Menstrual Hygiene and Safe Male Circumcision Promotion in Ugandan Schools (MENISCUS)

点击翻译按钮获取中文摘要

Menstrual hygiene interventions may improve girls’ school attendance.1-3 A systematic review 4identified 7 intervention studies of menstrual hygiene education; one also included provision ofa menstrual cup. These studies had major methodological limitations, but were generallyencouraging. A more recent small Ghanaian study5 reported 10% higher attendance after 5months both in girls receiving puberty education only and those receiving puberty educationplus sanitary pads, relative to controls. Some menstrual hygiene practices (e.g. using leavesand rags) can cause intra-vaginal infections.4 Girls’ school attendance is associated with earningpotential, improved maternal and child survival and reduced HIV infection.6 This research inUgandan schoolgirls will prepare for a cluster-randomised trial (CRT) of the impact of pubertyand menstrual hygiene education and of providing sanitary pads on school absenteeism.Male circumcision reduces men’s risk of HIV acquisition,7 yet circumcision prevalence inUganda remains low (~25%).8 We will use an innovative, single-session, football-basedintervention (“Make the Cut”) to promote voluntary medical male circumcision (VMMC) uptakein schoolboys.9 A small CRT of this intervention in Zimbabwean football teams showed anencouraging impact on uptake of circumcision (adjusted OR=9.16; 95%CI:0.88-95.1;p=0.06).We propose evaluating a locally-modified version of this intervention in 14-16 year-old boysattending the same classes as girls in the menstrual hygiene trial. This will enhance researchcost-effectiveness while deflecting criticisms of favouritism or stigmatisation of girls in the trial.This research will i) refine the interventions (menstrual hygiene education and providingdisposable pads; the “Make the Cut” VMMC promotion); ii) define the trial’s most suitabletarget school year group(s); assess school attendance and girls’ self-reported sanitary hygienepreferences, and boys’ circumcision prevalence in this setting; iii) develop closer links withstudy schools and sanitary pad manufacturers, and iv) validate self-administered vaginal swabcollection and laboratory test procedures.