Investigating the Association between Self-reported Menstrual Hygiene Practices and Prevalence of Female Genital Schistosomiasis and other Genital Abnormalities in Single Adult Zambian women Open Access

Bougouma, Katiana (Spring 2021)

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Background: Female genital schistosomiasis (FGS) is an important yet neglected public health problem in many tropical settings. FGS has been linked higher susceptibility to HIV and HPV/Cervical Cancer acquisition, and the burden of disease related to FGS alone is considerable; it is estimated that 56 million adolescent girls and women in Africa are burdened by morbidities associated with FGS, including genital abnormalities (GAs), infertility, pregnancy complications, lost productivity, extreme stigma and other maternal morbidities. The December 2019 UNAIDS report called for an integrated response within Sexual and Reproductive Health services that addresses FGS alongside other issues - including Menstrual Health Management - coherently.

Methods: This cross-sectional clinical study was conducted in two Zambian cities, Lusaka and Ndola. Eligible participants included women >18 years of age, HIV-negative, and self-identified as sex workers or single mothers. FGS risk factors surveys and gynecological exams were administered. Participants’ responses to the FGS risk factors survey, including their self-reported menstrual hygiene practices (MHP) were analyzed via exploratory bivariate analyses.

Results: The most reported absorbent type was sanitary pads (79.21%), followed by reusable cloths or towels (11.88%); 4.95% of participants reported using baby diapers, and one participant (0.99%) reported using cotton wool. 17.82% of women reported changing their absorbent at most twice a day, and 75.25% three times or more. 21.78% of participants reported self-washing at most twice a day, and 73.17% three times a day or more. 45.54% of women reported changing in a private room in the house, versus 51.49% reporting changing in a household toilet (with access to water). Participants also reported histories of infertility (22.77%), irregular bleeding (7.92%), contact pain during intercourse (6.93%), bloody urine (1.98%), and genital ulcer (1.98%). Less than 5% of participants reported living within 10 minutes of any open body of water such as rivers or streams (4.95%) and canal or drainage ditches (1.98%); 4.95% of participants reported entering nearby bodies of water every day. The main self-reported GA symptoms included vaginal itching (4.95%), abnormal vaginal discharge (4.95%), pelvic/back pain (3.96%), Cystitis/dysuria (UTI, 2.97%), Dyspareunia (painful intercourse, 2.97%), lower abdominal pain (2.97%), unpleasant vaginal or discharge odor (1.98%), and bloody vaginal discharge (0.99%)

Conclusion: Absorbent type was significantly associated with self-reported history of infertility, vaginal itching, an abnormal vaginal discharge. Self-wash frequency and Changing frequency were found to be MHPs associated with daily water sourcing. Self-reported history of infertility was significantly associated with stigma around reproductive health. Interventions aimed at urogenital schistosomiasis control should integrate support of adequate MHM to their approaches (including clean water, sanitation, and menstrual absorbent provisions). Future studies should aim to define and quantify the relationship between MHPs and laboratory confirmed cases of FGS and GAs.

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