Understanding the social and physical menstrual health environment of secondary schools in Uganda: A qualitative methods study.
Understanding the social and physical menstrual health environment of secondary schools in Uganda: A qualitative methods study.
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DOI：
10.1371/journal.pgph.0002665
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发表时间：
2023
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在资源匮乏的学校，青春期女孩面临着管理月经的社会、心理和身体问题。本研究旨在评估乌干达瓦基索和卡伦古地区中学的社会和生理月经健康环境，为随后的月经健康干预试验做准备，以改善教育、健康和福祉。我们在乌干达的75所中学进行了一次定性的快速评估。这包括在2021年5月至10月期间对150名校长/高级教师和274名学生进行深入访谈，与学生进行26次焦点小组讨论，并进行13次横断面步行，观察学校的供水、环卫和卫生设施。由于新冠肺炎相关学校停课，面对面的研究活动暂停，深度采访通过电话进行，取代了焦点小组讨论。我们采用了主题框架分析方法，使用社会生态模型(重点关注个人、人际、制度和社会因素之间的复杂相互作用)来生成主题和关键概念。与会者在个人层面描述了中学的社会和生理月经健康环境(关于月经初潮前的月经知识差距、对月经健康的负面规范和信念)；人际层面(有限的心理社会支持、关于卫生材料的处置和止痛的迷思和误解、学校护士、同龄人和高级教师对月经卫生管理的支持)；机构层面(没有执行关于月经卫生管理的政府通告、缺乏关于MHM的学校一级指导方针、政策和方案、洗涤设施差，即缺乏肥皂、安全水和不干净的厕所)；和社会层面(由民间社会团体、卫生工作者和学生学校协会提供的卫生保健管理方案)。研究结果显示，个人、社会和机构的负担与月经经历有关。需要采取多层次的循证干预措施，以改善上学女孩月经健康的社会和物质环境。
Adolescent girls face social, psychological, and physical problems managing menstruation in schools in low-resource settings. This study aimed to evaluate the social and physical menstrual health environment of secondary schools in Wakiso and Kalungu districts, Uganda, in preparation for a subsequent menstrual health intervention trial to improve education, health and wellbeing. We conducted a qualitative rapid assessment in 75 secondary schools in Uganda. This involved conducting in-depth interviews with 150 head/senior teachers and 274 students, 26 Focus Group Discussions with students, and 13 transect walks to observe school Water, Sanitation and Hygiene (WASH) facilities between May and October 2021. Due to COVID-19 related school closures, face-to-face research activities were halted and in-depth interviews were conducted over phone and replaced focus group discussions. We employed a thematic framework analysis approach using the social-ecological model (which focuses on the complex interplay between individual, interpersonal, institutional, and societal factors) to generate themes and key concepts. Participants described the social and physical menstrual health environment of secondary schools at the individual level (knowledge gaps on menstruation before menarche, negative norms and beliefs about menstrual health); interpersonal level (limited psycho-social support, myths and misconceptions about the disposal of sanitary materials and pain relief, menstrual hygiene management (MHM) support from school nurses, peers and senior teachers); institutional level (non-implementation of Government circulars on MHM, lack of school-level guidelines policies and programs on MHM and poor WASH facilities, i.e. lack of soap, safe water and unclean toilets); and societal level (MHM programmes provided by civil society groups, health workers, and students’ school associations). The findings showed individual, societal and institutional burdens related to menstrual experiences. Multi-level evidence-based interventions aimed at improving the social and physical environment for menstrual health among school-going girls are needed.