Menstrual hygiene and school absenteeism among Gambian schools: Preparatory phase for a RCT.

Lead Research Organisation: London School of Hygiene & Tropical Medicine
Department Name: Infectious and Tropical Diseases

Abstract

Poor menstrual hygiene management among adolescent girls have been associated with school absenteeism and other health outcomes. Globally girls around the world have developed their own personal strategies to cope with menstruation. These vary greatly from country to country, individual's personal preferences, available resources, local traditions and cultural beliefs and knowledge or education. Some of the menstrual practices have been associated with different health outcomes (Bacterial vaginosis and urogenital infections)(9). Across the globe menstruation and its management also have important social and cultural implications which may in turn impact girl's lives. Absence from school, has been of particular interest to International organisations and research bodies working in this area such a WaterAid, the Water Research Commission and Plan International. These organizations report that in their experience girls' absence from school during menstruation can have both physical and psychological causes. A literature review we conducted in 2013 found there was good evidence that educational interventions can improve menstrual hygiene practices and reduce social restrictions but there was no quantitative evidence that improvements in menstrual knowledge and management methods reduce school absenteeism and urogenital infections. This work will contribute to increase the knowledge on the effectiveness of potentially scalable interventions to improve menstrual hygiene management, school attendance of Gambian schoolgirls and reduce urogenital infections.

Technical Summary

Menstrual hygiene interventions may improve girls' school attendance. A systematic review we conducted in 2013 identified 7 interventions studies of menstrual hygiene education which show some evidence that educational interventions can improve MHM practices and reduce social restrictions but the studies had methodological issues(9). A recent qualitative study we carried out among Gambian schoolgirls showed that girls had a poor knowledge about menstruation and that some of the reasons why they miss school were association with menstrual hygiene management (8). Achieving higher levels of education are correlated to important public health outcomes, including reduction of early pregnancies, risk of HIV infection infant and maternal mortality as well as improvements in the nutritional status of children. The aim of this research will be: 1)to test different methods to measure outcomes and collection of basic epidemiology data, 2)understand the intervention needs of the target population,3)to refine the intervention, 4)to assess acceptability and feasibility of the intervention among schoolgirls, parents and teachers.
 
Description This sduty conducted in Gambia (MRC-PHIND) among school girls in Kiang region shows that challenges related to menstruation management at home or at school could be associated with negative health outcomes and school absenteeism. In the first part of this study, feasibility and qualitative studies showed that menstruation was strongly associated with school attendance in this population, and that there is an unmet need from girls, boys and parents for interventions to enable girls to better manage both the psychosocial aspects of menstruation (anxiety and distress) and the physical aspects (management of use of appropriate materials to eliminate leakage of menstrual blood and hygienic habits practices) (2). Our qualitative research showed that students (boys and girls) had poor knowledge about menstruation, largely due to the need for secrecy. We also observed that lack of knowledge of menstruation led to embarrassment and fear of teasing, and this, together with pain and lack of effective materials and WASH facilities for MHM led to school absenteeism. Menstruation was considered to be an illness and a period of impurity therefore girls have to adhere to religious and social restrictions. Boys were eager to learn about menstruation, but expressed difficulties talking to adults about it. Perceptions about used of disposable material were very negative among the community (its used was associated with issues of infertility). In our quantitative survey (n=331), most of the girls reported that they learnt about menstruation from teachers, peers and mothers. 31% of them reported that menstruation was a disease. Most of the girls in these region used cloth as an absorbent. 90% of girls reported that they dry the reusable pads inside the house, in a room or bathroom. And 35% of girls reported experiencing at least one of the urogenital symptoms asked in the questionnaire. A case-control study showed association between reusing pads and having symptoms of urogenital infections(UI) or having at least one UI infection (3).
15% reported missing at least one day of school during their most recent period. 20% reported that one of the reason was fear of staining in front of others, 22% reported that it was due to pain and 25% reported not feeling comfortable when using sanitation facilities at school when menstruating. In a sub-study of daily diaries to record school attendance and menstrual cycles, 15 girls reported school absence on 29% of period-days, compared with 15% of non-period days.
One workshop with different stakeholders (parents, teachers, students, clinicians, education regional officer and NGOs) was held in Keneba in May in order to present the initial findings, discuss the problems (using a problem tree exercise) and find possible solutions. After the workshop we all decided to create a 3 pack interventions that could be included in programmes already existing in these communities: Mother's club who will work with mums to inform about puberty, menstruation and absorbent and hygienic practices, Peers Education Programme, which will involve girls and boys in schools to discuss puberty and menstrual management issues, and Community meetings around puberty films.
Exploitation Route Other researchers working in the area of MHM in The Gambia or in another African countries can use the learning of this study in order to plan and design their studies. Information found in this study can be use at education departments at the government and regional level.
We have established strong links with relevant national stakeholders, including the Ministry of Basic and Secondary Education (MoBSE), District Education Officer, several school principals and NGOs such as UNICEF, NovaScotia, and FAWEGAM. In May 2017, we presented our findings at a workshop, including plans for this study. There is strong support for the study and during the study, we will liaise closely with the MoBSE to ensure that we are delivering an intervention package which is sustainable and in line with Government guidelines on teaching about puberty. Along the study, we will hold different workshop, with the stakeholders mentioned above as well as with members of the community at which we will present and discuss our findings, and our plans for the future.
Before starting the project, community sensitization was done in each village to inform them about the trial and ask for approval to carry out the project, towards the end of the study, we will hold another community meeting where we will feedback to the whole community our findings.
Sectors Education,Government, Democracy and Justice
URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407285/
 
Description Our study (MRC-PHIND) among school girls in Kiang region shows that challenges related to menstruation management at home or at school could be associated with negative health outcomes and school absenteeism. In the first part of this study, feasibility and qualitative studies showed that menstruation was strongly associated with school attendance in this population, and that there is an unmet need from girls, boys and parents for interventions to enable girls to better manage both the psychosocial aspects of menstruation (anxiety and distress) and the physical aspects (management of use of appropriate materials to eliminate leakage of menstrual blood and hygienic habits practices) (2). Our qualitative research showed that students (boys and girls) had poor knowledge about menstruation, largely due to the need for secrecy. We also observed that lack of knowledge of menstruation led to embarrassment and fear of teasing, and this, together with pain and lack of effective materials and WASH facilities for MHM led to school absenteeism. Menstruation was considered to be an illness and a period of impurity therefore girls have to adhere to religious and social restrictions. Boys were eager to learn about menstruation, but expressed difficulties talking to adults about it. Perceptions about used of disposable material were very negative among the community (its used was associated with issues of infertility). In our quantitative survey (n=331), most of the girls reported that they learnt about menstruation from teachers, peers and mothers. 31% of them reported that menstruation was a disease. Most of the girls in these region used cloth as an absorbent. 90% of girls reported that they dry the reusable pads inside the house, in a room or bathroom. And 35% of girls reported experiencing at least one of the urogenital symptoms asked in the questionnaire. 15% reported missing at least one day of school during their most recent period. 20% reported that one of the reason was fear of staining in front of others, 22% reported that it was due to pain and 25% reported not feeling comfortable when using sanitation facilities at school when menstruating. In a sub-study of daily diaries to record school attendance and menstrual cycles, 15 girls reported school absence on 29% of period-days, compared with 15% of non-period days. One workshop with different stakeholders (parents, teachers, students, clinicians, education regional officer and NGOs) was held in Keneba in May in order to present the initial findings, discuss the problems (using a problem tree exercise) and find possible solutions. After the workshop we all decided to create a 3 pack interventions that could be included in programmes already existing in these communities: Mother's club who will work with mums to inform about puberty, menstruation and absorbent and hygienic practices, Peers Education Programme, which will involve girls and boys in schools to discuss puberty and menstrual management issues, and Community meetings around puberty films. This study helped us to identify the barriers and facilitators of MHM interventions to improve menstrual health among adolescents, it also helped us to design a multicomponent intervention that it is not evaluated with a randomised control trial among 50 schools.
First Year Of Impact 2018
Sector Education,Government, Democracy and Justice
 
Description Engagement with Unicef/NovaScotia/FAWEGAM in their training activities and projects in Gambia
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Participation in a Meeting in Oxford on the 29th of November for the Scientific Meeting: priorities for primary research of menstrual management in low and middle income countries
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a guidance/advisory committee
 
Description Poster Presentation in 7th Virtual Conference on Menstrual Hygiene Management in Schools 2018: A rite of passage: knowledge, perceptions and practices of menstrual hygiene management in rural Gambia. A mixed methodology study
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in other policy documents
Impact Action to improve menstrual hygiene management (MHM) for schoolgirls in low- and middle income countries continues to gather momentum around the world. The annual virtual conference on MHM in schools shared recent evidence and programmes that illustratethe continuing progress in the field. The conference provides a vital global platform for practitioners and policy makers to share ideas, discuss approaches to common problems, and to assess progress against the five priorities of the 'MHM in Ten' agenda. Now in its seventh year, the conference illustrated some of the successes and challenges we face if we are to realise the MHM in Ten priorities that will improve girls' lives by 2024. This year's virtual conference was held on 30 October 2018 as part of the Water & Health Conference, hosted by the Water Institute at the University of North Carolina at Chapel Hill in the USA. It was streamed online for the second year, reaching an estimated 1,300 participants around the world. The registered participants represented the increasing diversity of the global MHM community, with over 100 countries represented. The participants included representatives from government ministries, civil society organizations, donor agencies, academic institutions, private sector companies, and United Nations agencies. Participants came from the WASH, education, gender, health and adolescent development sectors. The conference featured eight presentations and ten poster presentations. The presenters covered work on MHM that spanned countries and regions across the world, but they identified shared challenges in programme design, implementation, and monitoring. These included the challenges of monitoring increasingly complex and multi-sector interventions, and the challenges of taking small programmes to scale through national education and health systems. These commonalities show the importance of global learning and knowledge exchange platforms and events, to strengthen the global community of practice working towards fulfilling girls' rights to health, education, WASH and equality.
URL https://globalhandwashing.org/wp-content/uploads/2019/04/2018-unicef-proceedings-from-the-7th-virtua...
 
Description MRC/DFID/NIHR Call for research to improve adolescent health in an LMIC setting
Amount £312,731 (GBP)
Funding ID MR/R022194/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 04/2018 
End 04/2021
 
Description Menstrual health interventions and school attendance in Uganda (MENISCUs-2)
Amount £203,351 (GBP)
Funding ID MR/P020283/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 04/2017 
End 12/2018
 
Title Assessment of urinary tract infections 
Description We collected urine from the adolescent girls participating into our study, to assess for first time, the association between different menstrual hygiene practices and urinary tract infections (UTI). It is a simple dipstick technique, that allows a simple and quick determination of UTI in school settings. Girls that present symptoms or are positive for UTI are referred to the clinic to further diagnostic and also treatment advice. 
Type Of Material Physiological assessment or outcome measure 
Provided To Others? No  
Impact We believe this method is a simple method that could be used in non-laboratory settings and does not involve an invasive diagnostic tool. 
 
Title Data collection to characterise menstrual hygiene practices of 400 school adolescent girls and association with different health and social outcomes. 
Description We are collecting a very exhaustive data about different menstrual hygiene practices and knowledge from 400 school adolescent girls. We are also collecting data about different urogenital symptoms and also laboratory diagnosed UTIs. This data will provide very valuable information about which practices are related to different symptoms. We are also developing new method to collect data about the stress generated by managing menstruation in girls attending to the study schools. For that we are using an adapted scale and a new method designed by us. 
Type Of Material Database/Collection of data 
Provided To Others? No  
Impact This new tool could be useful to measure stressed/disconfort generated by management of menstruation among adolescent girls. We hope that this tool can be used and adapted by researchers working in other school settings from different countries. 
 
Title Design and pilot of a multicomponent intervention 
Description We have designed and pilot 2 subcomponent interventions to improve MHM among adolescent girls. We have generated training materials for the interventions and also tools to deliver the interventions. 
Type Of Material Database/Collection of data 
Year Produced 2017 
Provided To Others? No  
Impact These interventions were well accepted by schoolgirls, schoolboys and community members and they helped us to design a study in which we will be delivering and evaluating these interventions. We have the intervention packages that will be finalised and shared in the next stage of the project. 
 
Title Different tools to measure school attendance 
Description We are testing different methods to assess school attendance in the different study schools in Gambia. We are using 3 methods: -Self-reported by questionnaire. -School roll calls. -Self-filling diaries. With this methods we would like to assess which ones could be more useful to capture school absenteeism related to menstrual hygiene management issues. 
Type Of Material Database/Collection of data 
Provided To Others? No  
Impact We are collecting the data now, we have not have time to analyse or present to the public but we anticipate that these methods will be very useful for further research projects assessing school absenteism related to MHM. 
 
Description NovaScotia Gambia Association (NSGA) 
Organisation Halifax University, Nova Scotia, Canada
Country Canada 
Sector Academic/University 
PI Contribution Nova Scotia-Gambia Association (NSGA) is a Canadian NGO operating in The Gambia since 1985. It is a major force in youth education in The Gambia. Since its inception it has been working in various social advancement programmes in education and health targeted, at local communities and schools. NSGA projects emphasize the concept of learning through active involvement. It uses drama and theatre, radio and community video shows, and peer education techniques to build healthy communities and to introduce its programs. They were invited to a stakeholder workshop in Keneba and later we had further meetings with them, to discuss the idea to incorporated menstrual hygiene management (MHM) training into their peer-education programmes. They engaged the idea, and we helped them in preparing material and format for the peer education sessions.
Collaborator Contribution In the last four years, NSGA's programs have reached more than 100,000 students in over 200 schools; and, as well, 1,000 villages throughout The Gambia. The NSGA delivers its community empowerment and awareness programmes through taking a holistic approach employing the idea of information dissemination via active engagement of the beneficiaries.Over the last 20 odd years, NSGA has provided education and training workshops and seminars in communities and schools on malaria prevention, sanitation and clean water, good governance, reproductive and sexual health, gender equality issues, environmental awareness, HIV/Aids, sexually transmitted diseases among other civil society projects. They engaged with the idea to incorporate MHM component in their peer-school sessions, and we piloted some of the session in two schools. As the idea was well accepted by school girls and boys, teachers and community members, we decided that this could be a component of the full intervention to improve MHM among adolescent girls. We wrote a proposal where they were included as one of the implementer partners.
Impact 1-Creation of an intervention packaged to include MHM among school peer's sessions.2-Piloting of the intervention in two schools, 3-Evaluation of the intervention, 4-Writing a proposal (which has been granted) to do a RCT
Start Year 2017
 
Description Partnership FAWEGAM - Forum for African Women Educationalist The Gambia Chapter. 
Organisation FAWEGAM
Country Gambia 
Sector Learned Society 
PI Contribution FAWEGAM is a gender based education NGO which was founded in 1996. FAWEGAM together with the Ministry of Basic and Secondary Education (MoBSE) and UNICEF came up with the mothers club initiative to address girls education. It is used to change attitudes towards girls education and make mothers advocates for their girls education and influence leaders. The approach ensures community ownership and sustainability. They were invited to a stakeholder workshop in Keneba and later we had further meetings with them, to discuss the idea to incorporated menstrual hygiene management (MHM) training for mothers and girls within their clubs. They engaged the idea, and we helped them in preparing material and format for the clubs.
Collaborator Contribution Since 2001, FAWEGAM has set up 275 Mothers Clubs nationwide. They undertake income generating activities from the seed money given by UNICEF through FAWEGAM for the clubs and schools sustenance. The mothers raise funds to provide books, uniforms and shoes to needy children, so as to ensure they can continue coming to school, and in some cases they even built toilets and retain teachers for extra studies for the girls. The Mother's Clubs are involved in community mobilization and sensitization in education, enrolment drives, monitor the attendance and performance of students especially girls, and other community development initiatives. They also conduct guidance and counselling sessions, advocacy against gender based violence, eastly marriage and intervene in cases of early marriage. They engaged with the idea to incorporate MHM training within their clubs, and we piloted some of the clubs in two schools. As the idea was well accepted by mother and community members, we decided that this could be a component of the full intervention to improve MHM among adolescent girls. We wrote a proposal where they were included as one of the implementer partners.
Impact 1-Creation of an intervention packaged to include MHM among mother's club.2-Piloting of the intervention in two schools, 3-Evaluation of the intervention, 4-Writing a proposal (which has been granted) to do a RCT
Start Year 2017
 
Description Partnership with MRC Unit The Gambia 
Organisation FAWEGAM
Country Gambia 
Sector Learned Society 
PI Contribution We approached MRC Unit The Gambia in summer of 2015, when a student went to do her first MSc project in the area of menstrual hygiene. We were very well welcomed as this unit was working in Gambia for the last decades and had a huge record in working in nutrition within the community. The proposed inter-disciplinary school-based feasibility study had the potentil of improving our understanding of the issues involved and lay the groundwork for the main study aiming to reduce school absenteeism and urogenital symptoms and infections among the targeted adolescent girls while strengthening menstrual hygiene management and other issues around puberty. This proposal aim also to help to strengthen MRC Gambia and its partners' capacity in the emerging social science, implementation and policy research in a highly conductive mentoring and enabling south-north partnership.We have conducted training in qualitative and quantitative methods, establish good relationships with the clinic and stablish a good relationship with the data entry team.
Collaborator Contribution Our partners were very interested in getting experience and new learning in this new topic and they had the expertise to be working within these communities for the last 4 decades. Helen Nabwera has been working in MRC Gambia for the last 3 years and she has experience in the clinical care of children and adolescents inrural Gambia and Kenya and the use of quantitative and qualitative methods to assess psychococial stressors in rural Gambian female. She will help to coordinate and organize the field work as well as provide her expertise in women and community programmes. She is a co-PI for the study. The Gambian partner is the MRC-Gambia Unit which has a strong record of maternal and child nutrition research. We have involved in our study researchers from other projects that ended in Gambia,who were interested in this new topic and wanted to develop their skills in the social research area.LSHTM with Andrew Prentice leadership and MRC-Gambia have actively collaborated on bothresearch and capacity-strengthening over 20 years. Rita Wegmuller, Head of Station in Keneba, has provided scientific guidance for the study.They had also a sufficient readiness, administrative support and commitment at MRC Gambia to facilitate the achievement of the stated objectives and deliverables.
Impact -Contract agreement. -Gambian ethics obtained. -LSHTM ethics obtained. -Research fellow, research assistant, 2 field researchers hired. -Report of first part of work.
Start Year 2016
 
Description Partnership with MRC Unit The Gambia 
Organisation Medical Research Council (MRC)
Department MRC Unit, The Gambia
Country Gambia 
Sector Public 
PI Contribution We approached MRC Unit The Gambia in summer of 2015, when a student went to do her first MSc project in the area of menstrual hygiene. We were very well welcomed as this unit was working in Gambia for the last decades and had a huge record in working in nutrition within the community. The proposed inter-disciplinary school-based feasibility study had the potentil of improving our understanding of the issues involved and lay the groundwork for the main study aiming to reduce school absenteeism and urogenital symptoms and infections among the targeted adolescent girls while strengthening menstrual hygiene management and other issues around puberty. This proposal aim also to help to strengthen MRC Gambia and its partners' capacity in the emerging social science, implementation and policy research in a highly conductive mentoring and enabling south-north partnership.We have conducted training in qualitative and quantitative methods, establish good relationships with the clinic and stablish a good relationship with the data entry team.
Collaborator Contribution Our partners were very interested in getting experience and new learning in this new topic and they had the expertise to be working within these communities for the last 4 decades. Helen Nabwera has been working in MRC Gambia for the last 3 years and she has experience in the clinical care of children and adolescents inrural Gambia and Kenya and the use of quantitative and qualitative methods to assess psychococial stressors in rural Gambian female. She will help to coordinate and organize the field work as well as provide her expertise in women and community programmes. She is a co-PI for the study. The Gambian partner is the MRC-Gambia Unit which has a strong record of maternal and child nutrition research. We have involved in our study researchers from other projects that ended in Gambia,who were interested in this new topic and wanted to develop their skills in the social research area.LSHTM with Andrew Prentice leadership and MRC-Gambia have actively collaborated on bothresearch and capacity-strengthening over 20 years. Rita Wegmuller, Head of Station in Keneba, has provided scientific guidance for the study.They had also a sufficient readiness, administrative support and commitment at MRC Gambia to facilitate the achievement of the stated objectives and deliverables.
Impact -Contract agreement. -Gambian ethics obtained. -LSHTM ethics obtained. -Research fellow, research assistant, 2 field researchers hired. -Report of first part of work.
Start Year 2016
 
Description Partnership with MRC Unit The Gambia 
Organisation Nova Scotia-Gambia Association
Country Canada 
Sector Academic/University 
PI Contribution We approached MRC Unit The Gambia in summer of 2015, when a student went to do her first MSc project in the area of menstrual hygiene. We were very well welcomed as this unit was working in Gambia for the last decades and had a huge record in working in nutrition within the community. The proposed inter-disciplinary school-based feasibility study had the potentil of improving our understanding of the issues involved and lay the groundwork for the main study aiming to reduce school absenteeism and urogenital symptoms and infections among the targeted adolescent girls while strengthening menstrual hygiene management and other issues around puberty. This proposal aim also to help to strengthen MRC Gambia and its partners' capacity in the emerging social science, implementation and policy research in a highly conductive mentoring and enabling south-north partnership.We have conducted training in qualitative and quantitative methods, establish good relationships with the clinic and stablish a good relationship with the data entry team.
Collaborator Contribution Our partners were very interested in getting experience and new learning in this new topic and they had the expertise to be working within these communities for the last 4 decades. Helen Nabwera has been working in MRC Gambia for the last 3 years and she has experience in the clinical care of children and adolescents inrural Gambia and Kenya and the use of quantitative and qualitative methods to assess psychococial stressors in rural Gambian female. She will help to coordinate and organize the field work as well as provide her expertise in women and community programmes. She is a co-PI for the study. The Gambian partner is the MRC-Gambia Unit which has a strong record of maternal and child nutrition research. We have involved in our study researchers from other projects that ended in Gambia,who were interested in this new topic and wanted to develop their skills in the social research area.LSHTM with Andrew Prentice leadership and MRC-Gambia have actively collaborated on bothresearch and capacity-strengthening over 20 years. Rita Wegmuller, Head of Station in Keneba, has provided scientific guidance for the study.They had also a sufficient readiness, administrative support and commitment at MRC Gambia to facilitate the achievement of the stated objectives and deliverables.
Impact -Contract agreement. -Gambian ethics obtained. -LSHTM ethics obtained. -Research fellow, research assistant, 2 field researchers hired. -Report of first part of work.
Start Year 2016
 
Description Lecture at Module Tropical Environmental Health (Master level at London School of Hygiene and Tropical Medicine). 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Around 50 students each year receive a lecture tittled "Menstrual hygiene in LMIC", which sparked questions and discussions afterwards regarding menstrual hygiene management evidence and summer projects opportunities for the future.
Year(s) Of Engagement Activity 2018
 
Description Meeting with UNICEF Gambia 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Third sector organisations
Results and Impact Meeting with Unicef Gambia, to discuss their policies, programmes and projects related to MHM in Gambia and specifically at Kiang Region (where our study takes place). It stimulated discussions and interchange of information/evidence and engagement for future research opportunities.
Year(s) Of Engagement Activity 2017
 
Description Seminar about MHM and school absenteism in Gambia at ISGlobal (International Institute of Global Health Barcelona, Spain) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact 40 students attended to the weekly seminar at ISGLobal, regarding Menstrual Hygiene management (MHM) and links with school absenteeism. It stimulates a great interest among the participants (specially the female students), creating a great environment for discussions and research interests.
Year(s) Of Engagement Activity 2018
 
Description UNICEF Training talk about WASH and MHM 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact A lecture in a course for Unicef members to discuss about the importance of WASH and menstrual hygiene, and engage debates to review the evidence of studies which link impact of improvements of MHM on school absenteeism.
Year(s) Of Engagement Activity 2018
 
Description Workshop at Keneba (Gambia) with different stakeholders (parents, teachers, students, NGOs, Researchers) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Study participants or study members
Results and Impact One workshop with different stakeholders (parents, teachers, students, clinicians, education regional officer and NGOs) was held in Keneba (Gambia) in May 2017 in order to present the initial findings of the study, discuss the problems (using a problem tree exercise) and find possible solutions to improve MHM among school girls.
Year(s) Of Engagement Activity 2017