School absenteeism during menstruation among adolescent girls in Southern Uganda: A multi-level risk factors analysis.

Menstrual hygiene management (MHM) continues to be a major barrier impacting adolescent girls' school attendance in low-income countries. In Uganda, only 10 % of adolescent girls practice adequate MHM; and they miss an estimated 11 % of school days due to menstruation. Missing school (school absenteeism) has been associated with negative educational and social outcomes. This paper aimed to explore the individual, family, school and community-level factors associated with school absenteeism among adolescent girls during menstruation. We used crosssectional (baseline) data from 1,237 adolescent girls recruited from 47 secondary-schools in Southern Uganda. The nested logistic model analysis was used to test the significance of blocks of predictor factors on school absenteeism. The results showed that all blocks of factors are statistically significant. Discrete analysis indicated that dysmenorrhea was associated with an 8.1 % increase in school absenteeism. However, family sufficiency and support appeared to be protective factors decreasing absenteeism by 13.8 % and 4.9 %, respectively. Also, both schools' good water, sanitation, and hygiene (WASH) infrastructure and supportive teachers were associated with decreasing school absenteeism by 28.6 % and 4.6 %, respectively. Inaddition, cultural taboos on menstruation were associated with the strongest (34.3 %) increase in school absenteeism. Our results showed that all blocks of factors matter when discussing MHM and school absenteeism among adolescent girls. Therefore, more multifaceted interventions are needed to address the issue affecting millions of girls regularly.