title: Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess the status of menstrual hygiene management (MHM) among adolescent girls in India to determine unmet needs.
  
  
  METHODS
  Systematic review and meta-analysis. We searched PubMed, The Global Health Database, Google Scholar and references for studies published from 2000 to September 2015 on girls' MHM.
  
  
  METHODS
  India.
  
  
  METHODS
  Adolescent girls.
  
  
  METHODS
  Information on menarche awareness, type of absorbent used, disposal, hygiene, restrictions and school absenteeism was extracted from eligible materials; a quality score was applied. Meta-analysis was used to estimate pooled prevalence (PP), and meta-regression to examine the effect of setting, region and time.
  
  
  RESULTS
  Data from 138 studies involving 193 subpopulations and 97,070 girls were extracted. In 88 studies, half of the girls reported being informed prior to menarche (PP 48%, 95% CI 43% to 53%, I(2) 98.6%). Commercial pad use was more common among urban (PP 67%, 57% to 76%, I(2) 99.3%, n=38) than rural girls (PP 32%, 25% to 38%, I(2) 98.6%, n=56, p<0.0001), with use increasing over time (p<0.0001). Inappropriate disposal was common (PP 23%, 16% to 31%, I(2) 99.0%, n=34). Menstruating girls experienced many restrictions, especially for religious activities (PP 0.77, 0.71 to 0.83, I(2) 99.1%, n=67). A quarter (PP 24%, 19% to 30%, I(2) 98.5%, n=64) reported missing school during periods. A lower prevalence of absenteeism was associated with higher commercial pad use in univariate (p=0.023) but not in multivariate analysis when adjusted for region (p=0.232, n=53). Approximately a third of girls changed their absorbents in school facilities (PP 37%, 29% to 46%, I(2) 97.8%, n=17). Half of the girls' homes had a toilet (PP 51%, 36% to 67%, I(2) 99.4%, n=21). The quality of studies imposed limitations on analyses and the interpretation of results (mean score 3 on a scale of 0-7).
  
  
  CONCLUSIONS
  Strengthening of MHM programmes in India is needed. Education on awareness, access to hygienic absorbents and disposal of MHM items need to be addressed.
  
  
  BACKGROUND
  CRD42015019197.
authors.affiliation: Department of Clinical Sciences, Liverpool school of Tropical Medicine, Liverpool, UK.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: van Eijk
authors.affiliation: Tata Institute of Social Sciences, School of Health Systems Studies, Mumbai, Maharashtra, India.
authors.forename: M
authors.initials: M
authors.lastname: Sivakami
authors.affiliation: UNICEF India, New Delhi, India.
authors.forename: Mamita Bora
authors.initials: MB
authors.lastname: Thakkar
authors.affiliation: Department of Clinical Sciences, Liverpool school of Tropical Medicine, Liverpool, UK.
authors.forename: Ashley
authors.initials: A
authors.lastname: Bauman
authors.affiliation: Centers for Disease Control and Prevention (CDC) India, Atlanta, Georgia, USA.
authors.forename: Kayla F
authors.initials: KF
authors.lastname: Laserson
authors.affiliation: UNICEF India, New Delhi, India.
authors.forename: Susanne
authors.initials: S
authors.lastname: Coates
authors.affiliation: Department of Clinical Sciences, Liverpool school of Tropical Medicine, Liverpool, UK.
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Phillips-Howard
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene / Q000592:standards*; D007194:India; D008572:Menarche; D008598:Menstruation; D012424:Rural Population; D012574:Schools; D014505:Urban Population
keywords: PREVENTIVE MEDICINE; PUBLIC HEALTH