133 results on '"Linda Mason"'
Search Results
2. 'He’ll come with some sugar.' A qualitative study exploring the drivers and consequences of schoolgirls transactional sex behaviours
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Yandé Thiaw, Elizabeth Nyothach, Garazi Zulaika, Anna Maria van Eijk, Eunice Fwaya, David Obor, Penelope Phillips-Howard, and Linda Mason
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qualitative ,transactional sex ,Kenya ,adolescent girls ,schoolboys ,parents ,Reproduction ,QH471-489 ,Medicine (General) ,R5-920 - Abstract
IntoductionTransactional sex (TS) is common in areas of sub-Saharan Africa, motivated by reasons beyond financial support. Through this qualitative study we sought to understand the motivation driving TS among adolescent schoolgirls in rural western Kenya where rates are reportedly high. Identifying and understanding drivers within the local context is necessary for implementation of successful public health policy and programming to reduce the associated harms impacting health and wellbeing.MethodsTo understand the drivers of sexual behaviors, individual views, and socio-cultural norms, we spoke with schoolgirls, male peers, parents and teachers. The three latter groups may influence, encourage, and shape girls' views and behaviors and thus contribute to the perpetuation of cultural and societal norms.ResultsOne hundred and ninety-nine participants took part across 20 FGDs; 8 comprised of schoolgirl groups, and 4 each of schoolboy, parent or teacher groups. Through thematic analysis, poverty emerged as the key driver of TS and a normative behaviour amongst secondary school girls. Subthemes including parental influence, need for menstrual pads, pressure from boda boda drivers, peer pressure, and blame were part of a complex relationship linking poverty with TS.DiscussionWe conclude that whilst TS is perceived as inevitable, normal and acceptable it is not really a choice for many girls. Exploring ways to encourage communication between families, including around menstruation, may help enable girls to ask for help in acquiring essential items. In addition, education at a community level may shift social norms over time and decrease the prevalence of age-disparate TS among schoolgirls and older, wealthier men in the community.
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- 2024
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3. Research priorities for improving menstrual health across the life-course in low- and middle-income countries
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Marina Plesons, Belen Torondel, Bethany A. Caruso, Julie Hennegan, Marni Sommer, Jacquelyn Haver, Danielle Keiser, Anna M. van Eijk, Garazi Zulaika, Linda Mason, and Penelope A. Phillips-Howard
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menstrual hygiene management ,menstrual health ,wash ,education ,gender equity ,Public aspects of medicine ,RA1-1270 - Abstract
Background Research on menstrual health is required to understand menstrual needs and generate solutions to improve health, wellbeing, and productivity. The identification of research priorities will help inform where to invest efforts and resources. Objectives To identify research priorities for menstrual health across the life-course, in consultation with a range of stakeholder groups from a variety of geographic regions, and to identify if menstrual health research priorities varied by expertise. Methods A modified version of the Child Health and Nutrition Research Initiative approach was utilized to reach consensus on a set of research priorities. Multisector stakeholders with menstrual health expertise, identified through networks and the literature, were invited to submit research questions through an online survey. Responses were consolidated, and individuals were invited to rank these questions based on novelty, potential for intervention, and importance/impact. Research priority scores were calculated and evaluated by participants’ characteristics. Results Eighty-two participants proposed 1135 research questions, which were consolidated into 94 unique research questions. The mean number of questions did not differ between low- and middle-income country (LMIC) and high-income country (HIC) participants, but significantly more questions were raised by participants with expertise in mental health and WASH. Sixty-six participants then ranked these questions. The top ten-ranked research questions included four on ‘understanding the problem’, four on ‘designing and implementing interventions’, one on ‘integrating and scaling up’, and one on ‘measurement’. Indicators for the measurement of adequate menstrual health over time was ranked the highest priority by all stakeholders. Top ten-ranked research questions differed between academics and non-academics, and between participants from HICs and LMICs, reflecting differences in needs and knowledge gaps. Conclusions A list of ranked research priorities was generated through a consultative process with stakeholders across LMICs and HICs which can inform where to invest efforts and resources.
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- 2023
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4. Menstrual cups and cash transfer to reduce sexual and reproductive harm and school dropout in adolescent schoolgirls in western Kenya: a cluster randomised controlled trialResearch in context
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Garazi Zulaika, Elizabeth Nyothach, Anna Maria van Eijk, Duolao Wang, Valarie Opollo, David Obor, Linda Mason, Tao Chen, Emily Kerubo, Boaz Oyaro, Alex Mwaki, Alie Eleveld, Isaac Ngere, Eunice Fwaya, Feiko O. ter Kuile, Daniel Kwaro, and Penelope A. Phillips-Howard
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Adolescent girls ,HIV ,HSV-2 ,Cash transfers ,Menstrual cups ,Kenya ,Medicine (General) ,R5-920 - Abstract
Summary: Background: High rates of sexual and reproductive health (SRH) harms and interrupted schooling are global challenges for adolescent girls, requiring effective interventions. We assessed the impact of menstrual cups (MCs) or cash transfers conditioned on school attendance (CCTs), or both, on SRH and schooling outcomes in western Kenya. Methods: In this cluster-randomised Cups or Cash for Girls (CCG) trial, adolescent girls in Forms two and three at 96 secondary schools in Siaya County (western Kenya) were randomised to receive either CCT, MC, combined CCT and MC, or control (1:1:1:1) for an average of 30 months. The CCT intervention comprised 1500KES (US$15 in 2016) via a cash card each school trimester. All four treatment groups received puberty and hygiene training. Assenting girls with parent or guardian consent who were post-menarche, not pregnant, area residents, not boarding, and had no disabilities precluding participation were eligible. Socio-behavioural risk factors and incidence of HIV and herpes simplex virus type 2 (HSV-2) were measured annually. School retainment and adverse events were monitored throughout. The primary outcome comprised a composite of incident HIV, HSV-2 and/or all-cause school dropout by school exit examination. The primary analysis was by intention-to-treat (ITT) using generalised linear mixed models, controlling for a priori selected baseline covariates. The trial is registered with ClinicalTrials.gov, NCT03051789. Findings: Between February 28, 2017 and June 30, 2021, 4137 girls (median age 17.1 [interquartile range (IQR): 16.3–18.0]) were enrolled and followed annually until completion of secondary school (median 2.5 years [IQR: 2.4–2.7]); 4106 (99.3%) contributed to the ITT analysis. No differences in the primary composite outcome between intervention and control groups were seen (MC: 18.2%, CCT: 22.1%, combined: 22.1%, control: 19.6%; adjusted risk ratio [aRR]: 0.97, 95% confidence interval 0.76–1.24; 1.14, 0.90–1.45; and 1.13, 0.90–1.43, respectively). Incident HSV-2 occurred in 8.6%, 13.3%, 14.8%, and 12% of the MC, CCT, combined and control groups, respectively (MC: RR: 0.67, 0.47–0.95, p = 0.027; aRR: 0.71, 0.50–1.01, p = 0.057; CCT: aRR: 1.02, 0.73–1.41, p = 0.92; combined aRR: 1.16, 0.85–2.58, p = 0.36). Incident HIV was low (MC: 1.2%, CCT: 1.5%, combined: 1.0%, and control: 1.4%; aRR: 0.88, 0.38–2.05, p = 0.77, aRR: 1.16, 0.51–2.62, p = 0.72, aRR: 0.80, 0.33–1.94, p = 0.62, respectively). No intervention decreased school dropout (MC: 11.2%, CCT: 12.4%, combined: 10.9%, control: 10.5%; aRR: 1.16, 0.86–1.57; 1.23, 0.91–1.65; and 1.06, 0.78–1.44, respectively). No related serious adverse events were seen. Interpretation: MCs, CCTs, or both, did not protect schoolgirls against a composite of deleterious harms. MCs appear protective against HSV-2. Studies of longer follow-up duration with objective measures of health impact are needed in this population. Funding: Department of Health and Social Care, the Foreign, Commonwealth & Development Office, the Medical Research Council and Wellcome.
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- 2023
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5. Building menstrual health and hygiene-supportive environments: exploring teachers’ experience in rural Western Kenya
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Julia L. Shenkman, Leah C. Neubauer, Linda Mason, Kelvin Oruko, Kelly Alexander, Penelope A. Phillips-Howard, and Elizabeth Nyothach
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school health ,global health ,menstrual education ,menstrual products ,teacher perspectives ,Public aspects of medicine ,RA1-1270 - Abstract
IntroductionExisting school environments and staff play a critical role in Menstrual Health and Hygiene (MHH) for school aged girls in middle and low-income countries. This paper leverages teachers’ perspectives on menstruation and the impact of the Menstrual Solutions (MS) study, an open cluster randomized controlled feasibility study to determine the impact of puberty education, nurses support, and menstrual product provision on girls’ academic performance and emotional well-being.MethodsSeventeen focus group discussions were conducted from October 2012 through November 2013 with teachers at six participating schools, held at three different time points during the study period.ResultsKey themes that emerged were emotions and blood, absenteeism, the role of teachers in MHH, and the impact of sensitization. Teachers noted that poor MHH had an impact on school attendance, transparency and openness with teachers, and student behavior in class. It was reported that adolescent girls would absent themselves for 3–5 days during their menstrual cycle depending on what materials they could use, and they would often shy away from teachers, when possible, only speaking to them about their menses if it was urgent or they needed to go home. Emotions such as fear and embarrassment were commonly associated with bleeding. At the midpoint and end of the study, teachers noted that the puberty education and menstrual product provision (where applicable) had a positive impact on girls’ attendance, attention, and comfort in the classroom. Girls became more open with both male and female teachers about their menses, and more comfortable and confident in the classroom among all classmates.DiscussionThis research highlights the importance of building an MHH-supportive environment with multiple school personnel within schools to develop a gender-equitable environment for girls to learn confidently without undue interference. Teachers are key adults in adolescent girls’ lives, having the potential to foster an environment that empowers girls with greater autonomy to manage their menses. This highlights a need to consider their perspectives in intervention development. Sensitization of teachers and puberty education across both genders are key components to developing the MHH-supportive environment in schools.
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- 2023
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6. Cost-Effectiveness and Cost?Benefit Analyses of Providing Menstrual Cups and Sanitary Pads to Schoolgirls in Rural Kenya
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Masih A. Babagoli, Anja Benshaul-Tolonen, Garazi Zulaika, Elizabeth Nyothach, Clifford Oduor, David Obor, Linda Mason, Emily Kerubo, Isaac Ngere, Kayla F. Laserson, Rhiannon Tudor Edwards, and Penelope A. Phillips-Howard
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adolescence ,cost?benefit analysis ,cost-effectiveness analysis ,menstrual cup ,menstrual health ,randomized trial ,Gynecology and obstetrics ,RG1-991 ,Public aspects of medicine ,RA1-1270 - Abstract
Objective: To analyze the relative value of providing menstrual cups and sanitary pads to primary schoolgirls. Design: Cost-effectiveness and cost?benefit analyses of three-arm single-site open cluster randomized controlled pilot study providing menstrual cups or sanitary pads for 1 year. Participants: Girls 14?16 years of age enrolled across 30 primary schools in rural western Kenya. Methods: Cost-effectiveness analysis was conducted based on the health effects (reductions in disability-adjusted life years [DALYs]) and education effects (reductions in school absenteeism) of both interventions. The health and education benefits were separately valued and compared with relative program costs. Results: Compared with the control group, the cost of menstrual cups was estimated at $3,270 per year for 1000 girls, compared with $24,000 for sanitary pads. The benefit of the menstrual cup program (1.4 DALYs averted, 95% confidence interval [CI]: ?4.3 to 3.1) was higher compared with a sanitary pad program (0.48 DALYs averted, 95% CI: ?4.2 to 2.3), but the health effects of both interventions were not statistically significant likely due to the limited statistical power. Using point estimates, the menstrual cup intervention was cost-effective in improving health outcomes ($2,300/DALY averted). The sanitary pad intervention had a cost-effectiveness of $300/student-school year in reducing school absenteeism. When considering improvements in future earnings from reduced absenteeism, the sanitary pad program had a net benefit of +$68,000 (95% CI: ?$32,000 to +$169,000). Conclusions: The menstrual cup may provide a cost-effective solution for menstrual hygiene management in low-income settings. This study outlines a methodology for future analyses of menstrual hygiene interventions and highlights several knowledge gaps that need to be addressed. Trial registration: ISRCTN17486946.
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- 2022
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7. Thank You from the Management and Production Team!
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Linda Mason
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Special aspects of education ,LC8-6691 - Abstract
On behalf of the current managing/production editorial team, we want to thank all those who have supported the work in JIPE.
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- 2022
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8. Quality of life and well-being problems in secondary schoolgirls in Kenya: Prevalence, associated characteristics, and course predictors.
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Philip Spinhoven, Garazi Zulaika, Elizabeth Nyothach, Anna Maria van Eijk, David Obor, Eunice Fwaya, Linda Mason, Duolao Wang, Daniel Kwaro, and Penelope A Phillips-Howard
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Public aspects of medicine ,RA1-1270 - Abstract
BackgroundAdolescents in sub-Saharan Africa often report low levels of quality of life (QoL) and well-being, but reliable data are limited. This study examines which sociodemographic, health, and behavioral risk factors and adverse adolescent experiences are associated with, and predictive of, QoL in Kenyan secondary schoolgirls.Methods and findings3,998 girls at baseline in a randomised controlled trial in Siaya County, western Kenya were median age 17.1 years. Subjectively perceived physical, emotional, social and school functioning was assessed using the Pediatric Quality of Life (QoL) Inventory-23. Laboratory-confirmed and survey data were utilized to assess sociodemographic, health and behavioral characteristics, and adverse adolescent experiences. We identified a group of girls with Low QoL (n = 1126; 28.2%), Average QoL (n = 1445; 36.1%); and High QoL (n = 1427; 35.7%). Significantly higher scores on all well-being indicators in the LQoL compared with HQoL group indicated good construct validity (Odds Ratio's (ORs) varying from 3.31 (95% CI:2.41-4.54, p < .001) for feeling unhappy at home to 11.88 (95%CI:7.96-17.74, p< .001) for PHQ9 defined possible caseness (probable diagnosis) of depression. Adverse adolescent experiences were independently statistically significant in the LQoL compared to the HQoL group for threats of family being hurt (aOR = 1.35,1.08-1.68, p = .008), sexual harassment out of school (aOR = 2.17,1.79-2.64, p < .001), and for menstrual problems like unavailability of sanitary pads (aOR = 1.23,1.05-1.44, p = .008) and stopping activities due to menstruation (aOR = 1.77,1.41-2.24, p < .001). After 2-years follow-up of 906 girls in the LQoL group, 22.7% persisted with LQoL. Forced sex (aOR = 1.56,1.05-2.32, p = .028) and threats of family being hurt (aOR = 1.98,1.38-2.82, p < .001) were independent predictors of persistent LQoL problems.ConclusionsPersistent QoL problems in Kenyan adolescent girls are associated with adverse physical, sexual and emotional experiences and problems with coping with their monthly menstruation. A multi-factorial integral approach to reduce the rate of adverse adolescent experiences is needed, including provision of menstrual hygiene products.Trial registrationClinicalTrials.gov:NCT03051789.
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- 2022
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9. 'You don't have to sleep with a man to get how to survive': Girl's perceptions of an intervention study aimed at improving sexual and reproductive health and schooling outcomes.
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Linda Mason, Garazi Zulaika, Anna Maria van Eijk, Eunice Fwaya, David Obor, Penelope Phillips-Howard, and Elizabeth Nyothach
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Public aspects of medicine ,RA1-1270 - Abstract
In sub-Saharan Africa, girls suffer from high rates of morbidity and mortality, enduring high exposure to sexual and reproductive health harms. Staying in school helps protect girls from such harms. Focus group discussions were conducted in a rural, impoverished area of Kenya with adolescent girls participating in a 4-arm cluster randomised controlled trial, evaluating menstrual cups, cash transfer, or combined cups plus cash transfer against controls. To explore girls' perceptions of how trial interventions affected their SRH risks and schooling, semi-structured discussions were held at baseline, midline, and study end. Data was explored using thematic analysis. At baseline there were no discernible differences between the 4 intervention groups regarding their perceptions of relationships with boys/men, and difficulties attending or remaining in school. Midline and endline discussions found that narratives from those receiving cash transfer only, or alongside a cup were similar; girls noted fewer pregnancies and less school dropout, attributed to the cash transfer reducing the need for transactional sex. Lower absenteeism was reported by the cup only group, with perceived minimal effect on pregnancy and dropout. Girls in control and cup only groups described feeling valued through inclusion, benefitting from puberty and hygiene education. Although seemingly having little effect on reducing pregnancy or dropout, these inputs reportedly empowered girls, whilst cash transfer girls were emboldened to refuse male sexual advances. Girls noticed benefits from trial interventions, with a reduction in transactional sex and resulting pregnancy impacting on school dropout, or reduced menstrual related absenteeism. Education and study inclusion were perceived as important. Future programmes should consider alleviating material deprivation which prevents girls from attending or performing at school through schemes such as cash transfer, alongside hygiene and education packages. This will empower girls to refuse unwanted sex and understand risks, in addition to motivating academic achievement and school completion. Trial registration: ClinicalTrials.gov NCT03051789.
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- 2022
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10. Period poverty: The perceptions and experiences of impoverished women living in an inner-city area of Northwest England.
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Madeleine Boyers, Supriya Garikipati, Alice Biggane, Elizabeth Douglas, Nicola Hawkes, Ciara Kiely, Cheryl Giddings, Julie Kelly, Diane Exley, Penelope A Phillips-Howard, and Linda Mason
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Medicine ,Science - Abstract
BackgroundThe menstrual needs of girls and women are important to health, education, and well-being. Unmet need and harm from poor menstrual health in low-and- middle-income countries have been documented, but with little empirical research undertaken in high income countries. Continuing austerity in the UK suggests menstruators are likely more vulnerable to 'period poverty' than previously, with the COVID-19 pandemic assumed to exacerbate the situation.AimTo explore the menstrual experiences and perceptions of women in the UK who are living under circumstances of deprivation, alongside views of staff working in organisations supporting these women, to understand whether women's menstrual needs are met.MethodsA qualitative study was conducted in an inner-city in NW England. Three focus group discussions and 14 in-depth interviews were conducted across three study sites supporting impoverished women. Data was analysed thematically.ResultsThemes were: reflections on menstruation; affordability of products; access to public facilities; organisational support; potential solutions. Many women perceived menstruation as a burden in three aspects: physical discomfort and pain; psychological anxiety; and shame and stigma. Managing menstruation was difficult due to cost relative to low incomes, with food, heating and lighting prioritised, leaving women improvising with materials or wearing products for longer than desired. Most suggested that products should be free, often remarking if men required similar items this would happen. Most women were unaware supporting organisations provided free products. Staff felt the small range of products offered did not meet client needs and were ill-prepared to have conversations on products and clients' menstrual needs.ConclusionImpoverished women lack the necessary resources to manage their menses well which negatively impacts their health and brings stress, embarrassment, and shame. Support, including access to free products, is needed at both local and national level to help impoverished women manage their menstrual hygiene.
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- 2022
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11. Impact of COVID-19 lockdowns on adolescent pregnancy and school dropout among secondary schoolgirls in Kenya
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Duolao Wang, Supriya D Mehta, Penelope A Phillips-Howard, David Obor, Elizabeth Nyothach, Linda Mason, Garazi Zulaika, Miriam Bulbarelli, Annemieke van Eijk, Eunice Fwaya, and Daniel Kwaro
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Medicine (General) ,R5-920 ,Infectious and parasitic diseases ,RC109-216 - Published
- 2022
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12. Menstrual cups and cash transfer to reduce sexual and reproductive harm and school dropout in adolescent schoolgirls: study protocol of a cluster-randomised controlled trial in western Kenya
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Garazi Zulaika, Daniel Kwaro, Elizabeth Nyothach, Duolao Wang, Emily Zielinski-Gutierrez, Linda Mason, Alie Eleveld, Tao Chen, Emily Kerubo, Annemieke van Eijk, Cheryl Pace, David Obor, Jane Juma, Boaz Oyaro, Louis Niessen, Godfrey Bigogo, Isaac Ngere, Carl Henry, Maxwell Majiwa, Clayton O. Onyango, Feiko O. ter Kuile, and Penelope A. Phillips-Howard
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Sexual and reproductive health ,Adolescence ,Equity ,HIV ,HSV-2 ,Pregnancy ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Adolescent girls in sub-Saharan Africa are disproportionally vulnerable to sexual and reproductive health (SRH) harms. In western Kenya, where unprotected transactional sex is common, young females face higher rates of school dropout, often due to pregnancy, and sexually transmitted infections (STIs), including HIV. Staying in school has shown to protect girls against early marriage, teen pregnancy, and HIV infection. This study evaluates the impact of menstrual cups and cash transfer interventions on a composite of deleterious outcomes (HIV, HSV-2, and school dropout) when given to secondary schoolgirls in western Kenya, with the aim to inform evidence-based policy to improve girls’ health, school equity, and life-chances. Methods Single site, 4-arm, cluster randomised controlled superiority trial. Secondary schools are the unit of randomisation, with schoolgirls as the unit of measurement. Schools will be randomised into one of four intervention arms using a 1:1:1:1 ratio and block randomisation: (1) menstrual cup arm; (2) cash transfer arm, (3) cups and cash combined intervention arm, or (4) control arm. National and county agreement, and school level consent will be obtained prior to recruitment of schools, with parent consent and girls’ assent obtained for participant enrolment. Participants will be trained on safe use of interventions, with all arms receiving puberty and hygiene education. Annually, the state of latrines, water availability, water treatment, handwashing units and soap in schools will be measured. The primary endpoint is a composite of incident HIV, HSV-2, and all-cause school dropout, after 3 years follow-up. School dropout will be monitored each term via school registers and confirmed through home visits. HIV and HSV-2 incident infections and risk factors will be measured at baseline, mid-line and end-line. Intention to treat analysis will be conducted among all enrolled participants. Focus group discussions will provide contextual information on uptake of interventions. Monitoring for safety will occur throughout. Discussion If proved safe and effective, the interventions offer a potential contribution toward girls’ schooling, health, and equity in low- and middle-income countries. Trial registration ClinicalTrials.gov NCT03051789, 15th February 2017.
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- 2019
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13. Factors associated with the prevalence of HIV, HSV-2, pregnancy, and reported sexual activity among adolescent girls in rural western Kenya: A cross-sectional analysis of baseline data in a cluster randomized controlled trial.
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Garazi Zulaika, Elizabeth Nyothach, Anna Maria van Eijk, David Obor, Linda Mason, Duolao Wang, Tao Chen, Emily Kerubo, Valarie Opollo, Isaac Ngere, Samuel Omondi Owino, Boaz Oyaro, Feiko O Ter Kuile, Daniel Kwaro, and Penelope Phillips-Howard
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Medicine - Abstract
BackgroundAdolescence is a sensitive time for girls' sexual and reproductive health (SRH), as biological changes occur concurrently with heightening pressures for sexual activity. In western Kenya, adolescent girls are vulnerable to acquiring sexually transmitted infections (STIs), such as HIV and herpes simplex virus type 2 (HSV-2), and to becoming pregnant prior to reaching adulthood. This study examines associations between individual, household, and partner-related risk factors and the prevalence of sex, adolescent pregnancy, HIV, and HSV-2.Methods and findingsWe report baseline findings among 4,138 girls attending secondary school who were enrolled between 2017 and 2018 in the Cups or Cash for Girls (CCG) cluster randomized controlled trial in Siaya County, rural western Kenya. Laboratory confirmed biomarkers and survey data were utilized to assess the effects of girls' individual, household, and partner characteristics on the main outcome measures (adolescent reported sex, prior pregnancy, HIV, and HSV-2) through generalized linear model (GLM) analysis. Complete data were available for 3,998 girls (97%) with median age 17.1 years (interquartile range [IQR] 16.3 to 18.0 years); 17.2% were HSV-2 seropositive (n = 686) and 1.7% tested positive for HIV (n = 66). Sexual activity was reported by 27.3% girls (n = 1,090), of whom 12.2% had been pregnant (n = 133). After adjustment, orphanhood (adjusted risk ratio [aRR] 2.81, 95% confidence interval [CI] 1.18 to 6.71, p-value [p] = 0.020), low body mass index (BMI) (aRR 2.07; CI: 1.00 to 4.30, p = 0.051), and age (aRR 1.34, 1.18 to 1.53, p < 0.001) were all associated with HIV infection. Girls reporting light menstrual bleeding (aRR 2.42, 1.22 to 4.79, p = 0.012) for fewer than 3 days (aRR 2.81, 1.16 to 6.82, p = 0.023) were over twice as likely to have HIV. Early menarche (aRR 2.05, 1.33 to 3.17, p = 0.001) was associated with adolescent pregnancy and HSV-2-seropositive girls reported higher rates of pregnancy (aRR 1.62, CI: 1.16 to 2.27, p = 0.005). High BMI was associated with HSV-2 (aRR 1.24, 1.05 to 1.46, p = 0.010) and sexual activity (aRR 1.14, 1.02 to 1.28, p = 0.016). High levels of harassment were detected in the cohort (41.2%); being touched indecently conveyed the strongest association related to reported sexual activity (aRR 2.52, 2.26 to 2.81, p < 0.001). Study limitations include the cross-sectional design of the study, which informs on the SRH burdens found in this population but limits causal interpretation of associations, and the self-reported exposure ascertainment, which may have led to possible underreporting of risk factors, most notably prior sexual activity.ConclusionsOur findings indicate that adolescent girls attending school in Kenya face frequent harassment for sex and are at high risk of pregnancy and HSV-2, with girls experiencing early menarche particularly vulnerable. Targeted interventions, such as earlier sexual education programs, are warranted to address their vulnerability to SRH harms.Trial registrationClinicalTrials.gov NCT03051789.
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- 2021
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14. Characterization of Microbial Communities from the Alimentary Canal of Typhaea stercorea (L.) (Coleoptera: Mycetophagidae)
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Julius Eason and Linda Mason
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Typhaea stercorea ,fungivore ,alimentary canal ,16S rRNA amplicon sequencing ,bacterial symbionts ,Science - Abstract
The gut microbiomes of symbiotic insects typically mediate essential functions lacking in their hosts. Here, we describe the composition of microbes residing in the alimentary canal of the hairy fungus beetle, Typhaea stercorea (L.), at various life stages. This beetle is a post-harvest pest of stored grains that feeds on fungi and serves as a vector of mycotoxigenic fungi. It has been reported that the bacterial communities found in most insects’ alimentary canals contribute to nutrition, immune defenses, and protection from pathogens. Hence, bacterial symbionts may play a key role in the digestive system of T. stercorea. Using 16S rRNA amplicon sequencing, we examined the microbiota of T. stercorea. We found no difference in bacterial species richness between larvae and adults, but there were compositional differences across life stages (PERMANOVA:pseudo-F(8,2) = 8.22; p = 0.026). The three most abundant bacteria found in the alimentary canal of the larvae and adults included Pseudomonas (47.67% and 0.21%, respectively), an unspecified genus of the Enterobacteriaceae family (46.60 % and 90.97%, respectively), and Enterobacter (3.89% and 5.75%, respectively). Furthermore, Pseudomonas spp. are the predominant bacteria in the larval stage. Our data indicated that field-collected T. stercorea tended to have lower species richness than laboratory-reared beetles (Shannon: H = 5.72; p = 0.057). Furthermore, the microbial communities of laboratory-reared insects resembled one another, whereas field-collected adults exhibited variability (PERMANOVA:pseudo-F(10,3) = 4.41; p = 0.006). We provide evidence that the environment and physiology can shift the microbial composition in the alimentary canal of T. stercorea.
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- 2022
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15. Exploring menstrual products: A systematic review and meta-analysis of reusable menstrual pads for public health internationally.
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Anna Maria van Eijk, Naduni Jayasinghe, Garazi Zulaika, Linda Mason, Muthusamy Sivakami, Holger W Unger, and Penelope A Phillips-Howard
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Medicine ,Science - Abstract
BackgroundGirls and women need effective, safe, and affordable menstrual products. Single-use menstrual pads and tampons are regularly provided by agencies among resource-poor populations. Reusable menstrual pads (RMPs: fabric layers sewn together by an enterprise for manufacture of menstrual products) may be an effective alternative.MethodsFor this review (PROSPERO CRD42020179545) we searched databases (inception to November 1, 2020) for quantitative and qualitative studies that reported on leakage, acceptability, or safety of RMPs. Findings were summarised or combined using forest plots (random-effects meta-analysis). Potential costs and environmental savings associated with RMPs were estimated.ResultsA total of 44 studies were eligible (~14,800 participants). Most were conducted in low- and middle-income countries (LMIC, 78%), and 20% in refugee settings. The overall quality of studies was low. RMP uptake in cohort studies ranged from 22-100% (12 studies). One Ugandan trial among schoolgirls found leakage with RMPs was lower (44.4%, n = 72) compared to cloths (78%, n = 111, pConclusionRMPs are used internationally and are an effective, safe, cheaper, and environmentally friendly option for menstrual product provision by programmes. Good quality studies in this field are needed.
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- 2021
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16. Use of menstrual cups among school girls: longitudinal observations nested in a randomised controlled feasibility study in rural western Kenya
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Anna Maria van Eijk, Kayla F. Laserson, Elizabeth Nyothach, Kelvin Oruko, Jackton Omoto, Linda Mason, Kelly Alexander, Clifford Oduor, Aisha Mohammed, Alie Eleveld, Isaac Ngere, David Obor, John Vulule, and Penelope A. Phillips-Howard
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Schoolgirls ,Menstrual cup ,Menstrual hygiene management ,Silicone ,Mooncup ,Adolescents ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background A menstrual cup can be a good solution for menstrual hygiene management in economically challenged settings. As part of a pilot study we assessed uptake and maintenance of cup use among young school girls in Kenya. Methods A total of 192 girls between 14 to 16 years were enrolled in 10 schools in Nyanza Province, Western Kenya; these schools were assigned menstrual cups as part of the cluster-randomized pilot study. Girls were provided with menstrual cups in addition to training and guidance on use, puberty education, and instructions for menstrual hygiene. During repeated individual visits with nurses, girls reported use of the menstrual cup and nurses recorded colour change of the cup. Results Girls were able to keep their cups in good condition, with only 12 cups (6.3%) lost (dropped in toilet, lost or destroyed). Verbally reported cup use increased from 84% in the first 3 months (n = 143) to 96% after 9 months (n = 74). Colour change of the cup, as ‘uptake’ indicator of use, was detected in 70.8% of 192 participants, with a median time of 5 months (range 1–14 months). Uptake differed by school and was significantly higher among girls who experienced menarche within the past year (adjusted risk ratio 1.29, 95% CI 1.04–1.60), and was faster among girls enrolled in the second study year (hazard ratio 3.93, 95% CI 2.09–7.38). The kappa score comparing self-report and cup colour observation was 0.044 (p = 0.028), indicating that agreement was only slightly higher than by random chance. Conclusions Objective evidence through cup colour change suggests school girls in rural Africa can use menstrual cups, with uptake improving with peer group education and over time. Trial registration ISRCTN17486946. Retrospectively registered 09 December 2014.
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- 2018
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17. ‘We do not know’: a qualitative study exploring boys perceptions of menstruation in India
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Linda Mason, Muthusamy Sivakami, Harshad Thakur, Narendra Kakade, Ashley Beauman, Kelly T. Alexander, Anna Maria van Eijke, Kayla F. Laserson, Mamita B. Thakkar, and Penelope A. Phillips-Howard
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Focus group discussions ,Menstruation ,Perception ,Boys ,India ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background In low-middle income countries and other areas of poverty, menstrual hygiene management (MHM) can be problematic for women and girls. Issues include lack of knowledge about menstruation and MHM, and stigma around menstruation, also access to affordable and absorbent materials; privacy to change; adequate washing, cleaning and drying facilities; as well as appropriate and accessible disposal facilities. In order to effect change and tackle these issues, particularly in patriarchal societies, males may need to become advocates for MHM alongside women. However, little is known about their knowledge and attitudes towards menstruation, which may need addressing before they can assist in acting as advocates for change. The present study was undertaken to explore knowledge and attitudes about menstruation among adolescent boys across India, in order to gauge their potential to support their ‘sisters’. Methods The study was undertaken across three states in India, chosen a priori to represent the cultural and socio-economic diversity. Qualitative data using focus group discussions with 85 boys aged 13-17 years, from 8 schools, was gathered. Data were analysed using thematic analysis. Results The results were organised into three main themes, reflecting the key research questions: boys’ knowledge of menstruation, source of knowledge, and attitudes towards menstruation and menstruating girls. Knowledge comprised three aspects; biological function which were generally poorly understood; cultural rites which were recognized by all; and girls’ behaviour and demeanour, which were noted to be withdrawn. Some boys learnt about puberty and menstruation as part of the curriculum but had concerns this was not in-depth, or was missed out altogether. Most gathered knowledge from informal sources, from overhearing conversations or observing cultural rituals. Few boys openly displayed a negative attitude, although a minority voiced the idea that menstruation is a ‘disease’. Boys were mostly sympathetic to their menstruating sisters and wanted to support them. Conclusions These findings provide some optimism that males can become advocates in moving forward the MHM agenda. The reasons for this are twofold: boys were keen for knowledge about menstruation, searching information out despite societal norms being for them to remain ignorant, they were also largely sympathetic to their menstruating sisters and fellow classmates and understanding of the issues surrounding the need for good MHM.
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- 2017
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18. Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis
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Anna Maria van Eijk, PhD, Garazi Zulaika, MPH, Madeline Lenchner, MSc, Linda Mason, PhD, Muthusamy Sivakami, ProfPhD, Elizabeth Nyothach, MSc, Holger Unger, PhD, Kayla Laserson, ScD, and Penelope A Phillips-Howard, ProfPhD
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Public aspects of medicine ,RA1-1270 - Abstract
Summary: Background: Girls and women need effective, safe, and affordable menstrual products. Single-use products are regularly selected by agencies for resource-poor settings; the menstrual cup is a less known alternative. We reviewed international studies on menstrual cup leakage, acceptability, and safety and explored menstrual cup availability to inform programmes. Methods: In this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Web of Science, Popline, Cinahl, Global Health database, Emerald, Google Scholar, Science.gov, and WorldWideScience from database inception to May 14, 2019, for quantitative or qualitative studies published in English on experiences and leakage associated with menstrual cups, and adverse event reports. We also screened the Manufacturer and User Facility Device Experience database from the US Food and Drug Administration for events related to menstrual cups. To be eligible for inclusion, the material needed to have information on leakage, acceptability, or safety of menstrual cups. The main outcome of interest was menstrual blood leakage when using a menstrual cup. Safety outcomes of interest included serious adverse events; vaginal abrasions and effects on vaginal microflora; effects on the reproductive, digestive, or urinary tract; and safety in poor sanitary conditions. Findings were tabulated or combined by use of forest plots (random-effects meta-analysis). We also did preliminary estimates on costs and environmental savings potentially associated with cups. This systematic review is registered on PROSPERO, number CRD42016047845. Findings: Of 436 records identified, 43 studies were eligible for analysis (3319 participants). Most studies reported on vaginal cups (27 [63%] vaginal cups, five [12%] cervical cups, and 11 [25%] mixed types of cups or unknown) and 15 were from low-income and middle-income countries. 22 studies were included in qualitative or quantitative syntheses, of which only three were of moderate-to-high quality. Four studies made a direct comparison between menstrual cups and usual products for the main outcome of leakage and reported leakage was similar or lower for menstrual cups than for disposable pads or tampons (n=293). In all qualitative studies, the adoption of the menstrual cup required a familiarisation phase over several menstrual cycles and peer support improved uptake (two studies in developing countries). In 13 studies, 73% (pooled estimate: n=1144; 95% CI 59–84, I2=96%) of participants wished to continue use of the menstrual cup at study completion. Use of the menstrual cup showed no adverse effects on the vaginal flora (four studies, 507 women). We identified five women who reported severe pain or vaginal wounds, six reports of allergies or rashes, nine of urinary tract complaints (three with hydronephrosis), and five of toxic shock syndrome after use of the menstrual cup. Dislodgement of an intrauterine device was reported in 13 women who used the menstrual cup (eight in case reports, and five in one study) between 1 week and 13 months of insertion of the intrauterine device. Professional assistance to aid removal of menstrual cup was reported among 47 cervical cup users and two vaginal cup users. We identified 199 brands of menstrual cup, and availability in 99 countries with prices ranging US$0·72–46·72 (median $23·3, 145 brands). Interpretation: Our review indicates that menstrual cups are a safe option for menstruation management and are being used internationally. Good quality studies in this field are needed. Further studies are needed on cost-effectiveness and environmental effect comparing different menstrual products. Funding: UK Medical Research Council, Department for International Development, and Wellcome Trust.
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- 2019
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19. The State of the Art
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Beth Myers, Heidi Graff, and Linda Mason
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Special aspects of education ,LC8-6691 - Published
- 2019
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20. Relationship between Evaluations of Tracheal Tube Position Using Ultrasound and Fluoroscopy in an Infant and Pediatric Population
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Davinder Ramsingh, Elizabeth Ghazal, Brent Gordon, Philip Ross, Darren Goltiao, Matt Alschuler, Justin Pugh, Matthew Holsclaw, and Linda Mason
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point-of-care ultrasound ,pediatrics ,airway ultrasound ,tracheal tube positioning ,Medicine - Abstract
Introduction: A non-radiographic technique to measure the location of the tracheal tube (TT) in children is of value given the risk of inappropriate TT placement along with concerns about radiation exposure. Airway point-of-care ultrasound (POCUS) has demonstrated utility in children, but the examinations vary by age and may require non-traditional techniques or utilize less common probes. This study evaluated the performance of measuring the tracheal location of the cuffed TT using a novel, linear probe-based POCUS examination over a wide age range of children. After adjusting for the subjects’ height and TT size, ultrasound measurements of the TT cuff location were compared with fluoroscopy measurements of the TT tip location. Methods: Perioperative pediatric patients (p < 0.001). Conclusions: Our results demonstrate a strong correlation between POCUS TT localization measurements and traditional measurements via fluoroscopy. This study further supports the utility of POCUS for pediatric care.
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- 2020
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21. Transplantation of Fecal Microbiota Shaped by Diet
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Keiran McLeod, Linda Mason, and Eliana Mariño
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Biology (General) ,QH301-705.5 - Abstract
Alterations in diet and gut microbial ecology underlie the pathogenesis of type 1 diabetes (T1D). In the non-obese diabetic (NOD) mouse, we found high concentrations of bacterial metabolites acetate and butyrate in blood and faeces correlated with protection from disease. We reconstituted germ free (GF) NOD mice with fecal bacteria from protected NOD mice fed with high acetate- and butyrate-yielding diets, to test whether the transferred gut microbiota protect against the development of T1D. GF NOD mice that received a microbiota shaped by high acetate- but not butyrate-yielding diet showed a marked protection against diabetes. This fecal transplantation assay demonstrated the potential for a dietary technology to reshape the gut microbiota that enables specific bacteria to transfer protection against T1D.
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- 2018
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22. Water, Sanitation and Hygiene Conditions in Kenyan Rural Schools: Are Schools Meeting the Needs of Menstruating Girls?
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Kelly T. Alexander, Clifford Oduor, Elizabeth Nyothach, Kayla F. Laserson, Nyaguara Amek, Alie Eleveld, Linda Mason, Richard Rheingans, Caryl Beynon, Aisha Mohammed, Maurice Ombok, David Obor, Frank Odhiambo, Robert Quick, and Penelope A. Phillips-Howard
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school ,education ,children ,water sanitation and hygiene ,NGOs ,Africa ,Kenya ,menstruation ,Hydraulic engineering ,TC1-978 ,Water supply for domestic and industrial purposes ,TD201-500 - Abstract
Water, sanitation and hygiene (WASH) programs in African schools have received increased attention, particularly around the potential impact of poor menstrual hygiene management (MHM) on equity for girls’ education. This study was conducted prior to a menstrual feasibility study in rural Kenya, to examine current WASH in primary schools and the resources available for menstruating schoolgirls. Cross-sectional surveys were performed in 62 primary schools during unannounced visits. Of these, 60% had handwashing water, 13% had washing water in latrines for menstruating girls, and 2% had soap. Latrines were structurally sound and 16% were clean. Most schools (84%) had separate latrines for girls, but the majority (77%) had no lock. Non-governmental organizations (NGOs) supported WASH in 76% of schools. Schools receiving WASH interventions were more likely to have: cleaner latrines (Risk Ratio (RR) 1.5; 95% Confidence Intervals [CI] 1.0, 2.1), handwashing facilities (RR 1.6, CI 1.1, 2.5), handwashing water (RR 2.7; CI 1.4, 5.2), and water in girls’ latrines (RR 4.0; CI 1.4, 11.6). Schools continue to lack essential WASH facilities for menstruating girls. While external support for school WASH interventions improved MHM quality, the impact of these contributions remains insufficient. Further support is required to meet international recommendations for healthy, gender-equitable schools.
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- 2014
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23. 'He is the one who is providing you with everything so whatever he says is what you do': A Qualitative Study on Factors Affecting Secondary Schoolgirls' Dropout in Rural Western Kenya.
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Kelvin Oruko, Elizabeth Nyothach, Emily Zielinski-Gutierrez, Linda Mason, Kelly Alexander, John Vulule, Kayla F Laserson, and Penelope A Phillips-Howard
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Medicine ,Science - Abstract
Education is an effective way to improve girls' self-worth, health, and productivity; however there remains a gender gap between girls' and boys' completion of school. The literature around factors influencing girls' decision to stay in school is limited. Seven focus group discussions took place among 79 girls in forms 2 to 4 at secondary schools in rural western Kenya, to examine their views on why girls absent themselves or dropout from school. Data were analysed thematically. Lack of resources, sexual relationships with boyfriends, and menstrual care problems were reported to lead directly to dropout or school absence. These were tied to girls increased vulnerability to pregnancy, poor performance in school, and punishments, which further increase school absence and risk of dropout. Poverty, unmet essential needs, coercive sexual relationships, and an inequitable school environment collude to counter girls' resolve to complete their schooling. Lack of resources drive girls to have sex with boyfriends or men who provide them with essentials their family cannot afford, such as sanitary pads and transport to school. While these improve quality of their school life, this dynamic increases their exposure to sexual risk, pregnancy, punishment, and dropout. Evaluation of interventions to ameliorate these challenges is warranted, including provision of pocket money to address their needs.
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- 2015
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24. 'We keep it secret so no one should know'--a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya.
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Linda Mason, Elizabeth Nyothach, Kelly Alexander, Frank O Odhiambo, Alie Eleveld, John Vulule, Richard Rheingans, Kayla F Laserson, Aisha Mohammed, and Penelope A Phillips-Howard
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Medicine ,Science - Abstract
BACKGROUND:Keeping girls in school offers them protection against early marriage, teen pregnancy, and sexual harms, and enhances social and economic equity. Studies report menstruation exacerbates school-drop out and poor attendance, although evidence is sparse. This study qualitatively examines the menstrual experiences of young adolescent schoolgirls. METHODS AND FINDINGS:The study was conducted in Siaya County in rural western Kenya. A sample of 120 girls aged 14-16 years took part in 11 focus group discussions, which were analysed thematically. The data gathered were supplemented by information from six FGDs with parents and community members. Emergent themes were: lack of preparation for menarche; maturation and sexual vulnerability; menstruation as an illness; secrecy, fear and shame of leaking; coping with inadequate alternatives; paying for pads with sex; and problems with menstrual hygiene. Girls were unprepared and demonstrated poor reproductive knowledge, but devised practical methods to cope with menstrual difficulties, often alone. Parental and school support of menstrual needs is limited, and information sparse or inaccurate. Girls' physical changes prompt boys and adults to target and brand girls as ripe for sexual activity including coercion and marriage. Girls admitted 'others' rather than themselves were absent from school during menstruation, due to physical symptoms or inadequate sanitary protection. They described difficulties engaging in class, due to fear of smelling and leakage, and subsequent teasing. Sanitary pads were valued but resource and time constraints result in prolonged use causing chafing. Improvised alternatives, including rags and grass, were prone to leak, caused soreness, and were perceived as harmful. Girls reported 'other girls' but not themselves participated in transactional sex to buy pads, and received pads from boyfriends. CONCLUSIONS:In the absence of parental and school support, girls cope, sometimes alone, with menarche in practical and sometimes hazardous ways. Emotional and physical support mechanisms need to be included within a package of measures to enable adolescent girls to reach their potential.
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- 2013
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25. Exploring risk perception and attitudes to miscarriage and congenital anomaly in rural Western Kenya.
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Stephanie Dellicour, Meghna Desai, Linda Mason, Beatrice Odidi, George Aol, Penelope A Phillips-Howard, Kayla F Laserson, and Feiko O Ter Kuile
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Medicine ,Science - Abstract
Understanding the socio-cultural context and perceptions of adverse pregnancy outcomes is important for informing the best approaches for public health programs. This article describes the perceptions, beliefs and health-seeking behaviours of women from rural western Kenya regarding congenital anomalies and miscarriages.Ten focus group discussions (FGDs) were undertaken in a rural district in western Kenya in September 2010. The FGDs included separate groups consisting of adult women of childbearing age, adolescent girls, recently pregnant women, traditional birth attendants and mothers of children with a birth defect. Participants were selected purposively. A deductive thematic framework approach using the questions from the FGD guides was used to analyse the transcripts.There was substantial overlap between perceived causes of miscarriages and congenital anomalies and these were broadly categorized into two groups: biomedical and cultural. The biomedical causes included medications, illnesses, physical and emotional stresses, as well as hereditary causes. Cultural beliefs mostly related to the breaking of a taboo or not following cultural norms. Mothers were often stigmatised and blamed following miscarriage, or the birth of a child with a congenital anomaly. Often, women did not seek care following miscarriage unless there was a complication. Most reported that children with a congenital anomaly were neglected either because of lack of knowledge of where care could be sought or because these children brought shame to the family and were hidden from society.The local explanatory model of miscarriage and congenital anomalies covered many perceived causes within biomedical and cultural beliefs. Some of these fuelled stigmatisation and blame of the mother. Understanding of these beliefs, improving access to information about the possible causes of adverse outcomes, and greater collaboration between traditional healers and healthcare providers may help to reduce stigma and increase access to formal healthcare providers.
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- 2013
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26. Cost-Effectiveness and Cost–Benefit Analyses of Providing Menstrual Cups and Sanitary Pads to Schoolgirls in Rural Kenya
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Masih A. Babagoli, Anja Benshaul-Tolonen, Garazi Zulaika, Elizabeth Nyothach, Clifford Oduor, David Obor, Linda Mason, Emily Kerubo, Isaac Ngere, Kayla F. Laserson, Rhiannon Tudor Edwards, and Penelope A. Phillips-Howard
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wa_30 ,wa_546 ,wp_20 ,wa_670 ,General Agricultural and Biological Sciences ,ws_450 - Abstract
Objective: To analyze the relative value of providing menstrual cups and sanitary pads to primary schoolgirls.\ud \ud Design: Cost-effectiveness and cost–benefit analyses of three-arm single-site open cluster randomized controlled pilot study providing menstrual cups or sanitary pads for 1 year.\ud \ud Participants: Girls 14–16 years of age enrolled across 30 primary schools in rural western Kenya.\ud \ud Methods: Cost-effectiveness analysis was conducted based on the health effects (reductions in disability-adjusted life years [DALYs]) and education effects (reductions in school absenteeism) of both interventions. The health and education benefits were separately valued and compared with relative program costs.\ud \ud Results: Compared with the control group, the cost of menstrual cups was estimated at $3,270 per year for 1000 girls, compared with $24,000 for sanitary pads. The benefit of the menstrual cup program (1.4 DALYs averted, 95% confidence interval [CI]: −4.3 to 3.1) was higher compared with a sanitary pad program (0.48 DALYs averted, 95% CI: −4.2 to 2.3), but the health effects of both interventions were not statistically significant likely due to the limited statistical power. Using point estimates, the menstrual cup intervention was cost-effective in improving health outcomes ($2,300/DALY averted). The sanitary pad intervention had a cost-effectiveness of $300/student-school year in reducing school absenteeism. When considering improvements in future earnings from reduced absenteeism, the sanitary pad program had a net benefit of +$68,000 (95% CI: −$32,000 to +$169,000).\ud \ud Conclusions: The menstrual cup may provide a cost-effective solution for menstrual hygiene management in low-income settings. This study outlines a methodology for future analyses of menstrual hygiene interventions and highlights several knowledge gaps that need to be addressed.
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- 2022
27. The Causal Impact of Sanitary Products on School Absenteeism and Psychosocial Well-Being: Evidence from Western Kenya
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Anja Tolonen, Garazi Zulaik, Elizabeth Nyothach, Clifford Odour, Linda Mason, David Obor, Kelly T. Alexander, K La, and Penelope A. Phillips-Howard
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History ,Polymers and Plastics ,Business and International Management ,Industrial and Manufacturing Engineering - Published
- 2022
28. UKPMC: a full text article resource for the life sciences.
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Johanna R. McEntyre, Sophia Ananiadou, Stephen Andrews, William J. Black, Richard Boulderstone, Paula Buttery, David Chaplin, Sandeepreddy Chevuru, Norman Cobley, Lee-Ann Coleman, Paul Davey, Bharti Gupta, Lesley Haji-Gholam, Craig Hawkins, Alan Horne, Simon J. Hubbard, Jee-Hyub Kim, Ian Lewin, Vic Lyte, Ross MacIntyre, Sami Mansoor, Linda Mason, John McNaught, Elizabeth Newbold, Chikashi Nobata, Ernest Ong, Sharmila Pillai, Dietrich Rebholz-Schuhmann, Heather Rosie, Rob Rowbotham, C. J. Rupp, Peter Stoehr, and Philip Vaughan
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- 2011
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29. Systems modelling and simulation to inform strategic decision making for suicide prevention in rural New South Wales (Australia)
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Adam Skinner, Mark Heffernan, Dianne Currier, Jo-An Atkinson, Kylie King, Linda Mason, Sue Hackney, and Jane Pirkis
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Strategic planning ,Government ,Economic growth ,Decision Making ,Australia ,Suicide, Attempted ,General Medicine ,Suicide prevention ,Mental health ,030227 psychiatry ,03 medical and health sciences ,Psychiatry and Mental health ,Mental Health ,0302 clinical medicine ,Political science ,Strategic decision making ,Humans ,030212 general & internal medicine ,New South Wales ,Rural area - Abstract
Background: The need to understand and respond to the unique characteristics and drivers of suicidal behaviour in rural areas has been enabled through the Australian Government’s 2015 mental health reforms facilitating a move to an evidence-based, regional approach to suicide prevention. However, a key challenge has been the complex decision-making environment and lack of appropriate tools to facilitate the use of evidence, data and expert knowledge in a way that can inform contextually appropriate strategies that will deliver the greatest impact. This paper reports the co-development of an advanced decision support tool that enables regional decision makers to explore the likely impacts of their decisions before implementing them in the real world. Methods: A system dynamics model for the rural and remote population catchment of Western New South Wales was developed. The model was based on defined pathways to mental health care and suicidal behaviour and reproduced historic trends in the incidence of attempted suicide (self-harm hospitalisations) and suicide deaths in the region. A series of intervention scenarios were investigated to forecast their impact on suicidal behaviour over a 10-year period. Results: Post-suicide attempt assertive aftercare was forecast to deliver the greatest impact, reducing the numbers of self-harm hospitalisations and suicide deaths by 5.65% (95% interval, 4.87−6.42%) and 5.45% (4.68−6.22%), respectively. Reductions were also projected for community support programs (self-harm hospitalisations: 2.83%, 95% interval 2.23−3.46%; suicide deaths: 4.38%, 95% interval 3.78−5.00%). Some scenarios produced unintuitive impacts or effect sizes that were significantly lower than what has been anticipated under the traditional evidence-based approach to suicide prevention and provide an opportunity for learning. Conclusion: Systems modelling and simulation offers significant potential for regional decision makers to better understand and respond to the unique characteristics and drivers of suicidal behaviour in their catchments and more effectively allocate limited health resources.
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- 2020
30. Menstrual cups and cash transfer to reduce sexual and reproductive harm and school dropout in adolescent schoolgirls: study protocol of a cluster-randomised controlled trial in western Kenya
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Emily Zielinski-Gutierrez, Carl Henry, Annemieke van Eijk, Godfrey Bigogo, Penelope A. Phillips-Howard, Isaac Ngere, Boaz Oyaro, Emily Kerubo, Jane Juma, Louis W. Niessen, Elizabeth Nyothach, Clayton Onyango, David Obor, Maxwell Majiwa, Daniel Kwaro, Tao Chen, Alie Eleveld, Feiko O. ter Kuile, Linda Mason, Garazi Zulaika, Cheryl Pace, Duolao Wang, APH - Global Health, Graduate School, and AII - Infectious diseases
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medicine.medical_specialty ,Adolescent ,Student Dropouts ,Sexual and reproductive health ,education ,Psychological intervention ,HIV Infections ,Transactional sex ,wa_20_5 ,law.invention ,Study Protocol ,03 medical and health sciences ,0302 clinical medicine ,Harm Reduction ,Randomized controlled trial ,law ,Pregnancy ,medicine ,Humans ,030212 general & internal medicine ,Cluster randomised controlled trial ,Menstrual Hygiene Products ,Reproductive health ,Herpes Genitalis ,030505 public health ,School dropout ,business.industry ,Public health ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,HIV ,wp_400 ,lcsh:RA1-1270 ,wp_100 ,Public Assistance ,Equity ,HSV-2 ,Kenya ,Menstruation ,Adolescence ,Clinical trial ,Menstrual cup ,Research Design ,Family medicine ,Female ,wa_309 ,Biostatistics ,0305 other medical science ,business - Abstract
Background Adolescent girls in sub-Saharan Africa are disproportionally vulnerable to sexual and reproductive health (SRH) harms. In western Kenya, where unprotected transactional sex is common, young females face higher rates of school dropout, often due to pregnancy, and sexually transmitted infections (STIs), including HIV. Staying in school has shown to protect girls against early marriage, teen pregnancy, and HIV infection. This study evaluates the impact of menstrual cups and cash transfer interventions on a composite of deleterious outcomes (HIV, HSV-2, and school dropout) when given to secondary schoolgirls in western Kenya, with the aim to inform evidence-based policy to improve girls’ health, school equity, and life-chances. Methods Single site, 4-arm, cluster randomised controlled superiority trial. Secondary schools are the unit of randomisation, with schoolgirls as the unit of measurement. Schools will be randomised into one of four intervention arms using a 1:1:1:1 ratio and block randomisation: (1) menstrual cup arm; (2) cash transfer arm, (3) cups and cash combined intervention arm, or (4) control arm. National and county agreement, and school level consent will be obtained prior to recruitment of schools, with parent consent and girls’ assent obtained for participant enrolment. Participants will be trained on safe use of interventions, with all arms receiving puberty and hygiene education. Annually, the state of latrines, water availability, water treatment, handwashing units and soap in schools will be measured. The primary endpoint is a composite of incident HIV, HSV-2, and all-cause school dropout, after 3 years follow-up. School dropout will be monitored each term via school registers and confirmed through home visits. HIV and HSV-2 incident infections and risk factors will be measured at baseline, mid-line and end-line. Intention to treat analysis will be conducted among all enrolled participants. Focus group discussions will provide contextual information on uptake of interventions. Monitoring for safety will occur throughout. Discussion If proved safe and effective, the interventions offer a potential contribution toward girls’ schooling, health, and equity in low- and middle-income countries. Trial registration ClinicalTrials.gov NCT03051789, 15th February 2017.
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- 2019
31. Exploring menstrual products: A systematic review and meta-analysis of reusable menstrual pads for public health internationally
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Penelope A. Phillips-Howard, Anna Maria van Eijk, Linda Mason, Muthusamy Sivakami, Naduni Jayasinghe, Holger W. Unger, Garazi Zulaika, and Ravindran, Balasubramani
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Sanitation ,Economics ,Physiology ,Social Sciences ,Economic Geography ,Cohort Studies ,Sociology ,Average price ,Forest plot ,Medicine and Health Sciences ,Psychology ,Refugees ,Multidisciplinary ,Schools ,Geography ,wa_900 ,wp_400 ,Qualitative Studies ,Body Fluids ,Chemistry ,Blood ,Menstrual Product ,Research Design ,Meta-analysis ,Cohort ,Physical Sciences ,Medicine ,Low and Middle Income Countries ,Sensory Perception ,Female ,wa_309 ,Public Health ,Anatomy ,Cohort study ,Research Article ,medicine.medical_specialty ,wa_950 ,Science ,wa_395 ,Soaps ,Research and Analysis Methods ,Education ,Environmental health ,medicine ,Humans ,Menstrual Hygiene Products ,Demography ,business.industry ,Public health ,Pruritus ,Chemical Compounds ,Cognitive Psychology ,Biology and Life Sciences ,wp_100 ,People and Places ,Earth Sciences ,Cognitive Science ,Salts ,Perception ,business ,Neuroscience - Abstract
Background Girls and women need effective, safe, and affordable menstrual products. Single-use menstrual pads and tampons are regularly provided by agencies among resource-poor populations. Reusable menstrual pads (RMPs: fabric layers sewn together by an enterprise for manufacture of menstrual products) may be an effective alternative. Methods For this review (PROSPERO CRD42020179545) we searched databases (inception to November 1, 2020) for quantitative and qualitative studies that reported on leakage, acceptability, or safety of RMPs. Findings were summarised or combined using forest plots (random-effects meta-analysis). Potential costs and environmental savings associated with RMPs were estimated. Results A total of 44 studies were eligible (~14,800 participants). Most were conducted in low- and middle-income countries (LMIC, 78%), and 20% in refugee settings. The overall quality of studies was low. RMP uptake in cohort studies ranged from 22–100% (12 studies). One Ugandan trial among schoolgirls found leakage with RMPs was lower (44.4%, n = 72) compared to cloths (78%, n = 111, p Conclusion RMPs are used internationally and are an effective, safe, cheaper, and environmentally friendly option for menstrual product provision by programmes. Good quality studies in this field are needed.
- Published
- 2021
32. Impact of COVID-19 lockdowns on adolescent pregnancy and school dropout among secondary schoolgirls in Kenya
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Garazi Zulaika, Miriam Bulbarelli, Elizabeth Nyothach, Annemieke van Eijk, Linda Mason, Eunice Fwaya, David Obor, Daniel Kwaro, Duolao Wang, Supriya D Mehta, and Penelope A Phillips-Howard
- Subjects
Medicine (General) ,Adolescent ,SARS-CoV-2 ,Student Dropouts ,Health Policy ,public health ,education ,Public Health, Environmental and Occupational Health ,COVID-19 ,Infectious and parasitic diseases ,RC109-216 ,maternal health ,Kenya ,R5-920 ,Pregnancy ,Communicable Disease Control ,Pregnancy in Adolescence ,Humans ,Female ,Pandemics ,Original Research - Abstract
IntroductionSecondary school closures aimed at limiting the number of infections and deaths due to COVID-19 may have amplified the negative sexual and reproductive health (SRH) and schooling outcomes of vulnerable adolescent girls. This study aimed to measure pandemic-related effects on adolescent pregnancy and school dropout among school-going girls in Kenya.MethodsWe report longitudinal findings of 910 girls in their last 2 years of secondary school. The study took place in 12 secondary day schools in rural western Kenya between 2018 and 2021. Using a causal-comparative design, we compared SRH and schooling outcomes among 403 girls who graduated after completion of their final school examinations in November 2019 pre-pandemic with 507 girls who experienced disrupted schooling due to COVID-19 and sat examinations in March 2021. Unadjusted and adjusted generalised linear mixed models were used to investigate the effect of COVID-19-related school closures and restrictions on all outcomes of interest and on incident pregnancy.ResultsAt study initiation, the mean age of participants was 17.2 (IQR: 16.4–17.9) for girls in the pre-COVID-19 cohort and 17.5 (IQR: 16.5–18.4) for girls in the COVID-19 cohort. Girls experiencing COVID-19 containment measures had twice the risk of falling pregnant prior to completing secondary school after adjustment for age, household wealth and orphanhood status (adjusted risk ratio (aRR)=2.11; 95% CI:1.13 to 3.95, p=0.019); three times the risk of school dropout (aRR=3.03; 95% CI: 1.55 to 5.95, p=0.001) and 3.4 times the risk of school transfer prior to examinations (aRR=3.39; 95% CI: 1.70 to 6.77, p=0.001) relative to pre-COVID-19 learners. Girls in the COVID-19 cohort were more likely to be sexually active (aRR=1.28; 95% CI: 1.09 to 1.51, p=0.002) and less likely to report their first sex as desired (aRR=0.49; 95% CI: 0.37 to 0.65, pConclusionThe COVID-19 pandemic deleteriously affected the SRH of girls and amplified school transfer and dropout. Appropriate programmes and interventions that help buffer the effects of population-level emergencies on school-going adolescents are warranted.Trial registration numberNCT03051789.
- Published
- 2022
33. Investigation of the Environmental and Socio-Economic Characteristics of Counties with a High Asthma Burden to Focus Asthma Action in Utah
- Author
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Ruth Kerry, Maureen Vowles, Linda Mason, and Ben Ingram
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Regression-kriging ,elevation ,Health, Toxicology and Mutagenesis ,air pollution ,Air pollution ,Psychological intervention ,lcsh:Medicine ,010501 environmental sciences ,medicine.disease_cause ,01 natural sciences ,0302 clinical medicine ,Utah ,Socioeconomics ,mine dust ,media_common ,wa_30 ,Air Pollutants ,public health ,asthma emergency room visits ,Geography ,fine particulate matter ,aridity ,wf_600 ,altitude ,wa_754 ,Adult ,medicine.medical_specialty ,Inequality ,media_common.quotation_subject ,PM2.5 ,Disease cluster ,Article ,smoking ,inversion ,03 medical and health sciences ,medicine ,Humans ,Air quality index ,adult asthma prevalence ,0105 earth and related environmental sciences ,Asthma ,Public health ,lcsh:R ,Public Health, Environmental and Occupational Health ,asthma ,medicine.disease ,wf_20 ,desert dust ,Socioeconomic Factors ,030228 respiratory system ,Particulate Matter - Abstract
Rising adult asthma prevalence (AAP) rates and asthma emergency room (AER) visits constitute a large burden on public health in Utah (UT), a high-altitude state in the Great Basin Desert, USA. This warrants an investigation of the characteristics of the counties with the highest asthma burden within UT to improve allocation of health resources and for planning. The relations between several predictor environmental, health behavior and socio-economic variables and two health outcome variables, AAP and AER visits, were investigated for UT&rsquo, s 29 counties. Non-parametric statistical comparison tests, correlation and linear regression analysis were used to determine the factors significantly associated with AER visits and AAP. Regression kriging with Utah small area data (USAD) as well as socio-economic and pollution data enabled local Moran&rsquo, s I cluster analysis and the investigation of moving correlations between health outcomes and risk factors. Results showed the importance of desert/mining dust and socio-economic status as AAP and AER visits were greatest in the south of the state, highlighting a marked north&ndash, south divide in terms of these factors within the state. USAD investigations also showed marked differences in pollution and socio-economic status associated with AAP within the most populous northern counties. Policies and interventions need to address socio-economic inequalities within counties and between the north and south of the state. Fine (PM2.5) and coarse (PM10) particulate matter monitors should be installed in towns in central and southern UT to monitor air quality as these are sparse, but in the summer, air quality can be worse here. Further research into spatiotemporal variation in air quality within UT is needed to inform public health interventions such as expanding clean fuel programs and targeted land-use policies. Efforts are also needed to examine barriers to routine asthma care.
- Published
- 2020
34. Factors associated with the prevalence of HIV, HSV-2, pregnancy, and reported sexual activity among adolescent girls in rural western Kenya: A cross-sectional analysis of baseline data in a cluster randomized controlled trial
- Author
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Daniel Kwaro, Penelope A. Phillips-Howard, Garazi Zulaika, Anna Maria van Eijk, Linda Mason, Samuel Omondi Owino, Elizabeth Nyothach, Emily Kerubo, Duolao Wang, David Obor, Feiko O. ter Kuile, Tao Chen, Valarie Opollo, Isaac Ngere, and Boaz Oyaro
- Subjects
RNA viruses ,Rural Population ,Pregnancy Rate ,Epidemiology ,Physiology ,Cross-sectional study ,Maternal Health ,Social Sciences ,HIV Infections ,Overweight ,Pathology and Laboratory Medicine ,Adolescents ,Families ,Endocrinology ,Sociology ,Immunodeficiency Viruses ,Pregnancy ,Reproductive Physiology ,Risk Factors ,Medicine and Health Sciences ,Prevalence ,Cluster Analysis ,Children ,Reproductive health ,education.field_of_study ,Schools ,Obstetrics and Gynecology ,General Medicine ,Medical Microbiology ,Herpes Simplex Virus-2 ,HIV epidemiology ,Viral Pathogens ,Viruses ,Cohort ,Menarche ,Medicine ,Female ,Pathogens ,medicine.symptom ,Research Article ,Herpesviruses ,Sociodemographic Factors ,Adolescent ,Sexual Behavior ,Population ,Microbiology ,Education ,Retroviruses ,medicine ,Humans ,education ,Microbial Pathogens ,Menstrual Cycle ,Herpes Genitalis ,Endocrine Physiology ,business.industry ,Lentivirus ,Organisms ,Biology and Life Sciences ,HIV ,medicine.disease ,Kenya ,Herpes Simplex Virus ,Cross-Sectional Studies ,Age Groups ,Adolescent Behavior ,Medical Risk Factors ,Relative risk ,People and Places ,Women's Health ,Population Groupings ,DNA viruses ,business ,Demography - Abstract
Background Adolescence is a sensitive time for girls’ sexual and reproductive health (SRH), as biological changes occur concurrently with heightening pressures for sexual activity. In western Kenya, adolescent girls are vulnerable to acquiring sexually transmitted infections (STIs), such as HIV and herpes simplex virus type 2 (HSV-2), and to becoming pregnant prior to reaching adulthood. This study examines associations between individual, household, and partner-related risk factors and the prevalence of sex, adolescent pregnancy, HIV, and HSV-2. Methods and findings We report baseline findings among 4,138 girls attending secondary school who were enrolled between 2017 and 2018 in the Cups or Cash for Girls (CCG) cluster randomized controlled trial in Siaya County, rural western Kenya. Laboratory confirmed biomarkers and survey data were utilized to assess the effects of girls’ individual, household, and partner characteristics on the main outcome measures (adolescent reported sex, prior pregnancy, HIV, and HSV-2) through generalized linear model (GLM) analysis. Complete data were available for 3,998 girls (97%) with median age 17.1 years (interquartile range [IQR] 16.3 to 18.0 years); 17.2% were HSV-2 seropositive (n = 686) and 1.7% tested positive for HIV (n = 66). Sexual activity was reported by 27.3% girls (n = 1,090), of whom 12.2% had been pregnant (n = 133). After adjustment, orphanhood (adjusted risk ratio [aRR] 2.81, 95% confidence interval [CI] 1.18 to 6.71, p-value [p] = 0.020), low body mass index (BMI) (aRR 2.07; CI: 1.00 to 4.30, p = 0.051), and age (aRR 1.34, 1.18 to 1.53, p < 0.001) were all associated with HIV infection. Girls reporting light menstrual bleeding (aRR 2.42, 1.22 to 4.79, p = 0.012) for fewer than 3 days (aRR 2.81, 1.16 to 6.82, p = 0.023) were over twice as likely to have HIV. Early menarche (aRR 2.05, 1.33 to 3.17, p = 0.001) was associated with adolescent pregnancy and HSV-2–seropositive girls reported higher rates of pregnancy (aRR 1.62, CI: 1.16 to 2.27, p = 0.005). High BMI was associated with HSV-2 (aRR 1.24, 1.05 to 1.46, p = 0.010) and sexual activity (aRR 1.14, 1.02 to 1.28, p = 0.016). High levels of harassment were detected in the cohort (41.2%); being touched indecently conveyed the strongest association related to reported sexual activity (aRR 2.52, 2.26 to 2.81, p < 0.001). Study limitations include the cross-sectional design of the study, which informs on the SRH burdens found in this population but limits causal interpretation of associations, and the self-reported exposure ascertainment, which may have led to possible underreporting of risk factors, most notably prior sexual activity. Conclusions Our findings indicate that adolescent girls attending school in Kenya face frequent harassment for sex and are at high risk of pregnancy and HSV-2, with girls experiencing early menarche particularly vulnerable. Targeted interventions, such as earlier sexual education programs, are warranted to address their vulnerability to SRH harms. Trial registration ClinicalTrials.gov NCT03051789., In a cross sectional analysis, Garazi Zulaika and colleagues study associations between risk factors and prevalence of sexual activity, pregnancy, and HIV and HSV-2 infections among adolescent girls in rural Kenya., Author summary Why was this study done? Girls in low- and middle-income countries (LMICs) face severe health risks from becoming pregnant prior to reaching adulthood and from exposure to sexually transmitted infections (STIs) such as HIV and herpes simplex virus type 2 (HSV-2). Key factors found to be linked to adolescent sexual and reproductive health (SRH) in LMICs include household wealth, age at first sex, and schooling. Evidence of a positive association between girls’ SRH, and their education and economic potential has strengthened international resolve to identify risks and improve conditions that adolescent girls face in these settings. What did the researchers do and find? We collected data from 3,998 girls attending 96 public secondary day schools in 2017 and 2018 as part of the baseline assessment of a randomized controlled study. We explored whether girls’ personal characteristics were associated with SRH harms, namely adolescent sex, early pregnancy, and acquisition of HIV and HSV-2. We found biological factors including girls experiencing early menarche, having lighter periods, and body mass index (BMI); household level factors including being unhappy at home, being orphaned, and coming from poorer households; and social factors including experiencing harassment for sex both in and out of school or being touched indecently were significantly associated with girls’ sexual and reproductive harms, such as pregnancy, HSV-2, and/or HIV. What do these findings mean? These findings illustrate that the burden of SRH harms faced by adolescent girls attending school in rural western Kenya is high. Interventions and programs to improve SRH and continued education need to address both environmental and biological risk factors among vulnerable populations.
- Published
- 2021
35. Pregnancy and marriage among teenage schoolgirls in rural western Kenya; a secondary analysis of a menstrual solution feasibility COHORT study
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David Obor, Eleanor Ambrose, Linda Mason, Anna vanEijk, Penelope A. Phillips-Howard, Kayla Laseron, Elizabeth Nyothach, Garazi Zulaika, and Clifford Odour
- Subjects
Longitudinal study ,Pregnancy ,medicine.medical_specialty ,Social stigma ,business.industry ,Public health ,Psychological intervention ,wa_395 ,wa_310 ,medicine.disease ,Relative risk ,Child marriage ,Medicine ,wq_200 ,wa_19 ,ws_460 ,business ,Demography ,Cohort study - Abstract
Background: Adolescent pregnancy increases the risk of adverse health outcomes, social stigma, loss of education and employment, and early marriage. Research characterising at risk girls will inform targeting of effective interventions.Methods: Risk characteristics for adolescent pregnancy were evaluated in schoolgirls aged 14-16 years as a secondary analysis in a longitudinal study evaluating menstrual products in 30 primary schools in rural western Kenya. Characteristics of participants were collected at baseline and follow-up. Descriptive and multivariate analysis were conducted.Results: Of 766 girls enrolled into the study, aged 14-16 years and followed over a school year, 53 (7%) were or became pregnant, with three (6%) neonatal deaths reported. Girls with the lowest compared with the highest socio-economic status had 2.5-fold higher risk of pregnancy (13.1% vs 5.0%: adjusted risk ratio (aRR) 2.48, confidence limits 1.32-4.64). Girls reporting early menarche (
- Published
- 2021
36. A Roadmap for Transparent Research in Special Education and Related Disciplines
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Jill L. Adelson, Erin Barton, Catherine Bradshaw, Brian Bryant, Diane Bryant, Bryan G. Cook, Michael Coyne, Laurie DeBettencourt, Alexander Carl DeHaven, Stacy Dymond, Jolene Esposito, Thomas Farmer, Jessica Kay Flake, Nicholas A Gage, Michael Kennedy, Lee Kern, Kathleen Lynne Lane, David Lee, Erica Lembke, Felice Levine, John Wills Lloyd, Daniel Maggin, Lawrence Maheady, Matthew C. Makel, Linda Mason, Michael S. Matthews, Valerie L Mazzotti, David Thomas Mellor, Brian A. Nosek, Tyler L Renshaw, Rabia Anne Rabia Anne, Karrie Shogren, Courtney K. Soderberg, Emily Solari, Fred Spooner, Frank Symons, Elizabeth Talbott, Dave Test, William Therrien, James Thompson, Jason C Travers, and Gary Alan Troia
- Abstract
In this manuscript, we (a) briefly describe proposed open-science practices to increase transparency of research in special education and related disciplines, and (b) provide recommendations for research funders, professional societies, journal editors and publishers, and individual researchers to support awareness, exploration, and adoption of open science.
- Published
- 2019
37. Journal of Inclusive Postsecondary Education, Volume 1, Issue 1
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Kellar Institute for Human DisAbilities, George Mason University, Beth Myers, Heidi Graff, and Linda Mason
- Published
- 2019
- Full Text
- View/download PDF
38. Effect of menstruation on girls and their schooling, and facilitators of menstrual hygiene management in schools: surveys in government schools in three states in India, 2015
- Author
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Muthusamy Sivakami, Mamita Bora Thakkar, Harshad Thakur, Narendra Kakade, Kelly T. Alexander, Chetan Patil, Anna Maria van Eijk, Sharayu Shinde, Linda Mason, Yusuf Kabir, Penelope A. Phillips-Howard, Prathiba Singh, Bharathy Tahiliani, Arun Dobhal, Kayla F. Laserson, Nikita Surani, Ashley Bauman, and Garazi Zulaika
- Subjects
Health Knowledge, Attitudes, Practice ,Multivariate analysis ,Adolescent ,media_common.quotation_subject ,030231 tropical medicine ,education ,Psychological intervention ,India ,Menstruation ,03 medical and health sciences ,0302 clinical medicine ,Hygiene ,Surveys and Questionnaires ,Absenteeism ,Medicine ,Humans ,030212 general & internal medicine ,Menstrual Hygiene Products ,media_common ,Public Sector ,Schools ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Articles ,language.human_language ,Stratified sampling ,Tamil ,Menarche ,language ,Female ,business ,Demography - Abstract
Background Lack of menstrual knowledge, poor access to sanitary products and a non-facilitating school environment can make it difficult for girls to attend school. In India, interventions have been developed to reduce the burden of menstruation for school girls by government and non-governmental organizations (NGOs). We sought to identify challenges related to menstruation, and facilitators of menstrual management in schools in three states in India. Methods Surveys were conducted among menstruating school girls in class 8-10 (above 12 years of age) of 43 government schools selected through stratified random sampling in three Indian states (Maharashtra, Chhattisgarh, Tamil Nadu) in 2015. For comparison, ten model schools supported by NGOs or UNICEF with a focussed menstrual hygiene education program were selected purposely in the same states to represent the better-case scenario. We examined awareness about menarche, items used for menstruation, and facilitators on girls’ experience of menstruation in regular schools and compared with model schools. Factors associated with school absence during menstruation were explored using multivariate analysis. Findings More girls (mean age 14.1 years) were informed about menstruation before menarche in model schools (56%, n = 492) than in regular schools (36%, n = 2072, P
- Published
- 2018
39. Clean green: did you know that vinegar is great for wiping down counters? Read about natural cleaning agents that keep your home--and your kids--toxin-free
- Author
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Hunter, Linda Mason
- Subjects
Vinegar -- Usage ,House cleaning -- Methods - Abstract
WE ALL HAVE at least an inkling that conventional cleaners are among the most harmful products we can bring into our houses. Still, when looking for more natural choices, it's […]
- Published
- 2007
40. Syphilis sero-positivity among pregnant women attending public antenatal clinics: A five-year analysis from 15 public clinics in Gaborone, Botswana
- Author
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Langalibalele H. Mabuza, Adewale B. Ganiyu, and Linda Mason
- Subjects
Antenatal clinics ,medicine.medical_specialty ,Pregnancy ,Pediatrics ,030505 public health ,medicine.diagnostic_test ,Obstetrics ,business.industry ,medicine.disease ,Age specific ,Rapid plasma reagin ,Sero prevalence ,03 medical and health sciences ,0302 clinical medicine ,Age groups ,medicine ,Syphilis ,030212 general & internal medicine ,0305 other medical science ,business - Abstract
Background: The prevalence of syphilis in pregnancy varies across the globe and among different age groups within the same country. In sub-Saharan Africa, syphilis prevalence among pregnant women has been found to range from 2.5 to 18% among antenatal clinic attendees, with the highest prevalence in the age group 35–49 years. Also, it is higher in the rural than urban clinics.Objectives: To determine trends in syphilis prevalence using the Venereal Disease Research Laboratory (VDRL) and the Rapid Plasma Reagin (RPR) test among pregnant women attending the public antenatal clinics in Gaborone, Botswana (2004–2008).Study design: Cross-sectional study using routinely collected antenatal data.Results: The overall syphilis prevalence amongst pregnant women in Gaborone, Botswana decreased from 2.96% (95% CI, 2.55–3.37) in 2004 to 1.15% (95% CI, 0.89–1.41) in 2008 (p
- Published
- 2016
41. Handwashing for menstrual hygiene management among primary schoolgirls in rural western Kenya
- Author
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Kelvin Oruko, Frank Odhiambo, Penelope A. Phillips-Howard, John M. Vulule, Kelly T. Alexander, Elizabeth Nyothach, Kayla F. Laserson, Cliff I. Oduor, and Linda Mason
- Subjects
medicine.medical_specialty ,Pediatrics ,Sanitation ,business.industry ,media_common.quotation_subject ,education ,Alternative medicine ,Focus group ,Educational attainment ,law.invention ,Menstrual hygiene ,Menstrual cup ,law ,Hygiene ,Environmental health ,medicine ,Observational study ,business ,Water Science and Technology ,media_common - Abstract
Good hand hygiene contributes to the health and educational attainment of schoolchildren. Poor menstrual hygiene management (MHM) is recognized to impact on girls’ health, education, wellbeing and dignity, particularly in low-income countries. Identifying practical, affordable, and comfortable menstrual products to improve girls’ MHM is needed. One potential cost-effective product is the menstrual cup; however, provision of this insertable MHM product, in schools in low-income countries with challenging water, sanitation and hygiene (WASH) conditions, increases the need for assurance of good hand hygiene. This paper uses data from a randomized controlled feasibility study evaluating the acceptability, use and safety of menstrual hygiene products provided to schoolgirls in rural western Kenya. Here, we explore girls’ handwashing practices in school when using menstrual cups, sanitary pads or traditional items, examining the availability of WASH and the reported frequency of handwashing. Data generated from interviews with adults, girls’ private surveys, narratives from focus group discussions, and observational WASH surveys are explored. Reported presence of WASH was higher than that observed during random spot-checks. Overall, 10 per cent of girls never washed before, and 7 per cent never washed after, emptying or changing their menstrual item at school. Girls in cup schools were twice as likely to wash prior to emptying, compared with girls using other items. Handwashing among girls using traditional items was low, despite the same hand hygiene training across groups and a comparable WASH presence. Data highlight the need for sustained mechanisms to support schoolgirls’ handwashing practices for MHM.
- Published
- 2015
42. Schoolgirls’ experiences of changing and disposal of menstrual hygiene items and inferences for WASH in schools
- Author
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Kelvin Oruko, Penelope A. Phillips-Howard, Cliff I. Oduor, John M. Vulule, Kelly T. Alexander, Linda Mason, Kayla F. Laserson, Elizabeth Nyothach, and Frank Odhiambo
- Subjects
Menstrual hygiene ,Sanitation ,business.industry ,Environmental health ,Accidental ,Medicine ,Latrine ,Operations management ,business ,Quarter (United States coin) ,Water Science and Technology - Abstract
Menstrual hygiene management (MHM) challenges during changing and disposal of menstrual items are important in low-income countries (LICs) where schools lack sufficient water and sanitation. Changing in poorly maintained latrines may expose girls to excrement and infection. We examine the frequency of dropping menstrual items and disposal of waste by schoolgirls in a menstrual solutions feasibility study in western Kenya. Drops when changing were reported in 17 per cent (20 per cent
- Published
- 2015
43. Gift from the sea: in a stylish, West Indies-flavored carriage house by the sea, Florida beach life is relished at its easiest and breeziest
- Author
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Hunter, Linda Mason
- Subjects
Vacation homes -- Decoration and finishing ,Home and garden - Abstract
A carriage house inspired by a Louisiana bayou plantation house serves as a vacation hideaway in the planned town of Rosemary Beach, FL. The house is a simple cube with a pyramid roof and is furnished for simple yet sophisticated comfort.
- Published
- 2001
44. ‘We do not know’: a qualitative study exploring boys perceptions of menstruation in India
- Author
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Harshad Thakur, Penelope A. Phillips-Howard, Kayla F. Laserson, Kelly T. Alexander, Muthusamy Sivakami, Anna Maria van Eijke, Ashley Beauman, Linda Mason, Mamita Bora Thakkar, and Narendra Kakade
- Subjects
Male ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Adolescent ,media_common.quotation_subject ,Reproductive medicine ,India ,Qualitative property ,lcsh:Gynecology and obstetrics ,Developmental psychology ,03 medical and health sciences ,0302 clinical medicine ,Optimism ,wp_20 ,medicine ,Humans ,0501 psychology and cognitive sciences ,030212 general & internal medicine ,Health Education ,Curriculum ,lcsh:RG1-991 ,Qualitative Research ,media_common ,Boys ,wa_30 ,Poverty ,Research ,05 social sciences ,Obstetrics and Gynecology ,Men ,wp_400 ,wp_100 ,wp_101 ,Focus group ,Menstruation ,Reproductive Medicine ,Focus group discussions ,Perception ,Thematic analysis ,ws_460 ,Psychology ,050104 developmental & child psychology ,Qualitative research - Abstract
Background In low-middle income countries and other areas of poverty, menstrual hygiene management (MHM) can be problematic for women and girls. Issues include lack of knowledge about menstruation and MHM, and stigma around menstruation, also access to affordable and absorbent materials; privacy to change; adequate washing, cleaning and drying facilities; as well as appropriate and accessible disposal facilities. In order to effect change and tackle these issues, particularly in patriarchal societies, males may need to become advocates for MHM alongside women. However, little is known about their knowledge and attitudes towards menstruation, which may need addressing before they can assist in acting as advocates for change. The present study was undertaken to explore knowledge and attitudes about menstruation among adolescent boys across India, in order to gauge their potential to support their ‘sisters’. Methods The study was undertaken across three states in India, chosen a priori to represent the cultural and socio-economic diversity. Qualitative data using focus group discussions with 85 boys aged 13-17 years, from 8 schools, was gathered. Data were analysed using thematic analysis. Results The results were organised into three main themes, reflecting the key research questions: boys’ knowledge of menstruation, source of knowledge, and attitudes towards menstruation and menstruating girls. Knowledge comprised three aspects; biological function which were generally poorly understood; cultural rites which were recognized by all; and girls’ behaviour and demeanour, which were noted to be withdrawn. Some boys learnt about puberty and menstruation as part of the curriculum but had concerns this was not in-depth, or was missed out altogether. Most gathered knowledge from informal sources, from overhearing conversations or observing cultural rituals. Few boys openly displayed a negative attitude, although a minority voiced the idea that menstruation is a ‘disease’. Boys were mostly sympathetic to their menstruating sisters and wanted to support them. Conclusions These findings provide some optimism that males can become advocates in moving forward the MHM agenda. The reasons for this are twofold: boys were keen for knowledge about menstruation, searching information out despite societal norms being for them to remain ignorant, they were also largely sympathetic to their menstruating sisters and fellow classmates and understanding of the issues surrounding the need for good MHM.
- Published
- 2017
45. Water, Sanitation and Hygiene Conditions in Kenyan Rural Schools: Are Schools Meeting the Needs of Menstruating Girls?
- Author
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Elizabeth Nyothach, Frank Odhiambo, Nyaguara Amek, Kayla F. Laserson, Penelope A. Phillips-Howard, Richard Rheingans, Linda Mason, Aisha Mohammed, Alie Eleveld, Clifford Oduor, David Obor, Robert Quick, Caryl M. Beynon, Kelly T. Alexander, and Maurice Ombok
- Subjects
Kenya ,lcsh:Hydraulic engineering ,school ,education ,children ,water sanitation and hygiene ,NGOs ,Africa ,menstruation ,Sanitation ,media_common.quotation_subject ,030231 tropical medicine ,Geography, Planning and Development ,Psychological intervention ,wa_395 ,wa_670 ,Aquatic Science ,Biochemistry ,03 medical and health sciences ,lcsh:Water supply for domestic and industrial purposes ,0302 clinical medicine ,lcsh:TC1-978 ,wp_20 ,Environmental protection ,Hygiene ,Environmental health ,Medicine ,030212 general & internal medicine ,ws_450 ,Water Science and Technology ,media_common ,lcsh:TD201-500 ,wa_30 ,Potential impact ,business.industry ,4. Education ,1. No poverty ,3. Good health ,Menstrual hygiene ,Latrine ,wa_309 ,ws_460 ,business - Abstract
Water, sanitation and hygiene (WASH) programs in African schools have received increased attention, particularly around the potential impact of poor menstrual hygiene management (MHM) on equity for girls’ education. This study was conducted prior to a menstrual feasibility study in rural Kenya, to examine current WASH in primary schools and the resources available for menstruating schoolgirls. Cross-sectional surveys were performed in 62 primary schools during unannounced visits. Of these, 60% had handwashing water, 13% had washing water in latrines for menstruating girls, and 2% had soap. Latrines were structurally sound and 16% were clean. Most schools (84%) had separate latrines for girls, but the majority (77%) had no lock. Non-governmental organizations (NGOs) supported WASH in 76% of schools. Schools receiving WASH interventions were more likely to have: cleaner latrines (Risk Ratio (RR) 1.5; 95% Confidence Intervals [CI] 1.0, 2.1), handwashing facilities (RR 1.6, CI 1.1, 2.5), handwashing water (RR 2.7; CI 1.4, 5.2), and water in girls’ latrines (RR 4.0; CI 1.4, 11.6). Schools continue to lack essential WASH facilities for menstruating girls. While external support for school WASH interventions improved MHM quality, the impact of these contributions remains insufficient. Further support is required to meet international recommendations for healthy, gender-equitable schools.
- Published
- 2014
46. Meistroli Mathemateg CBAC TGAU: Uwch (Mastering Mathematics for WJEC GCSE: Higher Welsh-language Edition)
- Author
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Linda Mason, Roger Porkess, Linda Mason, and Roger Porkess
- Abstract
Help students get to grips with the new style examinations in Numeracy and Mathematics with books that build all the necessary skills to progress their learning and develop their problem-solving skills.- Provides one book for each tier ensuring full coverage, with mathematics only questions and chapters clearly highlighted so the specifications can be co-taught or taught separately as required- Organises topics into units so as to provide questions that build understanding and fluency enabling students to confidently tackle and solve real and interesting problems- Enables students to identify the appropriate remediation or extension steps they need in order to make the best progress, through easy to follow progression strands that help to identify gaps in learning- Offers a seamless five year progression when used in conjunction with KS3 MasteringMathematics
- Published
- 2016
47. Mastering Mathematics for WJEC GCSE Practice Book: Foundation
- Author
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Keith Pledger, Gareth Cole, Joe Petran, Linda Mason, Keith Pledger, Gareth Cole, Joe Petran, and Linda Mason
- Abstract
Exam Board: WJECLevel: GCSESubject: MathematicsFirst Teaching: September 2015First Exam: Summer 2017Provide structured support and extra practice with differentiated questions that focus on reasoning and problem-solving building the exam skills needed to succeed in the new GCSE specifications; developed by a team of expert authors with examining experience.- Develops confidence and supports independent learning with graduated exercises for each unit.- Builds fluency, problem-solving and reasoning skills with exam-style questions that build on previous learning.- Provides full coverage of the GCSE grade range with three books - matching the student books - meaning that content is focused at the right level for each student.
- Published
- 2016
48. The Effect of Primary Nursing on Nursing Quality Assurance
- Author
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Culpepper, Rebecca Clark, Richie, Mary Fern, Sinclair, Vaughn Gaston, Stephens, Nancy E., and Betz, Linda Mason
- Published
- 1986
- Full Text
- View/download PDF
49. Prevalence of reproductive tract infections and the predictive value of girls’ symptom-based reporting: findings from a cross-sectional survey in rural western Kenya
- Author
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Clement Zeh, Collins Odhiambo, Penelope A. Phillips-Howard, John M. Vulule, Ashley Bauman, Newton Otecko, Kelvin Oruko, Linda Mason, Kayla F. Laserson, Elizabeth Nyothach, and Emily Kerubo
- Subjects
Rural Population ,Health Knowledge, Attitudes, Practice ,Pediatrics ,Cross-sectional study ,Gonorrhea ,Prevalence ,Rural Health ,Reproductive Tract Infections ,0302 clinical medicine ,030212 general & internal medicine ,education.field_of_study ,Chlamydia ,Trichomoniasis ,Vaginosis, Bacterial ,Infectious Diseases ,Female ,wa_309 ,Bacterial vaginosis ,medicine.symptom ,Trichomonas Vaginitis ,ws_460 ,SEXUAL HEALTH ,AFRICA ,Vaginal discharge ,medicine.medical_specialty ,Adolescent ,Sexual Behavior ,030231 tropical medicine ,Population ,Sexually Transmitted Diseases ,Dermatology ,DIAGNOSIS ,26bc6fb8 ,Clinical ,03 medical and health sciences ,medicine ,Humans ,education ,Vaginal Smears ,business.industry ,Reproducibility of Results ,Chlamydia Infections ,medicine.disease ,Kenya ,wp_140 ,Cross-Sectional Studies ,Feasibility Studies ,Women's Health ,REPRODUCTIVE HEALTH ,business - Abstract
Objectives \ud Reproductive tract infections (RTIs), including sexually acquired, among adolescent girls is a public health concern, but few studies have measured prevalence in low-middle-income countries. The objective of this study was to examine prevalence in rural schoolgirls in Kenya against their reported symptoms.\ud \ud Methods\ud In 2013, a survey was conducted in 542 adolescent schoolgirls aged 14–17 years who were enrolled in a menstrual feasibility study. Vaginal self-swabbing was conducted after girls were interviewed face-to-face by trained nurses on symptoms. The prevalence of girls with symptoms and laboratory-confirmed infections, and the sensitivity, specificity, positive and negative predictive values of symptoms compared with laboratory results, were calculated.\ud \ud Results \ud Of 515 girls agreeing to self-swab, 510 answered symptom questions. A quarter (24%) reported one or more symptoms; most commonly vaginal discharge (11%), pain (9%) or itching (4%). Laboratory tests confirmed 28% of girls had one or more RTI. Prevalence rose with age; among girls aged 16–17 years, 33% had infections. Bacterial vaginosis was the most common (18%), followed by Candida albicans (9%), Chlamydia trachomatis (3%), Trichomonas vaginalis (3%) and Neisseria gonorrhoeae (1%). Reported symptoms had a low sensitivity and positive predictive value. Three-quarters of girls with bacterial vaginosis and C. albicans, and 50% with T. vaginalis were asymptomatic.\ud \ud Conclusions \ud There is a high prevalence of adolescent schoolgirls with RTI in rural Kenya. Public efforts are required to identify and treat infections among girls to reduce longer-term sequelae but poor reliability of symptom reporting minimises utility of symptom-based diagnosis in this population.\ud \ud Trial registration number: ISRCTN17486946.
- Published
- 2016
50. 'He is the one who is providing you with everything so whatever he says is what you do': A Qualitative Study on Factors Affecting Secondary Schoolgirls’ Dropout in Rural Western Kenya
- Author
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Penelope A. Phillips-Howard, Kelvin Oruko, Kayla F. Laserson, Linda Mason, Emily Zielinski-Gutierrez, John M. Vulule, Kelly T. Alexander, and Elizabeth Nyothach
- Subjects
Male ,Rural Population ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Science ,Student Dropouts ,Population ,education ,Psychological intervention ,Developmental psychology ,Pregnancy ,medicine ,Humans ,Socioeconomic status ,education.field_of_study ,wa_30 ,Multidisciplinary ,Poverty ,business.industry ,Kenya ,Pregnancy, Unwanted ,Focus group ,wa_320 ,Socioeconomic Factors ,Pregnancy in Adolescence ,Medicine ,Female ,wa_309 ,Rural area ,business ,ws_460 ,Student dropout ,Research Article ,Qualitative research - Abstract
Education is an effective way to improve girls' self-worth, health, and productivity; however there remains a gender gap between girls' and boys' completion of school. The literature around factors influencing girls' decision to stay in school is limited. Seven focus group discussions took place among 79 girls in forms 2 to 4 at secondary schools in rural western Kenya, to examine their views on why girls absent themselves or dropout from school. Data were analysed thematically. Lack of resources, sexual relationships with boyfriends, and menstrual care problems were reported to lead directly to dropout or school absence. These were tied to girls increased vulnerability to pregnancy, poor performance in school, and punishments, which further increase school absence and risk of dropout. Poverty, unmet essential needs, coercive sexual relationships, and an inequitable school environment collude to counter girls' resolve to complete their schooling. Lack of resources drive girls to have sex with boyfriends or men who provide them with essentials their family cannot afford, such as sanitary pads and transport to school. While these improve quality of their school life, this dynamic increases their exposure to sexual risk, pregnancy, punishment, and dropout. Evaluation of interventions to ameliorate these challenges is warranted, including provision of pocket money to address their needs.
- Published
- 2015
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