Menstrual Hygiene Management and Its Association With School Absenteeism Among Adolescent Girls in Ethiopia: A Cross Sectional Study

Abstract

ABSTRACT Menstrual hygiene management (MHM) is an essential public health and human rights priority that directly influences adolescent girls' educational attainment, psychosocial well-being, and reproductive health trajectory. In low-resource settings, inadequate school water, sanitation, and hygiene (WASH) infrastructure, persistent cultural taboos, and unaffordable absorbent materials frequently force adolescent girls to miss school during their menses. This institution-based cross-sectional study investigated menstrual hygiene management knowledge, practices, and their independent association with school absenteeism among 638 post-menarche adolescent secondary school girls in the Amhara Region, Northwest Ethiopia. Utilizing a stratified two stage cluster sampling design, data were collected using pre-tested, self administered structured questionnaires. The results revealed that only 47.3% of the participants demonstrated good menstrual hygiene practices, and 51.6% possessed adequate comprehensive knowledge regarding menstruation. Approximately 41.5% of the students reported missing school for at least one day per menstrual cycle, with an average absence of 1.8 ± 0.9 days per cycle. Key self-reported drivers of school absenteeism included severe dysmenorrheic pain without analgesic access (68.4%), absence of clean, functional, and lockable school gender-segregated latrines (61.8%), lack of running water and soap (54.2%), and intense fear of accidental menstrual leakage and peer teasing (51.7%). Multivariable logistic regression revealed that adolescent girls with poor MHM practices had nearly four times higher odds of experiencing menstruation-related school absenteeism compared to those with good practices (AOR = 3.92, 95% CI: 2.64–5.82, p < 0.001). Furthermore, lack of private, lockable school latrines (AOR = 2.48, 95% CI: 1.62–3.81, p < 0.001), lack of parental discussion regarding menstruation prior to menarche (AOR = 1.94, 95% CI: 1.31–2.87, p = 0.001), and unmanaged dysmenorrhea (AOR = 3.15, 95% CI: 2.11–4.70, p < 0.001) were significant independent determinants of school absenteeism. Ensuring gender sensitive school WASH facilities, integrating age-appropriate MHM curricula, and providing subsidized sanitary absorbents and pain relief protocols are imperative to reduce educational disparities and support female adolescent development in Ethiopia.

KEYWORDS: Menstrual Hygiene Management, School Absenteeism, Adolescent Girls, Water Sanitation and Hygiene (WASH), Dysmenorrhea, Menstrual Stigma, Gender Equity, Ethiopia