The impact of menstrual hygiene management on adolescent health: The effect of Go! pads on rate of urinary tract infection in adolescent females in Kibogora, Rwanda

Hannah Janoowalla, Hannah Keppler, Daniel Asanti, Xianhong Xie, Abdissa Negassa, Nerys Benfield, Stephen Rulisa, Lisa M. Nathan

Research output: Contribution to journalArticle


Objective: To determine the rates of urinary tract infection (UTI) in adolescent users of menstrual pads versus non-users in a rural area of Rwanda. Methods: An interventional prospective cohort study was conducted at four secondary schools in the Western Province of Rwanda from May 12, 2017 to October 20, 2017. Inclusion criteria were female students aged 18–24 who were menstruating and volunteered to participate in the study. In total, 240 adolescent participants were assigned to two cohorts; 120 received menstrual pads for 6 months and the other 120 did not use pads. Baseline symptoms and urine cultures were obtained. Symptoms and methods of menstrual hygiene management were assessed and urine cultures were obtained every 2 months. The primary outcome was the presence of UTI diagnosed by positive urine culture. Secondary outcomes were symptoms of UTI, vulvovaginal symptoms, sexual activity, dyspareunia, and self-reported sexually transmitted infection. Generalized estimating equations with nesting were used to assess associations of pad use with study outcomes. Results: A total of 209 participants completed the study. There was no difference in rates of positive urine culture. A decreased odds of vulvovaginal symptoms was found in self-reported ”always” versus “never” pad users (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.43–0.96; P=0.031). Conclusions: Despite not finding any difference in rates of UTI, the present study showed a decreased rate of vulvovaginal symptoms in users of menstrual pads. Further research investigating rates of genital infections in this population is thus necessary.

Original languageEnglish (US)
Pages (from-to)87-95
Number of pages9
JournalInternational Journal of Gynecology and Obstetrics
Issue number1
StatePublished - Jan 1 2020



  • Adolescent health
  • Global health
  • Menstrual hygiene management
  • Menstrual pads
  • Reproductive tract infection
  • Urinary tract infection

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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