The effect of a school-based educational intervention on menstrual health: an intervention study among adolescent girls in Bangladesh

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Abstract

Objectives

To assess the impact of a school-based menstrual education programme on: (1) menstrual knowledge, beliefs and practices, (2) menstrual disorders experienced, and (3) restrictions on menstruating adolescents.

Design

Intervention study.

Setting

Araihazar area, Bangladesh.

Participants

416 adolescent female students aged 11–16 years, in grade 6–8, and living with their parents.

Interventions

A school-based health education study conducted from April 2012 to April 2013.

Primary and secondary outcome measures

We randomly selected 3 of 26 high schools in the study area. We delivered 6 months of educational intervention by trained (by an obstetrician and gynaecologist) research assistants (RAs) on menstrual hygiene among school girls. RAs read the questionnaire and participants answered. The changes in knowledge, beliefs and practices regarding menstruation, menstrual disorders experienced, and the restrictions and behaviours practiced by menstruating adolescents were compared between the baseline and the follow-up assessments.

Results

After health education, participants reported a significant improvement (p<0.001) in ‘high knowledge and beliefs’ scores compared to baseline (51% vs 82.4%). Significant improvement was also observed in overall good menstrual practices (28.8% vs 88.9%), including improvements in using sanitary pads (22.4% change after the intervention), frequency of changing pads/cloths per day (68.8%), drying the used absorbent (77.6%), methods of disposing of the used absorbent (25.5%), and cleaning of genitalia (19.2%). During the follow-up, the participants reported significant improvements in the regularity of their menstrual cycle (94.5% vs 99.5%) and fewer complications during menstruation (78.6% vs 59.6%).

Conclusions

The programme produced significant changes in the knowledge, beliefs and practices of menstrual hygiene, complications from lack of hygiene, and the behaviour and restrictions of the menstruating adolescents. These results demonstrate the feasibility of implementing a health education programme for adolescents on menstrual hygiene in secondary schools serving rural Bangladesh.

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Most cited references 12

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A Systematic Review of the Health and Social Effects of Menstrual Hygiene Management

Colin Sumpter, Belen Torondel (2013)

Background Differing approaches to menstrual hygiene management (MHM) have been associated with a wide range of health and psycho-social outcomes in lower income settings. This paper systematically collates, summarizes and critically appraises the available evidence. Methods Following the PRISMA guidelines a structured search strategy was used to identify articles investigating the effects of MHM on health and psycho-social outcomes. The search was conducted in May 2012 and had no date limit. Data was extracted and quality of methodology was independently assessed by two researchers. Where no measure of effect was provided, but sufficient data were available to calculate one, this was undertaken. Meta-analysis was conducted where sufficient data were available. Results 14 articles were identified which looked at health outcomes, primarily reproductive tract infections (RTI). 11 articles were identified investigating associations between MHM, social restrictions and school attendance. MHM was found to be associated with RTI in 7 papers. Methodologies however varied greatly and overall quality was low. Meta-analysis of a subset of studies found no association between confirmed bacterial vaginosis and MHM (OR: 1.07, 95% CI: 0.52–2.24). No other substantial associations with health outcomes were found. Although there was good evidence that educational interventions can improve MHM practices and reduce social restrictions there was no quantitative evidence that improvements in management methods reduce school absenteeism. Conclusion The management of menstruation presents significant challenges for women in lower income settings; the effect of poor MHM however remains unclear. It is plausible that MHM can affect the reproductive tract but the specific infections, the strength of effect, and the route of transmission, remain unclear. There is a gap in the evidence for high quality randomised intervention studies which combine hardware and software interventions, in particular for better understanding the nuanced effect improving MHM may have on girls’ attendance at school.

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Menstrual hygiene among adolescent schoolgirls in Mansoura, Egypt.

Hady El-Khodary, Sanaâ El Atia, K Badawi (2005)

Learning about menstrual hygiene is a vital aspect of health education for adolescent girls. This study among 664 schoolgirls aged 14-18 in Mansoura, Egypt, asked about type of sanitary protection used, frequency of changing pads or cloths, means of disposal and bathing during menstruation. Girls were selected by cluster sampling technique in public secondary schools in urban and rural areas. Data were collected through an anonymous, self-administered, open-ended questionnaire during class time. The significant predictors of use of sanitary pads were availability of mass media at home, high and middle social class and urban residence. Use of sanitary pads may be increasing, but not among girls from rural and poor families, and other aspects of personal hygiene were generally found to be poor, such as not changing pads regularly or at night, and not bathing during menstruation. Lack of privacy was an important problem. Mass media were the main source of information about menstrual hygiene, followed by mothers, but a large majority of girls said they needed more information. Instruction in menstrual hygiene should be linked to an expanded programme of health education in schools. A supportive environment for menstrual hygiene has to be provided both at home and in school and sanitary pads made more affordable.

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Menstruation among adolescent girls in Malaysia: a cross-sectional school survey.

Yao-Shen Chen, Robert Lee, J Kaur (2006)

The onset of menstruation is part of the maturation process. However, variability in menstrual cycle characteristics and menstrual disorders are common. The purpose of this study was to determine the menstrual characteristics of adolescent females and factors associated with it. This is a cross-sectional descriptive study carried out on 2,411 secondary school adolescent females in Negeri Sembilan, Malaysia. Data were collected using a self-administered structured questionnaire on menstruation in Bahasa Malaysia. Abnormal cycle length (menstrual cycle longer than 35 days or cycle length between 14 to 20 days or irregular pattern) was common and affected 37.2 percent of subjects. The majority (74.6 percent) experienced premenstrual syndrome and 69.4 percent had dysmenorrhoea. About 18 percent reported excessive menstrual loss (use two pads at a time to prevent blood from soaking through or confirmed by doctor to be anaemic due to heavy menstrual flow). Only 11.1 percent of schoolgirls seeked medical consultation for their menstrual disorders. Mothers remained the most important source of information (80 percent). Menstrual disorders were significantly more common in female adolescents who smoke and have suicidal behaviours (p-value is less than 0.05). Menstrual problems among adolescent female are common. They are influenced by certain modifiable factors.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2014

Publication date (Electronic): 3 July 2014

Volume: 4

Issue: 7

Electronic Location Identifier: e004607

Affiliations

[1 ]UChicago Research Bangladesh , Dhaka, Bangladesh

[2 ]United Nations University-International Institute for Global Health (UNU-IIGH) , Kuala Lumpur, Malaysia

[3 ]International Health and Medicine, Division of Public Health, Graduate School of Medicine, Tokyo Medical and Dental University , Tokyo, Japan

[4 ]Honjo International Scholarship Foundation , Tokyo, Japan

[5 ]Wageningen University , Wageningen, The Netherlands

[6 ]Faculty of Policy Studies, Chuo University , Tokyo, Japan

Author notes

[Correspondence to ] Dr Syed Emdadul Haque; emdad91@ 123456gmail.com

Article

Publisher ID: bmjopen-2013-004607

DOI: 10.1136/bmjopen-2013-004607

PMC ID: 4091465

PubMed ID: 24993753

SO-VID: acb7d5bc-99d6-4377-a562-51fb4c458a22

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

History

Date received : 3 December 2013

Date revision received : 3 June 2014

Date accepted : 12 June 2014

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The effect of a school-based educational intervention on menstrual health: an intervention study among adolescent girls in Bangladesh

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Abstract

Objectives

Design

Setting

Participants

Interventions

Primary and secondary outcome measures

Results

Conclusions

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AIP Publishing: Coronavirus

Most cited references 12

A Systematic Review of the Health and Social Effects of Menstrual Hygiene Management

Menstrual hygiene among adolescent schoolgirls in Mansoura, Egypt.

Menstruation among adolescent girls in Malaysia: a cross-sectional school survey.

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Cited by 58

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