Menstrual health interventions and school attendance in Uganda (MENISCUs-2)

乌干达的月经健康干预措施和入学率 (MENISCUs-2)

• 批准号: MR/P020283/1
• 负责人: Helen Weiss
• 金额: $ 25.91万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FP020283%2F1
• 关键词: Menstrual; health; interventions; attendance; Uganda

In many resource-poor settings, girls lack adequate knowledge, facilities and materials to manage their menstruation. Challenges girls face include: feelings of embarrassment, fear of leaking menstrual blood or of teasing from boys due to a lack of privacy at school. Many girls do not have access to adequate materials (pads, tampons or cups) to manage their menstruation. These factors can lead girls to be absent from school during menstruation.We recently completed an MRC-funded study (MENISCUS-1) among girls aged 14-17 years old in peri-urban Wakiso District in Uganda. This was a series of small sub-studies to understand perceptions about menstruation, to estimate the association with school absenteeism, and to develop an intervention package designed to improve school attendance and performance, knowledge and attitudes towards MHM, and prevalence of the reproductive tract infection bacterial vaginosis. The study showed that menstruation is a key reason for school absenteeism, along with poverty. In a sub-study in which girls were asked to complete a daily diary recording school attendance and menstrual cycles, girls reported missing school on 1 in 4 schooldays when they were menstruating compared with 1 in 14 days when not menstruating. We tested the components of a possible MHM intervention, each in a small number of girls. In the current study (MENISCUs-2), we plan to pilot test the interventions together as a package, delivered to all girls (about 150 per school) in one school year (S2) in two schools in Wakiso District. The intervention components are: - Training of teachers to improve delivery of the Government guidelines for puberty education. - A drama skit to address issues around menstruation while engaging parents, boys and teachers.- Provision of a menstrual cup kit: Our implementing partner, WoMena, will train selected teachers and older girls to teach girls how to use a menstrual cup (the Ruby Cup) and a re-usable sanitary pad (AfriPad), both provided in a bag with a mirror, sterilisation/storage container and soap. The cup is reusable for 10 years, holds twice the volume of most pads, and can be used for up to 12 hours (i.e. girls do not usually need to empty it at school) so it should help girls manage periods whilst at school. - Supply painkillers for period pain (delivered using a voucher system)- Simple improvements to school water and sanitation facilities including locks on the toilet doors, provision of toilet paper, and a soap dispenser for hand-washing.The primary outcome of MENISCUs-2 is to evaluate the intervention package works sufficiently well to enable a trial to be justified. We will decide this based on how well the intervention package is delivered (e.g. of analgesics delivered). The criteria for progression is that the education session and drama skit were delivered, the majority of girls using the Ruby Cup or re-usable pads provided at endline, and accessing painkillers as needed, and soap and toilet paper available in schools for the majority of the time. We will also estimate the number of girls who progress to the next school year in order to know the likely loss to follow-up within a future trial. The criteria for progression to a trial will be a retention rate of 80% to allow for an acceptable loss to follow-up in the future trial. We will also estimate the likely intervention effect size. Finally, we will estimate the cost of the intervention delivery, and cost of monitoring trial outcomes.As part of the study, we also piloted a football-based intervention in Uganda to promote safe male circumcision for HIV prevention, which we have previously used in Zimbabwe. This worked well after modifications, and we will deliver this intervention in the future trial alongside the MHM intervention, but are not including this component in this study as it was fully tested previously.

在许多资源贫乏的环境中，女孩缺乏足够的知识、设施和材料来管理月经。女孩面临的挑战包括：尴尬的感觉，担心漏经血，或者因为在学校缺乏隐私而被男孩取笑。许多女孩没有足够的材料（卫生巾、卫生棉条或水杯）来管理月经。这些因素可能导致女孩在月经期间缺课。我们最近完成了一项mrc资助的研究（menisus -1），研究对象是乌干达瓦基索城郊地区14-17岁的女孩。这是一系列小的子研究，以了解对月经的看法，估计与学校缺勤的关系，并制定一个干预方案，旨在提高出勤率和表现，对MHM的知识和态度，以及生殖道感染细菌性阴道病的患病率。研究表明，月经和贫穷是缺课的主要原因。在一项子研究中，女孩们被要求完成一份记录上学情况和月经周期的每日日记，她们报告说，在月经期间，每4天就有1天缺课，而在非月经期间，缺课的比例为1 / 14。我们测试了一种可能的MHM干预的组成部分，每一部分都是在少数女孩身上进行的。在当前的研究（meniscus2）中，我们计划将干预措施作为一揽子措施进行试点测试，在Wakiso区的两所学校的一个学年（S2）内向所有女孩（每所学校约150名）提供干预措施。干预措施包括：-培训教师，以改进政府青春期教育指导方针的执行情况。-一个戏剧小品，在吸引家长、男孩和老师的同时，解决月经问题。-提供月经杯工具包：我们的执行伙伴WoMena将培训选定的教师和年龄较大的女孩，教她们如何使用月经杯（红宝石杯）和可重复使用的卫生巾（AfriPad），这两种产品都装在一个袋子里，里面有镜子、消毒/储存容器和肥皂。这种杯子可重复使用10年，容量是大多数卫生巾的两倍，可以使用长达12小时（也就是说，女孩通常不需要在学校清空它），所以它应该有助于女孩在学校管理月经。-为经期疼痛提供止痛药（使用代金券发放）-对学校供水和卫生设施进行简单改善，包括在厕所门上锁、提供厕纸和洗手用肥皂机。meniscus2的主要结果是评估一揽子干预措施的效果是否足够好，以证明试验是合理的。我们将根据干预方案的实施情况（例如镇痛药的实施情况）来决定这一点。进步的标准是教育课程和戏剧小品的提供，大多数女孩使用红宝石杯或在终点提供的可重复使用的卫生巾，并在大多数时间获得学校提供的止痛药，肥皂和卫生纸。我们还将估计升入下一学年的女孩人数，以便了解在未来试验中随访的可能损失。进入试验的标准是保留率为80%，以允许在未来试验中可接受的随访损失。我们还将估计可能的干预效应大小。最后，我们将估算干预交付的成本，以及监测试验结果的成本。作为研究的一部分，我们还在乌干达试点了一项以足球为基础的干预措施，以促进安全的男性包皮环切术预防艾滋病毒，我们之前在津巴布韦使用过这种方法。修改后效果良好，我们将在未来的试验中与MHM干预一起进行干预，但由于之前已经进行了充分的测试，因此不包括该成分。

项目成果

Menstrual characteristics, menstrual anxiety and school attendance among adolescents in Uganda: a longitudinal study.

• DOI: 10.1186/s12905-021-01544-6
• 发表时间: 2021-12-11
• 期刊: BMC women's health
• 作者: Tanton C;Nakuya K;Kansiime C;Hytti L;Torondel B;Francis SC;Namirembe P;Nakalema S;Nalugya R;Musoke SN;Neema S;Ross DA;Bonell C;Seeley J;Weiss HA
• 通讯作者: Weiss HA

Additional file 1 of Menstrual characteristics, menstrual anxiety and school attendance among adolescents in Uganda: a longitudinal study

乌干达青少年月经特征、月经焦虑和上学情况的附加文件 1：一项纵向研究

• DOI: 10.6084/m9.figshare.17162906
• 发表时间: 2021
• 作者: Tanton C

Additional file 2 of Menstrual characteristics, menstrual anxiety and school attendance among adolescents in Uganda: a longitudinal study

乌干达青少年的月经特征、月经焦虑和上学情况的附加文件 2：一项纵向研究

• DOI: 10.6084/m9.figshare.17162909
• 发表时间: 2021
• 作者: Tanton C