A multifaceted menstrual health intervention to improve psychosocial outcomes and menstrual practices among secondary schoolgirls in Northwest Tanzania: a pilot intervention study.

Abstract

Introduction: Schools provide an important opportunity to sustainably reach and improve menstrual experiences and outcomes among adolescent girls. This study examined changes in psychosocial outcomes and menstrual practices after a pilot menstrual health intervention in schools in Northwest Tanzania.

Methods: We conducted a pre/post evaluation of a pilot menstrual health intervention in four schools in Mwanza region. The intervention included: (i) 10-hours comprehensive menstrual sexual and reproductive health (MSRH) education curriculum delivered over 5 days, (ii) distribution of menstrual management kits, (iii) improvement of school WASH facility guided by needs, and (iv) training on menstrual pain management strategies, supply of pain killers and training a specific teacher on dispensing. The primary outcome was measured using the Menstrual Practices Need Scale (MPNS). We assessed seven secondary outcomes: menstrual pain management practice; self-efficacy in managing menstruation; menstrual-related anxiety; self-reported urogenital infection symptoms; MSRH knowledge; participation in school during menstruation; and school climate score. We used linear (for MPNS, and school climate score), and logistic (for remaining secondary outcomes) random-effect regression models to examine changes in outcomes between baseline and endline.

Results: A total of 486 schoolgirls (mean age 15.6 years [SD 1.3]) were recruited for the baseline survey; of these 396 participated in the endline survey. At 12-months follow up, menstrual experience improved for MPNS-36 subscales of transport and menstrual material needs, (mean difference (MD), 0.52; 95% CI 0.38-0.66), and menstrual material reuse needs, (MD 0.32; 0.14-0.50), while menstrual materials reuse insecurity did not change, (MD -0.08; -0.27-0.11). For the secondary outcomes, there was an increased use of analgesics for menstrual pain management, (OR 2.21; 95% CI 1.33-3.67); improved self-efficacy for managing menstruation, (OR 2.02; 1.35-3.04); MSRH knowledge, (OR 5.23; 3.25-8.39), participation in school (OR 2.80; 1.89-4.16) and reduced menstrual-related anxiety, (OR 0.38; 0.25-0.59). There was no evidence of change in self-reported urogenital symptoms, (OR 0.71; 0.49-1.01) or school climate, (MD 0.05; -0.19-0.28).

Conclusion: The pilot intervention showed improvements in menstrual practices, psychosocial outcomes and school participation among schoolgirls but had no effect on school climate or self-reported urogenital symptoms. Stronger evidence from rigorously designed trials is needed to confirm the effectiveness of the intervention and scalability of these findings.