title: Factors impacting on menstrual hygiene and their implications for health promotion.
abstract: BACKGROUND
  In the lives of women, puberty is marked by the onset of menarche. From this stage onwards until menopause, reproductive health and menstrual hygiene are important aspects of women's lives. In Zambia's Western Province, the natural process of menstruation is a taboo and dealt with secretly. Information and knowledge about menstruation and menstrual hygiene among adolescent girls is inadequate. This paper explores the factors influencing the understanding, experiences and practices of menstrual hygiene among adolescent girls in Mongu District, Western Province of Zambia.
  
  
  METHODS
  An explorative study design was used by means of six focus group discussions conducted with 51 respondents, aged 13-20 years, from three secondary schools. Their age at menarche was 11-15. For data analysis thematic content analysis was used.
  
  
  RESULTS
  The paper shows that the girls suffer from poor menstrual hygiene, originating from lack of knowledge, culture and tradition, and socio-economic and environmental constraints, leading to inconveniences, humiliation and stress. This leads to reduced school attendance and poor academic performance, or even drop outs, and ultimately infringes upon the girls' human rights.
  
  
  CONCLUSIONS
  To address these shortcomings, a 'super setting approach' is recommended, in which a Health Promoting School could improve the girls' individual and group needs, and a community setting which would address the broader socio-economic, cultural and environmental conditions. This would enable creating a supportive environment for the girls to manage their periods. To successfully utilize the approach, all stakeholders (parents, teachers, children, governments and communities) should cooperate to generate context-specific solutions for creating safe menstrual care, and better and dignified conditions for adolescent girls. Therefore, this calls for comprehensive, strident advocacy for policy changes at national level, and mediation and involvement at community level.
authors.affiliation: 1 Akros Global Health, Lusaka, Zambia.
authors.forename: Anne Mutunda
authors.initials: AM
authors.lastname: Lahme
authors.affiliation: 2 University of Western Cape - School of Public Health, Cape Town, South Africa.
authors.forename: Ruth
authors.initials: R
authors.lastname: Stern
authors.affiliation: 2 University of Western Cape - School of Public Health, Cape Town, South Africa.
authors.forename: Diane
authors.initials: D
authors.lastname: Cooper
mesh_terms: D000293:Adolescent; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D006920:Hygiene; D008572:Menarche; D008598:Menstruation; D036301:Qualitative Research; D060728:Reproductive Health / Q000331:legislation & jurisprudence; D012572:School Health Services / Q000331:legislation & jurisprudence; D012574:Schools; D012959:Socioeconomic Factors; D055815:Young Adult; D015024:Zambia
keywords: Africa; HIV/AIDS; advocacy (including media advocacy); gender; health promoting schools; qualitative; reproductive health; rural