Our study investigated the prevalence and predictors of menstruation-related school absenteeism among adolescent girls. The prevalence of school absenteeism was at least one-in-four girls, and the days spent away from school during their last menstruation ranged from one to seven days. Older adolescent girls (18–19 years), use of cloth as a sanitary material in the last menstruation and cultural restrictions were associated with higher odds of school absenteeism, while parent(s) income status (moderate-income) was associated with lower odds of school absenteeism. Mother’s education and privacy in school were not associated with school absenteeism at the multivariate regression level.
Our findings of more than a quarter of the adolescent girls missing out school days during their menstrual period highlights the many challenges girls face in managing their menstruation alongside schooling. Missing out school days means missing out critical lessons in class and sometimes examinations, which may never be recovered after they have returned to school. This puts them at a further disadvantage to the boys and has the potential to stall the academic performance of these girls [7, 15]. More so, consistent monthly absenteeism may lead to class repetition and subsequent school dropout of these girls due to poor academic performance . The prevalence of menstruation-related school absenteeism in our study is little lower than the 40% as found by Mohammed and colleagues , in Ghana, 40% in India by Vashisht and colleagues  and 54% in Ethiopia by Tegegne and Sisay . However, our finding is a little higher when compared to the 20% menstruation-related school absenteeism as reported in Uganda . The discrepancy could be due to differences in income levels, cultural settings and school infrastructure.
We also found that older adolescent girls were more likely to be absent from school due to menstruation-related issues when compared with the younger ones. Miiro and colleagues , in their study in Uganda reported that missing school during girl’s menstrual period was more common among the older adolescents. In a similar study in Indonesia by Davis and colleagues , it was also found that girls in higher grades were more likely to report school absenteeism due to menstruation during their last menstrual period. In older adolescents, there is an increased tendency to function independently of their parents and so they tend to make such critical decisions regarding sexual and reproductive health without the involvement of their parents . Older adolescents may therefore shy away from discussing and seeking support from their parents regarding menstrual-related challenges they might be facing in school even if the parents can provide support such as sanitary pad among others. This might be a possible explanation why older adolescent girls are more likely to stay at home during their menstrual period compared to the younger ones. Increased parental income was associated with reduced school absenteeism during menstruation. Girls from parent(s) with moderate-income status are likely to get funds that will cater for their monthly sanitary pads, and this might enhance their school attendance. Our findings aligns with a similar study in Northern Ethiopia .
The use of cloth in the last menstruation was associated with higher odds of school absenteeism among the girls. Hennegan and colleagues , suggested that the use of unclean cloth as a menstrual absorbent was associated with fear of odour, inability to concentrate in school and low confidence in answering questions in class, and this may contribute to abstaining from school during menstruation. In a similar study, Montgomery and colleagues , reported that school attendance during menstruation was higher among girls who were supplied with sanitary pads compared to those who were not supplied with sanitary pads. These findings are not surprising because most girls feel the sanitary pad is superior to cloth and therefore they are more comfortable using sanitary pad while in school without the fear of staining themselves and being teased . Similar findings are reported elsewhere in Ghana , Ethiopia , India , and Bhutan .
The prevalence of school absenteeism in our study was more common among girls who were culturally restricted during menstruation. The period of adolescence is of particular concern because in most LMICs, cultural restrictions, misconceptions, myths and taboos create barriers which prevents girls from understanding the scientific facts about menstruation. These restrictions limit their daily activities and have the potential to negatively affect their self-esteem, reproductive health and school attendance [24, 25]. For example, in certain cultural settings, menstruating girls are excluded from religious functions, water bodies, certain foods, family homes and from using sanitation facilities meant for public. It is also a taboo for girls to look in the mirror or bath during their menstrual period [24–27]. These girls will not be comfortable to go to school if they have not bathed particularly for a good number of days due to fear that they may be smelly and be teased at school. Studies in certain parts of India have also reported that menstruating girls are prevented from going to school until the period of menstruation is over [26, 27].
Our study had some limitations. The main limitation of the study is that it was a cross-sectional study and we cannot establish causal relationships. Also, our study did not consider some aspects of WASH such as water and soap availability at school. Furthermore, our variables were self-reported and recall bias might have been introduced. However, we expect recall bias to impact less on our outcome variable as it was measured in relation to the last menstrual period.