Menstrual health interventions and school attendance in Uganda (MENISCUs-2)

乌干达的月经健康干预措施和入学率 (MENISCUs-2)

基本信息

批准号：
MR/P020283/1
负责人：
Helen Weiss
金额：
$ 25.91万
依托单位：
London School of Hygiene & Tropical Medicine
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2017
资助国家：
英国
起止时间：
2017 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FP020283%2F1
关键词：
Menstrual health interventions attendance Uganda

项目摘要

In many resource-poor settings, girls lack adequate knowledge, facilities and materials to manage their menstruation. Challenges girls face include: feelings of embarrassment, fear of leaking menstrual blood or of teasing from boys due to a lack of privacy at school. Many girls do not have access to adequate materials (pads, tampons or cups) to manage their menstruation. These factors can lead girls to be absent from school during menstruation.We recently completed an MRC-funded study (MENISCUS-1) among girls aged 14-17 years old in peri-urban Wakiso District in Uganda. This was a series of small sub-studies to understand perceptions about menstruation, to estimate the association with school absenteeism, and to develop an intervention package designed to improve school attendance and performance, knowledge and attitudes towards MHM, and prevalence of the reproductive tract infection bacterial vaginosis. The study showed that menstruation is a key reason for school absenteeism, along with poverty. In a sub-study in which girls were asked to complete a daily diary recording school attendance and menstrual cycles, girls reported missing school on 1 in 4 schooldays when they were menstruating compared with 1 in 14 days when not menstruating. We tested the components of a possible MHM intervention, each in a small number of girls. In the current study (MENISCUs-2), we plan to pilot test the interventions together as a package, delivered to all girls (about 150 per school) in one school year (S2) in two schools in Wakiso District. The intervention components are: - Training of teachers to improve delivery of the Government guidelines for puberty education. - A drama skit to address issues around menstruation while engaging parents, boys and teachers.- Provision of a menstrual cup kit: Our implementing partner, WoMena, will train selected teachers and older girls to teach girls how to use a menstrual cup (the Ruby Cup) and a re-usable sanitary pad (AfriPad), both provided in a bag with a mirror, sterilisation/storage container and soap. The cup is reusable for 10 years, holds twice the volume of most pads, and can be used for up to 12 hours (i.e. girls do not usually need to empty it at school) so it should help girls manage periods whilst at school. - Supply painkillers for period pain (delivered using a voucher system)- Simple improvements to school water and sanitation facilities including locks on the toilet doors, provision of toilet paper, and a soap dispenser for hand-washing.The primary outcome of MENISCUs-2 is to evaluate the intervention package works sufficiently well to enable a trial to be justified. We will decide this based on how well the intervention package is delivered (e.g. of analgesics delivered). The criteria for progression is that the education session and drama skit were delivered, the majority of girls using the Ruby Cup or re-usable pads provided at endline, and accessing painkillers as needed, and soap and toilet paper available in schools for the majority of the time. We will also estimate the number of girls who progress to the next school year in order to know the likely loss to follow-up within a future trial. The criteria for progression to a trial will be a retention rate of 80% to allow for an acceptable loss to follow-up in the future trial. We will also estimate the likely intervention effect size. Finally, we will estimate the cost of the intervention delivery, and cost of monitoring trial outcomes.As part of the study, we also piloted a football-based intervention in Uganda to promote safe male circumcision for HIV prevention, which we have previously used in Zimbabwe. This worked well after modifications, and we will deliver this intervention in the future trial alongside the MHM intervention, but are not including this component in this study as it was fully tested previously.

在许多资源匮乏的地区，女孩缺乏足够的知识、设施和材料来管理月经。女孩面临的挑战包括：感到尴尬、担心经血泄漏或因学校缺乏隐私而受到男孩的嘲笑。许多女孩没有足够的材料（卫生巾、卫生棉条或杯子）来管理月经。这些因素可能导致女孩在月经期间缺课。我们最近完成了一项由 MRC 资助的研究 (MENISCUS-1)，对象是乌干达城郊瓦基索区 14 至 17 岁的女孩。这是一系列小型子研究，旨在了解对月经的看法，估计与学校缺勤的关系，并制定旨在提高学校出勤率和表现、对 MHM 的知识和态度以及生殖道感染患病率的干预方案细菌性阴道病。研究表明，月经和贫困都是缺课的主要原因。在一项要求女孩完成每日日记记录学校出勤情况和月经周期的子研究中，女孩报告称，在月经期间，四分之一的上课日缺课，而在非月经期间，这一比例为每 14 天缺课一次。我们在少数女孩中测试了可能的 MHM 干预措施的各个组成部分。在当前的研究 (MENISCUs-2) 中，我们计划将干预措施作为一揽子方案一起进行试点测试，在一个学年 (S2) 内向瓦克索区两所学校的所有女孩（每所学校约 150 名）提供。干预措施包括： - 培训教师，以改进政府青春期教育准则的实施。 - 一部解决月经问题的短剧，同时吸引家长、男孩和老师参与。- 提供月经杯套件：我们的执行合作伙伴 WoMena 将培训选定的教师和年龄较大的女孩，教女孩如何使用月经杯（Ruby）杯）和可重复使用的卫生巾（AfriPad），均装在一个袋子里，里面装有镜子、消毒/储存容器和肥皂。该杯子可重复使用 10 年，容量是大多数卫生巾的两倍，可使用长达 12 小时（即女孩通常不需要在学校倒空它），因此它应该可以帮助女孩在学校管理经期。 - 提供治疗经期疼痛的止痛药（使用代金券系统提供） - 对学校供水和卫生设施进行简单改进，包括锁厕所门、提供卫生纸和用于洗手的皂液器。MENISCUs-2 的主要成果的目的是评估干预方案的效果是否足够好，以使试验具有合理性。我们将根据干预方案的实施情况（例如止痛药的实施情况）来决定。进步的标准是教育课程和戏剧短剧已完成，大多数女孩使用终点线提供的红宝石杯或可重复使用的垫子，并根据需要获得止痛药，学校为大多数女孩提供肥皂和卫生纸时间。我们还将估计升入下一学年的女孩人数，以便了解未来试验中可能出现的随访损失。进入试验的标准是 80% 的保留率，以允许未来试验中随访的损失是可接受的。我们还将估计可能的干预效果大小。最后，我们将估计干预实施的成本以及监测试验结果的成本。作为研究的一部分，我们还在乌干达试点了一项基于足球的干预措施，以促进安全的男性包皮环切术以预防艾滋病毒，我们之前曾在津巴布韦。修改后效果很好，我们将在未来的试验中与 MHM 干预一起提供这种干预，但不包括在本研究中，因为它之前已经过充分测试。