Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India

Abstract

Menstrual hygiene management (MHM) practices vary worldwide and depend on the individual’s socioeconomic status, personal preferences, local traditions and beliefs, and access to water and sanitation resources. MHM practices can be particularly unhygienic and inconvenient for girls and women in poorer settings. Little is known about whether unhygienic MHM practices increase a woman’s exposure to urogenital infections, such as bacterial vaginosis (BV) and urinary tract infection (UTI). This study aimed to determine the association of MHM practices with urogenital infections, controlling for environmental drivers. A hospital-based case-control study was conducted on 486 women at Odisha, India. Cases and controls were recruited using a syndromic approach. Vaginal swabs were collected from all the participants and tested for BV status using Amsel’s criteria. Urine samples were cultured to assess UTI status. Socioeconomic status, clinical symptoms and reproductive history, and MHM and water and sanitation practices were obtained by standardised questionnaire. A total of 486 women were recruited to the study, 228 symptomatic cases and 258 asymptomatic controls. Women who used reusable absorbent pads were more likely to have symptoms of urogenital infection (AdjOR=2.3, 95%CI1.5-3.4) or to be diagnosed with at least one urogenital infection (BV or UTI) (AdjOR=2.8, 95%CI1.7-4.5), than women using disposable pads. Increased wealth and space for personal hygiene in the household were protective for BV (AdjOR=0.5, 95%CI0.3-0.9 and AdjOR=0.6, 95%CI0.3-0.9 respectively). Lower education of the participants was the only factor associated with UTI after adjusting for all the confounders (AdjOR=3.1, 95%CI1.2-7.9). Interventions that ensure women have access to private facilities with water for MHM and that educate women about safer, low-cost MHM materials could reduce urogenital disease among women. Further studies of the effects of specific practices for managing hygienically reusable pads and studies to explore other pathogenic reproductive tract infections are needed.

Assessment of Risk Factors and Medication Use for Infectious Vaginitis Among Females of Reproductive Age Visiting Maternity Hospital of Pokhara, Nepal

“…Though limited studies support the opinion that unhygienic menstrual management practice corresponds to increased risk of bacterial vaginosis [13,14]; our study reflects that majority of females with infectious vaginitis had the habit of using cloth napkins. This may have contributed to vaginitis due to the verity that reused cloth pads may not be well sanitized because cleaning may be often done without soap and with unclean water especially by people with low socioeconomic groups and rural areas.…”

Schoolgirls’ experience and appraisal of menstrual absorbents in rural Uganda: a cross-sectional evaluation of reusable sanitary pads

“…There is increasing recognition that in low-income contexts, women struggle to manage menstruation in effective and hygienic ways [1]. This has been linked to negative impacts on health, education and wellbeing [2, 3]. A lack of clean and reliable menstrual absorbents has received much of the attention, with interventions focussed on the provision of these products to improve poor menstrual hygiene and associated consequences [4, 5].…”

Design and rationale of a matched cohort study to assess the effectiveness of a combined household-level piped water and sanitation intervention in rural Odisha, India

“…77 Unhygienic washing practices are common in rural India and among women and girls in lower socioeconomic groups and may increase risk of urogenital infection. [78][79][80] However, the link between access to water and sanitation, menstrual hygiene management and urogenital infections has been poorly studied. Household surveys will be administered in round 4 to a randomly selected woman aged 18 or older, in a subset of 800 households, and will capture self-reported urogenital infection, defined as at least one of the following symptoms: (1) abnormal vaginal discharge (unusual texture and colour/more abundant than normal), (2) burning or itching in the genitalia, (3) burning or itching when urinating or (4) genital sores.…”