Puberty health interventions to improve menstrual health and School attendance among Gambian adolescents (MEGAMBO).

青春期女孩月经卫生管理不善与旷课和其他健康后果有关。在全球范围内，世界各地的女孩都制定了自己的应对月经的个人策略。不同的国家、个人的个人偏好、可用的资源、当地的传统和文化信仰以及知识或教育有很大的不同。有些月经习惯与不同的健康结局(泌尿生殖道感染)有关。在全球范围内，月经及其管理也具有重要的社会和文化影响，进而可能影响女孩的生活。在这一领域开展工作的国际组织和研究机构，如水援助组织、联合国儿童基金会、水研究委员会和国际计划组织，都对缺课问题特别感兴趣。女孩在月经期间上学时面临的挑战包括：月经时感到尴尬，害怕月经血泄漏或被男孩取笑，缺乏足够的吸收材料，缺乏隐私，无法在学校获得适当的水和卫生设施。这些因素会导致女孩在月经期间缺课。我们在2013年进行的一项文献回顾发现，有很好的证据表明，教育干预可以改善月经卫生习惯，减少社会限制，但没有定量证据表明，月经知识和管理方法的改善可以减少旷课和泌尿生殖系统感染。我们在冈比亚对Kung地区的女学生进行的一项研究(MRC-PHIND)表明，在家中或在学校进行月经管理方面的挑战可能与负面健康后果和缺课有关。我们的定性研究表明，学生(男孩和女孩)对月经的了解很少，这主要是因为需要保密。我们还观察到，缺乏月经知识会导致尴尬和害怕被取笑，这与疼痛和缺乏有效的MHM材料和洗涤设施一起导致缺课。男孩们渴望了解月经，但表示很难与成年人谈论这一问题。定性研究表明，在这一人群中，月经与上学人数密切相关，而女孩、男孩和父母对干预措施的需求尚未得到满足，以使女孩能够更好地管理月经的心理社会方面(焦虑和痛苦)和身体方面(管理使用适当的材料以消除月经血液泄漏和卫生习惯做法)。在一项记录上学和月经周期的每日日记的子研究中，15名女孩报告29%的经期日缺课，而非经期日的缺课天数为15%。2017年5月，与不同利益攸关方(家长、教师、学生、临床医生、教育区域官员和非政府组织)在基内巴举办了一次讲习班，目的是介绍初步结果，讨论问题(使用问题树练习)并找到可能的解决办法。研讨会结束后，我们都决定创建一个4包的干预措施，可以纳入这些社区现有的方案：母亲俱乐部，将与母亲合作，告知青春期、月经、吸收和卫生做法；同伴教育营，将让女孩和男孩在学校讨论青春期和月经管理问题；社区会议，围绕青春期电影和洗澡改进。我们研究的目的是测试、改进和调整第一项研究中建议的干预方案，并进行一项学校随机对照试验，以评估改善女孩MH以减少女孩缺课的干预措施的效果和成本效益。

Poor menstrual hygiene management among adolescent girls have been associated with school absenteeism and other health outcomes. Globally girls around the world have developed their own personal strategies to cope with menstruation. These vary greatly from country to country, individual's personal preferences, available resources, local traditions and cultural beliefs and knowledge or education. Some of the menstrual practices have been associated with different health outcomes (urogenital infections). Across the globe menstruation and its management also have important social and cultural implications which may in turn impact girl's lives. Absence from school, has been of particular interest to International organisations and research bodies working in this area such a WaterAid, Unicef, the Water Research Commission and Plan International. Challenges girls face when attending to school when menstruating, include: feelings of embarrassment when menstruating, fear of leaking menstrual blood or of teasing from boys, lack of adequate absorbent materials and lack of privacy and access to appropriate water and sanitation facilities at school. These factors can lead girls to be absent from school during menstruation. A literature review we conducted in 2013 found there was good evidence that educational interventions can improve menstrual hygiene practices and reduce social restrictions but there was no quantitative evidence that improvements in menstrual knowledge and management methods reduce school absenteeism and urogenital infections. A study that we are conducting in Gambia (MRC-PHIND) among school girls in Kiang region shows that challenges related to menstruation management at home or at school could be associated with negative health outcomes and school absenteeism. Our qualitative research showed that students (boys and girls) had poor knowledge about menstruation, largely due to the need for secrecy. We also observed that lack of knowledge of menstruation led to embarrassment and fear of teasing, and this, together with pain and lack of effective materials and WASH facilities for MHM led to school absenteeism. Boys were eager to learn about menstruation, but expressed difficulties talking to adults about it. The qualitative studies showed that menstruation was strongly associated with school attendance in this population, and that there is an unmet need from girls, boys and parents for interventions to enable girls to better manage both the psychosocial aspects of menstruation (anxiety and distress) and the physical aspects (management of use of appropriate materials to eliminate leakage of menstrual blood and hygienic habits practices).In a sub-study of daily diaries to record school attendance and menstrual cycles, 15 girls reported school absence on 29% of period-days, compared with 15% of non-period days. One workshop with different stakeholders (parents, teachers, students, clinicians, education regional officer and NGOs) was held in Keneba in May 2017 in order to present the initial findings, discuss the problems (using a problem tree exercise) and find possible solutions. After the workshop we all decided to create a 4 pack interventions that could be included in programmes already existing in these communities: Mother's club who will work with mums to inform about puberty, menstruation and absorbent and hygienic practices, Peers Education camps, which will involve girls and boys in schools to discuss puberty and menstrual management issues, Community meetings around puberty films and WASH improvements. The aim of our study is to test, refine and adapt the intervention packages suggested in the first study and to conduct a school-randomised controlled trial to evaluate the effect and cost-effect of an intervention to improve MH among girls to reduce school absenteeism in girls.