CoChat
Sign Up
Cited by 39Menstrual Health and DisordersGender Studies and Social IssuesChild Nutrition and Water Access

The relationship between household sanitation and women’s experience of menstrual hygiene: Findings from a cross-sectional survey in Kaduna State, Nigeria.

Open access
Hennegan, Julie, Zimmerman, Linnea, Shannon, Alexandra K., Exum, Natalie G., OlaOlorun, Funmilola, Omoluabi, Elizabeth, Schwab, Kellogg J.·2018·International Journal of Environmental Research and Public Health
DOI 10.3390/ijerph15050905PMC PMC5981944
Open this paper in CoChat — free accountOpen PDF

Abstract

Global efforts to improve sanitation have emphasized the needs of women and girls. Managing menstruation is one such need, yet there is scarce research capturing current practices. This study investigated the relationships between household sanitation and women’s experience of menstrual management. Secondary analyses were undertaken on data from 1994 women and girls collected through the Performance Monitoring and Accountability 2020 survey in Kaduna, Nigeria. In multivariable models, women had higher odds of using the main household sanitation facility for menstrual management when they had access to a basic (OR = 1.76 95%CI 1.26–2.46) or limited (OR = 1.63 95%CI 1.08–2.48) sanitation facility, compared to an unimproved facility. Women with no household sanitation facility had higher odds of using their sleeping area (OR = 3.56 95%CI 2.50–5.06) or having no facility for menstrual management (OR = 9.86 95%CI 5.76–16.87) than women with an unimproved sanitation facility. Menstrual management locations were associated with ratings of their characteristics. Safely managed or basic sanitation facilities were not rated more favorably than unimproved facilities in privacy (OR = 1.02 95%CI 0.70–1.48), safety (OR = 1.45 95%CI 0.98–2.15), access to a lock (OR = 0.93 95%CI 0.62–1.37), or soap and water (OR = 1.04 95%CI 0.70–1.56). Women using their sleeping area had more favorable perceptions of their environment. Findings suggest household sanitation influences women’s choices for menstrual management, but that existing indicators for improvement are not sensitive to menstrual needs.

AI snapshot

Written from the paper’s full text.

TL;DR

In Kaduna State, Nigeria, household sanitation type was associated with where women and girls managed menstruation, but safely managed/basic facilities were not rated better than unimproved facilities on privacy, safety, lockability, or soap/water access. The findings suggest current SDG sanitation indicators may not capture menstrual hygiene needs.

Key findings

  • In adjusted models, women with basic/safely managed sanitation (OR = 1.76, 95%CI 1.26–2.46) or limited sanitation (OR = 1.63, 95%CI 1.08–2.48) had higher odds of using the main household facility for menstrual management than women with an unimproved facility.
  • Women with no household sanitation facility had higher odds of using their sleeping area (OR = 3.56, 95%CI 2.50–5.06) or having no facility/backyard (OR = 9.86, 95%CI 5.76–16.87) than women with an unimproved facility.
  • Safely managed/basic facilities were not rated more favorably than unimproved facilities for privacy (OR = 1.02, 95%CI 0.70–1.48), safety (OR = 1.45, 95%CI 0.98–2.15), lockability (OR = 0.93, 95%CI 0.62–1.37), or soap and water (OR = 1.04, 95%CI 0.70–1.56), except cleanliness (OR = 4.53, 95%CI 2.87–7.16).
  • Women using their sleeping area had higher odds of reporting it was lockable (OR = 1.87, 95%CI 1.33–2.64), clean (OR = 4.66, 95%CI 3.18–6.84), private (OR = 2.60, 95%CI 1.82–4.94), and safe (OR = 2.24, 95%CI 1.55–3.22) than women using an unimproved facility, but lower odds of soap and water access (OR = 0.49, 95%CI 0.34–0.73).

Methods

  • Secondary analysis of PMA2020 survey data from Kaduna State, Nigeria, collected August–September 2015 using a two-stage cluster design; final sample was 1994 women and girls aged 15–49 from 1439 households who had menstruated in the prior three months and had valid menstrual management location data.
  • Household sanitation was categorized using Joint Monitoring Program ladders: safely managed/basic, limited, unimproved, and open defecation. Female questionnaire items captured menstrual management location and perceived characteristics: clean, private, safe, lockable, and soap/water access.
  • Analyses used Stata 15.1; weighted descriptive statistics and logistic regressions examined associations between sanitation type and menstrual management location, and between location and perceived characteristics, adjusting for sociodemographics, menstrual materials, and household handwashing facility, with standard errors clustered at household level.

Limitations

  • Stated in the paper: cross-sectional design precludes causal inference; secondary analysis used data collected before the study and survey items were not designed for this research question; limited past research informed hypotheses; binary logistic regressions produced non-orthogonal contrasts, likely increased familywise error, and varying statistical power across comparisons.
  • Evident from the text: self-reported, dichotomous yes/no ratings may not capture nuance and may be affected by social desirability around stigmatized menstruation; the survey lacked response options for bathing or laundry areas, making the “other sanitation facility” category ambiguous; only the main household sanitation facility type was collected, so facility type for “other sanitation facility” could not be determined.

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

Integrity signals

Registry

Crossref · 10.3390/ijerph15050905

Cites

23 of 23 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 28 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Women with no household sanitation facility had higher odds of using their sleeping area for menstrual management than women with an unimproved sanitation facility (OR = 3.57, 95%CI 2.50-5.06).

    “Women with no household sanitation facility had higher odds of using their sleeping area (OR = 3.56 95%CI 2.50–5.06) or having no facility for menstrual management (OR = 9.86 95%CI 5.76–16.87) than women with an unimproved sanitation facility.”
    • Also stated in: § 3.2. Relationships between Household Sanitation and Menstrual Management Location · plain
      “women with no household sanitation facility had significantly higher odds of using another sanitation facility (OR = 1.85 95%CI 1.09–3.15) or their sleeping area (OR = 3.57 95%CI 2.50–5.06) for menstrual management than those with an unimproved sanitation facility.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women's self-reported location of menstrual management accurately reflects their actual location for menstrual management.
  • Findingown data

    Safely managed or basic sanitation facilities were not rated more favorably than unimproved facilities in soap and water (OR = 1.04, 95%CI 0.70-1.56).

    “Safely managed or basic sanitation facilities were not rated more favorably than unimproved facilities in privacy (OR = 1.02 95%CI 0.70–1.48), safety (OR = 1.45 95%CI 0.98–2.15), access to a lock (OR = 0.93 95%CI 0.62–1.37), or soap and water (OR = 1.04 95%CI 0.70–1.56).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women's self-reported location of menstrual management accurately reflects their actual location for menstrual management.
  • Findingown data

    Safely managed or basic sanitation facilities were not rated more favorably than unimproved facilities in access to a lock (OR = 0.93, 95%CI 0.62-1.37).

    “Safely managed or basic sanitation facilities were not rated more favorably than unimproved facilities in privacy (OR = 1.02 95%CI 0.70–1.48), safety (OR = 1.45 95%CI 0.98–2.15), access to a lock (OR = 0.93 95%CI 0.62–1.37), or soap and water (OR = 1.04 95%CI 0.70–1.56).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women's self-reported location of menstrual management accurately reflects their actual location for menstrual management.
  • Findingown data

    Safely managed or basic sanitation facilities were not rated more favorably than unimproved facilities in privacy (OR = 1.02, 95%CI 0.70-1.48).

    “Safely managed or basic sanitation facilities were not rated more favorably than unimproved facilities in privacy (OR = 1.02 95%CI 0.70–1.48), safety (OR = 1.45 95%CI 0.98–2.15), access to a lock (OR = 0.93 95%CI 0.62–1.37), or soap and water (OR = 1.04 95%CI 0.70–1.56).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women's self-reported location of menstrual management accurately reflects their actual location for menstrual management.
  • Findingown data

    Women with access to a basic (safely managed/basic) sanitation facility had higher odds of using the main household sanitation facility for menstrual management than women with an unimproved facility (OR = 1.76, 95%CI 1.26-2.46).

    “women had higher odds of using the main household sanitation facility for menstrual management when they had access to a basic (OR = 1.76 95%CI 1.26–2.46) or limited (OR = 1.63 95%CI 1.08–2.48) sanitation facility, compared to an unimproved facility.”
    • Also stated in: § 3.2. Relationships between Household Sanitation and Menstrual Management Location · plain
      “women and girls with access to improved (safely managed/basic) sanitation facilities (OR = 1.76 95%CI 1.26–2.46) or limited facilities (OR = 1.63 95%CI 1.08–2.48) had significantly higher odds of using the main household facility to change their menstrual materials than those with an unimproved sanitation facility.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Women's self-reported location of menstrual management accurately reflects their actual location for menstrual management.
  • May combine two claims. 21
  • Classified as probably not a substantial claim. 26
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    Use of another facility was positively associated with higher levels of education and greater wealth.

    “It is further supported by associations with sociodemographic factors, which found that use of another facility was positively associated with higher levels of education, and greater wealth.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among women using safely managed/basic sanitation facilities for menstrual management, there were no statistically significant differences from women using unimproved facilities in the odds of reporting the location was private (OR=1.02, 95%CI 0.70-1.48), safe (OR=1.45, 95%CI 0.98-2.15), lockable (OR=0.93, 95%CI 0.62-1.37), or had access to soap and water (OR=1.04, 95%CI 0.70-1.56).

    “There were few statistically significant differences in reported environment characteristics between women using a safely managed/basic facility and those using unimproved sanitation facilities in multivariable models, including if the location was private (OR = 1.02 95%CI 0.70–1.48), safe (OR = 1.45 95%CI 0.98–2.15), lockable (OR = 0.93 95%CI 0.62–1.37) or had access to soap and water (OR = 1.04”
    • Also stated in: § 4. Discussion · plain
      “Women using safely managed or basic sanitation facilities for menstrual management did not provide significantly higher ratings of their locations as private, safe, or lockable, nor were they more likely to report that they had access to soap and water than women using unimproved facilities in multivariable models.”
    • Also stated in: § 5. Conclusions · plain
      “At the same time, use of a safely managed or basic sanitation facility was not associated with more favorable ratings of the environment when compared to women using unimproved facilities”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Over half of women with no household sanitation facility reported changing their absorbent in their sleeping area, with less than one third using no facility.

    “Indeed, over half of women with no household sanitation facility reported changing their absorbent in their sleeping area, with less than one third using no facility.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Approximately 15% of women who managed their menstruation outside a facility had access to safely managed or basic sanitation facilities, and 22% had unimproved sanitation facilities at home.

    “Approximately 15% of women who managed their menstruation outside a facility had access to safely managed or basic sanitation facilities, and 22% had unimproved sanitation facilities at home.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For women in a rural area, 57.71% (n=234) reported that their sleeping area was lockable, in contrast to only 33.32% (n=188) reporting a lock was present for those using main household sanitation facilities.

    “For women in a rural area, 57.71% (n = 234) reported that their sleeping area was lockable, in contrast to only 33.32% (n = 188) reporting a lock was present for those using main household sanitation facilities.”
    • Also stated in: § 4. Discussion · plain
      “Notably, the sleeping area was lockable for a much higher proportion of women in rural areas than the main household sanitation facility.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Women using no facility for menstrual management were not significantly less likely to report their management location was clean (OR=0.66, 95%CI 0.41-1.05), private (OR=0.67, 95%CI 0.42-1.05), or safe (OR=0.62, 95%CI 0.40-0.97) than women using an unimproved facility.

    “but were not significantly less likely to report their management location was clean (OR = 0.66 95%CI 0.41–1.05), private (OR = 0.67 95%CI 0.42–1.05), or safe (OR = 0.62 95%CI 0.40–0.97) than women using an unimproved facility.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Limited relationships between the characteristics supported use of items individually.

    “Limited relationships between the characteristics supported use of items individually.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The presence of a handwashing station in the household was associated with higher reports of access to soap and water in the location women changed their menstrual materials in descriptive statistics, but this relationship was not significant in multivariable models.

    “The presence of a handwashing station in the household was associated with higher reports of access to soap and water in the location women changed their menstrual materials in descriptive statistics, however, this relationship was not significant in multivariable models.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    While the presence of a lock was associated with increased reports of safety and privacy, many women without access to a lockable door still reported these characteristics.

    “While the presence of a lock was associated with increased reports of safety and privacy, many women without access to a lockable door still reported these characteristics.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Loughnan and colleagues proposed applying existing WASH indicators as proxies for measuring inadequate menstrual hygiene.

    “As such, Loughnan and colleagues proposed applying existing WASH indicators as proxies for measuring inadequate menstrual hygiene [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Loughnan, 2016, What can existing data on water and sanitation tell us about menstrual hygiene management?, Waterlines source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Categorizations of open defecation, unimproved, limited, basic and safely managed facilities as outlined by the Joint Monitoring Program focus on how waste is managed, but do not reflect other features of the environment that may be relevant to the needs of women and girls.

    “Categorizations of open defecation, unimproved, limited, basic and safely managed facilities as outlined by the Joint Monitoring Program [20] focus on how waste is managed, but do not reflect other features of the environment that may be relevant to the needs of women and girls [21].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [20] World Health Organization (WHO), and United Nations Children’s Fund (UNICEF) (2017). Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and Sdg Baselines, United Nations Children’s Fund (UNICEF).

      Not checked in the free run.

    • cites [21] Khan, S.M., Bain, R.E., Lunze, K., Unalan, T., Beshanski-Pedersen, B., Slaymaker, T., Johnston, R., and Hancioglu, A. (2017). Optimizing household survey methods to monitor the sustainable development goals targets 6.1 and 6.2 on drinking water, sanitation and hygiene: A mixed-methods field-test in Belize. PLoS ONE, 12. source

      Not checked in the free run.

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

    Premisenone given

    The PMA2020 survey program is the first to provide large-scale data on aspects of menstrual hygiene for a broad range of women and girls.

    “The PMA2020 survey program is the first to provide large-scale data on aspects of menstrual hygiene for a broad range of women and girls.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The finding that age, education, wealth, marital status, and urban residence were not associated with use of the sleeping area may suggest that this location is not only selected when household sanitation facilities are of poorer quality but may also be preferred by women for other reasons.

    “The finding that age, education, wealth, marital status, and urban residence were not associated with use of the sleeping area may also suggest that this location is not only selected when household sanitation facilities are of poorer quality but may also be preferred by women for other reasons.”
    Quote in the paperSubstantial claim

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

    Interpretationown data

    Improving household sanitation may increase women's access to such facilities for menstrual management.

    “While this may suggest that improving household sanitation may increase women’s access to such facilities for menstrual management”
    Quote in the paperNot a substantial claim

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

    Premisereasoning

    It is unclear how well current indicators capture menstrual hygiene.

    “While these estimates may provide some indication of access, it is unclear how well current indicators capture menstrual hygiene.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Approval for human subjects research was granted by National Health Research Ethics Committee (NHREC) of Nigeria.

    “Approval for human subjects research was granted by National Health Research Ethics Committee (NHREC) of Nigeria (approval code NHREC/01/01/2007-29th/09/2017B).”
    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

    Regression analyses were not weighted for survey sampling; standard errors were adjusted for clustering at the household level.

    “Regression analyses were not weighted for survey sampling. Standard errors were adjusted for clustering at the household level, as multiple women within the household were eligible to complete the female questionnaire and this was deemed a more proximal and critical source of bias.”
    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 response rate for the household questionnaire was 99.0%, and 97.9% for eligible females.

    “The response rate for the household questionnaire was 99.0%, and 97.9% for eligible females [25].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Zimmerman, 2017, Pma2020: Rapid turn-around survey data to monitor family planning service and practice in ten countries, Stud. Fam. Plan. source

      Not checked in the free run.

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

    Interpretationreasoning

    The presence of taboo and stigma around menstruation, or the need to hide menstrual status from others in the household, may dictate women changing their menstrual absorbents outside of the house.

    “The presence of taboo and stigma around menstruation, or the need to hide menstrual status from others in the household may dictate women changing their menstrual absorbents outside of the house.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The level of household sanitation does not necessarily indicate women's menstrual management location or lack of access to a location to change absorbents.

    “Findings of this study suggest that the level of household sanitation does not necessarily indicate women’s menstrual management location or lack of access to a location to change absorbents.”
    Quote in the paperSubstantial claim

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

    Interpretationcitation

    The findings are consistent with literature emphasizing that personal hygiene needs beyond sanitation and handwashing, including washing the body and laundry, are critical for women's wellbeing.

    “The findings are also consistent with limited, but important, literature which has emphasized that personal hygiene needs beyond sanitation and handwashing; including washing the body and laundry, are critical for women’s wellbeing [31,32,33].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [31] Fisher, J. (2006). For Her It’s the Big Issue: Putting Women and the Centre of Water Supply, Sanitation and Hygiene, Water Supply and Sanitation Collaborative Council.

      Not checked in the free run.

    • cites [32] Reddy, 2011, Sanitation and personal hygiene: What does it mean to poor and vulnerable women?, Indian J. Gend. Stud. source

      Not checked in the free run.

    • cites [33] Bhakta, A., Reed, B., and Fisher, J. (2017, January 24–28). Cleansing in hidden spaces: The bathign needs of perimenopausal women. Proceedings of the 40th WEDC International Conference 2017, Loughborough, UK.

      Not checked in the free run.

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

    Premisecitation

    Loughnan et al. suggest unimproved sanitation and open defecation as indicative of inadequate access to menstrual hygiene.

    “In their study of proxies for large-scale assessment of menstrual hygiene, Loughnan et al. [23] suggest unimproved sanitation and open defecation as indicative of inadequate access to menstrual hygiene.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Loughnan, 2016, What can existing data on water and sanitation tell us about menstrual hygiene management?, Waterlines source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Women using other areas in the household for menstrual management were likely included under the 'other sanitation facility' category, so that category does not only capture other sanitation facilities in the household.

    “It is likely that women using these locations for menstrual management were included under this category, and that this does not only capture other sanitation facilities in the household.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Interpretationreasoning

    The positive perceptions of the 'other sanitation facility' environment, including the presence of soap and water, cleanliness, privacy and safety, are consistent with this category including other areas in the household.

    “This is consistent with positive perceptions of the characteristics of this environment, including the presence of soap and water, cleanliness, privacy and safety.”
    Quote in the paperNot a substantial claim

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

    Interpretationreasoning

    The association between reusing menstrual materials and using the sleeping area may suggest this location supports storage or washing and drying of absorbents to a greater extent than a sanitation facility.

    “which may also suggest this location supports storage or washing and drying of absorbents to a greater extent than a sanitation facility.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The survey item capturing the location of menstrual management included no option for other areas in the household, such as bathing or laundry areas.

    “Importantly, the survey item capturing the location of menstrual management included no option for other areas in the household, such as bathing or laundry areas.”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    Proportions were adjusted for the complex survey design using weights provided in the PMA2020 data set.

    “Proportions were adjusted for the complex survey design using weights provided in the PMA2020 data set.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The finding that higher levels of sanitation according to existing criteria were not strongly associated with more positive perceptions of the menstrual management environment is consistent with studies of girls in schools reporting that girls may avoid using sanitation facilities due to stigma around menstruation and fears for privacy, and with women's sanitation-related stress.

    “However, this finding is consistent with studies of girls’ in schools, which have reported that girls may avoid using sanitation facilities due to stigma around menstruation and fears for privacy [2,12,13], and women’s sanitation-related stress [16,17].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [2] Hennegan, 2017, A qualitative understanding of the effects of reusable sanitary pads and puberty education: Implications for future research and practice, Reprod. Health source

      Not checked in the free run.

    • cites [12] Haver, J., Caruso, B.A., Ellis, A., Sahin, M., Villasenor, J.M., Andes, K.L., and Freeman, M.C. (2013). ‘Wash in Schools Empowers Girls’ Education in Masbate Province and Metro Manila, Philippines: An Assessment of Menstrual Hygiene Management in Schools’, UNICEF, Emory University.

      Not checked in the free run.

    • cites [13] Sommer, 2010, Where the education system and women’s bodies collide: The social and health impact of girls’ experiences of menstruation and schooling in tanzania, J. Adolesc. source

      Not checked in the free run.

    • cites [16] Sahoo, 2015, Sanitation-related psychosocial stress: A grounded theory study of women across the life-course in Odisha, India, Soc. Sci. Med. source

      Not checked in the free run.

    • cites [17] Henley, 2014, Cultural and socio-economic conditions as factors contributing to chronic stress in sub-Saharan African communities, Can. J. Physiol. Pharmacol. 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 conductnone given

    As a secondary analysis, data were collected prior to the study and survey items were not specifically designed for this research question.

    “As a secondary analysis, data were collected prior to the study and survey items were not specifically designed for this research question.”
    Quote in the paperNot a substantial claim

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

    Study design and conductcitation

    Limited items were available to appraise the adequacy of other menstrual hygiene proxies in current WASH monitoring.

    “Limited items were available to appraise the adequacy of other menstrual hygiene proxies in current WASH monitoring [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Loughnan, 2016, What can existing data on water and sanitation tell us about menstrual hygiene management?, Waterlines source

      Not checked in the free run.

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

    Interpretationreasoning

    Endorsement of the environment as clean, safe, or private may need to be interpreted with caution given the stigmatized nature of menstruation and likely social desirability of positively reporting on the location of management.

    “Endorsement of the environment as clean, safe, or private may need to be interpreted with caution given the stigmatized nature of menstruation and likely social desirability of positively reporting on the location of management.”
    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

    The cross-sectional design represents a limitation of the study and precludes causal inference.

    “The cross-sectional design represents a limitation of the study and precludes causal inference.”
    Quote in the paperNot a substantial claim

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

    Interpretationnone given

    This study was the first to provide a quantitative evaluation of the relationship between women's access to sanitation at home and their experience of menstrual hygiene.

    “This study was the first to provide a quantitative evaluation of the relationship between women’s access to sanitation at home and their experience of menstrual hygiene.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Women with poorer access to sanitation facilities often used their sleeping area for menstrual management or lacked access to a facility for menstrual management entirely and changed their absorbents outdoors.

    “Women with poorer access to sanitation facilities often used their sleeping area for menstrual management or lacked access to a facility for menstrual management entirely and changed their absorbents outdoors.”
    Quote in the paperSubstantial claim

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

    Study design and conductreasoning

    Increased familywise error from multiple contrasts is likely and effect sizes should be interpreted alongside the confidence interval and the limitations of this design.

    “Increased familywise error from multiple contrasts is likely and effect sizes should be interpreted alongside the confidence interval and the limitations of this design.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Responses were limited to a dichotomous 'yes' or 'no' response which is unlikely to capture a nuanced picture of women's experiences.

    “Further, responses were limited to a dichotomous “yes” or “no” response which is unlikely to capture a nuanced picture of women’s experiences.”
    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

    An analytic plan was specified in advance and all conducted analyses are reported here.

    “An analytic plan was specified in advance and all conducted analyses are reported here.”
    Quote in the paperNot a substantial claim

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

    Interpretationnone given

    Survey items may require some improvement to capture the variety of locations women and girls change their menstrual absorbents.

    “As noted above, survey items may require some improvement to capture the variety of locations women and girls’ change their menstrual absorbents.”
    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

    Differing group sizes for comparison meant that statistical power varied between these analyses and comparisons of the strength of associations across groups should be interpreted in light of the sample size.

    “Differing group sizes for comparison also meant that statistical power varied between these analyses and comparisons of the strength of associations across groups should be interpreted in light of the sample size.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The present study utilized large-scale survey data which provided sufficient numbers of women to assess differences across menstrual management locations and captured a broad sample of women across Kaduna state.

    “The present study utilized large-scale survey data which provided sufficient numbers of women to assess differences across menstrual management locations and captured a broad sample of women across Kaduna state.”
    Quote in the paperSubstantial claim

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

    Study design and conductreasoning

    Binary logistic regressions meant that contrasts were not orthogonal.

    “This meant that contrasts were not orthogonal.”
    Quote in the paperNot a substantial claim
41 of 41

  • The paper relies on this without support.

    Women's self-reported location of menstrual management accurately reflects their actual location for menstrual management.

    “Women were asked “What was the main place you used for changing your used pads, cloths, or other sanitary materials?””

  • The paper relies on this without support.

    The observed associations between household sanitation and menstrual management location are not due to unmeasured confounding.

    “These analyses were adjusted for socio-demographic characteristics, the type of menstrual material used, and the presence of a handwashing facility in the household”

  • The paper relies on this without support.

    There is limited existing literature on the relationship between household sanitation and women's experience of menstrual hygiene.

    “There is limited existing literature with which to compare the finding that higher levels of sanitation according to existing criteria were not strongly associated with more positive perceptions of the menstrual management environment.”
    “Limited past research was available to inform hypotheses or to compare the findings of the study.”
3 of 3

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) = 114.85reported p < .001 · recomputed p < .001

    “χ2(1) = 114.85, p < .001”

  • Consistentχ²(1) = 56.68reported p < .001 · recomputed p < .001

    “χ2(1) = 56.68, p < .001”

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.

  • Safety result is called nonsignificant despite its confidence interval

    Major

    The text says women using no facility were not significantly less likely to report safety, but the reported 95% confidence interval for safety (0.40-0.97) excludes the null odds ratio of 1.

  • Conclusion overlooks a favorable cleanliness result for improved facilities

    Minor

    The conclusion states that safely managed or basic facilities were not associated with more favorable ratings, but the results report significantly higher odds of those facilities being rated clean than unimproved facilities.

2 of 2

Cites

Flagged first, then by citations

1 of the 24 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Bhakta, A., Reed, B., and Fisher, J. (2017, January 24–28). Cleansing in hidden spaces: The bathign needs of perimenopausal women. Proceedings of the 40th WEDC International Conference 2017, Loughborough, UK.

Cited by

Sorted by citations

Related

Authors
Hennegan, J., Zimmerman, L., Shannon, A. K., Exum, N. G., OlaOlorun, F., Omoluabi, E., & Schwab, K. J.
Affiliations
  • Johns Hopkins University (US)
  • University of Ibadan (NG)
  • University of the Western Cape (ZA)
Corresponding author
Schwab, Kellogg J.
ORCID
Venue
International Journal of Environmental Research and Public Health
Publisher
MDPI AG
Published
2018-05-03
Volume
15
Issue
5
Pages
905
ISSN
1660-4601 (ISSN-L)
DOI
10.3390/ijerph15050905
PMC
PMC5981944
OpenAlex
W2801477663
Semantic Scholar
7d1c1a6bf5d89c6b4cde22c4a353b21bf9bbe774
Cited by
38
References
24
Citations by year
2026: 2 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 5 · 2021: 4 · 2020: 7 · 2019: 5 · 2018: 2
FWCI
4.29
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • UWC Research Repository (University of the Western Cape) (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
  • Social Sciences › Gender Studies › Gender Studies and Social Issues
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Keywords
household sanitation, menstrual hygiene management, women's health, sanitation indicators, women and girls, Kaduna State
MeSH terms
Adolescent, Adult, Cross-Sectional Studies, Family Characteristics, Female, Humans, Hygiene, Menstruation, Middle Aged, Nigeria, Surveys and Questionnaires, Sanitation, Soaps, Young Adult

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