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Introduction
Current institution
Publications
Publications (49)
Background:
A lack of adequate guidance on menstrual management; water, disposal, and private changing facilities; and sanitary hygiene materials in low- and middle-income countries leaves schoolgirls with limited options for healthy personal hygiene during monthly menses. While a plethora of observational studies have described how menstrual hygi...
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 infor...
Introduction
Secondary 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 gi...
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 th...
Background
Nonhygienic products for managing menstruation are reported to cause reproductive tract infections. Menstrual cups are a potential solution. We assessed whether menstrual cups would reduce bacterial vaginosis (BV), vaginal microbiome (VMB), and sexually transmitted infections (STIs) as studies have not evaluated this.
Methods and findin...
Introduction
Out-of-school girls are at higher risk of sexual and reproductive health (SRH) harms. Schools provide a protective environment for adolescents and lessen their exposure to such risks. This paper explores factors associated with school dropout, sexual activity, marriage and pregnancy among out-of-school girls in western Kenya.
Methods...
Background
Less than one-third of sub-Saharan Africans have access to improved water sources. In US, Indian, and African studies, Bacterial vaginosis (BV) is increased among women with poor water, sanitation, and hygiene (WASH). We examined water source, sanitation (latrine type), and rainfall in relation to the vaginal microbiome (VMB).
Methods
I...
Purpose
Out-of-school adolescent girls (OoSGs) can lack education on menstrual, sexual, reproductive, and mental health (SRMH) and be more vulnerable to SRMH harms. Targeted interventions could reduce these risks. We assessed interventions and their effectiveness among OoSGs globally.
Methods
Six online databases were searched for interventional s...
Introduction
The COVID-19 pandemic caused school closures, which intensified the negative sexual and reproductive health (SRH) of adolescent girls in sub-Saharan Africa (SSA), including increases in transactional sexual partnerships, gender-based violence, risk of early pregnancy and sexually transmitted infections (STIs). We conducted a qualitativ...
Background
In western Kenya, menstrual hygiene management (MHM) is a pervasive problem. Challenges are compounded for economically constrained women who continue to engage in sex during menses and resort to practices such as vaginal insertion of tissue and cotton to maintain dryness during sex. These practices can be harmful to the vaginal microbio...
Background
Kenya, like many countries, shuttered schools during COVID-19, with subsequent increases in poor mental health, sexual activity, and pregnancy.
Aim
We sought to understand how the COVID-19 pandemic may mediate the risk of reproductive tract infections.
Methods
We analyzed data from a cohort of 436 secondary schoolgirls in western Kenya...
Intoduction
Transactional 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 conte...
Introduction
Adequate menstrual health and hygiene (MHH) is necessary for women's health and equity of all menstruators. Female sex workers (FSW) require good MHH to prevent discomfort and exposure to pathogens. No studies have evaluated water, sanitation, and hygiene (WASH) conditions of FSW. We report on a cross-sectional WASH assessment at FSW v...
Background: Kenya, like many countries, shuttered schools during COVID–19, with subsequent increases in poor mental health, sexual activity, and pregnancy. We sought to understand how the COVID–19 pandemic may mediate risk of reproductive tract infections. We hypothesized that greater COVID–19 related stress would mediate risk via mental health, fe...
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 con...
Purpose
Despite the importance of menstrual health and hygiene (MHH) for adolescent girls' health, education, and gender equality, few countries monitor MHH. MHH needs remain underprioritized, and progress achieved through policies, programs, or investments go unmeasured. This article reports the systematic development of an indicator shortlist to...
A non-optimal vaginal microbiome (VMB) is typically diverse with a paucity of Lactobacillus crispatus and is often associated with bacterial vaginosis (BV) and sexually transmitted infections (STIs). Although compositional characterization of the VMB is well-characterized, especially for BV, knowledge remains limited on how different groups of bact...
Background
Research on menstrual health is required to understand the needs of girls, women, and others who menstruate; and to strengthen programmes with evidence-based interventions to improve health, wellbeing, and productivity. The identification of research priorities is an important process to help researchers, policymakers, programmers, and f...
Background
Adolescents 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 find...
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 control...
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 pr...
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 becomi...
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...
The vaginal microbiome (VMB) impacts numerous health outcomes, but evaluation among adolescents is limited. We characterized the VMB via 16S rRNA gene amplicon sequencing, and its association with Bacterial vaginosis (BV) and sexually transmitted infections (STIs; chlamydia, gonorrhea, trichomoniasis) among 436 schoolgirls in Kenya, median age 16.9...
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 seconda...
There is increasing global attention to the importance of menstrual health and hygiene (MHH) for the lives of those who menstruate and gender equality. Yet, the global development community, which focuses on issues ranging from gender to climate change to health, is overdue to draw attention to how addressing MHH may enable progress in attaining th...
Does access to sanitary products improve schoolgirls' well-being? We conduct the first cluster randomized controlled feasibility study to provide different sanitary technologies (sanitary pads or menstrual cup or usual practice) to 644 primary schoolgirls in western Kenya, across 30 schools with 10 schools per treatment arm. Inclusion restrictions...
Benshaul-Tolonen et al. shine a light on two methodological issues impacting a research question that has received much attention recently: whether the provision of menstrual hygiene products reduces schoolgirls’ absenteeism in low-income countries. First, they identify bias in data sources, such as school records and recall data. Second, they show...
Objective: To analyze the relative value of providing menstrual cups and sanitary pads to schoolgirls in rural Kenya.
Methods: From a healthcare payer or government program perspective, program costs were calculated for two interventions (provision of menstrual cups or sanitary pads) to girls (14-16 years old) in Kenya for one year. Cost-effective...
Evidence suggests an overlap between intimate partner violence (IPV) experience and perpetration. However, few studies in sub-Saharan Africa have investigated experience and perpetration of IPV among women and men within the same community. This study reports prevalence of past-year IPV experience and perpetration among women and men living in an i...
There exists growing global attention focused on tackling the menstrual management related challenges facing adolescent girls and women in low- and middle-income countries (LMIC). This includes a surge of growth in new and locally produced menstrual products, often accompanied by innovative distribution approaches aimed at enhancing accessibility,...
Background
Despite WHO advocating for an integrated approach to antenatal care (ANC), testing coverage for conditions other than HIV remains low and women are referred to distant laboratories for testing. Using point-of-care tests (POCTs) at peripheral dispensaries could improve access to testing and timely treatment. However, the effect of providi...
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 h...
Street-level environment characteristics influence the health behaviors and safety of urban residents, and may particularly threaten health within informal communities. However, available data on how such characteristics vary within and among informal communities is limited. We sought to adapt street audit strategies designed to characterize the ph...
Due to data limitations it is unclear if biological processes hinder girls in developing countries from participating in school to a greater extent than boys. We collect 32,000 unannounced random spot-checks for 6,000 students in Kenya to assess this claim. Although absenteeism is common, pubescent girls miss more schooldays because of school trans...
Inter-household patterns in drinking water access, consumption, perception, and quality among residents can vary in Rio das Pedras (RdP), a large favela in Rio de Janeiro, Brazil. While unreliable water quality can influence residents to diversify their drinking water supply, household drinking water management practices are not generally known for...
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 challe...
We explored links between food environments, dietary intake biomarkers, and sudden cardiac arrest in a population-based longitudinal study using cases and controls accruing between 1990 and 2010 in King County, WA. Surprisingly, presence of more unhealthy food sources near home was associated with a lower 18:1 trans-fatty acid concentration (-0.05%...
Many females lack access to water, privacy and basic sanitation—felt acutely when menstruating. Water, sanitation and hygiene (WASH) conditions in schools, such as access to latrines, water, and soap, are essential for the comfort, equity, and dignity of menstruating girls. Our study was nested within a cluster randomized controlled pilot feasibili...
Background:
Medical establishments in the neighborhood, such as pharmacies and primary care clinics, may play a role in improving access to preventive care and treatment and could explain previously reported neighborhood variations in sudden cardiac arrest (SCA) incidence and survival.
Methods:
The Cardiac Arrest Blood Study Repository is a popu...
There has been increasing recognition that the diversity and dynamic nature of family composition, structure, and living arrangements are intimately related to the key factors that support children’s care and well-being and should be central to informing social policies and programs targeted to vulnerable children and their caregivers. The critical...
Objectives:
To investigate accuracy of distance measures computed from Global Positioning System (GPS) points in New York City.
Methods:
We performed structured walks along urban streets carrying Globalsat DG-100 GPS Data Logger devices in highest and lowest quartiles of building height and tree canopy cover. We used ArcGIS version 10.1 to selec...
What follows are brief selections from a transcript of taped conversations between an anthropologist father, Joseba Zulaika, and his six-year-old daughter, Garazi. They are real life dialogues. They are offered as an ethnographic instance of the experience of anthropologists and members of their families shifting between field and home. In this cas...
