Poor menstrual health (MH) has been associated with reduced participation in school activities and diminished psychosocial wellbeing among adolescent girls. Despite increasing recognition of the importance of MH interventions, there is limited economic evidence to inform large-scale adoption and financial planning.

We conducted an incremental costing analysis of an MH intervention (MENISCUS) alongside a cluster-randomized trial in 60 secondary schools in Uganda. MENISCUS delivered puberty education, a drama skit, an MH kit, pain management strategies and improvements to water, sanitation and hygiene (WASH) facilities. We categorized the provider costs into start-up and implementation, and calculated unit costs per school, per student (male and female) and per female student respectively. We modelled two potential national scale-up scenarios (basic and enhanced) to 2,995 secondary schools using government delivery structures.

The total cost of the basic scenario is US$10,224,685 and the enhanced scenario is US$16,549,123. The unit cost of scaling the intervention nationwide was estimated at US$28 per student and US$58 per female student (basic scenario) and US$46 per student and US$95 per female student (enhanced scenario). The primary cost drivers were the MH kit and associated training, followed by pain management activities and improvements to WASH facilities. The enhanced scenario generated a higher unit cost per student and unit cost per female student due to additional components. Compared with trial costs, unit costs were lower in national scale-up, demonstrating economies of scale.

This study provides the first economic analysis of a potential national implementation of a school-based MH intervention in a low-resource setting. The findings provide critical benchmarks for governments seeking to integrate MH into national education curriculum and inform future investment decisions in adolescent health.

The authors have declared no competing interest.

ISRCTN45461276

https://link.springer.com/article/10.1186/s13063-022-06672-4

This study was supported by the Joint Global Health Scheme with funding from the UK Foreign, Commonwealth and Development Office (FCDO), the UK Medical Research Council (MRC), the UK Department of Health and Social Care (DHSC) through the National Institute for Health Research (NIHR) and Wellcome (grant ref MR/V005634/1). The funders had no role in the identification, design, conduct, reporting of the analysis and in the writing of the article.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

We obtained ethics approval from the Uganda Virus Research Institute (UVRI) & Ethics Committee (reference GC/127/819), the Uganda National Council of Science and Technology (reference HS1525ES), and the London School of Hygiene & Tropical Medicine (reference 22952). An independent Trial Steering Committee provided scientific guidance and monitored the progress of the trial. The Independent Data Monitoring and Ethics Committee (IDMEC) reviewed the trial recruitment and safety data and provided scientific guidance. The trial was prospectively registered (ISRCTN45461276).

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