Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: results from a cross-sectional survey
Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: results from a cross-sectional survey
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DOI：
10.1136/bmjopen-2016-015508
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发表时间：
2017-07-01
期刊：
影响因子：
2.9
通讯作者：
Unicomb, Leanne
中科院分区：
文献类型：
--
作者：
Alam, Mahbub-Ul;Luby, Stephen P.;Unicomb, Leanne
背景 低收入和中等收入国家的许多青春期女孩在学校缺乏管理月经的适当设施和支持。关于月经如何影响缺课的研究很少。本研究调查了孟加拉国女学生经期卫生管理知识、设施和实践与经期缺课之间的关系。方法我们于 2013 年 3 月至 6 月在孟加拉国学校对初潮的 11 至 17 岁女孩进行了一项具有全国代表性的横断面研究。我们使用概率与规模成比例的技术对来自 50 个城市和 50 个农村集群的 700 所学校进行了抽样。我们采访了2332名女学生，并对每所学校的经期卫生设施进行了抽查。为了评估与报告缺课相关的因素，我们使用广义估计方程来估计调整患病率差异 (APD)，以控制混杂因素的影响，以解释学校层面的聚类。结果 在初潮的女学生中，41% (931) 报告缺课，每个月经周期平均缺课 2.8 天。月经期间在学校感到不舒服的学生（99% vs 32%；APD=58%；CI 54 - 63）以及认为月经问题会影响学校表现的学生（64% vs 30%；APD=27；CI 20 - 33）比那些没有月经期间缺课的学生更有可能缺课。在厕所未上锁的学校上学的女孩中，月经期间缺课的情况较少见（35% vs 43%；APD=-5.4；CI -10 至 -1.6）。月经期间被禁止参加任何活动的女孩缺课的情况更为常见（41% vs 33%；APD=9.1；CI 3.3 至 14）。 结论 缺课的危险因素包括女孩的态度、对月经的误解、学校设施不足和不足以及家庭限制。通过在月经初潮前提供知识和管理方法、隐私和围绕月经问题的积极社会环境，使女孩能够在学校管理月经，有可能通过减少缺课而使学生受益。
Background Many adolescent girls in low-income and middle-income countries lack appropriate facilities and support in school to manage menstruation. Little research has been conducted on how menstruation affects school absence. This study examines the association of menstrual hygiene management knowledge, facilities and practice with absence from school during menstruation among Bangladeshi schoolgirls.Methods We conducted a nationally representative, cross-sectional study in Bangladeshi schools from March to June 2013 among girls 11 to 17 years old who reached menarche. We sampled 700 schools from 50 urban and 50 rural clusters using a probability proportional to size technique. We interviewed 2332 schoolgirls and conducted spot checks in each school for menstrual hygiene facilities. To assess factors associated with reported school absence, we estimated adjusted prevalence difference (APD) for controlling confounders' effect using generalised estimating equations to account for school-level clustering.Results Among schoolgirls who reached menarche, 41% (931) reported missing school, an average of 2.8 missed days per menstrual cycle. Students who felt uncomfortable at school during menstruation (99% vs 32%; APD=58%; CI 54 to 63) and who believed menstrual problems interfere with school performance (64% vs 30%; APD=27; CI 20 to 33) were more likely to miss school during menstruation than those who did not. School absence during menstruation was less common among girls attending schools with unlocked toilet for girls (35% vs 43%; APD=-5.4; CI -10 to -1.6). School absence was more common among girls who were forbidden from any activities during menstruation (41% vs 33%; APD=9.1; CI 3.3 to 14).Conclusion Risk factors for school absence included girl's attitude, misconceptions about menstruation, insufficient and inadequate facilities at school, and family restriction. Enabling girls to manage menstruation at school by providing knowledge and management methods prior to menarche, privacy and a positive social environment around menstrual issues has the potential to benefit students by reducing school absence.