Use of menstrual cups among school girls: longitudinal observations nested in a randomised controlled feasibility study in rural western Kenya

Abstract

First introduced in the 1930’s, there are now ~ 100 brands available worldwide – marketed as an eco-friendly and cost-saving approach to menstrual care [23]. According to the manufacturer, when inserted into the vaginal canal the cup collects ~ 30 ml of menstrual blood, lasting 4–8 h depending on flow before emptying is required [39]. Table 2 Factors affecting time to colour change of the menstrual cup, as observed during visits to the study nurse, Western Kenya, 2012–2013 Variable n Univariate Hazard ratio, 95% CIa p-value Multivariate Hazard ratio, 95% CIa p-value Class at time of enrolment 5 or 6 61 0.73, 0.57–0.94 0.013 NS 7 or 8 131 Reference Age at enrolment (years) 14 93 Reference NS 15 80 1.17, 0.88–1.56 0.268 16 19 3.81, 1.59–9.14 0.003 Socio-economic status household of girls Poorest 2 quintiles 22 1.12, 0.73–1.72 0.589 Not included Higher 3 SES quintiles 138 0.90, 0.70–1.15 0.410 No information 32 Reference Material used for menstruation before enrolment Used some pads 169 Reference Not included Cloths/other 23 0.92, 0.48–1.73 0.788 Time since menarche at enrolment < 1 year 51 1.01, 0.63–1.62 0.958 Not included ≥ 1 year 141 Reference Enrolment year 2012 126 Reference Reference 2013 66 3.93, 2.09–7.38 < 0.001 3.93, 2.09–7.38 < 0.001 Enrolled before/after peer educationb Before peer education 102 Reference NS After peer education 90 2.77, 1.25–6.13 0.012 CI confidence interval, NS not significant in multivariate model Note: a hazard ratio > 1 indicates a shorter duration to cup colour change aSchool included as cluster variable bPeer-to-peer classroom training conducted by ‘champion’ secondary schoolgirls from a school in a contiguous area in October 2012 Observed cup colour change and self-reported cup use There was a discrepancy between reported cup use and observed cup use from colour change of the cup or physical change such as the cup stem being cut for comfort, with reported use much higher than any of the other measures (Additional file 1: (DOCX 7327 kb) Authors’ Affiliations (1) Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), Pembroke Place, Liverpool, L3 5AQ, UK (2) Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya (3) Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, USA (4) Department of Obstetrics and Gynaecology, Siaya District Hospital, Ministry of Health, Siaya, Kenya (5) Division of Reproductive Health, Ministry of Health, Nairobi, Kenya (6) Safe Water and AIDS Project, Kisumu, Kenya (7) Ministry of Health, Siaya County, Kenya Sommer M, Caruso BA, Sahin M, Calderon T, Cavill S, Mahon T, Phillips-Howard PA.