INSPIRES: Investigating a reusable sanitary pad intervention in a rural educational setting - evaluating the acceptability and short term effect of teaching Kenyan school girls to make reusable sanitary towels on absenteeism and other daily activities: a partial preference parallel group, cluster randomised control trial.

Aims and Objectives: This pilot study aimed to evaluate the acceptability and short-term effect of teaching Kenyan schoolgirls to make reusable sanitary towels on school absenteeism and other daily activities.

Relevance/impact: Problems managing menstruation in Less Economically Developed Countries may hinder educational opportunities for girls through increased school absenteeism. The Millennium Development Goals have highlighted the importance of female empowerment in reducing poverty however menstrual hygiene management is still poorly researched. Previous research has highlighted school absenteeism as a barrier to economic development and good menstrual hygiene is an important factor in maintaining women’s mental and physical well-being.

Methods: Pupils (n=302) from ten schools in Nyanza province (Kenya) were randomised by school to either the intervention (training to make a reusable sanitary pad; five schools;n=143) or control arm of the study (completing only a questionnaire but with training given after follow-up;n=159). Outcomes were self-reported on a questionnaire in class. SPSS 19TM was used to analyse the data. Covariate adjusted t-tests were used to calculate the primary endpoint.

Outcomes: Our primary outcome was to measure difference in absenteeism between control and intervention groups at follow-up. Difference in mean number of days missed=1.48 days (P=0.077;95% CI -3.17:0.21)). Secondary outcomes found menstruation had an impact on daily activities and quality of life.

Discussion: This pilot study found promising evidence to suggest an association between menstruation and school absenteeism in Kenyan schoolgirls and found that a reusable sanitary product is potentially an acceptable method of addressing this problem. It was also found that it was feasible to carry out a cluster randomised control trial in schools of this Kenyan province. Reducing school absenteeism has been shown by others to benefit individual educational attainment and this effect may extend to improving local and national economies. A convincing basis for further research has been shown. This is imperative to help address absenteeism, and also the impact on women’s health.