Effect of menstruation on school attendance of girls along with water, sanitation, and hygiene services in Northwest Ethiopia.

INTRODUCTION

menstruation significantly affects schoolgirls' academic attendance and performance. This study aims to explore the relationship between monthly menstruation along with the availability of water, sanitation and hygiene services, and school attendance among schoolgirls.

METHODS

a mixed-method cross-sectional study was conducted between March 2022 and August 2023. Study participants were selected using systematic random and purposive sampling techniques for quantitative and qualitative, respectively. A self-administered questionnaire was used to collect information from students. Focus group discussions were conducted among mothers of schoolgirls and interreligious council members, and in-depth and key informant interviews were used to gather information from parent-teacher-student association chairpersons and the vice head and head of the Education and Health department offices, respectively. Quantitative data were analyzed using SPSS version 27, and qualitative data used ATLAS.ti. The Chi-square test and binary logistic regression were used to assess the statistical significance of the relationship among variables, ensuring the thoroughness and validity of the research.

RESULTS

in this study, more than half of the schoolgirls, 389 (55.50%), missed school days due to menstruation and related factors, and on average, the schoolgirls missed 2.08 (±0.87) days per month. Factors such as WASH facilities (χ= 46.78, p<0.0001; OR= 0.350, p<0,0001), accessibility with menstrual absorbent materials (χ=5.42, p=0.02; OR=0.634, p=0.012), menstrual hygiene management rooms (OR=0.669, p=0.029), socio-cultural constraints (χ= 22.08, p<0.0001; OR=0.539, p=<0.0001), menstrual-related pain (χ=5.9, p=0.015), fear (χ=36.32, p<0.0001; OR=2.505, p<0.0001), and teasing (χ=13.66, p-<0.0001; OR=1.754, p<0.0001), were significantly associated with school absenteeism. A qualitative study identified four themes that influence school attendance: inadequate water and sanitation facilities, lack of access to menstrual absorbent materials, sociocultural constraints, menstrual-related pain, and fear.

CONCLUSION

in the study area, a significant number (55.50%) of schoolgirls missed school days due to menstrual-related factors. The identified factors in the quantitative study were also supported by the themes emerging from the qualitative study. The identified modifiable factors are the areas of intervention that can increase schoolgirls´ school attendance.