Practices and predictors of menstrual hygiene management material use among adolescent and young women in rural Pakistan: A cross-sectional assessment.

Background: In low- and middle-income countries (LMICs), women often use inappropriate materials to manage menstruation, which can threaten their health. Improper practices can also have critical downstream consequences beyond physiologic health, including restricting adolescent girls' access to academic pursuits. Methods: We used cross-sectional data collected through a structured questionnaire from the menstruating adolescents and young women 15-23 years of age living in rural Pakistan (n = 25 305). We aimed to describe menstrual hygiene management (MHM) practices and generate a predictive model of the socioeconomic and demographic factors related to the use of MHM materials. Beliefs and barriers around MHM were also summarized. The outcome variable included: those who practiced appropriate and inappropriate MHM practices. Logistic regression was used to generate the predictive model, with results presented as odds ratios (OR) and 95% confidence interval (CI). Results: Inappropriate MHM practices were reported by 75% (n = 19 006) of participants. The majority 61.9% (n = 15 667) reported using old cloths, 12.6% (n = 3191) used nothing, and 0.5% (n = 136) used old cloth with a sanitary pad. One-fourth of participants reported appropriate MHM material use, including 16.2% (n = 4087) sanitary pads, 8.6% (n = 2167) new cloth, and a few reported using sanitary pads with new cloth 0.2% (n = 45). Inappropriate MHM practices were more common in lowest wealth quintile (OR = 4.41; 95% CI = 2.77-7.01, P < 0.0001), followed by those with no education (OR = 3.9; 95% CI = 3.36-4.52, P < 0.0001). Conclusions: The study indicates the need for multi-sectoral efforts to introduce MHM-specific and MHM-sensitive interventions to improve MHM practices, ranging from the availability of low-cost MHM materials to the inclusion of MHM education in school curriculums and within the community platforms.

Disparities in menstrual hygiene management between urban and rural schoolgirls in Northeast, Ethiopia.

INTRODUCTION: Even though menstruation is a normal biological process, adolescents are facing managing their menstruation when they are at school. It causes girls to miss their class on average three days every month. Studies in some countries showed that the magnitude of menstrual hygiene management problems is higher in rural adolescent girls, but little is known in the Ethiopia context. The objective of this study was to assess and compare menstrual hygiene management practices among rural and urban schoolgirls, Northeast, Ethiopia. METHODS: An institution-based comparative cross-sectional study was employed among 1078 schoolgirls (539 urban and 539 rural) from February to March 2020. The participants were selected using a multi-stage sampling technique. A structured self-administrative questionnaire and observational checklist were used for data collection. Bivariate and multivariable logistic regression analysis with a 95% confidence interval was employed. A P- value less than 0.05 was used to declare statistical significance. RESULTS: Overall, the magnitude of good menstrual hygiene practice was 52.9% (95%CI: 50.3%-56.5%), which was 65.9% (95% CI: 62.8%-70.7%) among urban and 39.9% (95% CI: 36.2%-44.6%) among rural schoolgirls. Among urban schoolgirls, the odds of good menstrual hygiene management practice was higher for girls aged below 18 years (AOR = 1.58, 95%CI: 1.05-2.39), learned about menstrual hygiene at school (AOR = 1.89, 95%CI: 1.21-2.97), heard about menstrual hygiene before menarche (AOR = 4.98, 95%CI: 2.71-9.13), and discussed menstrual hygiene with parents (AOR = 2.56, 95%CI: 1.25-5.27). Whereas, the odds of good menstrual hygiene management practice was higher among those who were knowledgeable on menstrual hygiene (AOR = 5.47, 95%CI: 3.68-8.12), those who learned about menstrual hygiene at school (AOR = 1.75, 95%CI: 1.13-2.70), and girls who heard about menstrual hygiene before menarche (AOR = 3.34, 95%CI: 1.44-7.76) in rural schoolgirls. CONCLUSIONS: Though the overall menstrual hygiene practice was low, it was relatively better among urban schoolgirls. This calls for more effort to solve these problems and achieve sustainable development goals. Therefore, education and awareness creation on menstrual hygiene for schoolgirls, even before menarche at both settings should be strengthened. Encouraging parent-adolescent discussion on menstrual hygiene would have paramount importance, particularly to urban schoolgirls.

Children as messengers of health knowledge? Impact of health promotion and water infrastructure in schools on facial cleanliness and trachoma in the community.

BACKGROUND: Health promotion is essential to the SAFE strategy for trachoma elimination. Schools are a valuable venue for health promotion. However, there is little literature about the impact of health education and water infrastructure in schools on facial cleanliness and trachoma in the community. Our study aimed to describe the current state of school health promotion in Kongwa, Tanzania, and to examine the transferability of health messages from schools to the community at large. METHODOLOGY/FINDINGS: A cross-sectional survey was carried out in all 92 villages in Kongwa district, which included 85 primary schools. Data were collected on health messages and water infrastructure in the schools. A random sample of 3084 children aged 0-5 were examined for facial cleanliness in all villages. In 50 villages, a random sample of 50 children aged 1-9 per village were examined for follicular trachoma (TF). Thirty-seven (44.6%) schools had educational materials on face-washing. Fifty (60.2%) schools had a washing station. The presence of a health teacher was correlated with having posters on face washing in classrooms. The presence of face-washing materials was correlated with the availability of washing stations. Neither teachers mentioning face-washing in health curricula nor educational materials in classrooms were associated with clean faces or trachoma in the community. Having a washing station in the school was associated with lower community rates of trachoma. CONCLUSIONS: Primary school health messages and materials on trachoma were not associated with clean faces or lower rates of trachoma in the community. The target audience for primary school health promotion is likely the students themselves, without immediate rippling effects in the community. A long-term perspective should be considered during the implementation of health promotion in schools. The goal of school health promotion should be training the next generation of parents and community health leaders in combatting trachoma.

Menstrual hygiene management in schools: midway progress update on the "MHM in Ten" 2014-2024 global agenda.

Progress has been made in recent years to bring attention to the challenges faced by school-aged girls around managing menstruation in educational settings that lack adequate physical environments and social support in low- and middle-income countries. To enable more synergistic and sustained progress on addressing menstruation-related needs while in school, an effort was undertaken in 2014 to map out a vision, priorities, and a ten-year agenda for transforming girls' experiences, referred to as Menstrual Hygiene Management in Ten (MHM in Ten). The overarching vision is that girls have the information, support, and enabling school environment for managing menstruation with dignity, safety and comfort by 2024. This requires improved research evidence and translation for impactful national level policies. As 2019 marked the midway point, we assessed progress made on the five key priorities, and remaining work to be done, through global outreach to the growing network of academics, non-governmental organizations, advocates, social entrepreneurs, United Nations agencies, donors, and national governments. This paper delineates the key insights to inform and support the growing MHM commitment globally to maximize progress to reach our vision by 2024. Corresponding to the five priorities, we found that (priority 1) the evidence base for MHM in schools has strengthened considerably, (priority 2) global guidelines for MHM in schools have yet to be created, and (priority 3) numerous evidence-based advocacy platforms have emerged to support MHM efforts. We also identified (priority 4) a growing engagement, responsibility, and ownership of MHM in schools among governments globally, and that although MHM is beginning to be integrated into country-level education systems (priority 5), resources are lacking. Overall, progress is being made against identified priorities. We provide recommendations for advancing the MHM in Ten agenda. This includes continued building of the evidence, and expanding the number of countries with national level policies and the requisite funding and capacity to truly transform schools for all students and teachers who menstruate.

A qualitative study of adolescent girls' experiences of menarche and menstruation in rural Tamil Nadu, India.

Background: In low- and middle-income countries, women and girls experience menstrual hygiene management-related health and social challenges such as urinary tract infections, social stigma, and school and workplace absenteeism. Purpose: In this study, we sought to explore how adolescent girls in rural Thirumalaikodi, Tamil Nadu, India experience menarche and menstruation, how their experiences connect to the sociocultural context, and what strategies they use to manage menstruation. This study also informed the adaptation and development of a school-based water, sanitation, and hygiene intervention. Methods: We conducted ten semi-structured qualitative interviews with adolescent girls in ninth standard from June-July 2018. Data were analysed using a thematic network approach. Results: Findings revealed that menarche inaugurates biological transitions of puberty and cultural codes that shape gender norms. Gender norms in turn generate, maintain, and reproduce stigmatizing attitudes, beliefs, and practices that influenced the development of coping mechanisms at home and at school. Resulting adaptations to the intervention consisted of two activities (school lesson and an extracurricular activity) that address knowledge gaps and myths. Conclusions: This study demonstrates the importance of qualitative research in unpacking adolescent girls' experiences with menarche and menstruation. Study findings also show how formative research can contribute to the adaptation and development of a contextually and culturally-relevant water, sanitation, and hygiene intervention.

Individual risk management strategy and potential therapeutic options for the COVID-19 pandemic.

It is an ugly fact that a significant amount of the world's population will contract SARS-CoV-II infection with the current spreading. While a specific treatment is not yet coming soon, individual risk assessment and management strategies are crucial. The individual preventive and protective measures drive the personal risk of getting the disease. Among the virus-contracted hosts, their different metabolic status, as determined by their diet, nutrition, age, sex, medical conditions, lifestyle, and environmental factors, govern the personal fate toward different clinical severity of COVID-19, from asymptomatic, mild, moderate, to death. The careful individual assessment for the possible dietary, nutritional, medical, lifestyle, and environmental risks, together with the proper relevant risk management strategies, is the sensible way to deal with the pandemic of SARS-CoV-II.

Estilo de vida e riscos à saúde de adolescentes e jovens / Lifestyle and health risks of adolescents and young people / Estilo de vida y riesgos para la salud de adolescentes y jóvenes

Objetivo: Descrever as condições do estilo de vida e riscos à saúde de um grupo de adolescentes e jovens participantes de um Núcleo de Atenção à Saúde do Adolescente (NASA). Métodos: Estudo descritivo de abordagem qualitativa realizado com 13 adolescentes e jovens cadastrados no NASA de um município da Baixada Litorânea do estado do Rio de Janeiro, por meio de questionários padronizados autoaplicáveis. Resultados: Foram identificados hábitos alimentares inadequados; precocidade das relações sexuais e uso irregular de preservativo; ausência de atividade física e situações constrangedoras vivenciadas na escola. Conclusão: O estudo aponta situações de riscos à saúde que demandam estratégias preventivas, sobretudo de promoção da saúde. Faz-se necessária a implementação de ações intersetoriais locais voltadas para a redução de vulnerabilidades com ênfase nos eixos temáticas de alimentação, sexualidade, atividade física, prevenção da violência e cultura da paz

Introduction: The occurrence of transmissible and non-communicable diseases related to lifestyle has acquired relevance in the juvenile phase. The objective was to describe aspects of the lifestyle of participants of a Teen Health Care Center. Materials and methods: Descriptive study of qualitative approach carried out with 13 adolescents and young people registered in the Adolescent Health Care Center of a city of Baixada Litorânea, state of Rio de Janeiro, Brazil, using standardized self-administered questionnaires. Results: Inappropriate eating habits; Precocity of the onset of sexual intercourse and irregular use of condoms; Absence of regular physical activity and embarrassing situations experienced at school were identified. Discussion: The commitment in these aspects of lifestyle indicates that there are situations of health risks that demand new preventive strategies besides the educational actions with the young public. Conclusions: There is a need for planning and implementation of local intersectoral actions at primary and secondary health care levels aimed at reducing youth vulnerabilities on inadequate feeding, sexual precocity, irregular physical activity and school violence

Introducción: La aparición de las enfermedades transmisibles y no transmisibles relacionadas con el estilo de vida ha obtenido relevancia en la fase juvenil. El objetivo fue describir aspectos del estilo de vida de participantes de un Núcleo de Atención a la Salud del Adolescente. Materiales y métodos: Estudio descriptivo del abordaje cualitativo realizado con 13 adolescentes y jóvenes registrados en el Núcleo de Atención a la Salud del Adolescente de un municipio de la Baixada Litoral del estado de Río de Janeiro, Brasil, por medio de cuestionarios estandarizados autoaplicables. Resultados: Se identificaron hábitos alimenticios inadecuados; Precocidad del inicio de las relaciones sexuales y uso irregular de preservativo; Ausencia de actividad física regular y situaciones embarazosas vivenciadas en la escuela. Discusión: El compromiso en estos aspectos del estilo de vida apunta que existen situaciones de riesgos a la salud que demandan nuevas estrategias preventivas además de las acciones educativas con el público joven. Conclusiones: Hay necesidad de planificación y realización de acciones intersectoriales locales en niveles de atención primaria y secundaria en salud que estén dirigidas a reducir las vulnerabilidades juveniles sobre alimentación inadecuada, precocidad sexual, actividad física irregular y violencia escolar

Evaluating the effectiveness of a community-based hygiene promotion program in a rural Salvadoran setting.

There has been considerable progress in the reduction of diarrheal disease among children under five through health and nutrition interventions. However, diarrheal disease is still the second leading cause of child death worldwide. There is growing recognition that comprehensive hygiene behavior improvements should be integral to prevention efforts, but the effectiveness of different approaches for hygiene promotion is still being established. Hygiene risk practices vary across settings, suggesting that prevention strategies should be adapted to local contexts using community-based approaches. We planned, implemented, and evaluated a hygiene promotion intervention using the hygiene cluster framework. The two-year, multi-level intervention was implemented by local health promoters who were involved in identifying and addressing disease transmission risks at the household, school, and community levels. The intervention was evaluated using a quasi-experimental pretest-posttest design with repeated follow-up assessments to determine changes in hygiene knowledge and behavior. A household survey instrument was administered at three time points in the intervention ( n = 480) and comparison ( n = 271) communities to assess two hygiene knowledge and eleven hygiene behavior outcome variables. We used one-way analysis of variance with post hoc analysis using Tukey's HSD for multiple comparisons to examine change and differences over time. We also fit a linear regression model to identify statistically significant differences. Study results demonstrated improvements in the areas of: knowledge of disease transmission and key times for handwashing, water container hygiene, sanitation practices, personal hygiene and food hygiene. The hygiene cluster framework is useful for hygiene promotion intervention planning and evaluation, and we recommended continued testing of this framework across contexts. We also recommend local community participatory approaches, as well as in-depth formative behavioral assessments by hygiene cluster that also consider environmental barriers to behavior change.

Evaluation of health education interventions on Chinese factory workers' knowledge, practices, and behaviors related to infectious disease.

BACKGROUND: Workplaces are a common location for infectious disease transmission among adults. To provide recommendations regarding appropriate health promotion programs, we evaluated the impact of three different interventions on factory workers. METHODS: In a prospective intervention study carried out from October 2012 to June 2013, three factories were selected and each was assigned a different intervention method (i.e. self-study group, manager training group and interactional group discussion group). Participants were scored on their knowledge, behavior, and hygienic practices related to infectious disease prevention both before and after the intervention. RESULTS: A total of 1154 participants completed the survey before the intervention and 1111 completed the survey after. The sum infectious disease knowledge score in the manager training group was higher after the intervention (9.09/12) than before (8.63/12, t=4.47, p<0.05). There was no significant difference in sum infectious disease knowledge score pre and post intervention for both the self-study group and the interactional group discussion. CONCLUSIONS: Overall, change in health behaviors and hygiene practices were not as affected compared to changes in knowledge after interventions related to infectious disease health promotion. Training managers who then interact with workers may be an effective and efficient way of educating workers on health issues.

Efecto del programa de servicios SaludArte en los componentes de alimentación y nutrición en escolares de la Ciudad de México / Effects of SaludArte program in feeding and nutrition components in school children in Mexico City

Resumen: Objetivo: Evaluar el efecto del programa de servicios SaludArte en sus componentes de educación en nutrición y de asistencia alimentaria, dentro de escuelas participantes, durante 2013-2015. Material y métodos: Se realizó un estudio comparativo de tres cohortes que consideró 1 620 escolares de 144 primarias. Se construyeron dos paneles: de tiempo continuo y de tiempo completo. Se obtuvo información de consumo y hábitos alimenticios, higiene y conservación de alimentos, actividad física (AF) y antropometría. El análisis fue por diferencia en diferencias y modelos de regresión logística dicotómica y multinomial. Resultados: Los efectos atribuibles al programa fueron: higiene personal (p=0.045), conocimientos en nutrición (p=0.003), AF (p=0.002, 2013-2014; p=0.032, 2015) y consumo de fibra (p=0.064). El consumo de azúcar total fue significativo contrario a lo esperado (p=0.012, tiempo continuo; p=0.037, tiempo completo). Conclusiones: SaludArte tuvo efectos positivos en algunos componentes. Sin embargo, es necesario considerar las lecciones aprendidas, a fin de institucionalizar el programa y darle permanencia y crecimiento en las escuelas.

Abstract: Objective: To assess the effect of Education in Nutrition and Food Assistance components of the SaludArte program in participant schools during 2013-2015. Materials and methods: A three cohort comparative study was used, with two type of follow-up panel structures: a complete panel and a continuous time, with a total of consisting on 1620 scholar children from 144 schools. Information on food intake, feeding behaviors, food preservation and hygiene, physical activity (PI) and anthropometry was registered. To stablish effect estimates, a difference in difference method combined with propensity score matching was carried out; as an alternative procedure, logistic-multinomial and logistic regression models were also used. Results: Program attributable estimated effects were as follows: an increase in personal hygiene (p=0.045), increase in nutrition knowledges (p=0.003), PI (p=0.002 2013-2014; p=0.032 2015) and increase in fiber Intake (p=0.064). Sugar intake, contrary to the expected showed a significant increase (p=0.012 continuous time and; p=0.037 complete time). Conclusions: SaludArte shows positive effects over some components as expected. However in order to institutionalize the SaludArte program, it is necessary to consider these learned lessons, give it permanence and impulse it in the schools.

Implementation, utilization and influence of a community-based participatory nutrition promotion programme in rural Ethiopia: programme impact pathway analysis.

OBJECTIVE: A community-based participatory nutrition promotion (CPNP) programme, involving a 2-week group nutrition session, attempted to improve child feeding and hygiene. The implementation, utilization and influence of the CPNP programme were examined by programme impact pathway (PIP) analysis. DESIGN: Five CPNP programme components were evaluated: (i) degree of implementation; (ii) participants' perception of the nutrition sessions; (iii) participants' message recall; (iv) utilization of feeding and hygiene practices at early programme stage; and (v) participants' engagement in other programmes. SETTING: Habro and Melka Bello districts, Ethiopia. SUBJECTS: Records of 372 nutrition sessions, as part of a cluster-randomized trial, among mothers (n 876 in intervention area, n 914 in control area) from a household survey and CPNP participants (n 197) from a recall survey. RESULTS: Overall, most activities related to nutrition sessions were successfully operated with high fidelity (>90 %), but a few elements of the protocol were only moderately achieved. The recall survey among participants showed a positive perception of the sessions (~90 %) and a moderate level of message recall (~65 %). The household survey found that the CPNP participants had higher minimum dietary diversity at the early stage (34·0 v. 19·9 %, P=0·01) and a higher involvement in the Essential Nutrition Action (ENA) programme over a year of follow-up (28·2 v. 18·3 %; P<0·0001) compared with non-participants within the intervention area. CONCLUSIONS: Our PIP analysis suggests that CPNP was feasibly implemented, promoted a sustained utilization of proper feeding behaviours, and enhanced participation in the existing ENA programme. These findings provide a possible explanation to understanding CPNP's effectiveness.

Impact of the Integration of Water Treatment, Hygiene, Nutrition, and Clean Delivery Interventions on Maternal Health Service Use.

AbstractReducing barriers associated with maternal health service use, household water treatment, and improved hygiene is important for maternal and neonatal health outcomes. We surveyed a sample of 201 pregnant women who participated in a clinic-based intervention in Kenya to increase maternal health service use and improve household hygiene and nutrition through the distribution of water treatment products, soap, protein-fortified flour, and clean delivery kits. From multivariable logistic regression analyses, the adjusted odds of ≥ 4 antenatal care (ANC4+) visits (odds ratio [OR] = 3.0, 95% confidence interval [CI] = 1.9-4.5), health facility delivery (OR = 5.3, 95% CI = 3.4-8.3), and any postnatal care visit (OR = 2.8, 95% CI = 1.9-4.2) were higher at follow-up than at baseline, adjusting for demographic factors. Women who completed primary school had higher odds of ANC4+ visits (OR = 1.8, 95% CI = 1.1-2.9) and health facility delivery (OR = 4.2, 95% CI = 2.5-7.1) than women with less education. For women who lived ≤ 2.5 km from the health facility, the estimated odds of health facility delivery (OR = 2.4, 95% CI = 1.5-4.1) and postnatal care visit (OR = 1.6, 95% CI = 1.0-2.6) were higher than for those who lived > 2.5 km away. Compared with baseline, a higher percentage of survey participants at follow-up were able to demonstrate proper handwashing (P = 0.001); water treatment behavior did not change. This evaluation suggested that hygiene, nutritional, clean delivery incentives, higher education level, and geographical contiguity to health facility were associated with increased use of maternal health services by pregnant women.

[Effects of SaludArte program in feeding and nutrition components in school children in Mexico City]. / Efecto del programa de servicios SaludArte en los componentes de alimentación y nutrición en escolares de la Ciudad de México.

OBJECTIVE: To assess the effect of Education in Nutrition and Food Assistance components of the SaludArte program in participant schools during 2013-2015. MATERIALS AND METHODS: A three cohort comparative study was used, with two type of follow-up panel structures: a complete panel and a continuous time, with a total of consisting on 1620 scholar children from 144 schools. Information on food intake, feeding behaviors, food preservation and hygiene, physical activity (PI) and anthropometry was registered. To stablish effect estimates, a difference in difference method combined with propensity score matching was carried out; as an alternative procedure, logistic-multinomial and logistic regression models were also used. RESULTS: Program attributable estimated effects were as follows: an increase in personal hygiene (p=0.045), increase in nutrition knowledges (p=0.003), PI (p=0.002 2013-2014; p=0.032 2015) and increase in fiber Intake (p=0.064). Sugar intake, contrary to the expected showed a significant increase (p=0.012 continuous time and; p=0.037 complete time). CONCLUSIONS: SaludArte shows positive effects over some components as expected. However in order to institutionalize the SaludArte program, it is necessary to consider these learned lessons, give it permanence and impulse it in the schools.

OBJETIVO: Evaluar el efecto del programa de servicios SaludArte en sus componentes de educación en nutrición y de asistencia alimentaria, dentro de escuelas participantes, durante 2013-2015. MATERIAL Y MÉTODOS: Se realizó un estudio comparativo de tres cohortes que consideró 1 620 escolares de 144 primarias. Se construyeron dos paneles: de tiempo continuo y de tiempo completo. Se obtuvo información de consumo y hábitos alimenticios, higiene y conservación de alimentos, actividad física (AF) y antropometría. El análisis fue por diferencia en diferencias y modelos de regresión logística dicotómica y multinomial. RESULTADOS: Los efectos atribuibles al programa fueron: higiene personal (p=0.045), conocimientos en nutrición (p=0.003), AF (p=0.002, 2013-2014; p=0.032, 2015) y consumo de fibra (p=0.064). El consumo de azúcar total fue significativo contrario a lo esperado (p=0.012, tiempo continuo; p=0.037, tiempo completo). CONCLUSIONES: SaludArte tuvo efectos positivos en algunos componentes. Sin embargo, es necesario considerar las lecciones aprendidas, a fin de institucionalizar el programa y darle permanencia y crecimiento en las escuelas.

Schoolgirls' experience and appraisal of menstrual absorbents in rural Uganda: a cross-sectional evaluation of reusable sanitary pads.

BACKGROUND: Governments, multinational organisations, and charities have commenced the distribution of sanitary products to address current deficits in girls' menstrual management. The few effectiveness studies conducted have focused on health and education outcomes but have failed to provide quantitative assessment of girls' preferences, experiences of absorbents, and comfort. Objectives of the study were, first, to quantitatively describe girls' experiences with, and ratings of reliability and acceptability of different menstrual absorbents. Second, to compare ratings of freely-provided reusable pads (AFRIpads) to other existing methods of menstrual management. Finally, to assess differences in self-reported freedom of activity during menses according to menstrual absorbent. METHODS: Cross-sectional, secondary analysis of data from the final survey of a controlled trial of reusable sanitary padand puberty education provision was undertaken. Participants were 205 menstruating schoolgirls from eight schools in rural Uganda. 72 girls who reported using the intervention-provided reusable pads were compared to those using existing improvised methods (predominately new or old cloth). RESULTS: Schoolgirls using reusable pads provided significantly higher ratings of perceived absorbent reliability across activities, less difficulties changing absorbents, and less disgust with cleaning absorbents. There were no significant differences in reports of outside garment soiling (OR 1.00 95%CI 0.51-1.99), or odour (0.84 95%CI 0.40-1.74) during the last menstrual period. When girls were asked if menstruation caused them to miss daily activities there were no differences between those using reusable pads and those using other existing methods. However, when asked about activities avoided during menstruation, those using reusable pads participated less in physical sports, working in the field, fetching water, and cooking. CONCLUSIONS: Reusable pads were rated favourably. This translated into some benefits for self-reported involvement in daily activities, although reports of actual soiling and missing activities due to menstruation did not differ. More research is needed comparing the impact of menstrual absorbents on girls' daily activities, and validating outcome measures for menstrual management research.

Community-based behavior change promoting child health care: a response to socio-economic disparity.

BACKGROUND: Early initiation of breastfeeding after birth is a key behavioral health factor known to decrease neonatal mortality risks. Yet, few demographic studies examined how a community-based intervention impacts postpartum breastfeeding among the socio-economically deprived population in Sub-Saharan Africa. A post-intervention evaluation was conducted in 2011 to measure the effect of a UNICEF-led behavior change communication program promoting child health care in rural Niger. METHODS: A quantitative survey is based on a post hoc constitution of two groups of a study sample, exposed and unexposed households. The sample includes women aged 15-49 years, having at least one child less than 24 months born with vaginal delivery. Rate ratio for bivariate analysis and multivariate logistic regression were applied for statistical analysis. The outcome variable is the initiation of breastfeeding within the first hour of birth. Independent variables include other behavioral outcome variables, different types of communication actions, and socio-demographic and economic status of mothers. RESULTS: The gaps in socio-economic vulnerability between the exposed and unexposed groups imply that mothers deprived from accessing basic health services and hygiene facilities are likely to be excluded from the communication actions. Mothers who practiced hand washing and used a traditional latrine showed 2.0 times more likely to initiate early breastfeeding compared to those who did not (95 % CI 1.4-2.7; 1.3-3.1). Home visits by community volunteers was not significant (AOR 1.2; 95 % CI 0.9-1.5). Mothers who got actively involved in exclusive breastfeeding promotion as peers were more likely to initiate breastfeeding within the first hour of birth (AOR 2.0; 95 % CI 1.4-2.9). CONCLUSIONS: A multi-sectorial approach combining hygiene practices and optimal breastfeeding promotion led to supporting early initiation of breastfeeding. A peer promotion of child health care suggests a model of behavior change communication strategy as a response to socio-economic disparity.