Effects of Menstrual Health and Hygiene on School Absenteeism and Drop-Out among Adolescent Girls in Rural Gambia.

Vishna Shah,Mariama Saidykhan,Yamoundaw Jallow,Belen Torondel,Bakary Sonko,Fatou Faal,Wolf-Peter Schmidt,Fatou Bajo,Helen Nabwera,Omar Keita

doi:10.3390/ijerph19063337

Abstract

Poor knowledge and management of menstruation impacts girls’ school attendance and academic performance. This paper aims to explore how menstrual hygiene management practices and related factors influence school absenteeism and drop-out among primary and secondary school girls in rural Gambia. Mixed-method studies were conducted among students and key informants from 19 schools from July 2015–December 2017. Focus group discussions, in-depth interviews, cross-sectional surveys, menstrual diaries, and school water, sanitation and hygiene (WASH) facility observations were used. Key findings from the interviews were that menstrual pain, cultural beliefs, fear of peers knowing menstrual status, and poor school WASH facilities led to school absenteeism, however, they had no impact on school drop-out. Of the 561 girls surveyed, 27% reported missing at least one school day per month due to menses. Missing school during the most recent menstrual period was strongly associated with menstrual pain (extreme pain adjusted odds ratio (AOR) = 16.8 (95% CI: 7.29–38.74)), as was having at least one symptom suggestive of urinary tract infection (AOR = 1.71 (95% CI: 1.16–2.52)) or reproductive tract infection (AOR = 1.99 (95% CI: 1.34–2.94)). Clean toilets (AOR = 0.44 (95% CI: 0.26–75)), being happy using school latrines while menstruating (AOR = 0.59 (95% CI: 0.37–0.93)), and soap availability (AOR = 0.46 (95% CI: 0.3–0.73)) were associated with reduced odds of school absenteeism. This study suggests menstrual pain, school WASH facilities, urogenital infections, and cultural beliefs affected school attendance among menstruating girls in rural Gambia.

Highlights

The objectives of this study are: (i) to explore knowledge, attitudes, and practices related to menstruation, (ii) to describe the school’s WASH facilities, (iii) to measure levels of school absenteeism due to menstruation, and (iv) to explore how factors linked to menstruation are associated with school absenteeism and drop-out among rural Gambian schoolgirls
This study shows that the management of menstruation in rural schools of The Gambia is a real challenge for schoolgirls, and it is clearly associated with school attendance
The effects of urogenital infections on school absenteeism have not been well explored; this study found that girls that reported symptoms of urinary and reproductive tract infections were more likely to miss school, which could be due to a higher level of discomfort and pain

Summary

Introduction

Licensee MDPI, Basel, Switzerland.Attribution (CC BY) license (https://creativecommons.org/licenses/by/Several studies across low and middle income countries (LMICS) suggest more than50% of girls have inadequate menstrual hygiene management (MHM) practices, with higher proportions in rural areas [1–4]. Poor MHM may lead to school absenteeism, disengagement or withdrawal from school [1,5], reproductive problems, urinary tract infections [5–7], withdrawal from social gatherings, and unnecessary restrictions to the daily routine [8]. 4.0/).Int. J. Environ. Res. Public Health 2022, 19, 3337. https://doi.org/10.3390/ijerph19063337 https://www.mdpi.com/journal/ijerph

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