Tembo Mandikudza, Simms Victoria, Weiss Helen A, Bandason Tsitsi, Redzo Nicol, Larsson Leyla, Dauya Ethel, Nzanza Tafadzwa, Ishumael Pauline, Gweshe Nancy, Nyamwanza Rangarirai, Ndlovu Precious, Bernays Sarah, Chikwari Chido Dziva, Mavodza Constancia Vimbayi, Renju Jenny, Francis Suzanna C, Ferrand Rashida A, Mackworth-Young Constance
Biomedical Research and Training Institute.
London School of Hygiene & Tropical Medicine.
Res Sq. 2023 Jun 26:rs.3.rs-3058045. doi: 10.21203/rs.3.rs-3058045/v1.
Achieving good menstrual health (MH), integral to women's well-being, remains a challenge. This study examined MH services uptake (including information, analgesics, and a choice of MH products - the menstrual cup and reusable pads) and sustained use of MH products within an integrated sexual and reproductive health intervention for young people in Zimbabwe.
This study was embedded within a cluster randomised trial of integrated sexual and reproductive health services (CHIEDZA) in three provinces (Harare, Mashonaland East, and Bulawayo). The study collected qualitative and quantitative data from female clients aged 16-24 years, who accessed CHIEDZA from April 2019 - March 2022. Uptake of MH information, products, and analgesics and other services was tracked for each client. Descriptive statistics and logistic regression were used to investigate MH service uptake and product choice and use over time, and the factors associated with these outcomes. Thematic analysis of focus group discussions and interviews were used to further explore providers' and participants' experiences of the MH service and CHIEDZA intervention.
Overall, 36991 clients accessed CHIEDZA of whom 27725 (75%) were female. Almost all (n = 26448; 95.4%) took up the MH service at least once: 25433 took up an MH product with the majority (23346; 92.8%) choosing reusable pads. The uptake of cups varied across province with Bulawayo province having the highest uptake (13.4%). Clients aged 20-24 years old were more likely to choose cups than reusable pads compared with those aged 16-19 years (9.4% vs 6.0%; p < 0.001). Over the implementation period, 300/1819 (16.5%) of clients swapped from the menstrual cup to reusable pads and 83/23346 (0.4%) swapped from reusable pads to the menstrual cup. Provision of the MH service encouraged uptake of other important SRH services. Qualitative findings highlighted the provision of free integrated SRH and MH services that included a choice of MH products and analgesics in a youth-friendly environment were key to high uptake and overall female engagement with SRH services.
High uptake demonstrates how the MH service provided much needed access to MH products and information. Integration of MH within an SRH intervention proved central to young women accessing other SRH services.
实现良好的月经健康（MH）是女性福祉的重要组成部分，但仍然是一项挑战。本研究调查了津巴布韦针对年轻人的性与生殖健康综合干预措施中，月经健康服务的接受情况（包括信息、镇痛药以及月经杯和可重复使用卫生巾等月经健康产品的选择）以及月经健康产品的持续使用情况。
本研究纳入了在三个省份（哈拉雷、东马绍纳兰和布拉瓦约）进行的性与生殖健康综合服务整群随机试验（CHIEDZA）。该研究收集了2019年4月至2022年3月期间使用CHIEDZA服务的16 - 24岁女性客户的定性和定量数据。跟踪了每位客户对月经健康信息、产品、镇痛药及其他服务的接受情况。使用描述性统计和逻辑回归来调查月经健康服务的接受情况、产品选择和随时间的使用情况，以及与这些结果相关的因素。通过对焦点小组讨论和访谈进行主题分析，进一步探索提供者和参与者对月经健康服务及CHIEDZA干预措施的体验。
总体而言，36991名客户使用了CHIEDZA服务，其中27725名（75%）为女性。几乎所有客户（n = 26448；95.4%）至少接受过一次月经健康服务：25433名客户使用了月经健康产品，其中大多数（23346名；92.8%）选择了可重复使用卫生巾。月经杯的接受情况在不同省份有所差异，布拉瓦约省的接受率最高（13.4%）。与16 - 19岁的客户相比，20 - 24岁的客户更有可能选择月经杯而非可重复使用卫生巾（9.4%对6.0%；p < 0.001）。在实施期间，1819名客户中有300名（16.5%）从月经杯换成了可重复使用卫生巾，23346名客户中有83名（0.4%）从可重复使用卫生巾换成了月经杯。提供月经健康服务促进了其他重要性与生殖健康服务的接受。定性研究结果强调，在对青年友好的环境中提供免费的综合性性与生殖健康及月经健康服务，包括月经健康产品和镇痛药的选择，是高接受率以及女性全面参与性与生殖健康服务的关键。
高接受率表明月经健康服务为获取月经健康产品和信息提供了急需的途径。将月经健康纳入性与生殖健康干预措施被证明是年轻女性获取其他性与生殖健康服务的核心。
