Menstruation and the Cycle of Poverty: A Cluster Quasi-Randomised Control Trial of Sanitary Pad and Puberty Education Provision in Uganda.
Menstruation and the Cycle of Poverty: A Cluster Quasi-Randomised Control Trial of Sanitary Pad and Puberty Education Provision in Uganda.
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DOI：
10.1371/journal.pone.0166122
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Scott L
中科院分区：
文献类型：
--
作者：
Montgomery P;Hennegan J;Dolan C;Wu M;Steinfield L;Scott L
月经知识不足和无法获得卫生产品被认为是月经健康和上学的障碍。作为回应，针对这些需求的干预措施在公共和私营部门得到越来越多的实施。然而，对其有效性的评估有限。评估提供可重复使用的卫生巾和青春期教育对女孩入学率和心理健康结果的影响。在乌干达农村地区的8所学校进行了一项准随机对照试验，其中包括1124名女孩。学校被分配到四个条件之一：仅提供青春期教育;仅提供可重复使用的卫生巾;青春期教育和可重复使用的卫生巾;以及对照（无干预）。主要结果是学校出勤率。次要结果反映了心理社会健康。在后续行动中，所有条件下的女孩入学率都有所下降。按方案分析显示，在对照条件d = 0.52（95%CI：0.26-0.77）中，这种下降幅度显著更大，对照学校的学生出勤率下降幅度比任何干预学校的学生大17.1%（95%CI：8.7-25.5）。干预条件之间无差异。高辍学率和转学率意味着试验遭受了大量参与者的辍学。使用两种不同插补策略的意向治疗分析与主要结果一致，最佳情况下的平均差异为5.2%，最差情况下的平均差异为24.5%。结果是强大的聚类调整。干预措施对女孩在月经期间自我报告的羞耻感或不安全感没有影响。试验的结果支持假设的积极影响，提供卫生巾或青春期教育的女孩上学在发展中国家的情况。研究结果必须谨慎解释，根据参与者保留，干预保真度差，出勤措施。泛非临床试验注册中心PACTR 201503001044408
Poor menstrual knowledge and access to sanitary products have been proposed as barriers to menstrual health and school attendance. In response, interventions targeting these needs have seen increasing implementation in public and private sectors. However, there has been limited assessment of their effectiveness. Assess the impact of providing reusable sanitary pads and puberty education on girls’ school attendance and psychosocial wellbeing outcomes. A cluster quasi-randomised controlled trial was conducted across 8 schools, including 1124 girls, in rural Uganda. Schools were allocated to one of four conditions: the provision of puberty education alone; reusable sanitary pads alone; puberty education and reusable sanitary pads; and a control (no intervention). The primary outcome was school attendance. Secondary outcomes reflected psychosocial wellbeing. At follow-up, school attendance had worsened for girls across all conditions. Per-protocol analysis revealed that this decline was significantly greater for those in the control condition d = 0.52 (95%CI 0.26–0.77), with those in control schools having a 17.1% (95%CI: 8.7–25.5) greater drop in attendance than those in any intervention school. There were no differences between the intervention conditions. High rates of school drop-out and transfer meant the trial suffered from substantial participant drop-out. Intention-to-treat analyses using two different imputation strategies were consistent with the main results, with mean differences of 5.2% attendance in best-case and 24.5% in worst-case imputations. Results were robust to adjustments for clustering. There was no impact of the interventions on girls’ self-reported shame or insecurity during menstruation. Results of the trial support the hypothesised positive impact of providing sanitary pads or puberty education for girls’ school attendance in a developing country context. Findings must be interpreted with caution in light of poor participant retention, intervention fidelity, and the attendance measures used. Pan African Clinical Trials Registry PACTR201503001044408
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