Reusable Pads Research Articles

Investigating the Impact of a Menstrual Hygiene Program on School Absenteeism of Rural Ugandan Girls: A Delayed Cluster Randomised Control Trial

Background: Observational studies have described how inadequate Menstrual Hygiene Management (MHM) impacts negatively on girls' engagement in school but are yet to confirm if MHM interventions can have an impact. We hypothesise that provision of menstrual health education and re-usable sanitary pads can improve girls' school attendance. Methods: We conducted a non-blinded delayed control cluster-randomised trial in 40 government primary schools in former Greater Bushenyi District, Western Uganda. A group of 30 girls aged 12-18 from each school was randomly assigned to intervention (menstrual health education and reusable sanitary pads) or control (receiving the intervention at the end of the study) groups. The primary outcome was the mean number of days of school missed per month. Findings: We randomised 1,170 girls from 20 intervention (582 girls) and 20 control (588 girls) schools. At follow-up, 499 girls from 20 intervention (259 girls) and 19 control (240 girls) were included in the primary analysis. School attendance according to register data was similar in the intervention group compared to the control (-0.22 days, 95% CI: -0.204, 0.644 days, p-value: 0.300). High rates of missing register data and school drop-out meant the trial suffered from substantial missing data. There was a positive non-statistically significant effect on girls' knowledge of menstruation, daily activities during menstruation and self-esteem. No adverse effects were reported. Interpretation: An MHM intervention consisting of pad distribution and education may not result in sustainable improvements in girls' school engagement. Future work should consider interventions that include behaviour change components . Results should be interpreted in light of issues with the volume of missing data. Work is needed to develop reliable and replicable methods of measuring the impact of MHM interventions on girls' school engagement. Trial Registration Number: The trial is registered with ClinicalTrials.gov, study ID: NCT02243488. Funding Statement: The Leverhulme Trust Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Ethics for this study has been granted by The University of Sheffield’s School of Health and Related Research (Ethics reference number: 0677/KW). Ethics approval has been obtained locally from Makerere University School of Public Health and the trial will be registered with The Ugandan National Council for Science and Technology (UNCST). The trial has also been registered with Clinicaltrials.gov and the protocol will be published online on the White Rose Consortium.

Imperfect Information in Menstrual Health and the Role of Informed Choice

This article explores how imperfect information and the culture of silence around menstruation have shaped the menstrual hygiene product market. It is generally considered that the use of sanitary napkins is equivalent to hygiene. This view is critically evaluated in light of evidence. In a highly competitive market, materials used in sanitary napkin products have evolved significantly. Policymakers and regulators need to be informed about the nature of products entering the Indian market and their implications on women’s health and cost to the environment. The menstrual hygiene market now offers some less-known innovations such as menstrual cups, reusable cloth pads and compostable sanitary napkins that could offer a more sustainable direction to the industry. However, they also have their own barriers to access and use. Given the increasing choice available in the market and potential for accessing information, it has become pertinent that relevant stakeholders—such as women, government officials and the media—are made aware of the basket of options for menstrual hygiene management. Field experiments done to this end indicate that informed choice will automatically ensure that cost to women’s health and the environment is minimised.

Menstrual hygiene management among women and adolescent girls in the aftermath of the earthquake in Nepal

BackgroundMenstrual hygiene management (MHM) is an essential aspect of hygiene for women and adolescent girls between menarche and menopause. Despite being an important issue concerning women and girls in the menstruating age group MHM is often overlooked in post-disaster responses. Further, there is limited evidence of menstrual hygiene management in humanitarian settings. This study aims to describe the experiences and perceptions of women and adolescent girls on menstrual hygiene management in post-earthquake Nepal.MethodsA mixed methods study was carried out among the earthquake affected women and adolescent girls in three villages of Sindhupalchowk district of Nepal. Data was collected using a semi-structured questionnaire that captured experiences and perceptions of respondents on menstrual hygiene management in the aftermath of the Nepal earthquake. Quantitative data were triangulated with in-depth interview regarding respondent’s personal experiences of menstrual hygiene management.ResultsMenstrual hygiene was rated as the sixth highest overall need and perceived as an immediate need by 18.8% of the respondents. There were 42.8% women & girls who menstruated within first week of the earthquake. Reusable sanitary cloth were used by about 66.7% of the respondents before the earthquake and remained a popular method (76.1%) post-earthquake. None of the respondents reported receiving menstrual adsorbents as relief materials in the first month following the earthquake. Disposable pads (77.8%) were preferred by respondents as they were perceived to be clean and convenient to use. Most respondents (73.5%) felt that reusable sanitary pads were a sustainable choice. Women who were in the age group of 15-34 years (OR = 3.14; CI = (1.07-9.20), did not go to school (OR = 9.68; CI = 2.16-43.33), married (OR = 2.99; CI = 1.22-7.31) and previously used reusable sanitary cloth (OR = 5.82; CI = 2.33-14.55) were more likely to use the reusable sanitary cloth.ConclusionsIn the immediate aftermath of the earthquake, women and girls completely depended on the use of locally available resources as adsorbents during menstruation. Immediate relief activities by humanitarian agencies, lacked MHM activities. Understanding the previous practice and using local resources, the reusable sanitary cloth is a way to address the menstrual hygiene needs in the post-disaster situations in Nepal.

Menstrual Hygiene, Management, and Waste Disposal: Practices and Challenges Faced by Girls/Women of Developing Countries.

Menstruation and menstrual practices still face many social, cultural, and religious restrictions which are a big barrier in the path of menstrual hygiene management. In many parts of the country especially in rural areas girls are not prepared and aware about menstruation so they face many difficulties and challenges at home, schools, and work places. While reviewing literature, we found that little, inaccurate, or incomplete knowledge about menstruation is a great hindrance in the path of personal and menstrual hygiene management. Girls and women have very less or no knowledge about reproductive tract infections caused due to ignorance of personal hygiene during menstruation time. In rural areas, women do not have access to sanitary products or they know very little about the types and method of using them or are unable to afford such products due to high cost. So, they mostly rely on reusable cloth pads which they wash and use again. Needs and requirements of the adolescent girls and women are ignored despite the fact that there are major developments in the area of water and sanitation. Women manage menstruation differently when they are at home or outside; at homes, they dispose of menstrual products in domestic wastes and in public toilets and they flush them in the toilets without knowing the consequences of choking. So, there should be a need to educate and make them aware about the environmental pollution and health hazards associated with them. Implementation of modern techniques like incineration can help to reduce the waste. Also, awareness should be created to emphasize the use of reusable sanitary products or the natural sanitary products made from materials like banana fibre, bamboo fibre, sea sponges, water hyacinth, and so on.

Design and Development of Feminine Re-usable Maxi Pads for Economically Challenged People

Design and Development of Feminine Re-usable Maxi Pads for Economically Challenged People

Disposable Versus Reusable Absorbent Underpads for Prevention of Hospital-Acquired Incontinence-Associated Dermatitis and Pressure Injuries.

The primary purpose of our study was to determine if there is a difference in the occurrence of hospital-acquired pressure injuries (HAPIs) and incontinence-associated dermatitis (IAD) in incontinent adults using a disposable versus reusable absorptive underpads. We also compared hospital length of stay in the 2 groups. Randomized controlled trial using cluster randomization based on inpatient care unit. Four hundred sixty-two patients admitted to 4 medical-surgical study units participated in the study; 252 used reusable underpads (control group) and 210 subjects used disposable underpads (intervention group). The study setting was a 711-bed acute care hospital located in Brooklyn, New York. Two units were randomly allocated to use disposable incontinence pads, and the remaining 2 units used standard, reusable incontinence pads. Data for PI and IAD occurrences were collected weekly by specially trained RNs (skin care champions) on the assigned units. A 2-level hierarchical linear model was used to analyze the effects of the intervention on primary and secondary outcomes separately from any effects of the unit of randomization. HAPIs were significantly lower in the disposable underpads group: 5% versus 12% (P = .02). Rates of hospital IAD were not significantly different between the groups (P = .22). Analysis of a secondary outcome, hospital length of stay, was also lower in patients who used disposable underpads (6 days vs 8 days; P = .02). Findings suggest that use of disposable incontinence pads reduces HAPI but not IAD occurrences. The effect of disposable, absorbent incontinence pads should be considered when initiating a hospital-wide skin and PI prevention and treatment plan.

A qualitative understanding of the effects of reusable sanitary pads and puberty education: implications for future research and practice

BackgroundThe management of menstruation has come to the fore as a barrier to girls’ education attainment in low income contexts. Interventions have been proposed and piloted, but the emerging nature of the field means limited evidence is available to understand their pathways of effect.MethodsThis study describes and compares schoolgirls’ experiences of menstruation in rural Uganda at the conclusion of a controlled trial of puberty education and sanitary pad provision to elucidate pathways of effect in the interventions. Semi-structured interviews were undertaken with schoolgirls who participated in the Menstruation and the Cycle of Poverty trial concurrent with the final set of quantitative surveys. A framework approach and cross-case analysis were employed to describe and compare the experiences of 27 menstruating girls across the four intervention conditions; education (n = 8), reusable sanitary pads (n = 8), education with reusable sanitary pads (n = 6), and control (n = 5).ResultsThemes included: menstrual hygiene, soiling, irritation and infection, physical experience, knowledge of menstruation, psychological, social and cultural factors, and support from others. Those receiving reusable pads experienced improvements in comfort and reliability. This translated into reduced fears around garment soiling and related school absenteeism. Other menstrual hygiene challenges of washing, drying and privacy remained prominent. Puberty education improved girls’ confidence to discuss menstruation and prompted additional support from teachers and peers.ConclusionsFindings have important implications for the development and evaluation of future interventions. Results suggest the provision of menstrual absorbents addresses one core barrier to menstrual health, but that interventions addressing broader needs such as privacy may improve effectiveness. Puberty education sessions should increase attention to body awareness and include strategies to address a wider range of practical menstrual challenges, including pain management. Interviews revealed possibilities for improving quantitative surveys in future research.Trial registrationPan-African Clinical Trials Registry PACTR201503001044408

Reducing barriers to primary school education for girls in rural Kenya: reusable pads' intervention.

Purpose The current study explored girls' perceptions of the impact of sanitary pads' intervention on their school attendance and grades. Methods Participants included 150 girls in 6th, 7th, and 8th grade in two rural schools in Kenya. Participants completed a questionnaire on menstrual health issues and the perceived impact on school attendance and academic performance. Results Results indicated that of all participants (150), those who had passed menarche and had cloth pads had similar comfort levels at school as those who had not yet had their period. Of those who had reached menarche (with pads n = 34, without pads n = 91), they answered questions about how much their period interfered with their attendance and grades. Those who had received the pads reported significantly less negative influence on their attendance and schoolwork than those who did not have pads. They also reported significantly lower levels of wanting to hide their menstrual cycle from friends and family. In addition, they reported significantly higher levels of comfort at home and school than those who did not have pads. Finally, those with pads reported significantly lower levels of fear during their period. Conclusion These findings suggest providing girls with pads minimizes the barriers to successful schooling.

Women Empowering Women Through Reusable Sanitary Pads

Menstrual Hygiene Management (MHM) is one of the top challenges for schoolgirls and female teachers in Uganda, leading to low retention rates for girls (25%) compared to boys (33%). One of Higher Education Resource Services-East Africa (HERS-EA) goals is to remove barriers to girls’ education and advance women in leadership. This paper summarizes results of a community engagement project that trained rural women in two districts of Uganda (Bulambuli and Butaleja) in entrepreneurial skills and production of affordable reusable sanitary pads. Additionally, a needs assessment was conducted by HERS-EA. MHM issues and possible research areas (community education, engineering, environmental, business and marketing of sanitary pads) were identified. The paper highlights the plight of schoolgirls and rural women regarding MHM and the need for affordable sanitary pads to keep girls in school. The paper further highlights the mutual benefits of collaboration and opportunities that support university primary missions of education, research, and outreach.

Menstruation and the Cycle of Poverty: A Cluster Quasi-Randomised Control Trial of Sanitary Pad and Puberty Education Provision in Uganda.

BackgroundPoor menstrual knowledge and access to sanitary products have been proposed as barriers to menstrual health and school attendance. In response, interventions targeting these needs have seen increasing implementation in public and private sectors. However, there has been limited assessment of their effectiveness.ObjectivesAssess the impact of providing reusable sanitary pads and puberty education on girls’ school attendance and psychosocial wellbeing outcomes.MethodsA cluster quasi-randomised controlled trial was conducted across 8 schools, including 1124 girls, in rural Uganda. Schools were allocated to one of four conditions: the provision of puberty education alone; reusable sanitary pads alone; puberty education and reusable sanitary pads; and a control (no intervention). The primary outcome was school attendance. Secondary outcomes reflected psychosocial wellbeing.ResultsAt follow-up, school attendance had worsened for girls across all conditions. Per-protocol analysis revealed that this decline was significantly greater for those in the control condition d = 0.52 (95%CI 0.26–0.77), with those in control schools having a 17.1% (95%CI: 8.7–25.5) greater drop in attendance than those in any intervention school. There were no differences between the intervention conditions. High rates of school drop-out and transfer meant the trial suffered from substantial participant drop-out. Intention-to-treat analyses using two different imputation strategies were consistent with the main results, with mean differences of 5.2% attendance in best-case and 24.5% in worst-case imputations. Results were robust to adjustments for clustering. There was no impact of the interventions on girls’ self-reported shame or insecurity during menstruation.ConclusionResults of the trial support the hypothesised positive impact of providing sanitary pads or puberty education for girls’ school attendance in a developing country context. Findings must be interpreted with caution in light of poor participant retention, intervention fidelity, and the attendance measures used.Trial RegistrationPan African Clinical Trials Registry PACTR201503001044408

Measuring the prevalence and impact of poor menstrual hygiene management: a quantitative survey of schoolgirls in rural Uganda

ObjectivesThe primary objective was to describe Ugandan schoolgirls’ menstrual hygiene management (MHM) practices and estimate the prevalence of inadequate MHM. Second, to assess the relative contribution of aspects of MHM...

Do Menstrual Hygiene Management Interventions Improve Education and Psychosocial Outcomes for Women and Girls in Low and Middle Income Countries? A Systematic Review.

BackgroundUnhygienic and ineffective menstrual hygiene management has been documented across low resource contexts and linked to negative consequences for women and girls.ObjectivesTo summarise and critically appraise evidence for the effectiveness of menstruation management interventions in improving women and girls’ education, work and psychosocial wellbeing in low and middle income countries.MethodsStructured systematic searches were conducted in peer-reviewed and grey literature to identify studies evaluating education and resource provision interventions for menstruation management. Individual and cluster randomised controlled trials were eligible for inclusion, as were non-randomised controlled trials. Study characteristics, outcomes and risk of bias were extracted using a piloted form. Risk of bias was independently assessed by two researchers.ResultsEight studies described in ten citations were eligible for inclusion. Studies were highly heterogeneous in design and context. Six included assessment of education-only interventions, and three provided assessment of the provision of different types of sanitary products (menstrual cups, disposable sanitary pads, and reusable sanitary pads). A moderate but non-significant standardised mean difference was found for the two studies assessing the impact of sanitary pad provision on school attendance: 0.49 (95%CI -0.13, 1.11). Included studies were heterogeneous with considerable risk of bias. Trials of education interventions reported positive impacts on menstrual knowledge and practices, however, many studies failed to assess other relevant outcomes. No trials assessed or reported harms.ConclusionsThere is insufficient evidence to establish the effectiveness of menstruation management interventions, although current results are promising. Eight trials have been conducted, but a high risk of bias was found and clinical heterogeneity precluded synthesis of most results. Whilst trials provided some indication of positive results, further research is needed to establish the role of menstruation hygiene management in education performance, employment and other psychosocial outcomes. This review provides a concise summary of present trials and highlights improvements for future work.

Menstrual hygiene - A salient hazard in rural schools: A case of Masvingo district of Zimbabwe.

Active participation of the girl child in development is hampered by Menstrual Hygiene Management (MHM) challenges. MHM is an important gender issue and a critical component in holistic human development. It affects about 25% of the global population aged between 15 and 49 years. Water, sanitation and hygiene (WASH) interventions in schools have not prioritised MHM, thus exposing girls and the entire school community to health related hazards. The study explored knowledge, attitudes and community practices, and investigated the impact of religious and cultural beliefs on MHM and how they impact on the girl child in Masvingo district. The survey was largely qualitative and employed methodologies of document analysis, Focus Group Discussions (FGD) and structured interviews. Participants included four churches, 13 NGOs, eight government departments and 40 women. Findings revealed deeply embedded power relations, a culture of silence around MHM, noninvolvement of men in MHM issues, limited availability in terms of information, and a girl unfriendly infrastructure, and limited access to menstrual hygiene products due to poverty and poor management and disposal practices. Resultant effects ranged from poor class participation, lack of concentration and constrained interactions with peers and teachers, low self-esteem, anxiety and the general feeling of being discriminated against. Results confirmed the need for increased awareness initiatives on MHM in a bid to tackle inherent religious and cultural beliefs that are a barrier to effective holistic implementation of WASH interventions that empower women and girls. Lobbying government to provide an appropriate policy framework, education and training, construction of girl friendly sanitary facilities, exploring and capitalisation of local production of Reusable Menstrual Pads (RUMPS), more research targeting children living with disabilities, those living in refugee and makeshift camps and Orphans and Vulnerable Children (OVC), are some of the recommendations coming out of the study.

Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India.

Menstrual hygiene management (MHM) practices vary worldwide and depend on the individual’s socioeconomic status, personal preferences, local traditions and beliefs, and access to water and sanitation resources. MHM practices can be particularly unhygienic and inconvenient for girls and women in poorer settings. Little is known about whether unhygienic MHM practices increase a woman’s exposure to urogenital infections, such as bacterial vaginosis (BV) and urinary tract infection (UTI). This study aimed to determine the association of MHM practices with urogenital infections, controlling for environmental drivers. A hospital-based case-control study was conducted on 486 women at Odisha, India. Cases and controls were recruited using a syndromic approach. Vaginal swabs were collected from all the participants and tested for BV status using Amsel’s criteria. Urine samples were cultured to assess UTI status. Socioeconomic status, clinical symptoms and reproductive history, and MHM and water and sanitation practices were obtained by standardised questionnaire. A total of 486 women were recruited to the study, 228 symptomatic cases and 258 asymptomatic controls. Women who used reusable absorbent pads were more likely to have symptoms of urogenital infection (AdjOR=2.3, 95%CI1.5-3.4) or to be diagnosed with at least one urogenital infection (BV or UTI) (AdjOR=2.8, 95%CI1.7-4.5), than women using disposable pads. Increased wealth and space for personal hygiene in the household were protective for BV (AdjOR=0.5, 95%CI0.3-0.9 and AdjOR=0.6, 95%CI0.3-0.9 respectively). Lower education of the participants was the only factor associated with UTI after adjusting for all the confounders (AdjOR=3.1, 95%CI1.2-7.9). Interventions that ensure women have access to private facilities with water for MHM and that educate women about safer, low-cost MHM materials could reduce urogenital disease among women. Further studies of the effects of specific practices for managing hygienically reusable pads and studies to explore other pathogenic reproductive tract infections are needed.

Analysis on User Sensitive Evaluations of Disposable and Reusable Sanitary Pads

Menstruation being an inevitable phenomenon for every women, reducing the discomfort during the menstruation period is one of the important issues for women’s well-being. This study was conducted through user evaluations on disposable pads and reusable pads to comprehend the discomfort factors of the sanitary pads and to provide basic information for improvement. Negative symptoms of the reponses on menstruation outnumbered the positive aspects, and the results suggested that menstruation period was perceived as a painful experience to women. There were difference between the negative and positive responses regarding the designs, functions, fittings, wearing sensations. and disposabilities of disposable pads and reusable pads. While disposable pads had the strength of convenient use, it had the weakness of wearing sensation, and while reusable pads had the strength of wearing sensation, it had the weakness of inconvenient keeping. When designs reflecting these results are made, it is expected to bring a synergy effect by bringing both a more pleasant menstruation period for the consumers and eventual profit to the manufacturers.

Development of a Low Cost Re-usable Microfibre Sanitary Pad

Menstrual hygiene management is a big problem for women and girls in Zimbabwe as the sanitary pads are expensive. An average pack of 8-10 at $US1.50 is significantly expensive for females coming from low income families, which has caused women and girls to resort to unhealthy ways such as using grass and cow dung for managing their menstruation, which exposes them to infections. The aim was to develop a low-cost re-usable microfibre sanitary pad with good performance properties and low cost maintenance, affordable to poor women. The design was based on the Johnson and Johnson re-usable (a rectangular shape) sanitary pads. The new re-usable pad was developed from polyester microfibre materials. It has a pocket for an insert of another material that will enhance the collection of blood. The developed pad was tested for wicking, leakage and strike through properties. The newly developed pad exhibited better properties and yet cheaper than the commercial disposable pads.

Empowering Women: Teaching Ethiopian Girls to Make Reusable Sanitary Pads

Empowering Women: Teaching Ethiopian Girls to Make Reusable Sanitary Pads

The Green Operating Room: Simple Changes to Reduce Cost and Our Carbon Footprint

Generating over four billion pounds of waste each year, the healthcare system in the United States is the second largest contributor of trash with one-third produced by operating rooms. Our objective is to assess improvement in waste reduction and recycling after implementation of a Green Operating Room Committee (GORC) at our institution. A surgeon and nurse-initiated GORC was formed with members from corporate leadership, nursing, anesthesia, and OR staff. Initiatives for recycling opportunities, reduction of energy and water use as well as solid waste were implemented and the results were recorded. Since formation of GORC in 2008, our OR has diverted 6.5 tons of medical waste. An effort to recycle all single-use devices was implemented with annual solid waste reduction of approximately 12,860 lbs. Disposable OR foam padding was replaced with reusable gel pads at greater than $50,000 per year savings. Over 500 lbs of previously discarded batteries were salvaged from the OR and donated to charity or redistributed in the hospital ($9,000 annual savings). A "Power Down" initiative to turn off all anesthesia and OR lights and equipment not in use resulted in saving $33,000 and 234.3 metric tons of CO2 emissions reduced per year. Converting from soap to alcohol-based waterless scrub demonstrated a potential saving of 2.7 million liters of water annually. Formation of an OR committee dedicated to ecological initiatives can provide a significant opportunity to improve health care's impact on the environment and save money.

Impact of Reusable Cloth Menstrual Pads on Unidentified Complaints of Female Students

Impact of Reusable Cloth Menstrual Pads on Unidentified Complaints of Female Students

Is there a risk of cross-infection from laundered reusable bedpads?

The risk of cross-infection from reusable incontinence bedpads was assessed by determining their microbial content after one night's use by incontinent adults and after laundering using the standard foul wash procedure specified by the NHS Executive (NHS E, 1995) (which includes heat disinfection at 71 degrees C for 3 minutes). Measurements were made on a total of 145 bedpads from five different product designs. It was found that effective laundering destroyed all known pathogenic organisms, although some commensal flora were isolated in small numbers (mean 12.2 colony forming units/ml). It is concluded that laundering reusable incontinence pads using the foul wash procedure leaves pads safe for multiple patient reuse with no demonstrable risk of cross-infection.