Menstrual characteristics, menstrual anxiety and school attendance among adolescents in Uganda: a longitudinal study.
Journal
BMC women's health
ISSN: 1472-6874
Titre abrégé: BMC Womens Health
Pays: England
ID NLM: 101088690
Informations de publication
Date de publication:
11 12 2021
11 12 2021
Historique:
received:
15
07
2020
accepted:
18
11
2021
entrez:
13
12
2021
pubmed:
14
12
2021
medline:
15
3
2022
Statut:
epublish
Résumé
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. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 34895210
doi: 10.1186/s12905-021-01544-6
pii: 10.1186/s12905-021-01544-6
pmc: PMC8665501
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
410Subventions
Organisme : Medical Research Council
ID : MC_UU_00027/4
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/P020283/1
Pays : United Kingdom
Informations de copyright
© 2021. The Author(s).
Références
Pan Afr Med J. 2014 Nov 07;19:253
pubmed: 25852796
PLoS Med. 2016 Feb 23;13(2):e1001962
pubmed: 26908274
BMJ Open. 2016 Mar 02;6(3):e010290
pubmed: 26936906
BMJ Open. 2016 Nov 23;6(11):e013229
pubmed: 27881530
BMC Public Health. 2019 Jan 5;19(1):16
pubmed: 30611223
J Adolesc. 2010 Aug;33(4):521-9
pubmed: 19395018
Health Educ Behav. 2004 Apr;31(2):143-64
pubmed: 15090118
Indian J Pediatr. 2019 Jan;86(Suppl 1):25-33
pubmed: 30637681
BMC Womens Health. 2009 Oct 05;9:29
pubmed: 19804623
PLoS One. 2012;7(10):e48274
pubmed: 23118968
Ghana Med J. 2012 Mar;46(1):3-7
pubmed: 22605882
Pilot Feasibility Stud. 2020 Apr 24;6:51
pubmed: 32346485
Arch Dis Child. 2018 Mar;103(3):235-239
pubmed: 28794095
Int J Environ Res Public Health. 2019 Apr 25;16(8):
pubmed: 31027248
J Pediatr Endocrinol Metab. 2016 Mar;29(3):343-50
pubmed: 26565544
PLoS One. 2013 Apr 26;8(4):e62004
pubmed: 23637945
J Urban Health. 2017 Dec;94(6):835-846
pubmed: 28875308
Ann Hum Biol. 1999 May-Jun;26(3):243-9
pubmed: 10355495
BMC Public Health. 2014 Oct 29;14:1118
pubmed: 25355406
Glob J Health Sci. 2012 Jan 01;4(1):105-11
pubmed: 22980118
J Am Acad Child Adolesc Psychiatry. 2001 Nov;40(11):1337-45
pubmed: 11699809
Afr J Med Med Sci. 1994 Mar;23(1):13-7
pubmed: 7839939
PLoS One. 2016 Feb 10;11(2):e0146985
pubmed: 26862750
PLoS Med. 2019 May 16;16(5):e1002803
pubmed: 31095568
PLoS One. 2013 Nov 14;8(11):e79132
pubmed: 24244435
Int J Gynaecol Obstet. 2012 Dec;119(3):281-3
pubmed: 22981340
BMC Womens Health. 2015 Sep 04;15:70
pubmed: 26341264
BMC Womens Health. 2018 Jan 03;18(1):4
pubmed: 29298699
Comp Educ Rev. 2013 May 1;57(2):260-284
pubmed: 25580018
BMJ Open. 2020 Feb 4;10(2):e031182
pubmed: 32024786