title: Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India.
abstract: Menstrual hygiene management (MHM) practices vary worldwide and depend on the individual's socioeconomic status, personal preferences, local traditions and beliefs, and access to water and sanitation resources. MHM practices can be particularly unhygienic and inconvenient for girls and women in poorer settings. Little is known about whether unhygienic MHM practices increase a woman's exposure to urogenital infections, such as bacterial vaginosis (BV) and urinary tract infection (UTI). This study aimed to determine the association of MHM practices with urogenital infections, controlling for environmental drivers. A hospital-based case-control study was conducted on 486 women at Odisha, India. Cases and controls were recruited using a syndromic approach. Vaginal swabs were collected from all the participants and tested for BV status using Amsel's criteria. Urine samples were cultured to assess UTI status. Socioeconomic status, clinical symptoms and reproductive history, and MHM and water and sanitation practices were obtained by standardised questionnaire. A total of 486 women were recruited to the study, 228 symptomatic cases and 258 asymptomatic controls. Women who used reusable absorbent pads were more likely to have symptoms of urogenital infection (AdjOR=2.3, 95%CI1.5-3.4) or to be diagnosed with at least one urogenital infection (BV or UTI) (AdjOR=2.8, 95%CI1.7-4.5), than women using disposable pads. Increased wealth and space for personal hygiene in the household were protective for BV (AdjOR=0.5, 95%CI0.3-0.9 and AdjOR=0.6, 95%CI0.3-0.9 respectively). Lower education of the participants was the only factor associated with UTI after adjusting for all the confounders (AdjOR=3.1, 95%CI1.2-7.9). Interventions that ensure women have access to private facilities with water for MHM and that educate women about safer, low-cost MHM materials could reduce urogenital disease among women. Further studies of the effects of specific practices for managing hygienically reusable pads and studies to explore other pathogenic reproductive tract infections are needed.
authors.affiliation: Disease Surveillance Laboratory, Asian Institute of Public health, Bhubaneswar, Odisha, India.
authors.forename: Padma
authors.initials: P
authors.lastname: Das
authors.affiliation: Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, United States of America.
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Baker
authors.affiliation: Disease Surveillance Laboratory, Asian Institute of Public health, Bhubaneswar, Odisha, India.
authors.forename: Ambarish
authors.initials: A
authors.lastname: Dutta
authors.affiliation: Disease Surveillance Laboratory, Asian Institute of Public health, Bhubaneswar, Odisha, India.
authors.forename: Tapoja
authors.initials: T
authors.lastname: Swain
authors.affiliation: Disease Surveillance Laboratory, Asian Institute of Public health, Bhubaneswar, Odisha, India.
authors.forename: Sunita
authors.initials: S
authors.lastname: Sahoo
authors.affiliation: Disease Surveillance Laboratory, Asian Institute of Public health, Bhubaneswar, Odisha, India.
authors.forename: Bhabani Sankar
authors.initials: BS
authors.lastname: Das
authors.affiliation: Department of Obstetrics and gynaecology, Capital Hospital, Bhubaneswar, Odisha, India.
authors.forename: Bijay
authors.initials: B
authors.lastname: Panda
authors.affiliation: Department of Obstetrics and gynaecology, Capital Hospital, Bhubaneswar, Odisha, India.
authors.forename: Arati
authors.initials: A
authors.lastname: Nayak
authors.affiliation: Department of Obstetrics and gynaecology, Ispat General Hospital, Rourkela, Odisha, India.
authors.forename: Mary
authors.initials: M
authors.lastname: Bara
authors.affiliation: Department of Obstetrics and gynaecology, Ispat General Hospital, Rourkela, Odisha, India.
authors.forename: Bibiana
authors.initials: B
authors.lastname: Bilung
authors.affiliation: Disease Surveillance Laboratory, Asian Institute of Public health, Bhubaneswar, Odisha, India.
authors.forename: Pravas Ranjan
authors.initials: PR
authors.lastname: Mishra
authors.affiliation: Departments of Epidemiology and Pediatrics, Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, United States of America.
authors.forename: Pinaki
authors.initials: P
authors.lastname: Panigrahi
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Sandy
authors.initials: S
authors.lastname: Cairncross
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Belen
authors.initials: B
authors.lastname: Torondel
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D004777:Environment; D005191:Family Characteristics; D005260:Female; D006801:Humans; D006920:Hygiene; D007194:India; D008598:Menstruation; D008875:Middle Aged; D012306:Risk; D012499:Sanitation / Q000379:methods; D014552:Urinary Tract Infections / Q000209:etiology* / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000209:etiology* / Q000382:microbiology*; D055815:Young Adult