Reviewer ’s report  
 
Title: Menstrual health and school ab senteeism among adolescent girls in Uganda 
(MENISCUS): A feasibility study  
 
Version: 0 Date: 08 Oct 2017  
 
Reviewer: Mags Beksinska  
 
Reviewer's report:  
 
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Review BMWH -D-17-00287  
This is a very interesting and w ell written paper, providing much needed evidence on effect of 
menstruation on school going girls and should be published.  However I think the paper could be  
improved as some areas were not clear to me.  
I have some questions and suggestions below: - 
The girls across the different schools seemed to be well resourced in terms of access to menstrual 
products compared to many other African settings.  However the way the paper is written its 
hard to get to see what proportion of girls used quality adequate  protection all the time and those 
who only had access to it some of the time or not at all.  
 
Multiple reasons were given for choosing disposable pads page 10 (and table 2), are you saying 
they were asked why they are choosing a pad compared to another pr oduct or nothing? No 
tampons are mentioned?  
You go onto say  a proportion of girls say they would be interested in using a locally made pad 
or reusable?  Line 250 here in the text it seems to suggest  two separate categories - while in the 
table it groups  together in the row  8 -9 locally made/ reusable. So I don't know if this is two 
products as suggested in text or one as in table? So what is a locally made pad? Is it somehow of 
less quality that it is not classified as a manufactured disposable pad?.  Th ere are reusable pads 
made in many countries so why does it not say they are manufactured?  Is the locally made one 
that is bought in a typical local supermarket and made in Uganda? Are there locally made 
disposable  pads available? If yes why do they not use them, sorry this was not clear.  
Page 10 in text states that 86.7%  and refers to Table 2 used disposables and about a third used 
combination (32.2%)  but I cant work out where the 32.2% or the 86.7% comes from?  The table 
actually says 86.1% not 86.7%  as the text states. If you combine the other two categories you get 
35.2% not 32.2%.  or are some of these girls using all 3 categories? Its not clear to me the 
proportion of girls using adequate "commercial" products vs inadequate methods of menstrual 
management. So for me it would be better to show the proportion who use adequate all the time, 
some of the time or not at all. I am also assuming from the article that no girl used tampons?  
Page 12 line 324 states some cases girls did not use any absorbant m aterial but instead used 
cloths etc.  again as above  would be good to classify the menstrual products as those that are 
"adequate" for menstrual management and those that are of less quality. In other African 
countries  we get many reports of use of toile t paper /newspaper or cotton? Was there no reports 
of this use in this study?  
 
Page 13 when you say Overall 9.5% of girls said they did not attend school during menstruation 
do you mean the whole cycle?  
Page 14 line 361, fear of leaking blood? this indica tes that they do not have adequate protection. 
If they had adequate protection they would not leak so maybe this should be rephrased. Did the 
girls who clearly had enough money to have adequate protection worry about leaking? Or was it 
just those that did not. 
 
Table 2  
I think the term used "absorbant material" is incorrect or rather the wrong word. It should really 
focus on adequate or inadequate protection. Clothes and rags are absorbant as is toilet paper. The 
issue is some are more absorbant than others , so inferior products are less absorbant.  In this 
table row 11 states old clothes under absorbant used in last cycle, yet under line 24 it also has old 
clothes/knickers under footnote, so the same product is under two different places.  In fact the 
footn ote is a combination of reusable pads and old clothes etc. this category should not be 
combined. Re -usable pads from what I have seen are considered to be adequate. But maybe you 
are talking about old clothes etc too. It might be good to have a definition somewhere as to what 
was used. Maybe describe exactly somewhere the products.  
In the top row of table 2 it says used in last period and then it goes onto Reusable/washable 
absorbents line 24 but does not say if in last period.  
The word absorbent is misspe lt in a couple of places in the table.  
Last category of reason for choosing disposable - last row says more modern? Again as above 
what is the comparison and why more modern as a response? Are they saying more modern then 
reusable pads as they are actually a more recent innovation. Or more modern than old clothes?  
The menstrual accident section - would be useful to know was this because they used 
"inadequate" protection or they used adequate protection but did not change often enough like 
use of a proper disp osable sanitary pad but used it for so long they had an accident as it was 
unable to absorb any more menstrual fluid.  
Table 3  
It would be good to combine adequate product vs inadequate so we see what proportion of girls 
actually had proper protection at la st cycle because this is not terribly clear. So in Table 3  we 
have 46 girls who did not use a disposable pad so what did they use? Are they  part of the 44 
who used a re -usable pad? And what about the girls that used old clothes are they in the category 
or reusable.  
Table 3 The larger proportion that did not use disposable pads for each day of their period n=79 
what did they do? Use nothing? Use old clothes?  
Just a question but did you perhaps collect data on in school activities missed such a sport etc, 
this is particularly sensitive as It singles out girls who sit on the sidelines as they cannot play 
sport.  
Otherwise it's  a very good paper with  a lot of interesting information. I enjoyed reading it.  
 
 
 
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
Are you able to assess any statistics in the manuscript or would you  recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
Quality of written English  
Please ind icate the quality of language in the manuscript:  
 
Acceptable  
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