Menstrual hygiene management practices and associated health outcomes among school-going adolescents in rural Gambia

Abstract

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.

Experiences of menstrual inequity and menstrual health among women and people who menstruate in the Barcelona area (Spain): a qualitative study

“…In turn, the lack of adequate menstrual management facilities in public spaces contributes to the invisibilization and taboo of menstruation. Besides, not being able to manage menstruation reinforces and perpetuates MI and may lead to health risks [ 18 , 59 – 61 ].…”

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

“…All participating schools ( n = 19) were asked to create lists of female students that were 13 years and older from grades 5–12, all girls from this list were asked their menstrual status, and those that had started menstruating were included in the survey. Sample size calculations for the individual cross-sectional studies are described elsewhere [ 6 , 26 ].…”

“…Several studies across low and middle income countries (LMICS) suggest more than 50% of girls have inadequate menstrual hygiene management (MHM) practices, with higher proportions in rural areas [ 1 , 2 , 3 , 4 ]. Poor MHM may lead to school absenteeism, disengagement or withdrawal from school [ 1 , 5 ], reproductive problems, urinary tract infections [ 5 , 6 , 7 ], withdrawal from social gatherings, and unnecessary restrictions to the daily routine [ 8 ].…”

Puberty health intervention to improve menstrual health and school attendance among adolescent girls in The Gambia: study methodology of a cluster-randomised controlled trial in rural Gambia (MEGAMBO TRIAL)

“…A study conducted in The Gambia (MRC-PHIND) among school girls in the Kiang region suggested challenges related to MH at home or school could be associated with negative health outcomes and school absenteeism [ 26 , 27 ]. The study showed that students (boys and girls) had poor knowledge about menstruation, largely due to the need for secrecy and cultural beliefs [ 26 , 27 ].…”

“…A study conducted in The Gambia (MRC-PHIND) among school girls in the Kiang region suggested challenges related to MH at home or school could be associated with negative health outcomes and school absenteeism [ 26 , 27 ]. The study showed that students (boys and girls) had poor knowledge about menstruation, largely due to the need for secrecy and cultural beliefs [ 26 , 27 ]. Findings from a mixed methods approach suggested that lack of knowledge of menstruation and adequate absorbent materials led to embarrassment and fear of teasing, and this, together with pain and poor school water sanitation and hygiene (WASH) facilities contributed to school absenteeism.…”