性健康和生殖健康(SRH)危害和中断的教育是青春期女孩面临的全球性挑战,需要有效的干预措施。我们评估了月经杯(MC)或现金转移对入学率(CCT)的影响,或者两者兼而有之,关于肯尼亚西部的SRH和学校教育结果。
■在这项集群随机杯子或女孩现金(CCG)试验中,西亚亚县(肯尼亚西部)96所中学的第二和第三形式的少女被随机分配接受CCT,MC,CCT和MC相结合,或对照(1:1:1:1)平均30个月。CCT干预措施包括1500KES(2016年为15美元),每个学校三个月都通过现金卡进行。所有四个治疗组都接受了青春期和卫生培训。经父母或监护人同意,同意初潮后的女孩,没有怀孕,地区居民,不是登机,并且没有排除参与的残疾是有资格的。每年测量HIV和2型单纯疱疹病毒(HSV-2)的社会行为危险因素和发病率。在整个过程中监测学校收容和不良事件。主要结果包括艾滋病毒事件的综合,HSV-2和/或所有原因因退学考试而辍学。主要分析是通过使用广义线性混合模型的意向治疗(ITT),控制先验选择的基线协变量。该试验已在ClinicalTrials.gov注册,NCT03051789。
■在2017年2月28日至2021年6月30日之间,注册了4137名女孩(平均年龄17.1[四分位数间距(IQR):16.3-18.0]),并每年随访至完成中学学业(中位数2.5年[IQR:2.4-2.7]);4106(99.3%)对ITT分析做出了贡献。观察到干预组和对照组的主要综合结局无差异(MC:18.2%,CCT:22.1%,合计:22.1%,控制:19.6%;调整风险比[aRR]:0.97,95%置信区间0.76-1.24;1.14,0.90-1.45;和1.13,0.90-1.43)。HSV-2发生率为8.6%,13.3%,14.8%,12%的MC,CCT,联合组和对照组,分别(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;组合aRR:1.16,0.85-2.58,p=0.36)。艾滋病毒发病率较低(MC:1.2%,CCT:1.5%,合计:1.0%,和对照: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)。无干预减少辍学率(MC:11.2%,CCT:12.4%,合计:10.9%,控制:10.5%;aRR:1.16,0.86-1.57;1.23,0.91-1.65;和1.06,0.78-1.44)。未见相关严重不良事件。
■MC,CCT,或者两者兼而有之,没有保护女学生免受各种有害伤害。MC表现出对HSV-2的保护作用。在该人群中,需要研究更长的随访时间,并客观地衡量健康影响。
■卫生和社会护理部,外国人,联邦和发展办公室,医学研究理事会和威康.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: Department of Health and Social Care, the Foreign, Commonwealth & Development Office, the Medical Research Council and Wellcome.