Improving Menstrual Health Through BCC Among Bangladeshi University Students

Summary

This study evaluated the effectiveness of a Behavior Change Communication (BCC) intervention in improving menstrual health among female university students in Bangladesh. The intervention focused on three outcomes: dysmenorrhea, premenstrual syndrome (PMS), and menstrual irregularity (MI), promoting a non-pharmacological, sustainable approach through behavioral and lifestyle changes.

Three structured educational sessions on menstrual health, healthy diet, and physical activity were delivered by trained female educators between May 20 and June 30, 2023, at Patuakhali Science and Technology University, Barishal University, and Khulna University. Participation was voluntary. Reinforcement follow-ups were conducted every two months for six months.

A quasi-experimental design was employed. Post-intervention data were collected from February to March 2024. Based on sample size calculations assuming a 30% reduction in disorder prevalence, 498 students (249 per group) were initially enrolled. After exclusions, 234 intervention and 238 control participants were analyzed for dysmenorrhea; 228 per group for PMS and MI. Propensity score matching (1:1, caliper 0.01, no replacement) yielded 98 matched participants per group for final analysis.

Eligible participants were female students aged ≥19 years, residing in university dormitories. Data collection used validated Bengali-language, interviewer-administered questionnaires, based on relevant literature and menstrual health IEC materials. Trained female enumerators ensured data quality and participant comfort.

Primary outcomes were: (1) Dysmenorrhea, measured by the Andersch and Milsom score (dichotomized Yes/No); (2) PMS, assessed using the Premenstrual Symptoms Screening Tool, with no/mild PMS and moderate to severe PMS/PMDD as the outcome; (3) MI, defined as self-reported menstrual cycles \<21 or \>35 days. The treatment variable was BCC exposure (Yes/No).

Covariates included physical activity, BMI, dietary diversity (DDS ≥5), food cravings, breakfast skipping, sleep duration, caffeine use, bedtime, family history of menstrual disorders, age at menarche, marital status, residence, and parental education and occupation.

Baseline differences were assessed using descriptive statistics, chi-square, and t-tests. Conditional logistic regression estimated intervention effects on matched data. Sensitivity analyses (ATE, ATT, balance diagnostics, Bayesian logistic regression) supported the robustness of results.

Conditions

• Dysmenorrhea
• Premenstrual Syndrome-PMS
• Menstrual Irregularity

Interventions

BEHAVIORAL

Behavioral change communication (BCC) module

The behavior change communication (BCC) module was designed to enhance awareness and promote effective management of menstrual disorders through structured lifestyle and behavioral guidance. It consisted of three 1-hour sessions: (1) education on menstrual disorders and related risk factors; (2) healthy dietary practices; and (3) physical activity (including yoga) and other lifestyle improvements. Sessions were held from May 20 to June 30, 2023, at three public universities in Bangladesh and were delivered by trained female educators. All session dates were approved by university authorities. Activities included interactive presentations, yoga demonstrations, pamphlet distribution, quizzes, and gift giveaways. To reinforce and support behavior change, follow-up visits were conducted every two months from July 15, 2023, to January 15, 2024.

Sponsors & Collaborators

• Shahjalal University of Science and Technology

  lead OTHER

Principal Investigators

• GM Rabiul Islam, PhD · Shahjalal University of Science and Technology Research

Study Design

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

19 Years

Max Age

25 Years

Sex

FEMALE

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2023-05-20

Primary Completion

2024-03-31

Completion

2024-03-31

Countries

• Bangladesh

Study Locations