Browsing by Author "Alezuyo, Connie"

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    Effects and costs of a multi-component menstrualhealth intervention (MENISCUS) on mental health problems, educational performance, and menstrual health in Ugandan secondary schools: an open-label, school-based, cluster-randomised controlled trial
    (The Lancet Global Health, 2025) Kate, Andrews Nelson; Stephen, Lagony; Kansiime, Catherine; Torondel, Belen; Clare, Tanton; Ndekezi, Denis; Mugenyi, Levicatus; Batuusa, Ratifah; Baleke, Christopher; Katherine, A. Thomas; Ssesanga, Titus; Bakanoma, Robert; Namirembe, Prossy; Tumuhimbise, Aggrey; Nanyonga, Beatrice; Nambi, Rodah; Obicho, Edward; Ssenyondwa, Denis; Bucci, Daria; Sophie, Belfield; Ocen, Agnes Akech; Nakalema, Shamirah; Alezuyo, Connie; Matovu, Fred; Neema, Stella; Kyegombe, Nambusi; Giulia, Greco; John, Jerrim; Chris, Bonell; Janet, A. Seeley; Helen A. Weiss
    Background Menstrual health is a human rights issue, affecting mental health, wellbeing, and education. We assessed the effectiveness and costs of a school-based multi-component menstrual health intervention (“MENISCUS”) to improve mental health problems and educational performance. Methods We conducted a cluster-randomised trial in 60 Ugandan secondary schools, randomised 1:1 to the intervention or control condition (printed government menstrual health materials). The intervention included creating action groups, strengthening teacher-delivered puberty education, distributing menstrual kits, supporting student-led drama skits, providing pain-management strategies, and improving school water and sanitation facilities. Primary outcomes were mental health problems using the Strength and Difficulties Questionnaire (SDQ) Total Difficulties Score and independently-assessed educational performance. Secondary outcomes included menstrual knowledge, attitudes, practices, and self-efficacy, school attendance, confidence, symptomatic urinary tract infections, and quality of life in females, plus knowledge and attitudes in males. We estimated intention-to-treat intervention effects using mixed-effects models accounting for school clustering and adjusted for randomisation strata and baseline school-level means of outcomes. Registration: ISRCTN45461276. Findings Between 21 March and 5 July 2022, 3841 female students participated in baseline assessments (89.7% of those eligible) and between 5 June and 22 August 2023, 3356 participated in endline assessments. At endline, there was no evidence of a difference in mental health problems (mean SDQ score: 10.8 vs 10.7 in intervention vs control arms; adjusted mean difference [aMD] 0.05, 95% CI -0.40 to 0.50) or educational performance (mean z-score: 0.20 vs 0.12; aMD 0.05, 95% CI -0.11 to 0.20). There was strong evidence for effects on menstrual health-related outcomes. Interpretation Improving multiple dimensions of menstrual health in secondary schools in Uganda is feasible and important for health and human rights but is not sufficient to improve mental health or educational performance over one year.
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    Menstrual health intervention and school attendance in Uganda (MENISCUS-2): a pilot intervention study
    (BMJ Open, 2020) Kansiime, Catherine; Hytti, Laura; Nalugya, Ruth; Nakuya, Kevin; Namirembe, Prossy; Nakalema, Shamirah; Neema, Stella; Tanton, Clare; Alezuyo, Connie; Namuli Musoke, Saidat; Torondel, Belen; Francis, Suzanna C.; Ross, David A.; Bonell, Christopher; Seeley, Janet; Weiss, Helen Anne
    Achieving good menstrual health and hygiene (MHH) is a public health challenge and there is little evidence to inform interventions. The aim of this study was to pilot test an intervention to improve MHH and school attendance in Uganda, in preparation for a future cluster-randomised trial. Design Longitudinal study with pre–post evaluation of a pilot intervention. Setting Two secondary schools in Entebbe, Uganda. Participants Of the 473 eligible students in secondary 2 (S2) at baseline, 450 (95.1%; 232 girls and 218 boys) consented/assented. 369 students (188 girls; 81.0%; and 181 boys; 83.0%) participated in the endline survey. Intervention The intervention comprised training teachers to improve delivery of government guidelines for puberty education, training in use of a menstrual kit and pain management, a drama skit, provision of analgesics and improvements to school water and sanitation hygiene facilities. Primary and secondary outcome measures Feasibility and acceptability of delivering the intervention. Baseline and endline quantitative surveys were conducted, with qualitative interviews conducted at endline. School attendance was assessed using self-completed daily diaries among a nested cohort of 100 female students. Results There were high levels of uptake of the individual and behavioural intervention components (puberty education, drama skit, menstrual hygiene management (MHM) kit and pain management). The proportion of girls reporting anxiety about next period decreased from 58.6% to 34.4%, and reported use of effective pain management increased from 76.4% to 91.4%. Most girls (81.4%) reported improved school toilet facilities, which improved their comfort managing menstruation. The diary data and qualitative data indicated a potential intervention impact on improving menstrual-related school absenteeism. Conclusions The pilot study showed that the multicomponent MHM intervention was acceptable and feasible to deliver, and potentially effective in improving menstruation knowledge and management. A cluster-randomised trial is needed to evaluate rigorously the intervention effects on MHM and school attendance.