CoChat
Sign Up
Cited by 160Menstrual Health and DisordersAdolescent Sexual and Reproductive HealthHypothalamic control of reproductive hormones

Measuring the prevalence and impact of poor menstrual hygiene management: A quantitative survey of schoolgirls in rural Uganda

Open access
Hennegan, Julie, Dolan, Catherine, Wu, Maryalice, Scott, Linda, Montgomery, Paul·2016·BMJ Open
DOI 10.1136/bmjopen-2016-012596PMC PMC5223625
Open this paper in CoChat — free accountOpen PDF

Abstract

Objectives: The primary objective was to describe Ugandan schoolgirls’ menstrual hygiene management (MHM) practices and estimate the prevalence of inadequate MHM. Second, to assess the relative contribution of aspects of MHM to health, education and psychosocial outcomes. Design: Secondary analysis of survey data collected as part of the final follow-up from a controlled trial of reusable sanitary pad and puberty education provision was used to provide a cross-sectional description of girls’ MHM practices and assess relationships with outcomes. Setting: Rural primary schools in the Kamuli district, Uganda. Participants: Participants were 205 menstruating schoolgirls (10–19 years) from the eight study sites. Primary and secondary outcome measures: The prevalence of adequate MHM, consistent with the concept definition, was estimated using dimensions of absorbent used, frequency of absorbent change, washing and drying procedures and privacy. Self-reported health, education (school attendance and engagement) and psychosocial (shame, insecurity, embarrassment) outcomes hypothesised to result from poor MHM were assessed as primary outcomes. Outcomes were measured through English surveys loaded on iPads and administered verbally in the local language. Results: 90.5% (95% CI 85.6% to 93.9%) of girls failed to meet available criteria for adequate MHM, with no significant difference between those using reusable sanitary pads (88.9%, 95% CI 79.0% to 94.4%) and those using existing methods, predominantly cloth (91.5%, 95% CI 85.1% to 95.3%; χ 2 (1)=0.12, p=0.729). Aspects of MHM predicted some consequences including shame, not standing in class to answer questions and concerns about odour. Conclusions: This study was the first to assess the prevalence of MHM consistent with the concept definition. Results suggest that when all aspects of menstrual hygiene are considered together, the prevalence is much higher than has previously been reported based on absorbents alone. The work demonstrates an urgent need for improved assessment and reporting of MHM, and for primary research testing the links between menstrual management and health, education and psychosocial consequences.

AI snapshot

Written from the paper’s full text.

TL;DR

This cross-sectional survey of 205 menstruating schoolgirls in rural Uganda found that 90.5% had inadequate menstrual hygiene management (MHM) under minimal criteria, with no significant difference between reusable pad users and those using existing methods. Aspects of MHM predicted some psychosocial and school-engagement outcomes, but the cross-sectional design and self-report limit causal inference.

Key findings

  • 90.5% (95% CI 85.6% to 93.9%) failed to meet minimal adequate MHM criteria; AFRIpad users were 88.9% inadequate vs 91.5% for existing methods (χ²(1)=0.12, p=0.729).
  • Under relaxed criteria, poor MHM remained 78.1% (95% CI 71.8% to 83.3%); AFRIpad users were 80.6% inadequate vs 76.7% for existing methods (χ²(1)=0.20, p=0.655).
  • Reported consequences included worrying others could smell their menstrual period (70.2%), avoiding standing in class to answer questions (64.7%), difficulty concentrating at school (51.0%), feeling ashamed (69.2%) and insecure (69.2%) during menstruation, and menstruation causing missed school (18.4%).
  • In multivariable models, privacy concerns about washing absorbents were associated with shame (ORadj 3.18, 95% CI 1.54–6.57), insecurity (ORadj 2.16, 95% CI 1.09–4.28), avoiding standing in class (ORadj 2.31, 95% CI 1.18–4.53), and difficulty concentrating (ORadj 3.03, 95% CI 1.54–5.99); unclean absorbents were associated with avoiding standing in class (ORadj 1.97, 95% CI 1.05–3.71), and changing absorbents 3+ times/day was associated with higher attendance (84.89% vs 76.40%, p<0.01).

Methods

  • Secondary analysis of final follow-up survey data from a controlled trial of reusable sanitary pad and puberty education provision; cross-sectional design with 205 menstruating schoolgirls aged 10–19 from eight rural primary schools in Kamuli district, Uganda.
  • Surveys were administered verbally in Lusoga by local research assistants using English surveys loaded on iPads in November 2014.
  • MHM prevalence was estimated by sequentially applying criteria for clean absorbent, change frequency, washing with soap, drying, and privacy, using minimal and relaxed definitions; outcomes included self-reported health, education, psychosocial measures (SDQ), and school attendance records, analyzed with descriptive statistics, χ² tests, logistic regressions, and t-tests in Stata 14.

Limitations

  • Stated: self-reported MHM behaviours and health, education, and psychosocial outcomes are vulnerable to bias, particularly social desirability; the cross-sectional design limits causal inference; analyses were limited by inability to adjust for sociodemographic confounds, small sample size, and no a priori power analyses due to lack of existing literature.
  • Evident: missing data occurred from iPad freezes/failed page loads in about 40 cases and item nonresponse; attendance data include both menstruating and non-menstruating days; the sample included intervention recipients, so prevalences may not reflect pre-intervention practices; MHM criteria lack validated/evidenced standards, and some concept aspects such as washing the body, changing in privacy, and disposal were not captured.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1136/bmjopen-2016-012596

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 51 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    There was no significant difference in failure to meet adequate MHM criteria between girls using reusable sanitary pads (88.9%, 95% CI 79.0% to 94.4%) and those using existing methods, predominantly cloth (91.5%, 95% CI 85.1% to 95.3%; χ2 (1)=0.12, p=0.729).

    “no significant difference between those using reusable sanitary pads (88.9%, 95% CI 79.0% to 94.4%) and those using existing methods, predominantly cloth (91.5%, 95% CI 85.1% to 95.3%; χ2 (1)=0.12, p=0.729)”
    Quote in the paperSubstantial claim
  • Findingown data

    Aspects of MHM predicted some consequences including shame, not standing in class to answer questions and concerns about odour.

    “Aspects of MHM predicted some consequences including shame, not standing in class to answer questions and concerns about odour.”
    Quote in the paperSubstantial claim
  • Findingown data

    90.5% (95% CI 85.6% to 93.9%) of girls failed to meet available criteria for adequate MHM.

    “90.5% (95% CI 85.6% to 93.9%) of girls failed to meet available criteria for adequate MHM”
    Quote in the paperSubstantial claim
  • Findingown data

    Approximately half of the sample reported discomfort.

    “Approximately half of the sample reported discomfort”
    Quote in the paperNot a substantial claim
  • Findingown data

    After the inclusion of available aspects, only 9.5% of the sample qualified as having adequate MHM using minimal criteria.

    “After the inclusion of available aspects, only 9.5% of the sample qualified as having adequate MHM using minimal criteria.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The minimal MHM criteria used are valid indicators of adequate MHM.
  • Classified as probably not a substantial claim. 67
  • May combine two claims. 44

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A total of 205 menstruating girls were included in this study.

    “A total of 205 menstruating girls were included in this study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of the 205 menstruating girls, 145 (70.7%) had been attending the schools in the trial at baseline.

    “Of them, 145 (70.7%) had been attending the schools in the trial at baseline.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    Two hundred five girls who reported in the survey that they had reached menarche were asked questions about menstrual management, and are included in this study.

    “Two hundred five girls who reported in the survey that they had reached menarche were asked questions about menstrual management, and are included in this study.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Girls ranged from a self-reported age of 10-19 years (mean =14.20, SD=1.12).

    “Girls ranged from a self-reported age of 10–19 years (mean =14.20, SD=1.12).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    All girls reported that itching/burning or discharge was experienced either only during their period, or during their period and at other times, so only a dichotomous experienced response was used.

    “All girls reported that this was experienced either only during their period, or during their period and at other times, so only a dichotomous experienced response was used.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Eighty-one girls in the full sample had received no intervention, including girls in the control condition and girls who failed to receive their assigned intervention.

    “Eighty-one girls in the full sample had received no intervention, this included girls in the control condition, as well as girls who failed to receive their assigned intervention.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    In total, 435 schoolgirls across the eight study schools completed follow-up surveys.

    “In total, 435 schoolgirls across the eight study schools completed follow-up surveys.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of the 145 trial girls, 96 (66.2%) had received one of the tested interventions.

    “Of the 145 trial girls, 96 (66.2%) had received one of the tested interventions”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Of the 60 girls who had not been in the trial schools at baseline, 20 (33.3%) had received pads alone and one had received the education intervention.

    “Of the 60 girls who had not been in the trial schools at baseline, 20 (33.3%) had received pads alone and one had received the education intervention.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Only the frequency of absorbent change was significantly associated with school attendance, although the sample size was limited.

    “Only the frequency of absorbent change was significantly associated with school attendance, although the sample size was limited.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    No girls reported disposing at community rubbish heaps, burning or burying pads.

    “No girls reported disposing at community rubbish heaps, burning or burying pads.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Self-reported menstrual hygiene practices accurately reflect girls' actual practices.

  • May combine two claims.

    Findingown data

    There were no significant associations with itching or burning, despite a consistently higher rate of report among those with poorer MHM.

    “There were no significant associations with itching or burning, despite a consistently higher rate of report among those with poorer MHM.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Self-reported menstrual hygiene practices accurately reflect girls' actual practices.

  • May combine two claims.

    Findingnone given

    Latrines were gender-separated but had few adequate doors or locks, and no access to water.

    “Latrines were gender-separated but had few adequate doors or locks, and no access to water.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The average age at menarche was 12.82 years (SD=1.28).

    “The average age at menarche was 12.82 years (SD=1.28).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Girls reported going home to change absorbents, and all stated that they washed and dried reusable absorbents at home, rather than at school.

    “Girls reported going home to change absorbents, and all stated that they washed and dried reusable absorbents at home, rather than at school.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Over half of the sample reported not standing to answer questions and difficulties concentrating in school.

    “Over half of the sample reported not standing to answer questions and difficulties concentrating in school.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Four girls did not report the type of absorbent used and therefore were not asked follow-up questions; the MHM practices table reports on 201 girls unless otherwise indicated.

    “Four did not report the type of absorbent used; therefore, were not asked follow-up questions. Thus the table reports on 201 girls, unless otherwise indicated.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Missing data from iPad issues and non-response do not bias the results.

  • May combine two claims.

    Findingown data

    Unclean absorbents and privacy were associated with higher odds of avoiding standing in class to answer questions, as were pooled MHM estimates.

    “Unclean absorbents and privacy were associated with higher odds of avoiding standing in class to answer questions, as were pooled MHM estimates.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Self-reported menstrual hygiene practices accurately reflect girls' actual practices.

  • May combine two claims.

    Findingown data

    Many girls reported genital irritation, discharge and concerns about odour.

    “Many girls reported genital irritation, discharge and concerns about odour.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Only one aspect of MHM was associated with school attendance, with those changing three times a day or more having a higher attendance rate.

    “Only one aspect of MHM was associated with school attendance, with those changing three times a day or more having a higher attendance rate.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Self-reported menstrual hygiene practices accurately reflect girls' actual practices.
    • Rests on an assumption: Attendance in week 4 of each term is representative of girls' overall school attendance.

  • May combine two claims.

    Findingown data

    Half of those who washed absorbents hid them to dry, most commonly under the bed.

    “Half of those who washed absorbents hid them to dry, most commonly under the bed.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Self-reported menstrual hygiene practices accurately reflect girls' actual practices.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The analyses are limited by the lack of existing literature on which to base power analyses.

    “lack of existing literature on which to base power analyses”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Study design and conductnone given

    Self-reported menstrual hygiene behaviours, health, education and psychosocial outcomes are vulnerable to biases, particularly social desirability.

    “Self-reported menstrual hygiene behaviours, health, education and psychosocial outcomes are vulnerable to biases, particularly social desirability.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    School absenteeism and disengagement have been emphasised as important consequences of poor MHM.

    “School absenteeism and disengagement have been emphasised as important consequences of poor MHM.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Quantitative evidence for links between MHM and attendance have been mixed, although studies have almost exclusively looked at absorbent type, rather than all MHM practices.

    “Quantitative evidence for links between MHM and attendance have been mixed, although studies have almost exclusively looked at absorbent type, rather than all MHM practices discussed below.9–12”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [9] Tegegne, 2014, Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia, BMC Public Health source

      Not checked in the free run.

    • cites [10] Grant, 2013, Menstruation and School Absenteeism: Evidence from Rural Malawi, Comp Educ Rev source

      Not checked in the free run.

    • cites [11] Montgomery, 2012, Sanitary pad interventions for girls’ education in Ghana: a pilot study, PLoS ONE source

      Not checked in the free run.

    • cites [12] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A case-control study concluded that there was evidence for an association between reusable pad use and laboratory-confirmed urogenital infection compared with disposable pads.

    “a case–control study concluded that there was evidence for an association between reusable pad use and laboratory-confirmed urogenital infection compared with disposable pads”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Qualitative research has documented challenges girls face in managing their menses and indicated health, education and psychosocial well-being consequences of poor management.

    “Qualitative research has documented challenges girls face in managing their menses and indicated health, education and psychosocial well-being consequences of poor management.1–4”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [1] House S , Cavill S , Mahon T , et al . Menstrual hygiene matters: a resource for improving menstrual hygiene around the world. Water Aid, 2012.

      Not checked in the free run.

    • cites [2] Crichton, 2013, Emotional and psychosocial aspects of menstrual poverty in resource-poor settings: a qualitative study of the experiences of adolescent girls in an informal settlement in Nairobi, Health Care Women Int source

      Not checked in the free run.

    • cites [3] Dolan, 2014, A blind spot in girls’ education: menarche and its webs of exclusion in Ghana, J Int Dev source

      Not checked in the free run.

    • cites [4] Sommer, 2014, A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia, Compare source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    None have included all aspects of MHM or considered a pooled, comprehensive prevalence estimate requiring all conditions to be met.

    “None have included all aspects of MHM or considered a pooled, comprehensive prevalence estimate requiring all conditions to be met.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    It may be inaccurate to label all of these predictors as MHM.

    “As argued below, it may be inaccurate to label all of these predictors as MHM.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    It is inaccurate to conclude from this finding that MHM does not predict attendance, but only that the type of absorbent used may not.

    “It is inaccurate to conclude from this finding that MHM does not predict attendance, but only that the type of absorbent used may not.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The SDQ questionnaire has been well validated and was a secondary outcome in the Menstruation and the Cycle of Poverty trial, with norms for different countries available online.

    “The questionnaire has been well validated and was a secondary outcome in the Menstruation and the Cycle of Poverty trial,23 with norms for different countries available online (http://www.sdqinfo.com).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] 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. In press. doi:10.1371/journal.pone.0166122 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisereasoning

    Washing with soap may be one important criterion.

    “Washing with soap may be one important criterion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    As criteria for MHM could be debated given the lack of evidence, an additional measure of MHM was used for comparison.

    “As criteria for MHM could be debated given the lack of evidence, an additional measure of MHM was used for comparison.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Most studies used only absorbent type to predict consequences and did not agree on the adequacy of absorbents such as cloth.

    “They found that most studies used only absorbent type to predict consequences and, even with this simplified criterion, did not agree on the adequacy of absorbents such as cloth.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Sumpter, 2013, A systematic review of the health and social effects of menstrual hygiene management, PLOS ONE source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationreasoning

    Other factors such as reductions in menstrual stigma, improved pain management strategies or improved social support among classmates may contribute to improvements in school attendance or psychosocial outcomes.

    “It may be that other factors such as reductions in menstrual stigma, improved pain management strategies or improved social support among classmates contribute to these improvements.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Survey items were designed following a pilot trial and qualitative research in Ghana, where a number of similar items were also used.

    “Survey items were designed following a pilot trial and qualitative research in Ghana,3 11 where a number of similar items were also used.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 3 11

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Negative psychosocial outcomes have been hypothesised to arise from poor MHM such as inadequate absorbent use.

    “Such negative psychosocial outcomes have been hypothesised to arise from poor MHM such as inadequate absorbent use.3”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Dolan, 2014, A blind spot in girls’ education: menarche and its webs of exclusion in Ghana, J Int Dev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductnone given

    While water sources were closer to some schools than others, water, sanitation and hygiene (WASH) for MHM was comparable across schools.

    “While water sources were closer to some schools than others, water, sanitation and hygiene (WASH) for MHM was comparable across schools.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Premisenone given

    Disposal method adequacy is likely to be contextually dependent and relies on latrine capacity, cultural appropriateness of burning absorbents and other waste disposal methods.

    “Similarly, disposal method adequacy is likely to be contextually dependent and relies on latrine capacity, cultural appropriateness of burning absorbents and other waste disposal methods.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Schools were paired to maximise distance between the four conditions and the risk of contamination.

    “Schools were paired to maximise distance between the four conditions and the risk of contamination.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Each of these aspects must be considered in trying to estimate the prevalence of MHM, establish relationships between predictors and consequences of poor MHM and evaluate interventions aimed at improving MHM.

    “Each of these aspects must be considered in trying to estimate the prevalence of MHM, establish relationships between predictors and consequences of poor MHM and evaluate interventions aimed at improving MHM.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Pairs were allocated sequentially in alphabetical order to conditions.

    “Pairs were allocated sequentially in alphabetical order to conditions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent calls for action, such as the MHM in Ten report, state the need for a strong quantitative evidence base.

    “Recent calls for action, such as the MHM in Ten report,22 state the need for a strong quantitative evidence base.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Sommer, 2016, A time for global action: addressing girls’ menstrual hygiene management needs in schools, PLoS Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Drying practices are important, with exposure to UV through sunlight known to have a microbicidal effect.

    “Drying practices are also important, with exposure to UV through sunlight known to have a microbicidal effect.21”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Bloomfield S , Exner M , Nath K , et al . The infection risks associated with clothing and household linens in home and everyday life settings, and the role of laundry. International Scientific Forum on Home Hygiene, 2011.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Leaving fabrics damp has been found to encourage microbial survival, and wearing absorbents wet has frequently been considered unhygienic, with some evidence for greater infection risk and discomfort.

    “Leaving fabrics damp has been found to encourage microbial survival, and wearing absorbents wet has frequently been considered unhygienic, with some evidence for greater infection risk and discomfort.1 6 21”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 1 6 21

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    Women and girls need privacy for all aspects of MHM, such as washing the body and absorbents.

    “Finally, while the concept definition stresses the need to change absorbents in privacy, women and girls need privacy for all aspects of MHM, such as washing the body and absorbents.7”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Winkler I , Roaf V . Bringing the dirty bloody linen out of its closet–menstrual hygiene as a priority for achieving gender equality. Cardozo J Law Gender 2015. http://ssrn.com/abstract=2575250 (accessed Nov 2015).

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Use of the term MHM has proliferated; however, operationalisation has been inconsistent.

    “Use of the term has proliferated; however, operationalisation has been inconsistent.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Criteria for each step of the MHM measure were derived from background literature, although existing evidence is sparse.

    “Criteria for each step were derived from background literature, although existing evidence is sparse.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    There were no appropriate items in the survey capturing washing the body or genitals, or items on the ability to change absorbents in privacy, which would have improved the MHM estimate.

    “There were no appropriate items in the survey capturing washing the body or genitals, or items on the ability to change absorbents in privacy, which would have improved the MHM estimate.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    This study was conducted and reported according to best practice guidelines in the Strengthening the Reporting of Observational studies in Epidemiology (STROBE).

    “This study was conducted and reported according to best practice guidelines in the Strengthening the Reporting of Observational studies in Epidemiology.24”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Overextension of the term has occurred with studies reporting a lack of knowledge about menstruation or cultural taboos as aspects of MHM, rather than contributors to MHM.

    “Overextension of the term has also occurred with studies reporting a lack of knowledge about menstruation or cultural taboos as aspects of MHM, rather than contributors to MHM.12”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Study design and conductnone given

    These aspects were considered the minimal requirements for MHM, using best available evidence.

    “These aspects were considered the minimal requirements for MHM, using best available evidence.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    There were no a priori power analyses for this cross-sectional assessment.

    “There were no a priori power analyses for this cross-sectional assessment as the study seeks to demonstrate the calculation of a prevalence estimate of MHM, and there was no past evidence from which to draw effect size estimates between aspects of MHM and health, education and psychosocial well-being outcomes assessed.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A recent systematic review of MHM studies in India reported that in multivariable models, the use of sanitary pads did not predict school attendance.

    “For example, a recent systematic review of MHM studies in India reported that in multivariable models, the use of sanitary pads did not predict school attendance.12”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Negative psychosocial outcomes may also result from a lack of knowledge and information about menstruation, cultural stigma and taboos, and transactional or coercive sex undertaken to meet MHM needs.

    “They may also result from a lack of knowledge and information about menstruation,14 cultural stigma and taboos,4 and as a result of transactional or coercive sex undertaken to meet MHM needs.15”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [14] Deo, 2005, Perceptions and practices regarding menstruation: a comparative study in urban and rural adolescent girls, Indian J Community Med

      Not checked in the free run.

    • cites [4] Sommer, 2014, A comparison of the menstruation and education experiences of girls in Tanzania, Ghana, Cambodia and Ethiopia, Compare source

      Not checked in the free run.

    • cites [15] Phillips-Howard, 2015, Menstrual needs and associations with sexual and reproductive risks in rural Kenyan females: a cross-sectional behavioral survey linked with HIV prevalence, J Womens Health (Larchmt) source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Schools were recruited through the partner NGO and selected to be comparable on characteristics such as size, educational provision and quality.

    “Schools were recruited through the partner NGO and selected to be comparable on characteristics such as size, educational provision and quality.23”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] 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. In press. doi:10.1371/journal.pone.0166122 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    MHM literature is yet to provide evidenced guidance for washing and drying absorbents.

    “MHM literature is yet to provide evidenced guidance for washing and drying absorbents.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Psychosocial consequences including shame, insecurity, anxiety and fear of stigma are well-documented correlates of menstruation in qualitative studies.

    “Psychosocial consequences including shame, insecurity, anxiety and fear of stigma are well-documented correlates of menstruation in qualitative studies.2 4”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 2 4

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Menstrual Hygiene Matters report suggested changing absorbents every 2-6 hours dependent on blood flow.

    “The Menstrual Hygiene Matters report suggested changing absorbents every 2–6 hours dependent on blood flow.1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] House S , Cavill S , Mahon T , et al . Menstrual hygiene matters: a resource for improving menstrual hygiene around the world. Water Aid, 2012.

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    While disposal methods were reported, there was no consistent guidance on what could be considered an adequate method, so this item was not included in the overall estimate.

    “While disposal methods were reported, there was no consistent guidance on what could be considered an adequate method, so this item was not included in the overall estimate.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Reusable absorbents such as cloth or reusable pads could be considered hygienic if cleaned appropriately.

    “Single-use absorbents such as sanitary pads are easily classified as clean; however, reusable absorbents such as cloth or reusable pads (homemade or commercially produced) could be considered hygienic if cleaned appropriately.20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Sumpter, 2013, A systematic review of the health and social effects of menstrual hygiene management, PLOS ONE source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Studies to date have only reported a few of the aspects of MHM; prevalence studies and quantitative assessments have focused on the type of absorbent used.

    “Studies to date have only reported a few of these aspects (J Hennegan. Menstrual hygiene management and human rights: the case for an evidence-based approach. Under review). Prevalence studies and quantitative assessments of predictors and consequences of poor MHM have focused on the type of absorbent used, the first aspect of MHM.17”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Choudhary, 2015, Status of female adolescents living at Rajshahi Slum in Bangladesh, Bangladesh J Med Sci source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Trials to date assume that improvements in school attendance or psychosocial outcomes observed are the result of improved MHM, but none have tested this.

    “Trials to date assume that improvements in school attendance or psychosocial outcomes observed are the result of improved MHM, but none have tested this.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Psychosocial well-being was assessed using the total score from the Strengths and Difficulties Questionnaire (SDQ).

    “Psychosocial well-being was assessed using the total score from the Strengths and Difficulties Questionnaire (SDQ26).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Additional questions were developed following feasibility and acceptability work leading to the selection of AFRIpads for the intervention study, and in consultation with stakeholders and partner NGO staff.

    “Additional questions were developed following feasibility and acceptability work leading to the selection of AFRIpads for the intervention study,25 and in consultation with stakeholders and partner NGO staff.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Scott L , Montgomery P , Stenfield L , et al . Sanitary pad acceptability and sustainability study. Oxford: University of Oxford, 2013. http://www.sbs.ox.ac.uk/sites/default/files/So-What-Statements/Docs/Uganda_study1.pdf source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    In a systematic review of MHM practices and infections, Sumpter and Torondel found no consistent standard in the application of 'good' and 'bad' MHM.

    “In a systematic review of MHM practices and infections, Sumpter and Torondel20 found no consistent standard in the application of ‘good’ and ‘bad’ MHM.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] Sumpter, 2013, A systematic review of the health and social effects of menstrual hygiene management, PLOS ONE source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Studies have focused on attendance, and additional work is needed to capture the impact of menstruation on concentration and engagement, even if girls are at school.

    “Studies have focused on attendance,5 and additional work is needed to capture the impact of menstruation on concentration and engagement, even if girls are at school.2 13”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [5] Hennegan, 2016, Do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in low and middle income countries? A systematic review, PLoS ONE source

      Not checked in the free run.

    • cites 2 13

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Premisenone given

    There is no clear guidance on optimal washing frequency or correct use of soap and water on the body and genitals.

    “There is no clear guidance on optimal washing frequency or correct use of soap and water on the body and genitals.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    While girls report that soap and water is available to them at home, qualitative interviews, site reports and reports from the field suggest always washing absorbents with soap to be unlikely.

    “While girls report that soap and water is available to them at home, qualitative interviews, site reports and reports from the field suggest always washing absorbents with soap to be unlikely.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    Findings support the value of considering all aspects of MHM together.

    “Nevertheless, findings support the value of considering all aspects of MHM together.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Transfer girls received the interventions alongside girls in the trial from baseline to ensure there was no stigmatisation of either group.

    “Transfer girls received the interventions alongside girls in the trial from baseline to ensure there was no stigmatisation of either group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Despite very large percentage differences in the reports of consequences between those categorised as having adequate and inadequate MHM, the small number of girls with adequate MHM meant there was insufficient power to demonstrate statistically significant effects.

    “Despite very large percentage differences in the reports of consequences between those categorised as having adequate and inadequate MHM, the small number of girls with adequate MHM meant there was insufficient power to demonstrate statistically significant effects.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The minimal MHM criteria used are valid indicators of adequate MHM.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    There is a lack of evidence for MHM criteria.

    “As noted previously, there is a lack of evidence for MHM criteria.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The prevalences of MHM behaviours are heavily dependent on the reliability of girls' reports and questions used.

    “The prevalences of MHM behaviours are heavily dependent on the reliability of girls’ reports and questions used, an issue that pervades MHM studies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Girls were not asked to record menstrual cycles, so attendance includes menstruating and non-menstruating days.

    “Girls were not asked to record menstrual cycles, so attendance includes menstruating and non-menstruating days.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Week 4 of the school term was selected to avoid very low attendance periods coinciding with school fee collection at the start of term or agricultural practices, based on advice from site visits and local agents.

    “Week 4 of the school term was selected to avoid very low attendance periods coinciding with school fee collection at the start of term or agricultural practices, based on advice from site visits and local agents.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Attendance in week 4 of each term is representative of girls' overall school attendance.

  • May combine two claims.

    Interpretationown data

    Minimal correlations between aspects of MHM and differential associations between aspects and consequences in multivariable models demonstrate unique impact of each facet.

    “Minimal correlations between aspects of MHM and differential associations between aspects and consequences in multivariable models demonstrate unique impact of each facet.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The use of an objective measure of school attendance meant this was not subject to girls' self-reports, but the data reflect attendance across all days including menstruating and non-menstruating days.

    “The use of an objective measure of school attendance meant this was not subject to girls’ self-reports, however, means these data reflect attendance across all days including menstruating and non-menstruating days.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The small sample size further limited these analyses.

    “The small sample size further limited these analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Past studies have failed to adequately report questions used to capture MHM practices, which limits comparison.

    “Past studies have also failed to adequately report questions used to capture MHM practices, which limits comparison (J Hennegan. Menstrual hygiene management and human rights: the case for an evidence-based approach. Under review).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites J Hennegan. Menstrual hygiene management and human rights: the case for an evidence-based approach. Under review

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Null results, particularly for psychosocial consequences, suggest more predictors may need to be considered.

    “Null results, particularly for psychosocial consequences, suggest more predictors may need to be considered.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    No survey items asked about transporting menstrual absorbents home for cleaning.

    “No survey items asked about transporting menstrual absorbents home for cleaning”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationown data

    The sample may be more disadvantaged, at least in terms of menstrual hygiene, than some past studies.

    “The sample may be more disadvantaged, at least in terms of menstrual hygiene, than some past studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Washing absorbents (with or without soap) was not used as a predictor in these comparisons as almost all girls reported doing so.

    “Washing absorbents (with or without soap) was not used as a predictor in these comparisons as almost all girls reported doing so.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Interventions were identical for all girls, including transfers.

    “Interventions were identical for all girls, including transfers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    Findings suggest all MHM aspects must be considered in testing links with hypothesised consequences.

    “Findings suggest all MHM aspects must be considered in testing links with hypothesised consequences.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Only the location of drying was used as a predictor in the models because all girls who never wore their absorbent damp had also dried outside.

    “so only the location of drying was used as a predictor in the models.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    In interpreting the primary trial results, it is likely that improvements to unmeasured aspects of menstrual management such as improving teachers' awareness of girls' needs or improved social support by prompting girls to discuss menstruation may have contributed to these effects.

    “In interpreting the primary trial results, which found improvements in school attendance following reusable pad provision,23 it is likely that improvements to unmeasured aspects of menstrual management such as improving teachers’ awareness of girls’ needs or improved social support by prompting girls to discuss menstruation may have contributed to these effects.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] 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. In press. doi:10.1371/journal.pone.0166122 source

      Not checked in the free run.

88 of 88

  • The paper relies on this without support.

    Self-reported menstrual hygiene practices accurately reflect girls' actual practices.

    “Girls in this study were compared according to their self-reported menstrual hygiene practices.”

  • The paper relies on this without support.

    Attendance in week 4 of each term is representative of girls' overall school attendance.

    “Week 4 of the school term was selected to avoid very low attendance periods coinciding with school fee collection at the start of term or agricultural practices, based on advice from site visits and local agents.”

  • The paper relies on this without support.

    The minimal MHM criteria used are valid indicators of adequate MHM.

    “After the inclusion of available aspects, only 9.5% of the sample qualified as having adequate MHM using minimal criteria.”

  • The paper relies on this without support.

    Missing data from iPad issues and non-response do not bias the results.

    “n is lower than 201 resulted in part from iPad issues where, in about 40 cases, the appropriate page froze or failed to load, additional missing resulted from girls not providing an answer to the question.”

  • The paper relies on this without support.

    There are presently no validated questionnaires for assessing practices such as absorbent washing and drying.

    “MHM literature has paid insufficient attention to measurement issues and there are presently no validated questionnaires for assessing practices such as absorbent washing and drying.”

  • The paper relies on this without support.

    MHM literature has paid insufficient attention to measurement issues.

    “MHM literature has paid insufficient attention to measurement issues and there are presently no validated questionnaires for assessing practices such as absorbent washing and drying.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentχ²(1) = 0.12reported p = .729 · recomputed p = .729

    “χ2 (1)=0.12, p = .729”

  • Consistentχ²(1) = 0.2reported p = .655 · recomputed p = .655

    “χ2 (1)=0.20, p = .655”

2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • The stated relationship between damp wear and outside drying is impossible

    Major

    The analysis says every girl who never wore an absorbent damp dried it outside. But 119 girls reported never wearing one damp, while only 64 reported drying one outside.

  • Narrative subgroup prevalences disagree with Table 3

    Minor

    The narrative gives poor-MHM prevalences of 88.6% for AFRIpad users and 90.5% for users of existing methods; Table 3 gives 88.9% and 91.5%, respectively.

  • Discharge outcome changes from grey to green

    Minor

    The survey-measures section describes a question about white or grey discharge, but the results table labels the outcome white or green discharge.

  • Washing-response counts exceed the stated sample size

    Minor

    The washing responses sum to 161, whereas the table labels this question n=158.

    Reported 158 · recomputed 161

  • Insecurity percentage for unclean-absorbent users is inconsistent with its count

    Minor

    Table 2 identifies 81 unclean-absorbent users (62 using old cloth and 19 using other materials). The 57 reporting insecurity are therefore 70.4% of that group, not 60.4%.

    Reported 60.4 · recomputed 70.37037

  • School-disposal percentage for "Other" is incorrect

    Minor

    The disposal counts total 154 responses; three "Other" responses are about 1.9%, not 12.0%.

    Reported 12 · recomputed 1.948052

  • Intervention subgroup counts exceed the reported total

    Minor

    The three intervention groups contain 36, 40 and 27 trial girls, totalling 103, not the reported 96.

    Reported 96 · recomputed 103

7 of 7

Cites

Flagged first, then by citations

2 of the 33 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Winkler I , Roaf V . Bringing the dirty bloody linen out of its closet–menstrual hygiene as a priority for achieving gender equality. Cardozo J Law Gender 2015. http://ssrn.com/abstract=2575250 (accessed Nov 2015).

Cited by

Sorted by citations

Related

Authors
Hennegan, J., Dolan, C., Wu, M., Scott, L., & Montgomery, P.
Affiliations
  • University of Oxford (GB)
  • SOAS University of London (GB)
  • University of Illinois Urbana-Champaign (US)
Corresponding author
Hennegan, Julie
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2016-12
Volume
6
Issue
12
Pages
e012596
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2016-012596
PMC
PMC5223625
OpenAlex
W2565221974
Semantic Scholar
04008157ef89361fbe43f04388ba50f5cc7b02aa
Cited by
160
References
33
Citations by year
2026: 8 · 2025: 15 · 2024: 18 · 2023: 21 · 2022: 22 · 2021: 35 · 2020: 19 · 2019: 12 · 2018: 7 · 2017: 2 · 2016: 1
FWCI
7.27
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMJ Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • SOAS Research Online (SOAS University of London) (publishedVersion, other-oa)
  • SOAS Research Online (SOAS University of London) (acceptedVersion)
  • SOAS Research Online (SOAS University of London) (submittedVersion, cc-by)
  • HighWire Press Open Archive (submittedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by)
Funders
Economic and Social Research Council (ES/I034145/2, ES/I034145/1)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
  • Health Sciences › Health Professions › General Health Professions › Adolescent Sexual and Reproductive Health
  • Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
Keywords
menstrual hygiene management, female students, adolescent girls, menstrual health, sanitary pads, privacy, psychosocial consequences, shame and embarrassment, school attendance, puberty education, rural Uganda, Kamuli District
MeSH terms
Adolescent, Adolescent Behavior, Child, Cross-Sectional Studies, Female, Health Education, Humans, Hygiene, Health Knowledge, Attitudes, Practice, Menstruation, Rural Population, School Health Services, Social Desirability, Uganda, Prevalence, Privacy, Feminine Hygiene Products, Hygiene Products

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review