Menstrual solutions in adolescent schoolgirls in western Kenya: an acceptability, feasibility and safety study

Lead Research Organisation: Liverpool School of Tropical Medicine
Department Name: Child and Reproductive Health

Abstract

Adolescent schoolgirls consider menstrual management as one of their main stressors. Menstrual difficulties result in missed schooling and drop-out, but studies on the true impact are limited, and baseline tools and data are lacking. One solution is Mooncups, silicone bell receptacles that store menstrual flow, available since the 1930s and marketed in Kenya and internationally. We will conduct a randomized proof of concept feasibility study on menstrual solutions to quantify cultural acceptance, use, satisfaction, costs and safety of Mooncups, sanitary pads and 'usual practice' in 750 schoolgirls in 15 schools in the demographic health and surveillance site in western Kenya. School nurse screening, self-completed menstrual calendars, behaviour surveys, water / sanitation / hygiene (WASH) evaluation in schools and homes, measures of school attrition, and laboratory checks on Staph aureus contamination, HIV, STI and reproductive tract infections will enable us to determine prevalence rates for outcome indicators, and exclude toxic shock syndrome and other safety concerns. Qualitative studies will provide contextual information to understand reasons for outcomes and behaviours. Data will inform policy and provide baseline information and statistics for the preparation of a randomized controlled trial to examine the cost-effectiveness of menstrual solutions to reduce school attrition and improve wellbeing

Technical Summary

Disproportionate mortality and morbidity in adolescent girls in sub-Saharan Africa reflects high HIV and STI prevalence, and poor teen maternal outcomes. Over a quarter of girls report first sexual encounter was forced, and early sexual debut is a risk factor for STIs. These neglected harms prevent attainment of millennium development goals. Sanitation studies identify poor menstrual management and fear of pregnancy as top stressors. Girls use unsanitary products which leak and irritate, impact on school engagement, and exacerbate sexual exposure as males consider them sexually mature, and girls seek money for pads from sex.

An FDA approved silicon-bell vaginal receptacle (menstrual cup; Mcup), which collects menstrual blood without leakage, is a potential cost-effective solution to enhance school engagement, reduce sexual exposure and harms, and improve girls? quality of life. This 3-year, open 2-armed cluster-randomised controlled prevention trial will be conducted in western Kenya, an area with high rates of HIV, STI, forced sex, and school drop-out among girls, with a well-established health and demographic surveillance system. It is designed to detect a 33% reduction in absenteeism in girls from 21% to 14%; unit of randomisation: schools. Sample size: 76 paired clusters of 40 girls per cluster; power 90%, alpha 0.05, ICC 0.1; enrolling 7600 girls allowing 20% loss-to-follow-up.

Secondary outcomes include Mcup tolerability, HIV incidence, sexual and reproductive tract infections, frequency of partners, forced sex, and age at debut. Data will be generated from unannounced school attendance surveys, pre- and post-HIV testing, 6-weekly nurse screening on Mcup use and infections (with laboratory confirmation), sexual behaviour and quality of life surveys, daily menstrual diaries and social studies over 24 months intervention. Economic sub-studies will examine return on investment for free, subsidised or full cost Mcups. Analysis will be by intention to treat and per-protocol using Poisson regression or negative binomial regression, taking the cluster design into account. The study will have one interim analysis at 12 months.

The trial strengthens existing collaborations between Liverpool and Bangor Universities, the KEMRI/CDC Research and Public Health Collaboration, the African Population Health and Research Centre, the Ministries of Public Health and Sanitation, Medical Services, and Education. Advisory support from DFID-sponsored SWASH (school water and sanitation), PATH, the German development agency (GIZ), and WHO Collaborating Centre on Violence, provides further partnership development. Findings will inform policy on prevention and care of adolescent girls, through menstrual solutions, at local, national, and international level, and the cost implications.

Publications

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Mason L (2019) Comparing use and acceptability of menstrual cups and sanitary pads by schoolgirls in rural Western Kenya in International Journal of Reproduction, Contraception, Obstetrics and Gynecology

 
Description Invited by Government of Kenya to be member of advisory panel developing national guidelines for menstrual hygiene
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
 
Description Kenya Ministry of Health Menstrual Hygiene Management Policy Round-table and Validation Workshop (April 2017) - invited speaker and contribute towards finalising policy documents and guidelines
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description MHM in Ten
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guideline committee
URL http://www.unicef.org/wash/schools/files/MHM_in_Ten_2014_Meeting_Report.pdf
 
Description Menstrual Hygiene Management for Schoolgirls in India
Geographic Reach Asia 
Policy Influence Type Participation in a national consultation
 
Description Panel member for MHM in 10 global group
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guideline committee
 
Description Research studies have informed national strategy, policy guidelines, and programme training materials to include menstrual cups
Geographic Reach National 
Policy Influence Type Citation in other policy documents
 
Description WHO Global research collaborative meeting on menstrual health in adolescents
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a advisory committee
 
Description British Council PMI2 (Connect)
Amount £10,700 (GBP)
Funding ID NPF 192 
Organisation British Council 
Sector Charity/Non Profit
Country United Kingdom
Start 05/2012 
End 09/2012
 
Description Global Health Trials
Amount £2,267,943 (GBP)
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 10/2015 
End 03/2020
 
Description Impact Evaluation of PEPFAR's DREAMS Initiative in Siaya County, Kenya - extension
Amount $32,000 (USD)
Organisation London School of Hygiene and Tropical Medicine (LSHTM) 
Sector Academic/University
Country United Kingdom
Start 03/2020 
End 06/2020
 
Description Menstrual cups and unconditional cash transfer to reduce sexual and reproductive harm and school drop-out in adolescent schoolgirls in western Kenya - extension
Amount £326,532 (GBP)
Funding ID MR/N006046/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 07/2019 
End 06/2020
 
Description NIHR Global Health Research Groups (as co-investigator)
Amount $1,950,000 (USD)
Funding ID 17/63/161 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 12/2017 
End 11/2021
 
Description Provide Mentorship on MHM to Grand Challenges Canada grantees
Amount $9,372 (CAD)
Funding ID SA_ROC05287913PP 
Organisation Government of Canada 
Department Grand Challenges Canada
Sector Public
Country Canada
Start 10/2018 
End 03/2019
 
Description Stars in Global Health Round 9 (Reproductive, Maternal, Newborn and Child Health) Grant
Amount $100,000 (CAD)
Funding ID R-ST-POC-1807-14223 
Organisation Government of Canada 
Department Grand Challenges Canada
Sector Public
Country Canada
Start 03/2018 
End 09/2019
 
Description UNICEF Project Grant
Amount $309,341 (USD)
Funding ID RFP/2014/058/9112095 
Organisation UNICEF 
Sector Public
Country United States
Start 10/2014 
End 12/2015
 
Description Effects on menstrual cups on the vaginal microbiome 
Organisation University of Illinois at Chicago
Country United States 
Sector Academic/University 
PI Contribution Our pilot study funded through Joint Global Health Trials identified a lower prevalence of bacterial vaginosis among girls using menstrual cups copared with other menstrual materials; and a lower prevalence of STI copared with girls using traditional materials. two possible causal pathways are postulated, one relating to cups protecting the vaginal microbiome, and also that provision of menstrual materials reduce exposure to transactional sex. in our curremt (full) trial we examine HIV, HSV-2 and school dropout among a cohort of schoolgirls provided cups, cash pocket money, both, and among controls. we do not have resources to examine other STI, or the vaginal microbiome.
Collaborator Contribution Collaborators at UoI and Nyanza Reproductive Health Society have expertise in examining penile and vaginal microbiome, and with our collaboration have been awarded a NIH grant to investigate the effect of cups on the vaginal microbiome in our trial cohort. Genital microbiota present in genomic DNA extracted from vaginal swab specimens will be characterized using high-throughput amplicon sequencing at UoI; and the grant will support diagnosis of STI and BV.
Impact NIH award (RO1)
Start Year 2017
 
Description Initiation of a Cup Coalition 
Organisation Church of Sweden
Country Sweden 
Sector Charity/Non Profit 
PI Contribution Our pilot and trial provide the evidence-base for safety and effectiveness of menstrual cup use in LMIC (experience, Kenya), support and guidance for tools, evaluation of research gaps, and monitoring and evaluation, for partners working in research and programmes across east and the horn of Africa, with potential to expand across other regions of Africa.
Collaborator Contribution Organised first meeting to discuss aim, purpose, and development of cup coalition,
Impact Agreement on value in developing Cup Coalition; preparation of terms of reference of Cup Coalition; definition of key gaps in menstrual cup research; sharing of monitoring and evaluation and guidance tools; coalition members support presentation of menstrual cup research and programmes at upcoming 'Women Deliver' conference in Canada; meeting held afterward with Save The Children Fund Nairobi and provision of our guidelines on cup training, for their setting up provision of cups in refugee camps; introduction of team in Eldoret to the Cup Foundation to assist in examining feasibility of providing menstrual cups to adolescent street girls; meeting with UNICEF on assisting them with cup programme in 2 districts in Kenya;
Start Year 2018
 
Description Initiation of a Cup Coalition 
Organisation Femme International
Country Canada 
Sector Charity/Non Profit 
PI Contribution Our pilot and trial provide the evidence-base for safety and effectiveness of menstrual cup use in LMIC (experience, Kenya), support and guidance for tools, evaluation of research gaps, and monitoring and evaluation, for partners working in research and programmes across east and the horn of Africa, with potential to expand across other regions of Africa.
Collaborator Contribution Organised first meeting to discuss aim, purpose, and development of cup coalition,
Impact Agreement on value in developing Cup Coalition; preparation of terms of reference of Cup Coalition; definition of key gaps in menstrual cup research; sharing of monitoring and evaluation and guidance tools; coalition members support presentation of menstrual cup research and programmes at upcoming 'Women Deliver' conference in Canada; meeting held afterward with Save The Children Fund Nairobi and provision of our guidelines on cup training, for their setting up provision of cups in refugee camps; introduction of team in Eldoret to the Cup Foundation to assist in examining feasibility of providing menstrual cups to adolescent street girls; meeting with UNICEF on assisting them with cup programme in 2 districts in Kenya;
Start Year 2018
 
Description Initiation of a Cup Coalition 
Organisation Population Council
Country United States 
Sector Charity/Non Profit 
PI Contribution Our pilot and trial provide the evidence-base for safety and effectiveness of menstrual cup use in LMIC (experience, Kenya), support and guidance for tools, evaluation of research gaps, and monitoring and evaluation, for partners working in research and programmes across east and the horn of Africa, with potential to expand across other regions of Africa.
Collaborator Contribution Organised first meeting to discuss aim, purpose, and development of cup coalition,
Impact Agreement on value in developing Cup Coalition; preparation of terms of reference of Cup Coalition; definition of key gaps in menstrual cup research; sharing of monitoring and evaluation and guidance tools; coalition members support presentation of menstrual cup research and programmes at upcoming 'Women Deliver' conference in Canada; meeting held afterward with Save The Children Fund Nairobi and provision of our guidelines on cup training, for their setting up provision of cups in refugee camps; introduction of team in Eldoret to the Cup Foundation to assist in examining feasibility of providing menstrual cups to adolescent street girls; meeting with UNICEF on assisting them with cup programme in 2 districts in Kenya;
Start Year 2018
 
Description Initiation of a Cup Coalition 
Organisation Ruby Life ltd
Country United Kingdom 
Sector Private 
PI Contribution Our pilot and trial provide the evidence-base for safety and effectiveness of menstrual cup use in LMIC (experience, Kenya), support and guidance for tools, evaluation of research gaps, and monitoring and evaluation, for partners working in research and programmes across east and the horn of Africa, with potential to expand across other regions of Africa.
Collaborator Contribution Organised first meeting to discuss aim, purpose, and development of cup coalition,
Impact Agreement on value in developing Cup Coalition; preparation of terms of reference of Cup Coalition; definition of key gaps in menstrual cup research; sharing of monitoring and evaluation and guidance tools; coalition members support presentation of menstrual cup research and programmes at upcoming 'Women Deliver' conference in Canada; meeting held afterward with Save The Children Fund Nairobi and provision of our guidelines on cup training, for their setting up provision of cups in refugee camps; introduction of team in Eldoret to the Cup Foundation to assist in examining feasibility of providing menstrual cups to adolescent street girls; meeting with UNICEF on assisting them with cup programme in 2 districts in Kenya;
Start Year 2018
 
Description Initiation of a Cup Coalition 
Organisation Save the Children
Country United States 
Sector Charity/Non Profit 
PI Contribution Our pilot and trial provide the evidence-base for safety and effectiveness of menstrual cup use in LMIC (experience, Kenya), support and guidance for tools, evaluation of research gaps, and monitoring and evaluation, for partners working in research and programmes across east and the horn of Africa, with potential to expand across other regions of Africa.
Collaborator Contribution Organised first meeting to discuss aim, purpose, and development of cup coalition,
Impact Agreement on value in developing Cup Coalition; preparation of terms of reference of Cup Coalition; definition of key gaps in menstrual cup research; sharing of monitoring and evaluation and guidance tools; coalition members support presentation of menstrual cup research and programmes at upcoming 'Women Deliver' conference in Canada; meeting held afterward with Save The Children Fund Nairobi and provision of our guidelines on cup training, for their setting up provision of cups in refugee camps; introduction of team in Eldoret to the Cup Foundation to assist in examining feasibility of providing menstrual cups to adolescent street girls; meeting with UNICEF on assisting them with cup programme in 2 districts in Kenya;
Start Year 2018
 
Description Initiation of a Cup Coalition 
Organisation The Cup Effect
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Our pilot and trial provide the evidence-base for safety and effectiveness of menstrual cup use in LMIC (experience, Kenya), support and guidance for tools, evaluation of research gaps, and monitoring and evaluation, for partners working in research and programmes across east and the horn of Africa, with potential to expand across other regions of Africa.
Collaborator Contribution Organised first meeting to discuss aim, purpose, and development of cup coalition,
Impact Agreement on value in developing Cup Coalition; preparation of terms of reference of Cup Coalition; definition of key gaps in menstrual cup research; sharing of monitoring and evaluation and guidance tools; coalition members support presentation of menstrual cup research and programmes at upcoming 'Women Deliver' conference in Canada; meeting held afterward with Save The Children Fund Nairobi and provision of our guidelines on cup training, for their setting up provision of cups in refugee camps; introduction of team in Eldoret to the Cup Foundation to assist in examining feasibility of providing menstrual cups to adolescent street girls; meeting with UNICEF on assisting them with cup programme in 2 districts in Kenya;
Start Year 2018
 
Description Initiation of a Cup Coalition 
Organisation United Nations (UN)
Department United Nations High Commissioner for Refugees
Country Switzerland 
Sector Public 
PI Contribution Our pilot and trial provide the evidence-base for safety and effectiveness of menstrual cup use in LMIC (experience, Kenya), support and guidance for tools, evaluation of research gaps, and monitoring and evaluation, for partners working in research and programmes across east and the horn of Africa, with potential to expand across other regions of Africa.
Collaborator Contribution Organised first meeting to discuss aim, purpose, and development of cup coalition,
Impact Agreement on value in developing Cup Coalition; preparation of terms of reference of Cup Coalition; definition of key gaps in menstrual cup research; sharing of monitoring and evaluation and guidance tools; coalition members support presentation of menstrual cup research and programmes at upcoming 'Women Deliver' conference in Canada; meeting held afterward with Save The Children Fund Nairobi and provision of our guidelines on cup training, for their setting up provision of cups in refugee camps; introduction of team in Eldoret to the Cup Foundation to assist in examining feasibility of providing menstrual cups to adolescent street girls; meeting with UNICEF on assisting them with cup programme in 2 districts in Kenya;
Start Year 2018
 
Description Initiation of a Cup Coalition 
Organisation WOMENA
Country United Arab Emirates 
Sector Private 
PI Contribution Our pilot and trial provide the evidence-base for safety and effectiveness of menstrual cup use in LMIC (experience, Kenya), support and guidance for tools, evaluation of research gaps, and monitoring and evaluation, for partners working in research and programmes across east and the horn of Africa, with potential to expand across other regions of Africa.
Collaborator Contribution Organised first meeting to discuss aim, purpose, and development of cup coalition,
Impact Agreement on value in developing Cup Coalition; preparation of terms of reference of Cup Coalition; definition of key gaps in menstrual cup research; sharing of monitoring and evaluation and guidance tools; coalition members support presentation of menstrual cup research and programmes at upcoming 'Women Deliver' conference in Canada; meeting held afterward with Save The Children Fund Nairobi and provision of our guidelines on cup training, for their setting up provision of cups in refugee camps; introduction of team in Eldoret to the Cup Foundation to assist in examining feasibility of providing menstrual cups to adolescent street girls; meeting with UNICEF on assisting them with cup programme in 2 districts in Kenya;
Start Year 2018
 
Description Joint partnership advising Canadian Grand Challenges on technical evaluations of Menstrual Hygiene Management grantee investments 
Organisation Columbia University
Department Mailman School of Public Health
Country United States 
Sector Academic/University 
PI Contribution Request by Grand Challenges Canada for Prof Marni Sommers (Columbia University) and myself to develop Theory of Change and indicators for menstrual hygiene management to use for evaluation of grants submissions, and monitoring successful investees proposed outcomes. We have reviewed and advised on the theory of change (partners' main contribution) and developed the monitoring and evaluation indicators, and guided on adaptation of grant review form to better evaluate investees potential contribution toward global lives improved..
Collaborator Contribution Columbia University spread-headed the theory of change and provided review feedback on draft indicators; team jointly completed this research work.
Impact Update of Grand Challenges Canada review process for applications for grants for menstrual hygiene management globally
Start Year 2017
 
Description Menstrual hygiene management collaboration 
Organisation Columbia University
Country United States 
Sector Academic/University 
PI Contribution I have been invited as a lead expert to join with the above partners (and a range of others) to develop a collaborative consortium to guide the next 10 years of research, programme, and policy on menstrual hygiene management (MHM) of schoolgirls in low and mid-income countries. or mandate will be to set the agenda, brining in financial support from large donors to support key activities. One of my main contributions will be to guide the quantitative research agenda, ensuring generation of 'hard outcomes/endpoints' (particularly sexual/reproductive, school drop-out, and cognitive measures), in large-scale trials and studies, to better evaluate impact of interventions. Other contributions will be to support definition of indicators for quantitative monitoring and evaluation of MHM programmes in schools, and support UNICEF with international training of 14 countries in Africa and Asia on quantitative aspects of research for improving MHM in schools. WaterAID prepared online manuals for MHM to assist programmes globally (we assisted with some technical guidance); they are now providing in-country support to develop tools and methods for monitoring and evaluation of MHM, and pushing for global recognition of the ikmportance of MHM for girls dignity in post-2015 policy documents
Collaborator Contribution Columbia University has, over the past ten years, initiated and spearheaded qualitative studies on menstrual hygiene management, and the development of materials to improve water sanitation and hygiene in schools to improve the quality of life of schoolgirls. Emory University has played a strong role in the past five years examining water sanitation and hygiene (WASH) in schools, and more recently, qualitative studies on girls menstrual needs internationally. Together with UNICEF they are developing an online e-training course to train programme managers in 14 countries in Africa and Asia on research techniques (predominantly qualitative) to improve MHM in schools UNICEF New York, and subsequently country offices, have been driving the agenda on improving water sanitation and hygiene in schools, and increasingly also on WASH effects on girls' MHM
Impact Annual virtual conference as webinars to enable access to participants globally to the conference presentations Invitation to present at the annual conference invitation and participation in the core collaborative partnership to develop strategy for MHM research programmes and policy for next ten years Invitation to our team to contribute towards in-country programme development, operational research, within the 14 country e-training Joint organization and presentation of MHM research programme and policy, and global next steps, as a Symposium, at the American Society of Tropical Medicine and Hygiene The broader collaboration includes academic, NGO, country programmes, aid agencies, international organisations, and private partners, and is multi-disciplinary including social scientists, epidemiologists, laboratory and clinicians, environmentalists, programme specialists, financial planners, policy experts, and others
Start Year 2013
 
Description Menstrual hygiene management collaboration 
Organisation Emory University
Country United States 
Sector Academic/University 
PI Contribution I have been invited as a lead expert to join with the above partners (and a range of others) to develop a collaborative consortium to guide the next 10 years of research, programme, and policy on menstrual hygiene management (MHM) of schoolgirls in low and mid-income countries. or mandate will be to set the agenda, brining in financial support from large donors to support key activities. One of my main contributions will be to guide the quantitative research agenda, ensuring generation of 'hard outcomes/endpoints' (particularly sexual/reproductive, school drop-out, and cognitive measures), in large-scale trials and studies, to better evaluate impact of interventions. Other contributions will be to support definition of indicators for quantitative monitoring and evaluation of MHM programmes in schools, and support UNICEF with international training of 14 countries in Africa and Asia on quantitative aspects of research for improving MHM in schools. WaterAID prepared online manuals for MHM to assist programmes globally (we assisted with some technical guidance); they are now providing in-country support to develop tools and methods for monitoring and evaluation of MHM, and pushing for global recognition of the ikmportance of MHM for girls dignity in post-2015 policy documents
Collaborator Contribution Columbia University has, over the past ten years, initiated and spearheaded qualitative studies on menstrual hygiene management, and the development of materials to improve water sanitation and hygiene in schools to improve the quality of life of schoolgirls. Emory University has played a strong role in the past five years examining water sanitation and hygiene (WASH) in schools, and more recently, qualitative studies on girls menstrual needs internationally. Together with UNICEF they are developing an online e-training course to train programme managers in 14 countries in Africa and Asia on research techniques (predominantly qualitative) to improve MHM in schools UNICEF New York, and subsequently country offices, have been driving the agenda on improving water sanitation and hygiene in schools, and increasingly also on WASH effects on girls' MHM
Impact Annual virtual conference as webinars to enable access to participants globally to the conference presentations Invitation to present at the annual conference invitation and participation in the core collaborative partnership to develop strategy for MHM research programmes and policy for next ten years Invitation to our team to contribute towards in-country programme development, operational research, within the 14 country e-training Joint organization and presentation of MHM research programme and policy, and global next steps, as a Symposium, at the American Society of Tropical Medicine and Hygiene The broader collaboration includes academic, NGO, country programmes, aid agencies, international organisations, and private partners, and is multi-disciplinary including social scientists, epidemiologists, laboratory and clinicians, environmentalists, programme specialists, financial planners, policy experts, and others
Start Year 2013
 
Description Menstrual hygiene management collaboration 
Organisation UNICEF
Country United States 
Sector Public 
PI Contribution I have been invited as a lead expert to join with the above partners (and a range of others) to develop a collaborative consortium to guide the next 10 years of research, programme, and policy on menstrual hygiene management (MHM) of schoolgirls in low and mid-income countries. or mandate will be to set the agenda, brining in financial support from large donors to support key activities. One of my main contributions will be to guide the quantitative research agenda, ensuring generation of 'hard outcomes/endpoints' (particularly sexual/reproductive, school drop-out, and cognitive measures), in large-scale trials and studies, to better evaluate impact of interventions. Other contributions will be to support definition of indicators for quantitative monitoring and evaluation of MHM programmes in schools, and support UNICEF with international training of 14 countries in Africa and Asia on quantitative aspects of research for improving MHM in schools. WaterAID prepared online manuals for MHM to assist programmes globally (we assisted with some technical guidance); they are now providing in-country support to develop tools and methods for monitoring and evaluation of MHM, and pushing for global recognition of the ikmportance of MHM for girls dignity in post-2015 policy documents
Collaborator Contribution Columbia University has, over the past ten years, initiated and spearheaded qualitative studies on menstrual hygiene management, and the development of materials to improve water sanitation and hygiene in schools to improve the quality of life of schoolgirls. Emory University has played a strong role in the past five years examining water sanitation and hygiene (WASH) in schools, and more recently, qualitative studies on girls menstrual needs internationally. Together with UNICEF they are developing an online e-training course to train programme managers in 14 countries in Africa and Asia on research techniques (predominantly qualitative) to improve MHM in schools UNICEF New York, and subsequently country offices, have been driving the agenda on improving water sanitation and hygiene in schools, and increasingly also on WASH effects on girls' MHM
Impact Annual virtual conference as webinars to enable access to participants globally to the conference presentations Invitation to present at the annual conference invitation and participation in the core collaborative partnership to develop strategy for MHM research programmes and policy for next ten years Invitation to our team to contribute towards in-country programme development, operational research, within the 14 country e-training Joint organization and presentation of MHM research programme and policy, and global next steps, as a Symposium, at the American Society of Tropical Medicine and Hygiene The broader collaboration includes academic, NGO, country programmes, aid agencies, international organisations, and private partners, and is multi-disciplinary including social scientists, epidemiologists, laboratory and clinicians, environmentalists, programme specialists, financial planners, policy experts, and others
Start Year 2013
 
Description Menstrual hygiene management collaboration 
Organisation WaterAid
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution I have been invited as a lead expert to join with the above partners (and a range of others) to develop a collaborative consortium to guide the next 10 years of research, programme, and policy on menstrual hygiene management (MHM) of schoolgirls in low and mid-income countries. or mandate will be to set the agenda, brining in financial support from large donors to support key activities. One of my main contributions will be to guide the quantitative research agenda, ensuring generation of 'hard outcomes/endpoints' (particularly sexual/reproductive, school drop-out, and cognitive measures), in large-scale trials and studies, to better evaluate impact of interventions. Other contributions will be to support definition of indicators for quantitative monitoring and evaluation of MHM programmes in schools, and support UNICEF with international training of 14 countries in Africa and Asia on quantitative aspects of research for improving MHM in schools. WaterAID prepared online manuals for MHM to assist programmes globally (we assisted with some technical guidance); they are now providing in-country support to develop tools and methods for monitoring and evaluation of MHM, and pushing for global recognition of the ikmportance of MHM for girls dignity in post-2015 policy documents
Collaborator Contribution Columbia University has, over the past ten years, initiated and spearheaded qualitative studies on menstrual hygiene management, and the development of materials to improve water sanitation and hygiene in schools to improve the quality of life of schoolgirls. Emory University has played a strong role in the past five years examining water sanitation and hygiene (WASH) in schools, and more recently, qualitative studies on girls menstrual needs internationally. Together with UNICEF they are developing an online e-training course to train programme managers in 14 countries in Africa and Asia on research techniques (predominantly qualitative) to improve MHM in schools UNICEF New York, and subsequently country offices, have been driving the agenda on improving water sanitation and hygiene in schools, and increasingly also on WASH effects on girls' MHM
Impact Annual virtual conference as webinars to enable access to participants globally to the conference presentations Invitation to present at the annual conference invitation and participation in the core collaborative partnership to develop strategy for MHM research programmes and policy for next ten years Invitation to our team to contribute towards in-country programme development, operational research, within the 14 country e-training Joint organization and presentation of MHM research programme and policy, and global next steps, as a Symposium, at the American Society of Tropical Medicine and Hygiene The broader collaboration includes academic, NGO, country programmes, aid agencies, international organisations, and private partners, and is multi-disciplinary including social scientists, epidemiologists, laboratory and clinicians, environmentalists, programme specialists, financial planners, policy experts, and others
Start Year 2013
 
Description Menstrual norms and associations with HIV 
Organisation Centers for Disease Control and Prevention (CDC)
Department Division of Global HIV/AIDS
Country United States 
Sector Public 
PI Contribution We contributed towards research tools to include menstrual and behavioural questions onto a wide-scale representative community survey in western Kenya
Collaborator Contribution CDC-Kenya Division of Global AIDS established a large-scale representative sampling frame of ~15,000 persons 13y and above in rural western Kenya in the KEMRI/CDC health and demographic surveillance site (HDSS). The study examines sexual behaviours associated with HIV, with parallel HIV testing and counselling.
Impact Analysis of data on-going, linking laboratory confirmed HIV status, HDSS data on socio-economic status, behavioural characteristics, and menstrual behaviours.
Start Year 2012
 
Description Menstrual norms and associations with HIV 
Organisation Kenyan Institute for Medical Research (KEMRI)
Department KEMRI/CDC Research and Public Health Collaboration
Country Kenya 
Sector Charity/Non Profit 
PI Contribution We contributed towards research tools to include menstrual and behavioural questions onto a wide-scale representative community survey in western Kenya
Collaborator Contribution CDC-Kenya Division of Global AIDS established a large-scale representative sampling frame of ~15,000 persons 13y and above in rural western Kenya in the KEMRI/CDC health and demographic surveillance site (HDSS). The study examines sexual behaviours associated with HIV, with parallel HIV testing and counselling.
Impact Analysis of data on-going, linking laboratory confirmed HIV status, HDSS data on socio-economic status, behavioural characteristics, and menstrual behaviours.
Start Year 2012
 
Description Menstrual solutions for adolescent schoolgirls 
Organisation Bangor University
Department University of North Wales Organization for Clinical Trials
Country United Kingdom 
Sector Academic/University 
PI Contribution Conceptualized and designed study to explore the acceptability use and safety of menstrual solutions in a school environment in rural western Kenya, investigating as a proof of concept, the potential impact such solutions have on reducing school attrition and increasing girls engagement with school and their well being.
Collaborator Contribution expertise on past early pilot studies; field research in the study site, advice on water sanitation and hygiene component, puberty education, sexual risk behavior, school atttrition.
Impact The study only began in April 2012, so is currently underway.
Start Year 2010
 
Description Menstrual solutions for adolescent schoolgirls 
Organisation Centers for Disease Control and Prevention (CDC)
Country United States 
Sector Public 
PI Contribution Conceptualized and designed study to explore the acceptability use and safety of menstrual solutions in a school environment in rural western Kenya, investigating as a proof of concept, the potential impact such solutions have on reducing school attrition and increasing girls engagement with school and their well being.
Collaborator Contribution expertise on past early pilot studies; field research in the study site, advice on water sanitation and hygiene component, puberty education, sexual risk behavior, school atttrition.
Impact The study only began in April 2012, so is currently underway.
Start Year 2010
 
Description Menstrual solutions for adolescent schoolgirls 
Organisation German Federal Enterprise for International Cooperation (GIZ)
Country Germany 
Sector Public 
PI Contribution Conceptualized and designed study to explore the acceptability use and safety of menstrual solutions in a school environment in rural western Kenya, investigating as a proof of concept, the potential impact such solutions have on reducing school attrition and increasing girls engagement with school and their well being.
Collaborator Contribution expertise on past early pilot studies; field research in the study site, advice on water sanitation and hygiene component, puberty education, sexual risk behavior, school atttrition.
Impact The study only began in April 2012, so is currently underway.
Start Year 2010
 
Description Menstrual solutions for adolescent schoolgirls 
Organisation Kenyan Institute for Medical Research (KEMRI)
Department Research Field Station, Western Kenya
Country Kenya 
Sector Academic/University 
PI Contribution Conceptualized and designed study to explore the acceptability use and safety of menstrual solutions in a school environment in rural western Kenya, investigating as a proof of concept, the potential impact such solutions have on reducing school attrition and increasing girls engagement with school and their well being.
Collaborator Contribution expertise on past early pilot studies; field research in the study site, advice on water sanitation and hygiene component, puberty education, sexual risk behavior, school atttrition.
Impact The study only began in April 2012, so is currently underway.
Start Year 2010
 
Description Menstrual solutions for adolescent schoolgirls 
Organisation Program for Appropriate Technology in Health (PATH)
Country United States 
Sector Charity/Non Profit 
PI Contribution Conceptualized and designed study to explore the acceptability use and safety of menstrual solutions in a school environment in rural western Kenya, investigating as a proof of concept, the potential impact such solutions have on reducing school attrition and increasing girls engagement with school and their well being.
Collaborator Contribution expertise on past early pilot studies; field research in the study site, advice on water sanitation and hygiene component, puberty education, sexual risk behavior, school atttrition.
Impact The study only began in April 2012, so is currently underway.
Start Year 2010
 
Description Menstrual solutions for adolescent schoolgirls 
Organisation Safe Water and AIDS Project (SWAP)
Country Kenya 
Sector Charity/Non Profit 
PI Contribution Conceptualized and designed study to explore the acceptability use and safety of menstrual solutions in a school environment in rural western Kenya, investigating as a proof of concept, the potential impact such solutions have on reducing school attrition and increasing girls engagement with school and their well being.
Collaborator Contribution expertise on past early pilot studies; field research in the study site, advice on water sanitation and hygiene component, puberty education, sexual risk behavior, school atttrition.
Impact The study only began in April 2012, so is currently underway.
Start Year 2010
 
Description Menstrual solutions for adolescent schoolgirls 
Organisation University of Florida
Department Department of Environmental and Global Health
Country United States 
Sector Academic/University 
PI Contribution Conceptualized and designed study to explore the acceptability use and safety of menstrual solutions in a school environment in rural western Kenya, investigating as a proof of concept, the potential impact such solutions have on reducing school attrition and increasing girls engagement with school and their well being.
Collaborator Contribution expertise on past early pilot studies; field research in the study site, advice on water sanitation and hygiene component, puberty education, sexual risk behavior, school atttrition.
Impact The study only began in April 2012, so is currently underway.
Start Year 2010
 
Description Menstrual solutions for adolescent schoolgirls 
Organisation WaterAid
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Conceptualized and designed study to explore the acceptability use and safety of menstrual solutions in a school environment in rural western Kenya, investigating as a proof of concept, the potential impact such solutions have on reducing school attrition and increasing girls engagement with school and their well being.
Collaborator Contribution expertise on past early pilot studies; field research in the study site, advice on water sanitation and hygiene component, puberty education, sexual risk behavior, school atttrition.
Impact The study only began in April 2012, so is currently underway.
Start Year 2010
 
Description Save the Children Fund Menstrual Hygiene Management Studies 
Organisation Emory University
Department Department of Behavioral Sciences and Health Education
Country United States 
Sector Academic/University 
PI Contribution Invitation to be a collaborator and provide advice on menstrual hygiene management studies exploring introduction of menstrual cups and reusable menstrual pads in other African countries and cultures (ie Mali). The partners seek our experience and expertise from the MRC/DfID/Wellcome Trust study in western Kenya on methodological approaches (i.e. how to engage with school-aged girls and parents), developing tools, and defining relevant research questions
Collaborator Contribution Partners who have invited our contribution are paying for the study, and have research and programme experience in menstrual hygiene, and water and sanitation in schools.
Impact Planning and preparation of research methodology and tools
Start Year 2013
 
Description Save the Children Fund Menstrual Hygiene Management Studies 
Organisation Save the Children
Department Department of Education and Child Development
Country United States 
Sector Charity/Non Profit 
PI Contribution Invitation to be a collaborator and provide advice on menstrual hygiene management studies exploring introduction of menstrual cups and reusable menstrual pads in other African countries and cultures (ie Mali). The partners seek our experience and expertise from the MRC/DfID/Wellcome Trust study in western Kenya on methodological approaches (i.e. how to engage with school-aged girls and parents), developing tools, and defining relevant research questions
Collaborator Contribution Partners who have invited our contribution are paying for the study, and have research and programme experience in menstrual hygiene, and water and sanitation in schools.
Impact Planning and preparation of research methodology and tools
Start Year 2013
 
Description ZanaAfrica 
Organisation ZanaAfrica Foundation
Country Kenya 
Sector Charity/Non Profit 
PI Contribution Request for our technical assistance in prioritising themes and developing information guidelines for reproductive health information for African girls and women; attend project board meetings, review materials for accuracy of technical and health advice content
Collaborator Contribution ZanaAfrica is equipping women and girls with the tools they need to thrive by developing radically affordable sanitary pads, coupled with reproductive health educational comics targeting behavior change, manufactured locally at large scale.
Impact Just starting, technical advice on reproductive health needs of young adolescent girls offered, and guidance on research methods
Start Year 2013
 
Title menstrual cups and sanitary pads 
Description Pilot testing of menstrual cups, compared with sanitary pads and usual practice to improve schoolgirls schooling, health and wellbeing 
Type Preventative Intervention - Physical/Biological risk modification
Current Stage Of Development Small-scale adoption
Year Development Stage Completed 2014
Development Status Closed
Clinical Trial? Yes
Impact research team experience - guiding national policy and programme guidelines in Kenya and India; advocacy and guidance internationally on expert and advisory panels; support other researchers internationally with research tools and methods 
URL http://www.isrctn.com/ISRCTN17486946
 
Description 3rd virtual conference on menstrual hygiene management 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Huge interest was generated from presentation of preliminary findings from our JGHT supported Menstrual Solutions Study. data presented are the first to show approaches to measure hard outcomes for the impact of improved menstrual hygiene management on schoolgirls. large donor organizations such as Gates Foundation, World Bank, USAID were present, and are interested in further dialogue, for consideration of future studies, and input into large-scale programmes. the presentation was an exemplar illustrating the potential for robust research to examine the cost-effectiveness of menstrual products to improve girls sexual and reproductive health and school retention.

After the presentation, on a second day when experts convened to define the way forward, I was invited to head the research component of the collaborative partnership - with an international team we will develop the mandate, research priorities, and goals for this.
Year(s) Of Engagement Activity 2014
URL http://www.unicef.org/wash/schools/files/MHM_vConf_2014.pdf
 
Description 4th virtual Conference on Menstrual Hygiene Management 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presentation on Menstrual Hygiene Management in schoolgirls in India, describing systematic review and meta-analysis of all studies in India, highlighting lack of impact of education to reduce cultural taboos, and evidence of increased availability of sanitary napkins to girls, with an association of reduced absenteeism in schools where prevalence of pads has risen .

Talk raised questions on why more such systematic reviews and meta-analyses had not been performed, and value of rigorous analyses; discussion on entrenched taboos causing health and school equity issues for girls have not been impacted by any programmes. concerns raised on lack of disposal of sanitary products in India and globally and potential environmental and health consequences.

Indian UNICEF representative discussed importance of findings to inform new national ministry guidelines on MHM for schoolgirls in India our team, UNICEF and other partners have developed for implementation throughout India

After this presentation, as well as many members requesting advice and guidance on MHM research, specific requests were made:
(i) Representative from Bill and Melinda Gates Foundation requested our Indian and Kenyan study JGHT pilot study data, and further meetings to support their scoping of priorities and needs for MHM in India Kenya and Ethiopia, for defining BMGF position / funding on MHM internationally
(ii) Ministry of Uganda head for gender equity requested all papers and reports to da
Year(s) Of Engagement Activity 2015
 
Description African Union Girls Summit - technical advice and presentation, Ghana 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact The Africa Union held it's second Girls Summit: ending child marriage in Africa, November 23-24th 2018 in Accra. As poor menstrual hygiene management impacts girls sexual and reproductive health (SRH) and can contribute to dropout of school, hence increasing risk of child marriage, a session dedicated to Menstrual Health was organised by UNFPA - intending to reach west African policy makers, politicians, donors, and grass roots organisations. I was asked to provide research findings to date on the effects of poor MHM on girls SRH, and to support technical discussions between the panel and audience participants. this follows the UNFPA east and southern Africa Menstrual Health meeting held in Johannesburg May 28-29th 2018, with the development of an African Menstrual Health Coalition; expanding to west Africa through the session held Accra Child Summit.
Year(s) Of Engagement Activity 2018
 
Description Attend MHM Grand Coalition Co-creation Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The workshop aims to bring together current and prospective core-members that will jointly formulate and establish the foundations of a Global Coalition on MHM. The Coalition will convene stakeholders from UN, CSO, academia and private sector agencies from relevant sectors, including WASH, health/SRHR, education, gender and human rights, for
collective endeavor to connect interests, commitments and expertise to scale up menstrual health and hygiene.
Year(s) Of Engagement Activity 2019
 
Description Attend and present menstrual health research to student neonatal obstetricians and gynecologists, Liverpool (Jan 2020) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Patients, carers and/or patient groups
Results and Impact One day annual meeting/workshop of trainee neonatal obstetric and gynecologists attended to learn about public health research or charity activities - i was invited to present on international research (and UK) on menstrual health and period poverty; audience extremely interested in the subject area and keen to consider menstrual health in their day to day work with women
Year(s) Of Engagement Activity 2019
 
Description Attend and present research at a one day workshop on 'Ending period poverty by 2030: From research to impact' at London School of Hygiene and Tropical Medicine (July 2019) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact One day workshop organised by London School of Hygiene and Tropical Medicine for researchers and practitioners to present results of menstrual health research and to deliberate with researchers, funders and NGOs and development agencies.
Year(s) Of Engagement Activity 2019
 
Description Co-organization of (and presentation at) international expert panel to standardize menstrual health measurement and indicators 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Member of the Scientific Technical Advisory Group on Menstrual Health and Hygiene Management to standardise indicators for MHM and robust measurement, 11th-13th March 2019. This is in collaboration with the UN Water Supply and Sanitation Collaborative Council's Grand Coalition on Menstrual Health, held in Geneva 14th-15th March 2019. Multi-sector global experts in sexual and reproductive health, education, water and sanitation, and gender were invited to meet to work with the STAG to examine, define and support the development of measures that synergise with other international indicators, and that can contribute to the Sustainable Development Goals. these indicators will be disseminated internationally to national menstrual health and hygiene management programmes, and for aid agencies and NGOs.
Year(s) Of Engagement Activity 2019
 
Description Conference presentation on adolescents western Kenya 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact 61st Annual Meeting; American Society of Tropical Medicine and Hygiene, Atlanta, November 11-15 2012; Abstract #1829; Mortality trends from 2003 to 2009 among adolescents and young adults in rural western Kenya using a health and demographic surveillance system; PA Phillips-Howard, FO Odhiambo, MJ Hamel, K Adazu, M Ackers, AM van Eijk, V Orimba, A van't Hoog, C Beynon, J Vulule, M Bellis, L Slutsker, K DeCock, R Breiman, KF Laserson' presented by KF Laserson

oral presentation of recent manuscript, stimulate discussion on needs of adolescents, and research including development of adolescent platform and portfolio including ongoing MRC study
Year(s) Of Engagement Activity 2012
 
Description Development of Adolescent Platform-Workshop and Launch 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation Workshop Facilitator
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Spearheaded workshop of multiple agencies, researchers, policymakers, ministry, NGO and charities to develop portfolio for research on adolescents at western Kenya research site
http://www.cph.org.uk/international/index.aspx?teamid=25


we have developed collaboration with national and international agencies, for development of joint research on adolescent health and wellbeing needs
Year(s) Of Engagement Activity 2011
 
Description Interviewed and quoted online in UK national newspaper (The Guardian) relating to studies addressing schoolgirls menstrual needs in low income countries 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Reported on pilot study rationale and issues, and interventions (results were not published then); put in wider global context, and recommendations for more research and investment, demonstrating need to UK public and global development professionals.
Year(s) Of Engagement Activity 2016
URL http://www.theguardian.com/global-development-professionals-network/2016/may/28/we-dont-know-enough-...
 
Description Member of Study Advisory Committee for MRC funded MHM study, Uganda 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Provide technical research guidance to 'Menstrual health interventions and School attendance among Ugandans (MENISCUs-2)', on protocol development, and research study related issues, provide evidence-base from studies we have completed in Kenya to inform if needed
Year(s) Of Engagement Activity 2017,2018
 
Description Member of Trial Steering Committee for MRC/DFID/NIHR funded Trial on menstrual health and School attendance, Gambia 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited to join Trial Steering Committee for 'Puberty health interventions to improve menstrual health and School attendance among Gambian adolescents (MEGAMBO)', to provide expertise and guidance on the trial.
Year(s) Of Engagement Activity 2018
 
Description Menstrual hygiene management of schoolgirls conference, Uganda 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Conference in Uganda to promote menstrual management awareness and advocacy. The primary target audience were the different partners that want to see menstrual management concerns addressed both at institutional and community levels. These included NGOs, Embassies, Business Development Services (BDS) partners, donors, UN agencies, government line Ministrys' of Health, Water, Gender and Education, local government and regulatory partners, private sector partners, and social investors. The conference aimed to bring these groups together to share, reflect, and set the menstrual management agenda as well as fast track interventions and advocacy initiatives. This exchange of ideas and discourse aimed to be a unique multi-stakeholder meeting to get to inform undertakings required in attaining menstrual management
Tow papers were presented on data generated from the Joint Global Health trials Menstrual Solutions Study, around water sanitation and hygiene needs of girls in school

good conference feedback, data used to inform water sanitation and hygiene, and menstrual hygiene management needs of girls' in schools policy and advocacy discussions
Year(s) Of Engagement Activity 2014
URL http://mhmconference2014.wordpress.com/2014/08/25/recommendations-from-mhm-conference-2014/
 
Description Posted pilot study outcomes on Sustainable Sanitation Alliance to expand readership beyond researchers, to programmers, local policy makers, others internationally 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Posted pilot study outcomes on SuSanA (sustainable sanitation alliance) with 1334 views, and discussion.
Year(s) Of Engagement Activity 2016
URL http://forum.susana.org/component/kunena/24-menstrual-hygiene-management-mhm/19650-studies-on-mhm-an...
 
Description Present keynote on menstrual cup research and participant of Cup Summit, Nairobi 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This was the first meeting of researchers, programmes, NGOs on menstrual cups in eastern and horn of Africa. The Summit was organised by the Cup Foundation, with the aim to build knowledge, develop partnerships, and share experiences and tools. Objectives included:
1. Identify, introduce and improve communication channels between (participant) cup groups who distribute cups and related training, do cup marketing or research into cup use.
2. Discuss pressing issues, which effect distribution, availability and use: how to better design our work to improve cup uptake, measure impact and ensure sustainability.
3. Identify common projects, how we together can fundraise, do campaigns and/or create awareness of the menstrual cup and underprivileged girls situation;
4. Cover any other priority topics from the participants related to programs, campaigns and more.

OUTPUTS:
1. Framework for communication and agreement on how it will be managed
2. Menstrual cup research priority list
3. Description of 1-3 projects that participant groups can collaborate on and preliminary ideas/agreement on how they will be managed
Year(s) Of Engagement Activity 2018
URL https://www.thecup.org
 
Description Present knowledge base on overlap between sexual and reproductive health and menstrual health to UNFPA informal meeting (September 2019) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact UNFPA requested myself and Prof Marni Sommer (Columbia University) to present on the current knowledge base relating to menstrual health and sexual and reproductive health, to support their decision making with funding and strategies
Year(s) Of Engagement Activity 2019
 
Description Present research evidence on effect of poor menstrual hygiene on girls education and health (Houses of Parliament) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Invited by the Commonwealth Education Commission to present to parliamentarians, members of the CEC, and other interested persons on the effect of poor menstrual hygiene on girls education and health in low middle income countries. discussions held on how to more widely disseminate as well as the need to conduct research in impoverished settings in the UK (period poverty) . A report of the meeting will be sent to parliamentarians for further action.
Year(s) Of Engagement Activity 2018
URL http://www.cecomm.org.uk/r?u=ySZ7jUTX4rpJMpW8BexsPglaiIerb8WVoZn6-rRm7OD1eJQKgeN4iN1nhnR8pdvbwIC1q3K...
 
Description Present update on menstrual research and randomised controlled trial on menstrual cups at Menstrual Cup Summit Nairobi 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Updated members of Menstrual Cup Coalition on menstrual cup research, and other Cup Summit members, including programme and NGO agencies working in rural impoverished areas and with refugees
Year(s) Of Engagement Activity 2019
 
Description Presentation and workshop member for finalizing Kenyan national Menstrual Hygiene Management Policy and Guidelines 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Request to present research evidence for menstrual hygiene management for women and girls in Kenya, to inform national policy and guidelines; meeting attended by all stakeholders and policy-makers in Kenya. Safety and effectiveness of menstrual cups considered warranting inclusion in policy, guidelines, and school training manuals for
Year(s) Of Engagement Activity 2017
 
Description Presentation at the first in a series of Webinars 'Period Posse' on robust field research on Menstrual health (Sept 2019) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Establishment of a monthly Webinar serioes (Period Posse) for practitioners, researchers, funders, NGO worldwide - this presentation was the first to kick start where key researchers presented findings and potential impact on public health
Year(s) Of Engagement Activity 2019
 
Description Presentation on global menstrual hygiene research at symposium at American Public Health Association 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited to present research priorities for menstrual health and hygiene research, reflecting on experience and application of knowledge from research in impoverished girls in low income to high income countries
Year(s) Of Engagement Activity 2018
URL http://www.publichealthnewswire.org/?p=21581
 
Description Provide technical support for THRiVE grant and east Africa working group on menstrual hygiene management 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact We supported Tanzanian group at the Kilimanjaro Christian Medical University College to receive a small career grant award through THRIVE (training health researchers into vocational excellence in east Africa) to do a study on one aspect of menstrual hygiene, plus have a workshop with east African MHM research and programme persons including the Ugandan (Kampala International University and St Augustine International University Kampala), Tanzanian (Kilimanjaro Christian Medical University College), Kenyan (Kenya Medical Research Institute), UK Universities (Liverpool School of Tropical Medicine; Sheffield University, Oxford University, London School of Hygiene and Tropical Medicine with MRC Uganda/Uganda Virus Research Institute), and menstrual product NGO's and programmes (Femme International; WoMena; Rubycups, AFRIpads). Workshop on 27-29th November 2017 sharing and advising on research tools and methods based on experience from MRC/DFID/Wellcome Trust Trial and pilot, other programmes, indicators, and supported Tanzanian study award design. Provided opportunity for networking and career development of our Kenyan partner also.
Year(s) Of Engagement Activity 2017
 
Description Raised media (newspapers, magazines, blogs, radio) awareness of menstrual cups for menstrual health through our Lancet systematic review 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Following publication of our systematic review and eta-analysis of research on menstrual cups we had overwealming interest internationally, with many invitations to provide information for newspapers, magazines, radio, and over 3000 comments on social media and 2500 through reddit (science). below are some of the news and radio outputs
1. https://www.npr.org/sections/goatsandsoda/2019/07/17/742370168/menstrual-cups-they-re-safe-to-use-and-people-like-using-them?t=1563437971535
2. https://www.bbc.co.uk/news/health-48988240
3. https://www.eurekalert.org/pub_releases/2019-07/tl-pss071519.php
4. https://www.nytimes.com/2019/07/16/health/menstrual-cup-periods-women.html
5. https://www.telegraph.co.uk/global-health/women-and-girls/menstrual-cups-safe-effective-sanitary-products-report-finds/
6. https://indianexpress.com/article/lifestyle/health/findings-to-be-published-today-menstrual-cups-safe-but-awareness-low-says-lancet-study-5833241/
7. https://edition.cnn.com/2019/07/16/health/menstrual-cup-study-intl-trnd/index.html
8. https://www.france24.com/en/20190717-menstrual-cups-safe-practical-cheap-study
9. https://www.huffingtonpost.co.uk/entry/this-massive-study-of-menstrual-cups-will-answer-all-your-questions_uk_5d2c7205e4b0bd7d1e1fd509
10. https://www.independent.co.uk/news/health/menstrual-cup-mooncup-period-poverty-tampons-sanitary-towels-hygiene-safety-a9007211.html
11. https://news.yahoo.com/menstrual-cups-safe-practical-cheap-study-223324930.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAEUaCa0up0TWLrxZMiknyriGyxzJF6wRkRAKM1Me-hDnCQ2ZAYrcpD2sBPTgBnyZRCFN8utSKnHZqybmUtL1Jh_h7D-WvNHCenuXeutOYySK_w9iKwTU5wgYfVrsSIQQbzso1gFBHEMGJKPGXWgqEPK7tMrlhwjIIptoQORHlXjt
12. https://www.eveningexpress.co.uk/news/menstrual-cups-safe-and-effective-scientific-review-suggests/
13. https://www.jwatch.org/fw115614/2019/07/17/leakage-rates-menstrual-cups-similar-other-feminine
14. https://www.buzzfeed.com/ginarushton/menstrual-moon-cups-safe-effective
15. https://www.theglobeandmail.com/canada/article-new-study-points-to-eco-friendly-alternative-for-womens-sanitary/
16. https://www.the-star.co.ke/health/2019-07-17-menstrual-cups-as-reliable-as-tampons/
17. https://www.news-medical.net/news/20190717/Menstrual-cups-are-safe-cost-effective-and-enable-waste-savings-review-finds.aspx
18. https://www.healthissuesindia.com/2019/07/17/menstrual-cups-a-viable-alternative/
19. https://www.tellerreport.com/news/2019-07-17---rules--menstrual-cups--safe--effective-and-economical-option-according-to-a-study-.B1FEt43-H.html
20. https://www.refinery29.com/en-gb/how-to-use-a-menstrual-cup-insertion
21. https://newpaper24.com/menstrual-cups-as-reliable-as-tampons-newpaper24/
22. https://www.itv.com/news/2019-07-16/menstrual-cups-safe-and-effective-scientific-review-suggests/
23. https://www.alphagalileo.org/en-gb/Item-Display/ItemId/181091?returnurl=https://www.alphagalileo.org/en-gb/Item-Display/ItemId/181091
24. https://www.hexham-courant.co.uk/whats-on/national-entertainment/17774597.menstrual-cups-safe-effective-scientific-review-suggests/
25. https://www.msn.com/en-gb/news/newslondon/reusable-menstrual-cups-just-as-safe-and-effective-as-traditional-products-landmark-lancet-report-reveals/ar-AAEs0Nf
26. https://medicalxpress.com/news/2019-07-menstrual-cups-safe-option-menstruation.html
27. https://www.irishexaminer.com/breakingnews/world/menstrual-cups-safe-and-effective-scientific-review-suggests-937476.html
28. https://uk.news.yahoo.com/menstrual-cups-safe-effective-scientific-223000843.html
29. https://www.aol.co.uk/news/2019/07/16/menstrual-cups-safe-and-effective-scientific-review-suggests/?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAMoYUIv94UrcHqRJbdRyv_Y2ExogRtYNt6JZmzKJNB9WJxrxq2zmp8ZkKix8L3SDT926RQU3Y_7gkjp_MljYLJmslEz0sIF3F6My2QQs2DRnQwV6ooGPqqvijlfG-6RlwUx5L7PlbcjhODHoRF5CRm7dQduR42IztmpuFfydHFH-
30. https://www.standard.co.uk/news/health/reusable-menstrual-cups-just-as-safe-and-effective-as-traditional-products-landmark-report-reveals-a4191711.html
31. https://happiful.com/menstrual-cups-found-to-be-safe-and-effective-in-first-scientific-review/
32. https://www.thelondoneconomic.com/lifestyle/health/menstrual-cups-safe-and-effective-scientific-review-suggests/17/07/?doing_wp_cron=1563373994.7595939636230468750000
33. https://www.thesun.co.uk/fabulous/9523088/menstrual-cups-reliable-tampons-cost-effective/
34. https://www.timeslive.co.za/sunday-times/lifestyle/health-and-sex/2019-07-17-menstrual-cups-safe-practical-and-cheap-study/
35. https://www.thehindu.com/sci-tech/health/menstrual-cups-are-safe-reusable-and-cheap-study/article28525793.ece
36. https://www.lshtm.ac.uk/newsevents/news/2019/first-scientific-review-menstrual-cups-expert-comment
37. https://www.cosmopolitan.com/uk/body/health/a28419596/how-to-use-menstrual-cup-period/
38. https://gizmodo.com/menstrual-cups-are-indeed-a-safe-alternative-to-tampons-1836459850
39. https://www.webmd.com/women/news/20190717/menstrual-cups-equal-pads-tampons-in-effectiveness-data-shows#1
40. https://www.news-medical.net/news/20190718/Menstrual-cups-just-as-good-as-sanitary-pads-or-tampons.aspx
41. https://putacupinit.com/menstrual-cup-study/
42. https://pcwhf.co.uk/news/results-of-first-scientific-review-of-menstrual-cups/
43. https://en.wikipedia.org/wiki/Menstrual_cup
44. https://www.irishnews.com/magazine/science/2019/07/16/news/menstrual-cups-safe-and-effective-scientific-review-suggests-1664607/
45. https://patient.info/news-and-features/menstrual-cups-are-safe-and-as-effective-as-other-period-products
46. https://www.nhs.uk/news/lifestyle-and-exercise/menstrual-cups-safe-and-effective-alternative-tampons-and-pads/
47. https://www.alphagalileo.org/en-gb/Print/itemId/181091/userId/-1/cultureCode/en-GB
48. https://www.newser.com/story/277927/money-saving-menstrual-cups-as-effective-as-tampons.html
49. https://www.thejakartapost.com/life/2019/07/17/menstrual-cups-safe-practical-and-cheap-study.html
50. https://www.independent.ie/life/health-wellbeing/menstrual-cups-are-safe-and-may-be-as-effective-as-other-sanitary-products-scientific-review-38321380.html
51. https://www.smh.com.au/lifestyle/health-and-wellness/menstrual-cups-safe-and-cheap-finds-first-major-review-20190717-p5285e.html
52. https://www.thetottenhamindependent.co.uk/news/national/17774597.menstrual-cups-safe-effective-scientific-review-suggests/
53. https://cinemaxxi.info/mini/lancet-study-menstrual-cups-safe-alternative-sanitary-pads-68804060
54. https://www.byuradio.org/episode/0f1fa8d0-1f11-42d5-9af4-d9108d899e98/top-of-mind-with-julie-rose-basic-menstrual-hygiene-is-a-global-problem-the-cup-can-help
Year(s) Of Engagement Activity 2019
 
Description Request from SuSanA Forum to provide study findings to update Wikipedia 'Menstrual Cup' section 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact The BMGF supported Sustainable sanitation Alliance (SuSanA) Forum - requested an update of all our research to date on the safety and effectiveness of menstrual cups to enable them to independently update the Menstrual Cup page of Wikipedia, which gets more than 1000 hits a day; 3 of our study papers from the pilot are now cited on the page
Year(s) Of Engagement Activity 2017
URL https://en.wikipedia.org/wiki/Menstrual_cup
 
Description Scientific workshop - Priorities for research for menstrual management in low middle income countries 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Meeting of international experts (UK, USA, Canada) on menstrual hygiene held by Green Templeton College, Oxford University to spearhead research agenda, 28th-29th November 2016.
Year(s) Of Engagement Activity 2016
 
Description Symposium at the American Society of Tropical Medicine and Hygiene 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Participants in your research and patient groups
Results and Impact The Symposia was very well received, generating questions around this neglected topic area. particular interest was shown in our study and the development of hard outcome/endpoint indicators to measure impact.

After the Symposia, the core presenters and some audience attendees met to discuss next steps for developing a global partnership, and research agenda.
Year(s) Of Engagement Activity 2014
 
Description UNFPA - East and Southern Africa Menstrual Hygiene Symposium and Coalition 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact UNFPA East and Southern Africa Regional Office and the Department of Women in the Presidency of the Republic of South Africa co-hosted the first East and Southern African Symposium on Menstrual Health Management (MHM) from 28 to 29 May 2018 in Johannesburg, South Africa. The intent was to raise awareness and inform attendees across different sectors from east and southern africa, of the importance of menstrual hygiene for public health and gender equity. I (i) supported development of the agenda, programme, provided technical support in writing up the call for action, (ii) presented to the plenary on the contribution of menstrual hygiene to sexual and reproductive health, and (iii) presented on research evidence to date, gaps in knowledge, and next steps.
Year(s) Of Engagement Activity 2018
URL https://esaro.unfpa.org/en/publications/first-east-and-southern-africa-regional-symposium-improving-...
 
Description UNICEF International Menstrual Management Conference and meetings, New York 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Health professionals
Results and Impact UNICEF/Columbia University Global virtual conference, but PI of MRC/DfID/Wellcome Trust grant invited to physically attend, to present the MRC study, development of tools, and experiences around implementation for researchers, international agencies and programmes, and public health audience. Organisers are specifically interested in our presenting the development and use of robust research methods, tools, and instruments.
Conference Title: 2nd Annual Virtual Conference on Menstrual Hygiene Management and WASH in Schools, New York, November 21st 2013.
Presentation Title:"Menstrual solutions in adolescent schoolgirls in western Kenya: an acceptability, feasibility and safety study".
Study tools and instruments will be presented and discussed (but no outcome data as study on-going).
Presenter: Oral presentation by PI (Penny Phillips-Howard) (UNICEF are supporting travel costs to physically attend).
Authors Phillips-Howard PA, Nyothach L, Odour C, Odhiambo F, Alexander K, Obor D, Oruko K, Mason L, Eleveld A, Vulule J, Laserson K.

UNICEF request to share our instruments to help guide future studies. In addition to conference PI is invited to attend series of planning meetings with UNICEF, Columbia University, and other agencies for developing future collaborations and international programme/research activities
Year(s) Of Engagement Activity 2013
URL http://www.unicef.org/wash/schools/files/2013-MHMvConf.pdf
 
Description Web posting, dialogue, sharing of information 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Journalists visited Kenya site, our MRC study was of greatest interest and a web article written, posted in Gates Foundation website, http://www.impatientoptimists.org/Posts/2012/10/One-Reason-Kenyan-Girls-in-Poor-Areas-Dont-Go-to-School;
then institutional websites; http://www.lstmliverpool.ac.uk/about-lstm/news-and-media/latest-news/menstrual-management-among-schoolgirls


further discussion on water and sanitation website; http://forum.susana.org/forum/categories/24-menstrual-hygiene-management-mhm/2381-a-12-years-primary-pupil-calls-for-help#2445 with forum discussion on issues around girls menstrual needs; this has been set up as an ongoing forum for public health persons interested to support the menstrual needs of girls
Year(s) Of Engagement Activity 2012
URL http://www.impatientoptimists.org/Posts/2012/10/One-Reason-Kenyan-Girls-in-Poor-Areas-Dont-Go-to-Sch...
 
Description Webinar FRESH schools lecture 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited to present our pilot study and current trial at the School Health and Nutrition webinar series, to celebrate Menstrual Hygiene Day in May 2018. FRESH webinars provide monthly presentations by leading policy makers, researchers and implementers engaged in improving the health and education of children in low and middle income countries across the globe. The webinars cover all areas of school health and nutrition with speakers draw from organisations engaged in furthering the aims and objectives of the FRESH movement. This series builds on the SHN Webinar series by Save the Children which began in 2011 and over the past 5 years has brought speakers from the SHN sector of many organizations, including policy makers, researchers and practitioners.
Year(s) Of Engagement Activity 2018
URL http://www.schoolsandhealth.org/Pages/SHN-Webinar-Series.aspx#
 
Description Webinar on menstrual health research to Plan International (September 2019) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Request by Plan International to present our menstrual health research from Kenya and India to build knowledge among Plan International staff
Year(s) Of Engagement Activity 2019
 
Description Wikipedia citing of feasibility study 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Requested by Water and Sanitation colleagues to include the JGHT supported feasibility study on the Wikipedia web page for menstrual cups and edit other sections to improve accuracy

web page gets 500 hits a day
Year(s) Of Engagement Activity 2015
URL https://en.wikipedia.org/wiki/Menstrual_cup
 
Description World Health Organization - Global research collaborative meeting on menstrual health, Geneva, 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact The issues of menarche, menstruation, menstrual hygiene and menstrual health have not been an explicit part of WHO's agenda. WHO's Gender Advisory Panel (GAP) have recommended its Department of Reproductive Health and Research (RHR) to develop a portfolio of work in this area. WHO brought together global research collaborative partners or a two-day technical workshop to review the recommendations from the GAP on developing a portfolio of work in the area of menarche, menstruation, menstrual hygiene and menstrual health; and - define RHR's work in this area. Recommendations from the meeting on development of guidelines, standards, dissemination of research internationally to support national and regional policy-makers and programmes. Follow-up meetings on specific technical topics envisaged.
Year(s) Of Engagement Activity 2018
 
Description publication on qualitative findings from feasibility study posted onto web forum 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact New topic on SuSanA Forum to showcase the qualitative results from JGHT feasibility study published in the special edition of Waterlines dedicated to menstrual hygiene management, to increase visibility, and encourage dialogue

online and off line inquiries about the study, research methods, inferences for policy and public health
Year(s) Of Engagement Activity 2015
URL http://forum.susana.org/forum/categories/24-menstrual-hygiene-management-mhm