Background: Around the time of menarche, the gap in academic achievement and psychosocial health between girls and boys in low and middle income countries substantially widens to the detriment of girls. This seems to be partially caused by girls’ poor ability to practice Menstrual Health Management (MHM). Poor MHM is also a challenge in Bangladesh, where 40% of girls reportedly miss three days of school during their menstrual period. We conduct a cluster randomized controlled trial of the impact of a complex intervention facilitating MHM in Bangladesh: the Ritu RCT study.
Methods: 150 Schools were randomized into three groups: i) receiving the basic school program ; ii) the basic school program and parent training; iii) a control group. The primary beneficiaries are schoolgirls. The program will last for 3 years, and the primary outcomes are academic attainment and psychosocial outcomes. Secondary outcomes include MHM knowledge, attitudes and practices, mobility, child marriage and teenage pregnancy. We will analyze both the short-term and long-term effects of both treatment arms on our primary and secondary outcomes. In addition, we will conduct cost-effectiveness evaluations of both treatment arms and a process evaluation of the entire intervention.
Discussion: Even though MHM programs are popular, there is very limited evidence on such programs. It is troubling that it is unclear what works, why, and at what cost. We aim to reduce these knowledge gaps by providing rigorous evidence. Different to most evaluations of public health programs, we evaluate a complex intervention and will include cost-effectiveness analysis for both treatment arms.