Table 1 Summary of the study findings

Beeman et al. [16]

Uganda

“Assess the desirability, acceptability, and feasibility of the Mini as an intervention to support safer, more dignified MH practices”

People who menstruate

Health and humanitarian members

Community members without access to Cocoon mini structures

Cocoon mini supervisors

Mixed methods

A total of 20 Cocoon Minis were constructed in the Bidi Bidi refugee settlement

The Minis provided access to a private latrine, bathing facility, water source, disposal options, and other features to support menstrual health management

The Cocoon Mini, a safe and private space for managing menstruation, was widely accepted and desirable among people who menstruate and the broader community

The Cocoon Mini improved menstrual health management by providing key features like waste bins, lighting, and water access

The Cocoon Mini increased the sense of physical and psychological safety for people who menstruate

95% of people who menstruate said the Cocoon Mini made menstrual health management easier

96% cited improved water access as a key feature that made menstrual health easier to manage

47% cited the disposal system as a key feature

94% of people who menstruate expressed approval of the Cocoon Mini space

Calderón-Villarreal et al. [19]

Bangladesh, Kenya, Uganda, South Sudan, and Zimbabwe

“To quantitatively analyse WASH access among refugee camps—To focus on WASH access in households with women of reproductive age”

Women refugees

Quantitative

N/A

Large inequalities in WASH access were found across refugee sites

High access to improved water (95%) but lower access to basic sanitation (30%)

The Female WASH Access Index identified that Zimbabwe had the lowest Female WASH Access Index Score

Households with members with disabilities or who are elderly had lower WASH access compared to other households

N/A

Crankshaw et al. [27]

South Africa

“Explore the reproductive health and rights needs and challenges amongst young refugee women in South Africa”

Young women refugees

Qualitative

N/A

Participants had poor reproductive health knowledge due to lack of access to comprehensive sexuality education

Positive experience of learning about menstruation

Learning from school and family members about menstruation, hygiene practices, and how to take care of oneself

Some participants had access to contraceptive and Termination of Pregnancy (TOP) services

N/A

Ene et al. [18]

Nigeria

“To assess the knowledge, attitude and practices of menstrual hygiene management among adolescent girls and young women in the Durumi IDP camp, Abuja, Nigeria”

Adolescent girls and young women refugees

Quantitative

N/A

The majority of the respondents had good knowledge and a positive attitude towards menstruation and menstrual hygiene management, despite residing in an IDP camp

90.7% had heard abunt menstrtuation and menstrual hugiene before menarche. 92.8% knew poor mentrual hugiene can reults in infection

Most respondents practiced good menstrual hygiene, such as using sanitary pads (69%), changing absorbents at least twice a day (90%), and washing hands before and after changing absorbents (91.8%)

N/A

IFRRCS [33]

Uganda, Somaliland, Madagascar

“Improve the dignity of women and adolescent girls during emergency situations and to provide further evidence for MHM Kits as global relief items”

Girls and women refugees

Mixed methods

MHM Kit A: Disposable sanitary pads for 1 month

MHM Kit B: Reusable sanitary pads for up to 12 months with monthly distribution of consumables like soap

MHM Kit C: Combination of reusable/washable pads along with disposable pads

The MHM kits and information sessions significantly improved beneficiaries' knowledge about menstruation across the three countries

The MHM kits led to significant improvements in dignity, with over 50% of respondents reporting reduced feelings of embarrassment during menstruation

There was a marked increase in the proportion of respondents, especially adolescent girls, who could correctly identify the normal duration of a menstrual period

Significant increases in knowledge about the normal length of menstruation, from 78 to 88% in Madagascar and 84% to 94% in Uganda

19% reduction in reported cases of itching or irritation in Somaliland

Reduction in reported restrictions in daily life during menstruation from 78 to 6% in Somaliland

Overall, infections and itching during menstrual flow reduced by 10%; preference for washable pads decreased from 87 to 57%, while preference for disposable pads increased from 8 to 40%

Ivanova et al. [26]

Uganda

“Assess sexual and reproductive health (SRH) experiences and knowledge of refugee girls in the Nakivale settlement”

Adolescent girls refugees

Mixed methods

N/A

A total of 43% of the menstruating girls missed school during their menstruation due to multiple reasons

The girls were also afraid of staining (22%) and some had no product to manage menstruation (16%)

Minority of them (2.8%) were afraid of being teased and the same proportion were also prevented from attending schools because of religious barriers or social taboos related to menstruation

N/A

Kemigisha et al. [24]

Uganda

“Describe the menstruation practices and experiences of adolescent girls living in the Nakivale refugee settlement in Southwest Uganda”

Adolescent girls refugees

Qualitative

N/A

The girls had unfavourable menstruation experiences included being unprepared for menarche, lack of knowledge, limitations in activity and leisure, pain, school absenteeism, and psychosocial effects (shock, fear, shame and embarraseement)

The girls' menstrual practices included the use of unsuitable alternatives for menstrual hygiene management and poor health-seeking behaviour

5–6 packets of disposable pads per woman for an average of six months (provided by UNHCR)

N/A

Kuncio [36]

Uganda

“Test the appropriateness and acceptability of AFRIpads reusable sanitary pads in southwestern (Ugandan) refugee context among schoolgirls”

Schoolgirls refugees (including Ugandan nationals)

Mixed methods

Distribution of AFRIpads Menstrual Kit (4 reusable sanitary pads, underwear, soap, and bucket) for three months

Menstrual hygiene training and instructions on the use and care of AFRIpads for three months

Schoolgirls in the refugee settlements lacked access to necessary menstrual hygiene products and knowledge prior to the intervention

20% of the surveyed girls admitted to reusing disposable menstrual pads at the basseline

The intervention with AFRIpads helped address the lack of menstrual products that the girls were facing

The girls were highly satisfied with the AFRIpads and widely adopted their use

Uptake of AFRIpads: 99% tried, 92% used during last period

School absenteeism: Reduced by half

Leaks: Reduced from 59 to 9%

Itching/Burning: Reduced from 73 to 24%

Satisfaction with menstrual products: Increased from 39.6% to 86.1%

Preference for reusable pads: Increased from 52 to 84%

Access to water: Increased to 73% always having enough- Not having enough products: No longer a top challenge post-intervention

Nielsen [20]

Tanzania

“Assess the appropriateness and level of Menstrual Health Management (MHM) for women and girls in the Nyarugusu refugee camp in order to inform the design of future interventions by humanitarian actors”

Girls and women refugees

Qualitative

N/A

Inadequate MHM interventions or sufficient to meet the needs of women and girls

Significant lack of essential resources such as underwear, water, soap, buckets, privacy, and sanitary materials necessary for maintaining proper hygiene during menstruation

The lack of adequate MHM support

Disconnect between the expressed needs of women and girls and the support provided by the interventions

Humanitarian organisations struggled with implementing effective MHM interventions due to a lack of experience, understanding, and knowledge

N/A

Norelius [28]

Uganda

“Investigate how the study population access information about menstruation and assess girls and women's access to and usage of sanitation facilities and materials as well as access to MHM influence the lives of girls and women in Rhino refugee settlement”

Girls and women refugees

Mixed-methods

N/A

37.1% used disposal pads, while 31.4% used old rags for MHM

Fear and shame limit access to information

Poverty was a major factor preventing girls and women from accessing the menstrual products

Lack of access to information, menstrual products, and soap caused significant stress and challenges for girls and women in the refugee settlement

Some girls reported missing school during their periods, mainly due to lack of menstrual products

Organisational support in MHM is inconsistent

N/A

Sanduvac et al. [25]

Tanzania

“Conduct a thorough assessment of Plan International Tanzania’s MHM program for adolescent girls, to identify gaps and to advise on which additional subjects girls need in school”

Adolescent girls refugees

Mixed methods

Distribution of dignity kits (including AfriPads, soap, panties, body lotion, and wrap cloth) to adolescent refugee girls, with AfriPads usable for 12 + months

Provision of Menstrual Hygiene Management (MHM) training to the girls at Hope Secondary School

Improvements to WASH (Water, Sanitation and Hygiene) facilities at Hope Secondary School

Lack of gender friendly-latrines

No reliable coping mechanism during menstruation,

Lack of menstrual hygiene management (MHM) severely impacts the daily school life and attendance of adolescent girls

Providing dignity kits and MHM training directly improves girls' school attendance

Adolescent girls lack reliable support from families, teachers, and the community during their menstruation, which jeopardises their education

MHM kits and training positively impacted on menstrual health, school attendance, readiness to menstruation, and confidence to handle menstruation

Schmitt et al. [21]

Nigeria

“Fill an identified gap in the MHM response literature and guidance around menstrual disposal and laundering of reusable menstrual materials”

Girls and women refugees

Humanitarian response staff

Qualitative

N/A

Poor access to menstrual materials and supplies

Insufficient menstrual protection for those using cloth

Challenges for using reusable pads due to lack of underwear, and items required for the routine cleaning them

Insufficient access to MHM-supportive toilets, including discret places for laundering, lack of disposal options and poor lighting

Inconsistent distribution of disposable and reusable menstrual pads by NGOs to adolescent girls and women aged 15–49 years

N/A

Sibanda et al. [34]

Zimbabwe

“Examine the appropriation of African Indigenous Knowledge Systems (AIKS) in the implementation of WASH activities by women at Tongogara Refugee Camp (TRC), Zimbabwe”

Women and males refugees

Qualitative

N/A

Women refugees recognises their roles in managing WASH activities in the camp using their AIKS

Menstruation is a significant challenge for adolescent girls in the camp, with cultural taboos and restrictions making their lives difficult, leading them to rely on traditional AIKS for managing menstrual health

Disposal of menstrual materials in pit latrines and waste bins by fearing that they could be retrived for witchcraft purposes

N/A

Sommer et al. [29]

Tanzania

“To systematically monitor and describe the implementation of the MHM in Emergencies Toolkit in an ongoing humanitarian emergency, to capture in real-time the lessons learned from the perspectives of practitioners addressing MHM, to refine the MHM in Emergencies Toolkit”

Adolescent girls and women refugees

A mixed-methods

Introduction and pilot testing of the “Menstrual Hygiene Management in Emergencies Toolkit” in three refugee camps in Northwest Tanzania

Training and capacity building activities to support the implementation of the toolkit across multiple organisations and sectors working in the refugee camps

Content gaps in the MHM toolkit

Multi-level trainings and leadership support were essential for the successful implementation of the MHM response

The study highlighted the importance of cross-sectoral collaboration, including non-WASH actors, in supporting menstrual hygiene management

The toolkit provided guidance on a comprehensive MHM response including menstrual materials and supplies, MHM supportive facilities, and MHM information

Training was found to be essential to the success of the MHM

Uwimana [17]

Rwanda

“To document knowledge, support and facilities given to menstruating girls and women in Kigeme Refugee Camp to highlight gaps and provide recommendations”

Girls and women refugees

Humanitarian organisations

Qualitative

N/A

Girls attending school tend to have more biological knowledge, while women have practical experience in managing menstruation

Insufficient menstrual materials, lack of privacy, and inadequate WASH (Water, Sanitation, and Hygiene) facilities

Challenges for the disposal of the saniatry pads

The taboo nature of menstruation often prevents girls and women from voicing their needs

N/A

Wynne [11]

Burundi and Uganda

“To conduct a comparative narrative analysis to evaluate learnings from four piloted MHM projects against the Toolkit guidance

To identify and explore synergies and gaps, or suggestions for improvement to future toolkits.”

Girls and women refugees

Support staff

Peers (boys and men)

Mixed methods

Distribution of reusable pads and menstrual cups, along with training on menstruation and MHM material use to girls in primary schools, their mothers/guardians, and other community members in Rhino

Distribution of disposable and reusable/washable menstrual hygiene kits, along with instructions on their use and safe MHM practices in Bwagiriza

Distribution of hygiene kits containing reusable sanitary pads, along with training on their use to primary and secondary schoolgirls in Kyaka II, Rwamwanja, Nakivale

Distributed reusable pads were perceieved easier to use in limited privacy

Improper disposal of pads had an environmental impacts such as polluted water sources, and blocked latrines

Single use pads were not viewed as sustainable solutions

68% of adolecents and 65% of women were satisfied or very satisfied with the disposable kits

Current focus should shift from distribution of menstrual materials to developing scalable long-term strategies

Retention of MHM knowledge after the training was reported to be a challenge

Basic MHM knowledge: Increased from 15 to 65%

Experiencing leaks and stains: Decreased from 59 to 9%

Satisfaction with reusable pads: 90% of adolescent girls and 85% of women satisfied or very satisfied in Bwagiriza camp

Satisfaction with menstrual cups (81%) and 52% preferred menstrual cups over reusable pads

Knowledge of average length of menstruation: Increased from 25 to 78%

Difficulties understanding hygiene items: Less than 10% reported difficulties

23% reported still lacking sufficient MHM information post-training: