gamification in education a systematic mapping study

Dominguez, A., Saenz-de-Navarrete, J., de-Marcos, L., Fernandez-Sanz, L., Pages, C., & Martinez-Herraiz, J. J. (2013). Gamifying learning experiences: Practical implications and outcomes. Computers & Education, 63, 380-392.

Gartner. (2013, August 19). Gartner's 2013 Hype Cycle for Emerging Technologies Maps Out Evolving Relationship Between Humans and Machines. Gartner. Retrieved June 1, 2014, from http://www.gartner.com/newsroom/id/2575515

Giannetto, D., Chao, J., & Fontana, A. (2013). Gamification in a social learning environment. Informing Science and Information Technology, 10, 195-207.

Gibbons, T. E. (2013). COR: A new course framework based on elements of game design. In W. D. Armitage (Ed.), Proceedings of 14th Annual Conference in Information Technology Education (SIGITE) (pp. 77-82). Orlando, FL: ACM.

Goehle, G. (2013). Gamification and web-based homework. Primus, 23(3), 234-246.

Gordon, N., Brayshaw, M., & Grey, S. (2013). Maximising gain for minimal pain: Utilising natural game mechanics. Innovations in Teaching & Learning in Information and Computer Sciences, 12(1), 27-38.

Haaranen, L., Ihantola, P., Hakulinen, L., & Korhonen, A. (2014). How (not) to introduce badges to online exercises. In J. Dougherty, & K. Nagel (Ed.), Special Interest Group on Computer Science Education 2014 (pp. 33-38). Atlanta, GA: ACM.

Hakulinen, L., & Auvinen, T. (2014). The effect of gamification on students with different achievement goal orientations. In B. Aris & A. Selamat (Eds.), Proceedings of Conference on Learning and Teaching in Computing and Engineering (LaTiCE 2014) (pp. 47-54). doi:10.1109/LaTiCE.2014.10

Hamari, J., Koivisto, J., & Sarsa, H. (2014). Does gamification work? A literature review of empirical studies on gamification. In R. Sprague et al. (Eds.), Proceedings of 47th Hawaii International Conference on System Sciences (pp. 3025-3034). doi:10.1109/HICSS.2014.649

Hentenryck, P. V., & Coffrin, C. (2014). Teaching creative problem solving in a MOOC. In J. Dougherty, & K. Nagel (Eds.), Special Interest Group on Computer Science Education 2014 (pp. 677-682). Atlanta, GA: ACM.

Holman, C., Aguilar, S., & Fishman, B. (2013). GradeCraft: what can we learn from a game-inspired learning management system?. In D. Suthers, & K. Verbert (Eds.), Proceedings of Third International Conference on Learning Analytics and Knowledge (pp. 260-264). Leuven, Belgium: ACM.

Iosup, A., & Epema, D. (2014). An experience report on using gamification in technical higher education. In J. Dougherty, & K. Nagel (Eds.), Special Interest Group on Computer Science Education 2014 (pp. 27-32). doi: 10.1145/2538862.2538899

Kapp, K. (2012a). Games, gamification, and the quest for learner engagement. T+D, 66(6), 64-68. Retrieved March 1, 2014 from https://www.td.org/Publications/Magazines/TD/TD-Archive/2012/06/ Games-Gamification-and-the-Quest-for-Learner-Engagement.

Kapp, K. (2012b). The gamification of learning and instruction: Game-based methods and strategies for training and education. San Francisco, cA: Pfeiffer.

Landers, R., & Callan, R. (2011). Casual social games as serious games: The psychology of gamification in undergraduate education and employee training. In M. Oikonomou, & L. C. Jain (Eds.), Serious games and edutainment applications (pp. 399-424). Surrey, UK: Springer.

Lee, J., & Hammer, J. (2011). Gamification in education: What, how, why bother? Academic Exchange Quarterly, 15(2), 146.

Lei, S. A. (2010). Intrinsic and extrinsic motivation: Evaluating benefits and drawbacks from college instructors' perspectives. Journal of Instructional Psychology, 37(2), 153-160.

Leong, B., & Luo, Y. (2011). Application of game mechanics to improve student engagement. In Proceedings of International Conference on Teaching and Learning in Higher Education. doi: 10.1.1.368.1256

Li, W., Grossman, T., & Fitzmaurice, G. (2014). CADament: A gamified multiplayer software tutorial system. In M. Jones, P. Palanque, A. Schmidt, & T. Grossman (Eds.), Proceedings of Conference on Human Factors in Computing Systems of the ACM Special Interest Group on Computer-Human Interaction (pp. 3369-3378). Toronto, Canada: ACM.

Mak, H. W. (2013). The gamification of college lectures at the University of Michigan. Retrieved June 1, 2014, from http://www.gamification.co/2013/02/08/the-gamification-of-college-lectures-at-the-university-of-michigan/

Mitchell, N., Danino, N., & May, L. (2013). Motivation and manipulation: A gamification approach to influencing undergraduate attitudes in computing. In P. Escudeiro, & C. de Carvalho (Eds.), Proceedings of European Conference on Game-Based Learning (pp. 394-400). Porto, Portugal: ACPI.

Morrison, B. B., & DiSalvo, B. (2014). Khan academy gamifies computer science. In J. D. Dougherty, & K. Nagel (Eds.), Special Interest Group on Computer Science Education (SIGCSE '14) (pp. 39-44). Atlanta, GA: ACM.

Nah, F. F. H., Zeng, Q., Telaprolu, V. R., Ayyappa, A. P., & Eschenbrenner, B. (2014). Gamification of education: A review of literature. In F. H. H. Nah (Ed.), Proceedings of 1st International Conference on Human-Computer Interaction in Business (pp. 401-409). Crete, Greece: LNCS Springer.

O'Donovan, S., Gain, J., & Marais, P. (2013). A case study in the gamification of a university-level games development course. Proceedings of South African Institute for Computer Scientists and Information Technologists Conference (pp. 245-251). doi:10.1145/2513456.2513469

Pirker, J., Riffnaller-Schiefer, M., & Gutl, C. (2014). Motivational active learning: Engaging university students in computer science education. In A. Cajander et al. (Ed.), Proceedings of 19th Annual Conference on Innovation and Technology in Computer Science Education (ITiCSE '14) (pp. 297-302). Uppsala, Sweden: ACM.

Simoes, J., Redondo, R. D., & Vilas, A. F. (2013). A Social gamification framework for a K-6 learning platform. Computers in Human Behavior, 29(2), 345-353.

Thomas, C., & Berkling, K. (2013). Redesign of a gamified software engineering course. Proceedings of International Conference on Interactive Collaborative Learning (pp. 778-786). doi:10.1109/ICL.2013.6644707

Todor, V., & Pitica, D. (2013). The Gamification of the study of electronics in dedicated e-learning platforms. Proceedings of IEEE 36th International Spring Seminar on Electronics Technology, (pp. 428-431). doi:10.1109/ISSE.2013.6648287

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Menstrual hygiene management interventions and their effects on schoolgirls’ menstrual hygiene experiences in low and middle countries: A systematic review

Balem Demtsu Betsu

1 Department of Midwifery, College of Health Sciences, Mekelle University, Mekelle, Ethiopia

Araya Abrha Medhanyie

2 School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia

Tesfay Gebregzabher Gebrehiwet

L. lewis wall.

3 Department of Anthropology, College of Arts and Sciences, Washington University in St. Louis, St. Louis, MO, United States of America

4 Department of Obstetrics & Gynecology, Washington University in St. Louis, St. Louis, MO, United States of America

5 Department of Obstetrics & Gynecology, Ayder Comprehensive Specialized Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia

Associated Data

data are all contained within the manuscript and/or Supporting Information files.

Inadequate menstrual hygiene management can result in physical, social, psychological, and educational challenges for schoolgirls. To address these issues, researchers have conducted intervention studies, but the impact on school attendance has varied. This review has systematically collected and evaluated evidence about the effects of menstrual hygiene interventions on schoolgirls.

A systematic search of the literature was done and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA statement). Both peer-reviewed journals and gray literature were searched using PubMed and Google Scholar. The search included individual, or cluster randomized controlled trials, and quasi-experimental studies, and covered the period from the date of indexing until January 3, 2023.

A review of sixteen trial studies showed that menstrual hygiene interventions have a positive effect on schoolgirls’ school attendance, performance, and dropout rates, as well as on their menstrual knowledge, attitudes, practices, and emotional well-being. There was a low to medium risk of bias in most of the studies. Additionally, the literature overlooked the impact of interventions that involve parental and male engagement, interventions correcting community misperceptions about menstruation, and the impact of infrastructure improvements on water, sanitation, and hygiene.

Interventions aimed at improving menstrual hygiene management can enhance schoolgirls’ educational outcomes, and can improve their menstrual knowledge, attitudes, and practices by helping them manage their periods more effectively. Most interventions have focused on the provision of menstrual products and menstrual education but have neglected improvements in the physical environment at home and school and the social norms surrounding menstruation. Trial studies should take a holistic approach that considers the total socio-cultural environment in which menstrual hygiene management takes place, thus enabling stakeholders and policymakers to develop sustainable, long-term solutions to these problems.

Introduction

Menstrual hygiene management (MHM) is defined as “women and adolescent girls using a clean menstrual management material to absorb or collect menstrual blood that can be changed in privacy as often as necessary for the duration of a menstrual period, using soap and water for washing the body as required, and having access to safe and convenient facilities to dispose of used menstrual management materials” [ 1 ]. Sommer et al. also added that menstruators should understand the menstrual cycle and be able to manage it comfortably and confidently [ 2 ].

Globally, over 50% of females are of reproductive age, and 500 million lack adequate menstrual hygiene facilities [ 3 – 5 ]. Many girls reach menarche without adequate knowledge or the skills to manage menstruation hygienically [ 6 – 9 ]. More than half (52%) of adolescent girls in Ethiopia have never received any information about menstrual hygiene [ 10 ], because of religious taboos, socio-cultural misinformation, and inadequate menstrual supplies and facilities, which leads to fear, confusion, and lack of confidence when menarche occurs [ 11 – 15 ].

Challenges related to menstrual hygiene have been found to contribute to absenteeism, poor academic performance, and school dropout among girls [ 16 – 19 ]. In Sub-Saharan Africa, a significant proportion of girls (50%-70%) miss school for 1.6–2.1 days per month due to menstruation, and more than half of girls in Ethiopia miss school during their periods [ 18 , 20 ]. Menstrual hygiene challenges also have negative impacts on health, psychosocial well-being, economic opportunities, and gender equality [ 21 – 26 ]. These challenges include insufficient knowledge about menstruation; inadequate access to water, sanitation, and hygiene services; lack of adequate hygiene materials; and social norms unsupportive of those who menstruate [ 27 – 29 ].

Several programs and global initiatives, such as the ‘MHM in Ten Agenda’, are being implemented to enhance menstrual hygiene management among schoolgirls [ 30 ]. These programs have utilized various interventions including the provision of menstrual hygiene products and supplies, improved water sanitation and hygiene facilities, as well as increased health education.

Studies assessing the effect of these interventions on girls’ school attendance, performance, physical and psychosocial wellbeing, and their knowledge and attitudes toward menstrual hygiene management indicated varying results. Some studies have shown positive effects on school attendance, whereas others have demonstrated no effect [ 31 – 34 ].

One of the largest intervention studies assessing the effects of improved menstrual hygiene management on school attendance in the Tigray Region of Ethiopia, conducted during the 2015–2016 school year, demonstrated 24% fewer school absences among girls compared to boys and showed that student sex was not a predictor of school absence during a similar time-period during the previous academic year [ 35 ].

Before the search date of January 3, 2023, various systematic reviews were conducted to assess the impact of menstrual hygiene management interventions on schoolgirls. However, these reviews had different population intervention control outcome and time (PICOT) criteria, and some included studies that used cross-sectional research methods [ 9 , 21 , 22 , 36 ]. This review specifically focuses on schoolgirls and includes up-to-date intervention studies, which distinguishes it from earlier reviews in terms of time, context, and population.

This review appraises and synthesizes the current evidence on the effects of menstrual hygiene management interventions on girls’ school attendance, school performance, and school dropout, as well as their effects on emotional well-being, menstrual knowledge, attitudes, and menstrual hygiene practices.

Materials and methods

Study design.

We conducted the review in accordance with the reporting guidelines described in the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement [ 37 ].

Author’s positionality

I (the first author) am a woman, a feminist, and an advocate for girls’ education. I am currently pursuing a PhD in public health. I am from Ethiopia, one of the countries studied in this paper. This gives me first-hand experience of what it is like to be a menstruating schoolgirl in an LMIC. However, I am an outsider to the other countries studied in this paper, which may leave room for bias or misunderstandings in the interpretation of results. In this systematic review, the researcher’s standpoint influences the research approach and findings. This study advocates accessible menstrual hygiene resources and aims to address the stigma surrounding menstruation. The conclusions are based on this perspective, and readers are encouraged to take this into account when interpreting the findings.

Inclusion criteria

We included studies in this review based on the following criteria: participants, interventions and comparators, outcomes of interest, and type of study (study design) (PICOT) [ 38 ].

Participants

The search was limited to studies that measured outcomes on schoolgirls because the objective of the review was to evaluate how menstrual hygiene management intervention programs impact schoolgirls’ attendance, academic performance, or dropout rates.

Interventions and setting

The menstrual hygiene management interventions can be categorized as interventions involving menstrual education and/or the provision of menstrual supplies.

• Menstrual education interventions include providing menstrual hygiene management information, puberty and reproductive health-related information, and training on the use of menstrual hygiene supplies.
• Menstrual supply interventions include providing menstrual hygiene materials and supplies as well as upgrading water and sanitation facilities. Menstrual hygiene materials are products used to absorb menstrual flow, such as pads, cloths, tampons, or cups. Menstrual supplies include soap and detergent, underwear, and analgesic medications for menstrual cramps. Menstrual facilities include toilets and water infrastructure, as well as private spaces for washing, changing, drying, and disposing of menstrual materials [ 27 , 39 ].

Schoolgirls who did not receive any of the interventions listed above.

School attendance, school performance, school dropout, emotional wellbeing, knowledge, attitudes, and menstrual hygiene practices.

Type of study design

Studies included individual, or cluster randomized controlled trials and quasi-experimental or non-randomized controlled trials.

Publication type

We included peer-reviewed journal articles and gray literature

Exclusion criteria

We excluded studies not available in the English language and conference abstracts.

Source of information and search strategy

We retrieved data from PubMed and Google Scholar databases using a mix of medical subject headings (MeSH) and relevant keywords from the date of indexing to January 3, 2023 ( Table 1 ). Citation lists and hand searches were done to locate additional citations. We limited the language to English. The search was re-run shortly before the final analysis.

Data management and selection process

We imported the identified, eligible studies into EndNote version X5, a specific software program for managing bibliographic data. Two independent researchers reviewed the data to double-check the title and abstracts against the eligibility criteria. Studies that the two reviewers agreed upon were subjected to full-text review. Any dispute was settled by a third reviewer and consensus was sought by discussion. Full-text articles of the potentially relevant studies were then screened for the final inclusion if they met eligibility criteria.

Data extraction process

A data extraction spreadsheet was prepared, and two reviewers extracted data manually. The spreadsheet was populated with the variables pertaining to the research question. From each study the following data were extracted; 1) Author name, 2) Year of publication, 3) Location, 4) Study design, 5) Population, 6) Sample size, 7) Duration of intervention, 8) Outcome measurement time, 9) Description of intervention, 10) Mode of intervention, and 11) Outcome of interest.

Risk of bias in individual studies

Two authors assessed the retrieved articles for quality and potential risk of bias using the Joanna Briggs Institute (JBI) critical appraisal assessment tools for Randomized Controlled Trials and Quasi-Experimental Studies/non-randomized experimental studies [ 40 ]. The studies that scored above half of the scored value of the tools were considered for minimum risk of bias and included in the review.

Data synthesis

We summarized data using tables, and narrative synthesis to include the type of intervention performed, characteristics of the target population, type of outcome, and a summary of the findings.

Sixteen trial studies that assessed the effect of menstrual hygiene management interventions on schoolgirls’ attendance, school performance, and school dropout, as well as emotional wellbeing and menstrual hygiene knowledge, attitudes, and practices were reviewed. This included 15 peer-reviewed articles and one article in the gray literature ( S1 Fig ). The studies represented a total of 17, 910 schoolgirls, 4,612 mothers, and 4,500 fathers/guardians from Ethiopia, Kenya, Nigeria, Ghana, Uganda, Iran, Nepal, Bangladesh, and Indonesia. The studies analyzed schoolgirls aged 9 to 25 years with a sample size that ranged from 60–8,839. The studies involved menstruating, pre-menarchal, and dysmenorrhea-affected schoolgirls, as well as parents ( Table 2 ).

The menstrual education components of the studies included puberty education, training on making reusable pads, distribution of books, magazines, posters, pamphlets, and menstrual calendars, as well as the incorporation of menstrual health topics into the school curriculum. Information was also shared through WhatsApp, face-to-face discussions, TV shows, festivals, essay competitions, storytelling, gamification, and question-and-answer sessions. These interventions were provided by trained individuals, including trained peer educators, teachers, research assistants, healthcare providers, and parents [ 31 , 32 , 34 , 35 , 41 , 42 , 44 – 46 , 49 – 52 ]. The menstrual supply interventions included the provision of disposable and reusable pads, underwear, menstrual cups, soap, or detergent to wash menstrual pads, and the installation or improvement of water, sanitation, and hygiene (WASH) facilities ( Table 2 ).

The reported trials evaluated several outcomes of interest, including school attendance, school dropout, and academic performance, as well as menstrual hygiene knowledge, attitudes, and practices, physical health, and emotional health including menstruation-related fear, shame, and stigma, as well as social attitudes regarding expected gender-related behavior (gender norms). Montgomery et al. suggested using school attendance and dropout rates as a proxy indicator of academic performance [ 32 ]. Some trials relied on self-reported/recorded attendance, which may have introduced recall bias, while others cross-checked attendance records [ 32 , 35 , 48 , 51 ] (Tables ​ (Tables3 3 and ​ and4). 4 ). The trial by Sol et al. cross-checked attendance of the school record with survey data using spot checks [ 50 ]. Official school attendance records were supplemented by individual diaries filled out by the schoolgirls in one of the trials [ 34 ]. Moreover, despite the presence of a standardized menstrual attitude questionnaire that can be validated contextually [ 53 ], some trials used non-standardized evaluation tools developed by specific researchers [ 31 , 42 , 45 , 52 ]. Causation is difficult to determine in some studies because the sample size was quite small [as few as 60 participants [ 46 ]].

Montgomery et al. carried out a study on peri-urban schools that were comparable, but they also incorporated a remote rural site lacking experience in using sanitary pads, with no access to electricity and unpaved roads. This may have affected baseline similarity and intervention fidelity, making it harder to determine the intervention’s actual effects [ 32 ]. In some studies, only a single-session educational intervention was provided, and only half of the girls attended the educational session in the study by Montgomery et al. [ 47 , 51 ]. Some studies did not provide information on the follow-up or dropout rates among the study groups [ 31 , 35 , 41 , 43 , 49 ], while others achieved a statistically significant improvement in school attendance and school performance using small sample sizes [ 32 , 46 ]. Blinding with respect to outcomes is crucial in reducing bias in experimental studies, but it is sometimes impractical to blind study participants, intervention providers, and assessors. This may lead to exaggerated intervention-effect estimates and performance bias [ 54 ]. Despite this, there are ongoing controversies concerning the advantage of blinding in clinical trials [ 55 – 57 ]. Outcome assessors, laboratory staff, and statisticians were blinded in only two trials [ 48 , 50 ].

The effect of menstrual hygiene management interventions on

Schoolgirls’ school attendance, performance, and dropout.

Of the trials that evaluated the effect of menstrual hygiene management interventions on school attendance, performance, and dropout, six studies reported that the intervention had a positive effect [ 32 , 35 , 46 , 47 , 50 , 51 ] while the remaining three studies found no significant effect [ 34 , 43 , 48 ].

Implementing pad and education interventions together increased school attendance by almost 6 days per term, equivalent to 9% of a girls’ school year. The study also showed that puberty education alone improved school attendance levels five months after intervention [ 32 ].

Belay et al. carried out an intervention at 15 schools (5 rural and 10 urban) involving 8,839 students, both male and female. All students received an educational intervention concerning menstruation and the female students also received four reusable pads and two pairs of regular underwear. School attendance was analyzed before and after the intervention and compared with attendance data from the prior school year. After the intervention, girls had 24% fewer school absences than boys and student sex was not a predictor of school absence during a similar time period during the previous academic year [ 35 ]. In another study, providing reusable pads, soap, and puberty education; training on making reusable sanitary pads and providing the equipment necessary to make pads resulted in decreased school absenteeism compared to controls [ 47 ].

School and household-based menstrual hygiene management interventions implemented in 148 schools involving 2,127 schoolgirls showed reduced school absences and dropout rates. The interventions included the integration of menstrual health education into the school curriculum and building/maintaining water, sanitation, and hygiene (WASH) infrastructure at schools. The provision of household interventions to improve parents’ knowledge didn’t show significant differences between the household-based and school-based intervention arms [ 50 ] ( Table 2 ).

On the other hand, three trials showed that school-based interventions did not affect school attendance or dropout. According to Phillips-Howard et al. providing either menstrual pads or cups did not reduce school dropout (control = 8.0%, cups = 11.2%, pads = 10.2%), though the finding should be taken with caution because of a nearly 40% loss-to-follow-up. Likewise, in this study school absenteeism was not analyzed because it was rarely reported [ 48 ]. The trial by Oster et al. found that providing menstrual cups to girls did not significantly increase school attendance [ 34 ]. This is congruent with the study by Austrian et al. that found no significant effect on school attendance after the provision of disposable sanitary pads and reproductive health education [ 43 ] ( Table 2 ).

Menstrual knowledge, attitude, menstrual hygiene practice, and emotional wellbeing

Studies have shown that both menstrual education and menstrual hygiene supply interventions have a positive effect on menstrual hygiene-related knowledge, attitudes, and practices among schoolgirls ( Table 5 ). These interventions help reduce menstrual-related shame, stigma, fear and also increase self-efficacy and promote open discussion about menstruation [ 31 , 41 – 43 , 45 , 46 , 49 , 50 , 52 ]. In Ethiopia, a trial by Blake et al. found that distributing puberty books to schoolgirls improved their menstrual knowledge and attitudes towards menstruation and reduced menstrual shame and fear [ 45 ]. The interventions had a significant effect on menstrual hygiene management practices such as increasing bathing during menstruation [ 31 , 43 ] ( Table 2 ). The impact of menstrual hygiene interventions on lower genital tract infections was assessed in one trial. Though non-significant, there was a lower prevalence of lower genital tract infections among the pooled menstrual cup plus sanitary pad arms, as compared to non-intervention arms [ 48 ] ( Table 2 ).

Key : 0 = No Impact, + = Positive Impact

This review included trial studies that implemented different types of menstrual hygiene management interventions using diverse delivery strategies, different types of intervention providers, and different durations of intervention. School attendance, school performance, school dropout, menstrual hygiene knowledge, attitudes, and practices, and aspects of emotional health related to menstruation such as menstrual stigma and shame were outcomes of interest.

Six trial studies indicated a positive effect of interventions on school attendance, school dropout rates, and schoolgirls’ academic performance [ 32 , 35 , 46 , 47 , 50 , 51 ]. However, most of the studies had low to moderate levels of bias (Tables ​ (Tables3 3 and ​ and4). 4 ). School attendance is usually documented by schoolteachers or by using self-reported diaries, but this method may not provide data accurate enough to reach firm conclusions. In addition, school attendance alone may not be predictive of the academic performance of schoolgirls. Betsu et al. found that a girl’s physical presence in a classroom did not necessarily correlate with her mental presence or paying attention [ 58 ]. Moreover, mood swings and severe premenstrual symptoms resulting from hormonal changes during menstruation impact paying attention [ 59 ]. Additional indicators such as formal educational achievement, school participation, and enrollment in the succeeding grades of school might provide a more robust picture of schoolgirls’ academic achievement and continuing access to education. The trial by Nyadoy et al. showed improved academic scores after telling stories and playing games about menstrual hygiene management in the intervention arm; however, the outcome was measured only 6 weeks after the baseline assessment, and the small sample size makes it difficult to draw firm conclusions [ 46 ].

On the other hand, some studies have found interventions to have no effect, including the studies that evaluate menstrual cups [ 34 , 43 , 48 ]. Despite being a potentially viable intervention, many people falsely believe that menstrual cups can cause loss of virginity and reduced fertility [ 60 ]. Furthermore, menstrual cups may be difficult to clean effectively whenever water supplies are inadequate. This may influence the results of interventions using this device. Studies reporting positive effects, or no intervention effect may suffer from different forms of bias, posing challenges for policymakers and stakeholders looking for evidence-based menstrual hygiene interventions.

The systematic review by Chandra-Mouli et al. highlighted the importance of providing accurate biological information to menstruating girls. In most cases, girls receive most of their information from their mothers, but schoolgirls also seek menstrual information and support from older siblings, and their peers. All of these sources, and particularly their mothers, may be significant sources of menstrual misinformation [ 17 , 58 ]. There is a great need to improve community knowledge of the biology of menstruation, but despite this fact, mothers as a group are generally not targeted for improved education. In most of the studies we reviewed, premenarchal schoolgirls, in particular, receive insufficient education concerning menstruation, leaving them unprepared for the biological changes associated with menarche and contributing to their frustration, bewilderment, and anxiety when menstruation begins [ 61 ].

For schoolgirls to manage menstruation safely and comfortably, they need supportive social norms in the community as well as a welcoming environment both at home and at school. Interventions that improve parental involvement in menstrual hygiene management and that also target community sources of menstrual misinformation are generally lacking in the literature. The study by Sol et al. that engaged parents found a positive effect on menstrual hygiene management and school attendance [ 50 ]. Another study by Agbede et al. looking at the combined effect of peer and parent educational interventions had the highest mean score of menstrual hygiene management practice among its study arms [ 42 ].

Discussing menstruation with male family members (including, and perhaps especially, fathers) is another challenge faced by schoolgirls [ 62 ]. Approximately 13% of Tanzanian girls have encountered period teasing, while over 80% expressed fear of being teased, particularly by male classmates. This results in reduced school attendance, participation, and concentration in class [ 63 ]. Another article exploring the beliefs and attitudes boys and men hold about menstruation revealed that men generally have more negative attitudes towards menstruation and view it as debilitating and requiring secrecy. However, these attitudes may soften as men age and gain more knowledge and experience with menstruation [ 64 ]. Certain religious texts can be interpreted to associate menstruation with impurity and uncleanliness, which leads to menstrual restrictions, shame, and taboos in some cultures [ 65 ]. Many of these challenges are unaddressed by most of the menstrual intervention studies. A qualitative investigation by Betsu et al. indicated that many school teachers support attitudes promoting menstrual secrecy by their comments in class concerning menstrual hygiene, saying things like “drying reusable pads in a hidden place is helpful to prevent Michi , ” a folk-ailment believed by many locals in Ethiopia to be caused by the exposure of used or washed menstrual pads to sunlight [ 58 ]. Those who provide menstrual hygiene education and interventions should be aware of common cultural misperceptions regarding menstruation that exist in their communities. Better training of the teachers who provide classroom instruction concerning menstruation is also needed.

The review has certain limitations. Many of the studies that were included in this review relied on self-reported menstrual knowledge, attitude, and practices, as well as potentially inaccurate school attendance records, which could lead to over- or under-estimation of the findings due to poor recording of school attendance, social desirability bias and recall bias. Most of the studies reviewed did not address the impact of water, sanitation, and hygiene interventions or other community-based interventions on menstrual hygiene management. The review consisted of trials that used different interventions and methods of measuring outcomes and included a wide range of ages (9–25 years). These variations make it challenging to compare the studies with one another and to capture accurately the impact of menstrual hygiene interventions on the outcomes of interest. All relevant studies may not have been captured for this review due to limitations in the search strategies and limiting the studies reviewed to those in English. Most of the literature about menstrual hygiene management, especially in low- and middle-income countries, doesn’t adequately address the needs of people who identify as gender-nonconforming. Since gender-diverse persons make up such a small percentage of the population, it can be assumed that most of the academic literature on MHM is written from the perspective of cis women. This exclusion may affect menstrual hygiene needs and experiences of transgender, non-binary, and other gender-varied individuals [ 66 ]. There was a paucity of randomized controlled trials and quasi-randomized controlled trials, and this may have biased the resulting literature. As a result, conclusions concerning the effectiveness of menstrual hygiene interventions should be interpreted with caution.

The review also has several strengths, providing an extensive summary of English-language evidence. It offers valuable insights by presenting a comprehensive review of English-language trial studies that evaluate the effect of menstrual hygiene management interventions on various aspects of schoolgirls’ lives. With a large sample size from multiple countries, the study covers a broad range of interventions, including puberty education, distribution of menstrual supplies, and integration of menstrual health topics into school curriculums. The findings not only underscore the positive effects of these interventions, such as increased school attendance and enhanced menstrual hygiene knowledge and attitudes but also shed light on the challenges and limitations observed in certain studies. This review will also have a great contribution to identifying research gaps for further studies.

The results of this review have several implications for practice in the field of menstrual hygiene management. It highlights the need for comprehensive and accurate education about menstruation, not only for girls but also for their parents, teachers, and communities. This education should address misconceptions, and cultural taboos, and provide information on appropriate menstrual hygiene practices. This can be implemented by incorporating menstrual hygiene management into school curriculum and training; providing access to affordable and hygienic menstrual products; ensuring adequate water and sanitation facilities and creating supportive environments that reduce stigma and shame associated with menstruation.

The findings of this review have important policy implications. Governments and policymakers should prioritize menstrual hygiene as a public health issue and develop policies and guidelines to meet the needs of menstruating girls including affordable menstrual products, proper hygiene facilities, education about menstruation, and access to healthcare services for managing menstrual health. It is also crucial to address cultural beliefs and misconceptions surrounding menstruation through awareness campaigns and community engagement. Adequate funding should be allocated to ensure the effective implementation and monitoring of these policies to ensure that all girls have access to menstrual hygiene facilities and education.

While this review provides valuable insights into the effectiveness of menstrual hygiene management interventions, there are several areas that require further research. Future studies should aim to overcome the limitations identified in this review, such as biases and small sample sizes. Longitudinal studies with larger sample sizes are needed to assess the long-term impact of menstrual hygiene management interventions on school attendance, academic performance, and emotional well-being. Additionally, more research is needed to explore the effectiveness of different delivery strategies and intervention providers. It would also be beneficial to investigate the cultural and social factors that influence menstrual hygiene practices and develop interventions that address these specific contexts. Overall, future research should focus on generating robust evidence to inform the development of evidence-based interventions and policies in the field of menstrual hygiene management.

Menstrual hygiene management interventions can have a positive impact on schoolgirls’ attendance, reducing dropout rates, and improving their school performance and emotional health. Moreover, such interventions can improve knowledge, attitudes, and practices pertaining to menstruation and its management. A holistic approach that includes accurate menstrual education, better access to hygiene products, improved water, sanitation, and hygiene facilities; and greater engagement of parents, religious and community leaders is likely to make the greatest impact in this area. Of crucial importance is treating all who menstruate with the respect they deserve and reducing the stigmatization and shame that often surrounds this biological process.

It is also important to standardize the interventions used as well as the tools used to measure outcomes if such programs are to be evaluated properly. This will help to identify best practices and improve the overall effectiveness of the menstrual hygiene interventions used. Organizing large randomized clinical trials to address these issues in a well-structured manner would be extremely useful in moving our knowledge forward on how to improve menstrual hygiene among schoolgirls in low- and middle-income countries.

Supporting information

S1 checklist, s1 protocol, funding statement.

The author(s) received no specific funding for this work.

Data Availability

• PLoS One. 2024; 19(8): e0302523.

Decision Letter 0

PONE-D-23-35026Menstrual hygiene management interventions and their effects on schoolgirls’ menstrual hygiene experiences in low and middle countries: A systematic reviewPLOS ONE

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Reviewers' comments:

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Reviewer #1: Yes

Reviewer #2: Yes

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: N/A

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Reviewer #1: I would encourage the authors to tighten the piece prior to publication in two ways. First, the nature of the search seems to have translated into several important studies escaping capture as part of the dataset. This is not fatal; it is the nature of the searches the authors chose to run. But I think the authors will want to cabin their conclusions as being only as good as the data the searches yielded, acknowledging that other work that did not fit the authors' relatively narrow criteria were therefore excluded. Second, I think the authors would be well-served to address the linguistic challenges in talking about "women and girls" and "menstrual hygiene," when those terms have been made much more complicated by excellent work in this field. The authors gesture at this by the use of the term "menstruand" (which I found jarring and out of synch with most other scholarship in the field," but they never address the issue head-on.

Reviewer #2: General

Much is written in passive voice – active voice would be preferable. Occasionally you use ‘we’ – you should pick one narrative style and stick to it.

I don’t think it’s necessary to have the acronyms listed since there are only two (unless this is a requirement of the journal then please ignore me). You haven’t included PICOT.

There are times when you spell out MHM and others when you use the acronym – be consistent and use the acronym throughout

The paper should recognise that it isn’t just cisgender women who menstruate but potentially also transgender men, non-binary and other gender diverse persons. The term ‘menstruator’ could be used instead of women and girls to be inclusive.

I think it would be helpful if you stated the countries where studies present different evidence else you might fall into making sweeping generalising comments. For example lines 88-89.

You’ve used WASH as an acronym and spelled out but haven’t introduced it as an acronym – please revise

You could consider adding a positionality statement at the beginning of the paper.

Why were no studies in any Ethiopian languages selected?

‘intervention’ seems like a rather broad keyword

MHM definition – could point out that depending on the materials used somewhere to wash and dry reusable materials is also necessary. Could also mention the access to and ability to wash and dry underwear is also a necessity.

Lines 84-87 its clearer written as: More than half (52 %) of adolescent girls in Ethiopia

have never received any information about menstrual hygiene due to socio-cultural

87 misinformation, religious taboos, and inadequate menstrual supplies and facilities, which leads to fear, confusion, and lack of confidence when menarche occurs (11-15).

Line 93 – what is meant by gender empowerment exactly? Vague phrase it might be interesting to unpack it.

111-112 you use the word review a lot

Good justification for the work.

I wonder if it would produce, more results if you googled gender neutral terms like ‘menstruator’ – it could be written as a limitation if you didn’t do this.

The systematic review following PRISMA is clearly and transparently described. Having three reviewers to judge papers against the outlined eligibility criteria reduces bias.

Line 175 - I don’t think mode of intervention needs an explanation.

The search strategy is well documented and comprehensive

Data bases and other sources of information are specified

The process of study selection is clearly outlined.

The process of data extraction is well documented

The key characteristics of included studies is clearly presented.

The studies were rigorously assessed for risk of bias using the Joanna Briggs Institute critical appraisal assessment tools

Line 192-193 - I think you mean Saudi Arabia, not Saudi Riyadh

From like 251 – have you listed all of the education components because saying they ‘included things such as…’ makes it seem that the list is not exhaustive but it seems to be that way. And perhaps it should be if not too long to include each component.

Line 279 - Good and transparent analysis of intervention fidelity

Interesting discussion on blinding.

Line 305 – et al is repeated

Table 2 and 3 – could we have colour code for severity of bias?

Table 4 – reduce space between lines so table is less spread out – its currently across 13 pages

Table 4 – expand acronyms

Table 5 – I assume the 0 means no impact and + means positive impact but you need to dd this key somewhere. It would be clearer if you also did a colour i.e. green for positive effect , yellow for neutral. It would also look better if the symbols were in the centre of the square. Table 5 – could you add the type of intervention into the summary table and group similar types of intervention together?

370 – was the not paying attention due to hormonal fluctuations or worry and concern about not being able to manage their period?

An important narrative I feel is missing more on which there is a growing body of literature on is the role of men/boys/non-menstruators is upholding stigma/teasing etc. you touch upon this in lines 405-406 but feel some more literature on how non-menstruators act as a barrier could be added in.

407 – careful not to generalise all religious beliefs be specific.

Implications

447-449 – be more specific – state the unmet needs

Seems like the conclusion is the first instance apart from the title where you mention low and middle income countries… why would this not be an issue in high income countries? The United Kingdom is currently going through a cost of living crises where people are in hygiene poverty – unable to buy basic hygiene items like menstrual pads. Ref - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255001&utm_source=miragenews&utm_medium=miragenews&utm_campaign=news

Furthermore – Saudi Arabia is one of the countries studied, which is a high income country.

Is categorising countries by their economic status quite western and neoliberal?

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Reviewer #1: No

Reviewer #2:  Yes:  Georgia Hales

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Author response to Decision Letter 0

17 Jan 2024

To Reviewer 1

• Dear reviewer, the conclusion provided in the manuscript is yielded from the findings (literatures reviewed). The findings evidenced that the interventions can enhance schoolgirls' educational outcomes, and can improve their menstrual knowledge, attitudes, and practices by helping them manage their periods more effectively.

• We used the term “Menstruant” not “menstruand” may be it is editorial error. The use of women and girl is more dominant in WASH sectors. While menstruants is emerging form gender inclusive perspective, hence, in the write up we tried to balance the use of the terms. However our search clearly identified literatures that assessed the effect of menstrual interventions on “school girls”.

To Reviewer 2

Authors’ response

• We have converted passive voice to active voice in most of the relevant sections.

• Acronyms have been spelled out and made consistent in the current version.

• Although "Menstruants" is a gender inclusive term, the primary objective is to assess its effect on “school girls” and we had to be specific to these group of study participants. Moreover, the studies we have reviewed mostly used the term "Schoolgirls," "Girls," and "Women". For this reason, we maintained the terms. However, in the write up section we have also considered “menstruants”

• The findings are form different low and middle income countries, and citation is in place ( line 89)

• The academic and research language for Ethiopia is English. So, there is no study conducted using Ethiopian language and which is not included.

• We have included positionality statement under the method section on the current version (line 128)

“Intervention" is preceded by "menstrual hygiene management" and expressed as “menstrual hygiene management interventions” to be more specific, (lines 27 and 34)

Authors’ Response: Agreed, we utilized the standard definitions, and employing operational definitions may provide further assistance.

Lines 84-87 its clearer written as: More than half (52%) of adolescent girls in Ethiopia have never received any information about menstrual hygiene due to socio-cultural

The issue is fixed accordingly: (line 86-89)

• “More than half (52 %) of adolescent girls in Ethiopia have never received any information about menstrual hygiene (10), due to religious taboos, socio-cultural misinformation, and inadequate menstrual supplies and facilities, which leads to fear, confusion, and lack of confidence when menarche occurs (11-15).”

• “gender empowerment” modified to “gender equality” ( line 93)

• In fact, we purposefully limited our search terms to be gender-specific to highlight the impact the interventions on schoolgirls, but it is still valued concern because it may have limited searching relevant literature. We have included it on the limitation section of the manuscript

Authors’ Response

Written as “Mode of intervention” only (Line 200, in the modified version)

• Saudi Arabiya is excluded from the analysis as it is one of the high income countries. And modification is made on the manuscript accordingly ( Line 215)

From line 251 – have you listed all of the education components because saying they ‘included things such as…’ makes it seem that the list is not exhaustive, but it seems to be that way. And perhaps it should be if not too long to include each component.

Modified as “The menstrual education components of the studies included; puberty education, training on…” (line 239)

Authors’ response: Amendment made (the repeated et al is deleted/ line 295)

Table 2 and 3 – could we have color code for severity of bias?

Authors’ response: Color code is given accordingly

Authors’ response: Resolved (line space of the table is reduced)

Table 5 – I assume the 0 means no impact and + means positive impact but you need to add this key somewhere. It would be clearer if you also did a colour i.e. green for positive effect, yellow for neutral. It would also look better if the symbols were in the centre of the square. Table 5 – could you add the type of intervention into the summary table and group similar types of intervention together?

• Acronyms are expand on the heading section

• Key is provided for Table-4 on line 337

Authors’ response: lack of attention in education could be attributed by both the hormonal fluctuations and worry about not being able to manage their period. We have added additional literatures to illustrate it. (Line 353)

Authors’ Response: Noted and we have added more details as follows

“One article exploring the beliefs and attitudes boys and men hold about menstruation revealed that men generally have more negative attitudes towards menstruation and view it as debilitating and requiring secrecy. However, these attitudes may soften as men age and gain more knowledge and experience with menstruation” (line 390)

407 – careful not to generalize all religious beliefs be specific.

Authors’ response: Addressed in line 394 as “most religious beliefs”, to avoid generalization.

Authors’ Response: specified on the current version on line 435-439

“Governments and policymakers should prioritize menstrual hygiene as a public health issue and develop policies and guidelines to meet the needs of menstruating girls including affordable menstrual products, proper hygiene facilities, education about menstruation, and access to healthcare services for managing menstrual health.”

Seems like the conclusion is the first instance apart from the title where you mention low- and middle-income countries… why would this not be an issue in high income countries? The United Kingdom is currently going through a cost-of-living crises where people are in hygiene poverty – unable to buy basic hygiene items like menstrual pads. Ref - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255001&utm_source=miragenews&utm_medium=miragenews&utm_campaign=news

Is categorizing countries by their economic status quite western and neoliberal?

� Menstrual hygiene management is indeed an issue that affects individuals in both high-income and low-income countries. In high-income countries, access to menstrual products and facilities for proper hygiene may be more readily available (as compared to low income countries), but issues such as stigma and access to education about menstrual hygiene persist. In low-income countries, the challenges may include limited access to sanitary products, clean water, and sanitation facilities, as well as social stigma and inadequate education about menstrual health. Therefore, addressing menstrual hygiene management is an important aspect of promoting gender equality and ensuring the well-being of individuals across different socioeconomic contexts.

� We have used the World Bank classification of countries based on economic status and we have excluded the finding from Saudi Arabia.

� Categorization is made by income level ( world bank)

Submitted filename: Response to Reviewers .docx

Decision Letter 1

29 Jan 2024

PONE-D-23-35026R1Menstrual hygiene management interventions and their effects on schoolgirls’ menstrual hygiene experiences in low and middle countries: A systematic reviewPLOS ONE

Thanks for doing a good job with the first round of comments.   I'm afraid both reviewers have some further things for you to address but I think these should be pretty straightforward now. Please submit your revised manuscript by Mar 14 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at  gro.solp@enosolp . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: (No Response)

2. Is the manuscript technically sound, and do the data support the conclusions?

3. Has the statistical analysis been performed appropriately and rigorously?

4. Have the authors made all data underlying the findings in their manuscript fully available?

5. Is the manuscript presented in an intelligible fashion and written in standard English?

6. Review Comments to the Author

Reviewer #1: Line 24: uses passive voice

Line 32: “Accordingly” doesn’t flow from previous sentence

Line 35: “However” is clunky here.

Line 82: You use the word “menstruants” without explaining this word choice. This absolutely needs to be addressed. It is not widely accepted (by two different “camps” for different reasons). It is jarring and merits context. If you believe that this is the term that is emerging, you should at least cite to some authority for that, because I don’t think there is consensus/agreement that many readers will have heard it before (“menstruator” is much more common in significant literature).

Lines 84-89: You definitely need to explain your focus on women and girls. Your response to the reviewers makes clear that it is because that is what the studies you survey are studying…but this does not come through in your paper. The reader is still left wondering why you are focusing on *girls* (but then again, are you focused just on girls? In fact, later in the paper, such as at Lines 296-98, you do cite studies involving boys). This needs to be clarified.

Lines 95-96: I don’t think the average reader will understand what you mean by “weak enabling environments”’

Line 111: comma missing

Line 114: reviews “were conducted” (passive voice) by WHOM?

Lines 143-145: Here you talk about limiting your search to studies in which the participants were schoolgirls only. Is this accurate? See comment above re Lined 296-98. Perhaps I am misunderstanding.

Line 148: Punctuation missing?

Lines 149, 152, 160: Colon not necessary?

Line 165: Unnecessary comma

Line 210: Do you mean “findings” (plural)?

Line 212: Are “menstrual interventions” the same as “menstrual hygiene management interventions” discussed on Line 146?

Line 254: Passive voice

Line 258: Odd initial cap for “School”

Lines 272-73: Awkward and difficult to follow sentence.

Line 298: Were these period underwear or regular underwear?

Lines 300-302: Run-on sentence.

Line 464: Instead of talking about “menstruating girls and women,” might this be an appropriate place to talk about “all who menstruate,” notwithstanding your focus?

Line 466: Queer theory would ask us to look rigorously at the word “normal.” I think you mean “involuntary” or “inevitable” (or perhaps drop the adjective entirely).

Reviewer #2: Dear authors,

Thanks for the effort you’ve put in to addressing my comments. I feel like the paper has now avoided a couple of easy pitfalls. The information in the tables is also now much easier for the reader to digest – thanks for this. There are just a few things I’m not sure were fully addressed; perhaps I did not explain myself very well so here I elucidate:

I understand the want to just focus on one particular group (schoolgirls). However, I raised this point as it is often gender diverse persons who are left out and not represented in this type of data collection, which is something that needs to change if the research is to remain relevant going forwards. I appreciate the mention of menstruators – it’s important as a limitation if anything to explain the data set is solely focused on cisgender girls and women.

Largely you give the country where the reference is from but not all the time. It’s important to do this consistently in order to avoid making generalisation about all low-income countries.

I’m happy to see the inclusion of the positionality statement – it adds transparency. Something I was looking for was mention of the country/countries the authors are from. There adds incongruence if the authors were from a high-income country say but are commenting on low income countries. How does where the authors are from impact the direction of the study or interpretation of results?

That’s a shame that you’ve now had to exclude Saudi Arabia. I hope my point that menstrual health is a global issue that impacts high-income countries was taken not to diminish the lack of access in lower income countries but to highlight it’s not just an issue in low-income countries and that there are inequalities within countries as well as between them.

Great that you’ve added in some literature regarding men/boys/non-menstruators however the point that I wanted to get at was that it can be these groups that also act as a barrier to schoolgirls’ attendance through teasing or shaming.

I don’t think changing the line to ‘most religious beliefs’ avoids generalisation either… this is a sensitive point and I understand what you’re getting at… but I think what you’re saying could be misinterpreted. Religion is interpreted and enacted differently across the world. For example in the UK, I don’t think many Christians would feel stigma towards menstruation because of what is written in the Bible. But I understand that other cultures might. What you can say instead which is factually true is that in certain religious texts menstruation is presented as making the menstruator impure or unclean. I would be particular about using the exact wording – so much of religious text is down to interpretation.

I feel that for this work to be relevant, contemporary, and self-aware, the authors should take a little more time to contemplate these last points. It would also be good to have a statement from the authors on why this paper is important and what new contribution to the discussions on MHM it brings.

Many thanks,

7. PLOS authors have the option to publish the peer review history of their article ( what does this mean? ). If published, this will include your full peer review and any attached files.

Author response to Decision Letter 1

Reviewer #1:

Line 24: uses passive voice

Authors ‘Response

Dear reviewers I agree with comments in line #24

The statement in line# 24 is replaced with active voice, “To address these issues, researchers have conducted intervention studies, but the impact on school attendance has varied”

I agree with comment of the reviewer, the statement in line 32 is paraphrased as

“Review of sixteen trial studies showed that menstrual hygiene interventions have a positive effect on schoolgirls' school attendance, performance, and dropout rates, as well as on their menstrual knowledge, attitudes, practices, and emotional well-being.”

The comment is well taken and “However” in line # 34 is omitted and the sentences is rephrased as “There was a low to medium risk of bias in the most of the studies.”

I agree with point raised and it is valued concern. Hence the word “menstruants” in line 82 is replaced with “menstruators” as per the recommendation

The comment is well accepted. The reason for focusing on schoolgirls is now explained in line 419-426 as follows, to make it clear to the reader.

“Most of the literature about menstrual hygiene management, especially in low- and middle-income counties, don’t adequately address the needs of people who identify as gender-nonconforming. Menstrual discourses, are frequently written from the perspective of a cis woman, highlighting only the menstrual experiences of adolescent girls and cis women. This exclusion may affect menstrual hygiene needs and experiences of transgender, non-binary, and other gender varied individuals”

This review investigated how involving males (boys, fathers, or parents) in interventions might improve schoolgirls' experiences. We included intervention studies targeting these male groups alongside traditional MHM interventions. This broadens the range of interventions studied, but the outcome/impact must be measured specifically on schoolgirls.

The comment is well accepted. In the old version we explained the word “weak enabling environments”’ using the list of challenges that came after it . i.e. “Insufficient knowledge about menstruation, inadequate access to water, sanitation and hygiene services, lack of adequate hygiene materials, and social norms unsupportive of those who menstruate”

But if it creates confusion for readers, the already listed challenges are more descriptive and we have omitted the phrase “weak enabling environment” to avoid ambiguity to the reader

Authors ‘Response .

This is well taken and Comma is used in line #110 “2015-2016 school year, demonstrated”

Dear reviewer, we have included the list of 4 citations which helps to address the potential question about “who conducted the review?”. The 4 citations in line 116 can address this concern than listing the name of the authors who did the review.

Dear reviewer, your understanding is correct. The statement is rephrased to “

The search was limited to studies that measured outcomes on schoolgirls because the objective of the review was to evaluate how menstrual hygiene management intervention programs impact schoolgirls' attendance, academic performance, or dropout rates. ” The study aimed to evaluate the effects of intervention programs on school attendance, performance, and dropout rates of schoolgirls, as clearly stated in lines 144-145. Therefore, while the intervention may involve parents, the community, and males, the outcomes must be assessed specifically for schoolgirls. We have included studies that involved parents or males in the intervention, with the actual outcomes measured for the schoolgirls. Additionally, we used terms such as fathers, mothers, community, and parents as search terms to encompass various types of interventions.

This is well noted punctuation is in place now, “supplies.”

Well noted and accepted, the colon in line 149 and 152 is removed and we kept the colon in line 159 and we deleted the word “includes” to make appropriate use of colon

Well accepted, comma in line 165 is removed the statement is written as “we excluded studies not available in the English language and conference abstracts.”

This is noted, line 208 in this version, is changed into plural “a summary of the findings”

Yes, it is the same and line 210 is corrected as “Sixteen trial studies that assessed the effect of menstrual hygiene management interventions…”

Dear reviewer the comment is accepted, the statement in line 252 is changed into active voice as follows

“Montgomery et al. suggested that using school attendance and dropout rates as a proxy indicator of academic performance”

This is accepted. Line 256 Changed from Official School attendance� Official school attendance

The comment is well accepted. The statement in line 270-272 which was “Montgomery et al. conducted study on comparable peri-urban schools but included one remote rural site without experience in using sanitary pads that had no electricity, and no paved roads.”is rephrased as follows:

“Montgomery et al. carried out study on peri-urban schools that were comparable, but they also incorporated a remote rural site lacking experience in using sanitary pads, with no access to electricity and unpaved roads.”

Dear reviewer, fortunately I physically knew the underwear’s provided in this specific intervention and they are normal/regular underwear’s and the term “ regular” is added ( line 297-298)

Well noted and accepted. The statement in line 297-299 “School attendance (data collected prospectively on-site by team researchers) was analyzed before and after the intervention and also compared with attendance data from the prior school year”

Is amended as

“School attendance was analyzed before and after the intervention and also compared with attendance data from the prior school year”

Line 464: Instead of talking about “menstruating girls and women,” might this be an appropriate place to talk about “all who menstruate,” notwithstanding your focus

Dear reviewer this comment is accepted. “Menstruating girls and women “is replaced with “all who menstruate” on the current version ( line # 470)

Line 466: Queer theory would ask us to look rigorously at the word “normal.” I think you mean “involuntary” or “inevitable” (or perhaps drop the adjective entirely) (line # 474).

Well Noted, the word “Normal” is dropped from line # 471

Reviewer #2: Dear authors,

The following paragraph would explain the limitation, which is placed in line # 416-421

“Most of the literature about menstrual hygiene management, especially in low- and middle-income counties, don’t adequately address the needs of people who identify as gender-nonconforming. Menstrual hygiene issues, are frequently written from the perspective of a cis woman, highlighting only the menstrual experiences of adolescent girls and cis women. This exclusion may affect menstrual hygiene needs and experiences of transgender, non-binary, and other gender varied individuals.”

Largely you give the country where the reference is from but not all the time. It’s important to do this consistently in order to avoid making generalization about all low-income countries.

The input is considered and included the countries where the citation exists, but country was not included mainly on table 5

Dear reviewer this is well accepted. The following statement is added the statement “I am from Ethiopia one of the low-income countries” in line 130 to indicate the principal investigator is from low income country.

Dear reviewer, issues of menstrual poverty and inequity are global challenges. It is widely recognized that individuals who menstruate in high-income countries encounter various challenges, although the severity and nature of these challenges may vary from LMIC. Our initial focus for the review was on addressing issues in low and middle-income countries. And we wrongly classified Saudi Arabia as LMIC and include it in the review process. However, this does not imply that menstrual hygiene management is not an issue in high income countries. Your feedback in the previous review highlighted the inclusion of one high-income country, Saudi Arabia, in the review. This was an important observation. It would not be appropriate to include a high-income country when the review is intended to focus on LMICs. This was the sole reason for its exclusion.

Dear reviewer the comment is well received. The following statement is included in line #389-392 on the current version which may address the concern about the effect of teasing by boys on school attendance and participation.

“Approximately 13% of Tanzanian girls have encountered period teasing, while over 80% expressed fear of being teased, particularly by male classmates. This results in reduced school attendance, participation, and concertation in class.”

I don’t think changing the line to ‘most religious beliefs’ avoids generalization either… this is a sensitive point or I understand what you’re getting at… but I think what you’re saying could be misinterpreted. Religion is interpreted and enacted differently across the world. For example in the UK, I don’t think many Christians would feel stigma towards menstruation because of what is written in the Bible. But I understand that other cultures might. What you can say instead which is factually true is that in certain religious texts menstruation is presented as making the menstruator impure or unclean. I would be particular about using the exact wording – so much of religious text is down to interpretation.

This is well accepted and the statement “Menstrual restrictions and cultural taboos are often rooted in most religious beliefs and untrue cultural assumptions” Is replaced with following statement on the current version (line #395-397)

“In certain religious texts, menstruation is often framed as making the menstruator impure or unclean, leading to menstrual restrictions, shame, and taboos”

The contribution of the study to the discussion on MHM is highlighted as follows in the strength section (line #425-434)

The review also has several strengths, providing an extensive summary of English-language evidence. It offers valuable insights by presenting a comprehensive review of English-language trial studies that evaluate the effect of menstrual hygiene management interventions on various aspects of schoolgirls' lives. With a large sample size from multiple countries, the study covers a broad range of interventions, including puberty education, distribution of menstrual supplies, and integration of menstrual health topics into school curriculums. The findings not only underscore the positive effects of these interventions, such as increased school attendance and enhanced menstrual hygiene knowledge and attitudes, but also shed light on the challenges and limitations observed in certain studies. This review will also have great contribution in identifying research gaps for further studies.

Submitted filename: Response to reviweres.docx

Decision Letter 2

18 Mar 2024

PONE-D-23-35026R2Menstrual hygiene management interventions and their effects on schoolgirls’ menstrual hygiene experiences in low and middle countries: A systematic reviewPLOS ONE

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.  There are just a few more minor points to address, as well as the need to check the grammar further.

Please submit your revised manuscript by May 02 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at  gro.solp@enosolp . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Reviewer #1: All comments have been addressed

Reviewer #1: N/A

Reviewer #1: I implore the authors to run their manuscript through a grammar-checking program (Grammarly, Paperpal, anything) or Chat GPT to improve the grammar and punctuation, especially in the first three pages. The authors have nicely addressed the substantive comments and have responded to specific grammatical errors pointed out by the reviewers. The manuscript still needs to be gone through line by line because parts of it are not well-edited. I do not consider it a good use of my professional time to provide a third round of input pointing out grammatical errors that could be addressed readily by the authors.

Reviewer #2: Thanks for addressing the comments. There are just a couple more tiny things to address and then I’m happy for the work to be published.

1. ‘frequently written from the perspective of a cis woman’ – although I completely agree with this perhaps it requires a reference? Maybe you could explain why you know this to be true as I’m not sure you’d actually be able to find a reference. You could say ‘Since gender-diverse persons make up such a small percentage of the population, it can be assumed that the vast majority of academic literature on MHM is written from the perspective of cis women’. Maybe I’m being unnecessarily pedantic here.

2. I think you would do well to read around the purpose of positionality statements and this would help to inform how to write one. I wasn’t looking for you just to state that you are Ethiopian but how that background and identity shapes and influences the research. For example something like: I am a woman (?) who comes from Ethiopia, which is one of the countries studied in this paper. This gives me first-hand experience of what it’s like to be a menstruating schoolgirl in an LMIC. However, I am an outsider to the other countries studied in this paper, which may leave room for bias or misunderstandings in the interpretation of results’. Something like this.

3. Perhaps I’m being too cautious but I still believe this could be interpreted as offensive to some readers ‘In certain religious texts, menstruation is often framed as making the menstruator impure or unclean, leading to menstrual restrictions, shame, and taboos’. To reiterate, so much religious text is down to interpretation and this is what can cause the issues of negative views towards menstruation, not necessarily the words in the text itself. I don’t know if you’re religious or not but this would be an instance where your positionality affects how you interpret data. For example, I’m not religious and therefore don’t understand or have association to any religious texts. I gave a lecture on MHM making the exact same point as you that religious texts e.g. The Quran says that menstruation is impure. This was of course from a translation from Arabic into English where meaning can get lost anyway. A Muslim student put their hand up to explain that this was a very negative interpretation of the text and that it doesn’t mean impure in a dirty way as was interpreted. I think it would be inoffensive but still make the same point to say ‘certain religious texts can be interpreted to associate menstruation with impurity and uncleanliness, which leads to menstrual restrictions, shame, and taboos in some cultures’ you need a reference for this as well.

Author response to Decision Letter 2

31 Mar 2024

Response to Reviewers

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict-of-interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

________________________________________

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #1: N/A

Reviewer #1: I implore the authors to run their manuscript through a grammar-checking program (Grammarly, Paperpal, anything) or Chat GPT to improve the grammar and punctuation, especially in the first three pages. The authors have nicely addressed the substantive comments and have responded to specific grammatical errors pointed out by the reviewers. The manuscript still needs to be gone through line by line because parts of it are not well-edited. I do not consider it a good use of my professional time to provide a third round of input pointing out grammatical errors that could be addressed readily by the authors.

Authors’ Response:

Dear reviewer, this is valued concern. The necessary grammar and spelling errors are fixed throughout the document on the current version manuscript.

Reviewer #2: Thanks for addressing the comments. There are just a couple tinier things to address and then I’m happy for the work to be published.

Dear reviewer this comment is valued and is addressed as follows in line # 415 and the statement is replaced with the recommended way of rephrasing.

‘Since gender-diverse persons make up such a small percentage of the population, it can be assumed that most of the academic literature on MHM is written from the perspective of cis women’.

2. I think you would do well to read around the purpose of positionality statements and this would help to inform how to write one. I wasn’t looking for you just to state that you are Ethiopian but how that background and identity shapes and influences the research. For example, something like: I am a woman (?) who comes from Ethiopia, which is one of the countries studied in this paper. This gives me first-hand experience of what it’s like to be a menstruating schoolgirl in an LMIC. However, I am an outsider to the other countries studied in this paper, which may leave room for bias or misunderstandings in the interpretation of results. Something like this.

Dear reviewer the comment is well noted and the positionality statement in line #128-136, is rephrased as;

“I (the first author) am a woman, a feminist, and an advocate for girls' education. I am currently pursuing a PhD in public health. I am from Ethiopia, which is one of the countries studied in this paper. This gives me first-hand experience of what it’s like to be a menstruating schoolgirl in an LMIC. However, I am an outsider to the other countries studied in this paper, which may leave room for bias or misunderstandings in the interpretation of results. In this systematic review, the researcher's standpoint influences the research approach and findings. This study advocates for accessible menstrual hygiene resources and aims to address the stigma surrounding menstruation. The conclusions are based on this perspective, and readers are encouraged to take this into account when interpreting the findings.”

3. Perhaps I’m being too cautious, but I still believe this could be interpreted as offensive to some readers ‘In certain religious texts, menstruation is often framed as making the menstruator impure or unclean, leading to menstrual restrictions, shame, and taboos’. To reiterate, so much religious text is down to interpretation, and this is what can cause the issues of negative views towards menstruation, not necessarily the words in the text itself. I don’t know if you’re religious or not, but this would be an instance where your positionality affects how you interpret data. For example, I’m not religious and therefore don’t understand or have association to any religious texts. I gave a lecture on MHM making the exact same point as you that religious texts e.g. The Quran says that menstruation is impure. This was of course from a translation from Arabic into English where meaning can get lost anyway. A Muslim student put their hand up to explain that this was a very negative interpretation of the text and that it doesn’t mean impure in a dirty way as was interpreted. I think it would be inoffensive but still make the same point to say ‘Certain religious texts can be interpreted to associate menstruation with impurity and uncleanliness, which leads to menstrual restrictions, shame, and taboos in some cultures’ you need a reference for this as well.

Dear reviewers I agree with comments. The statement in line Line #392-94: “In certain religious texts, menstruation is often framed as making the menstruator impure or unclean, leading to menstrual restrictions, shame, and taboos”

Is replaced with

‘Certain religious texts can be interpreted to associate menstruation with impurity and uncleanliness, which leads to menstrual restrictions, shame, and taboos in some cultures. And reference is cited.

Submitted filename: Response to Reviewers.docx

Decision Letter 3

PONE-D-23-35026R3

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A bibliometric analysis on artificial intelligence in mathematics education

• Prawidi Wisnu Subroto Universitas Muhammadiyah Tangerang Indonesia
• Maulana Malik Universiti Sultan Zainal Abidin Malaysia
• Aji Raditya Universitas Muhammadiyah Tangerang Indonesia
• Nisvu Nanda Saputra Universitas Muhammadiyah Tangerang Indonesia

The research on artificial intelligence in mathematics education has attracted much attention from researchers since the last decade. This study aims to provide holistic information about artificial intelligence in mathematics education research using bibliometric analysis. Data for the analysis were extracted from the Scopus database from 1986 – 2023. The analysis, conducted using R-packages (Bibliometrix) and VOSviewer software, identifies the relevant nations, affiliations, journals, articles, and keywords on artificial intelligence in mathematics education research. The study reveals that 565 documents have been published in 354 journals, with an average annual growth rate of 11.27%. These documents, on average, have received 14.61 citations each. The research field has engaged a total of 1,847 authors, with an average of 3.26 authors contributing to each document. Additionally, 17.17% of these publications involved international co-authorship, indicating a moderate level of global collaboration. Our findings reveal a growing interest in using artificial intelligence as an educational tools and methods, particularly in the United States and China, which lead in publication output and citations. The analysis also reveals emerging trends and research gaps. The keywords such as "virtual reality," "sustainable development," and "COVID-19" reflect recent research focus on artificial intelligence in mathematics education research. Meanwhile, the keywords such as "mathematical literacy," “assessment,” and "gamification" identified as underexplored areas, suggesting potential opportunities for future research on artificial intelligence in mathematics education research.

Aria, M., & Cuccurullo, C. (2017). bibliometrix: An R-tool for comprehensive science mapping analysis. Journal of Informetrics, 11(4), 959–975. https://doi.org/10.1016/j.joi.2017.08.007

Baker, R.S.J.d., Corbett, A.T., Roll, I. et al. (2008). Developing a generalizable detector of when students game the system. User Model User-Adap Inter 18, 287–314. https://doi.org/10.1007/s11257-007-9045-6

Belland, B. R., Walker, A. E., Kim, N. J., & Lefler, M. (2017). Synthesizing Results From Empirical Research on Computer-Based Scaffolding in STEM Education: A Meta-Analysis. Review of Educational Research, 87(2), 309–344. https://doi.org/10.3102/0034654316670999

Bray, A., & Tangney, B. (2017). Technology usage in mathematics education research – A systematic review of recent trends. Computers and Education, 114, 255–273. https://doi.org/10.1016/j.compedu.2017.07.004

Chen, C.-J., & Liu, P.-L. (2007). Personalized Computer-Assisted Mathematics Problem-Solving Program and Its Impact on Taiwanese Students. Journal of Computers in Mathematics and Science Teaching, 26(2), 105–121. https://www.learntechlib.org/p/21809

Chen, D., Liu, Z., Luo, Z., Webber, M., & Chen, J. (2016). Bibliometric and visualized analysis of emergy research. Ecological Engineering, 90, 285–293. https://doi.org/10.1016/j.ecoleng.2016.01.026

Chen, X., Xie, H., Zou, D., & Hwang, G. J. (2020). Application and theory gaps during the rise of Artificial Intelligence in Education. Computers and Education: Artificial Intelligence, 1(July), 100002. https://doi.org/10.1016/j.caeai.2020.100002

Chih-Ming, C., & Ying-You, L. (2020). Developing a computer-mediated communication competence forecasting model based on learning behavior features. Computers and Education: Artificial Intelligence, 1(August), 100004. https://doi.org/10.1016/j.caeai.2020.100004

Christopoulos, A., & Sprangers, P. (2021). Integration of educational technology during the Covid-19 pandemic: An analysis of teacher and student receptions. Cogent Education, 8(1). https://doi.org/10.1080/2331186X.2021.1964690

Civil, M., & Bernier, E. (2019). Exploring Images of Parental Participation in Mathematics Education: Challenges and Possibilities. Urban Parents’ Perspectives on Children’s Mathematics Learning and Issues of Equity in Mathematics Education, January 2015, 309–330. https://doi.org/10.4324/9780203764152-6

Craig, S. D., Hu, X., Graesser, A. C., Bargagliotti, A. E., Sterbinsky, A., Cheney, K. R., & Okwumabua, T. (2013). The impact of a technology-based mathematics after-school program using ALEKS on student’s knowledge and behaviors. Computers & Education, 68, 495–504. https://doi.org/10.1016/j.compedu.2013.06.010

del Olmo-Muñoz, J., González-Calero, J. A., Diago, P. D., Arnau, D., & Arevalillo-Herráez, M. (2023). Intelligent tutoring systems for word problem solving in COVID-19 days: could they have been (part of) the solution? ZDM - Mathematics Education, 55(1), 35–48. https://doi.org/10.1007/s11858-022-01396-w

Donthu, N., Kumar, S., Mukherjee, D., Pandey, N., & Lim, W. M. (2021). How to conduct a bibliometric analysis: An overview and guidelines. Journal of Business Research, 133(March), 285–296. https://doi.org/10.1016/j.jbusres.2021.04.070

Giannos, P., & Delardas, O. (2023). Performance of ChatGPT on UK Standardized Admission Tests: Insights from the BMAT, TMUA, LNAT, and TSA Examinations. JMIR Medical Education, 9. https://doi.org/10.2196/47737

Gu, Z., Meng, F., & Farrukh, M. (2021). Mapping the Research on Knowledge Transfer: A Scientometrics Approach. IEEE Access, 9, 34647–34659. https://doi.org/10.1109/ACCESS.2021.3061576

Gunel, K., & Asliyan, R. (2009). Determining difficulty of questions in intelligent tutoring. The Turkish Online Journal of Educational Technology - TOJET, 8(3), 14–22. https://files.eric.ed.gov/fulltext/EJ859488.pdf

Hammadi, S. S., Majeed, B. H., & Hassan, A. K. (2023). Impact of Deep Learning Strategy in Mathematics Achievement and Practical Intelligence among High School Students. International Journal of Emerging Technologies in Learning, 18(6), 42–52. https://doi.org/10.3991/ijet.v18i06.38615

Heffernan, N. T., & Heffernan, C. L. (2014). The ASSISTments ecosystem: Building a platform that brings scientists and teachers together for minimally invasive research on human learning and teaching. International Journal of Artificial Intelligence in Education, 24(4), 470–497. https://doi.org/10.1007/s40593-014-0024-x

Huang, X., Craig, S. D., Xie, J., Graesser, A., & Hu, X. (2016). Intelligent tutoring systems work as a math gap reducer in 6th grade after-school program. Learning and Individual Differences, 47, 258–265. https://doi.org/10.1016/j.lindif.2016.01.012

Hwang, G.-J., & Tu, Y.-F. (2021). Roles and Research Trends of Artificial Intelligence in Mathematics Education: A Bibliometric Mapping Analysis and Systematic Review. Mathematics, 9(6), 584. https://doi.org/10.3390/math9060584

Hwang, G. J., Sung, H. Y., Chang, S. C., & Huang, X. C. (2020). A fuzzy expert system-based adaptive learning approach to improving students’ learning performances by considering affective and cognitive factors. Computers and Education: Artificial Intelligence, 1(July), 100003. https://doi.org/10.1016/j.caeai.2020.100003

Jeong, J. S., & González-Gómez, D. (2020). A web-based tool framing a collective method for optimizing the location of a renewable energy facility and its possible application to sustainable STEM education. Journal of Cleaner Production, 251. https://doi.org/10.1016/j.jclepro.2019.119747

King, S., Boyer, J., Bell, T., & Estapa, A. (2022). An Automated Virtual Reality Training System for Teacher-Student Interaction: A Randomized Controlled Trial. JMIR Serious Games, 10(4). https://doi.org/10.2196/41097

Kuhail, M. A., Alturki, N., Alramlawi, S., & Alhejori, K. (2023). Interacting with educational chatbots: A systematic review. Education and Information Technologies, 28(1), 973–1018. https://doi.org/10.1007/s10639-022-11177-3

Li, Y., Wang, K., Xiao, Y., Froyd, J. E., & Nite, S. B. (2020). Research and trends in STEM education: a systematic analysis of publicly funded projects. International Journal of STEM Education, 7(1). https://doi.org/10.1186/s40594-020-00213-8

Özyurt, Ö., Özyurt, H., Baki, A., & Güven, B. (2013). Integration into mathematics classrooms of an adaptive and intelligent individualized e-learning environment: Implementation and evaluation of UZWEBMAT. Computers in Human Behavior, 29(3), 726–738. https://doi.org/10.1016/j.chb.2012.11.013

Paras, J. (2001). Crisis in mathematics education. Student failure: challenges and possibilities. South African Journal of Higher Education, 15(3), 66–73. https://doi.org/10.4314/sajhe.v15i3.25327

Pareto, L. A. (2014). Teachable Agent Game Engaging Primary School Children to Learn Arithmetic Concepts and Reasoning. Int J Artif Intell Educ 24, 251–283. https://doi.org/10.1007/s40593-014-0018-8

Park, I., & Yoon, B. (2018). Identifying promising research frontiers of pattern recognition through bibliometric analysis. Sustainability (Switzerland), 10(11). https://doi.org/10.3390/su10114055

Rebolledo-Mendez, G., Huerta-Pacheco, N. S., Baker, R. S., & du Boulay, B. (2022). Meta-Affective Behaviour within an Intelligent Tutoring System for Mathematics. International Journal of Artificial Intelligence in Education, 32(1), 174–195. https://doi.org/10.1007/s40593-021-00247-1

Saha, S., Park, C., Knapik, S., Guo, J., Huang, O., & Liu, W. K. (2023). Deep Learning Discrete Calculus (DLDC): a family of discrete numerical methods by universal approximation for STEM education to frontier research. Computational Mechanics, 72(2), 311–331. https://doi.org/10.1007/s00466-023-02292-0

Salmi, H. S., Thuneberg, H., & Bogner, F. X. (2023). Is there deep learning on Mars? STEAM education in an inquiry-based out-of-school setting. Interactive Learning Environments, 31(2), 1173–1185. https://doi.org/10.1080/10494820.2020.1823856

Sayed, W. S., Noeman, A. M., Abdellatif, A., Abdelrazek, M., Badawy, M. G., Hamed, A., & El-Tantawy, S. (2023). AI-based adaptive personalized content presentation and exercises navigation for an effective and engaging E-learning platform. Multimedia Tools and Applications, 82(3), 3303–3333. https://doi.org/10.1007/s11042-022-13076-8

Song, P., & Wang, X. (2020). A bibliometric analysis of worldwide educational artificial intelligence research development in recent twenty years. Asia Pacific Education Review, 21(3), 473–486. https://doi.org/10.1007/s12564-020-09640-2

Suwarno, S., Ibrahim, N., & Chaeruman, U. A. (2021). Mapping Scientific Research on Hypermedia Learning Technology Using Scopus Database: A Bibliometric Approach. Library Philosophy and Practice, 2021, 1–20.

Talan, T. (2021). Artificial Intelligence in Education: A Bibliometric Study. International Journal of Research in Education and Science, 7(3), 822–837. https://doi.org/10.46328/ijres.2409

van Eck, N. J., & Waltman, L. (2010). Software survey: VOSviewer, a computer program for bibliometric mapping. Scientometrics, 84(2), 523–538. https://doi.org/10.1007/s11192-009-0146-3

Wang, S., Christensen, C., Cui, W., Tong, R., Yarnall, L., Shear, L., & Feng, M. (2023). When adaptive learning is effective learning: comparison of an adaptive learning system to teacher-led instruction. Interactive Learning Environments, 31(2), 793–803. https://doi.org/10.1080/10494820.2020.1808794

Yang, S. J. H., Ogata, H., Matsui, T., & Chen, N. S. (2021). Human-centered artificial intelligence in education: Seeing the invisible through the visible. Computers and Education: Artificial Intelligence, 2(January), 100008. https://doi.org/10.1016/j.caeai.2021.100008

Zupic, I., & Čater, T. (2014). Bibliometric Methods in Management and Organization. Organizational Research Methods, 18(3), 429–472. https://doi.org/10.1177/1094428114562629

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