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

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.

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.