Menstrual Hygiene and Safe Male Circumcision Promotion in Ugandan Schools (MENISCUS)

Lead Research Organisation: London Sch of Hygiene and Trop Medicine

Abstract

Menstrual hygiene interventions may improve girls’ school attendance.1-3 A systematic review 4
identified 7 intervention studies of menstrual hygiene education; one also included provision of
a menstrual cup. These studies had major methodological limitations, but were generally
encouraging. A more recent small Ghanaian study5 reported 10% higher attendance after 5
months both in girls receiving puberty education only and those receiving puberty education
plus sanitary pads, relative to controls. Some menstrual hygiene practices (e.g. using leaves
and rags) can cause intra-vaginal infections.4 Girls’ school attendance is associated with earning
potential, improved maternal and child survival and reduced HIV infection.6 This research in
Ugandan schoolgirls will prepare for a cluster-randomised trial (CRT) of the impact of puberty
and menstrual hygiene education and of providing sanitary pads on school absenteeism.
Male circumcision reduces men’s risk of HIV acquisition,7 yet circumcision prevalence in
Uganda remains low (~25%).8 We will use an innovative, single-session, football-based
intervention (“Make the Cut”) to promote voluntary medical male circumcision (VMMC) uptake
in schoolboys.9 A small CRT of this intervention in Zimbabwean football teams showed an
encouraging impact on uptake of circumcision (adjusted OR=9.16; 95%CI:0.88-95.1;p=0.06).
We propose evaluating a locally-modified version of this intervention in 14-16 year-old boys
attending the same classes as girls in the menstrual hygiene trial. This will enhance research
cost-effectiveness while deflecting criticisms of favouritism or stigmatisation of girls in the trial.
This research will i) refine the interventions (menstrual hygiene education and providing
disposable pads; the “Make the Cut” VMMC promotion); ii) define the trial’s most suitable
target school year group(s); assess school attendance and girls’ self-reported sanitary hygiene
preferences, and boys’ circumcision prevalence in this setting; iii) develop closer links with
study schools and sanitary pad manufacturers, and iv) validate self-administered vaginal swab
collection and laboratory test procedures.

Technical Summary

Menstrual hygiene interventions may improve girls’ school attendance.1-3 A systematic review 4
identified 7 intervention studies of menstrual hygiene education; one also included provision of
a menstrual cup. These studies had major methodological limitations, but were generally
encouraging. A more recent small Ghanaian study5 reported 10% higher attendance after 5
months both in girls receiving puberty education only and those receiving puberty education
plus sanitary pads, relative to controls. Some menstrual hygiene practices (e.g. using leaves
and rags) can cause intra-vaginal infections.4 Girls’ school attendance is associated with earning
potential, improved maternal and child survival and reduced HIV infection.6 This research in
Ugandan schoolgirls will prepare for a cluster-randomised trial (CRT) of the impact of puberty
and menstrual hygiene education and of providing sanitary pads on school absenteeism.
Male circumcision reduces men’s risk of HIV acquisition,7 yet circumcision prevalence in
Uganda remains low (~25%).8 We will use an innovative, single-session, football-based
intervention (“Make the Cut”) to promote voluntary medical male circumcision (VMMC) uptake
in schoolboys.9 A small CRT of this intervention in Zimbabwean football teams showed an
encouraging impact on uptake of circumcision (adjusted OR=9.16; 95%CI:0.88-95.1;p=0.06).
We propose evaluating a locally-modified version of this intervention in 14-16 year-old boys
attending the same classes as girls in the menstrual hygiene trial. This will enhance research
cost-effectiveness while deflecting criticisms of favouritism or stigmatisation of girls in the trial.
This research will i) refine the interventions (menstrual hygiene education and providing
disposable pads; the “Make the Cut” VMMC promotion); ii) define the trial’s most suitable
target school year group(s); assess school attendance and girls’ self-reported sanitary hygiene
preferences, and boys’ circumcision prevalence in this setting; iii) develop closer links with
study schools and sanitary pad manufacturers, and iv) validate self-administered vaginal swab
collection and laboratory test procedures.
 
Description Joint Global Health Trials Development Grant
Amount £200,000 (GBP)
Funding ID MR/P020283/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 04/2017 
End 10/2018
 
Title Data for: "Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): feasibility study" 
Description The MENISCUS study investigated menstrual health and reasons for school absenteeism among adolescent girls in Uganda. The quantitative dataset contains questionnaire responses provided by 352 female students (one record per row), aged 12-20 (median age 16 years) recruited from four secondary schools in Entebbe sub-district, Uganda, in October and November 2015. Variables cover knowledge and perceptions about menstrual hygiene management and reasons for school absenteeism, as well as socio-demographic characteristics of each respondent. Qualitative data collected through in-depth interviews with selected girls are not included in the data collection. 
Type Of Material Database/Collection of data 
Year Produced 2018 
Provided To Others? Yes  
Impact Not known 
URL https://datacompass.lshtm.ac.uk/605/
 
Title MENISCUS SMC Dataset 
Description Dataset containing the variables collected. The study took place in four secondary schools in Entebbe sub-district, Uganda. Acceptability, perceptions and knowledge of safe male circumcision were assessed through a cross-sectional quantitative survey of 210 participants recruited from Forms 2 and 3. The dataset contains records of male students (one record per row), aged 13-25 (median ages 16-17 years) recruited in October and November 2015. It encompasses enrolment, treatment process (including therapy quality), clinical/other outcome data, and cost-effectiveness data. 
Type Of Material Database/Collection of data 
Year Produced 2017 
Provided To Others? Yes  
Impact Not known. 
URL https://datacompass.lshtm.ac.uk/517/
 
Description WoMena 
Organisation WOMENA
Country United Arab Emirates 
Sector Private 
PI Contribution Study design, coordination, analysis
Collaborator Contribution Study design, coordination, field work
Impact 10.1097/OLQ.0000000000000990 10.1186/s12905-017-0502-z. 10.1371/journal.pone.0185929 GCRF network grant (https://acmedsci.ac.uk/grants-and-schemes/grant-schemes/gcrf-networking-grants)
Start Year 2015
 
Description Dissemination workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Dissemination workshop. Helen to enter more text.
Year(s) Of Engagement Activity 2016