1. Mbvizo & Collegues ( 1997)
Tested menstrual knowledge by assessing students answers to questions about menstruation judged to represent low risk of bias as the ability to answer accurately was unlikely to be altered by lack of blinding. There was consideredable altrition in wilson etal as authors were unable to follow up one intervention school.
2. Djalalinia & Collegues
These are started in text that 5% of the sample was lost of follow up, however reported N’s deviate from these figure with 1231 participants of 1823 (67.5%) with even smaller numbers displayed in results tables.
3. Abedian et al study
He found a large positive impact of education ojn menstrual knowledge.On average, scores on the 10 item test designed by study authors increased from 3.86 to 8.99.
The study used the MAQ to assess attitudes & found medium to large effects on most sub scales.
4. Fetohy study
He found a large positive effects of education on menstrual attitudes compared to controls however menstrual attitude was conceptualised an attitude towards healthy practices which fails capture attitudes towards experiencing menstruation and is not comparable to other studies Fetohy found a large differences in menstrual knowledge post education, with intervention and controll groups differing by approxmately 10 points on a test scored from 0 to 33. Similarly there was a large standardised mean difference between intervention and control students in self reported hygiene behaviours. However, this outcome was measured immediately after single session of education. Leaving students no time to have changed behaviours. Thus, these result is likely to represent recall bias / Social desirability effects and demonstrates the biases inherent in self - reported behavioural outcomes, particularly where blinding to condition is not possible.
5. Sumpter & Torondel ( 2012)
Conducted the only systemic review of MHM interventions focusing on health outcomes. The review included some education and social outcomes, but had a number of limitations. First, pre test and post test comparisons and observational studies were symthesized along side rondomised controlled trials despite representing different risks of bias. Second, the review searched only - peer - reviewed journals thus missed the wider grey literature. Third, only limited terms ‘school’ & education were used to search for education out comes. Only social restrictions such as restricting diet / interations during menstruation, rather than psyco social consequences described in the literature, were included. The review did not discuss the inclusion / exclusion of wash interventions.
6. Ethiopian Study
An ethiopian study suggests that many other factors play a larger roll in keeping girls out of school(30). Althrough 43% of respondents miss school because of menstruation, this factor ranks low on the consensus analysis performed on all the survey that contribute to school absence (30). Menstruation ranks ninth out of 10 factors attributable to items for school absence. Other items such as early marriage, absent parents, work load,family poverty, general disinterest, feeling that school is un important and distance rank higher than menstruation on the consensus analysis (30).
7. A Kenyan Survey
This demonstrates that girls have difficulty in decribing menstruation in biological terms. This survey among females leaving in an informal urban settlement demonstrate that only a minority of the participants are able to describe menstruation in biological terms (15). There is also a discrepancy is perceived knowledge versus correct knowledge among school girls. In a nigerian study, the data shows that 85% of school girls perceive they possess correct knowledge (3).While the perceived knowledge of respondents is not influenced by parental education, girls with correct knowledge are more likely to have parents with atleast a secondary education. Similarly, parents with atleast the secondary are more likely to have a pre menarchral discussion to prepare their daughters for menses than those with lower education levels (3)
8. Findings from Nigerian Study
It suggest that women in the rural communities communicate with a girl about the onset of menstruation by preparing special food for her. And the rest of the house, passing on warnings about staying away from boys & about pregnancy risks (11) . Often the massages are delivered in harsh tones, and some times false informations is passed along. Other families secretely rejoice when a daughters matures to womanhood. When probed further about discussing menstruation with their daughters, the women convey they often impast traditional practises and knowledge that they learned from their own mothers. Some others believe it is important to talk to their daughters about menstruation and they would like to be able to share bilogical information about menstruation.
9. Ugandan Study demonstrates
It demonstrates that most girls from poor urban settings learn about menstruation from theri peers & Sisters, while the majority of girls from rural areas receive information fron their mothers. Findings suggests that the rural mothers feel more comfortable discussing menstration with their daughters than the urban poor mothers who typically stay silent (12)
10. A descriptive cross sectional study
It was conducted among 160 adolescent girls of a secondary school with the help of a pre - designed & pre tested questionnaire. Data were analyzed statistically by simple proportions. Out of 160 respondents 108 ( 67.5%) girls were aware about menstruation prior to attainment of menarche. Mother was the first informant regarding menstruation in case of 60 (37.5%) girls. 138 (86.25%) girls believed it is a physicological process, 78 (48.75%) girls knew that use of sanitary pad during menstruation. Regarding practices only 18 (11.25%) girls used sanitary pads during menstruation. For cleaning purpose 156 (97.5%) girls used both soap and water.
11. A participatory action study
It was conducted at primary health centres in 23 villages to study the effect of a community based health education intervention on awarness and behaviour change of rural adolescent girls regarding their management of menstrual higiene. Study objects were unmarried rural adolescent girls (12-13 years). Programme for appropriate technology for health guidelines were used to develop a pre tested hand made flip book containing needs based key massages about the management of menstrual hygiene. The messages were delivered at monthly meetings of village based groups of adolescent girls. After 3 years the effect of the messages was assessed using a combination of quantitative and qualitative methods. Significantly more adolescent girls (55%) were aware of menstruation before its initation compared with baseline (35%).The practice of using readymade pads increased significantly from 5 to 25% and reuse of cloth declined from 57 to 85%.
12. A matched cross control study
It was conducted on are unhygienic practices during the menstrual partum & post parten periods risk factors for secondary in fertility in selected population. Four hundred cases were selected from five infertility clinics affiliated with tertiary care hospitals. After taking written consent trained interviewers conducted interviewes using a pre tested structured questionnaire. Factors found to the independently associated with secondary infertility were previous delivery at an unclean place, delivery by a birth attendant without washing hands with soap, use of unclean material for absorption of lochia. Non washing of perineal area after urination & insertion of homemade vaginal medications.
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