Challenges faced by adolescent girls on Menstrual Hygiene Management: School-based study, Siha, Kilimanjaro, Tanzania

Menstrual hygiene management (MHM) has received increasing attention as a public health issue globally. Governments and stakeholders have started to engage communities to address barriers and challenges faced by adolescents in and out of school. This study, conducted in Siha District, northern Tanzania, responds to the call for evidence sensitive to local barriers and challenges to inform successful strategies in MHM.

Methods:

Institutional-based cross-sectional study which involved 400 school girls aged 10 to 19 years old who attained menarche were randomly selected in four secondary and advanced level government schools from September 2019 to January 2020. Bivariate and multivariable logistic regression analysis were employed. A P-value less than 0.05 was used to declare statistical significance.

Results:

Among all the girls who participated in the study 30%  reported missing school due to menstruation while 56% of the girls reported using toilets as changing places at school. The use of reusable sanitary material was 52% compared with non-reusable materials which was 48%. In urban areas, 34.5% of students reported missing school due to menstruation compared to 25% who reported in rural areas. The findings show that school absenteeism among adolescent girls during menstruation is significantly associated with a headache (Adjusted odds ratio (AOR) = 3.3 (95% CI:1.32 – 8.23)) and abdominal waist pain (AOR = 8.50 (95% CI: 6.27 – 15.56)), lack of changing rooms in school (AOR = 5.85 (95% CI: 4.82 – 7.93)). In addition, the high cost of sanitary pads was mentioned as one of the main reasons for students not using sanitary pads.

Conclusion:

This study calls for promoting MHM-friendly practices in schools to create a supportive and conducive learning environment for adolescent girls. Ongoing school infrastructure improvements such as the construction of classrooms and toilets in schools should include the construction of proper changing places to reduce the number of adolescent girls who miss school due to menstruation.

月经卫生管理（Menstrual hygiene management, MHM）作为一项全球公共卫生议题，正受到越来越多的关注。各国政府与利益相关方已着手动员社区，应对学龄及非学龄青少年面临的各类障碍与挑战。本研究于坦桑尼亚北部锡哈区开展，旨在响应“聚焦本地障碍与挑战以制定有效月经卫生管理策略”的研究呼吁。

方法：
本研究为基于机构的横断面研究，于2019年9月至2020年1月期间，从4所公立中学及高级中学中随机抽取400名已经历初潮、年龄介于10至19岁之间的女学生作为研究对象。研究采用双变量及多变量logistic回归分析方法，以P值小于0.05作为统计学显著性的判定标准。

结果：
本次研究的受访女学生中，30%报告曾因月经缺课；56%的受访者表示在校期间以卫生间作为更换卫生用品的场所。可重复使用卫生用品的使用率为52%，不可重复使用用品的使用率为48%。城区有34.5%的学生报告因月经缺课，农村地区该比例为25%。研究结果显示，青春期女性经期缺课与头痛（校正比值比（Adjusted odds ratio, AOR）=3.3，95%置信区间（Confidence Interval, CI）：1.32~8.23）、腰腹痛（校正比值比（Adjusted odds ratio, AOR）=8.50，95%置信区间（Confidence Interval, CI）：6.27~15.56）以及校内缺乏专用更换空间（校正比值比（Adjusted odds ratio, AOR）=5.85，95%置信区间（Confidence Interval, CI）：4.82~7.93）显著相关。此外，卫生用品价格高昂被列为学生未使用卫生用品的主要原因之一。

结论：
本研究呼吁在校园内推广友好型月经卫生管理实践，为青春期女性营造支持性且适宜的学习环境。后续校园基础设施建设（如教室与卫生间修建）应配套建设专用更换场所，以减少因月经而缺课的青春期女性数量。