# Effects of a comprehensive menstrual and sexual reproductive health intervention on RTI symptoms among adolescent girls in the Mwanza region: a mixed-methods analysis

## TL;DR

A program to improve menstrual hygiene among schoolgirls in Mwanza increased use of clean products but had mixed effects on reproductive tract infection symptoms.

## Contribution

This study provides the first comprehensive analysis of the PASS MHW intervention's impact on RTI symptoms and menstrual practices among adolescent girls.

## Key findings

- Use of hygienic menstrual products increased from 32% to 77% after the intervention.
- Fish-smelling discharge increased significantly among urban participants.
- Referral services faced barriers like poor quality, cost, stigma, and consent issues.

## Abstract

Poor menstrual hygiene management (MHM) has been implicated in increasing RTI symptoms. The Partnering to Support Schools to Promote Good Menstrual Health and Well-being (PASS MHW) intervention was designed to address menstrual-related challenges among schoolgirls. However, no comprehensive analysis has evaluated its impact on menstrual management practices or its potential influence on reducing reproductive tract infection (RTI) symptoms.

This study examined the effects of a comprehensive Menstrual and Sexual Reproductive Health (MSRH) intervention on reproductive tract infection (RTI) symptoms among adolescent girls and aimed to identify the key predictors of these changes.

This was a mixed-methods secondary analysis of the PASS MHW project that involved surveys from 424 secondary school girls to assess changes in RTI symptoms and menstrual hygiene practices. In addition, 20 in-depth interviews were conducted with subsamples of girls referred for RTI treatment to assess their experience with health care services.

There was a significant postintervention increase in the proportion of schoolgirls using hygienic menstrual products, increasing from 32 to 77% (p = 0.001). RTI symptoms presented mixed outcomes: thick, white, clumped discharge decreased from 33 to 26% (p = 0.026), while fish-smelling discharge increased from 6 to 16% (p = 0.001), with urban participants experiencing a significant increase (OR = 2.15, 95% CI: 1.31–3.52, p = 0.002. Among older adolescents, there was an increase in genital symptoms, including itching, sores, and rash, particularly redness or irritation, although adjusted analysis indicated a lower likelihood compared to younger adolescent (OR = 0.67, 95% CI: 0.46–0.98, p = 0.039). Referral services encounter barriers, including poor service quality, financial limitations, stigma, and issues related to obtaining consent.

The PASS MHW intervention improved the use of hygienic menstrual products but had mixed effects on RTI symptoms. Some symptoms decreased, whereas others increased, especially among urban participants and younger adolescents. Barriers in referral services, including quality, cost, stigma, and consent issues, remain challenges.