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Paul Montgomery - One of the best experts on this subject based on the ideXlab platform.
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A Study of Environmentally Friendly Menstrual Absorbents in the Context of Social Change for Adolescent Girls in Low- and Middle-Income Countries
'MDPI AG', 2021Co-Authors: Jasmin Foster, Paul MontgomeryAbstract:Girls in low- and middle-income countries struggle to maintain good menstrual hygiene in part due to a lack of affordable Sanitary products. The unaffordability of reliable Sanitary products can lead to school absenteeism and is a barrier to education attainment and gender equality for girls in low-income contexts. Further, the lack of adequate disposal facilities can lead to social embarrassment and environmental pollution. Low-cost biodegradable absorbents (cotton terry cloth, linen, hemp cloth and bamboo wadding) were investigated in gelatine solution in terms of their absorption for use in menstrual hygiene. Bamboo wadding exhibits the highest absorption index (7.86), greater than cotton terry cloth (0.84), hemp cloth (1.4), linen (1.57) and a commercial Sanitary Pad (4.38). Though the absorption index of bamboo wadding is promising, especially in light of the vast availability of bamboo in tropical low- and middle-income countries, challenges lie in overcoming complex extraction processes from bamboo plants, which is discussed. This simple research of a physical material from a technical aspect, if further investigated with a social science and policy lens, could increase school attendance, improve the education levels attained by girls and be a key step towards gender equality in low- and middle-income countries
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A qualitative understanding of the effects of reusable Sanitary Pads and puberty education: implications for future research and practice
'Springer Science and Business Media LLC', 2017Co-Authors: Julie Hennegan, Catherine Dolan, Laurel Steinfield, Paul MontgomeryAbstract:Abstract Background The management of menstruation has come to the fore as a barrier to girls’ education attainment in low income contexts. Interventions have been proposed and piloted, but the emerging nature of the field means limited evidence is available to understand their pathways of effect. Methods This study describes and compares schoolgirls’ experiences of menstruation in rural Uganda at the conclusion of a controlled trial of puberty education and Sanitary Pad provision to elucidate pathways of effect in the interventions. Semi-structured interviews were undertaken with schoolgirls who participated in the Menstruation and the Cycle of Poverty trial concurrent with the final set of quantitative surveys. A framework approach and cross-case analysis were employed to describe and compare the experiences of 27 menstruating girls across the four intervention conditions; education (n = 8), reusable Sanitary Pads (n = 8), education with reusable Sanitary Pads (n = 6), and control (n = 5). Results Themes included: menstrual hygiene, soiling, irritation and infection, physical experience, knowledge of menstruation, psychological, social and cultural factors, and support from others. Those receiving reusable Pads experienced improvements in comfort and reliability. This translated into reduced fears around garment soiling and related school absenteeism. Other menstrual hygiene challenges of washing, drying and privacy remained prominent. Puberty education improved girls’ confidence to discuss menstruation and prompted additional support from teachers and peers. Conclusions Findings have important implications for the development and evaluation of future interventions. Results suggest the provision of menstrual absorbents addresses one core barrier to menstrual health, but that interventions addressing broader needs such as privacy may improve effectiveness. Puberty education sessions should increase attention to body awareness and include strategies to address a wider range of practical menstrual challenges, including pain management. Interviews revealed possibilities for improving quantitative surveys in future research. Trial registration Pan-African Clinical Trials Registry PACTR20150300104440
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menstruation and the cycle of poverty a cluster quasi randomised control trial of Sanitary Pad and puberty education provision in uganda
PLOS ONE, 2016Co-Authors: Paul Montgomery, Laurel Steinfield, Catherine Dolan, Julie Hennegan, Linda M. ScottAbstract: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.
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op47 menstruation and the cycle of poverty a cluster quasi randomised control trial of Sanitary Pad and puberty education provision in uganda
Journal of Epidemiology and Community Health, 2016Co-Authors: Paul Montgomery, Catherine Dolan, Julie Hennegan, Linda M. ScottAbstract:Background The management of menstruation has been posited as a significant barrier to girls’ educational attainment in low income contexts. Interventions providing Sanitary products and information about menstruation have been proposed as simple and efficient strategies for improving girls’ attendance and gender parity in education. Despite increasing implementation of such interventions, there have been limited high quality assessments of the effectiveness of proposed interventions to date. This trial aimed to assess the impact of providing Sanitary Pads and puberty education on school attendance and psychosocial outcomes for girls in rural Uganda. Methods A cluster quasi-randomised controlled trial was conducted across 8 schools, including 1124 girls, in rural Uganda. The trial included four conditions: the provision of puberty education alone; reusable Sanitary Pads alone; puberty education and reusable Sanitary Pads; and a control receiving no intervention. The primary outcome was school attendance measured at baseline and 18-month follow up. Change scores were compared across conditions. Secondary outcomes reflected psychosocial wellbeing including shame and insecurity during menstruation and were measured at the end of the follow-up period (24-months after intervention) through surveys administered verbally in the local language. Results After 18-months, school attendance 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 17% greater drop in attendance than those in any intervention school. There was no difference between the intervention conditions. High rates of school-drop out, school-transfer, and girls moving away meant the trial suffered from substantial participant drop-out. However, intention-to-treat analyses using different imputation strategies revealed the same pattern of attendance retention in intervention conditions compared to the control. There were no differences between any of the conditions on girls’ self-reported feelings of shame and insecurity experienced during menstruation. Conclusion This trial is the largest to date demonstrating a positive impact of providing Sanitary Pads or puberty education for girls’ school attendance in a developing context. The study revealed no difference in the effectiveness of Sanitary Pad provision compared to education.
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do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in low and middle income countries a systematic review
PLOS ONE, 2016Co-Authors: Julie Hennegan, Paul MontgomeryAbstract:Background Unhygienic and ineffective menstrual hygiene management has been documented across low resource contexts and linked to negative consequences for women and girls. Objectives To summarise and critically appraise evidence for the effectiveness of menstruation management interventions in improving women and girls’ education, work and psychosocial wellbeing in low and middle income countries. Methods Structured systematic searches were conducted in peer-reviewed and grey literature to identify studies evaluating education and resource provision interventions for menstruation management. Individual and cluster randomised controlled trials were eligible for inclusion, as were non-randomised controlled trials. Study characteristics, outcomes and risk of bias were extracted using a piloted form. Risk of bias was independently assessed by two researchers. Results Eight studies described in ten citations were eligible for inclusion. Studies were highly heterogeneous in design and context. Six included assessment of education-only interventions, and three provided assessment of the provision of different types of Sanitary products (menstrual cups, disposable Sanitary Pads, and reusable Sanitary Pads). A moderate but non-significant standardised mean difference was found for the two studies assessing the impact of Sanitary Pad provision on school attendance: 0.49 (95%CI -0.13, 1.11). Included studies were heterogeneous with considerable risk of bias. Trials of education interventions reported positive impacts on menstrual knowledge and practices, however, many studies failed to assess other relevant outcomes. No trials assessed or reported harms. Conclusions There is insufficient evidence to establish the effectiveness of menstruation management interventions, although current results are promising. Eight trials have been conducted, but a high risk of bias was found and clinical heterogeneity precluded synthesis of most results. Whilst trials provided some indication of positive results, further research is needed to establish the role of menstruation hygiene management in education performance, employment and other psychosocial outcomes. This review provides a concise summary of present trials and highlights improvements for future work.
Linda M. Scott - One of the best experts on this subject based on the ideXlab platform.
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menstruation and the cycle of poverty a cluster quasi randomised control trial of Sanitary Pad and puberty education provision in uganda
PLOS ONE, 2016Co-Authors: Paul Montgomery, Laurel Steinfield, Catherine Dolan, Julie Hennegan, Linda M. ScottAbstract: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.
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op47 menstruation and the cycle of poverty a cluster quasi randomised control trial of Sanitary Pad and puberty education provision in uganda
Journal of Epidemiology and Community Health, 2016Co-Authors: Paul Montgomery, Catherine Dolan, Julie Hennegan, Linda M. ScottAbstract:Background The management of menstruation has been posited as a significant barrier to girls’ educational attainment in low income contexts. Interventions providing Sanitary products and information about menstruation have been proposed as simple and efficient strategies for improving girls’ attendance and gender parity in education. Despite increasing implementation of such interventions, there have been limited high quality assessments of the effectiveness of proposed interventions to date. This trial aimed to assess the impact of providing Sanitary Pads and puberty education on school attendance and psychosocial outcomes for girls in rural Uganda. Methods A cluster quasi-randomised controlled trial was conducted across 8 schools, including 1124 girls, in rural Uganda. The trial included four conditions: the provision of puberty education alone; reusable Sanitary Pads alone; puberty education and reusable Sanitary Pads; and a control receiving no intervention. The primary outcome was school attendance measured at baseline and 18-month follow up. Change scores were compared across conditions. Secondary outcomes reflected psychosocial wellbeing including shame and insecurity during menstruation and were measured at the end of the follow-up period (24-months after intervention) through surveys administered verbally in the local language. Results After 18-months, school attendance 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 17% greater drop in attendance than those in any intervention school. There was no difference between the intervention conditions. High rates of school-drop out, school-transfer, and girls moving away meant the trial suffered from substantial participant drop-out. However, intention-to-treat analyses using different imputation strategies revealed the same pattern of attendance retention in intervention conditions compared to the control. There were no differences between any of the conditions on girls’ self-reported feelings of shame and insecurity experienced during menstruation. Conclusion This trial is the largest to date demonstrating a positive impact of providing Sanitary Pads or puberty education for girls’ school attendance in a developing context. The study revealed no difference in the effectiveness of Sanitary Pad provision compared to education.
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Sanitary Pad: Acceptability and Sustainability Study
2013Co-Authors: Linda M. Scott, Paul Montgomery, Laurel Steinfield, Catherine Dolan, Sue Dopson, Jim HecimovichAbstract:Why focus on girls’ secondary education? Retaining girls in school through the secondary level is now understood to have far-reaching effects on national wellbeing and prosperity for developing nations. Many of the benefits are related to the first years of sexual maturity—for instance, fewer early pregnancies, lower HIV transmission, and reduced infant mortality—and thus could be expected to accrue within only a few years of a successful intervention.
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Sanitary Pad interventions for girls education in ghana a pilot study
PLOS ONE, 2012Co-Authors: Paul Montgomery, Catherine Dolan, Sue Dopson, Caitlin Ryus, Linda M. ScottAbstract:Background: Increased education of girls in developing contexts is associated with a number of important positive health, social, and economic outcomes for a community. The event of menarche tends to coincide with girls’ transitions from primary to secondary education and may constitute a barrier for continued school attendance and performance. Following the MRC Framework for Complex Interventions, a pilot controlled study was conducted in Ghana to assess the role of Sanitary Pads in girls’ education. Methods: A sample of 120 schoolgirls between the ages of 12 and 18 from four villages in Ghana participated in a nonrandomized trial of Sanitary Pad provision with education. The trial had three levels of treatment: provision of Pads with puberty education; puberty education alone; or control (no Pads or education). The primary outcome was school attendance. Results: After 3 months, providing Pads with education significantly improved attendance among participants, (lambda 0.824, F=3.760, p,.001). After 5 months, puberty education alone improved attendance to a similar level (M=91.26, SD=7.82) as sites where Pads were provided with puberty education (Rural M=89.74, SD=9.34; Periurban M=90.54, SD=17.37), all of which were higher than control (M=84.48, SD=12.39). The total improvement through Pads with education intervention after 5 months was a 9% increase in attendance. After 3 months, providing Pads with education significantly improved attendance among participants. The changes in attendance at the end of the trial, after 5 months, were found to be significant by site over time. With puberty education alone resulting in a similar attendance level. Conclusion: This pilot study demonstrated promising results of a low-cost, rapid-return intervention for girls’ education in a developing context. Given the considerable development needs of poorer countries and the potential of young women there, these results suggest that a large-scale cluster randomized trial is warranted.
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Sanitary Pad Interventions for Girls' Education in Ghana: A Pilot Study
2012Co-Authors: Paul Montgomery, Sue Dopson, Caitlin Ryus, Catherine S. Dolan, Linda M. ScottAbstract:BackgroundIncreased education of girls in developing contexts is associated with a number of important positive health, social, and economic outcomes for a community. The event of menarche tends to coincide with girls' transitions from primary to secondary education and may constitute a barrier for continued school attendance and performance. Following the MRC Framework for Complex Interventions, a pilot controlled study was conducted in Ghana to assess the role of Sanitary Pads in girls' education. MethodsA sample of 120 schoolgirls between the ages of 12 and 18 from four villages in Ghana participated in a non-randomized trial of Sanitary Pad provision with education. The trial had three levels of treatment: provision of Pads with puberty education; puberty education alone; or control (no Pads or education). The primary outcome was school attendance. ResultsAfter 3 months, providing Pads with education significantly improved attendance among participants, (lambda 0.824, F = 3.760, p
Julie Hennegan - One of the best experts on this subject based on the ideXlab platform.
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Understanding interventions to improve menstrual health in low and middle income countries: evidence and future directions.
2017Co-Authors: Julie HenneganAbstract:Background. Menstrual health has emerged as an under recognised barrier to women and girls' dignity, health, education, and psychosocial wellbeing in low and middle income contexts. Interventions targeting this issue have seen increasing dissemination, despite little evidence for their effectiveness and sparse research to inform intervention development or evaluation. Objectives. 1) Appraise current evidence for the effectiveness of menstrual health interventions; 2) Evaluate the effectiveness of a reusable Sanitary Pad and puberty education intervention for girls’ school attendance; and, 3) Expand understanding of menstrual health to inform future research and practice. Methods.. The multiple objectives of this thesis were addressed through a range of methodological approaches, reported across six manuscripts. The first collates and critically appraises existing evidence in a systematic review, while the second provides a broader overview in a position piece advocating for an evidence-based approach to menstrual health. The third paper reports on a cluster quasi-randomised control trial of reusable Sanitary Pad and puberty education interventions undertaken in Uganda. The fourth and fifth papers report secondary analyses of the trial survey data to investigate the prevalence and consequences of menstrual hygiene, and schoolgirls’ experiences with menstrual absorbents. The final manuscript presents a qualitative, framework analysis to describe and compare the menstrual experiences of 27 schoolgirls in the controlled trial. Results. Systematic review identified eight controlled trials of menstrual health interventions. There was emerging evidence for the effectiveness of both education and product provision interventions, although methodological quality was poor. The controlled trial of reusable Sanitary Pad and puberty education provision found both interventions were similarly effective in reducing school absenteeism, with a moderate effect size. Follow-up quantitative papers provided insights into girls’ menstrual experiences. In the first of these, the prevalence of inadequate menstrual hygiene was estimated to be 91% when measured consistently with the consensus definition, and did not differ between those using trial-provided reusable Sanitary Pads and those using existing methods. Aspects of menstrual hygiene were associated with shame, reduced school engagement, and health concerns. In the second follow-up, girls rated the trial-provided reusable Sanitary Pads favourably. However, greater perceptions of reliability did not translate into reduced rates of soiling or odour in the last menses. Finally, qualitative work provided process evaluation and nuanced understanding of the interventions’ change mechanisms. Reduced fears of soiling improved school attendance for those provided with absorbents, while improvements in social support may have mediated the impact of the puberty education on attendance. Conclusions. This thesis represents a significant step forward in the emerging field of menstrual health research. The work provides critical appraisal of existing studies and new evidence for the effectiveness of interventions to improve outcomes for girls' in low and middle income contexts. Further, new insights on the prevalence and consequences of menstrual hygiene, girls' appraisal of menstrual absorbents, and qualitative exploration of girls’ experiences provide guidance for the development of future interventions and evaluations.
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A qualitative understanding of the effects of reusable Sanitary Pads and puberty education: implications for future research and practice
'Springer Science and Business Media LLC', 2017Co-Authors: Julie Hennegan, Catherine Dolan, Laurel Steinfield, Paul MontgomeryAbstract:Abstract Background The management of menstruation has come to the fore as a barrier to girls’ education attainment in low income contexts. Interventions have been proposed and piloted, but the emerging nature of the field means limited evidence is available to understand their pathways of effect. Methods This study describes and compares schoolgirls’ experiences of menstruation in rural Uganda at the conclusion of a controlled trial of puberty education and Sanitary Pad provision to elucidate pathways of effect in the interventions. Semi-structured interviews were undertaken with schoolgirls who participated in the Menstruation and the Cycle of Poverty trial concurrent with the final set of quantitative surveys. A framework approach and cross-case analysis were employed to describe and compare the experiences of 27 menstruating girls across the four intervention conditions; education (n = 8), reusable Sanitary Pads (n = 8), education with reusable Sanitary Pads (n = 6), and control (n = 5). Results Themes included: menstrual hygiene, soiling, irritation and infection, physical experience, knowledge of menstruation, psychological, social and cultural factors, and support from others. Those receiving reusable Pads experienced improvements in comfort and reliability. This translated into reduced fears around garment soiling and related school absenteeism. Other menstrual hygiene challenges of washing, drying and privacy remained prominent. Puberty education improved girls’ confidence to discuss menstruation and prompted additional support from teachers and peers. Conclusions Findings have important implications for the development and evaluation of future interventions. Results suggest the provision of menstrual absorbents addresses one core barrier to menstrual health, but that interventions addressing broader needs such as privacy may improve effectiveness. Puberty education sessions should increase attention to body awareness and include strategies to address a wider range of practical menstrual challenges, including pain management. Interviews revealed possibilities for improving quantitative surveys in future research. Trial registration Pan-African Clinical Trials Registry PACTR20150300104440
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menstruation and the cycle of poverty a cluster quasi randomised control trial of Sanitary Pad and puberty education provision in uganda
PLOS ONE, 2016Co-Authors: Paul Montgomery, Laurel Steinfield, Catherine Dolan, Julie Hennegan, Linda M. ScottAbstract: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.
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op47 menstruation and the cycle of poverty a cluster quasi randomised control trial of Sanitary Pad and puberty education provision in uganda
Journal of Epidemiology and Community Health, 2016Co-Authors: Paul Montgomery, Catherine Dolan, Julie Hennegan, Linda M. ScottAbstract:Background The management of menstruation has been posited as a significant barrier to girls’ educational attainment in low income contexts. Interventions providing Sanitary products and information about menstruation have been proposed as simple and efficient strategies for improving girls’ attendance and gender parity in education. Despite increasing implementation of such interventions, there have been limited high quality assessments of the effectiveness of proposed interventions to date. This trial aimed to assess the impact of providing Sanitary Pads and puberty education on school attendance and psychosocial outcomes for girls in rural Uganda. Methods A cluster quasi-randomised controlled trial was conducted across 8 schools, including 1124 girls, in rural Uganda. The trial included four conditions: the provision of puberty education alone; reusable Sanitary Pads alone; puberty education and reusable Sanitary Pads; and a control receiving no intervention. The primary outcome was school attendance measured at baseline and 18-month follow up. Change scores were compared across conditions. Secondary outcomes reflected psychosocial wellbeing including shame and insecurity during menstruation and were measured at the end of the follow-up period (24-months after intervention) through surveys administered verbally in the local language. Results After 18-months, school attendance 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 17% greater drop in attendance than those in any intervention school. There was no difference between the intervention conditions. High rates of school-drop out, school-transfer, and girls moving away meant the trial suffered from substantial participant drop-out. However, intention-to-treat analyses using different imputation strategies revealed the same pattern of attendance retention in intervention conditions compared to the control. There were no differences between any of the conditions on girls’ self-reported feelings of shame and insecurity experienced during menstruation. Conclusion This trial is the largest to date demonstrating a positive impact of providing Sanitary Pads or puberty education for girls’ school attendance in a developing context. The study revealed no difference in the effectiveness of Sanitary Pad provision compared to education.
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do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in low and middle income countries a systematic review
PLOS ONE, 2016Co-Authors: Julie Hennegan, Paul MontgomeryAbstract:Background Unhygienic and ineffective menstrual hygiene management has been documented across low resource contexts and linked to negative consequences for women and girls. Objectives To summarise and critically appraise evidence for the effectiveness of menstruation management interventions in improving women and girls’ education, work and psychosocial wellbeing in low and middle income countries. Methods Structured systematic searches were conducted in peer-reviewed and grey literature to identify studies evaluating education and resource provision interventions for menstruation management. Individual and cluster randomised controlled trials were eligible for inclusion, as were non-randomised controlled trials. Study characteristics, outcomes and risk of bias were extracted using a piloted form. Risk of bias was independently assessed by two researchers. Results Eight studies described in ten citations were eligible for inclusion. Studies were highly heterogeneous in design and context. Six included assessment of education-only interventions, and three provided assessment of the provision of different types of Sanitary products (menstrual cups, disposable Sanitary Pads, and reusable Sanitary Pads). A moderate but non-significant standardised mean difference was found for the two studies assessing the impact of Sanitary Pad provision on school attendance: 0.49 (95%CI -0.13, 1.11). Included studies were heterogeneous with considerable risk of bias. Trials of education interventions reported positive impacts on menstrual knowledge and practices, however, many studies failed to assess other relevant outcomes. No trials assessed or reported harms. Conclusions There is insufficient evidence to establish the effectiveness of menstruation management interventions, although current results are promising. Eight trials have been conducted, but a high risk of bias was found and clinical heterogeneity precluded synthesis of most results. Whilst trials provided some indication of positive results, further research is needed to establish the role of menstruation hygiene management in education performance, employment and other psychosocial outcomes. This review provides a concise summary of present trials and highlights improvements for future work.
Catherine Dolan - One of the best experts on this subject based on the ideXlab platform.
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A qualitative understanding of the effects of reusable Sanitary Pads and puberty education: implications for future research and practice
'Springer Science and Business Media LLC', 2017Co-Authors: Julie Hennegan, Catherine Dolan, Laurel Steinfield, Paul MontgomeryAbstract:Abstract Background The management of menstruation has come to the fore as a barrier to girls’ education attainment in low income contexts. Interventions have been proposed and piloted, but the emerging nature of the field means limited evidence is available to understand their pathways of effect. Methods This study describes and compares schoolgirls’ experiences of menstruation in rural Uganda at the conclusion of a controlled trial of puberty education and Sanitary Pad provision to elucidate pathways of effect in the interventions. Semi-structured interviews were undertaken with schoolgirls who participated in the Menstruation and the Cycle of Poverty trial concurrent with the final set of quantitative surveys. A framework approach and cross-case analysis were employed to describe and compare the experiences of 27 menstruating girls across the four intervention conditions; education (n = 8), reusable Sanitary Pads (n = 8), education with reusable Sanitary Pads (n = 6), and control (n = 5). Results Themes included: menstrual hygiene, soiling, irritation and infection, physical experience, knowledge of menstruation, psychological, social and cultural factors, and support from others. Those receiving reusable Pads experienced improvements in comfort and reliability. This translated into reduced fears around garment soiling and related school absenteeism. Other menstrual hygiene challenges of washing, drying and privacy remained prominent. Puberty education improved girls’ confidence to discuss menstruation and prompted additional support from teachers and peers. Conclusions Findings have important implications for the development and evaluation of future interventions. Results suggest the provision of menstrual absorbents addresses one core barrier to menstrual health, but that interventions addressing broader needs such as privacy may improve effectiveness. Puberty education sessions should increase attention to body awareness and include strategies to address a wider range of practical menstrual challenges, including pain management. Interviews revealed possibilities for improving quantitative surveys in future research. Trial registration Pan-African Clinical Trials Registry PACTR20150300104440
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menstruation and the cycle of poverty a cluster quasi randomised control trial of Sanitary Pad and puberty education provision in uganda
PLOS ONE, 2016Co-Authors: Paul Montgomery, Laurel Steinfield, Catherine Dolan, Julie Hennegan, Linda M. ScottAbstract: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.
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op47 menstruation and the cycle of poverty a cluster quasi randomised control trial of Sanitary Pad and puberty education provision in uganda
Journal of Epidemiology and Community Health, 2016Co-Authors: Paul Montgomery, Catherine Dolan, Julie Hennegan, Linda M. ScottAbstract:Background The management of menstruation has been posited as a significant barrier to girls’ educational attainment in low income contexts. Interventions providing Sanitary products and information about menstruation have been proposed as simple and efficient strategies for improving girls’ attendance and gender parity in education. Despite increasing implementation of such interventions, there have been limited high quality assessments of the effectiveness of proposed interventions to date. This trial aimed to assess the impact of providing Sanitary Pads and puberty education on school attendance and psychosocial outcomes for girls in rural Uganda. Methods A cluster quasi-randomised controlled trial was conducted across 8 schools, including 1124 girls, in rural Uganda. The trial included four conditions: the provision of puberty education alone; reusable Sanitary Pads alone; puberty education and reusable Sanitary Pads; and a control receiving no intervention. The primary outcome was school attendance measured at baseline and 18-month follow up. Change scores were compared across conditions. Secondary outcomes reflected psychosocial wellbeing including shame and insecurity during menstruation and were measured at the end of the follow-up period (24-months after intervention) through surveys administered verbally in the local language. Results After 18-months, school attendance 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 17% greater drop in attendance than those in any intervention school. There was no difference between the intervention conditions. High rates of school-drop out, school-transfer, and girls moving away meant the trial suffered from substantial participant drop-out. However, intention-to-treat analyses using different imputation strategies revealed the same pattern of attendance retention in intervention conditions compared to the control. There were no differences between any of the conditions on girls’ self-reported feelings of shame and insecurity experienced during menstruation. Conclusion This trial is the largest to date demonstrating a positive impact of providing Sanitary Pads or puberty education for girls’ school attendance in a developing context. The study revealed no difference in the effectiveness of Sanitary Pad provision compared to education.
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Sanitary Pad: Acceptability and Sustainability Study
2013Co-Authors: Linda M. Scott, Paul Montgomery, Laurel Steinfield, Catherine Dolan, Sue Dopson, Jim HecimovichAbstract:Why focus on girls’ secondary education? Retaining girls in school through the secondary level is now understood to have far-reaching effects on national wellbeing and prosperity for developing nations. Many of the benefits are related to the first years of sexual maturity—for instance, fewer early pregnancies, lower HIV transmission, and reduced infant mortality—and thus could be expected to accrue within only a few years of a successful intervention.
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Sanitary Pad interventions for girls education in ghana a pilot study
PLOS ONE, 2012Co-Authors: Paul Montgomery, Catherine Dolan, Sue Dopson, Caitlin Ryus, Linda M. ScottAbstract:Background: Increased education of girls in developing contexts is associated with a number of important positive health, social, and economic outcomes for a community. The event of menarche tends to coincide with girls’ transitions from primary to secondary education and may constitute a barrier for continued school attendance and performance. Following the MRC Framework for Complex Interventions, a pilot controlled study was conducted in Ghana to assess the role of Sanitary Pads in girls’ education. Methods: A sample of 120 schoolgirls between the ages of 12 and 18 from four villages in Ghana participated in a nonrandomized trial of Sanitary Pad provision with education. The trial had three levels of treatment: provision of Pads with puberty education; puberty education alone; or control (no Pads or education). The primary outcome was school attendance. Results: After 3 months, providing Pads with education significantly improved attendance among participants, (lambda 0.824, F=3.760, p,.001). After 5 months, puberty education alone improved attendance to a similar level (M=91.26, SD=7.82) as sites where Pads were provided with puberty education (Rural M=89.74, SD=9.34; Periurban M=90.54, SD=17.37), all of which were higher than control (M=84.48, SD=12.39). The total improvement through Pads with education intervention after 5 months was a 9% increase in attendance. After 3 months, providing Pads with education significantly improved attendance among participants. The changes in attendance at the end of the trial, after 5 months, were found to be significant by site over time. With puberty education alone resulting in a similar attendance level. Conclusion: This pilot study demonstrated promising results of a low-cost, rapid-return intervention for girls’ education in a developing context. Given the considerable development needs of poorer countries and the potential of young women there, these results suggest that a large-scale cluster randomized trial is warranted.
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A qualitative understanding of the effects of reusable Sanitary Pads and puberty education: implications for future research and practice
'Springer Science and Business Media LLC', 2017Co-Authors: Julie Hennegan, Catherine Dolan, Laurel Steinfield, Paul MontgomeryAbstract:Abstract Background The management of menstruation has come to the fore as a barrier to girls’ education attainment in low income contexts. Interventions have been proposed and piloted, but the emerging nature of the field means limited evidence is available to understand their pathways of effect. Methods This study describes and compares schoolgirls’ experiences of menstruation in rural Uganda at the conclusion of a controlled trial of puberty education and Sanitary Pad provision to elucidate pathways of effect in the interventions. Semi-structured interviews were undertaken with schoolgirls who participated in the Menstruation and the Cycle of Poverty trial concurrent with the final set of quantitative surveys. A framework approach and cross-case analysis were employed to describe and compare the experiences of 27 menstruating girls across the four intervention conditions; education (n = 8), reusable Sanitary Pads (n = 8), education with reusable Sanitary Pads (n = 6), and control (n = 5). Results Themes included: menstrual hygiene, soiling, irritation and infection, physical experience, knowledge of menstruation, psychological, social and cultural factors, and support from others. Those receiving reusable Pads experienced improvements in comfort and reliability. This translated into reduced fears around garment soiling and related school absenteeism. Other menstrual hygiene challenges of washing, drying and privacy remained prominent. Puberty education improved girls’ confidence to discuss menstruation and prompted additional support from teachers and peers. Conclusions Findings have important implications for the development and evaluation of future interventions. Results suggest the provision of menstrual absorbents addresses one core barrier to menstrual health, but that interventions addressing broader needs such as privacy may improve effectiveness. Puberty education sessions should increase attention to body awareness and include strategies to address a wider range of practical menstrual challenges, including pain management. Interviews revealed possibilities for improving quantitative surveys in future research. Trial registration Pan-African Clinical Trials Registry PACTR20150300104440
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menstruation and the cycle of poverty a cluster quasi randomised control trial of Sanitary Pad and puberty education provision in uganda
PLOS ONE, 2016Co-Authors: Paul Montgomery, Laurel Steinfield, Catherine Dolan, Julie Hennegan, Linda M. ScottAbstract: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.
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Sanitary Pad: Acceptability and Sustainability Study
2013Co-Authors: Linda M. Scott, Paul Montgomery, Laurel Steinfield, Catherine Dolan, Sue Dopson, Jim HecimovichAbstract:Why focus on girls’ secondary education? Retaining girls in school through the secondary level is now understood to have far-reaching effects on national wellbeing and prosperity for developing nations. Many of the benefits are related to the first years of sexual maturity—for instance, fewer early pregnancies, lower HIV transmission, and reduced infant mortality—and thus could be expected to accrue within only a few years of a successful intervention.
