Article Text

Original research
A mixed-methods study measuring the effectiveness of a menstrual health intervention on menstrual health knowledge, perceptions and practices among young women in Zimbabwe
  1. Mandikudza Tembo1,2,3,
  2. Helen A Weiss3,
  3. Leyla Sophie Larsson2,
  4. Tsitsi Bandason2,
  5. Nicol Redzo2,
  6. Ethel Dauya2,
  7. Tafadzwa Nzanza2,
  8. Pauline Ishumael2,
  9. Nancy Gweshe2,
  10. Precious Ndlovu2,
  11. Chido Dziva Chikwari3,
  12. Constancia Vimbayi Mavodza2,4,
  13. Jenny Renju3,
  14. Suzanna C Francis3,
  15. Rashida Ferrand2,5,
  16. Constance R S Mackworth-Young1,2
  1. 1Department of Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
  2. 2Biomedical Research and Training Institute, Harare, Zimbabwe
  3. 3MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  4. 4Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, London, UK
  5. 5Clinical Research Department, London School of Hygiene and Tropical Medicine Department of Clinical Research, London, London, UK
  1. Correspondence to Dr Mandikudza Tembo; Mandikudza.Tembo{at}lshtm.ac.uk

Abstract

Objectives While integral to women’s physical and mental well-being, achieving good menstrual health (MH) remains a challenge for many women. This study investigated the effectiveness of a comprehensive MH intervention on menstrual knowledge, perceptions and practices among women aged 16–24 years in Harare, Zimbabwe.

Design A mixed-methods prospective cohort study with pre-post evaluation of an MH intervention.

Setting Two intervention clusters in Harare, Zimbabwe.

Participants Overall, 303 female participants were recruited, of whom 189 (62.4%) were seen at midline (median follow-up 7.0; IQR 5.8–7.7 months) and 184 (60.7%) were seen at endline (median follow-up 12.4; IQR 11.9–13.8 months). Cohort follow-up was greatly affected by COVID-19 pandemic and associated restrictions.

Intervention The MH intervention provided MH education and support, analgesics, and a choice of menstrual products in a community-based setting to improve MH outcomes among young women in Zimbabwe.

Primary and secondary outcomes Effectiveness of a comprehensive MH intervention on improving MH knowledge, perceptions, and practices among young women over time. Quantitative questionnaire data were collected at baseline, midline, and endline. At endline, thematic analysis of four focus group discussions was used to further explore participants’ menstrual product use and experiences of the intervention.

Results At midline, more participants had correct/positive responses for MH knowledge (adjusted OR (aOR)=12.14; 95% CI: 6.8 to 21.8), perceptions (aOR=2.85; 95% CI: 1.6 to 5.1) and practices for reusable pads (aOR=4.68; 95% CI: 2.3 to 9.6) than at baseline. Results were similar comparing endline with baseline for all MH outcomes. Qualitative findings showed that sociocultural norms, stigma and taboos around menstruation, and environmental factors such as limited access to water, sanitation and hygiene facilities affected the effect of the intervention on MH outcomes.

Conclusions The intervention improved MH knowledge, perceptions and practices among young women in Zimbabwe, and the comprehensive nature of the intervention was key to this. MH interventions should address interpersonal, environmental and societal factors.

Trial registration number NCT03719521.

  • public health
  • public health
  • qualitative research

Data availability statement

Data are available on reasonable request. The datasets used and/or analysed during the current study are available from the corresponding author on request.

https://creativecommons.org/licenses/by/4.0/

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Data availability statement

Data are available on reasonable request. The datasets used and/or analysed during the current study are available from the corresponding author on request.

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Footnotes

  • Twitter @_ndiku_, @chidodc

  • Contributors MT is the guarantor and designed the menstrual health intervention, and collected, analysed and interpreted the quantitative and qualitative data, and drafted the manuscript. CRSM-Y assisted in analysing the qualitative data and was a major contributor in writing the manuscript. HAW assisted in analysing the quantitative data and was a major contributor in writing the manuscript. LSL assisted in analysing the quantitative data. NG, PN, TN and PI assisted in the collection of the qualitative and quantitative data. TB and NR assisted with quantitative data collection and management. RF, CDC, CVM, and ED contributed to the coordination of the study and critical revisions of the manuscript. SCF and JR contributed to the design of the menstrual health intervention and the analysis plan. RF is the Principal Investigator of the CHIEDZA trial. All authors read and approved the final manuscript.

  • Funding Swiss Agency for Development and Cooperation funding, the Wellcome Trust through a Senior Fellowship to RAF (206316/Z/17/Z) and the Fogarty International Centre of the National Institutes of Health under Award Number D43 TW009539.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the 'Methods' section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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