Physicians' perspectives on the perceived increase in respiratory infections post-COVID-19 in Pakistan: a qualitative study.

Menstrual health is defined as complete physical, mental, and social well-being in relation to the menstrual cycle []. Menstrual health is multi-dimensional, including menstrual knowledge (access to accurate, timely, age-appropriate information about the menstrual cycle and menstruation), attitudes (experiencing a positive and respectful environment in relation to the menstrual cycle, free from stigma and psychological distress), self-efficacy (ability to confidently care for their bodies and make informed decisions about self-care throughout their menstrual cycle) and menstrual practices (accessing and using effective and affordable menstrual materials, having supportive facilities, and cleaning and/or disposing of used materials) []. Adolescents often have insufficient knowledge to manage menstruation [–], exacerbated by prevalent taboos, myths and misconceptions. These cultural constructs contribute to negative perceptions and attitudes towards menstruation within many communities [–]. A review of 81 quantitative and qualitative studies from 25 low- and middle-income countries (LMICs) showed that adolescent girls (aged 10–19 years) often have inadequate knowledge about menstruation before they experience it, with approximately half of girls not aware of menstruation prior to menarche []. A scoping review of younger adolescents (aged 10–14 years) identified 44 studies across 12 countries and found that many adolescents in LMICs are inadequately prepared for the onset of puberty. They often lack sufficient knowledge about menstruation, only learning about menstruation after experiencing their first period, and this can contribute to negative attitudes towards menstruation []. Further, adolescents frequently encounter challenges with managing menstruation, and experiences with menarche are often linked to negative emotions []. Gender disparities in menstrual health education, leaves male adolescents less informed about menstruation, contributing to negative attitudes and behaviours [, , –]. Educational interventions delivered by trained personnel can be effective in improving menstrual knowledge and attitudes of young female adolescents (age 10–14 years) []. Among 11 studies included in a systematic review, the most effective strategy for improving knowledge was interactive small group or peer-led interventions (average Cohen d = 5.34 and 10.04), rather than pamphlet distribution (d = 0.33) [].