Using qualitative data to build causal pathways on perceived associations between poor menstrual health and hygiene and harms among schoolgirls in western Kenya.
6 affiliations
- 1Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
- 2Department Applied Health Sciences, School of Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, United Kingdom.
- 3Safe Water and AIDS Project, Kisumu, Kenya.
- 4Kenya Medical Training College, Nairobi, Kenya.
- 5Centre for Health Services Studies, University of Kent, Canterburty, United Kingdom.
- 6Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
Abstract
Background
Poor menstrual health and hygiene (MHH) is a global public health concern, particularly in low- and middle-income countries. It can result in adverse health and educational impacts. Narratives from baseline focus group discussions (FGDs) conducted during a pilot intervention study in rural western Kenya were explored to reveal perceived associations.Methods
Transcripts of 19 FGDs involving 87 post-menarche schoolgirls, 47 parents, and 46 teachers were analysed thematically to identify perceived causal links between menstrual issues and health and educational outcomes. Quotes illustrating these perceived cause-and-effect relationships were logged and synthesised into a series of pathways, from which an overarching causal pathway model was produced.Results
Poverty underpinned poor MHH, characterised by the inability to afford products, the use of inadequate products, and the prolonged use of products. Key outcomes included menstrual issues, menstrual accidents (e.g., leaking), psychosocial distress (e.g., humiliation), poor educational outcomes (e.g., school absence), transactional sex, adolescent pregnancy, and infections (e.g., localised or reproductive tract infections). Poor MHH outcomes were often perceived as "nodes" or drivers that led to further distal outcomes. Four pathways emerged, all stemming from poverty. In pathway 1, poverty led to poor educational outcomes via inadequate menstrual materials, menstrual accidents, and psychosocial stress. In pathway 2, poverty led to poor educational outcomes via inadequate menstrual materials and physical discomfort. In pathway 3, poverty caused infections through the use of inadequate materials. In Pathway 4, inadequate materials resulted in transactional sex.Conclusion
Four perceived pathways linking poverty and poor MHH to an endpoint were used to develop a single overall causal pathway. The most frequently perceived outcome was school absence, with pregnancy and school dropout noted much less frequently. As poverty, the perceived underlying cause in this pathway, is a complex target, focusing interventions on proximal perceived key nodes in the pathway, such as poor MHH, would be of value.
Related
- Awareness of menstrual health disorders among Omani schoolgirls: a cross-sectional survey
- Perceived outcomes of an integrated menstrual hygiene intervention on empowerment among secondary school girls in Nasarawa State Nigeria
- Exploring menstrual health knowledge, attitude, and experiences among adolescent girls in public schools in Georgia: a qualitative study.
- Youth insights on menstrual health and hygiene in Burkina Faso; a comparison of written versus spoken qualitative text
- Prevalence of qualitative platelet disorders in adolescents and young adults with heavy menstrual bleeding: a single center experience
BibTeX
@article{ansell2026using,
title = {{Using qualitative data to build causal pathways on perceived associations between poor menstrual health and hygiene and harms among schoolgirls in western Kenya.}},
author = {Ellie Ansell and Israa Saleh and Garazi Zulaika and David Obor and Anna Maria van Eijk and Kelvin Oruko and Sandra Oketch and Penelope A Phillips-Howard and Linda Mason},
journal = {Frontiers in reproductive health},
year = {2026},
month = oct,
doi = {10.3389/frph.2026.1931799},
url = {https://europepmc.org/article/MED/42909003},
note = {CC BY},
}
RIS
TY - JOUR
TI - Using qualitative data to build causal pathways on perceived associations between poor menstrual health and hygiene and harms among schoolgirls in western Kenya.
AU - Ellie Ansell
AU - Israa Saleh
AU - Garazi Zulaika
AU - David Obor
AU - Anna Maria van Eijk
AU - Kelvin Oruko
AU - Sandra Oketch
AU - Penelope A Phillips-Howard
AU - Linda Mason
PY - 2026
DA - 2026/10/07
JO - Frontiers in reproductive health
DO - 10.3389/frph.2026.1931799
UR - https://europepmc.org/article/MED/42909003
AB - Background Poor menstrual health and hygiene (MHH) is a global public health concern, particularly in low- and middle-income countries. It can result in adverse health and educational impacts. Narratives from baseline focus group discussions (FGDs) conducted during a pilot intervention study in rural western Kenya were explored to reveal perceived associations.Methods Transcripts of 19 FGDs involving 87 post-menarche schoolgirls, 47 parents, and 46 teachers were analysed thematically to identify perceived causal links between menstrual issues and health and educational outcomes. Quotes illustrating these perceived cause-and-effect relationships were logged and synthesised into a series of pathways, from which an overarching causal pathway model was produced.Results Poverty underpinned poor MHH, characterised by the inability to afford products, the use of inadequate products, and the prolonged use of products. Key outcomes included menstrual issues, menstrual accidents (e.g., leaking), psychosocial distress (e.g., humiliation), poor educational outcomes (e.g., school absence), transactional sex, adolescent pregnancy, and infections (e.g., localised or reproductive tract infections). Poor MHH outcomes were often perceived as "nodes" or drivers that led to further distal outcomes. Four pathways emerged, all stemming from poverty. In pathway 1, poverty led to poor educational outcomes via inadequate menstrual materials, menstrual accidents, and psychosocial stress. In pathway 2, poverty led to poor educational outcomes via inadequate menstrual materials and physical discomfort. In pathway 3, poverty caused infections through the use of inadequate materials. In Pathway 4, inadequate materials resulted in transactional sex.Conclusion Four perceived pathways linking poverty and poor MHH to an endpoint were used to develop a single overall causal pathway. The most frequently perceived outcome was school absence, with pregnancy and school dropout noted much less frequently. As poverty, the perceived underlying cause in this pathway, is a complex target, focusing interventions on proximal perceived key nodes in the pathway, such as poor MHH, would be of value.
SN - 2673-3153
ER -