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

The DOI matches its Crossref record; 31 of the 33 references it cites were found in a registry or an index; none of the 51 sources its claims cite is checked for support yet.

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

Open access

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.

Overview

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

Verification

Claims the paper makes

59 Own result · 37 Not checked yet · 30 Own method · 19 Own interpretation · 16 No basis given

Verify all 51 references — free account

Show all 73 claims

  • Probably not a substantial claim. 67
  • It may state two separate claims as one. 44
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.

7 of 7

Citations

Cites

Show all 33 references

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

Metadata

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
Venue
BMJ Open
Publisher
BMJ
Published
2016-12
Volume
6
Issue
12
Pages
e012596
ISSN
2044-6055 (ISSN-L)
OpenAlex
W2565221974
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 › Medicine › Public Health, Environmental and Occupational Health › 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.

A language model drew the claims from the paper on 2026-10-08, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-08 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

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