Menstrual cups and unconditional cash transfer to reduce sexual and reproductive harm and school drop-out in adolescent schoolgirls in western Kenya

月经杯和无条件现金转移，以减少肯尼亚西部少女的性和生殖伤害以及辍学率

• 批准号: MR/N006046/1
• 负责人: Penelope Anne Phillips-Howard
• 金额: $ 335.85万
• 依托单位: Liverpool School of Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2015
• 资助国家: 英国
• 起止时间: 2015 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FN006046%2F1
• 关键词: Menstrual; cups; unconditional; cash; transfer

Girls in low-income countries leave school early due to pregnancy, illness, early marriage, and lack of money for schooling and personal needs, including for menstrual hygiene management (MHM). School drop-out places girls at greater risk of sexual and reproductive health harms such as pregnancy, increased fertility, sexually transmitted infections (STIs) including HIV, and higher mortality of their children. School drop-out also reduces economic opportunity, keeping girls' in poverty and thereby at risk of increased morbidity and reduced quality of life. For economic, health, and social reasons, these are government ministry priorities, and interventions are needed to keep girls in school and improve their sexual and reproductive health. The Liverpool School of Tropical Medicine, with Kenyan partners including the Ministries of Education and Health (MOE/MOH), have completed a Joint Global Health Trials-funded pilot study, examining girls' use of menstrual cups and sanitary pads in rural primary schools in western Kenya. Pre-intervention, girls reported using rags, bedding or paper for MHM, causing discomfort, humiliating leaks and odour, reducing ability to concentrate in school, and causing them to skip school. Girls followed up revealed pads and cups were comfortable, increased their ability to engage in class, prevented leakage, and reduced the need to have sex with boyfriends in return for money to buy pads. No health or safety issues were found. At study completion girls were checked for STIs, and school drop-out (for pregnancy, marriage or other reasons). These negative outcomes combined were halved in girls using pads or cups compared with girls in control schools. Girls using cups preferred these to pads, because pads are ten-fold more costly, cause chafing if not changed frequently, and packs have to be shared with others. Girls did not share cups for fear of infection. We now propose to conduct a large-scale trial in the same area, in secondary schoolgirls, who are older but have increased drop-out rates (over a third higher), and a higher risk of HIV, STI, and pregnancy. We will examine if cups enable girls to stay in school and reduce their sexual and reproductive harms; while cups will improve dignity, health and wellbeing, and confidence at school, they may not be sufficient to resolve all girls' unmet needs, which cause them to drop-out of school. Cash transfer (CT) is an alternate but more expensive intervention, with studies showing it reduces absenteeism, drop-out, and sexual risks. In Malawi, CT reduced schoolgirls risk of HIV and human simplex virus (HSV-2; an indicator of girls' sexual risk behaviour), and reduced pregnancy. Cash amounts vary by study but the researchers recommend $5(£3.5) a month as sufficient. Our 4.5 year trial will examine if cash, cups, or cash and cups both provided, will prevent school drop-out and improve girls' sexual and reproductive health. For statistical rigor we will recruit 4032 secondary schoolgirls in 56 schools, provide interventions and follow-up them for 2 school years (6 terms). We will evaluate the cost per outcome (school drop-out including for pregnancy, HIV and HSV-2) prevented for single and combined interventions. The study will provide vital information on the comparative value of each intervention, how the interventions are used, any problems encountered, and their effect on girls' sexual behaviour, their wellbeing and school completion. We will seek advice from girls, schools, communities and stakeholders, working with all beneficiaries including MOE/MOH, using workshops to evaluate progress and develop materials for implementation packages. Girls clubs will be funded to encourage peer-support and advocacy. Packages will support scale-up should the trial demonstrate cost-effective outcomes. Findings will be widely disseminated to strengthen the evidence base supporting advocacy to improve the quality and equity of girls' lives.

低收入国家的女孩由于怀孕、疾病、早婚以及缺乏上学和个人需要的资金，包括月经卫生管理(MHM)，过早离开学校。辍学使女孩面临更大的性健康和生殖健康损害风险，如怀孕、生育率增加、包括艾滋病毒在内的性传播感染(STI)，以及其子女更高的死亡率。辍学还减少了经济机会，使女孩陷入贫困，从而面临发病率增加和生活质量下降的风险。出于经济、健康和社会原因，这些是政府部门的优先事项，需要采取干预措施，让女孩继续上学，改善她们的性健康和生殖健康。利物浦热带医学院与肯尼亚教育部和卫生部(MOE/MOH)等肯尼亚合作伙伴完成了一项由全球健康试验资助的联合试点研究，调查了肯尼亚西部农村小学女孩使用月经杯和卫生巾的情况。在干预前，女孩报告使用破布、床上用品或纸张进行MHM，造成不适，羞辱泄漏和气味，降低在学校集中注意力的能力，并导致她们逃学。女孩们跟进后发现，护垫和杯子很舒服，增加了她们上课的能力，防止了渗漏，减少了为了钱买护垫而与男朋友发生性关系的需要。没有发现任何健康或安全问题。在研究结束时，对女孩进行性传播感染和辍学(因怀孕、结婚或其他原因)的检查。与对照学校的女孩相比，使用护垫或杯子的女孩的这些负面结果加在一起减少了一半。使用杯子的女孩比使用护垫的女孩更喜欢这些，因为护垫的价格是护垫的十倍，如果不经常更换，会引起摩擦，而且背包必须与其他人共用。女孩们不共用杯子，因为担心感染。我们现在提议在同一地区对中学女生进行大规模试验，她们年龄较大，但辍学率增加(高出三分之一以上)，艾滋病毒、性传播感染和怀孕的风险更高。我们将研究杯子是否使女孩能够留在学校，并减少性伤害和生殖伤害；虽然杯子将提高尊严、健康和福祉，并增强学校的信心，但它们可能不足以解决所有女孩未得到满足的需求，这些需求导致她们辍学。现金转移(CT)是一种替代的但成本更高的干预措施，研究表明，它可以减少旷工、辍学和性风险。在马拉维，CT降低了女学生感染艾滋病毒和人类单纯性病毒(HSV-2；女童性行为风险的指标)的风险，并减少了怀孕。现金数额因研究而异，但研究人员建议每月5美元(3.5 GB)就足够了。我们为期四年半的试验将检验现金、杯子或现金和杯子是否都提供，以防止辍学并改善女孩的性健康和生殖健康。为了统计的准确性，我们将在56所学校招募4032名中学女生，提供干预措施，并对她们进行2个学年(6个学期)的跟踪调查。我们将评估单一和联合干预措施预防的每个结局(辍学包括怀孕、艾滋病毒和HSV-2)的成本。这项研究将提供关于每种干预措施的相对价值、如何使用干预措施、遇到的任何问题以及它们对女童的性行为、福祉和完成学业的影响的重要信息。我们将征求女童、学校、社区和利益攸关方的意见，与包括教育部/卫生部在内的所有受益者合作，利用讲习班评估进展情况，并为实施一揽子计划编写材料。将为女孩俱乐部提供资金，以鼓励同龄人支持和倡导。如果试验证明具有成本效益，套餐将支持扩大规模。将广泛传播调查结果，以加强支持倡导改善女孩生活质量和公平的证据基础。

项目成果

Do Water, Sanitation and Hygiene Conditions in Primary Schools Consistently Support Schoolgirls' Menstrual Needs? A Longitudinal Study in Rural Western Kenya.

• DOI: 10.3390/ijerph15081682
• 发表时间: 2018-08-07
• 期刊: International journal of environmental research and public health
• 作者: Alexander KT;Zulaika G;Nyothach E;Oduor C;Mason L;Obor D;Eleveld A;Laserson KF;Phillips-Howard PA
• 通讯作者: Phillips-Howard PA

Evaluating the impact of DREAMS on HIV incidence among adolescent girls and young women: A population-based cohort study in Kenya and South Africa.

• DOI: 10.1371/journal.pmed.1003837
• 发表时间: 2021-10
• 期刊: PLoS medicine
• 影响因子: 15.8
• 作者: Birdthistle I;Kwaro D;Shahmanesh M;Baisley K;Khagayi S;Chimbindi N;Kamire V;Mthiyane N;Gourlay A;Dreyer J;Phillips-Howard P;Glynn J;Floyd S
• 通讯作者: Floyd S

The Palgrave Handbook of Critical Menstruation Studies

• DOI: 10.1080/26410397.2020.1854928
• 发表时间: 2020-12-16
• 期刊: Sexual and Reproductive Health Matters
• 影响因子: 6
• 作者: Lowik A

Analysis of bacterial vaginosis, the vaginal microbiome, and sexually transmitted infections following the provision of menstrual cups in Kenyan schools: Results of a nested study within a cluster randomized controlled trial.

• DOI: 10.1371/journal.pmed.1004258
• 发表时间: 2023-07
• 期刊: PLoS medicine
• 影响因子: 15.8

Period poverty: The perceptions and experiences of impoverished women living in an inner-city area of Northwest England.

• DOI: 10.1371/journal.pone.0269341
• 发表时间: 2022
• 期刊: PloS one
• 影响因子: 3.7