Menstrual Pattern following Tubal Ligation: A Historical Cohort Study

Background

Tubal ligation (TL) is recommended for women who have completed their family planning. The existence of the menstrual disorders following this procedure has been the subject of debate for decades. This study was conducted to identify the relationship between tubal ligation and menstrual disorders.

Materials and Methods

A historical cohort study was carried out on 140 women undergoing tubal ligation (TL group) and on 140 women using condom as the main contraceptive method (Non-TL group). They aged between 20 and 40 years and were selected from a health care center in Rudsar, Guilan Province, Iran, during 2013-2014. The two groups were comparable in demographic characteristics, obstetrical features and menstrual bleeding pattern using a routine questionnaire. A validated pictorial blood loss assessment chart (PBLAC) was also used to measure the menstrual blood loss.

Results

Women with TL had more menstrual irregularity than those without TL (24.3 vs. 10%, P=0.002). Women with TL had more polymenorrhea (9.3 vs. 1.4%, P=0.006), hypermenorrhea (12.1 vs. 2.1%, P=0.002), menorrhagia (62.9 vs. 22.1%, P<0.0001) and menometrorrhagia (15.7 vs. 3.6%, P=0.001) than those without TL. There is a significant difference in the PBLAC score between women with and without TL (P<0.0001). According to logistic regression, age odds ratio [(OR=1.08, con- fidence interval (CI):1.07-1.17, P=0.03)], TL (OR=5.95, CI:3.45-10.26, P<0.0001) and cesarean section (OR=2.72, CI:1.49-4.97, P=0.001) were significantly associated with menorrhagia.

Conclusion

We found significant differences in menstrual disorders between women with and without TL. Therefore, women should be informed by the health providers regarding the advantages and disadvantages of TL before the procedures.

Comparison of menstrual disorders between groups

Parameters	Non-TL	TL	Sig
Menstrual irregularities*	14 (10)	34 (24.3)	0.002a
Oligomenorrhea*	12 (8.6)	21 (15)	0.12a
Polymenorrhea*	2 (1.4)	13 (9.3)	0.006a
Hypermenorrhea*	3 (2.1)	17 (12.1)	0. 002a
Metrorrhagia*	9 (6.4)	12 (8.6)	0.64a
Menorrhagia*	31 (22.1)	88 (62.9)	<0.0001a
Menometrorrhagia*	5 (3.6)	22 (15.7)	0.001a
PBLAC score**	87.91 ± 51.06	137.72 ± 90.91	<0.0001b

*; n (%), **; Values are mean ± SD, a; Chi-square test, b; T test, TL; Tubal ligation, and PBLAC; Pictorial blood loss assessment chart.

Full article at:   http://goo.gl/m3gdFa

By:  Shahideh Jahanian Sadatmahalleh, M.Sc,¹ Saeideh Ziaei, M.D,^1,* Anoshirvan Kazemnejad, Ph.D,² and Eesa Mohamadi, Ph.D³

¹Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

²Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

³Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

1 Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University,  Tehran, Iran

² Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

³ Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

* Corresponding Address:P.O. Box: 1415-111, Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran,

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Menstrual Hygiene Practices in Context of Schooling: A Community Study among Rural Adolescent Girls in Varanasi

INTRODUCTION:

Up until now, poor menstrual hygiene in developing countries has been an insufficiently acknowledged problem. The lack of attention to this issue is striking as we cannot achieve several Millennium Development Goals (MDGs), that is, 2, 3 4,5, and 5B. This study aimed to assess the level of awareness about menarche and hygienic practices during menstruation in context of schooling.

MATERIALS AND METHODS:

Community-based cross-sectional study using a mix method approach (qualitative and quantitative). It was conducted among 650 adolescent girls in the field practice area of Rural Health and Training Centre, Chiraigaon block of district Varanasi between January and June2011. Pretested, semistructured interview schedule was used. Data were analyzed statistically by using Statistical Package for Social Sciences (SPSS) software.

RESULTS:

Out of the total 650 respondents, 590 (90.78%) had attained menarche at the time of interview and only one-third of the respondents (29.4%) were aware of menstruation before menarche and sisters (55%) played the key role in providing information to them. Only 31% respondents were using sanitary pads during menstruation. Self-reported reproductive tract infection (RTI) was observed more in respondents not maintaining hygienic practices (6.6%) as compared to those maintaining hygiene (2.6%).

CONCLUSION AND RECOMMENDATIONS:

From the Focus Group Discussions (FGDs) as well as quantitative survey it was observed that the awareness about menarche before its onset was still poor in rural areas. Significant association (P < 0.05) was observed between respondent education and their awareness about menarche before its onset. Therefore, it is recommended that teachers can play an influential role in informing them about changes during adolescence, especially about menarche and other issues related to menstruation. As per the present study, sisters and mothers were the major source of information. Therefore, there is a need for the provision of comprehensive family life education for the parents also.

Below:  Association of hygienic practices during menstruation and respondent's socioeconomic and demographic characteristics

Full article at:   http://goo.gl/g4rl4D

By:  Kansal S1, Singh S1, Kumar A1.

• 1Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
• Indian J Community Med. 2016 Jan-Mar;41(1):39-44. doi: 10.4103/0970-0218.170964. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Do Menstrual Hygiene Management Interventions Improve Education and Psychosocial Outcomes for Women and Girls in Low and Middle Income Countries? A Systematic Review

BACKGROUND:

Unhygienic and ineffective menstrual hygiene management has been documented across low resource contexts and linked to negative consequences for women and girls.

OBJECTIVES:

To summarise and critically appraise evidence for the effectiveness of menstruation management interventions in improving women and girls' education, work and psychosocial wellbeing in low and middle income countries.

METHODS:

Structured systematic searches were conducted in peer-reviewed and grey literature to identify studies evaluating education and resource provision interventions for menstruation management. Individual and cluster randomised controlled trials were eligible for inclusion, as were non-randomised controlled trials. Study characteristics, outcomes and risk of bias were extracted using a piloted form. Risk of bias was independently assessed by two researchers.

RESULTS:

Eight studies described in ten citations were eligible for inclusion. Studies were highly heterogeneous in design and context. Six included assessment of education-only interventions, and three provided assessment of the provision of different types of sanitary products (menstrual cups, disposable sanitary pads, and reusable sanitary pads). A moderate but non-significant standardised mean difference was found for the two studies assessing the impact of sanitary pad provision on school attendance: 0.49 (95%CI -0.13, 1.11). Included studies were heterogeneous with considerable risk of bias. Trials of education interventions reported positive impacts on menstrual knowledge and practices, however, many studies failed to assess other relevant outcomes. No trials assessed or reported harms.

CONCLUSIONS:

There is insufficient evidence to establish the effectiveness of menstruation management interventions, although current results are promising. Eight trials have been conducted, but a high risk of bias was found and clinical heterogeneity precluded synthesis of most results. Whilst trials provided some indication of positive results, further research is needed to establish the role of menstruation hygiene management in education performance, employment and other psychosocial outcomes. This review provides a concise summary of present trials and highlights improvements for future work.

Below: Review authors’ judgements about methodological items for each included study

Full article at:   http://goo.gl/fH2C4K

By:  Hennegan J1, Montgomery P1.

• 1Centre for Evidence-Based Intervention, University of Oxford, Oxford, United Kingdom.
• PLoS One. 2016 Feb 10;11(2):e0146985. doi: 10.1371/journal.pone.0146985. eCollection 2016. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

The Relationship Between Food Frequency & Menstrual Distress in High School Females - Iran

BACKGROUND:

Nutrition pattern is one of the important factors predicting menstrual distress, which varies among different cultures and countries. The purpose of this study is to determine the relationship between food frequency and menstrual distress in high school girls from Mashhad.

MATERIALS AND METHODS:

This cross-sectional study was conducted in 2012 using a two-stage sampling method on 407 high school female students from Mashhad who met the inclusion criteria. Subjects completed questionnaires of demographic characteristics, food frequency, and Menstrual Distress Questionnaire (MDQ) during three phases of the menstrual cycle (a week before bleeding, during menstrual bleeding period, and a week after menstruation). The collected data were analyzed by statistical tests such as Pearson correlation coefficient test, independent Student's t-test, and one-way analysis of variance (ANOVA).

RESULTS:

Results showed that 87.7% of the students were at moderate economic status, 82.2% were exposed to cigarette smoke, 94.8% had mothers without university education, and 9.4% had working mothers. About 71% of the students reported minor pre-menstruation distress, 81% reported minor distress during bleeding, and 39% reported minor post-menstruation distress. In addition, the mean (SD) values for sweet-fatty foods, salty-fatty foods, fast foods, and caffeine were 3.6, 3.3, 1.3, and 10.2 per week, respectively. In addition, Pearson correlation coefficient test showed no significant correlation between total menstruation distress and food frequency (P > 0.05).

CONCLUSIONS:

With regard to the inappropriate food frequency and high intensity of menstrual distress among high school students and as health care and educational efforts for prevention and health promotion in society are among the duties of health workers, the results of this study can help the officials involved in education to emphasize on nutrition and the menstrual health of students.

Below:  Frequency distribution of age, BMI, and socioeconomic status among female students

Below:  Frequency distribution of nightly and daily sleep, physical activity and length of physical activity, and exposure to smoke among female students

Below:  Frequency distribution of subjects’ nutritional pattern based on the number of weekly consumptions

Full article at:   http://goo.gl/wwlhlH

By:  Mohamadirizi S1, Kordi M2.

• 1Department of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
• 2Department of Midwifery School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
• Iran J Nurs Midwifery Res. 2015 Nov-Dec;20(6):689-93. doi: 10.4103/1735-9066.170000. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Educational Needs of Adolescents Regarding Normal Puberty and Menstrual Patterns

OBJECTIVE:

The study aimed to determine the level of knowledge and the sources of information about normal puberty and menstrual patterns in Turkish schoolgirls from İstanbul.

METHODS:

The study sample was comprised of 922 randomly chosen schoolgirls. A questionnaire survey of knowledge of normal pubertal development and menstrual patterns was conducted.

RESULTS:

The age of the girls ranged between 10 and 17 years and 82.3% had had menarche. The leading source of pubertal information was the mothers (84.2%). There was no statistically significant relationship between the mothers' education level and the level of knowledge of the students about pubertal development (p>0.05). The main source for 18% of students was their teacher, but only 6% had a preference for their teacher providing education on this topic. 

Students who attained menarche preferred education about puberty to be given by health professionals and to both genders at the same setting (p<0.01). A total of 31.5% of students thought that the first symptom of puberty was acne. Half (50.7%) of the students did not know the time period between the beginning of puberty and menarche. The girls who had attained menarche were more knowledgeable about puberty, largely through their own experience.

CONCLUSION:

This study shows that schoolgirls have an insufficient level of knowledge about normal puberty. Education programs must be conducted for students and their parents.

Full article at: http://goo.gl/rz6zBH

By:  İşgüven P1, Yörük G, Çizmecioğlu FM.

• 1Sakarya University Faculty of Medicine, Department of Pediatric Endocrinology, Sakarya, Turkey Phone: +90 216 495 68 26 E-mail: pinarisguven@gmail.com.
• J Clin Res Pediatr Endocrinol. 2015 Dec 5;7(4):312-22. doi: 10.4274/jcrpe.2144. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

The Menstrual Cycle Influences the Gastric Emptying of Alcohol

We previously reported that ingestion of 60 mL of red wine or vodka prior to the ingestion of a pancake significantly inhibited the gastric emptying of the pancake in male subjects, but not in female subjects, and that the retention times of wine and vodka were significantly longer than those of the congener of red wine and mineral water in male subjects, whereas in female subjects the retention times of these four drinks did not differ significantly from one another. 

We hypothesized that the menstrual cycle may influence the gastric emptying of alcohol beverages. Here, we determined and compared the retention times of vodka and water in the stomach during the luteal phase and the follicular phase. Ten female healthy volunteers were studied. They recorded their basal body temperatures every day, and participated in the following experiments: each volunteer drank mineral water or vodka containing 14% alcohol (60 mL) during the low-temperature (follicular) phase as well as during the high-temperature (luteal) phase. The retention time of vodka was significantly longer than that of mineral water during the follicular phase, but no significant differences between the retention times of the two drinks were observed during the luteal phase. 

In conclusion, the menstrual cycle influences the gastric emptying rate of alcohol.

Full [PDF] article at:   https://goo.gl/ByRbg9

By:   Kaibara N1, Kobori A, Sekime A, Miyasaka K.

• 1Department of Physiology, Tokyo Kasei University Graduate School of Human Life Sciences.
• Biomed Res. 2015;36(6):411-5. doi: 10.2220/biomedres.36.411. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Characteristics of the Menstrual Cycle in 13-Year-Old Flemish Girls & The Impact of Menstrual Symptoms on Social Life

ABSTRACT

This study aimed to investigate the characteristics of symptoms related to the menstrual cycle and their impact on social activities in young teenage girls. Between March and June 2009, all girls born in 1996 who were residents of eight regions in Flanders (Belgium) received a semi-structured questionnaire, including questions about the age of menarche, characteristics of the menstrual cycle, and its impact on social activities. 

Participants were 792 13-year-old girls (15.7 % of the target population). Out of 363 (47.2 % of participants) postmenarcheal girls, 41.6 % (95 % confidence interval (CI) 36.4-47.0 %) reported painful menstruations. 

The proportion of girls with painful menstrual periods decreased approximately 16 % with each year the age at menarche increased (relative risk (RR) = 0.84; 0.73-0.98; p < 0.05) and was positively correlated with the amount of blood loss (RR = 0.33; 0.16-0.67; p < 0.05 when little and 1.85; 1.49-2.31; p < 0.001 when abundant, compared to average). 

One in four (25.4 %) postmenarcheal girls indicated a negative impact of menstruation on social activities, but this proportion was significantly higher in girls who experienced menstruation as painful (41.3 %) compared to those who did not (14.2 %).

CONCLUSION:

Early menstrual complaints are common in young adolescent girls and the likelihood of pain increased significantly with lower menarcheal age. 

What is Known? 

• Menstrual cycle-related symptoms may negatively interfere with school absence and social activities. 
• Early menarche and severe dysmenorrhea are correlated with endometriosis. 

What is New? 

• In this large population-based study on the characteristics of the menstrual cycle in young teenage girls at or shortly after menarche, painful menstruation was highly prevalent (41.7 %), but related school absenteeism was low (3.2 %). The likelihood of pain increased significantly with lower menarcheal age.
• The findings support the need for a systematic evaluation of the characteristics of the menstrual cycle shortly after menarche.

Purchase full article at:   http://goo.gl/RKfelw

By:   Hoppenbrouwers K1, Roelants M2, Meuleman C3, Rijkers A4, Van Leeuwen K5, Desoete A6, D'Hooghe T7.

• 1Centre of Environment and Health, Department of Public Health and Primary Care, University Leuven, Kapucijnenvoer 35, block d, 7001, 3000, Leuven, Belgium. karel.hoppenbrouwers@med.kuleuven.be.
• 2Centre of Environment and Health, Department of Public Health and Primary Care, University Leuven, Kapucijnenvoer 35, block d, 7001, 3000, Leuven, Belgium. mathieu.roelants@med.kuleuven.be.
• 3University Fertility Centre, Department of Obstetrics and Gynaecology, University Hospital Leuven, 3000, Leuven, Belgium. christel.meuleman@uzleuven.be.
• 4University Fertility Centre, Department of Obstetrics and Gynaecology, University Hospital Leuven, 3000, Leuven, Belgium. lian.rijkers@uzleuven.be.
• 5Parenting and Special Education Research Group, University Leuven, 3000, Leuven, Belgium. karla.vanleeuwen@ppw.kuleuven.be.
• 6Department of Experimental Clinical and Health Psychology, University Ghent, 9000, Ghent, Belgium. annemie.desoete@ugent.be.
• 7University Fertility Centre, Department of Obstetrics and Gynaecology, University Hospital Leuven, 3000, Leuven, Belgium. thomas.dhooghe@uzleuven.be. 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Detection of High-Risk Human Papillomavirus Using Menstrual Blood in Women with High-Grade Squamous Intraepithelial Lesions or High-Risk Human Papillomavirus Infections

AIM:

Few studies have reported that human papillomavirus (HPV) tests using menstrual blood (MB) may be a convenient and effective screening modality for cervical cancer. Therefore, we aimed to investigate the efficacy of detecting high-risk (HR)-HPV from MB in women with high-grade squamous intraepithelial lesions or HR-HPV infections dependent on menstrual days.

MATERIALS AND METHODS:

In this prospective exploratory pilot study, a clinical trial was conducted in 19 women. On enrollment into the study, gynecologists collected cervical cells. On the first and second day of menstruation, MB was self-collected by patients using a sanitary pad with a filter. The distribution of HPVs from MB and the accuracy of menstrual HR-HPV tests were evaluated using HPV genotyping. The agreement rate of detecting HR-HPVs using cervical and MB samples was also investigated.

RESULTS:

The sensitivity, specificity, positive and negative predictive values of the MB HR-HPV test for detecting cervical intraepithelial neoplasia (CIN) 3 or worse were 87.5%, 45.5%, 53.8%, and 83.3%, respectively, during both menstrual cycle day (MCD) 1 and 2 and MCD 1 only; and 62.5%, 27.3%, 38.5%, and 50.0%, respectively, during MCD 2 only. For CIN 3 or worse, the agreement rate between positive cervical and MB HR-HPV test results was 87.5% during MCD 1 and 62.5% during MCD 2.

CONCLUSIONS:

We demonstrated the possibility of using the MB HPV test as a screening modality for cervical cancer.

Purchase full article at:  http://goo.gl/lbzRsw

By:   Lee B1, Cho HY2, Jeon KJ1, Kim K1,3, Lee JR1,3, Moon JJ4, No JH1,3, Kim YB1,3.

• 1Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, Republic of Korea.
• 2Department of Obstetrics and Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-Si, Gyeonggi-do, Republic of Korea.
• 3Seoul National University, School of Medicine, Seoul, Republic of Korea.
• 4Goodgene Inc. Koyang-Si, Gyeonggi-do, Republic of Korea. 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Influence of Socioeconomic Status in the Age at the of Menarche and Duration of Menstrual Bleeding

Purpose:

The study of the relationship ,between the age at menarche and socioeconomic status in a rural area in Sudan.

Work method:

This was a cross-sectional descriptive study conducted in Altadamon and Eldubha areas in the northern state of Sudan during year 2006. It included 182 girls of age between 13 to 18 years in elementary and secondary school.

Work results:

The mean age at menarche for girls in Northern Sudan in this study was 13.93 ± 1.29 year, the mean menarcheal age in these girls are amongst the lowest values presented for African countries. The mean duration of menstrual bleeding among girls in the Northern Sudan in this study was 4.8 ± 1.22 days. We also found statistically significant differences in age at menarche between girls whose parents had a higher educational level and those with a lower educational level and also according to the economic status and size of the family.

Conclusion:

Between the girls whose parents were living together and girls whose parents separated there was a significant difference of 1.02 day.

Below:  Distribution of sample according to age of menarche

Below:  Distribution of sample according to duration of menstrual bleeding

Below:  Distribution of sample according to economic status

Below:  Correlation between age of menarche and economic status

Full article at:   http://goo.gl/ekZLus

By:   Mohammed Elshiekh1 and Ammar Mohammed Ali Mohammed2

¹Department of Physiology, Faculty of Medicine, University of Dongola, Dongola, Sudan

²Department of Anatomy, Faculty of Medicine, University of Dongola, Dongola, Sudan

Corresponding author: Ammar Mohammed Ali Mohammed, MD. Department of psysiology, Faculty of medicine, University of Dongola, Dongola, Sudan. E-mail: moc.liamtoh@2002oremama

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

'He is the one who is providing you with everything so whatever he says is what you do': A Qualitative Study on Factors Affecting Secondary Schoolgirls’ Dropout in Rural Western Kenya

Education is an effective way to improve girls’ self-worth, health, and productivity; however there remains a gender gap between girls’ and boys’ completion of school. The literature around factors influencing girls’ decision to stay in school is limited. Seven focus group discussions took place among 79 girls in forms 2 to 4 at secondary schools in rural western Kenya, to examine their views on why girls absent themselves or dropout from school. Data were analysed thematically. 

Lack of resources, sexual relationships with boyfriends, and menstrual care problems were reported to lead directly to dropout or school absence. These were tied to girls increased vulnerability to pregnancy, poor performance in school, and punishments, which further increase school absence and risk of dropout. Poverty, unmet essential needs, coercive sexual relationships, and an inequitable school environment collude to counter girls’ resolve to complete their schooling. 

Lack of resources drive girls to have sex with boyfriends or men who provide them with essentials their family cannot afford, such as sanitary pads and transport to school. While these improve quality of their school life, this dynamic increases their exposure to sexual risk, pregnancy, punishment, and dropout. Evaluation of interventions to ameliorate these challenges is warranted, including provision of pocket money to address their needs.

...Poverty was a constant underlying element in girls’ narratives [11], and responsible either directly or indirectly for the greater proportion of absenteeism or dropout. Lack of cash for fees or personal needs was noted as a main factor directly leading to dropout. Although the Kenyan government extended free education from primary into secondary schools in 2008, girls’ narratives describing ‘school fees’ drove us to examine what comprised ‘fees’ in the area since tuition fees were already paid. Schools provided us with standard invoices per student; these included PTA / development levies, and fees for lunch, exams, activities, PE, district evaluation, and ICT maintenance. Adding further costs for uniforms and books, we estimate around Ksh 20,000 (~£126) is required per girl each year. A separate study suggested these additional costs amount to 55% of the average rural households’ annual per capita expenditure [13]. Should such fees be afforded for a girl (assuming no competing male sibling), any further personal items required by girls would be beyond the reach of many families who have a mean wealth index of ~£426 [33]. We noted two-thirds of the annual fees are requested in the first school term. Girls’ dropout over the year thus occurs after the bulk of fees are paid, with a lack of smaller sums of money acting as a barrier to completion.

Girls in our study describe many items they need that are beyond the household budget. Top among these were sanitary pads for menstrual care. The reporting of menstrual care problems in school was very common in the present study, with girls discussing this as a main cause of school absence, and some considering repeated absence resulted in eventual dropout. Teasing and public humiliation, discomfort from poor quality sanitary items, and poor engagement due to fear of leakage and odour are well described in the literature [20,21,34]. Sanitary pads are a frequently cited item girls say they need, but parents’ budgets seldom stretch to provide the quality or amount required. Girls’ narratives indicate some boyfriends provide pads directly, while other girls request money from sexual partners to buy pads. In a study among girls and women below 30 years of age in the same area, half said they received commercial pads from a sexual partner [35]. While sex for money in order to purchase pads was seldom recorded (~3% among young single females), it was reported among 10% of 15 year olds. It was significantly higher among girls dependent on family for source of income, and among girls reporting two or more sexual partners in the past 12 months [35]. Removing menstrual need as a burden for schoolgirls would improve their dignity, engagement in school, and potentially improve their performance. It would also reduce one reason for dependence on sexual partners, and could contribute to reducing their exposure to sexual and reproductive harms, and possible school dropout.

Along with menstrual items, a variety of relatively low budget items such as face cream, body oil, panties, sodas, and snacks were also seen as necessary items for girls to have. Having a boyfriend was considered essential, as boys (and men) buy them or provide money for these needs. A strong literature exists on procurement of socially desirable items from sexual partners in impoverished communities [36–38], with a particular focus around implications for HIV risk for young females [39,40]...

Full article at:  http://goo.gl/iolCfQ

By:  

Kelvin Oruko, Elizabeth Nyothach, John Vulule, Penelope A. Phillips-Howard

Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya

Emily Zielinski-Gutierrez, Kayla F. Laserson

Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America

Linda Mason, Kelly Alexander, Penelope A. Phillips-Howard

Department of Clinical Studies, Liverpool School of Tropical Medicine, Liverpool, United Kingdom

More at:  https://twitter.com/hiv_insight

And:        http://twitter.com/Prison_Health