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

经期卫生干预可以提高女孩的入学率。1-3系统评价4确定了7项月经卫生教育干预研究；其中一项还包括提供月经杯。这些研究在方法上有很大的局限性，但总体上令人鼓舞。最近在加纳进行的一项小型研究显示，5个月后，只接受青春期教育的女孩和接受青春期教育加卫生巾的女孩的出勤率都比对照组高10%。一些经期卫生习惯（如使用树叶和抹布）可引起阴道内感染女孩上学与收入潜力、改善妇幼生存和减少艾滋病毒感染有关这项针对乌干达女学生的研究将为一项关于青春期和经期卫生教育以及提供卫生巾对学校缺勤的影响的聚类随机试验（CRT）做准备。男性包皮环切术降低了男性感染艾滋病毒的风险7，但包皮环切术在乌干达的流行率仍然很低（约25%）8我们将采用一种创新的、以足球为基础的单次干预（“Make the Cut”）来促进男生自愿接受医疗男性包皮环切术（VMMC）在津巴布韦足球队中进行的一项小型CRT研究显示，这种干预对包皮环切术的接受产生了令人鼓舞的影响（调整后的OR=9.16; 95%CI:0.88-95.1;p=0.06）。我们建议在14-16岁的男孩和女孩参加月经卫生试验的同一班级中评估这种干预的地方修改版本。这将提高研究的成本效益，同时转移对在试验中偏袒或侮辱女孩的批评。本研究将i)改进干预措施（经期卫生教育和提供一次性卫生巾；“Make the Cut”VMMC推广）；Ii)确定试验最适合的目标学年组；评估学校出勤率和女孩自我报告的卫生偏好，以及该地区男孩的包皮环切率；Iii)与学习学校和卫生巾制造商建立更密切的联系，iv)验证自我阴道拭子采集和实验室测试程序。

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.