{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T04:21:44Z","timestamp":1792815704912,"version":"4.5.0"},"reference-count":53,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,11,1]]},"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Conduct a feasibility study on the effect of menstrual hygiene on schoolgirls' school and health (reproductive\/sexual) outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>3-arm single-site open cluster randomised controlled pilot study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>30 primary schools in rural western Kenya, within a Health and Demographic Surveillance System.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Primary schoolgirls 14\u201316\u2005years, experienced 3 menses, no precluding disability, and resident in the study area.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>1 insertable menstrual cup, or monthly sanitary pads, against \u2018usual practice\u2019 control. All participants received puberty education preintervention, and hand wash soap during intervention. Schools received hand wash soap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>\n                      Primary: school attrition (drop-out, absence); secondary: sexually transmitted infection (STI) (\n                      <jats:italic>Trichomonas vaginalis<\/jats:italic>\n                      ,\n                      <jats:italic>Chlamydia trachomatis<\/jats:italic>\n                      ,\n                      <jats:italic>Neisseria gonorrhoea<\/jats:italic>\n                      ), reproductive tract infection (RTI) (bacterial vaginosis,\n                      <jats:italic>Candida albicans<\/jats:italic>\n                      ); safety: toxic shock syndrome, vaginal\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 751 girls enrolled 644 were followed-up for a median of 10.9\u2005months. Cups or pads did not reduce school dropout risk (control=8.0%, cups=11.2%, pads=10.2%). Self-reported absence was rarely reported and not assessable. Prevalence of STIs in the end-of-study survey among controls was 7.7% versus 4.2% in the cups arm (adjusted prevalence ratio (aPR) 0.48, 0.24 to 0.96, p=0.039), 4.5% with pads (aPR=0.62; 0.37 to 1.03, p=0.063), and 4.3% with cups and pads pooled (aPR=0.54, 0.34 to 0.87, p=0.012). RTI prevalence was 21.5%, 28.5% and 26.9% among cup, pad and control arms, 71% of which were bacterial vaginosis, with a prevalence of 14.6%, 19.8% and 20.5%, per arm, respectively. Bacterial vaginosis was less prevalent in the cups (12.9%) compared with pads (20.3%, aPR=0.65, 0.44 to 0.97, p=0.034) and control (19.2%, aPR=0.67, 0.43 to 1.04, p=0.075) arm girls enrolled for 9\u2005months or longer. No adverse events were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Provision of menstrual cups and sanitary pads for \u223c1 school-year was associated with a lower STI risk, and cups with a lower bacterial vaginosis risk, but there was no association with school dropout. A large-scale trial on menstrual cups is warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.isrctn.com\/ISRCTN17486946\" ext-link-type=\"uri\">ISRCTN17486946<\/jats:ext-link>\n                      ; Results\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-013229","type":"journal-article","created":{"date-parts":[[2016,11,23]],"date-time":"2016-11-23T20:50:21Z","timestamp":1479934221000},"page":"e013229","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":167,"title":["Menstrual cups and sanitary pads to reduce school attrition, and sexually transmitted and reproductive tract infections: a cluster randomised controlled feasibility study in rural 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