The association between menstrual hygiene, workplace sanitation practices and self-reported urogenital symptoms in a cross-sectional survey of women working in Mukono District, Uganda

Sarah A Borg; Justine N Bukenya; Simon P S Kibira; Petranilla Nakamya; Fredrick E Makumbi; Natalie G Exum; Kellogg J Schwab; Julie Hennegan

doi:10.1371/journal.pone.0288942

The association between menstrual hygiene, workplace sanitation practices and self-reported urogenital symptoms in a cross-sectional survey of women working in Mukono District, Uganda

PLoS One. 2023 Jul 20;18(7):e0288942. doi: 10.1371/journal.pone.0288942. eCollection 2023.

Authors

Sarah A Borg¹, Justine N Bukenya², Simon P S Kibira², Petranilla Nakamya², Fredrick E Makumbi³, Natalie G Exum⁴, Kellogg J Schwab⁴, Julie Hennegan^{1

4}

Affiliations

¹ Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia.
² Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
³ Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
⁴ The Water Institute, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.

Abstract

Background: Women worldwide experience challenges managing their periods. Menstrual and genital hygiene behaviours have been linked to negative health outcomes, including urogenital symptoms and confirmed infections. However, evidence testing this association has been limited and mixed. This study aimed to (1) describe the menstrual care practices and prevalence of self-reported urogenital symptoms among working women in Mukono District, Uganda, and (2) test the associations between menstrual and genital care practices, and urogenital symptoms.

Methodology: We undertook a cross-sectional survey of women aged 18-45 working in markets, schools, and healthcare facilities in Mukono District, with 499 participants who had menstruated in the past two months included in this analysis. We developed an aggregated measure of menstrual material cleanliness, incorporating material type and laundering practices. Associations with urogenital symptoms were tested using the aggregated material cleanliness measure alongside the frequency of changing materials, handwashing before menstrual tasks, and sanitation practices.

Results: Among our sample, 41% experienced urogenital symptoms in the past month. Compared to women exclusively using disposable pads, using appropriately cleaned or non-reused improvised materials (PR = 1.33, 95%CI 1.04-1.71), or inadequately cleaned materials (improvised or commercially produced reusable pads) (PR = 1.84, 95%CI 1.46-3.42) was associated with an increased prevalence of self-reported urogenital symptoms in the last month. There was no difference between those using disposable pads and those using clean reusable pads (PR = 0.98; 95%CI 0.66-1.57). Infrequent handwashing before changing materials (PR 1.18, 95%CI: 0.96-1.47), and delaying urination at work (PR = 1.37, 95%CI: 1.08-1.73) were associated with an increased prevalence of self-reported symptoms.

Conclusion: Prevalence of self-reported urogenital symptoms was associated with the type and cleanliness of menstrual material used as well as infrequent handwashing and urinary restriction. There is a need for interventions to enable women to maintain cleanliness of their menstrual materials and meet their menstruation, urination and hand washing needs at home and work.

Copyright: © 2023 Borg et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Female
Health Knowledge, Attitudes, Practice
Humans
Hygiene*
Menstrual Hygiene Products
Menstruation*
Sanitation
Self Report
Uganda / epidemiology
Workplace

Grants and funding

This study was funded by the Osprey Foundation of Maryland (http://www.ospreyfdn.org/ received by KS, no grant no). JH is supported by a NHMRC Investigator Grant (https://www.nhmrc.gov.au/ GNT2008600) and the Reckitt Global Hygiene Institute (RGHI) (https://rghi.org/). The views expressed are those of the authors and not necessarily those of RGHI. The authors gratefully acknowledge the contribution to this work of the Victorian Operational Infrastructure Support Program received by the Burnet Institute (https://www.burnet.edu.au/). The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.