PMID- 29298699 OWN - NLM STAT- MEDLINE DCOM- 20190125 LR - 20210109 IS - 1472-6874 (Electronic) IS - 1472-6874 (Linking) VI - 18 IP - 1 DP - 2018 Jan 3 TI - Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): a feasibility study. PG - 4 LID - 10.1186/s12905-017-0502-z [doi] LID - 4 AB - BACKGROUND: Management of menstruation can present substantial challenges to girls in low-income settings. In preparation for a menstrual hygiene intervention to reduce school absenteeism in Uganda, this study aimed to investigate menstruation management practices, barriers and facilitators, and the influence of menstruation on school absenteeism among secondary school students in a peri-urban district of Uganda. METHODS: Qualitative and quantitative studies were conducted among consenting girls and boys aged 14-17 years in four secondary schools in Entebbe sub-District, Uganda. Methods included group and in-depth interviews with students, a quantitative cross-sectional questionnaire, a prospectively self-completed menstrual diary, key informant interviews with policy makers, and observations of school water, sanitation and hygiene facilities. Multiple logistic regression was used to assess factors associated with school absenteeism during the most recent menstrual period. RESULTS: Girls reported substantial embarrassment and fear of teasing related to menstruation in the qualitative interviews, and said that this, together with menstrual pain and lack of effective materials for menstrual hygiene management, led to school absenteeism. All policy makers interviewed reported poverty and menstruation as the key factors associated with school attendance. The 352 girls with questionnaire data had a median age of 16 (inter-quartile range (IQR) = 15,16) years, with median age at menarche of 13 (IQR = 13,14) years. Of these, 64 girls (18.7%) reported having stained their clothes and 69 (19.7%) reported missing at least 1 day of school, during their most recent period. Missing school during the most recent period was associated with physical symptoms (headache (odds ratio (OR) = 2.15, 95%CI:1.20, 3.86), stomach pain (OR = 1.89, 95%CI:0.89, 4.04), back pain (OR = 1.75, 95%CI:0.97, 3.14), and with changing protection 4 or more times per 24 h period (OR = 2.08, 95%CI:1.06, 4.10). In the diary sub-study among 40 girls, school absence was reported on 28% of period-days, compared with 7% of non-period days (adjusted odds ratio = 5.99, 95%CI:4.4, 8.2; p < 0.001). CONCLUSION: In this peri-urban Ugandan population, menstruation was strongly associated with school attendance. Evaluation of a menstrual management intervention that address both psychosocial (e.g. self-confidence, attitudes) and physical (e.g. management of pain, use of adequate menstrual hygiene materials, improved water and sanitation facilities) aspects of menstruation are needed. FAU - Miiro, George AU - Miiro G AD - Uganda Virus Research Institute, Entebbe, Uganda. FAU - Rutakumwa, Rwamahe AU - Rutakumwa R AD - Medical Research Council, Uganda Virus Research Institute, Entebbe, Uganda. FAU - Nakiyingi-Miiro, Jessica AU - Nakiyingi-Miiro J AD - Medical Research Council, Uganda Virus Research Institute, Entebbe, Uganda. FAU - Nakuya, Kevin AU - Nakuya K AD - Medical Research Council, Uganda Virus Research Institute, Entebbe, Uganda. FAU - Musoke, Saidat AU - Musoke S AD - Uganda Virus Research Institute, Entebbe, Uganda. FAU - Namakula, Juliet AU - Namakula J AD - Uganda Virus Research Institute, Entebbe, Uganda. FAU - Francis, Suzanna AU - Francis S AD - London School of Hygiene and Tropical Medicine, London, UK. FAU - Torondel, Belen AU - Torondel B AD - London School of Hygiene and Tropical Medicine, London, UK. FAU - Gibson, Lorna J AU - Gibson LJ AD - London School of Hygiene and Tropical Medicine, London, UK. AD - MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. FAU - Ross, David A AU - Ross DA AD - Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland. FAU - Weiss, Helen A AU - Weiss HA AUID- ORCID: 0000-0003-3547-7936 AD - London School of Hygiene and Tropical Medicine, London, UK. helen.weiss@lshtm.ac.uk. AD - MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. helen.weiss@lshtm.ac.uk. LA - eng GR - MC_PC_14098/Medical Research Council (GB)/International GR - MR/K012126/1/MRC_/Medical Research Council/United Kingdom GR - MC_PC_14098/MRC_/Medical Research Council/United Kingdom GR - 001/WHO_/World Health Organization/International GR - G1002369/MRC_/Medical Research Council/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20180103 PL - England TA - BMC Womens Health JT - BMC women's health JID - 101088690 SB - IM MH - *Absenteeism MH - Adolescent MH - Cross-Sectional Studies MH - Dysmenorrhea/psychology MH - Embarrassment MH - Feasibility Studies MH - Female MH - Feminine Hygiene Products/supply & distribution MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Interviews as Topic MH - Menarche MH - Menstruation/*psychology MH - Poverty MH - Schools MH - Students/*psychology/*statistics & numerical data MH - Suburban Population MH - Surveys and Questionnaires MH - Toilet Facilities MH - Uganda PMC - PMC5753466 OTO - NOTNLM OT - Adolescence OT - Menstrual health OT - Menstrual knowledge OT - School absenteeism OT - School attendance OT - School girls COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The study was approved by the Ethics Committees of the Uganda Virus Research Institute (GC/127 /15/04/508), the Uganda National Council for Science and Technology (HS/1810), and the London School of Hygiene and Tropical Medicine (Ref 9682). Written consent for participation was requested of their parents/ guardians and assent from students aged 11-17 years, and consent from those aged 18 years or older. School representatives gave consent as the guardians of students in boarding schools. CONSENT FOR PUBLICATION: Participants consented to the research findings being published in international science journals and electronic websites, on condition that that findings cannot be traced to individuals. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2018/01/05 06:00 MHDA- 2019/01/27 06:00 PMCR- 2018/01/03 CRDT- 2018/01/05 06:00 PHST- 2017/07/24 00:00 [received] PHST- 2017/12/19 00:00 [accepted] PHST- 2018/01/05 06:00 [entrez] PHST- 2018/01/05 06:00 [pubmed] PHST- 2019/01/27 06:00 [medline] PHST- 2018/01/03 00:00 [pmc-release] AID - 10.1186/s12905-017-0502-z [pii] AID - 502 [pii] AID - 10.1186/s12905-017-0502-z [doi] PST - epublish SO - BMC Womens Health. 2018 Jan 3;18(1):4. doi: 10.1186/s12905-017-0502-z.