Handwashing for menstrual hygiene management among primary schoolgirls in rural western Kenya
Elizabeth Nyothach | Kelly T. Alexander | Cliff Oduor | Linda Mason | Kelvin Oruko | Frank O. Odhiambo | John Vulule | Kayla F. Laserson | Penelope A. Phillips-Howard
Good hand hygiene contributes to the health and educational attainment of schoolchildren. Poor menstrual hygiene management (MHM) is recognized to impact on girls’ health, education, wellbeing and dignity, particularly in low-income countries. Identifying practical, affordable, and comfortable menstrual products to improve girls’ MHM is needed. One potential cost-effective product is the menstrual cup; however, provision of this insertable MHM product, in schools in low-income countries with challenging water, sanitation and hygiene (WASH) conditions, increases the need for assurance of good hand hygiene. This paper uses data from a randomized controlled feasibility study evaluating the acceptability, use and safety of menstrual hygiene products provided to schoolgirls in rural western Kenya. Here, we explore girls’ handwashing practices in school when using menstrual cups, sanitary pads or traditional items, examining the availability of WASH and the reported frequency of handwashing. Data generated from interviews with adults, girls’ private surveys, narratives from focus group discussions, and observational WASH surveys are explored. Reported presence of WASH was higher than that observed during random spot-checks. Overall, 10 per cent of girls never washed before, and 7 per cent never washed after, emptying or changing their menstrual item at school. Girls in cup schools were twice as likely to wash prior to emptying, compared with girls using other items. Handwashing among girls using traditional items was low, despite the same hand hygiene training across groups and a comparable WASH presence. Data highlight the need for sustained mechanisms to support schoolgirls’ handwashing practices for MHM.African Population and Health Research Center (APHRC) (2010) ‘Policy brief: Attitudes towards, and acceptibility of, menstrual cups as a method for managing menstruation’, Nairobi: APHRC [accessed 1 June 2013].
Alexander, K.T., Dreibelbis, R., Freeman, M.C., Ojeny, B. and Rheingans, R. (2013) ‘Improving service delivery of water, sanitation, and hygiene in primary schools: a cluster-randomized trial in western Kenya’, Journal of Water and Health, 11: 507–19 <http://dx.doi.org/10.2166/wh.2013.213>.
Alexander, K., Oduor, C., Nyothach, E., Laserson, K., Amek, N., Eleveld, A., Mason, L., Rheingans, R., Beynon, C., Mohammed, A., Ombok, M., Obor, D., Odhiambo, F., Quick, R. and Phillips-Howard, P. (2014) ‘Water, sanitation and hygiene conditions in Kenyan rural schools: are schools meeting the needs of menstruating girls? Water, 6: 1453–66 <http://dx.doi.org/10.3390/w6051453>.
Ali, T.S. and Rizvi, S.N. (2010) ‘Menstrual knowledge and practices of female adolescents in urban Karachi, Pakistan’, Journal of Adolescence, 33: 531–41 <http://dx.doi.org/10.1016/j.adolescence.2009.05.013>.
Averbach, S., Sahin-Hodoglugil, N., Musara, P., Chipato, T. and Van Der Straten, A. (2009) ‘Duet for menstrual protection: a feasibility study in Zimbabwe’, Contraception, 79: 463–8 <http://dx.doi.org/10.1016/j.contraception.2008.12.002>.
Blanton, E., Ombeki, S., Oluoch, G.O., Mwaki, A., Wannemuehler, K. and Quick, R. (2010) ‘Evaluation of the role of school children in the promotion of point-of-use water treatment and handwashing in schools and households—Nyanza Province, Western Kenya’, The American Journal of Tropical Medicine and Hygiene, 82: 664–71 <http://dx.doi.org/10.4269/ajtmh.2010.09-0422>.
Bowen, A., Ma, H., Ou, J., Billhimer, W., Long, T., Mintz, E., Hoekstra, R.M. and Luby, S. (2007) ‘A cluster-randomized controlled trial evaluating the effect of a handwashing-promotion program in Chinese primary schools’, The American Journal of Tropical Medicine and Hygiene, 76: 1166–73 <http://www.ajtmh.org/content/76/6/1166.short>.
Boyatzis, R.E. (1998) Transforming Qualitative Information: Thematic Analysis and Code Development, London and New Delhi: SAGE Publications.
Bundy, D.A. and Guyatt, H.L. (1996) ‘Schools for health: Focus on health, education and the school-age child’, Parasitology Today, 12 (8): 1–14 <http://dx.doi.org/10.1016/0169-4758(96)30011-2>.
Czerwinski, B.S. (2000) ‘Variation in feminine hygiene practices as a function of age’, Journal of Obstetric, Gynecologic, & Neonatal Nursing, 29: 625–33: <http://dx.doi.org/10.1111/j.1552-6909.2000.tb02076.x>.
Dasgupta, A. and Sarkar, M. (2008) ‘Menstrual hygiene: how hygienic is the adolescent girl?’ Indian Journal of Community Medicine, 33 (2): 77–80 <http://dx.doi.org/10.4103/0970-0218.40872>.
Dreibelbis, R., Greene, L.E., Freeman, M.C., Saboori, S., Chase, R.P. and Rheingans, R. (2013) ‘Water, sanitation, and primary school attendance: A multi-level assessment of determinants of household-reported absence in Kenya’, International Journal of Educational Development. 33: 457–465 <http://dx.doi.org/10.1016/j.ijedudev.2012.07.002>.
El-Gilany, A.H., Badawi, K. and El-Fedawy, S. (2005) ‘Menstrual hygiene among adolescent schoolgirls in Mansoura, Egypt’, Reproductive Health Matters, 13 (26): 147–52 <http://dx.doi.org/10.1016/S0968-8080(05)26191-8>.
Friedrich Jr, E.G. (1981) ‘Tampon effects on vaginal health’, Clinical Obstetetrics & Gynecology, 24: 395–406.
Halder, A.K., Tronchet, C., Akhter, S., Bhuiya, A., Johnston, R. and Luby, S.P. (2010) ‘Observed hand cleanliness and other measures of handwashing behavior in rural Bangladesh’, BMC Public Health, 10: 545 doi: <http://dx.doi.org/10.1186/1471-2458-10-545>.
Hewett, P.C., Mensch, B.S. and Erulkar, A.S. (2004) ‘Consistency in the reporting of sexual behaviour by adolescent girls in Kenya: a comparison of interviewing methods’, Sexually Transmitted Infections, 80 (suppl 2): ii43–48 <http://dx.doi.org/10.1136/sti.2004.013250>.
Howard, C., Rose, C.L., Trouton, K., Stamm, H., Marentette, D., Kirkpatrick, N., Karalic, S., Fernandez, R. and Paget, J. (2011) ‘FLOW (finding lasting options for women): multicentre randomized controlled trial comparing tampons with menstrual cups’, Canadian Family Physician, 57: e208–15 <http://www.cfp.ca/content/57/6/e208.short>.
Manun’ebo, M., Cousens, S., Haggerty, P., Kalengaie, M., Ashworth, A. and Kirkwood, B. (1997) ‘Measuring hygiene practices: a comparison of questionnaires with direct observations in rural Zaire’, Tropical Medicine & International Health, 2: 1015–21 <http://dx.doi.org/10.1046/j.1365-3156.1997.d01-180.x>.
Mason, L., Laserson, K., Oruko, K., Nyothach, E., Alexander, K., Odhiambo, F., Eleveld, A., Isiye, E., Ngere, I., Omoto, J., Mohammed, A., Vulule, J. and Phillips-Howard, P. (2014) ‘Adolescent schoolgirls’ experiences of menstrual cups and pads in rural western Kenya: a qualitative study’, Waterlines, 34 (1): 15–30 <http://dx.doi.org/10.3362/1756-3488.2015.003>.
Mason, L., Nyothach, E., Alexander, K., Odhiambo, F.O., Eleveld, A., Vulule, J., Rheingans, R., Laserson, K.F., Mohammed, A. and Phillips-Howard, P.A. (2013) ‘“We keep it secret so no one should know” – a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural Western kenya’, PLoS One, 8: e79132 <http://dx.doi.org/10.1371/journal.pone.0079132>.
McMahon, S.A., Winch, P.J., Caruso, B.A., Obure, A.F., Ogutu, E.A., Ochari, I.A. and Rheingans, R.D. (2011) ‘“The girl with her period is the one to hang her head”: Reflections on menstrual management among schoolgirls in rural Kenya’, BMC International Health & Human Rights, 11: 7 <http://dx.doi.org/10.1186/1472-698X-11-7>.
Mensch, B.S., Clark, W.H., Lloyd, C.B. and Erulkar, A.S. (2001) ‘Premarital sex, schoolgirl pregnancy, and school quality in rural Kenya’, Studies in Family Planning, 32: 285–301 <http://dx.doi.org/10.1111/j.1728-4465.2001.00285.x>.
Migele, J., Ombeki, S., Ayalo, M., Biggerstaff, M. and Quick, R. (2007) ‘Diarrhea prevention in a Kenyan school through the use of a simple safe water and hygiene intervention’, The American Journal of Tropical Medicine and Hygiene, 76, 351–3. Doi: 76/2/351 [pii].
Mugo, J., Kaburu, A., Limboro, C. and Kimutai, A. (2012) ‘Are our children learning?’ In Annual Learning Assessment Report, Nairobi, Kenya: Uwezo Kenya.
Odhiambo, F.O., Laserson, K.F., Sewe, M., Hamel, M.J., Feikin, D.R., Adazu, K., Ogwang, S., Obor, D., Amek, N., Bayoh, N., Ombok, M., Lindblade, K., Desai, M., Ter Kuile, F., Phillips-Howard, P., Van Eijk, A.M., Rosen, D., Hightower, A., Ofware, P., Muttai, H., Nahlen, B., Decock, K., Slutsker, L., Breiman, R.F. and Vulule, J.M. (2012) ‘Profile: The KEMRI/CDC Health and Demographic Surveillance System—Western Kenya’, International Journal of Epidemiology, 41: 977–87 <http://dx.doi.org/10.1093/ije/dys108>.
Omwami, E. and Omwami, R. (2009) ‘Public investment and the goal of providing universal access to primary education by 2015 in Kenya’, International Journal of Education Development, 30: 243–53 <http://dx.doi.org/10.1016/j.ijedudev.2009.09.002>.
Oster, E. and Thornton, R. (2012) ‘Determinants of technology adoption: Peer effects in menstrual cup up-take’, Journal of the European Economic Association, 10: 1263–93 <http://dx.doi.org/10.1111/j.1542-4774.2012.01090.x>.
Pickering, A.J., Blum, A.G., Breiman, R.F., Ram, P.K. and Davis, J. (2014) ‘Video surveillance captures student hand hygiene behavior, reactivity to observation, and peer influence in Kenyan primary schools’, PloS one, 9: e92571 <http://dx.doi.org/10.1371/journal.pone.0092571>.
Ram, P. (2013) ‘Practical guidance for measuring handwashing behavior: 2013 Update’, Global Scaling Up Hand washing Project, Water and Sanitation Project, Washington, DC: The World Bank.
Schmidt, W.P., Aunger, R., Coombes, Y., Maina, P.M., Matiko, C.N., Biran, A. and Curtis, V. (2009) ‘Determinants of handwashing practices in Kenya: the role of media exposure, poverty and infrastructure’, Tropical Medicine & International Health, 14: 1534–41 <http://dx.doi.org/10.1111/j.1365-3156.2009.02404.x>.
Sommer, M. (2010) ‘Where the education system and women’s bodies collide: The social and health impact of girls’ experiences of menstruation and schooling in Tanzania’, Journal of Adolescence, 33: 521–9 <http://dx.doi.org/10.1016/j.adolescence.2009.03.008>.
Sommer, M. and Sahin, M. (2013) ‘Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls’, American Journal of Public Health, 103: 1556–9 <http://dx.doi.org/10.2105/AJPH.2013.301374>.
Stewart, K., Greer, R. and Powell, M. (2010) ‘Women’s experience of using the Mooncup’, Journal of Obstetrics & Gynaecology, 30: 285–7 <http://dx.doi.org/10.3109/01443610903572117>.
Stewart, K., Powell, M. and Greer, R. (2009) ‘An alternative to conventional sanitary protection: would women use a menstrual cup?’ Journal of Obstetrics & Gynaecology, 29: 49–52 doi: <http://dx.doi.org/10.1080/01443610802628841>.
Talaat, M., Afifi, S., Dueger, E., El-Ashry, N., Marfin, A., Kandeel, A., Mohareb, E. and El-Sayed, N. (2011) ‘Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza and absenteeism in schoolchildren, Cairo, Egypt’, Emerging Infectious Diseases, 17 (4): 619–25 <http://dx.doi.org/10.3201/eid1704.101353>.
Tellier, M., Hyttel, M. and Gad, M. (2012) ‘Assessing acceptability and hygienic safety of menstrual cups as a menstrual management method for vulnerable young women in Uganda’, Red Cross Society’s Life Planning Skills Project, Kampala: Red Cross Uganda and WoMena <https://www.changemakers.com/sites/default/files/red_cross_and_womena_ltd_-_uganda_pilot_study_report_dec_2012_.pdf> [accessed 9 September 2015].
Trego, L.L. (2012) ‘Prevention is key to maintaining gynaeclogical health during deployment’, AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses, 41, 283–92 <http://dx.doi.org/10.1111/j.1552-6909.2011.01337.x>.
UNICEF (2010) ‘Raising clean hands: advancing learning, health and participation through WASH in schools’, New York: UNICEF.
UNICEF (2011) WASH in Schools Monitoring Package, New York: UNICEF.
UNICEF (2012) ‘Raising even more clean hands: Advancing health, learning and equity through WASH in schools’, New York: UNICEF.
WaterAid (2009) ‘Is menstrual hygiene and management an issue for adolescent school girls? A comparative study of four schools in different settings of Nepal’, Nepal: Water Aid.
African Population and Health Research Center (APHRC) (2010) ‘Policy brief: Attitudes towards, and acceptibility of, menstrual cups as a method for managing menstruation’, Nairobi: APHRC [accessed 1 June 2013].
Alexander, K.T., Dreibelbis, R., Freeman, M.C., Ojeny, B. and Rheingans, R. (2013) ‘Improving service delivery of water, sanitation, and hygiene in primary schools: a cluster-randomized trial in western Kenya’, Journal of Water and Health, 11: 507–19 <http://dx.doi.org/10.2166/wh.2013.213>.
Alexander, K., Oduor, C., Nyothach, E., Laserson, K., Amek, N., Eleveld, A., Mason, L., Rheingans, R., Beynon, C., Mohammed, A., Ombok, M., Obor, D., Odhiambo, F., Quick, R. and Phillips-Howard, P. (2014) ‘Water, sanitation and hygiene conditions in Kenyan rural schools: are schools meeting the needs of menstruating girls? Water, 6: 1453–66 <http://dx.doi.org/10.3390/w6051453>.
Ali, T.S. and Rizvi, S.N. (2010) ‘Menstrual knowledge and practices of female adolescents in urban Karachi, Pakistan’, Journal of Adolescence, 33: 531–41 <http://dx.doi.org/10.1016/j.adolescence.2009.05.013>.
Averbach, S., Sahin-Hodoglugil, N., Musara, P., Chipato, T. and Van Der Straten, A. (2009) ‘Duet for menstrual protection: a feasibility study in Zimbabwe’, Contraception, 79: 463–8 <http://dx.doi.org/10.1016/j.contraception.2008.12.002>.
Blanton, E., Ombeki, S., Oluoch, G.O., Mwaki, A., Wannemuehler, K. and Quick, R. (2010) ‘Evaluation of the role of school children in the promotion of point-of-use water treatment and handwashing in schools and households—Nyanza Province, Western Kenya’, The American Journal of Tropical Medicine and Hygiene, 82: 664–71 <http://dx.doi.org/10.4269/ajtmh.2010.09-0422>.
Bowen, A., Ma, H., Ou, J., Billhimer, W., Long, T., Mintz, E., Hoekstra, R.M. and Luby, S. (2007) ‘A cluster-randomized controlled trial evaluating the effect of a handwashing-promotion program in Chinese primary schools’, The American Journal of Tropical Medicine and Hygiene, 76: 1166–73 <http://www.ajtmh.org/content/76/6/1166.short>.
Boyatzis, R.E. (1998) Transforming Qualitative Information: Thematic Analysis and Code Development, London and New Delhi: SAGE Publications.
Bundy, D.A. and Guyatt, H.L. (1996) ‘Schools for health: Focus on health, education and the school-age child’, Parasitology Today, 12 (8): 1–14 <http://dx.doi.org/10.1016/0169-4758(96)30011-2>.
Czerwinski, B.S. (2000) ‘Variation in feminine hygiene practices as a function of age’, Journal of Obstetric, Gynecologic, & Neonatal Nursing, 29: 625–33: <http://dx.doi.org/10.1111/j.1552-6909.2000.tb02076.x>.
Dasgupta, A. and Sarkar, M. (2008) ‘Menstrual hygiene: how hygienic is the adolescent girl?’ Indian Journal of Community Medicine, 33 (2): 77–80 <http://dx.doi.org/10.4103/0970-0218.40872>.
Dreibelbis, R., Greene, L.E., Freeman, M.C., Saboori, S., Chase, R.P. and Rheingans, R. (2013) ‘Water, sanitation, and primary school attendance: A multi-level assessment of determinants of household-reported absence in Kenya’, International Journal of Educational Development. 33: 457–465 <http://dx.doi.org/10.1016/j.ijedudev.2012.07.002>.
El-Gilany, A.H., Badawi, K. and El-Fedawy, S. (2005) ‘Menstrual hygiene among adolescent schoolgirls in Mansoura, Egypt’, Reproductive Health Matters, 13 (26): 147–52 <http://dx.doi.org/10.1016/S0968-8080(05)26191-8>.
Friedrich Jr, E.G. (1981) ‘Tampon effects on vaginal health’, Clinical Obstetetrics & Gynecology, 24: 395–406.
Halder, A.K., Tronchet, C., Akhter, S., Bhuiya, A., Johnston, R. and Luby, S.P. (2010) ‘Observed hand cleanliness and other measures of handwashing behavior in rural Bangladesh’, BMC Public Health, 10: 545 doi: <http://dx.doi.org/10.1186/1471-2458-10-545>.
Hewett, P.C., Mensch, B.S. and Erulkar, A.S. (2004) ‘Consistency in the reporting of sexual behaviour by adolescent girls in Kenya: a comparison of interviewing methods’, Sexually Transmitted Infections, 80 (suppl 2): ii43–48 <http://dx.doi.org/10.1136/sti.2004.013250>.
Howard, C., Rose, C.L., Trouton, K., Stamm, H., Marentette, D., Kirkpatrick, N., Karalic, S., Fernandez, R. and Paget, J. (2011) ‘FLOW (finding lasting options for women): multicentre randomized controlled trial comparing tampons with menstrual cups’, Canadian Family Physician, 57: e208–15 <http://www.cfp.ca/content/57/6/e208.short>.
Manun’ebo, M., Cousens, S., Haggerty, P., Kalengaie, M., Ashworth, A. and Kirkwood, B. (1997) ‘Measuring hygiene practices: a comparison of questionnaires with direct observations in rural Zaire’, Tropical Medicine & International Health, 2: 1015–21 <http://dx.doi.org/10.1046/j.1365-3156.1997.d01-180.x>.
Mason, L., Laserson, K., Oruko, K., Nyothach, E., Alexander, K., Odhiambo, F., Eleveld, A., Isiye, E., Ngere, I., Omoto, J., Mohammed, A., Vulule, J. and Phillips-Howard, P. (2014) ‘Adolescent schoolgirls’ experiences of menstrual cups and pads in rural western Kenya: a qualitative study’, Waterlines, 34 (1): 15–30 <http://dx.doi.org/10.3362/1756-3488.2015.003>.
Mason, L., Nyothach, E., Alexander, K., Odhiambo, F.O., Eleveld, A., Vulule, J., Rheingans, R., Laserson, K.F., Mohammed, A. and Phillips-Howard, P.A. (2013) ‘“We keep it secret so no one should know” – a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural Western kenya’, PLoS One, 8: e79132 <http://dx.doi.org/10.1371/journal.pone.0079132>.
McMahon, S.A., Winch, P.J., Caruso, B.A., Obure, A.F., Ogutu, E.A., Ochari, I.A. and Rheingans, R.D. (2011) ‘“The girl with her period is the one to hang her head”: Reflections on menstrual management among schoolgirls in rural Kenya’, BMC International Health & Human Rights, 11: 7 <http://dx.doi.org/10.1186/1472-698X-11-7>.
Mensch, B.S., Clark, W.H., Lloyd, C.B. and Erulkar, A.S. (2001) ‘Premarital sex, schoolgirl pregnancy, and school quality in rural Kenya’, Studies in Family Planning, 32: 285–301 <http://dx.doi.org/10.1111/j.1728-4465.2001.00285.x>.
Migele, J., Ombeki, S., Ayalo, M., Biggerstaff, M. and Quick, R. (2007) ‘Diarrhea prevention in a Kenyan school through the use of a simple safe water and hygiene intervention’, The American Journal of Tropical Medicine and Hygiene, 76, 351–3. Doi: 76/2/351 [pii].
Mugo, J., Kaburu, A., Limboro, C. and Kimutai, A. (2012) ‘Are our children learning?’ In Annual Learning Assessment Report, Nairobi, Kenya: Uwezo Kenya.
Odhiambo, F.O., Laserson, K.F., Sewe, M., Hamel, M.J., Feikin, D.R., Adazu, K., Ogwang, S., Obor, D., Amek, N., Bayoh, N., Ombok, M., Lindblade, K., Desai, M., Ter Kuile, F., Phillips-Howard, P., Van Eijk, A.M., Rosen, D., Hightower, A., Ofware, P., Muttai, H., Nahlen, B., Decock, K., Slutsker, L., Breiman, R.F. and Vulule, J.M. (2012) ‘Profile: The KEMRI/CDC Health and Demographic Surveillance System—Western Kenya’, International Journal of Epidemiology, 41: 977–87 <http://dx.doi.org/10.1093/ije/dys108>.
Omwami, E. and Omwami, R. (2009) ‘Public investment and the goal of providing universal access to primary education by 2015 in Kenya’, International Journal of Education Development, 30: 243–53 <http://dx.doi.org/10.1016/j.ijedudev.2009.09.002>.
Oster, E. and Thornton, R. (2012) ‘Determinants of technology adoption: Peer effects in menstrual cup up-take’, Journal of the European Economic Association, 10: 1263–93 <http://dx.doi.org/10.1111/j.1542-4774.2012.01090.x>.
Pickering, A.J., Blum, A.G., Breiman, R.F., Ram, P.K. and Davis, J. (2014) ‘Video surveillance captures student hand hygiene behavior, reactivity to observation, and peer influence in Kenyan primary schools’, PloS one, 9: e92571 <http://dx.doi.org/10.1371/journal.pone.0092571>.
Ram, P. (2013) ‘Practical guidance for measuring handwashing behavior: 2013 Update’, Global Scaling Up Hand washing Project, Water and Sanitation Project, Washington, DC: The World Bank.
Schmidt, W.P., Aunger, R., Coombes, Y., Maina, P.M., Matiko, C.N., Biran, A. and Curtis, V. (2009) ‘Determinants of handwashing practices in Kenya: the role of media exposure, poverty and infrastructure’, Tropical Medicine & International Health, 14: 1534–41 <http://dx.doi.org/10.1111/j.1365-3156.2009.02404.x>.
Sommer, M. (2010) ‘Where the education system and women’s bodies collide: The social and health impact of girls’ experiences of menstruation and schooling in Tanzania’, Journal of Adolescence, 33: 521–9 <http://dx.doi.org/10.1016/j.adolescence.2009.03.008>.
Sommer, M. and Sahin, M. (2013) ‘Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls’, American Journal of Public Health, 103: 1556–9 <http://dx.doi.org/10.2105/AJPH.2013.301374>.
Stewart, K., Greer, R. and Powell, M. (2010) ‘Women’s experience of using the Mooncup’, Journal of Obstetrics & Gynaecology, 30: 285–7 <http://dx.doi.org/10.3109/01443610903572117>.
Stewart, K., Powell, M. and Greer, R. (2009) ‘An alternative to conventional sanitary protection: would women use a menstrual cup?’ Journal of Obstetrics & Gynaecology, 29: 49–52 doi: <http://dx.doi.org/10.1080/01443610802628841>.
Talaat, M., Afifi, S., Dueger, E., El-Ashry, N., Marfin, A., Kandeel, A., Mohareb, E. and El-Sayed, N. (2011) ‘Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza and absenteeism in schoolchildren, Cairo, Egypt’, Emerging Infectious Diseases, 17 (4): 619–25 <http://dx.doi.org/10.3201/eid1704.101353>.
Tellier, M., Hyttel, M. and Gad, M. (2012) ‘Assessing acceptability and hygienic safety of menstrual cups as a menstrual management method for vulnerable young women in Uganda’, Red Cross Society’s Life Planning Skills Project, Kampala: Red Cross Uganda and WoMena <https://www.changemakers.com/sites/default/files/red_cross_and_womena_ltd_-_uganda_pilot_study_report_dec_2012_.pdf> [accessed 9 September 2015].
Trego, L.L. (2012) ‘Prevention is key to maintaining gynaeclogical health during deployment’, AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses, 41, 283–92 <http://dx.doi.org/10.1111/j.1552-6909.2011.01337.x>.
UNICEF (2010) ‘Raising clean hands: advancing learning, health and participation through WASH in schools’, New York: UNICEF.
UNICEF (2011) WASH in Schools Monitoring Package, New York: UNICEF.
UNICEF (2012) ‘Raising even more clean hands: Advancing health, learning and equity through WASH in schools’, New York: UNICEF.
WaterAid (2009) ‘Is menstrual hygiene and management an issue for adolescent school girls? A comparative study of four schools in different settings of Nepal’, Nepal: Water Aid.
African Population and Health Research Center (APHRC) (2010) ‘Policy brief: Attitudes towards, and acceptibility of, menstrual cups as a method for managing menstruation’, Nairobi: APHRC [accessed 1 June 2013].
Alexander, K.T., Dreibelbis, R., Freeman, M.C., Ojeny, B. and Rheingans, R. (2013) ‘Improving service delivery of water, sanitation, and hygiene in primary schools: a cluster-randomized trial in western Kenya’, Journal of Water and Health, 11: 507–19 <http://dx.doi.org/10.2166/wh.2013.213>.
Alexander, K., Oduor, C., Nyothach, E., Laserson, K., Amek, N., Eleveld, A., Mason, L., Rheingans, R., Beynon, C., Mohammed, A., Ombok, M., Obor, D., Odhiambo, F., Quick, R. and Phillips-Howard, P. (2014) ‘Water, sanitation and hygiene conditions in Kenyan rural schools: are schools meeting the needs of menstruating girls? Water, 6: 1453–66 <http://dx.doi.org/10.3390/w6051453>.
Ali, T.S. and Rizvi, S.N. (2010) ‘Menstrual knowledge and practices of female adolescents in urban Karachi, Pakistan’, Journal of Adolescence, 33: 531–41 <http://dx.doi.org/10.1016/j.adolescence.2009.05.013>.
Averbach, S., Sahin-Hodoglugil, N., Musara, P., Chipato, T. and Van Der Straten, A. (2009) ‘Duet for menstrual protection: a feasibility study in Zimbabwe’, Contraception, 79: 463–8 <http://dx.doi.org/10.1016/j.contraception.2008.12.002>.
Blanton, E., Ombeki, S., Oluoch, G.O., Mwaki, A., Wannemuehler, K. and Quick, R. (2010) ‘Evaluation of the role of school children in the promotion of point-of-use water treatment and handwashing in schools and households—Nyanza Province, Western Kenya’, The American Journal of Tropical Medicine and Hygiene, 82: 664–71 <http://dx.doi.org/10.4269/ajtmh.2010.09-0422>.
Bowen, A., Ma, H., Ou, J., Billhimer, W., Long, T., Mintz, E., Hoekstra, R.M. and Luby, S. (2007) ‘A cluster-randomized controlled trial evaluating the effect of a handwashing-promotion program in Chinese primary schools’, The American Journal of Tropical Medicine and Hygiene, 76: 1166–73 <http://www.ajtmh.org/content/76/6/1166.short>.
Boyatzis, R.E. (1998) Transforming Qualitative Information: Thematic Analysis and Code Development, London and New Delhi: SAGE Publications.
Bundy, D.A. and Guyatt, H.L. (1996) ‘Schools for health: Focus on health, education and the school-age child’, Parasitology Today, 12 (8): 1–14 <http://dx.doi.org/10.1016/0169-4758(96)30011-2>.
Czerwinski, B.S. (2000) ‘Variation in feminine hygiene practices as a function of age’, Journal of Obstetric, Gynecologic, & Neonatal Nursing, 29: 625–33: <http://dx.doi.org/10.1111/j.1552-6909.2000.tb02076.x>.
Dasgupta, A. and Sarkar, M. (2008) ‘Menstrual hygiene: how hygienic is the adolescent girl?’ Indian Journal of Community Medicine, 33 (2): 77–80 <http://dx.doi.org/10.4103/0970-0218.40872>.
Dreibelbis, R., Greene, L.E., Freeman, M.C., Saboori, S., Chase, R.P. and Rheingans, R. (2013) ‘Water, sanitation, and primary school attendance: A multi-level assessment of determinants of household-reported absence in Kenya’, International Journal of Educational Development. 33: 457–465 <http://dx.doi.org/10.1016/j.ijedudev.2012.07.002>.
El-Gilany, A.H., Badawi, K. and El-Fedawy, S. (2005) ‘Menstrual hygiene among adolescent schoolgirls in Mansoura, Egypt’, Reproductive Health Matters, 13 (26): 147–52 <http://dx.doi.org/10.1016/S0968-8080(05)26191-8>.
Friedrich Jr, E.G. (1981) ‘Tampon effects on vaginal health’, Clinical Obstetetrics & Gynecology, 24: 395–406.
Halder, A.K., Tronchet, C., Akhter, S., Bhuiya, A., Johnston, R. and Luby, S.P. (2010) ‘Observed hand cleanliness and other measures of handwashing behavior in rural Bangladesh’, BMC Public Health, 10: 545 doi: <http://dx.doi.org/10.1186/1471-2458-10-545>.
Hewett, P.C., Mensch, B.S. and Erulkar, A.S. (2004) ‘Consistency in the reporting of sexual behaviour by adolescent girls in Kenya: a comparison of interviewing methods’, Sexually Transmitted Infections, 80 (suppl 2): ii43–48 <http://dx.doi.org/10.1136/sti.2004.013250>.
Howard, C., Rose, C.L., Trouton, K., Stamm, H., Marentette, D., Kirkpatrick, N., Karalic, S., Fernandez, R. and Paget, J. (2011) ‘FLOW (finding lasting options for women): multicentre randomized controlled trial comparing tampons with menstrual cups’, Canadian Family Physician, 57: e208–15 <http://www.cfp.ca/content/57/6/e208.short>.
Manun’ebo, M., Cousens, S., Haggerty, P., Kalengaie, M., Ashworth, A. and Kirkwood, B. (1997) ‘Measuring hygiene practices: a comparison of questionnaires with direct observations in rural Zaire’, Tropical Medicine & International Health, 2: 1015–21 <http://dx.doi.org/10.1046/j.1365-3156.1997.d01-180.x>.
Mason, L., Laserson, K., Oruko, K., Nyothach, E., Alexander, K., Odhiambo, F., Eleveld, A., Isiye, E., Ngere, I., Omoto, J., Mohammed, A., Vulule, J. and Phillips-Howard, P. (2014) ‘Adolescent schoolgirls’ experiences of menstrual cups and pads in rural western Kenya: a qualitative study’, Waterlines, 34 (1): 15–30 <http://dx.doi.org/10.3362/1756-3488.2015.003>.
Mason, L., Nyothach, E., Alexander, K., Odhiambo, F.O., Eleveld, A., Vulule, J., Rheingans, R., Laserson, K.F., Mohammed, A. and Phillips-Howard, P.A. (2013) ‘“We keep it secret so no one should know” – a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural Western kenya’, PLoS One, 8: e79132 <http://dx.doi.org/10.1371/journal.pone.0079132>.
McMahon, S.A., Winch, P.J., Caruso, B.A., Obure, A.F., Ogutu, E.A., Ochari, I.A. and Rheingans, R.D. (2011) ‘“The girl with her period is the one to hang her head”: Reflections on menstrual management among schoolgirls in rural Kenya’, BMC International Health & Human Rights, 11: 7 <http://dx.doi.org/10.1186/1472-698X-11-7>.
Mensch, B.S., Clark, W.H., Lloyd, C.B. and Erulkar, A.S. (2001) ‘Premarital sex, schoolgirl pregnancy, and school quality in rural Kenya’, Studies in Family Planning, 32: 285–301 <http://dx.doi.org/10.1111/j.1728-4465.2001.00285.x>.
Migele, J., Ombeki, S., Ayalo, M., Biggerstaff, M. and Quick, R. (2007) ‘Diarrhea prevention in a Kenyan school through the use of a simple safe water and hygiene intervention’, The American Journal of Tropical Medicine and Hygiene, 76, 351–3. Doi: 76/2/351 [pii].
Mugo, J., Kaburu, A., Limboro, C. and Kimutai, A. (2012) ‘Are our children learning?’ In Annual Learning Assessment Report, Nairobi, Kenya: Uwezo Kenya.
Odhiambo, F.O., Laserson, K.F., Sewe, M., Hamel, M.J., Feikin, D.R., Adazu, K., Ogwang, S., Obor, D., Amek, N., Bayoh, N., Ombok, M., Lindblade, K., Desai, M., Ter Kuile, F., Phillips-Howard, P., Van Eijk, A.M., Rosen, D., Hightower, A., Ofware, P., Muttai, H., Nahlen, B., Decock, K., Slutsker, L., Breiman, R.F. and Vulule, J.M. (2012) ‘Profile: The KEMRI/CDC Health and Demographic Surveillance System—Western Kenya’, International Journal of Epidemiology, 41: 977–87 <http://dx.doi.org/10.1093/ije/dys108>.
Omwami, E. and Omwami, R. (2009) ‘Public investment and the goal of providing universal access to primary education by 2015 in Kenya’, International Journal of Education Development, 30: 243–53 <http://dx.doi.org/10.1016/j.ijedudev.2009.09.002>.
Oster, E. and Thornton, R. (2012) ‘Determinants of technology adoption: Peer effects in menstrual cup up-take’, Journal of the European Economic Association, 10: 1263–93 <http://dx.doi.org/10.1111/j.1542-4774.2012.01090.x>.
Pickering, A.J., Blum, A.G., Breiman, R.F., Ram, P.K. and Davis, J. (2014) ‘Video surveillance captures student hand hygiene behavior, reactivity to observation, and peer influence in Kenyan primary schools’, PloS one, 9: e92571 <http://dx.doi.org/10.1371/journal.pone.0092571>.
Ram, P. (2013) ‘Practical guidance for measuring handwashing behavior: 2013 Update’, Global Scaling Up Hand washing Project, Water and Sanitation Project, Washington, DC: The World Bank.
Schmidt, W.P., Aunger, R., Coombes, Y., Maina, P.M., Matiko, C.N., Biran, A. and Curtis, V. (2009) ‘Determinants of handwashing practices in Kenya: the role of media exposure, poverty and infrastructure’, Tropical Medicine & International Health, 14: 1534–41 <http://dx.doi.org/10.1111/j.1365-3156.2009.02404.x>.
Sommer, M. (2010) ‘Where the education system and women’s bodies collide: The social and health impact of girls’ experiences of menstruation and schooling in Tanzania’, Journal of Adolescence, 33: 521–9 <http://dx.doi.org/10.1016/j.adolescence.2009.03.008>.
Sommer, M. and Sahin, M. (2013) ‘Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls’, American Journal of Public Health, 103: 1556–9 <http://dx.doi.org/10.2105/AJPH.2013.301374>.
Stewart, K., Greer, R. and Powell, M. (2010) ‘Women’s experience of using the Mooncup’, Journal of Obstetrics & Gynaecology, 30: 285–7 <http://dx.doi.org/10.3109/01443610903572117>.
Stewart, K., Powell, M. and Greer, R. (2009) ‘An alternative to conventional sanitary protection: would women use a menstrual cup?’ Journal of Obstetrics & Gynaecology, 29: 49–52 doi: <http://dx.doi.org/10.1080/01443610802628841>.
Talaat, M., Afifi, S., Dueger, E., El-Ashry, N., Marfin, A., Kandeel, A., Mohareb, E. and El-Sayed, N. (2011) ‘Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza and absenteeism in schoolchildren, Cairo, Egypt’, Emerging Infectious Diseases, 17 (4): 619–25 <http://dx.doi.org/10.3201/eid1704.101353>.
Tellier, M., Hyttel, M. and Gad, M. (2012) ‘Assessing acceptability and hygienic safety of menstrual cups as a menstrual management method for vulnerable young women in Uganda’, Red Cross Society’s Life Planning Skills Project, Kampala: Red Cross Uganda and WoMena <https://www.changemakers.com/sites/default/files/red_cross_and_womena_ltd_-_uganda_pilot_study_report_dec_2012_.pdf> [accessed 9 September 2015].
Trego, L.L. (2012) ‘Prevention is key to maintaining gynaeclogical health during deployment’, AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses, 41, 283–92 <http://dx.doi.org/10.1111/j.1552-6909.2011.01337.x>.
UNICEF (2010) ‘Raising clean hands: advancing learning, health and participation through WASH in schools’, New York: UNICEF.
UNICEF (2011) WASH in Schools Monitoring Package, New York: UNICEF.
UNICEF (2012) ‘Raising even more clean hands: Advancing health, learning and equity through WASH in schools’, New York: UNICEF.
WaterAid (2009) ‘Is menstrual hygiene and management an issue for adolescent school girls? A comparative study of four schools in different settings of Nepal’, Nepal: Water Aid.
African Population and Health Research Center (APHRC) (2010) ‘Policy brief: Attitudes towards, and acceptibility of, menstrual cups as a method for managing menstruation’, Nairobi: APHRC [accessed 1 June 2013].
Alexander, K.T., Dreibelbis, R., Freeman, M.C., Ojeny, B. and Rheingans, R. (2013) ‘Improving service delivery of water, sanitation, and hygiene in primary schools: a cluster-randomized trial in western Kenya’, Journal of Water and Health, 11: 507–19 <http://dx.doi.org/10.2166/wh.2013.213>.
Alexander, K., Oduor, C., Nyothach, E., Laserson, K., Amek, N., Eleveld, A., Mason, L., Rheingans, R., Beynon, C., Mohammed, A., Ombok, M., Obor, D., Odhiambo, F., Quick, R. and Phillips-Howard, P. (2014) ‘Water, sanitation and hygiene conditions in Kenyan rural schools: are schools meeting the needs of menstruating girls? Water, 6: 1453–66 <http://dx.doi.org/10.3390/w6051453>.
Ali, T.S. and Rizvi, S.N. (2010) ‘Menstrual knowledge and practices of female adolescents in urban Karachi, Pakistan’, Journal of Adolescence, 33: 531–41 <http://dx.doi.org/10.1016/j.adolescence.2009.05.013>.
Averbach, S., Sahin-Hodoglugil, N., Musara, P., Chipato, T. and Van Der Straten, A. (2009) ‘Duet for menstrual protection: a feasibility study in Zimbabwe’, Contraception, 79: 463–8 <http://dx.doi.org/10.1016/j.contraception.2008.12.002>.
Blanton, E., Ombeki, S., Oluoch, G.O., Mwaki, A., Wannemuehler, K. and Quick, R. (2010) ‘Evaluation of the role of school children in the promotion of point-of-use water treatment and handwashing in schools and households—Nyanza Province, Western Kenya’, The American Journal of Tropical Medicine and Hygiene, 82: 664–71 <http://dx.doi.org/10.4269/ajtmh.2010.09-0422>.
Bowen, A., Ma, H., Ou, J., Billhimer, W., Long, T., Mintz, E., Hoekstra, R.M. and Luby, S. (2007) ‘A cluster-randomized controlled trial evaluating the effect of a handwashing-promotion program in Chinese primary schools’, The American Journal of Tropical Medicine and Hygiene, 76: 1166–73 <http://www.ajtmh.org/content/76/6/1166.short>.
Boyatzis, R.E. (1998) Transforming Qualitative Information: Thematic Analysis and Code Development, London and New Delhi: SAGE Publications.
Bundy, D.A. and Guyatt, H.L. (1996) ‘Schools for health: Focus on health, education and the school-age child’, Parasitology Today, 12 (8): 1–14 <http://dx.doi.org/10.1016/0169-4758(96)30011-2>.
Czerwinski, B.S. (2000) ‘Variation in feminine hygiene practices as a function of age’, Journal of Obstetric, Gynecologic, & Neonatal Nursing, 29: 625–33: <http://dx.doi.org/10.1111/j.1552-6909.2000.tb02076.x>.
Dasgupta, A. and Sarkar, M. (2008) ‘Menstrual hygiene: how hygienic is the adolescent girl?’ Indian Journal of Community Medicine, 33 (2): 77–80 <http://dx.doi.org/10.4103/0970-0218.40872>.
Dreibelbis, R., Greene, L.E., Freeman, M.C., Saboori, S., Chase, R.P. and Rheingans, R. (2013) ‘Water, sanitation, and primary school attendance: A multi-level assessment of determinants of household-reported absence in Kenya’, International Journal of Educational Development. 33: 457–465 <http://dx.doi.org/10.1016/j.ijedudev.2012.07.002>.
El-Gilany, A.H., Badawi, K. and El-Fedawy, S. (2005) ‘Menstrual hygiene among adolescent schoolgirls in Mansoura, Egypt’, Reproductive Health Matters, 13 (26): 147–52 <http://dx.doi.org/10.1016/S0968-8080(05)26191-8>.
Friedrich Jr, E.G. (1981) ‘Tampon effects on vaginal health’, Clinical Obstetetrics & Gynecology, 24: 395–406.
Halder, A.K., Tronchet, C., Akhter, S., Bhuiya, A., Johnston, R. and Luby, S.P. (2010) ‘Observed hand cleanliness and other measures of handwashing behavior in rural Bangladesh’, BMC Public Health, 10: 545 doi: <http://dx.doi.org/10.1186/1471-2458-10-545>.
Hewett, P.C., Mensch, B.S. and Erulkar, A.S. (2004) ‘Consistency in the reporting of sexual behaviour by adolescent girls in Kenya: a comparison of interviewing methods’, Sexually Transmitted Infections, 80 (suppl 2): ii43–48 <http://dx.doi.org/10.1136/sti.2004.013250>.
Howard, C., Rose, C.L., Trouton, K., Stamm, H., Marentette, D., Kirkpatrick, N., Karalic, S., Fernandez, R. and Paget, J. (2011) ‘FLOW (finding lasting options for women): multicentre randomized controlled trial comparing tampons with menstrual cups’, Canadian Family Physician, 57: e208–15 <http://www.cfp.ca/content/57/6/e208.short>.
Manun’ebo, M., Cousens, S., Haggerty, P., Kalengaie, M., Ashworth, A. and Kirkwood, B. (1997) ‘Measuring hygiene practices: a comparison of questionnaires with direct observations in rural Zaire’, Tropical Medicine & International Health, 2: 1015–21 <http://dx.doi.org/10.1046/j.1365-3156.1997.d01-180.x>.
Mason, L., Laserson, K., Oruko, K., Nyothach, E., Alexander, K., Odhiambo, F., Eleveld, A., Isiye, E., Ngere, I., Omoto, J., Mohammed, A., Vulule, J. and Phillips-Howard, P. (2014) ‘Adolescent schoolgirls’ experiences of menstrual cups and pads in rural western Kenya: a qualitative study’, Waterlines, 34 (1): 15–30 <http://dx.doi.org/10.3362/1756-3488.2015.003>.
Mason, L., Nyothach, E., Alexander, K., Odhiambo, F.O., Eleveld, A., Vulule, J., Rheingans, R., Laserson, K.F., Mohammed, A. and Phillips-Howard, P.A. (2013) ‘“We keep it secret so no one should know” – a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural Western kenya’, PLoS One, 8: e79132 <http://dx.doi.org/10.1371/journal.pone.0079132>.
McMahon, S.A., Winch, P.J., Caruso, B.A., Obure, A.F., Ogutu, E.A., Ochari, I.A. and Rheingans, R.D. (2011) ‘“The girl with her period is the one to hang her head”: Reflections on menstrual management among schoolgirls in rural Kenya’, BMC International Health & Human Rights, 11: 7 <http://dx.doi.org/10.1186/1472-698X-11-7>.
Mensch, B.S., Clark, W.H., Lloyd, C.B. and Erulkar, A.S. (2001) ‘Premarital sex, schoolgirl pregnancy, and school quality in rural Kenya’, Studies in Family Planning, 32: 285–301 <http://dx.doi.org/10.1111/j.1728-4465.2001.00285.x>.
Migele, J., Ombeki, S., Ayalo, M., Biggerstaff, M. and Quick, R. (2007) ‘Diarrhea prevention in a Kenyan school through the use of a simple safe water and hygiene intervention’, The American Journal of Tropical Medicine and Hygiene, 76, 351–3. Doi: 76/2/351 [pii].
Mugo, J., Kaburu, A., Limboro, C. and Kimutai, A. (2012) ‘Are our children learning?’ In Annual Learning Assessment Report, Nairobi, Kenya: Uwezo Kenya.
Odhiambo, F.O., Laserson, K.F., Sewe, M., Hamel, M.J., Feikin, D.R., Adazu, K., Ogwang, S., Obor, D., Amek, N., Bayoh, N., Ombok, M., Lindblade, K., Desai, M., Ter Kuile, F., Phillips-Howard, P., Van Eijk, A.M., Rosen, D., Hightower, A., Ofware, P., Muttai, H., Nahlen, B., Decock, K., Slutsker, L., Breiman, R.F. and Vulule, J.M. (2012) ‘Profile: The KEMRI/CDC Health and Demographic Surveillance System—Western Kenya’, International Journal of Epidemiology, 41: 977–87 <http://dx.doi.org/10.1093/ije/dys108>.
Omwami, E. and Omwami, R. (2009) ‘Public investment and the goal of providing universal access to primary education by 2015 in Kenya’, International Journal of Education Development, 30: 243–53 <http://dx.doi.org/10.1016/j.ijedudev.2009.09.002>.
Oster, E. and Thornton, R. (2012) ‘Determinants of technology adoption: Peer effects in menstrual cup up-take’, Journal of the European Economic Association, 10: 1263–93 <http://dx.doi.org/10.1111/j.1542-4774.2012.01090.x>.
Pickering, A.J., Blum, A.G., Breiman, R.F., Ram, P.K. and Davis, J. (2014) ‘Video surveillance captures student hand hygiene behavior, reactivity to observation, and peer influence in Kenyan primary schools’, PloS one, 9: e92571 <http://dx.doi.org/10.1371/journal.pone.0092571>.
Ram, P. (2013) ‘Practical guidance for measuring handwashing behavior: 2013 Update’, Global Scaling Up Hand washing Project, Water and Sanitation Project, Washington, DC: The World Bank.
Schmidt, W.P., Aunger, R., Coombes, Y., Maina, P.M., Matiko, C.N., Biran, A. and Curtis, V. (2009) ‘Determinants of handwashing practices in Kenya: the role of media exposure, poverty and infrastructure’, Tropical Medicine & International Health, 14: 1534–41 <http://dx.doi.org/10.1111/j.1365-3156.2009.02404.x>.
Sommer, M. (2010) ‘Where the education system and women’s bodies collide: The social and health impact of girls’ experiences of menstruation and schooling in Tanzania’, Journal of Adolescence, 33: 521–9 <http://dx.doi.org/10.1016/j.adolescence.2009.03.008>.
Sommer, M. and Sahin, M. (2013) ‘Overcoming the taboo: advancing the global agenda for menstrual hygiene management for schoolgirls’, American Journal of Public Health, 103: 1556–9 <http://dx.doi.org/10.2105/AJPH.2013.301374>.
Stewart, K., Greer, R. and Powell, M. (2010) ‘Women’s experience of using the Mooncup’, Journal of Obstetrics & Gynaecology, 30: 285–7 <http://dx.doi.org/10.3109/01443610903572117>.
Stewart, K., Powell, M. and Greer, R. (2009) ‘An alternative to conventional sanitary protection: would women use a menstrual cup?’ Journal of Obstetrics & Gynaecology, 29: 49–52 doi: <http://dx.doi.org/10.1080/01443610802628841>.
Talaat, M., Afifi, S., Dueger, E., El-Ashry, N., Marfin, A., Kandeel, A., Mohareb, E. and El-Sayed, N. (2011) ‘Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza and absenteeism in schoolchildren, Cairo, Egypt’, Emerging Infectious Diseases, 17 (4): 619–25 <http://dx.doi.org/10.3201/eid1704.101353>.
Tellier, M., Hyttel, M. and Gad, M. (2012) ‘Assessing acceptability and hygienic safety of menstrual cups as a menstrual management method for vulnerable young women in Uganda’, Red Cross Society’s Life Planning Skills Project, Kampala: Red Cross Uganda and WoMena <https://www.changemakers.com/sites/default/files/red_cross_and_womena_ltd_-_uganda_pilot_study_report_dec_2012_.pdf> [accessed 9 September 2015].
Trego, L.L. (2012) ‘Prevention is key to maintaining gynaeclogical health during deployment’, AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses, 41, 283–92 <http://dx.doi.org/10.1111/j.1552-6909.2011.01337.x>.
UNICEF (2010) ‘Raising clean hands: advancing learning, health and participation through WASH in schools’, New York: UNICEF.
UNICEF (2011) WASH in Schools Monitoring Package, New York: UNICEF.
UNICEF (2012) ‘Raising even more clean hands: Advancing health, learning and equity through WASH in schools’, New York: UNICEF.
WaterAid (2009) ‘Is menstrual hygiene and management an issue for adolescent school girls? A comparative study of four schools in different settings of Nepal’, Nepal: Water Aid.
The Menstrual Practices Questionnaire (MPQ): development, elaboration, and implications for future research
Hennegan, Julie
Nansubuga, Agnes
Akullo, Agnes
Smith, Calum
Schwab, Kellogg J.
Global Health Action, Vol. 13 (2020), Iss. 1
https://doi.org/10.1080/16549716.2020.1829402 [Citations: 22]Menstrual hygiene management among girls at a peri-urban senior high school in the Volta Region, Ghana
Baku, Elizabeth Aku
Adrakpanya, Victor
Konlan, Kennedy Diema
Adatara, Peter
African Journal of Midwifery and Women's Health, Vol. 14 (2020), Iss. 1 P.1
https://doi.org/10.12968/ajmw.2018.0020 [Citations: 1]Physical, Social, and Political Inequities Constraining Girls’ Menstrual Management at Schools in Informal Settlements of Nairobi, Kenya
Girod, Candace
Ellis, Anna
Andes, Karen L.
Freeman, Matthew C.
Caruso, Bethany A.
Journal of Urban Health, Vol. 94 (2017), Iss. 6 P.835
https://doi.org/10.1007/s11524-017-0189-3 [Citations: 52]Use of menstrual cups among school girls: longitudinal observations nested in a randomised controlled feasibility study in rural western Kenya
van Eijk, Anna Maria
Laserson, Kayla F.
Nyothach, Elizabeth
Oruko, Kelvin
Omoto, Jackton
Mason, Linda
Alexander, Kelly
Oduor, Clifford
Mohammed, Aisha
Eleveld, Alie
Ngere, Isaac
Obor, David
Vulule, John
Phillips-Howard, Penelope A.
Reproductive Health, Vol. 15 (2018), Iss. 1
https://doi.org/10.1186/s12978-018-0582-8 [Citations: 28]Menstrual cups and sanitary pads to reduce school attrition, and sexually transmitted and reproductive tract infections: a cluster randomised controlled feasibility study in rural Western Kenya
Phillips-Howard, Penelope A
Nyothach, Elizabeth
ter Kuile, Feiko O
Omoto, Jackton
Wang, Duolao
Zeh, Clement
Onyango, Clayton
Mason, Linda
Alexander, Kelly T
Odhiambo, Frank O
Eleveld, Alie
Mohammed, Aisha
van Eijk, Anna M
Edwards, Rhiannon Tudor
Vulule, John
Faragher, Brian
Laserson, Kayla F
BMJ Open, Vol. 6 (2016), Iss. 11 P.e013229
https://doi.org/10.1136/bmjopen-2016-013229 [Citations: 107]Impact of Hazardous Chemical compounds on Reproductive System Reported in Sanitary Products
K. Gaikwad, Mayuri
Upadhye, Mohini
Borchate, Dhanashri
Jankar, Nilam
(2023) P.112
https://doi.org/10.52711/2321-5836.2023.00021 [Citations: 0]Measurement in the study of menstrual health and hygiene: A systematic review and audit
Hennegan, Julie
Brooks, Deborah Jordan
Schwab, Kellogg J.
Melendez-Torres, G. J.
Pant Pai, Nitika
PLOS ONE, Vol. 15 (2020), Iss. 6 P.e0232935
https://doi.org/10.1371/journal.pone.0232935 [Citations: 45]Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis
van Eijk, Anna Maria
Zulaika, Garazi
Lenchner, Madeline
Mason, Linda
Sivakami, Muthusamy
Nyothach, Elizabeth
Unger, Holger
Laserson, Kayla
Phillips-Howard, Penelope A
The Lancet Public Health, Vol. 4 (2019), Iss. 8 P.e376
https://doi.org/10.1016/S2468-2667(19)30111-2 [Citations: 126]Examining the safety of menstrual cups among rural primary school girls in western Kenya: observational studies nested in a randomised controlled feasibility study
Juma, Jane
Nyothach, Elizabeth
Laserson, Kayla F
Oduor, Clifford
Arita, Lilian
Ouma, Caroline
Oruko, Kelvin
Omoto, Jackton
Mason, Linda
Alexander, Kelly T
Fields, Barry
Onyango, Clayton
Phillips-Howard, Penelope A
BMJ Open, Vol. 7 (2017), Iss. 4 P.e015429
https://doi.org/10.1136/bmjopen-2016-015429 [Citations: 28]Hand hygiene practices among primary and secondary school students in sub-Saharan Africa: a systematic review
Bishoge, Obadia Kyetuza
Omary, Mwanaidi
Liheluka, Edwin
Mshana, Jonathan Mcharo
Nguyamu, Maryyusta
Mbatia, Yolanda Joseph
Njee, Robert Mussa
Kafuye, Mwanaidi
Journal of Water, Sanitation and Hygiene for Development, Vol. 13 (2023), Iss. 12 P.1018
https://doi.org/10.2166/washdev.2023.222 [Citations: 0]Menstrual health and hygiene (MHH): a bibliometric analysis
Pandey, Neha
Desul, Sudarsan
Patra, Raj Kishore
Sethy, Mrutyunjay
(2023)
https://doi.org/10.1108/GKMC-07-2023-0234 [Citations: 0]
- A call to action: organizational, professional, and personal change for gender transformative WASH programming
- Providing municipal faecal sludge management services: lessons from Bangladesh
- Menstrual hygiene management: education and empowerment for girls?
- Webwatch
- Transgender-inclusive sanitation: insights from South Asia
Browse our other journals
