A multifaceted menstrual health intervention to improve psychosocial outcomes and menstrual practices among secondary schoolgirls in Northwest Tanzania: a pilot intervention study

Introduction : Schools provide an important opportunity to sustainably reach and improve menstrual experiences and outcomes among adolescent girls. This study examined changes in psychosocial outcomes and menstrual practices after a pilot menstrual health intervention in schools in Northwest Tanzania. Methods : We conducted a pre/post evaluation of a pilot menstrual health intervention in four schools in Mwanza region. The intervention included: i) 10-hours comprehensive menstrual sexual and reproductive health (MSRH) education curriculum delivered over 5 days, ii) distribution of menstrual management kits, iii) improvement of school WASH facility guided by needs, and iv) training on menstrual pain management strategies, supply of pain killers and training a specific teacher on dispensing. The primary outcome was measured using the Menstrual Practices Need Scale (MPNS). We assessed seven secondary outcomes: menstrual pain management practice; self-efficacy in managing menstruation; menstrual-related anxiety; self-reported urogenital infection symptoms; MSRH knowledge; participation in school during menstruation; and school climate score. We used linear (for MPNS, and school climate score), and logistic (for remaining secondary outcomes) random-effect regression models to examine changes in outcomes between baseline and endline. Results: A total of 486 schoolgirls (mean age 15.6 years [SD 1.3]) were recruited for the baseline survey; of these 396 participated in the endline survey. At 12-months follow up, menstrual experience improved for MPNS-36 subscales of transport and menstrual material needs, (mean difference (MD), 0.52; 95% CI 0.38 – 0.66), and menstrual material reuse needs, (MD 0.32; 0.14 – 0.50), while menstrual materials reuse insecurity did not change, (MD -0.08; -0.27 – 0.11). For the secondary outcomes, there was an increased use of analgesics for menstrual pain management, (OR 2.21; 95% CI 1.33 – 3.67); improved self-efficacy for managing menstruation, (OR 2.02; 1.35 – 3.04); MSRH knowledge, (OR 5,23; 3.25 – 8.39), participation in school (OR 2.80; 1.89 – 4.16) and reduced menstrual-related anxiety, (OR 0.38; 0.25 – 0.59). There was no evidence of change in self-reported urogenital symptoms, (OR 0.71; 0.49 – 1.01) or school climate, (MD 0.05; -0.19 – 0.28). Conclusion : The pilot intervention showed improvements in menstrual practices, psychosocial outcomes and school participation among schoolgirls but had no effect on school climate or reported MSRH symptoms. Stronger evidence from rigorously designed trials is needed to confirm the effectiveness of the intervention and scalability of these findings.