colleges of Bhutan, documenting conditions of available MHM facilities, from August to September 2018.
Abstract: Background. Girls and women face substantial menstrual hygiene management (MHM) challenges in low and middle-income countries. These challenges are related to inadequate knowledge, and insufficient water, sanitation and hygiene (WASH) facilities. Currently, literature on MHM among college-attending women in Bhutan is scarce. We aimed to explore knowledge, attitudes, and practices (KAP) of female college students from all ten government colleges of Bhutan, documenting conditions of available MHM facilities, from August to September 2018. Methods: A cross-sectional KAP survey was conducted with a random sample of female students from all years and a random sample of MHM facilities at each college and hostel. A questionnaire was adapted from a similar study conducted with school students in Bhutan. Socio-demographics, overall KAP findings, and differences in KAP between first and final year students were analyzed; college and hostel toilets were reported. Results: 1,010 participants completed the self-administered questionnaire. Comprehensive knowledge of menstruation was low (35.5%). Half (50.3%) reported their mother as source of information and 35.1% of the participants agreed that women should not enter a shrine during menstruation. Approximately 4% of median monthly pocket money was spent on absorbents with 96.9% absorbents wrapped before disposal. Half (55.1%) reported menstruation affecting daily activities and 24.2% missed college due to dysmenorrhea. One fifth of participants (21.3%) reported unavailability of water in college, 80.1% of participants reported absence of soap for hand washing and 24.1% described no bins for disposal. In 33.7% of hostel toilets, participants reported doors missing locks. Our team’s observations had similar findings. Conclusion: Female students living in hostels during college years lose considerable resources during their formative years of learning: time, energy, and money, due to issues of menstruation management. Although the overall understanding of menstruation was low, our participants’ MHM practices scored highly, and the vast majority of them asked for a platform to discuss menstruation. Despite some agreement with menstrual taboos (e.g. visiting shrine), only 5.1% were uncomfortable conversing about MHM. Improved public health knowledge, psychosocial/medical support, and WASH infrastructure with freely available menstrual products could lead to more effective MHM practices among female college students.

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TL;DR: One-third of the school girls had poor menstrual hygiene practices which may affect their school performance and the reproductive health, and tailored menstrual hygiene information should be given to school girls and parents.
Abstract: Background: During menstruation, school girls face obstacles connected to menstrual hygiene management in schools. Due to their monthly period, up to 20% of girls miss school globally, and one in ten will drop out entirely. Three hundred thirty-five million girls attended school without access to running water or soap. In Ethiopia, 67% of girls have no access to education on puberty and menstrual health; menstrual hygiene management continues to be one of the major problems among school girls. Thus, context-specific assessment of the practice may be useful in developing customized intervention approaches. Thus, the objective of the study was to assess practices of menstrual hygiene management and associated determinants among secondary school girls in East Hararghe, Ethiopia from 1 to 30 December 2020. Methods: A school-based cross-sectional survey was undertaken with 486 randomly selected female students. Data were collected by pretested self-administered questionnaire. Descriptive statistical tests and multivariate logistic regression were used to describe the study variables and to examine the association. Statistical package for social science version 23 was used for data analysis, and a p-value of 0.05 was considered as a cut-off point for statistical significance. Results: Of the total, 328 (68%) of the study participants practiced appropriate menstrual hygiene. Besides, 350 (72.6%) had a good level of understanding about menstrual hygiene. A higher level of knowledge (adjusted odds ratio = 2.12, 95% confidence interval = 1.28, 3.53), a greater wealth indexed family (adjusted odds ratio = 7.14, 95% confidence interval = 3.98, 12.88), earning permanent pocket money (adjusted odds ratio = 0.495, 95% confidence interval = 0.299, 0.821), and being in grade level (11–12) (adjusted odds ratio = 3.45, 95% confidence interval = 1.75, 4.501) were significant predictors of the good menstrual hygiene practice. Conclusion: One-third of the school girls had poor menstrual hygiene practices which may affect their school performance and the reproductive health. Hence, tailored menstrual hygiene information should be given to school girls and parents. Besides, efforts ought to be made for the provision of affordable sanitary materials in schools.

5 citations

Journal ArticleDOI
01 Mar 2023-BMJ Open
TL;DR: In this article , the authors investigated some aspects of menstrual health and hygiene among young female students at Birzeit University in the West Bank of the occupied Palestinian territory (oPt).
Abstract: Objective We investigated some aspects of menstrual health and hygiene among young female students at Birzeit University in the West Bank of the occupied Palestinian territory. Design Cross-sectional study in a large central university. Participants Out of a total of 8473 eligible female students, a calculated sample size of 400 students aged between 16 and 27 years was obtained. Setting Large central university, West Bank, occupied Palestinian territory (oPt). Measures An anonymous structured international research instrument consisting of 39 questions based on the Menstrual Health Questionnaire, in addition to few questions relevant to the context, was administered. Results 30.5% of participants were not informed about menstruation before menarche, and 65.3% reported that they were not ready when they got their first period. The highest reported source of information regarding menstruation was family (74.1%), followed by school (69.3%). About 66% of respondents reported that they need more information on various topics of menstruation. The most common type of menstrual hygiene products used were single-use pads (86%), followed by toilet paper (13%), nappies (10%) and reusable cloths (6%). Of the total 400 students, 14.5% reported that menstrual hygiene products are expensive, and 15.3% reported that they always/sometimes had to use menstrual products that they do not like because they are cheaper. Most (71.9%) of the respondents reported that they used menstrual products for longer time than recommended due to inadequate washing facilities at the university campus. Conclusions The findings provide useful evidence on the lack and the need for menstrual-related information for female university students, inadequate infrastructure to help them manage their menstruation with dignity and pointed to some menstrual poverty in accessing menstrual products. A national intervention programme is needed to increase awareness regarding menstrual health and hygiene among women in local communities and female teachers in schools and universities to enable them to disseminate information to and meet the practical needs of girls at home, at school and at the university.

1 citations

Journal ArticleDOI
TL;DR: The research showed that a high percentage of school toilets in rural areas meet the basic service criteria, but the obstacles to reaching the criteria for advanced service level are the insufficient provision of facilities for the disposal of menstrual products in toilet cubicles, as well as the absence of menstrual hygiene education in 50% of schools.
Abstract: Good menstrual hygiene management in schools means that schoolgirls have access to adequate school toilets that meet criteria for basic sanitation and hygiene service, but also that they have basic knowledge about menstrual hygiene. The aim of this work is to assess sanitation and hygiene conditions for adequate menstrual hygiene management in rural schools in the Šumadija and Pomoravlje districts. The study was conducted on the territory of the rural areas of Šumadija and Pomoravlje districts in 2016. It encompassed 238 schools, of which 108 in Šumadija and 130 in Pomoravlje district. To assess sanitation and hygiene conditions for adequate menstrual hygiene management, a questionnaire was created, with questions related to: existence of toilets at schools and whether they are functional, accessible, single-sex, and ensure privacy, to provision of soap and toilet paper, handwashing facilities, bins with a lid in toilet cubicles for schoolgirls, and to provision of menstrual hygiene education. This research showed that a high percentage of school toilets in rural areas meet the basic service criteria (more than 90% for sanitation and about 85% for hygiene) in respect of toilet type and whether toilets are single-sex, usable, and with functional handwashing facilities. However, the obstacles to reaching the criteria for advanced service level are the insufficient provision of facilities for the disposal of menstrual products in toilet cubicles (76.9%), as well as the absence of menstrual hygiene education in 50% of schools. The research indicated the need to improve sanitation and hygiene conditions in order to reach advanced service level that would include better menstrual hygiene management in rural schools in Serbia. Also, a continued research should be focused on the role of social and economic aspects concerning schoolgirls and their families in the attainment of adequate menstrual hygiene.

1 citations

References
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Journal ArticleDOI
Jennifer E. Huffman1, Eva Albrecht, Alexander Teumer2, Massimo Mangino3, Karen Kapur, Toby Johnson4, Z. Kutalik, Nicola Pirastu5, Giorgio Pistis6, Lorna M. Lopez1, Toomas Haller7, Perttu Salo8, Anuj Goel9, Man Li10, Toshiko Tanaka8, Abbas Dehghan11, Daniela Ruggiero, Giovanni Malerba12, Albert V. Smith13, Ilja M. Nolte, Laura Portas, Amanda Phipps-Green14, Lora Boteva1, Pau Navarro1, Åsa Johansson15, Andrew A. Hicks16, Ozren Polasek17, Tõnu Esko18, John F. Peden9, Sarah E. Harris1, Federico Murgia, Sarah H. Wild1, Albert Tenesa1, Adrienne Tin10, Evelin Mihailov7, Anne Grotevendt2, Gauti Kjartan Gislason, Josef Coresh10, Pio D'Adamo5, Sheila Ulivi, Peter Vollenweider19, Gérard Waeber19, Susan Campbell1, Ivana Kolcic17, Krista Fisher7, Margus Viigimaa, Jeffrey Metter8, Corrado Masciullo6, Elisabetta Trabetti12, Cristina Bombieri12, Rossella Sorice, Angela Doering, Eva Reischl, Konstantin Strauch20, Albert Hofman11, André G. Uitterlinden11, Melanie Waldenberger, H-Erich Wichmann20, Gail Davies1, Alan J. Gow1, Nicola Dalbeth21, Lisa K. Stamp14, Johannes H. Smit22, Mirna Kirin1, Ramaiah Nagaraja8, Matthias Nauck2, Claudia Schurmann2, Kathrin Budde2, Susan M. Farrington1, Evropi Theodoratou1, Antti Jula8, Veikko Salomaa8, Cinzia Sala6, Christian Hengstenberg23, Michel Burnier19, R Maegi7, Norman Klopp20, Stefan Kloiber24, Sabine Schipf25, Samuli Ripatti26, Stefano Cabras27, Nicole Soranzo28, Georg Homuth2, Teresa Nutile, Patricia B. Munroe4, Nicholas D. Hastie1, Harry Campbell1, Igor Rudan1, Claudia P. Cabrera29, Chris Haley1, Oscar H. Franco11, Tony R. Merriman14, Vilmundur Gudnason13, Mario Pirastu, Brenda W.J.H. Penninx30, Brenda W.J.H. Penninx11, Harold Snieder, Andres Metspalu7, Marina Ciullo, Peter P. Pramstaller16, Cornelia M. van Duijn11, Luigi Ferrucci8, Giovanni Gambaro31, Ian J. Deary1, Malcolm G. Dunlop1, James F. Wilson1, Paolo Gasparini5, Ulf Gyllensten15, Tim D. Spector3, Alan F. Wright1, Caroline Hayward1, Hugh Watkins9, Markus Perola8, Murielle Bochud32, W. H. Linda Kao10, Mark J. Caulfield4, Daniela Toniolo6, Henry Voelzke25, Christian Gieger, Anna Koettgen33, Veronique Vitart1 
26 Mar 2015-PLOS ONE
TL;DR: Interactions between body mass index (BMI) and common genetic variants affecting serum urate levels, genome-wide, and regression-type analyses in a non BMI-stratified overall sample suggested a role for N-glycan biosynthesis as a prominent urate-associated pathway in the lean stratum.
Abstract: We tested for interactions between body mass index (BMI) and common genetic variants affecting serum urate levels, genome-wide, in up to 42569 participants. Both stratified genome-wide association (GWAS) analyses, in lean, overweight and obese individuals, and regression-type analyses in a non BMI-stratified overall sample were performed. The former did not uncover any novel locus with a major main effect, but supported modulation of effects for some known and potentially new urate loci. The latter highlighted a SNP at RBFOX3 reaching genome-wide significant level (effect size 0.014, 95% CI 0.008-0.02, Pinter= 2.6 x 10-8). Two top loci in interaction term analyses, RBFOX3 and ERO1LB-EDARADD, also displayed suggestive differences in main effect size between the lean and obese strata. All top ranking loci for urate effect differences between BMI categories were novel and most had small magnitude but opposite direction effects between strata. They include the locus RBMS1-TANK (men, Pdifflean-overweight= 4.7 x 10-8), a region that has been associated with several obesity related traits, and TSPYL5 (men, Pdifflean-overweight= 9.1 x 10-8), regulating adipocytes-produced estradiol. The top-ranking known urate loci was ABCG2, the strongest known gout risk locus, with an effect halved in obese compared to lean men (Pdifflean-obese= 2 x 10-4). Finally, pathway analysis suggested a role for N-glycan biosynthesis as a prominent urate-associated pathway in the lean stratum. These results illustrate a potentially powerful way to monitor changes occurring in obesogenic environment.

1,293 citations

Journal ArticleDOI
26 Apr 2013-PLOS ONE
TL;DR: There was no quantitative evidence that improvements in management methods reduce school absenteeism and there is a gap in the evidence for high quality randomised intervention studies which combine hardware and software interventions.
Abstract: BACKGROUND: Differing approaches to menstrual hygiene management (MHM) have been associated with a wide range of health and psycho-social outcomes in lower income settings. This paper systematically collates, summarizes and critically appraises the available evidence. METHODS: Following the PRISMA guidelines a structured search strategy was used to identify articles investigating the effects of MHM on health and psycho-social outcomes. The search was conducted in May 2012 and had no date limit. Data was extracted and quality of methodology was independently assessed by two researchers. Where no measure of effect was provided, but sufficient data were available to calculate one, this was undertaken. Meta-analysis was conducted where sufficient data were available. RESULTS: 14 articles were identified which looked at health outcomes, primarily reproductive tract infections (RTI). 11 articles were identified investigating associations between MHM, social restrictions and school attendance. MHM was found to be associated with RTI in 7 papers. Methodologies however varied greatly and overall quality was low. Meta-analysis of a subset of studies found no association between confirmed bacterial vaginosis and MHM (OR: 1.07, 95% CI: 0.52-2.24). No other substantial associations with health outcomes were found. Although there was good evidence that educational interventions can improve MHM practices and reduce social restrictions there was no quantitative evidence that improvements in management methods reduce school absenteeism. CONCLUSION: The management of menstruation presents significant challenges for women in lower income settings; the effect of poor MHM however remains unclear. It is plausible that MHM can affect the reproductive tract but the specific infections, the strength of effect, and the route of transmission, remain unclear. There is a gap in the evidence for high quality randomised intervention studies which combine hardware and software interventions, in particular for better understanding the nuanced effect improving MHM may have on girls' attendance at school.

275 citations

Journal ArticleDOI
TL;DR: A growing focus on menstrual hygiene management from nongovernmental organizations, the United Nations Children's Fund (UNICEF), and other international agencies now highlights the profound impact of this problem on school-aged girls and provides the basis for a much needed research, programming, and policy agenda as discussed by the authors.
Abstract: INADEQUATE WATER AND sanitation facilities pose a major impediment to school-going girls during menstruation, compromising their ability to maintain proper hygiene and privacy. A growing focus on menstrual hygiene management (MHM) from nongovernmental organizations, the United Nations Children’s Fund (UNICEF), and other international agencies now highlights the profound impact of this problem on school-aged girls and provides the basis for a much needed research, programming, and policy agenda.

223 citations

Journal ArticleDOI
30 Jun 2015-PLOS ONE
TL;DR: Interventions that ensure women have access to private facilities with water for MHM and that educate women about safer, low-cost MHM materials could reduce urogenital disease among women.
Abstract: Menstrual hygiene management (MHM) practices vary worldwide and depend on the individual's socioeconomic status, personal preferences, local traditions and beliefs, and access to water and sanitation resources. MHM practices can be particularly unhygienic and inconvenient for girls and women in poorer settings. Little is known about whether unhygienic MHM practices increase a woman's exposure to urogenital infections, such as bacterial vaginosis (BV) and urinary tract infection (UTI). This study aimed to determine the association of MHM practices with urogenital infections, controlling for environmental drivers. A hospital-based case-control study was conducted on 486 women at Odisha, India. Cases and controls were recruited using a syndromic approach. Vaginal swabs were collected from all the participants and tested for BV status using Amsel's criteria. Urine samples were cultured to assess UTI status. Socioeconomic status, clinical symptoms and reproductive history, and MHM and water and sanitation practices were obtained by standardised questionnaire. A total of 486 women were recruited to the study, 228 symptomatic cases and 258 asymptomatic controls. Women who used reusable absorbent pads were more likely to have symptoms of urogenital infection (AdjOR=2.3, 95%CI1.5-3.4) or to be diagnosed with at least one urogenital infection (BV or UTI) (AdjOR=2.8, 95%CI1.7-4.5), than women using disposable pads. Increased wealth and space for personal hygiene in the household were protective for BV (AdjOR=0.5, 95%CI0.3-0.9 and AdjOR=0.6, 95%CI0.3-0.9 respectively). Lower education of the participants was the only factor associated with UTI after adjusting for all the confounders (AdjOR=3.1, 95%CI1.2-7.9). Interventions that ensure women have access to private facilities with water for MHM and that educate women about safer, low-cost MHM materials could reduce urogenital disease among women. Further studies of the effects of specific practices for managing hygienically reusable pads and studies to explore other pathogenic reproductive tract infections are needed.

206 citations

Journal ArticleDOI
TL;DR: Interventions to address discrimination against childbearing Romani women and underlying health provider prejudice are urgently needed, alongside analysis of factors predicting the success or failure of such initiatives.
Abstract: Freedom from discrimination is one of the key principles in a human rights-based approach to maternal and newborn health. To review the published evidence on discrimination against Romani women in maternity care in Europe, and on interventions to address this. A systematic search of eight electronic databases was undertaken in 2015 using the terms “Roma” and “maternity care”. A broad search for grey literature included the websites of relevant agencies. Standardised data extraction tables were utilised, quality was formally assessed and a line of argument synthesis was developed and tested against the data from the grey literature. Nine hundred papers were identified; three qualitative studies and seven sources of grey literature met the review criteria. These revealed that many Romani women encounter barriers to accessing maternity care. Even when they are able to access care, they can experience discriminatory mistreatment on the basis of their ethnicity, economic status, place of residence or language. The grey literature revealed some health professionals held underlying negative beliefs about Romani women. There were no published research studies examining the effectiveness of interventions to address discrimination against Romani women and their infants in Europe. The Roma Health Mediation Programme is a promising intervention identified in the grey literature. There is evidence of discrimination against Romani women in maternity care in Europe. Interventions to address discrimination against childbearing Romani women and underlying health provider prejudice are urgently needed, alongside analysis of factors predicting the success or failure of such initiatives.

181 citations