Mugenyi Levicatus, Tembo Mandikudza, Nelson Kate Andrews, Thomas Katherine A, Kansiime Catherine, Lagony Stephen, Mpaata Alex Muleyi, Belfield Sophie, Nakalema Shamirah, Akech Agnes, Torondel-Lopez Belen, Weiss Helen A
Statistics, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
London School of Hygiene & Tropical Medicine, London, UK.
BMJ Open. 2024 Dec 5;14(12):e087438. doi: 10.1136/bmjopen-2024-087438.
A greater choice of menstrual products may improve menstrual health (MH). This study assessed factors associated with declining consent to receive a menstrual cup by parents and female students participating in a MH intervention trial in Ugandan schools.
We analysed baseline data from a cluster-randomised trial evaluating the effectiveness of a multicomponent MH intervention among female students in 60 Ugandan secondary schools. Parental consent and student assent to receive a menstrual cup and training on its use was sought separately from consent from other trial activities. Random-effects logistic regression models were used to estimate adjusted OR (aOR) and 95% CIs for factors associated with (i) parents or guardians declining the cup and (ii) students declining the cup using hierarchical conceptual frameworks.
The baseline trial population comprised 3705 post-menarchal students (mean age 15.6 (SD 0.9 years), of whom 2048 (55.3%) were day students. Among the parents of the 3635 participants aged <18 years, 1566 (43.1%) declined consent for their student to receive the cup. This was higher in Wakiso District than in Kalungu District (52.9% vs 8.0%, p<0.001). Parental decline of the cup differed by ethnicity, and this association varied between districts (p=0.004). Overall, 20.5% students declined the cup (Kalungu 21.1%, Wakiso 20.2%, p=0.62). Student decline of the cup was higher among day than boarding students (aOR=1.40, 95% CI 1.07 to 1.84), those with academic performance above the median score (aOR=1.29, 95% CI 1.01 to 1.65), those whose menstrual practice needs score was above the median (aOR=1.36, 95% CI 1.08 to 1.72) and those with more negative attitudes to MH (aOR=1.46, 95% CI 1.16 to 1.83).
Among Ugandan students and their parents, declining consent to receive a menstrual cup varied by district and ethnicity as well as academic performance and menstrual-related factors. A contextual understanding of the barriers for uptake of the menstrual cup is needed to guide future interventions.
ISRCTN45461276.
更多种类的经期用品或许能改善经期健康（MH）。本研究评估了参与乌干达学校MH干预试验的家长和女学生中，同意接受月经杯的比例下降的相关因素。
我们分析了一项整群随机试验的基线数据，该试验评估了乌干达60所中学的女学生中多成分MH干预措施的有效性。分别从其他试验活动的同意书中获取家长同意和学生同意接受月经杯及其使用培训的情况。使用随机效应逻辑回归模型，通过分层概念框架估计与以下因素相关的调整后比值比（aOR）和95%可信区间（CI）：（i）家长或监护人拒绝接受月经杯；（ii）学生拒绝接受月经杯。
基线试验人群包括3705名初潮后的学生（平均年龄15.6岁（标准差0.9岁）），其中2048名（55.3%）为走读生。在3635名年龄<18岁的参与者的家长中，1566名（43.1%）拒绝同意其学生接受月经杯。瓦基索区的这一比例高于卡伦古区（52.9%对8.0%，p<0.001）。家长对月经杯的拒绝情况因种族而异，且这种关联在不同地区有所不同（p=0.004）。总体而言，20.5%的学生拒绝接受月经杯（卡伦古区21.1%，瓦基索区20.2%，p=0.62）。走读生拒绝接受月经杯的比例高于寄宿生（aOR=1.40，95%CI 1.07至1.84），学业成绩高于中位数分数的学生（aOR=1.29，95%CI 1.01至1.65），月经习惯需求得分高于中位数的学生（aOR=1.36，95%CI 1.08至1.72），以及对MH态度更消极的学生（aOR=1.46，95%CI 1.16至1.83）。
在乌干达学生及其家长中，同意接受月经杯的比例下降因地区、种族、学业成绩和与月经相关的因素而异。需要对月经杯使用的障碍有情境化的理解，以指导未来的干预措施。
ISRCTN45461276。
