Women In Low-income Countries Research Articles

Clinical assessment of micronutrient deficiencies among children (1- 5 years) enrolled in anganwadis of old Hubli slums, Karnataka, India

Background: Micronutrients are vitamins and minerals required in small amounts that are essential to our health, development, and growth. As tiny as the amounts are, however, the consequences of their absence are severe. Iodine, vitamin A and iron are most important in global public health terms; their lack represents a major threat to the health and development, particularly children and pregnant women in low-income countries. The objectives were to clinically evaluate micronutrient deficiencies among children aged 1-5 years enrolled in anganwadi’s of old Hubli.Methods:A community-based cross-sectional study was carried out on 100 children enrolled in the anganwadis of Hubli slums for signs and symptoms of micronutrient deficiency.Results: Pallor was found in 78% children and delayed developmental milestones in 20% followed by delayed eruption of teeth in 17%. Among the studied group 37% had dry hair and dry skin. Vitamin A, B, C, D deficiency was seen in 1%, 29%, 14%, 38% respectively.Conclusions:The study concludes micronutrient deficiencies are prevalent among preschool children more so in with higher birth order having partial immunization. This appeals effective implementation of national health programmes, which can play a crucial role in addressing the hidden hunger. Correcting micronutrient deficiencies can significantly reduce childhood mortality and morbidity.

Pregnancy and birth in the global South: a review of critical approaches to sociocultural risk illustrated with fieldwork data from northern Uganda

In this article, I examine whether a critical approach to risk is relevant to pregnancy and maternity care in global South settings and I illustrate my review of current literature with examples from fieldwork I conducted in northern Uganda in 2012. Coxon, in a Health, Risk & Society editorial entitled ‘Risk in pregnancy and birth: are we talking to ourselves?’ (2014, Health, Risk & Society, 16(6), 481–493), noted that the analysis of risk in pregnancy has tended to focus on ‘relatively privileged women in high-income countries’ (p. 490), a narrow lens that in her view not only led to an account that was ‘highly partial’ but also contributed to theory in this area being overly focused on individual accounts, rather than structural inequalities. In this article, I draw on my experiences researching and writing about maternity care in Uganda, to consider whether and how a critical approach to sociocultural risk is relevant in low-income global South countries, as well as how a shift in lens to include less privileged women in low-income countries also shifts the theoretical contribution of a critical risk approach. I examine screening and surveillance as well as risk subjectivity, areas central to the discussion of risk and pregnancy, and find that a critical approach to risk offers insight into new forms of control and new discourses of responsibility. At the same time, I note that the social, political and medical contexts shaping both clinical and critical sociocultural approaches to risk have not occurred universally, and the critiques developed by scholars in and of the global North are not directly transferable to global South settings. Overall, I find that a critical approach to risk is indeed relevant and points to specific cases and discourses where such a lens is particularly valuable.

A descriptive longitudinal study protocol: recurrence and pregnancy post-repair of obstetric fistula in Guinea.

BackgroundObstetric fistula is a serious medical condition which affects women in low income countries. Despite the progress of research on fistula, there is little data on long term follow-up after surgical repair. The objective of this study is to analyse the factors associated with the recurrence of fistula and the outcomes of pregnancy following fistula repair in Guinea.MethodsA descriptive longitudinal study design will be used. The study will include women who underwent fistula repair between 2012 and 2015 at 3 fistula repair sites supported by the Fistula Care Project in Guinea (Kissidougou Prefectoral Hospital, Labé Regional Hospital and Jean Paul II Hospital of Conakry).Participants giving an informed consent after a home visit by the Fistula Counsellors will be interviewed for enrolment at least 3 months after hospital discharge The study enrolment period is January 1, 2012 − June 30, 2015. Participants will be followed-up until June 30, 2016 for a maximum follow up period of 48 months. The sample size is estimated at 364 women.The cumulative incidence rates of fistula recurrence and pregnancy post-repair will be calculated using Kaplan-Meier methods and the risk factor analyses will be performed using adjusted Cox regression. The outcomes of pregnancy will be analysed using proportions, the Pearson’s Chi Square (χ2) and a logistic regression with associations reported as risk ratios with 95 % confidence intervals. All analyses will be done using STATA version 13 (STATA Corporation, College Station, TX, USA) with a level of significance set at P < 0.05.DiscussionThis study will contribute to improving the prevention and management of obstetric fistula within the community and support advocacy efforts for the social reintegration of fistula patients into their communities. It will also guide policy makers and strategic planning for fistula programs.Trial registrationClinicalTrials.gov Identifier: NCT02686957. Registered 12 February 2016 (Retrospectively registered).

Should low-income countries invest in breast cancer screening?

With the increase in incidence and mortality of breast cancer in low-income countries (LICs), the question of whether LICs should promote breast cancer screening for early detection has gained tremendous importance. Because LICs have limited financial resources, the value of screening must be carefully considered before integrating screening programs into national healthcare system. Mammography-the most commonly used screening tool in developed countries-reduces breast cancer-specific mortality among women of age group 50-69, but the evidence is not so clear for younger women. Further, it does not reduce the overall mortality. Because the women in LICs tend to get breast cancer at younger age and are faced with various competing causes of mortality, LICs need to seriously evaluate whether mammographic screening presents a good value for the investment. Instead, we suggest a special module of clinical breast examination that could provide similar benefits at a very low cost. Nevertheless, we believe that LICs would obtain a much greater value for their investment if they promote primary prevention by tobacco cessation, healthier food and healthier lifestyle campaigns instead.

English

Earlier studies conducted in Africa have generally generated evidence that women in low income countries have a high physical workload that is sustained during pregnancy. This high physical workload was believed to contribute to the high incidence of low birth weight. However, there are only few published studies on physical activity among pregnant women in low-income countries, and most have been based on questionnaires. This research aims to explore the status of physical activity and factors influencing physical activity in pregnant women in Africa. Pubmed, Scopus and Cinahl databases were searched with no date restrictions using the Mesh terms “pregnancy”, “physical activity”, “exercise” and “Africa”. Articles were independently screened by 2 reviewers. A meta-analysis could not be done due to the heterogeneity of the articles hence a narrative synthesis of evidence was done instead. The results revealed a total of 5 articles from Africa. The major form of physical activity reported was household activities which fall below the recommended intensity during pregnancy. Physical activity tended to decrease as pregnancy progressed. The study thus, low levels of physical activity in pregnancy are prevalent in developing countries as well as in developed countries. However existing published data are too few to generalize to the whole of the African continent household activities. Key words: Pregnancy, exercise, physical activity

Raising Questions About Capitalist Globalization and Universalizing Views on Women: A Transnational Feminist Critique of the World Development Report: Gender Equality and Development.

Nursing in the United States has embraced global health primarily from a clinical perspective, with emphasis on care delivery to populations in underserved, resource-poor settings. Less attention has been devoted to developing expertise about social, economic, and political contexts that produce ill health around the world. The purpose of this article is to offer a transnational feminist critique of the World Development Report: Gender Equality and Development and to illuminate implications such reports may have in the lives of the world's most marginalized women and girls. We examine the political economy idealized in the report, raising questions about the capitalist framework underpinning its agenda. Second, we examine the assumptive language used in the report, suggesting that it discursively constructs a problematic representation of women in low-income countries. We contend that the report perpetuates a hegemonic discourse of patriarchy and inequality for women in the Global South through the use of an uncontested economic framework and universalist reasoning. We conclude the article with discussion about a transformative policy making that could be more inclusive of the wisdoms, values, and everyday experiences of women living in the Global South and about the vital role nurses can play in advancing gender equity through their active collaboration in policy critique and policy formulation.

Micronutrient deficiencies in pregnancy worldwide: health effects and prevention.

Micronutrients, vitamins and minerals accessible from the diet, are essential for biologic activity. Micronutrient status varies widely throughout pregnancy and across populations. Women in low-income countries often enter pregnancy malnourished, and the demands of gestation can exacerbate micronutrient deficiencies with health consequences for the fetus. Examples of efficacious single micronutrient interventions include folic acid to prevent neural tube defects, iodine to prevent cretinism, zinc to reduce risk of preterm birth, and iron to reduce the risk of low birth weight. Folic acid and vitamin D might also increase birth weight. While extensive mechanistic and association research links multiple antenatal micronutrients with plausible materno-fetal health advantages, hypothesized benefits have often been absent, minimal or unexpected in trials. These findings suggest a role for population context in determining health responses and filling extensive gaps in knowledge. Multiple micronutrient supplements reduce the risks of being born with low birth weight, small for gestational age or stillborn in undernourished settings, and justify micronutrient interventions with antenatal care. Measurable health effects of gestational micronutrient exposure might persist into childhood but few data exists on potential long-term benefits. In this Review, we discuss micronutrient intake recommendations, risks and consequences of deficiencies, and the effects of interventions with a particular emphasis on offspring.

Pregnant Women Diet Quality and Its Sociodemographic Determinants in Southwestern Bangladesh.

Diet diversity of pregnant women is associated with nutrition sufficiency, micronutrient adequacy, and pregnancy outcomes. However, the sociodemographic determinants of diet diversity among pregnant women in low-income countries are not well studied. The analysis was undertaken to study the determinants of high dietary diversity and consumption of micronutrient-rich foods by pregnant women from rural Bangladesh. Pregnant women (508) were randomly selected from southwestern Bangladesh and interviewed to collect data about diet and sociodemographic characteristics. A 24-hour recall was used to collect information about diet. Diet diversity score was calculated for 9 major food groups. All analyses were conducted using STATA SE 12. The overall mean diet diversity score was low at 4.28 and was significantly high among pregnant women who have higher educational achievement, whose husbands' occupation was business, who live in households of 4 or more family members, and who were dwelling in a house with more than 1 room. Highest gap on knowledge and consumption was reported for 3 food groups including dairy foods, eggs, and dark green leafy vegetables. Consumption of dairy and eggs was lower among women from low socioeconomic status, but no significant association was found between sociodemographic characteristics and consumption of leafy vegetables. Our analysis has shown that diet quality of pregnant women was poor and intake of micronutrient-rich foods was low despite having knowledge about the importance of these foods, underscoring the need for promoting the diet quality in developing countries through behavior change communication programs.

The Role of Cultural Beliefs in Accessing Antenatal care in Malawi: A Qualitative Study.

The World Health Organization in 2002 recommended a focused antenatal care model of four visits for women in low-income countries. Despite the high percentage of mothers (95%) who see a skilled attendant and the adaptation of the recommended antenatal model, only 46% of Malawian mothers meet the recommendation. The purpose of this study was to identify the cultural beliefs that influence women's antenatal care or pregnancy-related health care decisions. Twenty pregnant mothers and eight health workers from two urban tertiary care hospitals in Malawi were recruited to participate in a qualitative study assessing barriers to antenatal care. Data were collected between September and December 2014 through face-face, audio-recorded interviews, and a demographic survey. Identified maternal cultural beliefs included: seeking advice from village elders, spousal fidelity, and disclosing pregnancy. Health workers mentioned that providers often held the same cultural beliefs and, therefore, turned women away if they tried to go against cultural norms. Cultural beliefs play an integral role in the decision-making process of antenatal care. Specifically, the belief and practice of when to disclose pregnancy prohibits women from seeking antenatal care in the first trimester.

Awareness that early cancer lump is painless could decrease breast cancer mortality in developing countries.

There are several factors which contribute to patients' reporting late to healthcare facility even after detecting the breast lump (patient delay). Amongst these, one of the important factors in low- and middle-income countries is lack of awareness that early cancer lump is painless (ECLIPs). Pain is often taken as a danger sign and absence of pain is often not taken seriously. The studies have shown that up to 98% of women in low-income countries are unaware that a painless lump could be a warning sign of early breast cancer. This fact is significant because this could be one of the prime reasons for the women having discovered a painless lump in the breast, accidentally or by breast self-examination, presume it to be harmless and don't report early to health care facility. Therefore, creating awareness about ECLIPs could be an effective strategy to reduce mortality due to breast cancer in low- and middle-income countries. Moreover, unlike modifying risk factors which requires long term behavior modification, creating awareness about ECLIPs is easy and cost effective.

Contractual Transaction: How Renting a Uterus Makes the Human Body a Commodity in Nepal

The issue of surrogate motherhood has started public debates in Nepal. With surrogacy a child becomes the object of a legal transaction, while the surrogate mother is used, in effect as an incubator, and the hospital declares commissioned parents’ name of a newborn child. The poor women in low-income countries have been used as means to compensate for the reproductive deficiencies of high-income infertile parents. Do purchasing cheaper services, receiving surrogates easier, and having the possibility of gender selection, all in the poor countries, support ‘surrogacy tourism’ or is it a kind of exploitative relationship? Until today, Nepal’s laws do not have any specific provision to deal with surrogacy and, therefore, it is urgent to address the challenges with commercial surrogacy and establish a precise legal policy.

The time has come to make cervical cancer prevention an essential part of comprehensive sexual and reproductive health services for HIV-positive women in low-income countries.

IntroductionHIV and cervical cancer are intersecting epidemics that disproportionately affect one of the most vulnerable populations in the world: women in low- and middle-income countries (LMICs). Historically, the disparity in cervical cancer risk for women in LMICs has been due to the lack of organized screening and prevention programmes. In recent years, this risk has been augmented by the severity of the HIV epidemic in LMICs. HIV-positive women are at increased risk for developing cervical precancer and cancer, and while the introduction of antiretroviral therapy has dramatically improved life expectancies among HIV-positive women it has not been shown to improve cancer-related outcomes. Therefore, an increasing number of HIV-positive women are living in LMICs with limited or no access to cervical cancer screening programmes. In this commentary, we describe the gaps in cervical cancer prevention, the state of evidence for integrating cervical cancer prevention into HIV programmes and future directions for programme implementation and research.DiscussionDespite the biologic, behavioural and demographic overlap between HIV and cervical cancer, cervical cancer prevention has for the most part been left out of sexual and reproductive health (SRH) services for HIV-positive women. Lower cost primary and secondary prevention strategies for cervical cancer are becoming more widely available in LMICs, with increasing evidence for their efficacy and cost-effectiveness. Going forward, cervical cancer prevention must be considered a part of the essential package of SRH services for HIV-positive women. Effective cervical cancer prevention programmes will require a coordinated response from international policymakers and funders, national governments and community leaders. Leveraging the improvements in healthcare infrastructure created by the response to the global HIV epidemic through integration of services may be an effective way to make an impact to prevent cervical cancer among HIV-positive women, but more work remains to determine optimal approaches.ConclusionsCervical cancer prevention is an essential part of comprehensive HIV care. In order to ensure maximal impact and cost-effectiveness, implementation strategies for screening programmes must be adapted and rigorously evaluated through a framework that includes equal participation with policymakers, programme planners and key stakeholders in the target communities.

Expanding availability of safe abortion services through private sector accreditation: a case study of the Yukti Yojana program in Bihar, India.

BackgroundRecognizing the need to increase access to safe abortion services to reduce maternal mortality and morbidity, the state government of Bihar, India introduced an innovative mechanism of accrediting private health care facilities. The program, Yukti Yojana (‘a scheme for solution’), accredits eligible health facilities and supports them in providing abortion-related services free of charge to rural and low-income urban women. This paper describes implementation of Yukti Yojana.MethodsA descriptive analysis of abortion services provided under the Yukti Yojana program was conducted using four data sources: 1) assessment of accredited facilities over 6 months; 2) induced and incomplete abortion service registers; 3) client exit interviews and associated direct observation of client-provider interaction for a sample of accredited facilities; and 4) in-depth interviews with providers and key stakeholders responsible for providing or influencing abortion services. These analyses assessed characteristics of women receiving abortion services, quality of care and client satisfaction, and barriers and facilitating factors of a successful accreditation process.ResultsForty-nine private facilities were accredited during the first two years of the program, and 84 % had begun providing abortion services, in all 27,724 women were served. Overall, 53 % of beneficiaries reported holding a “Below Poverty Line” card, while 71 % had low living standard. The majority of women (n = 569) reported satisfaction (90 %) with their care, while 68 % perceived good quality of services. Having a government-led initiative was considered a key element of success, while stringent requirements for site approval, long waiting time for accreditation, complicated and delayed reimbursement process and low reimbursement fees for abortion services were identified as barriers to implementation.ConclusionsYukti Yojana provides a model for successfully involving private OB/GYNs and general physicians to deliver safe abortion services to poor women on a large scale and offers additional evidence that public-private partnerships can be used to ensure availability of high-quality maternal health services to women in low-income countries. Private facility accreditation also offers a promising solution to the limited availability of safe abortion services in low resource settings such as Bihar, India.

Agenda setting for maternal survival: the power of global health networks and norms.

Nearly 300,000 women--almost all poor women in low-income countries--died from pregnancy-related complications in 2010. This represents a decline since the 1980s, when an estimated half million women died each year, but is still far higher than the aims set in the United Nations Millennium Development Goals (MDGs) at the turn of the century. The 1970s, 1980s and 1990 s witnessed a shift from near complete neglect of the issue to emergence of a network of individuals and organizations with a shared concern for reducing maternal deaths and growth in the number of organizations and governments with maternal health strategies and programmes. Maternal health experienced a marked change in agenda status in the 2000s, attracting significantly higher level attention (e.g. from world leaders) and greater resource commitments (e.g. as one issue addressed by US$40 billion in pledges to the 2010 Global Strategy for Women's and Children's Health) than ever before. Several differences between network and actor features, issue characteristics and the policy environment pre- and post-2000 help to explain the change in agenda status for global maternal mortality reduction. Significantly, a strong poverty reduction norm emerged at the turn of the century; represented by the United Nations MDGs framework, the norm set unusually strong expectations for international development actors to advance included issues. As the norm grew, it drew policy attention to the maternal health goal (MDG 5). Seeking to advance the goals agenda, world leaders launched initiatives addressing maternal and child health. New network governance and framing strategies that closely linked maternal, newborn and child health shaped the initiatives. Diverse network composition--expanding beyond a relatively narrowly focused and technically oriented group to encompass allies and leaders that brought additional resources to bear on the problem--was crucial to maternal health's rise on the agenda in the 2000s.

Saving for delivery through technology: an inquiry into an electronic commitment savings product for maternal healthcare in Kenya.

Many women in low-income countries cannot afford maternal healthcare services. Changamka, a Kenyan company, developed an electronic, stored-value card to help pregnant women save for maternal healthcare at a Nairobi hospital. This paper reports results from a mixed-methods process evaluation of the card's implementation. The study found high levels of uptake and identified several benefits of the program, such as facilitating payment for services. The evaluation also identified several challenges. Most users completed only one transaction before discontinuing card use; only 6% of women who acquired the card used it to pay for delivery, and slightly less than 1% used it as it was originally intended-to pay for several antenatal care visits and for delivery. According to respondents, the main reason for this discontinuation was a lack of understanding about how to use the card. Users were, on average, of a higher socioeconomic and educational status than non-card users. Most users obtained the card in their third trimester, and among those who used the card to save for delivery, most started to do so too late in pregnancy to accumulate sufficient savings to pay for that service. Copyright © 2015 John Wiley & Sons, Ltd.

Use of mental health services by women in low and middle income countries

Purpose – The purpose of this paper is to examine sex differences in mental health service usage among upper-middle, lower-middle, and low-income countries (LICs). Design/methodology/approach – Data from 62 low- and middle-income countries (LAMICs) were collected with the World Health Organization – Assessment Instrument for Mental Health Systems (WHO-AIMS). Sex differences in mental health service utilization were assessed by comparing the proportion female in the general population with the proportion female treated for mental illness in five different types of mental health facility. Findings – Two-sided t-tests for significance (a=0.05) revealed a significant difference between the proportion female in the population and the proportion treated in inpatient facilities (community-based and mental hospitals) in LICs. There was also a trend toward decreased use of outpatient facilities by women in LICs (p=0.08). Lower-middle and upper-middle income countries showed no differences. In day treatment facilities for the entire sample, there was a significant difference between the proportion female in the population and the proportion treated female (weighted mean difference overall=0.10, p=0.035). Research limitations/implications – The authors found significantly reduced utilization of mental health services by women in LICs in community-based inpatient facilities and mental hospitals and a trend toward decreased use in outpatient facilities. Future studies investigating the factors contributing to the lower utilization of services by women in LICs are essential. Originality/value – This study presents the first comprehensive study of mental health service usage by sex in 62 LAMICs.

Fish-enhanced and soybean-enhanced supplemental snacks are acceptable among pregnant women in rural Kenya.

Although animal-source foods provide a rich source of complete protein and a variety of micronutrients, a majority of these foods are not accessible to a large proportion of populations in low-income nations. Locally available and affordable nutrient-dense dietary solutions that are accessible all year round can provide the most viable solution to improving food and nutrition security for these vulnerable populations. However, their potential to improve nutritional status among pregnant women has not been documented. The study was conducted to help guide the development of fish-enhanced and soybean-enhanced supplemental snacks and evaluate their acceptability among pregnant women in rural Kenya. We developed fish-enhanced and soybean-enhanced snacks using the small local lake fish omena (Rastrineobola argentea) and soybean flour. A cross-sectional study design was used to assess snack acceptance levels among HIV-infected and -noninfected pregnant women, two high-risk groups for nutrient deficiencies. Overall, 96%, 80%, and 81% of participants, indicated that they liked the taste, odor, texture, and color of wheat, fish-enhanced, or soybean-enhanced snacks, respectively. No significant differences were noted across participants' HIV status. Focus group discussions with the women further supported results from the quantitative ratings. Our analysis demonstrates the feasibility of developing acceptable, nutrient-dense food supplements using locally available foods in rural Kenya and contributes culturally acceptable, affordable, and sustainable solutions to the problem of undernutrition among pregnant women in low-income countries in sub-Saharan Africa.

Expression of HPV-16 L1 capsomeres with glutathione-S-transferase as a fusion protein in tobacco plastids: An approach for a capsomere-based HPV vaccine

Human Papillomavirus (HPV) is the main cause of cervical cancer, which is the second most severe cancer of women worldwide, particularly in developing countries. Although vaccines against HPV infection are commercially available, they are neither affordable nor accessible to women in low income countries e.g. Africa. Thus, alternative cost-effective vaccine production approaches need to be developed. This study uses tobacco plants to express pentameric capsomeres of HPV that have been reported to generate elevated immune responses against HPV. A modified HPV-16 L1 (L1_2xCysM) protein has been expressed as a fusion protein with glutathione-S-transferase (GST) in tobacco chloroplasts following biolistic transformation. In total 7 transplastomic lines with healthy phenotypes were generated. Site specific integration of the GST-L1_2xCysM and aadA genes was confirmed by PCR. Southern blot analysis verified homogenous transformation of all transplastomic lines. Antigen capture ELISA with the conformation-specific antibody Ritti01, showed protein expression as well as the retention of immunogenic epitopes of L1 protein. In their morphology, GST-L1 expressing tobacco plants were identical to wild type plants and yielded fertile flowers. Taken together, these data enrich knowledge for future development of cost-effective plant-made vaccines against HPV.

Surveillance and response system for maternal deaths in Sri Lanka: an audit

BackgroundMany women in low-income countries die from pregnancy-related causes. Review of maternal deaths can help to prevent such deaths and improve delivery of maternal care services, but audits of maternal deaths are not easy to do in resource-poor settings. We audited probable maternal deaths reported during 2012 in Sri Lanka. MethodsWe analysed data for death collected by the Family Health Bureau, which coordinates audits of maternal death in Sri Lanka. Field and hospital health staff are required to notify deaths, do post mortems, investigate, and report to national level each maternal death. We analysed each death related to three delays: in seeking health care, in reaching a health facility, and in treatment. We asked health-care workers in 26 districts to suggest strategies to change and improve service delivery. FindingsOf 218 probable maternal deaths, we classified 134 as maternal deaths (WHO definition) and calculated the national maternal mortality rate (37·7 per 100 000 live births). Haemorrhage (n=22) and heart disease (n=15) were leading causes of death. Women who died tended to be well educated (n=109, 81%) and from rural regions (n=106, 79%). 92 (69%) of these women died in the postnatal period. Delays in seeking health care contributed to 64 deaths (71%), whereas delays in receiving treatment contributed to 54 (60%) and delays in reaching a health facility contributed to two (2%). Not promoting family planning, substandard management, and inadequate field post-natal care were identified as deficiencies. InterpretationSri Lanka implements a systematic surveillance of maternal deaths at low cost, with involvement of key partners to further reduce deaths and improve care. Such a system is replicable in any setting if launched methodically and in collaboration with committed partners. FundingNone.

Menstrual management: a neglected aspect of hygiene interventions

Purpose– Effective menstrual management is essential for the mental and physical well being of women. However, many women in low-income countries lack access to the materials and facilities required. They are thus restricted in their activities whilst menstruating thus compromising their education, income and domestic responsibilities. The paper aims to discuss these issues.Design/methodology/approach– This study describes the menstrual management challenges faced by women in an emergency situation in Uganda. Totally, 50 interviews and focus group discussions were conducted with women from villages, internally displaced person (IDP) camps and schools so that the menstrual management of the host population could be compared with the IDPs.Findings– This study showed that in IDP camps there was a significant lack of materials including soap, underpants and absorbing cloth, and facilities like latrines and bathing shelters. As a consequence women in IDP camps suffer with poor health and diminished dignity. There is also a lack of education about menstruation and reproductive health and practices are strongly influenced by cultural taboos.Originality/value– This is the first time that the menstrual management of women in IDP or refugee camps has been studied.