Menstrual Health Management (MHM)

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2025 Mar 27;19:20. doi: 10.

1186/s13031-025-00657-1 Menstrual hygiene management among girls and women refugees in Africa: a scoping review 1 Faculty of Health Sciences, Durban University of Technology, Durban, South Africa 2 College of Healthcare Sciences, James Cook University, Townsville, Australia Find articles by Alexis Harerimana 1 Faculty of Health Sciences, Durban University of Technology, Durban, South Africa Find articles by Gugu Mchunu 1 Faculty of Health Sciences, Durban University of Technology, Durban, South Africa Find articles by Julian David Pillay 1 Faculty of Health Sciences, Durban University of Technology, Durban, South Africa 2 College of Healthcare Sciences, James Cook University, Townsville, Australia Received 2024 Nov 15; Accepted 2025 Mar 10; Collection date 2025.

PMCID: PMC11948744 PMID: 40148980 Menstrual Hygiene Management (MHM) presents a significant public health challenge for refugee women and girls in Africa. Displaced populations often lack access to menstrual products, adequate Water, Sanitation, and Hygiene (WASH) infrastructure, as well as comprehensive menstrual health education.

This scoping review aimed to understand the state of MHM, identify key challenges, and evaluate existing interventions among refugee women and girls in Africa. Employing Levac et al. ’s framework, the review analysed evidence from databases like CINAHL, Emcare, PubMed, Scopus, and Web of Science, focusing on studies published between 2014 and 2024.

Sixteen articles met the inclusion criteria, and both numerical summaries and descriptive analyses were conducted. Refugee women and girls often lack access to both disposable and reusable menstrual products, resorting to unhygienic alternatives such as clothing, leaves, and paper. Inadequate WASH facilities restrict safe and private spaces for menstrual management.

Cultural stigma and taboos surrounding menstruation contribute to social exclusion and school absenteeism among girls. The interventions included distributing dignity kits, enhancing WASH infrastructure, and providing menstrual health education; however, they were inconsistently implemented due to resource limitations and cultural obstacles.

This study highlights the urgent need for sustainable menstrual health solutions in refugee settings. Without access to necessary products, WASH facilities, and stigma-free education, women and girls risk exclusion, health issues, and interrupted education. Addressing these barriers requires consistent, well-resourced interventions that integrate cultural sensitivity to ensure dignity and long-term impact.

Keywords: Menstrual health, Menstrual hygiene, Menstrual products, Girls, Women, Refugees, Africa Menstrual health is increasingly recognised as essential to gender equality and human rights [ 1 ].

Access to menstrual hygiene products, education on reproductive health, and suitable sanitation facilities form the core of Menstrual Health and Hygiene Management (MHHM), which is integral to women’s overall health and well-being—an essential focus of Sustainable Development Goal (SDG) 3 [ 2 , 3 ].

The term “Menstrual Health and Hygiene (MHH)” is used to describe the needs experienced by the people who menstruate, including having safe and easy access to information, supplies, and infrastructure needed to manage their periods with dignity and comfort [ 3 ].

Menstrual Hygiene Management (MHM) refers to the practice of women and adolescent girls using clean materials to absorb menstrual blood, which can be changed privately as often as needed throughout their menstrual period. It also includes access to soap and water for personal hygiene, the washing of reusable materials when required, and facilities for properly disposing of used items [ 4 , 5 ]. According to Budhathoki et al.

[ 4 ], “menstrual hygiene management (MHM) is an essential aspect of hygiene for women and adolescent girls between menarche and menopause”. MHM among refugee and migrant women is a critical yet often overlooked issue in humanitarian contexts [ 4 , 6 ]. Addressing MHM in humanitarian settings requires a multisectoral approach, including education, improved facilities, and culturally appropriate interventions [ 7 ].

Innovative approaches to address these issues include designing female-friendly Water, Sanitation, and Hygiene (WASH) facilities, improving waste management, and engaging beneficiaries in the design process [ 8 ]. These interventions can reduce the stigma around menstruation through education and awareness campaigns [ 9 , 10 ].

Strategies like workshops and pamphlets are essential for explaining menstruation and providing practical hygiene advice [ 11 ]. To improve menstrual health, policies should incorporate it into broader health and education efforts and address social issues like poverty and gender inequality [ 12 ].

Displaced and refugee women face numerous challenges, including insufficient access to safe and private facilities, limited resources, and alterations in menstrual practices [ 8 , 13 – 15 ]. Furthermore, stigma surrounds menstruation, causing fear and social isolation, especially in public areas of humanitarian settings [ 16 , 17 ].

Many women lack access to sanitary products, soap, and clean water, making it difficult to manage their menstruation effectively [ 18 ]. In refugee camps, poor sanitation facilities can lead to harassment and gender-based violence [ 19 , 20 ]. Additionally, the lack of proper disposal options increases feelings of embarrassment and health risks [ 8 , 16 , 21 – 23 ].

Many girls miss school due to menstrual pain, insufficient supplies, and fear of leaks [ 24 , 25 ]. Cultural restrictions further limit their ability to participate in daily activities [ 18 ]. Studies have shown that refugee girls and women experience unpreparedness for menarche, limitations in cultural, physical, religious and social activities, and school absenteeism due to poor MHM [ 20 , 21 , 24 ].

Furthermore, there is a lack of accurate information about sexual and reproductive health, which leads to misconceptions about menstruation [ 26 , 27 ]. Studies highlight the urgent need for thorough research on effective MHM practices and involving the communities affected by these issues to develop appropriate and lasting solutions [ 28 , 29 ].

Furthermore, Improving menstrual health and hygiene management for women refugees and migrants is essential to protect their well-being and dignity [ 7 , 11 , 30 ]. Enhancing collaboration across different sectors to tackle the various menstrual health and hygiene challenges is essential [ 11 , 19 ].

Drawing from background and contextual insights of issues around menstrual hygiene, this study aims to understand the state of MHM, identify key challenges, and evaluate existing interventions for refugee women and girls in Africa. This study used the scoping review framework from Levac et al. [ 31 ] to map the evidence about MHM in Africa.

This framework outlined the systematic approach used to map the existing literature and included the following steps: identifying the research questions, identifying relevant studies, study selection, charting the data, collating, summarising and reporting the results.

Identifying the research question The first step in the scoping study methodology is to formulate the research question, which provides the foundation for the entire review by setting its direction and scope [ 31 ].

While scoping reviews typically begin with broad research questions to encompass a wide range of evidence, researchers should aim for clarity by defining key elements such as the central concept, target population, and specific outcomes of interest [ 31 ].

Arksey and O'Malley [ 32 ] highlighted the need for broad questions and recommended clearly defining the scope of inquiry early on, linking the research question to a well-defined study purpose to organise the selection of relevant studies and identify potential outcomes. In this study, developing research questions involved several important steps for clarity and relevance.

Researchers identified a knowledge gap and issues which required exploration, followed by a literature review to understand existing studies. This was followed by defining the study’s aim, deciding on the questions needed, and ensuring they aligned with the research methods. Researchers discussed the questions with peers and experts to make sure they were clear and specific.

The following research questions were used to map the studies about the current state of MHM among women refugees in Africa: What is the current state of MHM knowledge and practices among women refugees and migrants in Africa? What are the challenges faced by women refugees and migrants in accessing MHM resources and services in Africa?

What are the effective interventions and strategies for improving MHM among women refugees and migrants in Africa? Identifying relevant studies The second step of the scoping study methodology focused on identifying relevant studies to ensure a comprehensive review [ 31 ]. A comprehensive search strategy was developed to identify peer-reviewed articles and grey literature, as recommended by Levac et al.

[ 31 ]. In this study, databases included CINAHL, Emcare, PubMed, Scopus, and Web of Science. Each database specialises in different fields, ensuring we captured a wide range of studies, especially those focused on healthcare practices for refugee women and girls.

CINAHL and Emcare emphasised nursing and health research, while PubMed provided biomedical studies on menstrual hygiene management. Scopus and Web of Science added insights from social sciences and high-quality peer-reviewed research. This comprehensive approach ensured we didn’t overlook important information, leading to more reliable findings on menstrual hygiene challenges faced by refugee women and girls in Africa.

Additionally, a hand search strategy was conducted on Google and Google Scholar to find resources that might have been missed during electronic database searches. Databases were searched using keywords: menstruation, menstrual health, menstrual hygiene, hygiene management, refugees, girls, women, and Africa. Search terms were adapted for each database to ensure a broad coverage of relevant literature.

To refine the search results and improve the accuracy, the following approaches were used: Boolean operators (AND, OR, NOT) were used to narrow search results, Parenthesis () to group words and retrieve the results related to each other, Quotation marks (“”) to retrieve results with exact phrases rather than individual words, wildcards and Truncation by using Asterisk (*) and question mark (?)

to represent multiple character variations of a word. The following is an example of the keyword combinations: S1 : (Menstruat* OR “Menstrual Health” OR “Menstrual Hygiene” OR “Menstrual Management”) S5 : S1 AND S2 AND S3 AND S4 A timeframe of 10 years was considered from 2014 to 2024 to ensure the balance between comprehensiveness and relevance.

Furthermore, a 10-year limit ensured the inclusion of studies reflecting the latest MHM policy shifts, advancements, interventions and challenges. Selecting relevant studies Step three entailed selecting relevant studies using inclusion and exclusion criteria, as Levac et al. [ 31 ] recommended.

The included studies were peer-reviewed articles or grey literature, including dissertations and reports on menstrual health and hygiene management among African girls and women refugees. Those studies were published in English. Exclusion criteria included non-empirical studies that were not specific to the target population or region and those that did not address MHM.

Furthermore, the research questions and Mixed Methods Appraisal Tool (MMAT) guided the selection of the relevant studies. EndNote Version 20 was used to manage the retrieved sources. After the quality appraisal, a PRISMA flow diagram was used to display the final number (Fig.

1 ). The process of identifying relevant studies was systematically divided into three main phases: identification, screening, and inclusion. In the identification phase, a total of 3127 records were retrieved through database searches, supplemented by an additional 27 records identified through manual searches (Google and Google Scholar).

Following the removal of duplicates, 2867 records remained for screening. During the screening phase, all 2867 records were assessed, resulting in the exclusion of 2833 records based on predetermined relevance and eligibility criteria. Consequently, 34 full-text records were reviewed for eligibility; however, 18 were excluded for reasons being non-empirical (n = 10) and not relevant (n = 8).

In the final inclusion phase, 16 studies were selected for data extraction and descriptive analysis. Selected studies included six qualitative, two quantitative, and eight mixed-methods studies. Step four of the scoping study methodology focuses on data charting, where researchers extract and organise key information from selected studies [ 31 ].

The goal is to develop a structured overview of the existing literature, which aids in effectively summarising and comparing studies [ 31 ]. Rather than simply summarising the studies, this step emphasises organising data to support meaningful analysis and synthesis in later stages. Levac et al.

[ 31 ] emphasise that charting should be an iterative process, allowing researchers to refine the charting form based on data extraction and the research question. In this study, the data-charting form included the following relevant variables: Authors, year, location of the study, aim, population, study design, intervention, findings and intervention effects if applicable (Table 1 ).

Summary of the study findings “Assess the desirability, acceptability, and feasibility of the Mini as an intervention to support safer, more dignified MH practices” Health and humanitarian members Community members without access to Cocoon mini structures 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” 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 “Explore the reproductive health and rights needs and challenges amongst young refugee women in South Africa” 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 “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 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%) 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” 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% “Assess sexual and reproductive health (SRH) experiences and knowledge of refugee girls in the Nakivale settlement” Adolescent girls refugees 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 “Describe the menstruation practices and experiences of adolescent girls living in the Nakivale refugee settlement in Southwest Uganda” Adolescent girls refugees 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) “Test the appropriateness and acceptability of AFRIpads reusable sanitary pads in southwestern (Ugandan) refugee context among schoolgirls” Schoolgirls refugees (including Ugandan nationals) 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 “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” 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 “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” 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 “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 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 “Fill an identified gap in the MHM response literature and guidance around menstrual disposal and laundering of reusable menstrual materials” Humanitarian response staff 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 “Examine the appropriation of African Indigenous Knowledge Systems (AIKS) in the implementation of WASH activities by women at Tongogara Refugee Camp (TRC), Zimbabwe” 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 “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 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 “To document knowledge, support and facilities given to menstruating girls and women in Kigeme Refugee Camp to highlight gaps and provide recommendations” Humanitarian organisations 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 “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.

” 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: Collating, summarising and reporting the results Step five of the scoping study methodology involved collating, summarising, and reporting the results, as recommended by Levac et al.

[ 31 ]. This phase assisted in organising and analysing the collected data. Numerical summaries and descriptive analyses highlighted the scope of the literature.

Quantitative metrics detailed the characteristics of the studies, while descriptive analysis identified key patterns and relationships within themes. The findings were systematically presented in accordance with the objectives of the scoping review. The extracted data were synthesised to provide an overview of the current state of MHM among women refugees in Africa.

The synthesis was narrative, summarising the key themes and findings from the literature. The findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines to ensure transparency and completeness. Ethical approval was not required since this is a scoping review of published literature.

However, the review adhered to PRISMA-ScR guidelines for conducting research and reporting findings. The scoping review analysed 16 studies with various research designs for data collection and analysis. Six (37.

5%) of these studies used a qualitative research design and relied on interviews, focus groups, and observational methods for comprehensive insights. On the other hand, 2 out of the 16 studies (12. 5%) used a quantitative research design, focusing on statistical and numerical data for conclusions.

Eight of the 16 studies used a mixed methods approach, applying statistical analyses and qualitative insights for a more comprehensive perspective. Furthermore, six of the 16 studies focused on the interventions to improve the MHM. Regarding the location where the studies were conducted, the majority of the studies were conducted in Uganda (n = 5), followed by Tanzania (n = 3), Nigeria (n = 2).

South Africa, Rwanda, and Zimbabwe have one study each. Three studies were conducted in multiple countries: Burundi and Uganda; Somalia, Madagascar and Uganda; and Kenya, Uganda, South Soudan, Zimbabwe and Bangladesh. The reviewed research studies primarily focused on the study population of girls and women of reproductive age residing in refugee or humanitarian environments.

These studies centred on the distinct challenges encountered by this demographic, particularly regarding their menstrual health and hygiene. Alongside this primary group, a few studies incorporated key informants, including representatives from both male and female humanitarian organisations and community members.

These supplementary perspectives aided in developing a more comprehensive understanding of the support systems, obstacles, and social dynamics surrounding the study population. MHM knowledge and practices among girls and women refugees Across 16 studies included in this review, knowledge and practices about menstrual hygiene were discussed.

Although those studies found that girls and women had a certain level of knowledge in managing menstrual hygiene, in four studies [ 11 , 21 , 24 , 25 ], there was a consistent emphasis on the lack of adequate menstrual education, which leaves women and girls without the necessary knowledge or tools to manage their menstruation safely and hygienically.

This educational gap often resulted in adverse health outcomes, social stigma, and challenges in education. A study by Sanduvac et al. [ 25 ] in Tanzania revealed that adolescent girls often lacked basic menstrual knowledge before menarche, leading to feelings of unpreparedness and shame.

These girls frequently resorted to unhygienic materials, increasing their risk of infections and contributing to social isolation due to stigma and exclusion from school activities. Similarly, Schmitt et al. [ 21 ] reported that women in displaced communities in Nigeria faced confusion about managing menstrual health.

Additionally, Schmitt et al. [ 21 ] highlighted the ineffective use of reusable menstrual products distributed by non-governmental organisations (NGOs) due to insufficient training, underscoring the need for comprehensive educational programs. In Uganda, Kemigisha et al.

[ 24 ] found that inadequate information led to widespread misconceptions about menstruation, often perceived as a disease or curse. This misinformation fostered poor hygiene practices and emphasised the necessity of integrating menstrual health education into school curricula to provide accurate, age-appropriate information [ 24 ].

Wynne [ 11 ] found that limited access to health information led to unsanitary practices, and a successful educational intervention by healthcare workers and NGOs significantly improved menstrual health knowledge and practices among participants. Girls and women in refugee settings used menstrual products, including disposable Pads, reusable pads, improvised materials and makeshift Pads [ 21 , 25 , 28 , 33 ].

Disposable pads were widely favoured for their convenience and effectiveness; however, they were not consistently accessible in refugee settings. Schmitt et al. [ 21 ] highlighted that while NGOs may distribute these pads during emergencies, their regular availability was not assured, and many could not afford them consistently.

The ability to discard them after use is particularly advantageous when washing facilities are inadequate. Schmitt et al. [ 21 ] noted that many women in Nigeria continue to prefer disposable pads due to cultural norms and the stigma surrounding menstrual blood.

In humanitarian settings, reusable pads have gained traction due to their sustainability. These washable pads can last for months or even years and are frequently included in dignity kits provided by NGOs [ 21 , 33 ]. Specific humanitarian organisations have introduced Afripads, reusable sanitary pads designed explicitly for low-resource environments.

Sanduvac et al. [ 25 ] noted that Afripads are distributed in some camps as part of dignity kits, providing a durable option that