Changes in the menstrual hygiene management facilities and usage among Bangladeshi school girls and its effect on school absenteeism from 2014 to 2018

Figures & data

Figure 1. Flowchart: study sampling procedure.

Table 1. Demographic characteristics of the study participants.

	2014 (N = 2333)		2018 (N = 2816)
Indicators	Rural schools (n, %*)	Urban schools (n, %*)	All schools (n, %*)	Rural schools (n, %*)	Urban schools (n, %*)	All schools (n, %*)
Place of residence	1106 (47)	1227 (53)	2333	1664 (59)	1152 (41)	2816
Type of school
Primary school	1005 (91)	1139 (93)	2144 (91)	644 (39)	480 (42)	1124 (39)
Secondary school	101 (9)	88 (7)	189 (9)	1020 (61)	672 (58)	1692 (61)
Education level of participants
Primary level	780 (71)	794 (65)	1574 (70)	572 (35)	436 (38)	1008 (35)
Secondary level	326 (29)	433 (35)	759 (30)	1083 (65)	715 (62)	1798 (65)
Age of the participants
9–12	593 (54)	625 (51)	1218 (53)	544 (33)	403 (35)	947 (33)
13–17	513 (46)	601 (49)	1114 (47)	1107 (67)	746 (65)	1853 (67)
Mean age of students	12.5	12.5	12.5	13.2	13.2	13.2
Mean age at first menstruation (years)	11.5	11.5	11.5	11.7	11.6	11.7

*Weighted percentage for rural/urban balance and school size.

Table 2. Changes in the knowledge and perception of adolescent schoolgirls in urban and rural schools of Bangladesh from 2014 to 2018.

Indicators	Rural school (N = 2757)		PD (CI)	Urban school (N = 2375)		PD (CI)	All school (N = 5132)		PD (CI)
	2014 (n, %*)	2018 (n, %*)		2014 (n, %*)	2018 (n, %*)		2014 (n, %*)	2018 (n, %*)
Knowledge on menstruation†	N = 1106	N = 1651		N = 1226	N = 1149		N = 2332	N = 2800
Knew about menstruation before menarche	395 (36)	882 (53)	17 (12, 23)	467 (38)	613 (53)	15 (10, 20)	862 (36)	1495 (53)	17 (12, 22)
Believes menstrual problems interfere with school performance	345 (31)	757 (46)	14 (7.9, 20)	411 (34)	457 (40)	5.3 (−1.5, 12)	756 (31)	1214 (45)	13 (7.5, 19)
Believes menstruation is a female/personal matter	528 (48)	704 (43)	−7.3 (−16, 1.7)	620 (51)	463 (40)	−10 (−18, -2.0)	1148 (48)	1167 (42)	−7.6 (−16, 0.47)
Knows about the implication of inadequate management of menstrual hygiene	625 (57)	677 (41)	−15 (−25, -6.1)	732 (60)	523 (46)	−15 (−24, -6.2)	1357 (57)	1200 (41)	−15 (−24,−7.0)
Perception regarding menstruation
A normal biological process for women	433 (39)	683 (41)	2.3 (−6.0, 11)	526 (43)	555 (48)	4.8 (−3.7, 13)	959 (40)	1238 (42)	2.6 (−4.9, 10)
An illness of females	117 (11)	76 (5)	−6.8 (−12, −1.5)	112 (9)	69 (6)	−3.2 (−7.0, 0.72)	229 (10)	145 (5)	−6.3 (−11, -1.7)
Curse of God	6 (1)	36 (2)	1.7 (.22, 3.2)	6 (1)	27 (2)	2.0 (.30, 3.6)	12 (1)	63 (2)	1.7 (0.40, 3.1)

PD = Proportion difference; CI = Confidence interval.

Positive (Yes) responses from students were considered.

*Weighted percentage for rural/urban balance and school size.

^†Multiple answers under this variable.

Table 3. Changes in practices among adolescent schoolgirls in urban and rural schools of Bangladesh from 2014 to 2018.

Indicators	Rural school (N = 2757)		PD (CI)	Urban school (N = 2375)		PD (CI)	All school (N = 5132)		PD (CI)
	2014 (n, %*)	2018 (n, %*)		2014 (n, %*)	2018 (n, %*)		2014 (n, %*)	2018 (n, %*)
Practices regarding menstrual hygiene
Materials used during menstruation	N = 1106	N = 1651		N = 1226	N = 1149		N = 2332	N = 2800
Reused cloth/rag	922 (83)	654 (40)	−37 (−40, −34)	887 (72)	311 (27)	−39 (−43, −35)	1809 (82)	965 (38)	−37 (−40, −34)
Sanitary pad	97 (9)	915 (55)	39 (36, 41)	258 (21)	781 (68)	39 (36, 42)	355 (10)	1696 (57)	38 (36, 41)
Others (new cloth/cotton/tissue/jute of garments/nothing)	87 (8)	82 (5)	−2.5 (−6.3, 1.4)	81 (7)	57 (5)	−1.8 (−5.0, 1.3)	168 (8)	139 (5)	−2.4 (−5.9, 1.0)
Materials used for cleaning the cloth	N = 962	N = 723		N = 943	N = 355		N = 1905	N = 1078
Soap/detergent and water	864 (90)	651 (90)	0.33 (−2.9, 3.5)	814 (86)	318 (90)	3.5 (−1.5, 8.6)	1678 (89)	969 (90)	0.68 (−2.3, 3.7)
Soap, disinfectant with water	16 (2)	13 (2)	0.13 (−1.1, 1.4)	35 (4)	9 (3)	−1.4 (−4.3, 1.6)	51 (2)	22 (2)	−.04 (−1.3, 1.2)
Water	53 (5)	20 (3)	−3.3 (−6.5, −.16)	838 (4)	8 (2)	−2.1 (−5.6, 1.4)	91 (5)	28 (3)	−3.2 (−6.0, −.31)
Didn’t clean	25 (3)	29 (4.0)	1.3 (−.34, 2.9)	44 (5)	14 (4)	−.76 (−4.0, 2.5)	69 (3)	43 (4)	1.1 (−0.44, 2.6)
Washed reused cloth with soap, water and dried in sunlight	276 (29)	177 (25)	−3.1 (−9.6, 3.3)	242 (26)	76 (22)	−2.8 (−10, 4.5)	518 (28)	253 (24)	−3.1 (−8.9, 2.8)
	N = 937	N = 694		N = 899	N = 342		N = 1836	N = 1036
Stored menstrual cloth normally like other clothes	56 (6)	65 (9)	3.5 (.67, 6.3)	75 (8)	56 (16)	7.0 (2.8, 11)	131 (6)	121 (10)	3.8 (1.2, 6.3)
Dried menstrual cloth outside the house and in sunlight	295 (31)	193 (28)	−2.8 (−9.7, 4.0)	268 (30)	84 (25)	−3.8 (−12, 4.1)	563 (31)	277 (28)	−2.9 (−9.1, 3.3)
	N = 1055	N = 1651		N = 1162	N = 1149		N = 2217	N = 2800
Disposal of menstrual absorbents if there’s no separate place†
Openly disposed	38 (4)	28 (2)	−2.1 (−4.2, .06)	33 (3)	18 (2)	−1.3 (−3.7, 0.95)	71 (4)	46 (2)	−2.0 (−3.9, −0.09)
Disposed inside toilet pan	55 (5)	375 (23)	17 (13, 22)	30 (3)	239 (21)	19 (13, 24)	85 (5)	614 (22)	17 (13, 21)
Didn’t change at school	897 (85)	1220 (74)	−11 (−16, −4.7)	1038 (89)	8701 (76)	−13 (−19, −7.3)	1935 (86)	2,090 (74)	−11 (−16, −5.6)

PD = Proportion difference; CI = Confidence interval.

Positive (Yes) responses from students were considered.

*Weighted percentage for rural/urban balance and school size.

^†Multiple answers under this variable.

Table 4. Changes in menstrual hygiene management facilities and education in urban and rural schools in Bangladesh from 2014 to 2018.

Indicators	Rural schools (N = 2757)		PD (CI)	Urban schools (N = 2375)		PD (CI)	All schools (N = 5132)		PD (CI)
	2014 (n, %*)	2018 (n, %*)		2014 (n, %*)	2018 (n, %*)		2014 (n, %*)	2018 (n, %*)
	N = 1106	N = 1651		N = 1226	N = 1149		N = 2332	N = 2800
Separate facility at school for changing menstrual materials	38 (3)	137 (8)	4.6 (1.6, 7.6)	29 (2)	98 (8)	6.1 (2.5, 9.7)	67 (3)	235 (8)	4.8 (2.0, 7.5)
	N = 38	N = 137		N = 29	N = 98		N = 67	N = 235
The separate facility at school is safe, clean, and private to use	25 (66)	111 (81)	11 (-10, 33)	21 (72)	87 (89)	13 (−4.3, 30)	46 (66)	198 (82)	12 (−7.7, 31)
The separate facility at school is used by students	20 (53)	95 (69)	16 (-6.4, 39)	13 (45)	72 (73)	26 (4.6, 48)	33 (52)	167 (70)	17 (-3.4, 38)
	N = 1106	N = 1651		N = 1226	N = 1149		N = 2332	N = 2800
Dustbin for throwing menstrual materials in girls’ toilet	37 (3)	368 (22)	19 (14, 24)	63 (5)	312 (27)	20 (15, 27)	100 (4)	680 (23)	19 (15, 24)
Availability of hygiene kit (Dettol, cotton/rag, soap) during menstruation	11 (1)	160 (10)	9.5 (4.7, 14)	12 (1)	205 (18)	20 (14, 26)	23 (1)	365 (11)	11 (6.1, 15)
Distribution of menstruation materials at school	8 (1)	98 (6)	5.9 (2.4, 9.5)	13 (1)	116 (10)	9.9 (5.8, 14)	21 (1)	214 (6)	6.4 (3.3, 9.6)
Menstrual hygiene management education in schools
Received any information regarding MHM before menarche from school	22 (2)	366 (22)	22 (17, 26)	95 (8)	304 (26)	18 (13, 22)	117 (3)	670 (23)	21 (17, 25)
Counselling for students regarding MHM	60 (5)	323 (20)	14 (9.4, 18)	172 (14)	279 (24)	10 (4.7, 16)	232 (6)	602 (20)	13 (9.5, 17)
Separate classes held for girls	9 (1)	67 (4)	3.4 (1.2, 5.5)	11 (1)	76 (7)	6.2 (2.8, 9.5)	20 (1)	143 (4)	3.7 (1.7, 5.6)

PD = Proportion difference; CI = Confidence interval.

Positive (Yes) responses from students were considered.

*Weighted percentage for rural/urban balance and school size.

Table 5. Changes in school absenteeism due to menstruation in urban and rural schools in Bangladesh from 2014 to 2018.

Indicators	Rural schools (N = 2757)		PD (CI)	Urban schools (N = 2375)		PD (CI)	All schools (N = 5132)		PD (CI)
	2014 (n, %*)	2018 (n, %*)		2014 (n, %*)	2018 (n, %*)		2014 (n, %*)	2018 (n, %*)
	N = 1106	N = 1651		N = 1226	N = 1149		N = 2332	N = 2800
Missed schools during menstruation	287 (26)	246 (15)	−11 (−17, −5.6)	247 (20)	117 (10)	-11 (−16, −5.2)	534 (25)	363 (14)	−11 (−16, −6.1)
Mean number of missed days at school due to menstruation	2.8	2.5	−.36 (−.61, −.10)	2.6	2.6	−.12 (−.45, .19)	2.8	2.5	−.33 (−.57, −.10)
Missed classes at school due to menstruation	449 (41)	515 (31)	−10 (−16, −3.3)	482 (39)	249 (22)	−18 (−24, −12)	931 (40)	764 (30)	−10 (−17, −4.9)
Reasons for missing schools during menstruation†	N = 287	N = 246		N = 247	N = 117		N = 534	N = 363
No separate place to change rag/cloths	22 (8)	35 (14)	5.8 (.77, 11)	26 (11)	20 (17)	4.8 (−2.9, 12)	48 (8)	55 (14)	5.7 (1.1, 10)
Felt uncomfortable	149 (52)	128 (52)	−1.7 (−13, 9.2)	138(56)	60 (51)	−5.4 (−18, 6.9)	287 (52)	188 (52)	−2.04 (−12, 7.9)
No water/soap	6 (2)	10 (4)	1.8 (−1, 4.7)	3 (1)	6 (5)	3.1 (.18,6.1)	9 (2)	16 (4)	2.0 (−.62,4.5)
	N = 1106	N = 1651		N = 1226	N = 1149		N = 2332	N = 2800
Parent’s restriction to go out during menstruation	282 (26)	235 (14)	−12 (−18, −5.6)	322 (26)	101 (9)	−19 (−26, −12)	604 (26)	336 (14)	−13 (−18, −6.9)

PD = Proportion difference; CI = Confidence interval.

Positive (Yes) responses from students were considered

*Weighted percentage for rural/urban balance and school size.

^†Multiple answers under this variable.

Table 6. School absenteeism and associated factors.

Variables	Absenteeism
	Yes	No	P value
Time
2013	25%	75%	0.003*
2018	14%	86%
Age
9–12	26%	74%	0.031*
13–17	16%	84%
Area
Rural	21%	79%	0.446
Urban	16%	84%
School type
Primary school	25%	75%	0.019*
Secondary school	10%	90%
Education level of students
Primary	28%	72%	0.010*
Secondary	12%	88%
Knowledge of menstruation before menarche
Yes	18%	82%	0.175
No	23%	77%
Believe menstruation interferes with school performance
Yes	35%	65%	0.002*
No	12%	88%
Received any information regarding MHM from school
Yes	9%	91%	<0.001*
No	22%	78%
Parent’s restriction in going out during menstruation
Yes	29%	71%	0.197
No	19%	81%
Using old clothes
Yes	23%	77%	0.246
No	17%	83%
Separate place for changing MHM materials
Yes	12%	88%	0.012*
No	21%	79%
Separate latrine and urine facility
Yes	10%	90%	0.05*
No	22%	78%

*(Statistically significant <=0.05).

Table 7. Factors associated with school absenteeism among adolescents.

Variable	Unadjusted		Adjusted
Outcome variable Absenteeism	Coefficient (CI)	P value	Coefficient (CI)	P value
Exposure variable
Changes in time	−11 (−16, −6.1)	<.001*	−10.29 (−15.81–4.77)	<0.001*
Independent variables
Age			−2.41 (−5.17–0.34)	0.086
Area			−5.6 (−10.06–1.14)	0.014*
School type			−4.59 (−9.64–0.46)	0.075
Education level of students			−9.48 (−14.17–4.79)	<0.001*
Knowledge of menstruation before menarche			−1.26 (−4.39–1.86)	0.427
Believe menstruation interferes with school performance			23.32 (19.71–26.93)	<0.001*
Received any information regarding MHM from school			0 (−0.02–0.02)	0.951
Parent’s restriction in going out during menstruation			4.47 (0.75–8.2)	0.019*
Using old clothes			−4.2 (−7.6–0.79)	0.016*
Separate place for changing MHM materials			−0.21 (−7.25–6.82)	0.953
Separate latrine and urine facility			−5.44 (−11.46–0.59)	0.077

*(Statistically significant <=0.05).

Data availability statement

The data described in this study are accessible upon request from the corresponding author. Due to privacy and ethical restrictions, the data are not publicly accessible.