Effectiveness of a menstrual health education program on psychological well-being and behavioral change among adolescent girls in rural Uganda





Menstrual hygiene, Adolescent girls, Reusable Sanitary Product, Psychosocial aspect


Objectives. Menstrual hygiene management is one of the main barriers to girls’ education attainment in low-and middle-income countries. Poor access to sanitary products and lack of menstrual knowledge affect students’ performance at school compared to the opposite sex. Limited evidence is available to provide solutions for schoolgirls. This study examines the effectiveness of menstrual health education programs on well-being and behavioral change among adolescent girls in rural Uganda.
Methods. A cluster randomized controlled trial was conducted across 3 schools, including 66 girls aged 13-17 years, in a rural village in Mukono District, Uganda. Schools were randomly allocated to 2 groups: i) health education program intervention and ii) control group (no intervention).
Results. After 5 weeks of the Health Education Program, the schoolgirls in experiment groups showed significantly less fear of sharing the menstruation-related concern with parents and pupils [Mean Difference (MD)=0.87, P=0.029) (MD=2.02, P=0.000), and the sense of shameful feelings during menstruation (MD=1.65, P= 0.004); conversely, the fear to go to school during menstruation did not differ between experiment and control groups (MD=-0.04, P=0.94). However, the changes in feeling comfortable having a period at school were significantly different between the experiment and control groups (P=0.001).
Conclusions. The study demonstrated promising results of a low-cost intervention for enhancing girls’ menstrual health education in a low-income context. Puberty education and reusable pad sewing provision were strongly associated with improving schoolgirls’ psychosocial wellbeing related to menstrual management.

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Jabbour HN, Kelly RW, Fraser HM, Critchley HOD. Endocrine regulation of menstruation. Endocr Rev 2006;27:17–46. DOI: https://doi.org/10.1210/er.2004-0021

Sommer M, Caruso BA, Sahin M, et al. A time for global action: addressing girls’ menstrual hygiene management needs in schools. PLoS Med 2016;13:e1001962. DOI: https://doi.org/10.1371/journal.pmed.1001962

Eijk AMV, Sivakami M, Thakkar MB, et al. Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis. BMJ Open 2016;6:e010290. DOI: https://doi.org/10.1136/bmjopen-2015-010290

Wall LL, Teklay K, Desta A, Belay S. Tending the ‘monthly flower:’ a qualitative study of menstrual beliefs in Tigray, Ethiopia. BMC Womens Health 2018;18:183. DOI: https://doi.org/10.1186/s12905-018-0676-z

Sperling GB, Winthrop R. What works in girls' education: evidence for the world's best investment. Washington D.C: Brookings Institution Press; 2015.

Adams J, Bartram J, Chartier Y, Sims J. Water, sanitation and hygiene standards for schools in low-cost settings. Geneva: World Health Organization; 2009. Available from: https://apps.who.int/iris/handle/10665/44159

Montgomery P, Ryus CR, Dolan CS, et al. Sanitary pad interventions for girls education in ghana: a pilot study. PLoS One 2012;7:e48274. DOI: https://doi.org/10.1371/journal.pone.0048274

Wilson E, Reeve J, Pitt A. Education. Period. Developing an acceptable and replicable menstrual hygiene intervention. Dev Pract 2014;24:63–80. DOI: https://doi.org/10.1080/09614524.2014.867305

Hyttel M, Thomsen CF, Luff B, et al. Drivers and challenges to use of menstrual cups among schoolgirls in rural Uganda: a qualitative study. Waterlines 2017;36:109–24. DOI: https://doi.org/10.3362/1756-3488.16-00013

Miiro G, Rutakumwa R, Nakiyingi-Miiro J, et al. Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): a feasibility study. BMC Womens Health 2018;18:4. DOI: https://doi.org/10.1186/s12905-017-0502-z

Montgomery P, Hennegan J, Dolan C, et al. Menstruation and the cycle of poverty: a cluster quasi-randomised control trial of sanitary pad and puberty education provision in Uganda. PLoS One 2016;11:e0166122. DOI: https://doi.org/10.1371/journal.pone.0166122

North S, Bishop E, Denavit C. MHM in Ten: advancing the MHM agenda in WASH in schools report. New York: UNICEF, 2016. Available from: https://menstrualhygieneday.org/wp-content/uploads/2017/03/2016-MHM-in-Ten-Meeting-Report.pdf (please confirm link) it is correct

Sommer M, Sutherland C, Chandra-Mouli V. Putting menarche and girls into the global population health agenda. Reproductive Health 2015;12:24. DOI: https://doi.org/10.1186/s12978-015-0009-8

Sommer M, Sahin M. Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls. Am J Public Health 2013;103:1556–9. DOI: https://doi.org/10.2105/AJPH.2013.301374

Kuhlmann AS, Henry K, Wall LL. Menstrual hygiene management in resource-poor countries. Obstet Gynecol Surv 2017;72:356–76. DOI: https://doi.org/10.1097/OGX.0000000000000443

Chandra-Mouli V, Patel SV. Mapping the knowledge and understanding of menarche, menstrual hygiene and menstrual health among adolescent girls in low- and middle-income countries. Reprod Health 2017;14:30. DOI: https://doi.org/10.1186/s12978-017-0293-6

Mcmahon SA, Winch PJ, Caruso BA, et al. The girl with her period is the one to hang her head. Reflections on menstrual management among schoolgirls in rural Kenya. BMC Int Health Hum Rights 2011;11:7. DOI: https://doi.org/10.1186/1472-698X-11-7

El-Gilany AH, Badawi K, El-Fedawy S. Menstrual hygiene among adolescent schoolgirls in Mansoura, Egypt. Reprod Health Matters 2005;13:147–52. DOI: https://doi.org/10.1016/S0968-8080(05)26191-8

Sumpter C, Torondel B. A systematic review of the health and social effects of menstrual hygiene management. PLoS ONE 2013;8:e62004. DOI: https://doi.org/10.1371/journal.pone.0062004

Sommer M, Hirsch JS, Nathanson C, Parker RG. Comfortably, safely, and without shame: defining menstrual hygiene management as a public health issue. Am J Public Health 2015;105:1302–11. DOI: https://doi.org/10.2105/AJPH.2014.302525




How to Cite

Yang, Y.-T., & Chen, D.-R. (2023). Effectiveness of a menstrual health education program on psychological well-being and behavioral change among adolescent girls in rural Uganda. Journal of Public Health in Africa, 14(3). https://doi.org/10.4081/jphia.2023.1971



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