Protocol for the Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study in Khulna, Bangladesh: A Prospective cohort to quantify the influence of menstrual health on adolescent girls' health and education outcomes

Julie Hennegan; Md Tanvir Hasan; Abdul Jabbar; Tasfiyah Jalil; Elissa Kennedy; Erin Hunter; Adrita Kaiser; Sabina Akter; Afreen Zaman; Mahfuj-Ur Rahman; Laura Dunstan; Alexandra Head; Nick Scott; Helen Anne Weiss; Thin Mar Win; G J Melendez-Torres; Kyu Kyu Than; Chad L Hughes; Sonia Grover; Mahadi Hasan; Sabina Faiz Rashid; Peter Azzopardi

doi:10.1136/bmjopen-2023-079451

Protocol for the Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study in Khulna, Bangladesh: A Prospective cohort to quantify the influence of menstrual health on adolescent girls' health and education outcomes

BMJ Open. 2024 Apr 10;14(4):e079451. doi: 10.1136/bmjopen-2023-079451.

Authors

Julie Hennegan^{1

2

3}, Md Tanvir Hasan⁴, Abdul Jabbar⁴, Tasfiyah Jalil⁴, Elissa Kennedy^{5

6

7}, Erin Hunter^{8

9

10}, Adrita Kaiser⁴, Sabina Akter⁴, Afreen Zaman⁴, Mahfuj-Ur Rahman¹¹, Laura Dunstan^{5

7

12}, Alexandra Head^{5

7}, Nick Scott^{5

13}, Helen Anne Weiss¹⁴, Thin Mar Win¹⁵, G J Melendez-Torres¹⁶, Kyu Kyu Than¹⁵, Chad L Hughes¹⁷, Sonia Grover^{7

18}, Mahadi Hasan¹¹, Sabina Faiz Rashid⁴, Peter Azzopardi^{5

7

18

19}

Affiliations

¹ Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia [email protected].
² School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
³ Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
⁴ BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
⁵ Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia.
⁶ School of Population Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
⁷ Murdoch Children's Research Institute, Parkville, Victoria, Australia.
⁸ Department of Public Health Sciences, Clemson University College of Behavioral Social and Health Sciences, Clemson, South Carolina, USA.
⁹ Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
¹⁰ Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
¹¹ WaterAid Bangladesh, Dhaka, Bangladesh.
¹² School of Social and Political Sciences, University of Melboune, Melbourne, Victoria, Australia.
¹³ Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
¹⁴ MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
¹⁵ Myanmar Country Program, Burnet Institute, Yangon, Myanmar.
¹⁶ Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
¹⁷ Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.
¹⁸ Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
¹⁹ Telethon Kids Institute, Adelaide, South Australia, Australia.

Abstract

Background: Menstrual health is essential for gender equity and the well-being of women and girls. Qualitative research has described the burden of poor menstrual health on health and education; however, these impacts have not been quantified, curtailing investment. The Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study aims to describe menstrual health and its trajectories across adolescence, and quantify the relationships between menstrual health and girls' health and education in Khulna, Bangladesh.

Methods and analysis: AMEHC is a prospective longitudinal cohort of 2016 adolescent girls recruited at the commencement of class 6 (secondary school, mean age=12) across 101 schools selected through a proportional random sampling approach. Each year, the cohort will be asked to complete a survey capturing (1) girls' menstrual health and experiences, (2) support for menstrual health, and (3) health and education outcomes. Survey questions were refined through qualitative research, cognitive interviews and pilot survey in the year preceding the cohort. Girls' guardians will be surveyed at baseline and wave 2 to capture their perspectives and household demographics. Annual assessments will capture schools' water, sanitation and hygiene, and support for menstruation and collect data on participants' education, including school attendance and performance (in maths, literacy). Cohort enrolment and baseline survey commenced in February 2023. Follow-up waves are scheduled for 2024, 2025 and 2026, with plans for extension. A nested subcohort will follow 406 post-menarche girls at 2-month intervals throughout 2023 (May, August, October) to describe changes across menstrual periods. This protocol outlines a priori hypotheses regarding the impacts of menstrual health to be tested through the cohort.

Ethics and dissemination: AMEHC has ethical approval from the Alfred Hospital Ethics Committee (369/22) and BRAC James P Grant School of Public Health Institutional Review Board (IRB-06 July 22-024). Study materials and outputs will be available open access through peer-reviewed publication and study web pages.

Keywords: Adolescent; Dysmenorrhea; EPIDEMIOLOGY; Health Equity; Health policy; PUBLIC HEALTH.

MeSH terms

Adolescent
Bangladesh / epidemiology
Child
Female
Health Knowledge, Attitudes, Practice*
Humans
Menarche
Menstruation* / psychology
Prospective Studies