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Menstrual Hygiene Management and School Absenteeism among Adolescents in Ghana: Results from a School-Based Cross-Sectional Study in a Rural Community.

ABSTRACT: The study aimed to deepen our understanding of the menstrual hygiene management (MHM) of adolescents and the influence of menstruation on school absenteeism. We employed a school-based cross-sectional design in five Junior High Schools combining both quantitative and qualitative data collection methods. A questionnaire was used to collect quantitative data from 250 schoolgirls, and key informant interviews were conducted with a teacher in each of the five schools. We performed logistic regression analysis to provide crude and adjusted effect estimates and 95% confidence intervals. About fifty percent of the girls were engaged in good MHM, and approximately forty percent of them reported menstrual-related school absenteeism. We did not find evidence (p = 0.858) of association between MHM and menstrual-related school absenteeism. However, after controlling for the effect of other factors, we found evidence that the age of the schoolgirls, their father's occupation, and the receipt of allowance for menstrual care products were associated with MHM. When compared to those aged 17 to 19, those aged 10 to 13 years had 0.72 (95% CI 0.21, 2.44) decreased odds of poor MHM while those aged 14 to 16 had almost 3-fold increased odds (95% CI 1.49, 4.55) of poor MHM. The adolescents whose fathers were farmers had 0.42 (95% CI 0.21, 0.82) decreased odds of poor MHM while those whose fathers were unemployed had 0.24 (95% CI 0.10, 0.61) decreased odds of poor MHM. We found that girls who did not receive regular allowance for menstrual care products had nearly 2-fold increased odds (95% CI 1.06, 3.09) of poor MHM compared to those who received allowance for menstrual care products. Menstrual pain (82.2%), fear of staining clothing (70.3%), fear of being teased (70.3%), nonavailability of sanitary pad (63.4%), and lack of private place to manage period at school (60.4%) were the common reasons cited for menstrual-related school absenteeism.

SUBMITTER: Mohammed S

PROVIDER: S-EPMC7204135 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Menstrual Hygiene Management and School Absenteeism among Adolescents in Ghana: Results from a School-Based Cross-Sectional Study in a Rural Community.

Mohammed Shamsudeen S Larsen-Reindorf Roderick Emil RE Awal Issahaku I

International journal of reproductive medicine 20200427

The study aimed to deepen our understanding of the menstrual hygiene management (MHM) of adolescents and the influence of menstruation on school absenteeism. We employed a school-based cross-sectional design in five Junior High Schools combining both quantitative and qualitative data collection methods. A questionnaire was used to collect quantitative data from 250 schoolgirls, and key informant interviews were conducted with a teacher in each of the five schools. We performed logistic regressio ...[more]

PMID: 32411782

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Project description:Inadequate menstrual hygiene management (MHM) practices have been associated with adverse health outcomes. This study aimed to describe MHM practices among schoolgirls from rural Gambia and assess risk factors associated with urogenital infections and depressive symptoms. A cross-sectional study was conducted among adolescent schoolgirls in thirteen schools in rural Gambia. A questionnaire was used to collect information on socio-demographics, MHM practices and clinical symptoms of reproductive and urinary tract infections (UTIs). A modified Beck Depression Inventory-II was used to screen for depressive symptoms. Mid-stream urine samples were collected to assess for UTIs. Modified Poisson regression analysis was used to determine risk factors for symptoms of urogenital infections and depression among adolescent girls. Three hundred and fifty-eight girls were recruited. Although, 63% of the girls attended schools providing free disposable pads, reusable cloths/towels were the commonest absorbent materials used. Heavy menstrual bleeding was associated with depressive symptoms (adjusted prevalence ratio, aPR 1.4 [95% CI 1.0, 1.9]), while extreme menstrual pain (aPR 1.3 [95% CI 1.2, 1,4]), accessing sanitary pads in school (aPR 1.4 [95% CI 1.2, 1.5]) and less access to functional water source at school (aPR 1.4 [95% CI 1.3, 1.6]) were associated with UTI symptoms. Conversely, privacy in school toilets (aPR 0.6 [95% CI 0.5, 0.7]) was protective for UTI symptoms. Heavy menstrual bleeding (aPR 1.4 [95% CI 1.1, 2.0]) and taking <30 minutes to collect water at home were associated with RTI symptoms (aPR 1.2 [95% CI 1.0, 1.5]) while availability of soap in school toilets (aPR 0.6 [95% CI 0.5, 0.8] was protective for RTI symptoms. Interventions to ensure that schoolgirls have access to private sanitation facilities with water and soap both at school and at home could reduce UTI and RTI symptoms. More attention is also needed to support girls with heavy menstrual bleeding and pain symptoms.

Project description:IntroductionMenstruation is crucial in the reproductive lives of all women. The advent of menses in most settings is accompanied by physical and psychological health, religious, social, and cultural implications. The research intends to identify determinants of menstrual hygiene management (MHM) practices among adolescent girls in Junior High Schools in the West Gonja Municipality of the Savannah Region of Ghana.MethodsThe study employed an analytical cross-sectional design with 430 adolescent schoolgirls selected through multistage sampling techniques. A structured questionnaire was used to collect data and analyzed using STATA version 14. A logistic regression model was run to determine the predictors of MHM practices.ResultsThe study discovered that 63.7% of the girls had sufficient knowledge of menstruation and menstrual hygiene. Almost all girls (97%) used some form of absorbent materials during menses, with over half of these girls (58.6%) using commercial sanitary pads, 30.5% using cloth, 3.7% using cotton, and 4.2% using tissue papers with 3.0% reported not using any absorbent material. Only 44.4% reported reusing their absorbent materials. Out of which, the majority (88.5%) of the schoolgirls cleaned their reusable absorbent material using soap and water with 77.5% drying absorbent materials in the sun. Overall, 84.9% practiced good MHM. Type of school [Adjusted Odds Ratio (AOR) =6.0; 95% Confidence Interval (CI) (2.64-13.59)], pocket money [AOR =2.5; 95% CI (1.27-4.86)], and residence [AOR =2.8 95% CI (1.55-5.18)] were the most significant determinants of menstrual hygiene management practice.ConclusionAbout two-thirds of the schoolgirls are knowledgeable in menstrual hygiene but access to management materials is problematic whereas approximately half of the girls have access to sanitary pads and the rest resort to the use of cloth and cotton. Pocket money and residential status were the most important predictors of the menstrual hygiene management. The government initiative to provide schoolgirls with sanitary pads could go a long way to improve menstrual hygiene management if implemented across all schools in Ghana, particularly in rural areas.

Project description:BackgroundMany adolescent girls in low-income and middle-income countries lack appropriate facilities and support in school to manage menstruation. Little research has been conducted on how menstruation affects school absence. This study examines the association of menstrual hygiene management knowledge, facilities and practice with absence from school during menstruation among Bangladeshi schoolgirls.MethodsWe conducted a nationally representative, cross-sectional study in Bangladeshi schools from March to June 2013 among girls 11 to 17 years old who reached menarche. We sampled 700 schools from 50 urban and 50 rural clusters using a probability proportional to size technique. We interviewed 2332 schoolgirls and conducted spot checks in each school for menstrual hygiene facilities. To assess factors associated with reported school absence, we estimated adjusted prevalence difference (APD) for controlling confounders' effect using generalised estimating equations to account for school-level clustering.ResultsAmong schoolgirls who reached menarche, 41% (931) reported missing school, an average of 2.8 missed days per menstrual cycle. Students who felt uncomfortable at school during menstruation (99% vs 32%; APD=58%; CI 54 to 63) and who believed menstrual problems interfere with school performance (64% vs 30%; APD=27; CI 20 to 33) were more likely to miss school during menstruation than those who did not. School absence during menstruation was less common among girls attending schools with unlocked toilet for girls (35% vs 43%; APD=-5.4; CI -10 to -1.6). School absence was more common among girls who were forbidden from any activities during menstruation (41% vs 33%; APD=9.1; CI 3.3 to 14).ConclusionRisk factors for school absence included girl's attitude, misconceptions about menstruation, insufficient and inadequate facilities at school, and family restriction. Enabling girls to manage menstruation at school by providing knowledge and management methods prior to menarche, privacy and a positive social environment around menstrual issues has the potential to benefit students by reducing school absence.

Project description:BackgroundWomen in rural settings particularly in schools suffer more from stigma and lack of services and facilities during menstruation. However, the issue has not received proper attention from school water sanitation and hygiene programs. And this study was aimed to identify knowledge and practice of menstrual hygiene, and associated factors.MethodInstitution based cross-sectional study was employed among 441 school girls in Mekidela city. EpiData Version 4.6 and the Statistical Package for the Social Sciences Version 25.0 were used for data entry and analysis, respectively. Bivariable and multivariable logistic regression was employed to identify factors associated with the outcome variables. Variables with a p-value<0.25 in the bivariable analysis were a candidate for multivariable logistic regression and p-value<0.05 in the multivariable analysis was used to declare significant association.ResultsOf the respondents, 64.9% reported good knowledge of menstrual hygiene management. In multivariable analysis; grade level (grade 11 & 12) [adjusted odds ratio (AOR) = 2.23, 95% C.I (1.19-4.16)], age ≥ 19 years [AOR = 3.45, 95% C.I (1.78-6.69)], residence [AOR = 1.90, 95% C.I: (1.12-3.23)], know sanitary pads [AOR = 2.67, 95% CI: (1.19-6.00)] and learned about menstrual hygiene [AOR = 1.71, 95% CI: (1.02-2.87)] found to be associated with knowledge. About 62.4% have good menstrual hygiene practices. Knowledge on menstrual hygiene [AOR = 1.73, 95% C.I (1.07-2.80)], know about reproductive tract/sexually transmitted infections [AOR = 2.46, 95% CI: (1.37-4.43)], having private shower [AOR = 2.04, 95% C.I 2.04(1.24-3.37)] and residence [AOR = 3.76, 95% C.I:(2.18-6.51)] were factors associated with practice.ConclusionOverall nearly two-third of respondents had good knowledge and good practice of menstrual hygiene management. Factors significantly associated with their knowledge included age, grade level, residence, learning on menstrual hygiene, and knowledge of sanitary pads. Residence, knowledge on menstrual hygiene, know about sexually transmitted infections and having a private shower were found to be associated with practice of menstrual hygiene management. In general, our finding indicates that menstrual hygiene was unsatisfactory among adolescent school girls and more should be done on the factors identified.

Project description:IntroductionEven though menstruation is a normal biological process, adolescents are facing managing their menstruation when they are at school. It causes girls to miss their class on average three days every month. Studies in some countries showed that the magnitude of menstrual hygiene management problems is higher in rural adolescent girls, but little is known in the Ethiopia context. The objective of this study was to assess and compare menstrual hygiene management practices among rural and urban schoolgirls, Northeast, Ethiopia.MethodsAn institution-based comparative cross-sectional study was employed among 1078 schoolgirls (539 urban and 539 rural) from February to March 2020. The participants were selected using a multi-stage sampling technique. A structured self-administrative questionnaire and observational checklist were used for data collection. Bivariate and multivariable logistic regression analysis with a 95% confidence interval was employed. A P- value less than 0.05 was used to declare statistical significance.ResultsOverall, the magnitude of good menstrual hygiene practice was 52.9% (95%CI: 50.3%-56.5%), which was 65.9% (95% CI: 62.8%-70.7%) among urban and 39.9% (95% CI: 36.2%-44.6%) among rural schoolgirls. Among urban schoolgirls, the odds of good menstrual hygiene management practice was higher for girls aged below 18 years (AOR = 1.58, 95%CI: 1.05-2.39), learned about menstrual hygiene at school (AOR = 1.89, 95%CI: 1.21-2.97), heard about menstrual hygiene before menarche (AOR = 4.98, 95%CI: 2.71-9.13), and discussed menstrual hygiene with parents (AOR = 2.56, 95%CI: 1.25-5.27). Whereas, the odds of good menstrual hygiene management practice was higher among those who were knowledgeable on menstrual hygiene (AOR = 5.47, 95%CI: 3.68-8.12), those who learned about menstrual hygiene at school (AOR = 1.75, 95%CI: 1.13-2.70), and girls who heard about menstrual hygiene before menarche (AOR = 3.34, 95%CI: 1.44-7.76) in rural schoolgirls.ConclusionsThough the overall menstrual hygiene practice was low, it was relatively better among urban schoolgirls. This calls for more effort to solve these problems and achieve sustainable development goals. Therefore, education and awareness creation on menstrual hygiene for schoolgirls, even before menarche at both settings should be strengthened. Encouraging parent-adolescent discussion on menstrual hygiene would have paramount importance, particularly to urban schoolgirls.

Project description:BACKGROUND:Menstruation is a normal physiological process of females at their reproductive age. However, it is surrounded with social taboos and supernatural beliefs. The poor knowledge and understanding of menstruation may lead to unsafe hygienic practice that intern increases the risk of reproductive and genito-urinary tract infections, cervical cancer, school drop-out, poor academic performance and overall poor quality of life. Despite such clinical and academic effects, the knowledge and hygienic practice of adolescent girls towards menstruation is not well addressed in Ethiopia, particularly among school adolescent girls. Therefore, the main objective of this study was to assess the knowledge and menstrual hygiene practice among adolescent school girls in southern Ethiopia. METHODS:This was an institutional based cross-sectional study conducted at Gedeo zone high schools among 791 randomly selected adolescent girls using multi stage sampling technique. Data were collected using interviewer administered questionnaire. The collected data were entered to EPI-INFO (soft ware) and exported to SPSS version 20 for analysis. Bivariable and multivariable logistics analyses were computed to identify factors associated with the poor menstrual hygienic practice. During bi-variable analysis, variables with P-values of less than 0.25 were entered to multivariable model for further analysis. In the final model, P-value of less than 0.05 was used as a base to identify factors having a statistically significant association with poor menstrual hygiene practice at corresponding 95% confidence interval. RESULT:From a total of 791 adolescent girls participated in this study, 68.3% had poor knowledge of menstruation. About 48.1% of school girls used absorbent materials, and 69.5% clean their external genitalia. Generally, 60.3% of girls had poor menstrual hygienic practice. Age less than 15?years [OR?=?1.71:95% CI (1.22, 2.39)], longer days of menstrual flow [OR?=?2.51:95% CI (1.66, 3.80)] and poor knowledge of menses [OR?=?1.48:95% CI (1.04, 2.1)] had a significantly associated with poor menstrual hygiene practice. CONCLUSION:Majority of adolescent school girls had poor knowledge regarding menstruation and their hygienic practices are incorrect. This demonstrates a need to design acceptable awareness creation and advocacy programs to improve the knowledge and promote safe hygienic practice of adolescent school girls during menstruation.

Project description:On a daily basis, schoolgirls in low and middle-income countries discover blood on their clothing for the first time in school environments without toilets, water, or a supportive teacher, mentor, or role model to help them understand the changes happening in their bodies. This study aimed to examine the menstrual knowledge, sociocultural restrictions, and barriers to menstrual hygiene management in school environment among adolescent schoolgirls in a rural community. We collected quantitative data from 250 adolescent schoolgirls and qualitative data from thirty schoolboys and five schoolteachers in five Junior High Schools in the Kumbungu district of northern Ghana. Binary logistic regression models were fitted to determine the predictors of poor menstrual knowledge. Qualitative data were transcribed verbatim, coded, and organized into themes. Overall, 53.6% of the girls had poor knowledge about menstruation. Most of the boys had heard about menstruation and had an idea about what menstruation is with most of them describing it as "the flow of blood through the vagina of a female." The boys revealed that terms such as "Vodafone," "Red card," and "Palm oil" are used to describe menstruation in the schools and within the community. After adjusting for the effect of other sociodemographic factors, we found evidence that girls in their late adolescents were less likely to have poor menstrual knowledge compared to those aged 10-14 years (aOR 0.20, 95%CI 0.08-0.48). Maternal education was protective against poor menstrual knowledge. When compared to adolescents whose mothers were illiterates, those whose mothers had basic education (aOR 0.62, 95%CI 0.28-1.40) and those whose mothers had secondary or higher education (AOR 0.22, 95%CI 0.06-0.76) were less likely to have poor knowledge about menstruation. Adolescents from homes with no television and radio sets were more likely to have poor menstrual knowledge compared to those from homes with television and radio sets (aOR 2.42, 95%CI 1.41-4.15). Comfort, safety, and cost were the major factors that influenced their choice of sanitary products. Most of the teachers said the schools do not provide students with sanitary products, even in emergencies. We found that girls were not to prepare some local dishes (e.g. Wasawasa) during their periods and are forbidden from participating in religious activities (i.e. read the Holy Quran or pray in the mosque) during the period of menstruation. Open discussions about menstruation and its management are not encouraged and girls are considered unclean and impure during the period of menstruation. None of the schools had a regular supply of water in WASH facilities, a mirror for girls to check their uniforms for bloodstains or soap in the toilet facilities for handwashing. Menstrual education through the standard school curriculum, starting from primary school, could prepare girls for menarche, improve their knowledge on menstruation, and teach boys how to support girls and women during the period of menstruation. This could also eliminate the sociocultural misconceptions surrounding menstruation.

Dataset Information

Menstrual Hygiene Management and School Absenteeism among Adolescents in Ghana: Results from a School-Based Cross-Sectional Study in a Rural Community.

Publications

Menstrual Hygiene Management and School Absenteeism among Adolescents in Ghana: Results from a School-Based Cross-Sectional Study in a Rural Community.

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