Problems and Practice of Management on Menstruation by Adolescents Girls of Basic Schools of Chitwan, Nepal

2020 ◽  
Vol 8 ◽  
pp. 85-94
Author(s):  
Sudha Ghimire
Keyword(s):  
Current Practice ◽  
Quantitative Information ◽  
Community Schools ◽  
Mixed Method Research ◽  
Participatory Action ◽  
Group Discussions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Field Notes ◽  
Sanitary Pads

Managing menstruation in a hygienic way is a challenge in most of the low and middle-income countries (LMIC) including Nepal, where normal and natural physiological process of menstruation is considered as girls’ problem which is viewed as sinful, unholy and matter of shame. This paper explores the current practice and existing difficulties that adolescents girls encounter hygienic management of menstruation (MHM) especially during school days. The study was conducted on five purposively selected community schools of Chitwan district. The study adopted Participatory Action Research (PAR) as an approach, that is encapsulated with mixed method research design. For qualitative information observation, focus group discussions (FGD) and field notes were used, whereas for quantitative data self-administrative questionnaires were used. Quantitative information was collected from 205 girls students who were present at schools on the day of data collection. The finding shows that majority of the girls (93.7%) who encounter hygienic management of menstruation were of 10-14 years old age, whereas nearly one third of them were (29%) from grade eight. Similarly, among the total 205 girls, only 79 girls have already started their menstruation; among those who have started menstruation majority (78%) had heard about menstruation form their mothers. Likewise, 35% girls used homemade cotton pads and 40.5% of them changed pad three times a day. During FGD, adolescents girls shared that lack of water and soap in toilets, stress and lack of concentration during menstruation are the major difficulties which they encounter during days of menstruation. They suggested the concerned authorities to manage pad bank, make soap and water available, and develop skills for proper disposing of used sanitary pads for MHM at schools. 

scholarly journals Understanding Period Poverty: Socio-Economic Inequalities in Menstrual Hygiene Management in Eight Low- and Middle-Income Countries

2021 ◽  
Vol 18 (5) ◽  
pp. 2571
Author(s):  
Laura Rossouw ◽  
Hana Ross
Keyword(s):  
Decomposition Methods ◽  
Middle Income ◽  
Menstrual Hygiene ◽  
Middle Income Countries ◽  
Menstrual Hygiene Management ◽  
Hygiene Management ◽  
Menstrual Health ◽  
Women And Girls ◽  
Sanitary Pads ◽  
Unequal Access

Menstrual hygiene management and health is increasingly gaining policy importance in a bid to promote dignity, gender equality and reproductive health. Effective and adequate menstrual hygiene management requires women and girls to have access to their menstrual health materials and products of choice, but also extends into having private, clean and safe spaces for using these materials. The paper provides empirical evidence of the inequality in menstrual hygiene management in Kinshasa (DRC), Ethiopia, Ghana, Kenya, Rajasthan (India), Indonesia, Nigeria and Uganda using concentration indices and decomposition methods. There is consistent evidence of wealth-related inequality in the conditions of menstrual hygiene management spaces as well as access to sanitary pads across all countries. Wealth, education, the rural-urban divide and infrastructural limitations of the household are major contributors to these inequalities. While wealth is identified as one of the key drivers of unequal access to menstrual hygiene management, other socio-economic, environmental and household factors require urgent policy attention. This specifically includes the lack of safe MHM spaces which threaten the health and dignity of women and girls.

scholarly journals Determinants of Long Immunization Clinic Wait Times in a Sub-Saharan African Country

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110282
Author(s):  
Osayame Austine Ekhaguere ◽  
Rosena Olubanke Oluwafemi ◽  
Angela Oyo-Ita ◽  
Burke Mamlin ◽  
Paul Bondich ◽  
...  
Keyword(s):  
Focus Group ◽  
Critical Mass ◽  
Wait Time ◽  
Wait Times ◽  
Group Discussions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Group Data ◽  
Focus Group Data ◽  
Sub Saharan

The wait time clients spend during immunization clinic visits in low- and middle-income countries is a not well-understood reported barrier to vaccine completion. We used a prospective, observational design to document the total time from client arrival-to-discharge and all sequential provider-client activities in 1 urban, semi-urban, and rural immunization clinic in Nigeria. We also conducted caregiver and provider focus group discussions to identify perceived determinants of long clinic wait times. Our findings show that the time from arrival-to-discharge varied significantly by the clinic and ranged between 57 and 235 minutes, as did arrival-to-all providers-client activities. Focus group data attributed workflow delays to clinic staff waiting for a critical mass of clients to arrive for their immunization appointment before starting the essential health education talk or opening specific vaccine vials. Additionally, respondents indicated that complex documentation processes caused system delays. Research on clinic workflow transformation and simplification of immunization documentation is needed.

scholarly journals Why Do Farmers Grow Tobacco? A Qualitative Exploration of Farmers Perspectives in Indonesia and Philippines

2019 ◽  
Vol 16 (13) ◽  
pp. 2330 ◽  
Author(s):  
Adriana Appau ◽  
Jeffrey Drope ◽  
Firman Witoelar ◽  
Jenina Joy Chavez ◽  
Raphael Lencucha
Keyword(s):  
Institutional Factors ◽  
Interpretive Description ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Middle Income ◽  
Access To Credit ◽  
Middle Income Countries ◽  
Alternative Livelihood ◽  
Qualitative Exploration ◽  
Inductive Thematic Analysis

Tobacco supply remains a pressing challenge to tobacco control. Tobacco remains a dominant cash crop in many low- and middle-income countries, despite the evidence suggesting that it is not as profitable as industry claims and is harmful to health and the environment. In order to implement successful and sustainable alternative livelihood interventions, it is important to understand why farmers continue to grow tobacco. This study explores this question from the perspective of farmers in Indonesia and Philippines. This study was informed by interpretive description methodology. Data was collected through focus group discussions (FGDs) (n = 7) with farmers (n = ~60). The FGDs were audio recorded, transcribed verbatim, and then translated into English. An inductive thematic analysis of the data was conducted to identify and categorize the reason provided by participants. We identified two overarching themes: (1) perceived viability (profitability, ready market, and environmental factors) and (2) financial context. Financial context included lumpsum payments and access to financial loans and credit facilities in light of their lack of capital. These results highlight that, in addition to identifying viable alternatives to tobacco, institutional factors such as improved access to credit and well-developed supply chains are key to the successful uptake of alternative livelihoods.

scholarly journals Comparing use and acceptability of menstrual cups and sanitary pads by schoolgirls in rural Western Kenya

2019 ◽  
Vol 8 (8) ◽  
pp. 2974
Author(s):  
Linda Mason ◽  
Elizabeth Nyothach ◽  
Anna Maria Van Eijk ◽  
David Obor ◽  
Kelly T. Alexander ◽  
...  
Keyword(s):  
Linear Trend ◽  
Prior Experience ◽  
Middle Income ◽  
Western Kenya ◽  
Middle Income Countries ◽  
Product Use ◽  
Sanitary Pads ◽  
Menstrual Products ◽  
Over Time

Background: Girls in low and middle-income countries (LMIC) lack access to hygienic and affordable menstrual products. We explore Kenyan schoolgirls’ use and views of the cup compared to girls provided with disposable sanitary pads for a feasibility study.Methods: Schoolgirls aged 14-16 years, received a menstrual cup in 10 schools or 16 pads/month in another10 schools. All were trained by nurses on puberty, hand washing, and product use. They self-completed a net book survey at baseline and twice a term during a year follow-up. We examined their reported ease of insertion and removal, also comfort, soreness, and pain with product use. An aggregate ‘acceptability’ score was compiled for each product and girls’ socio-demographic and menstrual characteristics were compared.Results: 195 participants received cups and 255 pads. Mean age was 14.6 years, menarchial age was 13.6 years, with an average 3.8 days menses per month. Cup use was 39% in month 1, rising to 80% by month 12 (linear trend p<0.001). Pad use rose from 85% to 92% (linear trend p=0.15). Measures of cup acceptability demonstrated girls had initial problems using the cup but reported difficulties with insertion, removal and comfort reduced over time. Girls using pads reported fewer acceptability issues. At baseline, approximately a quarter of girls in the pad arm reported inserting pads intravaginally although this was significantly lower among girls with prior experience of pad use (aRR 0.62; 0.45-0.87).Conclusions: While a smaller proportion of girls provided with cups used them in the first months compared to girls given pads, reported use was similar by study-end, and early acceptability issues reduced over time. Girls in LMIC may successfully and comfortably use cups, but require instruction, support and some persistence.

Linking Participatory Action Research on Health Systems to Justice in Global Health: A Case Study of the Maternal and Neonatal Implementation for Equitable Health Systems Project in Rural Uganda

2017 ◽  
Vol 13 (1) ◽  
pp. 74-87 ◽  
Author(s):  
Bridget Pratt ◽  
Adnan A. Hyder
Keyword(s):  
Health Systems ◽  
Ethical Framework ◽  
Participatory Action ◽  
Middle Income ◽  
Makerere University ◽  
Middle Income Countries ◽  
Systems Research ◽  
Study Sites ◽  
Health Justice

An ethical framework called “research for health justice” provides initial guidance on how to link health systems research in low- and middle-income countries to health equity. To further develop the largely conceptual framework, we tested its guidance against the experience of the Maternal and Neonatal Implementation for Equitable Health Systems (Manifest) project, which was performed in rural Uganda by researchers from Makerere University. We conducted 21 in-depth interviews with investigators and research implementers, directly observed study sites, and reviewed study-related documents. Our analysis identifies where alignment exists between the framework’s guidance and the Manifest project, providing initial lessons on how that was achieved. It also identifies where nonalignment occurred and gaps in the framework’s guidance. Suggestions are then made for revising and expanding “research for health justice.”

‘Everyone is exhausted and frustrated’: exploring psychosocial impacts of the lack of access to safe water and adequate sanitation in Usoma, Kenya

2016 ◽  
Vol 6 (2) ◽  
pp. 205-214 ◽  
Author(s):  
Elijah Bisung ◽  
Susan J. Elliott
Keyword(s):  
Health Issues ◽  
Group Discussions ◽  
Water And Sanitation ◽  
Middle Income ◽  
Western Kenya ◽  
Safe Water ◽  
Middle Income Countries ◽  
Psychosocial Concerns ◽  
Psychosocial Impacts ◽  
Negative Identity

The lack of access to safe water and adequate sanitation pose significant health challenges for many individuals and communities in low and middle-income countries. Aside from direct health issues, the lack of access to safe water and adequate sanitation is increasingly associated with psychosocial concerns that affect the wellbeing of individuals and communities. However, the nature of these concerns has received little attention in peer-reviewed literature. This paper draws on environmental stress and ecosocial theories to explore psychosocial concerns related to water and sanitation in Usoma, a lakeshore community in Western Kenya. The study used qualitative key informant interviews (n = 9) and focus group discussions (n = 10). Results reveal deep feelings of anxiety and frustration, embarrassment, negative identity, feelings of marginalization, and lack of self-efficacy. These stressors were a byproduct of daily lived experiences associated with lack of access to safe water and adequate sanitation, as well as the coping strategies people adopted. The paper suggests that benefits of water interventions transcend disease reduction to improved wellbeing through complex social pathways. The findings contribute to knowledge gaps within the water–health nexus and direct policy responses toward largely unexplored psychosocial concerns associated with water and sanitation.

scholarly journals Formative Research to Design a Child-Friendly Latrine in Bangladesh

2021 ◽  
Vol 18 (21) ◽  
pp. 11092
Author(s):  
Tarique Md. Nurul Huda ◽  
Tania Jahir ◽  
Sushobhan Sarker ◽  
Farzana Yeasmin ◽  
Abdullah Al Masud ◽  
...  
Keyword(s):  
Focus Group Discussions ◽  
Group Discussions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Roof Tile ◽  
Enabling Technologies ◽  
Child Friendly ◽  
Common Barriers ◽  
Depth Interviews ◽  
Latrine Use

In low- and middle-income countries, most latrines are not accessible to young children. We explored how to modify existing pit latrines to make them child friendly. We conducted four focus group discussions with mothers to explore barriers to child latrine use. We then enrolled 20 households with a child aged 3–7 years old to test six enabling technologies developed based on the identified barriers. Two to three weeks after installing the selected enabling technologies in each household, researchers conducted 19 in-depth interviews with caregivers to explore the technologies’ acceptance and feasibility. Common barriers included the discomfort of squatting on a large pan, fear of darkness, and fear of a slippery floor. Of the potential solutions, a ring to stabilize the child while squatting in the latrine was preferred by children and was affordable and available. A wooden board with a smaller hole than the usual pan reduced fears of falling and helped eliminate discomfort but was inconvenient to handle and clean. A transparent fiberglass roof tile was affordable, available, increased visibility, and kept the latrine floor dry. In conclusion, the fiberglass roof tile and stability ring were two affordable and locally available technologies that facilitated latrine use by children aged 3–7 years.

scholarly journals Determinants of Clinician and Patient to prescription of antimicrobials: case of Mulanje, Southern Malawi

2021 ◽  
Author(s):  
Morris Chalusa ◽  
Felix Khuluza ◽  
Chiwoza Bandawe
Keyword(s):  
Health Facilities ◽  
Limited Attention ◽  
Inappropriate Prescription ◽  
Group Discussions ◽  
Middle Income ◽  
Medical Assistants ◽  
Middle Income Countries ◽  
Definition Of ◽  
Clinical Officers ◽  
Antimicrobial Prescription

Abstract BackgroundAntimicrobial resistance is an emerging problem in low- and middle-income countries. The problem is exacerbated by inappropriate prescription of antimicrobials. Factors leading to overuse or inappropriate prescription of antimicrobials by the cadre of medical assistants, clinical technicians and clinical officers have received limited attention. This study investigated factors that influence prescription behaviours of antimicrobials among clinical officers in various health facilities in Mulanje district, Southern Malawi. MethodsIn-depth interviews (n=18) and focus group discussions (n=2) were conducted with COs from four health facilities in Mulanje district. Purposive sampling was done to arrive at a sample size of 30 health cadres. ResultsParticipants pointed out that patient preferences, belief and clinicians’ inadequate education on this issue were among the factors that contribute to inappropriate antimicrobial prescription. 75-% of clinicians showed lack of knowledge on the definition of antibiotic and antimicrobial resistance. ConclusionInappropriate use of antimicrobials is facilitated by prescribing decisions made by clinicians who are greatly influenced by their patients. Interventions aimed at improving antimicrobial prescription should target both clinicians and patients.

Task Sharing to Support Paediatric Service Delivery in Low- and Middle-income Countries: Current Practice and a Scoping Review of Emerging Opportunities

2021 ◽  
Author(s):  
Yingxi Zhao ◽  
Christiane Hagel ◽  
Raymond Tweheyo ◽  
Nathanael Sirili ◽  
David Gathara ◽  
...  
Keyword(s):  
Child Health ◽  
Service Delivery ◽  
Scoping Review ◽  
Chronic Conditions ◽  
Current Practice ◽  
Task Sharing ◽  
Middle Income ◽  
Middle Income Countries ◽  
Paediatric Service ◽  
Training Opportunities

Abstract BackgroundDemographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for complex and chronic conditions in the 0-19 years (paediatric) age range. The general and skilled paediatric workforce shortage especially in low- and middle-income countries (LMICs) will impede the provision of additional paediatric services. This paper examines experiences with task sharing as part of the solution to this human resources challenge in LMICs and specifically looks beyond the provision of care for acute infectious diseases and malnutrition that are widely and historically shifted. MethodsWe (1) reviewed the Global Burden of Diseases study to understand which conditions may need to be prioritised; (2) investigated training opportunities and national policies related to task sharing (current practice) in five purposefully selected African countries (Kenya, Uganda, Tanzania, Malawi and South Africa); and (3) summarised reported experience of task sharing and paediatric service delivery through a scoping review of research literature in LMICs published between 1990-2019 using MEDLINE, Embase, Global Health, PsycINFO, CINAHL and the Cochrane Library. ResultsWe found that while some training opportunities nominally support emerging roles for non-physician clinicians and nurses, formal scopes of practices often remain rather restricted and neither training nor policy seems well aligned with probable needs from high-burden complex and chronic conditions. From 83 studies in 24 LMICs, and aside from the historically shifted conditions, we found there is some evidence available for task sharing for a small set of specific conditions (circumcision, some complex surgery, rheumatic heart diseases, epilepsy, mental health). ConclusionAs child health strategies are further redesigned to address the previously unmet needs careful strategic thinking on the development of an appropriate paediatric workforce is needed. To achieve coverage at scale countries may need to transform their paediatric workforce including possible new roles for mid-level cadres to support safe, accessible and high-quality care.

Poverty Measurement

2017 ◽  
Author(s):  
Timothy M. Smeeding
Keyword(s):  
Great Recession ◽  
Current Practice ◽  
Developing Nations ◽  
Poverty Measurement ◽  
Absolute Poverty ◽  
Social Scientists ◽  
Middle Income ◽  
The Great Recession ◽  
Middle Income Countries ◽  
Empirical Estimates

This article focuses on the complexities and idiosyncrasies of poverty measurement, from its origins to current practice. It first considers various concepts of poverty and their measurement and how economists, social statisticians, public policy scholars, sociologists, and other social scientists have contributed to this literature. It then discusses a few empirical estimates of poverty across and within nations, drawing primarily on data from the Luxembourg Income Study and the Organization for Economic Cooperation and Development (OECD) to highlight levels and trends in overall poverty, while also referring to the World Bank’s measures of global absolute poverty. In the empirical examinations, the article takes a look at rich and middle-income countries and some developing nations. It compares trends in relative poverty over different time periods and in relative and anchored poverty across the Great Recession.

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