Association between unhygienic menstrual management practices and prevalence of lower reproductive tract infections in rural community of Kilolo District, Tanzania

doi:10.21203/rs.3.rs-4996096/v1

Introduction: This study aimed to determine whether poor menstrual hygiene practices were associated with common infections of the lower reproductive tract mainly Bacterial vaginosis (BV) and Candida.

Method: Methodology included non-pregnant women of reproductive age (14–45 years) attending the four selected health. A standardized questionnaire was used to collect information on: MHM practices and socio-economic and demographic information. Specimens from posterior vaginal fornix were collected using swabs for diagnosis of BV and Candida infection.

Results: The results showed that; A total of 207 women were recruited for the study of whom 37.2 % were diagnosed with the tested lower reproductive tract infections. After adjustment for potentially confounding factors, women diagnosed with RTIs infection were more likely to use reusable absorbent material (P<0.001) and practice lower frequency of personal washing (P=0.004)On multivariate analysis finds point that being not married is associated with a higher likelihood of having an RTI and Changing absorbents only once a day is associated with a higher likelihood of having an RTI.

Conclusion: In conclusion, the study findings highlight the critical role of absorbent changing frequency in the incidence of reproductive tract infections (RTIs). Specifically, changing absorbents only once a day is significantly associated with a higher likelihood of developing an RTI compared to more frequent changes. This underscores the importance of proper hygiene practices in preventing RTIs.

Reproductive tract infections (RTIs)

Bacterial vaginosis (BV)

Hygiene

sanitation

menstrual management practices

Kilolo

Menstruation, a natural phenomenon in the reproductive cycle, marks a significant transition for adolescent girls as they embark on their journey into womanhood. With the onset of menstruation, or menarche, typically occurring between the ages of 11 and 14 years, girls enter a phase where hygiene during menstruation becomes paramount for their dignity and well-being (Mohammed, Larsen-Reindorf, and Awal, 2020). However, the age of menarche can vary, with some girls experiencing it as early as 8 years old and others as late as 17 or older.

Globally, there are approximately 600 million adolescent girls, and ensuring their access to proper menstrual hygiene management (MHM) is imperative (Action, 2016). Adolescence is a crucial period requiring special attention to address the needs of all girls, particularly the most vulnerable, and to break intergenerational cycles of poverty and gender inequality. MHM is not just a matter of hygiene but also a fundamental issue of human rights, dignity, and public health. Every girl should have the ability to manage her menstruation without stress, shame, or barriers to essential information and supplies.

However, the reality is that around 500 million women and girls worldwide lack adequate facilities for menstrual hygiene management, particularly in public places such as schools and workplaces (Sylivester W. Mkama, 2022). Societal myths, stigmas, cultural taboos, and economic factors contribute to unmet menstrual hygiene needs, placing women and girls at risk of reproductive tract infections (RTIs) and other health complications. Insufficient access to water, sanitation, and hygiene (WASH) facilities further exacerbates the challenges faced by women and girls in managing their menstruation.

The intersectionality of MHM requires integrated action across sectors, including WASH, education, health, and gender. As research on the importance of MHM expands, there is a growing interest in addressing the needs of women, girls, and all individuals who menstruate (Poirier and Cover, 2020). Menstrual hygiene products play a crucial role in maintaining personal hygiene during menstruation, but access to and knowledge about these products remain limited in many settings.

In the absence of suitable and affordable menstrual care products, some women and girls resort to unhygienic alternatives, such as newspaper, old rags, or plant material, to manage their periods (Robert M. Njee et al., 2021). These practices, coupled with inadequate hygiene facilities and socio-cultural taboos, increase the risk of RTIs and other health issues among women and girls.

The burden of RTIs is particularly pronounced in resource-constrained settings, where access to healthcare and menstrual hygiene products is limited. Studies have shown associations between unhygienic menstrual practices and the prevalence of RTIs, highlighting the need for further research in this area (Sumpter and Torondel, 2013). Addressing the socio-cultural determinants of MHM is essential for promoting women's and girls' health, dignity, and empowerment.

In light of these challenges, this study aims to assess the association between menstrual hygiene management practices and the prevalence of RTIs among women of childbearing age in a rural community in Kilolo, Tanzania. By exploring MHM practices and their impact on reproductive health outcomes, this study seeks to contribute to the evidence base for informed policy and programmatic interventions aimed at improving menstrual health and hygiene for women and girls in low-resource settings.

3.1 Study design

Refer to arrangement of conditions for collection and analysis of data in a manner that aims to combine relevance to the research purpose with economy in procedure (Kothari, 2004). The study was descriptive cross-sectional design. This design is suitable for the respective study as it involves collection of data at one point in time in different healthcare facilities.

3.2. Study approaches

The study employed both the quantitative approach.

3.3 Study participants/population

The study participants were the population from which the sample is chosen and that are accessible to meet eligibility criteria to be used in the study. Study participants were non-pregnant women of child bearing age (14–45) that attended the RCH and OPD of targeted (4) HCFs in the period of data collection.

3.3.1 Inclusion criteria

Inclusion criteria/eligibility criteria used in the study was non-pregnant women of reproductive age (14–45 years) attended the RCH and OPD with vaginal symptoms (vaginal discharge, itching, burning, dyspareunia, with lower abdominal pain, and lower back pain), or attending the Family Welfare Department (FWD) for contraceptives, such as intra-uterine devices (IUD) were eligible for enrolment.

3.3.2. Exclusion criteria

Excluded from the study were those women who menstruate during the clinic visit, pregnant women, had a hysterectomy, taken a course of antibiotics during the previous three weeks, used oral contraceptive pills in the previous three months, had diabetes mellitus, HIV positive/immune-compromised, or with any severe medical disorders requiring immediate referral to a higher level of health care.

3.4 Description of Study Area

The study was conducted at Kilolo District Council, including four 4 Public Health Care Facilities in Ruaha mbuyuni and Nyanzwa wards in Kilolo, Tanzania where there is large population of Sagara and Masai tribes characterized by unhygienic behaviors of managing menstruation, main of these behavior being use of cow dung to control menstrual blood(Tamiru et al. 2015).

Kilolo district is one among the local government Authorities under President’s Office and governed by the ministry of Regional Administration and Local Government Authorities. The district was established on the year 2005 by Government announcement No. 220 after division of Iringa as mother District. Hence for the period of 1961–2005 the district of Kilolo was part of Wards and Divisions of the Iringa District.

The district is found between Latitude 70 − 8.30 degrees southern of equator line and Longitude 340–370 degrees eastern of “Greenwich” line. The district is bounded with the district of Mpwapwa (Dodoma) on the northern side, the district of Kilosa (Morogoro) on the north east side and the district of Kilombero on eastern side in Morogoro region. On the southern side is bounded with Mufindi district whereas on the western side is bounded with Iringa district.

Kilolo district has an estimated area of about 7,882 km², an average of 86.32% of this area is suitable for agricultural activities whereby it is equal to 6803.2km², the remaining area of about 1077.8 km² is covered by water, animal reserves, mountains and forests.

The Kilolo district is divided into three divisions which are Kilolo, Mazombe and Mahenge. However the district has 24 ward and 94 villages, 16 streets at Ilula township authority and a total of 499 hamlets and with a total population of 218,130(Republic et al. 2013) Fig. 1 below.

3.5 Sampling frame

The sampling frame for this research consists of non-pregnant women of reproductive age (14–45 years) with RTI symptoms (vaginal discharge, itching, burning, dyspareunia, lower abdominal pain, and lower back pain) or those visiting the Family Welfare Department (FWD) for contraceptive services, such as intra-uterine devices (IUD).

3.5 Sample and sampling technique

3.5.1 Sample Size

A subset of a population (sample) selected to participate in a study was obtained from the population of non-pregnant individuals/women. Sample size as a total number of individuals required to participate in the study was obtained using the following statistical Fisher’s formula:-

N = (Z² p (1 – p)/D²

Where;

N = Total number of subjects required in the sample

Z = value for a level of confidence 95% (1.96)

P = Estimate of prevalence 16%

D = Marginal error which corresponds to the level of precision of the results desired. This study tolerated 5% (0.05)

For this study, the value for a level of confidence 95% spread limit used Z = 1.96; this value was the more preferred level of confidence for scientific comparison.

The expected proportion (P) of the study was obtained from a previous study done in public hospitals in Odisha, India. From these studies it was indicated that, 16% was the prevalence of women who had Reproductive Tract Infections (RTIs) (Baisley et al. 2009). Therefore, the expected proportion for this study is considered to be 16%.

Therefore: Z = 1.96, p = 16%, D = 0.05

Then: N = 1.96² x 0.16 (1–0.16)/0.05² = 207

Hence: The sample size in this study is 207

3.3 Study participants/population

The study participants were the population from which the sample is chosen and that are accessible to meet eligibility criteria to be used in the study. Study participants were non-pregnant women of child bearing age (14–45) that attended the RCH and OPD of targeted (4) HCFs in the period of data collection.

3.3.1 Inclusion criteria

Inclusion criteria/eligibility criteria used in the study was non-pregnant women of reproductive age (14–45 years) attended the RCH and OPD with vaginal symptoms (vaginal discharge, itching, burning, dyspareunia, with lower abdominal pain, and lower back pain), or attending the Family Welfare Department (FWD) for contraceptives, such as intra-uterine devices (IUD) were eligible for enrolment.

3.3.2. Exclusion criteria

Excluded from the study were those women who menstruate during the clinic visit, pregnant women, had a hysterectomy, taken a course of antibiotics during the previous three weeks, used oral contraceptive pills in the previous three months, had diabetes mellitus, HIV positive/immune-compromised, or with any severe medical disorders requiring immediate referral to a higher level of health care.

3.4 Description of Study Area

The study was conducted at Kilolo District Council, including four 4 Public Health Care Facilities in Ruaha mbuyuni and Nyanzwa wards in Kilolo, Tanzania where there is large population of Sagara and Masai tribes characterized by unhygienic behaviors of managing menstruation, main of these behavior being use of cow dung to control menstrual blood(Tamiru et al. 2015).

Kilolo district is one among the local government Authorities under President’s Office and governed by the ministry of Regional Administration and Local Government Authorities. The district was established on the year 2005 by Government announcement No. 220 after division of Iringa as mother District. Hence for the period of 1961–2005 the district of Kilolo was part of Wards and Divisions of the Iringa District.

The district is found between Latitude 70 − 8.30 degrees southern of equator line and Longitude 340–370 degrees eastern of “Greenwich” line. The district is bounded with the district of Mpwapwa (Dodoma) on the northern side, the district of Kilosa (Morogoro) on the north east side and the district of Kilombero on eastern side in Morogoro region. On the southern side is bounded with Mufindi district whereas on the western side is bounded with Iringa district.

Kilolo district has an estimated area of about 7,882 km², an average of 86.32% of this area is suitable for agricultural activities whereby it is equal to 6803.2km², the remaining area of about 1077.8 km² is covered by water, animal reserves, mountains and forests.

The Kilolo district is divided into three divisions which are Kilolo, Mazombe and Mahenge. However the district has 24 ward and 94 villages, 16 streets at Ilula township authority and a total of 499 hamlets and with a total population of 218,130(Republic et al. 2013) Fig. 1 below.

3.5 Sampling frame

The sampling frame for this research consists of non-pregnant women of reproductive age (14–45 years) with RTI symptoms (vaginal discharge, itching, burning, dyspareunia, lower abdominal pain, and lower back pain) or those visiting the Family Welfare Department (FWD) for contraceptive services, such as intra-uterine devices (IUD).

3.5 Sample and sampling technique

3.5.1 Sample Size

A subset of a population (sample) selected to participate in a study was obtained from the population of non-pregnant individuals/women. Sample size as a total number of individuals required to participate in the study was obtained using the following statistical Fisher’s formula:-

N = (Z² p (1 – p)/D²

Where;

N = Total number of subjects required in the sample

Z = value for a level of confidence 95% (1.96)

P = Estimate of prevalence 16%

D = Marginal error which corresponds to the level of precision of the results desired. This study tolerated 5% (0.05)

For this study, the value for a level of confidence 95% spread limit used Z = 1.96; this value was the more preferred level of confidence for scientific comparison.

The expected proportion (P) of the study was obtained from a previous study done in public hospitals in Odisha, India. From these studies it was indicated that, 16% was the prevalence of women who had Reproductive Tract Infections (RTIs) (Baisley et al. 2009). Therefore, the expected proportion for this study is considered to be 16%.

Therefore: Z = 1.96, p = 16%, D = 0.05

Then: N = 1.96² x 0.16 (1–0.16)/0.05² = 207

Hence: The sample size in this study is 207

Therefore: Z = 1.96, p = 16%, D = 0.05

Then: N = 1.96² x 0.16 (1–0.16)/0.05² = 207

3.5.2 Sampling technique

The sampling technique used in this study was a combination of Purposive and Convenience sampling methods.

First, purposive sampling was used to select the 4 health facilities of Ruaha mbuyuni and Nyanzwa Dispensaries as well as Ruaha mbuyuni and Mtandika Health Centres in Nyanzawa and Ruaha Mbuyuni wards where there is large population of Sagara and Masai tribes characterized by unhygienic behaviors of managing menstruation, main of these behavior being use of cow dung to control menstrual blood. Then researcher introduced the study to eligible participants who were already seeking medical care or contraceptive services at the healthcare facilities. From this pool of individuals, participants were conveniently selected, and their consent was obtained.

Next, the selected participants underwent clinical diagnosis in the doctor's room and later on proceeded with the laboratory procedures for further diagnosis of possible Reproductive Tract Infections (RTIs). After the confirmatory diagnosis, the respondents were categorized as either positive or negative for RTIs. They were then provided with a special coded questionnaire labeled "A" or "B," respectively. This questionnaire aimed to retrospectively investigate their Menstrual Hygiene Management (MHM) practices.

3.6 Study variables

3.6.1 Dependent variable

Dependent variable of this study was prevalence of Reproductive Tract Infections (RTIs).

3.6.2 Independent variables

Independent variable in this study was menstrual hygiene management practices.

3.7 Data collection methods

3.7.1 Data collection tools

Data for this study were collected in 4 chosen healthcare facilities at Kilolo, Tanzania; the researcher provided a well written, structured self-administered questionnaire with closed-ended questions to participants to obtain/collect information about potential risk factors for the two infections. For those who wished to participate in research but were not able to write due to various reasons, researcher was there to administer questionnaires and help them so as to get appropriate data as needed to be given by respondents.

Further data were collected through medical laboratory equipment like High Vaginal Swab (HVS) and then further processed to provide the necessary required information.

3.7.2 Data collection procedures and instruments

The research data were collected using simple structured questionnaire that were filled by participants themselves. The Swahili structured questionnaires were also used for those who do not understand English language. This helped to ensure that, data to be collected are accurate. Also, vaginal specimens from the posterior vaginal fornix were collected using two High Vaginal Swabs (HVS) then labeled. After labeling, all materials (slides and swabs) were immediately temporally stored in a sterile container or processed by using a local laboratory for preservation and subsequent diagnosis. Diagnosis of BV and Candida was done through locally available microscopic examinations procedures.

3.8 Data analysis and presentation

All the data collected by this study were analyzed by using powerful statistical software platform (a computer program packages for data analysis) that is Statistical Package for the Social Sciences (SPSS). Descriptive statistics was done later; frequency distribution table be used to display the results. Chi-square test was used to asses association between variable and p-value of less than 0.05 was considered as statistically significant, cross-tabulation was done to show association between variable.

3.9 Ethical consideration

Ethical clearance was obtained from RUCU Research and Publication Committee. The research permission to conduct this study was obtained from Environmental Health Science department of Ruaha Catholic University (RUCU) as well as from the health department of Kilolo district council.

Eligible women for the study were informed on the purpose of study, and then included in the study after giving verbal and written consent. Diagnostic and other participants’ information were confidentially maintained/managed using codes instead of names during filling of some of their information.

4.1 Socio-demographic characteristics of the study participants

A total of 207 eligible women participated in the study. Majority of the participants were married (59.4%) while 40.6% were single, also majority of respondents (45.9%) achieved primary education, whereas 26.6% completed ordinary level education and 21.7% had not achieved any formal education. However the study included many age groups ranging from 14 to 45 years whereas the most abundant population of respondents were between ages 14 - 18 years (30.9%) and 19-24 years(30.4%) as shown in Table 1.

Table 1: Socio-demographic characteristics of the study participants

VARIABLE	CATEGORY	FREQUENCY (%)
Age group	14 – 18	64 (30.9)
	19 – 24	63 (30.4)
	25 – 30	43 (20.8)
	31 – 45	33 (15.9)
	Above 45	4 (1.9)
Level of Education	No formal education	45(21.7)
	Completed primary education	95(45.9)
	Completed O'level education	55(26.6)
	Completed advanced level education	8(3.9)
	Achieved college education	4(1.9)
Marital Status	Married	123(59.4)
	Single	84(40.6)

4.3 Menstrual Hygiene Management Practices of Women

Majority of respondents (54.6%) use sanitary pads as menstrual absorbent materials, while 35.3% of the respondents use pieces of cloths as absorbents. More than half of the respondents who use reusable cloths they often clean cloths without soap, which is 67.6%. About 56% of the respondents often change the menstrual absorbents less than three times a day whereas; only 44% of respondents change the pads within the recommended time of more than three times a day. Furthermore, majority of the respondents (47.3%) lack a place for changing menstrual absorbents and they use toilet room instead. 10% of women use other traditional menstrual management methods such as cow dung, paper/plant material while 11% use either tampons/menstrual cups.

In addition, concerning genitalia cleansing practices, 42% of the respondents wash areas around vagina with water only while 32.9% not washing the area around the vagina during menstruation. However, regarding handwashing issue critical times 35.3% of respondents only use soap and water to clean their hand after changing absorbents whereas 27.5 wash their hands before and after changing absorbents as shown in Table 2.

Table 2: Menstrual Hygiene Management Practices of Women (n=207)

VARIABLE	CATEGORY	FREQUENCY (%)
Types of absorbent materials	Sanitary pads	113(54.6)
	Piece of cloth	73(35.3)
	Any other	21(10.1)
Menstrual absorbents changing frequency	Less than three times a day	116(56.0)
	More than three times a day	91(44.0)
Cleaning of reusable cloths	Cleaning of cloths is often done without soap	49(67.6)
	Cleaning with clean water and drying indoors	1(1.9)
	Cleaning with clean water and soap and drying in sunlight or open air	17(22.7)
	Not cleaning at all	6(7.7)
Genitalia cleansing practices	Washing the area around vagina at least twice a day with soap and water	38 (18.4)
	Washing the area around vagina with water only	87(42.0)
	Not washing the area around the vagina during menstruation	68(32.9)
	Cleansing inside area of vagina through douching	14(6.8)
Hand washing materials used	Soap and water	120(58)
	Water only	87(42)
Hand washing critical times	Before changing absorbent	29(14)
	After changing absorbents	73(35.3)
	Before and after changing absorbents	57(27.5)
	Regularly after handling contaminants	30(14.5)
	Every time when there is a need to do so	18(8.7)

4.4 Association between RTI and menstrual hygiene practice

On univariate analysis RTI varied significantly by types of absorbent materials (P<0.001) whereby majority of women (100%) use types of absorbents other than Sanitary pads and piece of cloth had more infection. Also RTI varied significantly by menstrual absorbents changing frequency (P<0.001) whereby majority of women (60.3%) who changed menstrual absorbents less than three times a day had more infection as compared to those who changed more than three times a day.

As well, RTI varied significantly by cleaning of reusable cloths (P<0.001) whereby majority of women (57.4%) who cleaned cloth absorbents with water and drying indoors as well as women who often cleaned cloth absorbent without soap (35.7%) had more infection as compared to those who cleaned cloth absorbents with clean water and soap and drying outdoors.

Furthermore, there is significant variation in RTI by genitalia cleansing practices (P<0.001) whereby majority of women (71.4%) who cleaned inside area of vagina through douching as well as women who washed the area around vagina with water only (44.8%) had more infection as compared to those who washed the area around vagina at least twice a day with soap and water (5.3%).

Moreover, RTI had high significant variation by hand washing critical times (P=0.004) whereby majority of women (55.2%) who washed hands before changing absorbents as well as women who regularly washed hands after handling contaminants (53.3%) had more infection as compared to those who washed their hands before and after changing absorbents. However, RTI did not differ by types of hand washing facilities (P=0.065) and availability of changing places for absorbents (P= 0.204), Table 3 below.

Table 3: association between type of absorbent material and RTIs

VARIABLE	CATEGORY	FREQUENCY(%)		P-VALUE
Age group	14 – 18	31 (48.4)	0.189
	19 – 24	22 (34.9)
	25 – 30	12 (27.9)
	31 – 45	10 (30.3)
	Above 45	2 (50)
Level of Education	No formal education	14(31.1)	0.058
	Completed primary education	34(35.8)
	Completed O'Level education	27(49.1)
	Completed advanced level education	0(0.0)
	Achieved college education	2(50)
Marital status	Married	48(39.0)	0.511
	Single	29(34.5)
Types of absorbent materials	Sanitary pads	27 (23.9)	0.000
	Piece of cloth	29 (39.7)
	Any other	21 (100)
Menstrual absorbents changing frequency	Less than three times a day	70(60.3)	0.000
	More than three times a day	7(7.7)
Cleaning of reusable cloths	Cleaning of cloths is often done without soap	50(35.7)	0.000
	Cleaning with clean water and drying indoors	27(57.4)
	Cleaning with clean water and soap and drying in sunlight or open air	0(0.0)
Genitalia cleansing practices	Washing the area around vagina at least twice a day with soap and water	2(5.3%)	0.000
	Washing the area around vagina with water only	39(44.8)
	Not washing the area around the vagina during menstruation	26(38.2)
	Cleansing inside area of vagina through douching	10(71.4)
Hand washing critical times	Before changing absorbent	16(55.2)	0.004
	After changing absorbents	29(39.7)
	Before and after changing absorbents	12(21.1)
	Regularly after handling contaminants	16(53.3)
	Every time when there is a need to do so	4(22.2
Availability of place for changing menstrual absorbents	Yes	2(100)	0.065
	No	75(36.6)
Changing place name	Cloak room	2(33.3)	0.001
	Toilet	49(50.0)
	Bathroom	4(11.4)
	Bedroom	22(32.4)
Hand washing materials used	Soap and water	49(40.8)	0.204
	Water only	28(32.2)

On multivariate analysis no significant association was found between being in the 26-35 age group and the likelihood of having an RTI. But the age of 36-45 (0.49382, p = 0.0906) shows a trend toward a higher likelihood of RTI compared to the reference group (likely 18-25), but the association is not statistically significant (p < 0.05).There is a trend indicating that using absorbents other than sanitary pads might be associated with a lower likelihood of RTI, but this association is not statistically significant.

Frequency of Changing Absorbents has shown being significant thus changing absorbents only once a day is significantly associated with a higher likelihood of having an RTI compared to more frequent changes. Generally this finds point that being not married is associated with a higher likelihood of having an RTI and Changing absorbents only once a day is associated with a higher likelihood of having an RTI, Table 4 below.

Table 4: Multivariate analysis on RTI and other factors

5.1 Conclusion

In conclusion, the study findings highlight the critical role of absorbent changing frequency in the incidence of reproductive tract infections (RTIs). Specifically, changing absorbents only once a day is significantly associated with a higher likelihood of developing an RTI compared to more frequent changes. This underscores the importance of proper hygiene practices in preventing RTIs. Additionally, the study points to a correlation between marital status and RTI occurrence, with unmarried individuals being more likely to experience RTIs. These insights emphasize the need for targeted interventions and education on hygiene practices, particularly among unmarried individuals, to reduce the risk of RTIs.

5.2 Recommendations

To address the limitations identified in the research study, the following recommendations can be considered for future studies and research:

Public health campaigns should emphasize the importance of changing absorbents more frequently to reduce the risk of reproductive tract infections. Educational materials should be developed and disseminated to raise awareness of the risks associated with infrequent absorbent changes.Unmarried individuals, who are at a higher risk of RTIs according to the study, should be a primary focus for educational interventions. These should include information on the importance of frequent absorbent changes and other hygiene practices to minimize the risk of RTIs.

To Ensure that affordable and high-quality absorbents are accessible to all, particularly in low-income communities. Providing subsidies or distributing free absorbents in vulnerable populations could be an effective strategy. And train healthcare providers to counsel patients on the importance of menstrual hygiene management and the risks associated with infrequent absorbent changes. Providers should also be encouraged to screen for RTIs during routine visits, especially in unmarried individuals. Lastly is to conduct additional studies to explore the underlying reasons why unmarried individuals are more likely to experience RTIs, and to identify other potential risk factors. This could help in designing more effective, targeted interventions.

These results (37.2% prevalence) are slightly lesser than those observed in a hospital-based cross-sectional study in Odisha, India on the association between unhygienic menstrual management practices and prevalence of lower reproductive tract infections (2018) survey which reported a 62.4% prevalence of RTI/STIs in Odisha(Torondel et al. 2018). This difference may be due to the use of the different diagnostic methods and criteria used in the two studies, the use of different diagnostic tests, as well as the criteria for classifying individuals as having an RTI, can influence the observed prevalence rates. Also the two studies have involved different study populations with varying characteristics, such as age, socio-economic status, and access to healthcare. Additionally, differences in the sample size of the studies affected the reliability and generalizability of the results. Additionally, geographical variations in the occurrence of RTIs can play a significant role. The prevalence of infections can vary based on factors such as regional health practices, hygiene habits, and access to healthcare services.

The study demonstrated that a significant percentage (35.7%) of participants cleaned their reusable cloths without soap, while 57.4% used clean water for cleaning. Notably, none of the participants reported using soap and drying the cloths in sunlight or open air. This contrasts with previous research (Laitala, Klepp, and Henry 2018), which emphasized the importance of using soap for effective cleaning to eliminate bacteria and odor from reusable cloths.

The study shows that sanitary pads were the most common absorbent material used (23.9%), followed closely by pieces of cloth (39.7%). Interestingly, a substantial proportion of respondents (100%) reported using "any other" types of absorbents. This finding is in line with previous research that highlighted the diversity of menstrual absorbent choices among individuals (Hennegan et al. 2020). The previous study found that there is a shift towards more sustainable and eco-friendly options, such as menstrual cups and period panties, which might explain the high percentage of "any other" absorbents.

The data revealed that the majority of participants (60.3%) changed their menstrual absorbents less than three times a day, while only a small percentage (7.7%) changed them more than three times a day. This finding aligns with previous research that indicated most individuals prefer to change their menstrual absorbents every few hours during the day (Johnson and Johnson 2019). The previous study emphasized the importance of frequent changing to maintain hygiene and reduce the risk of leakage and infection.

The study reported various genitalia cleansing practices during menstruation. While only a small percentage (5.3%) reported using soap and water to wash the area around the vagina, a considerable proportion used water only (44.8%) or did not wash the area at all (38.2%). Furthermore, a concerning finding was that some participants practiced douching (71.4%), which is associated with health risks (Alcaide et al. 2017). In contrast, previous research (Chen et al. 2017)highlighted the importance of gentle cleansing with water or mild cleansers and avoiding douching to maintain vaginal health during menstruation.

The data showed that handwashing practices varied during critical times. While 55.2% of participants reported washing their hands before changing absorbents, only 39.7% did so after changing them. These findings are consistent with previous research (Tsay et al. 2017), which found that handwashing compliance tends to be higher before certain activities (e.g., eating) compared to after. The previous study emphasized the need for continuous education and reminders to improve hand hygiene practices consistently.

The study revealed that only 2 out of 77 participants (2.6%) had access to a place for changing menstrual absorbents. This highlights a potential issue with the lack of dedicated spaces for this purpose. Previous research (Hennegan et al. 2021) also identified a similar concern, emphasizing the need for appropriate facilities to ensure privacy, comfort, and hygiene during menstruation.

Among those who had access to a changing place, the most common locations were toilets (50.0%) and bedrooms (32.4%). Previous research (Magayane and Meremo 2021) corroborates these findings and suggests that having a designated and clean changing place is essential to ensure proper hygiene and prevent potential contamination.

The data showed that soap and water (40.8%) were the most commonly used materials for handwashing, followed by water only (32.2%). While the majority used soap and water, the percentage using water only was still significant. Previous research (Chowdhury and Chakraborty 2017) demonstrated that soap is more effective in removing pathogens from hands, and promoting its use in handwashing campaigns can improve overall hand hygiene.

In conclusion, the study findings highlight the critical role of absorbent changing frequency in the incidence of reproductive tract infections (RTIs). Specifically, changing absorbents only once a day is significantly associated with a higher likelihood of developing an RTI compared to more frequent changes. This underscores the importance of proper hygiene practices in preventing RTIs. Additionally, the study points to a correlation between marital status and RTI occurrence, with unmarried individuals being more likely to experience RTIs. These insights emphasize the need for targeted interventions and education on hygiene practices, particularly among unmarried individuals, to reduce the risk of RTIs.

5.2 Recommendations

To address the limitations identified in the research study, the following recommendations can be considered for future studies and research:

Public health campaigns should emphasize the importance of changing absorbents more frequently to reduce the risk of reproductive tract infections. Educational materials should be developed and disseminated to raise awareness of the risks associated with infrequent absorbent changes.Unmarried individuals, who are at a higher risk of RTIs according to the study, should be a primary focus for educational interventions. These should include information on the importance of frequent absorbent changes and other hygiene practices to minimize the risk of RTIs.

To Ensure that affordable and high-quality absorbents are accessible to all, particularly in low-income communities. Providing subsidies or distributing free absorbents in vulnerable populations could be an effective strategy. And train healthcare providers to counsel patients on the importance of menstrual hygiene management and the risks associated with infrequent absorbent changes. Providers should also be encouraged to screen for RTIs during routine visits, especially in unmarried individuals. Lastly is to conduct additional studies to explore the underlying reasons why unmarried individuals are more likely to experience RTIs, and to identify other potential risk factors. This could help in designing more effective, targeted interventions.

Ethical aspects

According to the Declaration by Helsinki on ethical principles for medical research involving human subjects, including research on identifiable human material and data study participants under this study were provided with a consent form which provide to them an informed consent for them to decide. But the ethical clearance was provided by Ruaha catholic university ethical board.

Author contribution

Peter M Chilipweli is the corresponding author who did data analysis and validation,Farida Idi did the discussion part and data collection, Vicent T Madelemo design the study and its idea formulation, Paul A Sabuni did data analyais and Given Mwambope was a supervisor of the work.

Funding

No fund was provided for this work

Data Availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

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No competing interests reported.

Association between unhygienic menstrual management practices and prevalence of lower reproductive tract infections in rural community of Kilolo District, Tanzania

Status:

Version 1

Abstract

Figures

Introduction

Methods

3.1 Study design

3.2. Study approaches

3.3 Study participants/population

3.3.1 Inclusion criteria

3.3.2. Exclusion criteria

3.4 Description of Study Area

3.5 Sampling frame

3.5 Sample and sampling technique

3.5.1 Sample Size

3.3 Study participants/population

3.3.1 Inclusion criteria

3.3.2. Exclusion criteria

3.4 Description of Study Area

3.5 Sampling frame

3.5 Sample and sampling technique

3.5.1 Sample Size

3.5.2 Sampling technique

3.6 Study variables

3.6.1 Dependent variable

3.6.2 Independent variables

3.7 Data collection methods

3.7.1 Data collection tools

3.7.2 Data collection procedures and instruments

3.8 Data analysis and presentation

3.9 Ethical consideration

Results

4.1 Socio-demographic characteristics of the study participants

4.3 Menstrual Hygiene Management Practices of Women

5.1 Conclusion

5.2 Recommendations

Discussion

Conclusion

5.2 Recommendations

Declarations

Data Availability

References

Additional Declarations

Status:

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