Menstrual hygiene management and educational disruption among adolescent girls in select secondary schools in Ekwulobia, Nigeria

Abstract

Abstract Background Menstrual hygiene management (MHM) challenges can adversely affect adolescent girls’ educational participation through absenteeism, diminished concentration, and social stigma. This study examined the relationship between MHM practices, access to menstrual materials and school WASH (Water, Sanitation, and Hygiene) facilities, and educational disruption among secondary-school girls in Ekwulobia, Anambra State, Nigeria. Methods A school-based, descriptive cross-sectional mixed-methods study was conducted between March and May 2025 among 400 menstruating students selected from five secondary schools in Ekwulobia. Schools were purposively chosen for feasibility and diversity, while students were randomly selected from class registers. Quantitative data were collected using a validated, pre-tested questionnaire and analyzed with SPSS v25. Descriptive statistics, chi-square tests, odds ratios (OR), and 95% confidence intervals (CI) were computed at a 95% confidence level (α = 0.05). The expression for sample size was based on Cochran’s formula for finite populations: $$\:n=\frac{{Z}^{2}p(1-p)}{{d}^{2}}\times\:\frac{N}{N+\left({Z}^{2}p\right(1-p)-1)}\:$$ where n = required sample size, Z = 1.96 (95% confidence level), p = 0.5 (assumed prevalence of good MHM), d = 0.05 (margin of error), and N = total population of eligible students in the selected schools. The computed sample size was adjusted for a 10% non-response rate, giving a final sample of 400 participants. Qualitative data from 15 in-depth interviews (10 students and 5 school health staff) were analyzed thematically using Braun and Clarke’s six-step approach. Results Among the 400 respondents, 260 (65.0%) had regular access to sanitary pads, 205 (51.3%) had access to private girls’ toilets, and 180 (45.0%) reported water availability in school toilets. Menstruation-related absenteeism was reported by 130 (32.5%). Absenteeism was higher among girls in schools with inadequate sanitation (53.8%) compared to those with adequate sanitation (12.2%) [χ²(1) = 87.65, p < 0.001; OR = 8.4, 95% CI: 5.07–13.91]. Poor menstrual hygiene knowledge was also associated with educational disruption (52.8% vs. 15.9%; χ²(1) = 69.12, p < 0.001; OR = 9.9, 95% CI: 6.11–16.04). Thematic analysis revealed three major themes: (1) challenges in accessing menstrual materials, (2) inadequate school WASH infrastructure, and (3) insufficient menstrual health education. Conclusion In this rural Nigerian community, limited access to menstrual materials, poor hygiene knowledge, and inadequate WASH facilities significantly contribute to menstrual-related educational disruption in Ekwulobia. Improving WASH facilities, menstrual education, and affordability of menstrual products is crucial for reducing gender disparities in education through comprehensive interventions that combine improved school infrastructure, menstrual health education, and support for affordable materials are needed to promote girls’ educational participation.