Menstrual health and education, health and well-being outcomes Other
Conditions
Interventions
This study will be an open-cohort cluster randomised control trial with 60 schools (clusters) randomised 1:1 to two arms, with a mixed-methods process evaluation, and economic and policy analyses to e
Sponsors
London School of Hygiene & Tropical Medicine
Eligibility
Sex/Gender
All
Age
11 Years to 21 Years
Inclusion criteria
Inclusion criteria: Current inclusion criteria as of 18/12/2023: School-level inclusion criteria: 1. Mixed-sex secondary schools with S1–S4 classes 2. Day or mixed day/boarding schools. 3. At least minimal WASH facilities (including an improved water source and sex-specific sanitation facilities that are functional, usable, and accessible to female students at the time of the rapid assessment eligibility survey) 4. Estimated enrolment of 50–125 female S1 students in Wakiso and 40–125 female students in S1 in Kalungu, based on the 2019 report on the Master List of Education Institutions in Uganda School-level exclusion criteria: 1. Schools that are currently participating in a menstrual health-related programme 2. Boarding schools with no day students 3. Single-sex schools 4. Schools exclusively for students with disabilities 5. Schools where more than approximately ~10% of students or parents of students do not understand Luganda or English Participant-level inclusion criteria: 1. Female students in the class cohort of S2 in 2022 who were enrolled in a trial school at the time of the baseline and/or endline survey 2. Male students in the class cohort of S2 in 2022 who were enrolled in a trial school at the time of the baseline survey 3. For the diary sub-study, female trial participants were eligible if they reported having started menstruation at the time of the baseline survey Previous inclusion criteria: 1. All female students starting Secondary 2 during 2021/2022 who are present and whose parents have given consent will be eligible for the baseline survey and to receive the intervention. 2. A simple random sample of ~15 male students (starting S2 during 2021) per school (900 total) who are present during Q4 2021 will be selected to participate in the baseline survey and asked to provide assent for data collection. The sampling will be done by the trial statistician using the random-number generator in Stata 3. The endline survey and assessment will be in Q1-2 2023, and all female students present and who have given consent/assent for the research will be eligible, as will the male students with baseline data
Exclusion criteria
Exclusion criteria: Does not meet the inclusion criteria
Design outcomes
Secondary
| Measure | Time frame |
|---|---|
| Current secondary outcome measures as of 18/12/2023: 1. Knowledge of puberty and menstruation; myths & attitudes towards menstruation (among all girls and a random sample of boys) reported by participants at endline measured by the number of knowledge items answered correctly (N=9) and myths/attitudes items answered correctly (N=3) Among all girls: 2. Menstrual practices at last menstrual period (LMP) reported by participants at endline by direct questions (the odds of using only adequate menstrual materials that are appropriately cleaned or disposed of at LMP), and the mean score on the Menstrual Practice Needs Scale 3. Pain management during LMP reported by participants at endline by direct questions (the odds of using at least one effective pain management method and no ineffective methods) 4. Self-efficacy in addressing menstrual needs experiences at LMP measured using the mean score on Self-efficacy in Addressing Menstrual Needs Scale at endline 5. Quality of life reported by participants using the mean CHU9D score with Ugandan tariffs at endline 6. Symptomatic urinary tract infections (UTIs) measured as the odds of a positive test result from a urine sample if symptomatic at endline Among sample of ~1500 girls: 7. School and class absence during menses measured as the odds of school days and classes missed during period-days compared with non-period days, measured from a daily diary for approximately 3 months prior to endline 8. School and class absence overall measured as the odds of all school days with school and/or class absence (regardless of menstruation) measured from a daily diary for 3 months prior to endline 9. Self-confidence in Mathematics and science abilities reported by participants at endline measured using the TIMMS confidence scale Previous secondary outcome measures as of 08/08/2022: 1. Knowledge of puberty and menstruation; attitudes towards menstruation (among all girls and a random sample of boys) reported by participants at endline usin | — |
Primary
| Measure | Time frame |
|---|---|
| Among all girls included in the endline survey: 1. Educational attainment of girls independently and objectively evaluated by endline perfomance in a bespoke examination set by the Uganda National Exam Board, which will assess the maths, English and biology curricula taught during the intervention implementation year, adjusted for baseline exam performance. 2. Mental health symptoms assessed in all girls using the Total Difficulties Scale of the Strengths and Difficulties Questionnaire (SDQ-25) adjusted for baseline | — |
Countries
Uganda
Outcome results
None listed