Menstrual characteristics, menstrual anxiety and school attendance among adolescents in Uganda: a longitudinal study

Abstract

Background Qualitative data show negative impacts of menstruation on health and education in many settings, but there are few longitudinal quantitative studies of the impact of menstruation. We analyse associations with menstrual anxiety and school attendance in a study of Ugandan secondary school students. Methods Data were from a longitudinal pilot study of a menstrual health intervention (MENISCUS), conducted in two secondary schools in Entebbe sub-district, Uganda. Self-completed menstrual-related data, including menstrual anxiety, were collected from 232 participants pre- and post-intervention. A sub-cohort of 100 randomly-selected post-menarcheal girls were asked to self-complete daily diaries during 10 months of follow-up, with data on menstrual flow, pain, and school attendance. We used multivariable logistic regression to estimate associations with menstrual anxiety among all girls at baseline, and random-effects logistic regression to estimate associations of menstrual characteristics with school non-attendance for 3 months pre-intervention in the sub-cohort, adjusting for within-girl clustering. Results Overall, 130/222 (58.6%) of menstruating girls reported being anxious about their next period. Menstrual anxiety was higher in those not living with their mother (adjusted odds ratio (OR) = 1.91; 95% confidence interval (CI) 1.01–3.60), believing menstrual myths (aOR = 1.83; 0.95–3.50 for not agreeing that it is healthy for a girl to run, dance or cycle during her period; aOR = 1.97; 1.04–3.73 for agreeing that when a girl has her period she is unclean), lower menstrual confidence (aOR = 2.49; 1.33–4.65 for avoiding physical activity during her period; aOR = 1.68; 0.89–3.17 for not feeling comfortable to talk to other girls about her period; aOR = 2.89; 1.28–6.54 for agreeing that boys/girls tease them about their periods; and aOR = 2.27; 1.21–4.27 for worrying about being teased during her period). Those with lower knowledge about menstruation were less likely to report anxiety (aOR = 0.44; 0.23–0.84). During the pre-intervention period of the sub-cohort, school non-attendance was associated with menstrual pain, with 21.7% of girls missing school on days when they reported pain vs. 8.3% on days when no pain was reported (aOR = 3.82; 1.66–8.77). Conclusions Menstruation causes substantial anxiety in Ugandan schoolgirls, and menstrual pain is associated with missing school on period-days. Menstrual health interventions should address socio-cultural aspects of menstruation to reduce anxiety, and provide education on pain management strategies to support school attendance.

Prevalence and factors associated with unmet need for menstrual hygiene management in six countries in Sub-Saharan Africa: a multilevel analysis

“…This study found that younger women were more likely to have unmet need for MHM compared to older women aged 35 and above. This nding is attributable to the fact that younger women are more likely to be exposed to MHM barriers in school (29)(30)(31), work (23) and other physical activities like sporting(16); and are highly likely to be impacted by menstrual challenges (32). Younger women therefore present as the age-group with a greater need for adequate MHM, which explains why most previous studies have focused on adolescent girls and school-age women.…”

“…The study included 4427 women in Kenya, 4406 in Ethiopia, 2667 in Uganda, 1976 in Burkina Faso, 1766 in Niger and 2806 in Ghana. Most of the participants in the six countries were middle aged (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), were married or cohabiting and had never given birth(parity). While most of the countries had higher proportion of urban residents, Kenya and Uganda had higher proportions of rural residents.…”

Premenstrual Syndrome, Anxiety, and Depression Among Menstruating Rural Adolescent Girls: A Community-Based Cross-Sectional Study

“…A study conducted by Mohamadirizi and Kordi showed that a high percentage of students suffer from psychological disorders; it also indicated a significant link between menstruation signs and anxiety, depression, and stress [ 25 ]. A longitudinal study undertaken in Uganda among adolescents regarding menstrual characteristics and menstrual anxiety similarly revealed that menstruation caused substantial anxiety [ 26 ]. It also showed that menstrual problems had a clinically and statistically significant association with depression among adolescent girls aged 9-11 years.…”

Understanding the social and physical menstrual health environment of secondary schools in Uganda: A qualitative methods study

“…Similar results were observed in a systematic review and qualitative meta-synthesis of women’s and girls’ experiences of menstruation, where girls perceived menarche as something to be feared [ 1 ]. This may lead to anxiety, depression and a lack of preparedness on how to handle menstruation [ 30 , 31 ]. Additionally, our findings showed the limited knowledge and the unmet need for engaging boys and male teachers, who have the potential to support females in MH.…”