title: A systematic review of the health and social effects of menstrual hygiene management.
abstract: BACKGROUND
  Differing approaches to menstrual hygiene management (MHM) have been associated with a wide range of health and psycho-social outcomes in lower income settings. This paper systematically collates, summarizes and critically appraises the available evidence.
  
  
  METHODS
  Following the PRISMA guidelines a structured search strategy was used to identify articles investigating the effects of MHM on health and psycho-social outcomes. The search was conducted in May 2012 and had no date limit. Data was extracted and quality of methodology was independently assessed by two researchers. Where no measure of effect was provided, but sufficient data were available to calculate one, this was undertaken. Meta-analysis was conducted where sufficient data were available.
  
  
  RESULTS
  14 articles were identified which looked at health outcomes, primarily reproductive tract infections (RTI). 11 articles were identified investigating associations between MHM, social restrictions and school attendance. MHM was found to be associated with RTI in 7 papers. Methodologies however varied greatly and overall quality was low. Meta-analysis of a subset of studies found no association between confirmed bacterial vaginosis and MHM (OR: 1.07, 95% CI: 0.52-2.24). No other substantial associations with health outcomes were found. Although there was good evidence that educational interventions can improve MHM practices and reduce social restrictions there was no quantitative evidence that improvements in management methods reduce school absenteeism.
  
  
  CONCLUSIONS
  The management of menstruation presents significant challenges for women in lower income settings; the effect of poor MHM however remains unclear. It is plausible that MHM can affect the reproductive tract but the specific infections, the strength of effect, and the route of transmission, remain unclear. There is a gap in the evidence for high quality randomised intervention studies which combine hardware and software interventions, in particular for better understanding the nuanced effect improving MHM may have on girls' attendance at school.
authors: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom. colin.sumpter@lshtm.ac.uk
authors: Colin
authors: C
authors: Sumpter
authors: Belen
authors: B
authors: Torondel
mesh_terms: D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006262:Health; D006801:Humans; D006920:Hygiene; D008598:Menstruation / Q000523:psychology*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D017594:Publication Bias; D011785:Quality Assurance, Health Care; D016585:Vaginosis, Bacterial / Q000473:pathology
references: Sex Transm Dis. 2008 Nov;35(11):946-59
references: 18685546
references: Sex Transm Infect. 2005 Jun;81(3):242-7
references: 15923295
references: Int J Gynaecol Obstet. 2011 Oct;115(1):61-4
references: 21798535
references: J Adolesc. 2010 Aug;33(4):521-9
references: 19395018
references: PLoS One. 2012;7(4):e35828
references: 22558233
references: Soc Sci Med. 2002 Jan;54(1):105-17
references: 11820674
references: J Adolesc. 2010 Aug;33(4):531-41
references: 19589587
references: Glob Public Health. 2009;4(3):284-302
references: 19437216
references: J Health Popul Nutr. 2007 Jun;25(2):189-94
references: 17985820
references: BMC Infect Dis. 2011 Jan 11;11:10
references: 21223574
references: Indian J Community Med. 2012 Jan;37(1):34-8
references: 22529538
references: J Egypt Public Health Assoc. 2007;82(1-2):105-26
references: 18217327
references: Afr J Reprod Health. 2008 Apr;12(1):74-83
references: 20695158
references: Am J Hum Biol. 2009 Jan-Feb;21(1):130-2
references: 18942702
references: Br J Obstet Gynaecol. 1984 Aug;91(8):797-801
references: 6466582
references: Sex Transm Infect. 2009 Sep;85(5):370-5
references: 19473997
references: Indian J Med Sci. 2001 Apr;55(4):209-14
references: 11665391
references: Curr Opin Obstet Gynecol. 2002 Apr;14(2):115-8
references: 11914687
references: AIDS. 2008 Jul 31;22(12):1493-501
references: 18614873
references: Stud Fam Plann. 1989 Mar-Apr;20(2):69-80
references: 2785722
references: Indian J Community Med. 2008 Apr;33(2):77-80
references: 19967028
references: World Health Popul. 2007;9(3):48-54
references: 18272942
references: Oman Med J. 2009 Oct;24(4):288-93
references: 22216382
references: Stud Fam Plann. 1997 Mar;28(1):35-43
references: 9097384
references: Stud Fam Plann. 1993 May-Jun;24(3):175-86
references: 8351698
references: Eur J Obstet Gynecol Reprod Biol. 2007 May;132(1):8-19
references: 17204360
references: BMC Infect Dis. 2005 Mar 09;5:12
references: 15757510
references: Ann Hum Biol. 1990 Mar-Apr;17(2):159-62
references: 2334111
references: BMC Int Health Hum Rights. 2011 Jun 16;11:7
references: 21679414
references: Pan Afr Med J. 2009 Jun 29;2:9
references: 21532905
references: BMC Public Health. 2012 Mar 15;12:193
references: 22420743
references: Int J Surg. 2010;8(5):336-41
references: 20171303
references: Infect Dis Obstet Gynecol. 2000;8(3-4):184-90
references: 10968604
references: Stud Fam Plann. 1995 Jul-Aug;26(4):203-16
references: 7482678