Namuwonge Flavia, Kizito Samuel, Ssentumbwe Vicent, Namatovu Phionah, Namuli Florence, Tutlam Nhial T, Nabunya Proscovia, Ssewamala Fred M
International Center for Child Health and Development, Masaka Field Office, P.O. Box 1988, Masaka, Uganda.
International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA.
BMC Womens Health. 2025 May 15;25(1):230. doi: 10.1186/s12905-025-03778-0.
In many Sub-Saharan African countries (SSA), including Uganda, adolescent girls, especially those from low-income families, are disproportionately affected by inadequate menstrual hygiene management (MHM) facilities and supplies. This study assesses the impact of two interventions, including economic empowerment and family-strengthening interventions, on the self-esteem of adolescent girls and explores the moderating effects of cultural attitudes and menstrual hygiene knowledge.
We analyzed longitudinal data from a 3-arm Cluster Randomized Control Trial, Suubi4Her study, with a follow-up period of 24 months (2018-2022). A total of 1260 adolescent girls, aged 14-17 years, and living within a family were recruited from 47 schools within five geopolitical districts in Southwestern Uganda. The three study arms were: control (n = 16 schools, n = 408 students), Economic Empowerment using incentivized youth development accounts (YDA) (n = 16 schools, n = 471 students), and YDA + a family strengthening intervention that uses Multiple Family Group (MFG) meetings to address adolescent girls' and family health and wellbeing (n = 15 schools, n = 381 students). We used mixed-effect linear regression models to assess the impact of economic empowerment on self-esteem, measured by the Rosenberg Self-Esteem Scale, and the moderation effect of menstrual hygiene knowledge, measured by a nine-item scale, and cultural attitudes, measured by self-reported school absence during menstrual periods.
Baseline demographic characteristics indicate no statistically significant difference across the intervention arms. We found statistically significant main effects for time (χ(2) = 102.07, p < 0.001) and intervention-time interaction effects (χ(4) = 12.99, p = 0.011). Pairwise group comparisons at the different assessment time points showed no significant differences in self-esteem between YDA group and the control at baseline (β = 0.173 (-1.453, 1.108), p = 0.791), at 12 months (β = 0.372 (-0.893, 1.637), p = 0.565), and at 24 months (β = 0.153 (-0.904, 1.210), p = 0.777), indicating no significant effect of the YDA intervention alone on self-esteem. Similarly, no significant differences in self-esteem were found between the YDA + MFG group and the control at baseline (β=-0.299 (-1.713, 1.114), p = 0.678) and 12 months (β = 0.986 (-0.495, 2.468), p = 0.192). However, at 24-months follow-ups, the YDA + MFG group showed significantly higher self-esteem than the control (β = 1.282 (0.084, 2.480), p = 0.036). Additionally, those who reported school absenteeism due to cultural or religious reasons and received the YDA + MFG intervention reported higher self-esteem than usual care (β = 1.57 (0.07, 3.07), p = 0.004). No significant moderation by menstrual hygiene knowledge or cultural attitude was detected.
The YDA + MFG intervention and natural age progression improved self-esteem, though reliance on self-reported data may introduce bias. However, the YDA intervention alone did not significantly improve self-esteem at any assessment point.
在包括乌干达在内的许多撒哈拉以南非洲国家（SSA），青春期女孩，尤其是来自低收入家庭的女孩，在月经卫生管理（MHM）设施和用品不足方面受到的影响尤为严重。本研究评估了两项干预措施，包括经济赋权和家庭强化干预措施，对青春期女孩自尊的影响，并探讨了文化态度和月经卫生知识的调节作用。
我们分析了一项三臂整群随机对照试验“Suubi4Her研究”的纵向数据，随访期为24个月（2018 - 2022年）。从乌干达西南部五个地缘政治区的47所学校招募了总共1260名14 - 17岁且生活在家庭中的青春期女孩。三个研究组分别为：对照组（n = 16所学校，n = 408名学生），使用激励性青年发展账户（YDA）的经济赋权组（n = 16所学校，n = 471名学生），以及YDA + 一项使用多家庭小组（MFG）会议来解决青春期女孩及其家庭健康和幸福问题的家庭强化干预组（n = 15所学校，n = 381名学生）。我们使用混合效应线性回归模型来评估经济赋权对自尊的影响（通过罗森伯格自尊量表测量），以及月经卫生知识（通过一个九项量表测量）和文化态度（通过月经期间自我报告的缺课情况测量）的调节作用。
基线人口统计学特征表明各干预组之间无统计学显著差异。我们发现时间的主效应具有统计学显著性（χ(2) = 102.07，p < 0.001）以及干预 - 时间交互效应具有统计学显著性（χ(4) = 12.99，p = 0.011）。在不同评估时间点的两两组间比较显示，YDA组与对照组在基线时自尊无显著差异（β = 0.173（-1.453，1.108），p = 0.791），在12个月时（β = 0.372（-0.893，1.637），p = 0.565），以及在24个月时（β = 0.153（-0.904，1.210），p = 0.777），这表明单独的YDA干预对自尊无显著影响。同样，YDA + MFG组与对照组在基线时（β = -0.299（-1.713，1.114），p = 0.678）和12个月时（β = 0.986（-0.495，2.468），p = 0.192）自尊也无显著差异。然而，在24个月随访时，YDA + MFG组的自尊显著高于对照组（β = 1.282（0.084，2.480），p = 0.036）。此外，那些因文化或宗教原因报告缺课并接受YDA + MFG干预的人报告的自尊高于常规护理组（β = 1.57（0.07，3.07），p = 0.004）。未检测到月经卫生知识或文化态度的显著调节作用。
YDA + MFG干预和自然年龄增长改善了自尊，尽管依赖自我报告数据可能会引入偏差。然而，单独的YDA干预在任何评估点均未显著提高自尊。
