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2.
PLoS One ; 14(8): e0220114, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31369595

RESUMO

There has been growing recognition of menstrual hygiene management (MHM) as a significant public health issue. However, research has predominately focused on the experiences of adolescent girls in school settings. The purpose of this research is to examine detailed accounts of menstruation for women in rural Odisha, India at various life stages with a view toward improving international monitoring of MHM. Focus group discussions and in-depth interviews were conducted to understand women's experiences of menstruation across four life stages (unmarried women, recently married women, married women, and older women). Thematic analysis was used to identify menstruation-related challenges and needs. We found women voiced needs that aligned with those captured by the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) definition for MHM: access to clean materials, privacy for changing materials, soap and water for bathing, and disposal facilities for materials. However, we also found women require materials that are not only clean but comfortable and reliable; soap and water for more than bathing; privacy for the full spectrum of menstruation-related practices, not just when changing; and disposal facilities that are private and safe, not just accessible. Additionally, we identified needs that extend beyond the existing definition: pain management, social support, and an enabling sociocultural environment. Overall, women representing all life stages discussed menstruation challenges, including bathing, pain, and washing, drying, and storing cloth materials. Cloth management challenges were most acute for unmarried and recently married women, who were concerned that practices could reveal their menstrual status and harm their reputations, thus informing their preference for disposable materials, if attainable. We propose a revised definition of adequate MHM for this population that more comprehensively captures their needs. This definition may also prove useful for other populations, future research, creating measures of assessment, and guiding interventions and program priorities.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Higiene/normas , Produtos de Higiene Menstrual/normas , Menstruação/psicologia , Saneamento/normas , Apoio Social , Abastecimento de Água/métodos , Adolescente , Adulto , Idoso , Feminino , Grupos Focais , Humanos , Higiene/educação , Índia , Produtos de Higiene Menstrual/provisão & distribução , Pessoa de Meia-Idade , População Rural , Adulto Jovem
3.
BMC Public Health ; 19(1): 16, 2019 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-30611223

RESUMO

INTRODUCTION: While in school, girls require an environment that is supportive of menstrual hygiene management (MHM) in order to ensure regular school attendance and participation. Little is known about schoolgirls access to and practice of MHM in rural Zambia. This study explores girls' experiences of MHM in rural schools of Zambia from the perspectives of schoolgirls, schoolboys and community and school-based adults key to MHM for schoolgirls. METHODS: In July and August 2015, we conducted this qualitative exploratory study in six rural schools of Mumbwa and Rufunsa districts of Zambia. Twelve in-depth interviews (IDIs) and six focus group discussions (FGDs) were conducted among girls ages 14-18 who had begun menstruating. Two FGDs with boys ages 14-18 and 25 key informant interviews were also conducted with teachers, female guardians and traditional leaders to provide the context within which schoolgirls practice MHM. RESULTS: Most girls reported learning about menstruation only at menarche and did not know the physiological basis of menstruation. They reported MHM-related challenges, including: use of non-absorbent and uncomfortable menstrual cloth and inadequate provision of sanitary materials, water, hygiene and sanitation facilities (WASH) in schools. In particular, toilets did not have soap and water or doors and locks for privacy and had a bad odor. Girls' school attendance and participation in physical activities was compromised when menstruating due to fear of teasing (especially by boys) and embarrassment from menstrual leakage. Boys said they could tell when girls were menstruating by the smell and their behaviour, for instance, moving less and isolating themselves from their peers. Girls complained of friction burns on their inner thighs during their long journey to school due to chaffing of wet non-absorbent material used to make menstrual cloth. Girls preferred to dispose used menstrual materials in pit latrines and not waste bins for fear that they could be retrieved for witchcraft against them. Though traditional leaders and female guardians played a pivotal role in teaching girls MHM, they have not resolved challenges to MHM among schoolgirls. CONCLUSION: When menstruating, schoolgirls in rural Zambia would rather stay home than be uncomfortable, inactive and embarrassed due to inadequate MHM facilities at school. A friendly and supportive MHM environment that provides education, absorbent sanitary materials and adequate WASH facilities is essential to providing equal opportunity for all girls.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Higiene , Menstruação/psicologia , População Rural , Instituições Acadêmicas/estatística & dados numéricos , Absenteísmo , Adolescente , Feminino , Grupos Focais , Humanos , Masculino , Produtos de Higiene Menstrual/provisão & distribução , Pesquisa Qualitativa , Saneamento/normas , Zâmbia
4.
J Glob Health ; 9(1): 010408, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30546869

RESUMO

Background: Lack of menstrual knowledge, poor access to sanitary products and a non-facilitating school environment can make it difficult for girls to attend school. In India, interventions have been developed to reduce the burden of menstruation for school girls by government and non-governmental organizations (NGOs). We sought to identify challenges related to menstruation, and facilitators of menstrual management in schools in three states in India. Methods: Surveys were conducted among menstruating school girls in class 8-10 (above 12 years of age) of 43 government schools selected through stratified random sampling in three Indian states (Maharashtra, Chhattisgarh, Tamil Nadu) in 2015. For comparison, ten model schools supported by NGOs or UNICEF with a focussed menstrual hygiene education program were selected purposely in the same states to represent the better-case scenario. We examined awareness about menarche, items used for menstruation, and facilitators on girls' experience of menstruation in regular schools and compared with model schools. Factors associated with school absence during menstruation were explored using multivariate analysis. Findings: More girls (mean age 14.1 years) were informed about menstruation before menarche in model schools (56%, n = 492) than in regular schools (36%, n = 2072, P < 0.001). Girls reported menstruation affected school attendance (6% vs 11% in model vs regular schools respectively, P = 0.003) and concentration (40% vs 45%, P = 0.1) and was associated with pain (31% vs 38%, P = 0.004) and fear of stain or smell (11% vs 16%, P = 0.002). About 45% of girls reported using disposable pads in both model and regular schools, but only 55% and 29% of pad-users reported good disposal facilities, respectively (P < 0.001). In multivariate analysis, reported absenteeism during menstruation was significantly lower in Tamil Nadu (adjusted prevalence ratio (APR) 95% confidence interval (CI) = 0.24, 0.14-0.40) and Maharashtra (APR 0.56, CI = 0.40-0.77) compared to Chhattisgarh, and halved in model compared to regular schools (APR 0.50, CI = 0.34-0.73). Pain medication in school (APR 0.71, CI = 0.51-0.97) and use of disposable pads (APR 0.57, CI = 0.42-0.77) were associated with lower absenteeism and inadequate sanitary facilities with higher absenteeism during menstruation. Conclusions: Menstrual hygiene education, accessible sanitary products, pain relief, and adequate sanitary facilities at school would improve the schooling-experience of adolescent girls in India.


Assuntos
Higiene , Menstruação , Instituições Acadêmicas/organização & administração , Absenteísmo , Adolescente , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia , Produtos de Higiene Menstrual/provisão & distribução , Setor Público , Inquéritos e Questionários
5.
Reprod Health ; 15(1): 218, 2018 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-30594217

RESUMO

BACKGROUND: The onset of puberty and menarche is a specifically vulnerable time for girls, during which they begin to show interest in the opposite sex, while becoming exposed to a myriad of external pressures, including sexual coercion or harassment from boys and men, expectations to marry from their families, and the need to perform well in primary school in order to qualify for secondary school. According to several qualitative studies in Africa, such pressures are exacerbated by girls' lack of knowledge of their bodies, their rights, and the implications of their decisions, and by their inability to manage puberty and adolescence safely and comfortably with appropriate menstrual health and hygiene management (MHM) products. The evaluation of the Nia Project is one of the first to analyze the individual and combined contributions of sanitary pads and provision of comprehensive reproductive health education on girls' education and reproductive health outcomes. METHODS: The design for the evaluation of the Nia Project is a longitudinal, cluster-randomized controlled trial consisting of a baseline survey with a cohort of Class 7 girls, a school quality survey, qualitative data collection, school attendance tracking, and an endline survey at the completion of the 18-month intervention period with the same cohort. The study involves 140 public primary schools in three rural sub-counties (Magarini, Kaloleni and Ganze) of Kilifi County in the Coastal area of Kenya. The research sample includes 3489 girls, with about 25 girls per school on average. Before program implementation, the schools were stratified by sub-county and randomized to one of four study arms (35 schools per arm): 1) control, 2) disposable sanitary pads distribution, 2) reproductive health education, and 4) sanitary pad distribution and reproductive health education. DISCUSSION: The evidence provided will inform program investment and design, and contribute to the literature on the effect of menstrual health-based interventions on girls' agency, safety and life outcomes. TRIAL REGISTRATION: ISRCTN10894523 . Trial Registration Date: August 22, 2017.


Assuntos
Produtos de Higiene Menstrual/provisão & distribução , Saúde Reprodutiva/educação , Educação Sexual/organização & administração , Adolescente , Análise por Conglomerados , Currículo , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Quênia , Menstruação/psicologia , Psicologia do Adolescente , Projetos de Pesquisa , Instituições Acadêmicas , Autoeficácia
6.
Pan Afr Med J ; 31: 222, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-31447980

RESUMO

Introduction: pubescent girls from developing countries are confronted with diverse menstrual hygiene management (MHM) challenges, especially at school. Girls from rural pastoralist communities experience insurmountable MHM barriers. Inadequate coping strategies adopted result in sub-optimal school performance, absenteeism and physical problems. We conducted a study to assess MHM practices among primary school girls from a pastoralist community in Kenya. Methods: a cross sectional survey was done among primary school girls in Kajiado County, Kenya. Accent was sought. We administered structured questionnaires which sought information on socio-demographics, knowledge, perceptions and practices. Results: we enrolled 320 girls; with mean age of 14.9 years. Their parents were mostly (69.4%) self-employed pastoralists. Good menstruation knowledge was observed in 51.6%, while 45.5% reported diverse perceptions about menstruation. Majority, (80.9%) used sanitary towels as absorbents, but 40.3% delayed changing by > 6 hours. Poor MHM practices were documented in 28.8% and 32.2% kept the issue secret. Factors associated with poor MHM practices on univariable analysis were age (p=0.016), religion (p=0.037), non-discussions (p=0.001), lack of sanitary pads (p<0.0001), lack of latrine privacy (p=0.031), lack of water (p=0.001) and teasing by boys (p=0.016). On logistic regression, factors that independently influenced MHM practices were inadequate latrine privacy (p=0.031) and fear of teasing by boys (p=0.016). Conclusion: a third of pubescent pastoralist girls had poor MHM practices largely determined by inadequate latrine privacy and fear of teasing by boys.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Higiene/normas , Menstruação , Estudantes/estatística & dados numéricos , Absenteísmo , Adolescente , Estudos Transversais , Feminino , Humanos , Quênia , Produtos de Higiene Menstrual/provisão & distribução , População Rural/estatística & dados numéricos , Instituições Acadêmicas , Inquéritos e Questionários , Toaletes/normas
7.
J Urban Health ; 94(6): 835-846, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28875308

RESUMO

Access to adequate water and sanitation is limited in informal settlements, contributing to girls' challenges managing menstruation at school, especially when they cannot access materials to absorb menstrual blood and appropriate facilities for hygiene. This study documents differences between girls' experience of menstruation at public schools (where the Kenyan government provides menstrual pads) and private schools (where pads are not provided) in two informal settlements of Nairobi, Kenya. Results showed that supply chains to public schools were not reliable, and equitable pad provision was not assured. Girls in private schools struggled to access pads because they were not provided. Sanitation facilities were physically available, but Muslim girls were unable to practice ablution due to the design of toilets in our study schools. Girls experienced fear and anxiety due to harassment from male peers and had incomplete information about menstruation from teachers. Findings suggest that practitioners and policy-makers should acknowledge the diversity of school populations and monitor programs to ensure efforts do not contribute to inequity.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Produtos de Higiene Menstrual/provisão & distribução , Saneamento/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Fatores Socioeconômicos , Adolescente , Saúde do Adolescente/estatística & dados numéricos , Serviços de Saúde do Adolescente , Criança , Feminino , Humanos , Quênia , Menstruação/psicologia , Áreas de Pobreza , Serviços de Saúde Escolar/estatística & dados numéricos
8.
PLoS One ; 11(12): e0166122, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28002415

RESUMO

BACKGROUND: Poor menstrual knowledge and access to sanitary products have been proposed as barriers to menstrual health and school attendance. In response, interventions targeting these needs have seen increasing implementation in public and private sectors. However, there has been limited assessment of their effectiveness. OBJECTIVES: Assess the impact of providing reusable sanitary pads and puberty education on girls' school attendance and psychosocial wellbeing outcomes. METHODS: A cluster quasi-randomised controlled trial was conducted across 8 schools, including 1124 girls, in rural Uganda. Schools were allocated to one of four conditions: the provision of puberty education alone; reusable sanitary pads alone; puberty education and reusable sanitary pads; and a control (no intervention). The primary outcome was school attendance. Secondary outcomes reflected psychosocial wellbeing. RESULTS: At follow-up, school attendance had worsened for girls across all conditions. Per-protocol analysis revealed that this decline was significantly greater for those in the control condition d = 0.52 (95%CI 0.26-0.77), with those in control schools having a 17.1% (95%CI: 8.7-25.5) greater drop in attendance than those in any intervention school. There were no differences between the intervention conditions. High rates of school drop-out and transfer meant the trial suffered from substantial participant drop-out. Intention-to-treat analyses using two different imputation strategies were consistent with the main results, with mean differences of 5.2% attendance in best-case and 24.5% in worst-case imputations. Results were robust to adjustments for clustering. There was no impact of the interventions on girls' self-reported shame or insecurity during menstruation. CONCLUSION: Results of the trial support the hypothesised positive impact of providing sanitary pads or puberty education for girls' school attendance in a developing country context. Findings must be interpreted with caution in light of poor participant retention, intervention fidelity, and the attendance measures used. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR201503001044408.


Assuntos
Educação em Saúde , Produtos de Higiene Menstrual/provisão & distribução , Menstruação/psicologia , Puberdade/psicologia , Adolescente , Criança , Análise por Conglomerados , Feminino , Humanos , Pobreza/estatística & dados numéricos , Psicologia do Adolescente , População Rural , Autorrelato , Evasão Escolar/estatística & dados numéricos , Inquéritos e Questionários , Uganda
9.
Int Marit Health ; 66(3): 123-38, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26394312

RESUMO

BACKGROUND: This is a collaborative study from the International Maritime Health Association, International Seafarers' Welfare and Assistance Network, International Transport Workers' Federation and the Seafarers Hospital Society. The aim of the study was to look at the health and welfare needs of women seafarers and how organisations can best make or campaign for improvements to the health information and services available to women seafarers. MATERIALS AND METHODS: A pilot study was conducted in July 2014 and following review of the data and revision of the questionnaire the study was launched in December 2014, running until the middle of March 2015. Results collected from the survey are also supported by qualitative data obtained from two focus groups run during February and March. RESULTS: 595 responses were received from a range of nationalities, ages and positions on board ships. The findings suggest that joint/back pain, stress/depression/anxiety and headache seem to be the most common symptoms reported by women seafarers and that 55% felt that they are related to their work. 48% state that they have problems with seeking medical care and offer suggestions to improve this. Routine wellness checks, nutrition and information on joint and back pain are the main areas that women seafarers stated health screening/services/information would be most useful to improve their health and wellbeing. They suggested this could best be received directly from health professionals, or alternatively by reading leaflets or from online websites/an app. Significantly 37% of women seafarers also stated that they do not have access to sanitary bins within the toilet and 18% say that sexual harassment is an issue. CONCLUSIONS: The responses received highlight a small number of areas where relatively simple and low-cost interventions might improve the health and welfare of women seafarers. Specifically these include the production and appropriate distribution of gender-specific information on back pain, mental health and nutrition in addition to gynaecological complaints, to all women seafarers; the introduction of means for disposing of sanitary waste for all female crew on all ships and the improved availability of female specific products e.g. sanitary products in port shops and welfare centres worldwide. Additional work is needed to investigate these areas more fully and to look at the issue of confidence in medically trained staff, medical confidentiality and sexual harassment. Any further work and interventions will require the support of all of the main stakeholders and we plan a briefing meeting to publicise the findings to date and to identify support for further work in this area.


Assuntos
Acesso aos Serviços de Saúde , Navios , Saúde da Mulher , Adulto , Ansiedade/epidemiologia , Informação de Saúde ao Consumidor , Depressão/epidemiologia , Feminino , Grupos Focais , Cefaleia/epidemiologia , Inquéritos Epidemiológicos , Humanos , Comportamento de Busca de Informação , Produtos de Higiene Menstrual/provisão & distribução , Pessoa de Meia-Idade , Dor Musculoesquelética/epidemiologia , Medicina Naval , Determinação de Necessidades de Cuidados de Saúde , Saúde do Trabalhador , Ocupações/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Eliminação de Resíduos , Assédio Sexual , Estresse Psicológico/epidemiologia , Adulto Jovem
10.
Am J Public Health ; 105(7): 1302-11, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25973831

RESUMO

In recent years, the menstrual hygiene management challenges facing schoolgirls in low-income-country contexts have gained global attention. We applied Gusfield's sociological analysis of the culture of public problems to better understand how this relatively newly recognized public health challenge rose to the level of global public health awareness and action. We similarly applied the conceptualization by Dorfman et al. of the role of public health messaging in changing corporate practice to explore the conceptual frames and the news frames that are being used to shape the perceptions of menstrual hygiene management as an issue of social justice within the context of public health. Important lessons were revealed for getting other public health problems onto the global-, national-, and local-level agendas.


Assuntos
Higiene , Menstruação , Saúde Pública , Cultura , Países em Desenvolvimento , Feminino , Humanos , Higiene/normas , Produtos de Higiene Menstrual/provisão & distribução , Menstruação/etnologia , Política , Saúde Pública/normas , Segurança , Justiça Social , Responsabilidade Social
11.
Matern Child Health J ; 16(4): 767-74, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-21505773

RESUMO

The onset of menstruation is one of the most important physiological changes occurring among girls during the adolescent years. Menstruation heralds the onset of physiological maturity in girls. It becomes the part and parcel of their lives until menopause. Apart from personal importance, this phenomenon also has social significance. In India, menstruation is surrounded by myths and misconceptions with a long list of "do's" and "don'ts" for women. Hygiene-related practices of women during menstruation are of considerable importance, as it may increase vulnerability to Reproductive Tract Infections (RTI's). Poor menstrual hygiene is one of the major reasons for the high prevalence of RTIs in the country and contributes significantly to female morbidity. Most of the adolescent girls in villages use rags and old clothes during menstruation, increasing susceptibility to RTI's. Adolescents constitute one-fifths of India's population and yet their sexual health needs remain largely unaddressed in the national welfare programs. Poor menstrual hygiene in developing countries has been an insufficiently acknowledged problem. In June 2010, the Government of India proposed a new scheme towards menstrual hygiene by a provision of subsidized sanitary napkins to rural adolescent girls. But there are various other issues like awareness, availability and quality of napkins, regular supply, privacy, water supply, disposal of napkins, reproductive health education and family support which needs simultaneous attention for promotion of menstrual hygiene. The current article looks at the issue of menstrual hygiene not only from the health point of view, but also considers social and human rights values attached to it.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Higiene , Produtos de Higiene Menstrual , Menstruação , Adolescente , Feminino , Doenças dos Genitais Femininos/etiologia , Doenças dos Genitais Femininos/prevenção & controle , Educação em Saúde/métodos , Inquéritos Epidemiológicos , Humanos , Índia , Produtos de Higiene Menstrual/provisão & distribução , População Rural , Fatores Socioeconômicos
12.
Nurs Stand ; 23(6): 24-5, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18988564
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