Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): a feasibility study

Abstract

Background: Management of menstruation can present substantial challenges to girls in low-income settings. In preparation for a menstrual hygiene intervention to reduce school absenteeism in Uganda, this study aimed to investigate menstruation management practices, barriers and facilitators, and the influence of menstruation on school absenteeism among secondary school students in a peri-urban district of Uganda. Methods: Qualitative and quantitative studies were conducted among consenting girls and boys aged 14-17 years in four secondary schools in Entebbe sub-District, Uganda. Methods included group and in-depth interviews with students, a quantitative cross-sectional questionnaire, a prospectively self-completed menstrual diary, key informant interviews with policy makers, and observations of school water, sanitation and hygiene facilities. Multiple logistic regression was used to assess factors associated with school absenteeism during the most recent menstrual period. Results: Girls reported substantial embarrassment and fear of teasing related to menstruation in the qualitative interviews, and said that this, together with menstrual pain and lack of effective materials for menstrual hygiene management, led to school absenteeism. All policy makers interviewed reported poverty and menstruation as the key factors associated with school attendance. The 352 girls with questionnaire data had a median age of 16 (inter-quartile range (IQR) = 15,16) years, with median age at menarche of 13 (IQR = 13,14) years. Of these, 64 girls (18.7%) reported having stained their clothes and 69 (19. 7%) reported missing at least 1 day of school, during their most recent period. Missing school during the most recent period was associated with physical symptoms (headache (odds ratio (OR) = 2.15, 95%CI:1.20, 3.86), stomach pain (OR = 1.89, 95%CI:0.89, 4.04), back pain (OR = 1.75, 95%CI:0.97, 3.14), and with changing protection 4 or more times per 24 h period (OR = 2.08, 95%CI:1.06, 4.10). In the diary sub-study among 40 girls, school absence was reported on 28% of period-days, compared with 7% of non-period days (adjusted odds ratio = 5.99, 95%CI:4.4, 8.2; p < 0.001). Conclusion: In this peri-urban Ugandan population, menstruation was strongly associated with school attendance. Evaluation of a menstrual management intervention that address both psychosocial (e.g. self-confidence, attitudes) and physical (e.g. management of pain, use of adequate menstrual hygiene materials, improved water and sanitation facilities) aspects of menstruation are needed.

Menstrual hygiene management and school absenteeism among adolescent students in Indonesia: evidence from a cross‐sectional school‐based survey

“…Pain was also associated with school absenteeism in our study as has been reported from studies with adolescent girls in Uganda . Although evidence for delivering pain medication and its impact on absenteeism is limited , taboos and myths surrounding the use of pain medication during menstruation have been reported in other contexts and should be considered in the design of interventions to support pain management for menstruating girls in Indonesia. Delivering comprehensive sexual and reproductive health education programmes that address knowledge and practical skills relating to menstruation and MHM, including pain management, may contribute to reducing absenteeism in this context.…”

“…Girls in higher grades were more likely to report absenteeism due to menstruation during their last menstrual period. Miiro et al [34]. also found that missing school during a girl's most recent menstruation was associated with older age.…”

“…More than one in ten girls missed at least one day of school due to menstruation during their last menstruation, and this varied considerably by province. This is lower than has been reported in studies from African contexts but is still substantial . Studies on the education and health impacts of absenteeism are largely limited to high income settings but indicate that absenteeism is associated with poorer school completion and education outcomes, and poorer health outcomes .…”

“…Miiro et al . . also found that missing school during a girl's most recent menstruation was associated with older age.…”

Menstrual health management and schooling experience amongst female learners in Gauteng, South Africa: a mixed method study

“…Data emerging from the African context suggest that girls may miss school due to their menses [10][11][12][13]. However, there exist a number of reasons why a learner may miss school while menstruating, including physical symptoms, shame, secrecy and fear of leakage, access to products and/or ability to manage menstruation at school [5,[14][15][16].…”