The Effect of Sanitary Pads and Menstrual Symptom Management on School Performance of Adolescent Girls in Rural Kenya: A Cluster Randomized Trial

Abstract

Background: Access to education is an important social determinant for adolescent and maternal health. Despite the recognized importance of menstruation‐related problems as a barrier to adolescent girls' education, studies addressing this have failed to show improved school attendance. Additionally, school performance has not been studied in this context. Thus, the purpose of this study was to determine whether the availability of menstrual products and ibuprofen would improve examination scores of seventh and eight grade girls. Methods: A cluster randomized controlled trial was performed in which both intervention and control groups received puberty education, and the intervention group received sanitary pads and ibuprofen. Fourteen schools in rural Kenya were randomized (seven to each group) and included menstruating seventh and eight grade girls. Additionally, baseline demographic data on participant characteristics were collected. The outcome was the mean difference in school test scores from the baseline term (T1) to the second (T2) and third (T3) terms in the intervention, compared to the control group. Findings: Exam results and baseline data were available for 99 participants (54 control and 45 intervention). From T1 to T2 the change in test scores were 3.5 (SD 6.9) in the control group and 5.5 (SD 4.0) in the intervention group, and from T1 to T3, the change in scores were 0.1 and‐0.6 respectively. The differences between the intervention and control groups were not significant when adjusted for grade level, wealth index variables, and baseline menstrual symptoms (p= 0.35 for T1‐T2 and p= 0.82 for T1‐T3). Interpretation: There are many hidden cultural and socioeco‐nomic factors at play in rural Kenya that may have influenced the results of this study, such as reported 'feelings of isolation.' Although unidentifiable confounding variables may have played a role, sanitary pads and ibuprofen were not shown to be effective in improving school performance when added to an education program for adolescent girls in rural Kenya.