Table 2 Primary and secondary impact outcome measures
Outcome | Measure | Tool | Study population |
|---|---|---|---|
1) Educational attainment in girls (primary outcome) | Mean total score on examination of curricula material in English, Mathematics, and Biology taught during the intervention year (adjusted for baseline score) | Examination set by UNEB | All girls in the endline survey |
2) Mental health problems (primary outcome) | Mean Total Difficulties score from the Strengths and Difficulties questionnaire (adjusted for baseline SDQ score) | Strengths and Difficulties 25-item questionnaire | |
i) Knowledge of puberty and menstruation; attitudes towards menstruation | Proportion answering all knowledge questions correctly Proportion answering all questions on myths correctly Proportion with “good” responses on attitudes | Endline survey | All girls and a random sample of boys in the endline survey |
ii) Menstrual practices at last menstrual period (LMP) | Proportion using manufactured methods only at LMP Proportion correctly washing and drying reusable pads and/or menstrual cups at LMP Proportion with ‘adequate MHM at school’ at LMPa Mean score on the Menstrual Practice Needs Scale | Endline survey | All girls in the endline survey |
iii) Knowledge and practices of pain management at LMP | Proportion knowing 4 or more effective pain management methodsb Proportion of those with pain at LMP who used an effective pain management method | ||
iv) Self-efficacy of MH | Mean score on Self-efficacy in Addressing Menstrual Needs Scale [26] | ||
v) Quality of life and happiness | Mean CHU9D score (9-dimension questionnaire) Self-reported measure of happiness | ||
vi) Prevalence of urogenital infections | Prevalence of bacterial vaginosis (Nugent score >7) Prevalence of vaginal yeast (Gram stain) Prevalence of UTI (symptoms ± leucocyte esterase and/or nitrates with urine dipstick) | 2 vaginal swabsc Urine Multistix 8 dipstick if symptomatic for UTI | Post-menarchal girls only (~95%) at endline |
vii) School and class absence during menses | Proportion of full school days missed by girls during their period (adjusted for absence on non-period days) Proportion of school days with classes missed by girls during their period (adjusted for absence on non-period days) | Daily diary on school attendance and menstrual cycle, administered for 12 weeks at endline | Random subsample of ~1500 post-menarchal girls at endline |
viii) School and class attendance overall | Proportion of full school days missed Proportion of school days with classes missed | ||
ix) Self-confidence in Mathematics and science abilities | Mean score on the Students Confident in Mathematics scaled Mean score on the Students Confident in Science scaled | Endline survey | All girls in the endline survey |