Effects of sanitary pad distribution and reproductive health education on upper primary school attendance and reproductive health knowledge and attitudes in Kenya: a cluster randomized controlled trial.
Effects of sanitary pad distribution and reproductive health education on upper primary school attendance and reproductive health knowledge and attitudes in Kenya: a cluster randomized controlled trial.
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DOI：
10.1186/s12978-021-01223-7
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发表时间：
2021-08-31
影响因子：
3.4
通讯作者：
Soler-Hampejsek E
中科院分区：
文献类型：
--
作者：
Austrian K;Kangwana B;Muthengi E;Soler-Hampejsek E
青春期女孩对自己身体的态度和无法管理月经可能会加剧她们辍学和面临生殖健康挑战的风险。我们评估了卫生垫分发和生殖健康教育对肯尼亚基利菲小学七年级女孩的影响。采用整群随机对照试验设计。符合条件的群组是基利菲县三个副县的所有非寄宿学校，这些学校至少有25名小学七年级女生入学。140所小学，每组35所，被随机分配到四个研究组：(1)对照组；(2)卫生巾配送；(3) RH教育；(4)卫生巾分发与RH教育并举。结果包括出勤率、学校参与度、生殖健康知识和态度、性别规范和自我效能感。对于基线和终点测量的结果，估计差异中的差异（DID）模型，对于没有基线数据的结果，使用协方差模型分析。该研究随机选择了3489名小学7年级的女孩，平均年龄为14.4岁（标准差1.5）。2号和4号武器组的女孩平均收到20包卫生巾中的17.6包，3号和4号武器组的女孩平均参加了25次RH中的21次。94%的基线样本在干预结束时接受了采访，各组之间没有差异减员。没有证据表明在第2组（系数[coef] 0.37, 95% CI - 0.73, 1.46）、第3组（系数[coef] 0.14, 95% CI - 0.99, 1.26）或第4组（系数[coef] 0.58, 95% CI - 1.46）中对小学出勤率有影响。37岁,1.52)。第3组女孩RH阳性态度增加（DID系数）。0.63, 95% CI 0.40-0.86)和第4组（DID系数）。0.85, 95% ci 0.64,−1.07)。在第3组和第4组中，RH知识、性别规范和自我效能感也有所增加。研究结果表明，卫生巾的分发和生殖健康教育，无论是单独还是一起，都不足以提高小学入学率。然而，由于生殖健康教育干预措施改善了生殖健康结果，有证据表明，卫生巾的分发和生殖健康教育可以定位于更广泛的女孩生殖健康规划。试验注册号：ISRCTN， ISRCTN10894523。2017年8月22日注册-回顾性注册，http://www.isrctn.com/ISRCTN10894523在线版本包含补充材料，可在10.1186/s12978-021-01223-7获得。少女面临一系列挑战，可能影响她们完成学业或性健康和生殖健康的机会。由于女孩对自己的身体感到羞耻，特别是对月经感到羞耻，或者缺乏帮助她们管理月经的卫生用品，这些挑战可能会进一步复杂化。这项研究旨在评估向肯尼亚农村沿海地区的七年级女孩提供卫生巾和性教育是否能缓解这些挑战。这项研究包括140所学校，每所学校有35所被随机分配到以下计划包之一：(1)标准的政府提供卫生巾和健康教育；（二）每月定期发放卫生巾；（三）性教育；(4)每月定期提供卫生巾和性教育。研究发现，这三个项目都没有对出勤率产生影响，但那些参加过性教育的人对月经的态度更积极，对性健康和生殖健康了解更多，性别规范更公平，在项目结束时更自信。研究结果表明，解决女孩的月经健康挑战很重要，但更好的定位是作为综合性教育方案的一部分，解决与月经有关的耻辱和羞耻、获得月经产品、不公平的性别规范以及性健康和生殖健康知识差距，而不是女孩教育干预。在线版本包含补充材料，可在10.1186/s12978-021-01223-7获得。
Adolescent girls’ risk of school dropout and reproductive health (RH) challenges may be exacerbated by girls’ attitudes toward their bodies and inability to manage their menstruation. We assessed effects of sanitary pad distribution and RH education on girls in primary grade 7 in Kilifi, Kenya. A cluster randomized controlled trial design was used. Eligible clusters were all non-boarding schools in three sub-counties in Kilifi County that had a minimum of 25 girls enrolled in primary grade 7. 140 primary schools, 35 per arm, were randomly assigned to one of four study arms: (1) control; (2) sanitary pad distribution; (3) RH education; or (4) both sanitary pad distribution and RH education. Outcomes were school attendance, school engagement, RH knowledge and attitudes, gender norms, and self-efficacy. For outcomes measured both at baseline and endline, difference-in-differences (DID) models were estimated and for outcomes without baseline data available, analysis of covariance models were used. The study enrolled 3489 randomly selected girls in primary grade 7, with a mean age of 14.4 (SD 1.5). Girls in arms 2 and 4 received on average 17.6 out of 20 packets of sanitary pads and girls in arms 3 and 4 participated on average in 21 out of 25 RH sessions. Ninety-four percent of the baseline sample was interviewed at the end of the intervention with no differential attrition by arm. There was no evidence of an effect on primary school attendance on arm 2 (coefficient [coef] 0.37, 95% CI − 0.73, 1.46), arm 3 (coef 0.14, 95% CI − 0.99, 1.26) or arm 4 (coef 0.58, 95% CI − .37, 1.52). There was increased positive RH attitudes for girls in arm 3 (DID coef. 0.63, 95% CI 0.40–0.86) and arm 4 (DID coef. 0.85, 95% CI 0.64, − 1.07). There was also an increase in RH knowledge, gender norms and self-efficacy in arms 3 and 4. The findings suggest that neither sanitary pad distribution nor RH education, on their own or together, were sufficient to improve primary school attendance. However, as the RH education intervention improved RH outcomes, the evidence suggests that sanitary pad distribution and RH education can be positioned in broader RH programming for girls. Trial registration: ISRCTN, ISRCTN10894523. Registered 22 August 2017—Retrospectively registered, http://www.isrctn.com/ISRCTN10894523 The online version contains supplementary material available at 10.1186/s12978-021-01223-7. Adolescent girls face a range of challenges that may compromise their chances of completing school or their sexual and reproductive health. These challenges can be even further complicated by girls’ feelings of shame about their bodies, in particular about menstruation, or their lack of sanitary products to help them manage menstruation. This study sought out to assess if providing girls in grade 7 in a rural, coastal area of Kenya with sanitary pads and sex education would alleviate some of those challenges. One hundred and forty schools were included in the study and 35 each were randomly assigned to one of the following program packages: (1) standard government provision of pads and health education; (2) regular monthly provision of sanitary pads; (3) sex education; or (4) both regular monthly provision of sanitary pads and sex education. The study found that none of the three program packages had an impact on school attendance, however those that participated in the sex education felt more positively about menstruation, knew more about sexual and reproductive health, had more equitable gender norms and were more self-confident at the end of the program. The study results show that addressing girls’ menstrual health challenges are important, but are better positioned as part of comprehensive sexuality education programs addressing stigma and shame associated with menstruation, access to menstrual products, inequitable gender norms and sexual and reproductive health knowledge gaps, as opposed to a girls education intervention. The online version contains supplementary material available at 10.1186/s12978-021-01223-7.
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影响因子：
3.7
作者：
Montgomery P;Hennegan J;Dolan C;Wu M;Steinfield L;Scott L
通讯作者：
Scott L
DOI：
10.1363/4103115
发表时间：
2015-03-01
影响因子：
4.4
作者：
Haberland, Nicole A.
通讯作者：
Haberland, Nicole A.
影响因子：
3
作者：
McMahon, Shannon A.;Winch, Peter J.;Rheingans, Richard D.
通讯作者：
Rheingans, Richard D.
影响因子：
1.4
作者：
Dolan, Catherine S.;Ryus, Caitlin R.;Scott, Linda
通讯作者：
Scott, Linda
影响因子：
3.7
作者：
Mason, Linda;Nyothach, Elizabeth;Phillips-Howard, Penelope A.
通讯作者：
Phillips-Howard, Penelope A.