Does distribution of menstrual products through community-based, peer-led sexual and reproductive health services increase use of appropriate menstrual products? Findings from the Yathu Yathu trial.
Does distribution of menstrual products through community-based, peer-led sexual and reproductive health services increase use of appropriate menstrual products? Findings from the Yathu Yathu trial.
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DOI：
10.1186/s12978-023-01631-x
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发表时间：
2023-06-20
影响因子：
3.4
通讯作者：
Ayles, Helen
中科院分区：
文献类型：
--
作者：
Hensen, Bernadette;Gondwe, Melleh;Phiri, Mwelwa;Schaap, Ab;Sigande, Lucheka;Floyd, Sian;Simuyaba, Melvin;Zulu-Phiri, Rosemary;Mwape, Louis;Fidler, Sarah;Hayes, Richard;Simwinga, Musonda;Ayles, Helen
在全球范围内，数百万来月经的青春期女孩和年轻妇女(AGYW)获得适当和舒适的产品来管理其月经的机会有限。Yathu Yathu是一项整群随机试验(CRT)，评估了以社区为基础、同行主导的性健康和生殖健康(SRH)服务对青少年和15-24岁年轻人艾滋病毒状况知识的影响(AYP)。Yathu Yathu提供的服务包括免费的一次性护垫和月经杯。这项研究旨在调查通过Yathu Yathu获得免费月经产品是否会增加AGYW在最后一次月经时使用合适的月经产品，并探索AGYW通过Yathu Yathu获得月经产品的特点。Yathu Yathu于2019年至2021年在赞比亚卢萨卡两个城市社区的20个区域进行。区域被随机分配到干预或标准护理臂。在干预区，建立了一个以社区为基础的中心，由同行组成，提供SRH服务。2019年，在所有地区进行了人口普查；所有同意的15-24岁的AYP都获得了Yathu Yathu预防积分卡，这使AYP能够获得积分，以便在枢纽和卫生设施(干预部门)或仅在卫生设施(控制部门)获得服务。积分可以换取奖励，从而对双方都起到激励作用。我们在2021年进行了一项横断面调查，以估计Yathu Yathu对初级结局(艾滋病毒状况的了解)和次级结局的影响。抽样是按性别和年龄组分层的；我们分析了来自AGYW的数据，只是为了估计Yathu Yathu在最后一次月经期间使用适当的月经产品(一次性或可重复使用的垫子、杯子、卫生棉条)的影响。我们使用推荐用于 <； 15 Clusters/ARM的CRT的两阶段流程，在区域级别分析数据。在参加调查的985名经历过月经初潮的AGYW中，最常用的产品是一次性护垫(88.8%；n = 875/985)。在最后一次月经期间，干预组93.3%(n = 459/492)的妇女使用了合适的月经产品，而对照组为85.7%(n = 420/490)(adjPR = 1.0995%CI 1.02，1.17；p = 0.02)。未发现年龄的交互作用(p = 0.20)，但干预组青少年使用适当产品的比例高于对照组(95.5%vs84.5%，adjPR = 1.14 95%CI 1.04，1.25；p = 0.006)，而年轻女性之间的差异无统计学意义(91.1%vs87.0%，adjPR = 1.06 95%CI 0.96，1.16，p = 0.22)。在Yathu Yathu研究开始时，在15-19岁的青春期女孩中，提供基于社区的同行主导的SRH服务增加了适当月经产品的使用。在经济独立性较低的情况下，免费提供适当的月经产品对青春期女孩获得使其能够有效管理月经的材料至关重要。网上版载有补充材料，可在10.1186/s12978-023-01631-x查阅。
Globally, millions of adolescent girls and young women (AGYW) who menstruate have limited access to appropriate and comfortable products to manage their menstruation. Yathu Yathu was a cluster randomised trial (CRT) that estimated the impact of community-based, peer-led sexual and reproductive health (SRH) services on knowledge of HIV status among adolescents and young people aged 15–24 (AYP). Among the services offered through Yathu Yathu were free disposable pads and menstrual cups. This study aimed to investigate whether the availability of free menstrual products through Yathu Yathu increased AGYW’s use of an appropriate menstrual product at their last menstruation and explored the characteristics of AGYW who accessed menstrual products through Yathu Yathu. Yathu Yathu was conducted between 2019 and 2021 in 20 zones across two urban communities of Lusaka, Zambia. Zones were randomly allocated to the intervention or standard-of-care arm. In intervention zones, a community-based hub, staffed by peers, was established to provide SRH services. In 2019, a census was conducted in all zones; all consenting AYP aged 15–24 were given a Yathu Yathu Prevention Points Card, which allowed AYP to accrue points for accessing services at the hub and health facility (intervention arm), or the health facility only (control arm). Points could be exchanged for rewards, thus acting as an incentive in both arms. We conducted a cross-sectional survey in 2021 to estimate the impact of Yathu Yathu on the primary outcome (knowledge of HIV status) and secondary outcomes. Sampling was stratified by sex and age group; we analysed data from AGYW only to estimate the impact of Yathu Yathu on use of an appropriate menstrual product (disposable or reusable pad, cup, tampon) at last menstruation. We analysed data at zone-level using a two-stage process recommended for CRTs with < 15 clusters/arm. Among 985 AGYW participating in the survey who had experienced menarche, the most commonly used products were disposable pads (88.8%; n = 875/985). At their last menstruation, 93.3% (n = 459/492) of AGYW in the intervention arm used an appropriate menstrual product compared to 85.7% (n = 420/490) in the control arm (adjPR = 1.09 95%CI 1.02, 1.17; p = 0.02). There was no evidence for interaction by age (p = 0.20), but use of appropriate products was higher among adolescents in the intervention arm relative to control (95.5% vs 84.5%, adjPR = 1.14 95%CI 1.04, 1.25; p = 0.006) with no evidence for a difference among young women (91.1% vs 87.0%, adjPR = 1.06 95%CI 0.96, 1.16, p = 0.22). Delivering community-based peer-led SRH services increased the use of appropriate menstrual products among adolescent girls aged 15–19 at the start of the Yathu Yathu study. With less economic independence, the free provision of appropriate menstrual products is critical for adolescent girls to access materials that allow them to effectively manage their menstruation. The online version contains supplementary material available at 10.1186/s12978-023-01631-x.
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