Menstrual hygiene management practices and associated factors among in-school adolescent girls in Uganda: Secondary analysis of the 2023 AGYW survey data

Abstract Background Menstrual hygiene is a key determinant of school attendance. However, younger in-school adolescent girls may have limited menstrual management experience, affecting school attendance. We assessed menstrual hygiene management practices and associated factors among in-school girls aged 10–17 years. Methods This is a secondary analysis of data collected as part of a large survey conducted among 5,449 in- and out-of-school adolescent girls and young women (AGYW) aged 10–24 years in 14 purposively selected districts in Uganda in July 2023. Data were collected on socio-demographics (e.g., age, level of education, persons lived with), household possessions (to generate a wealth index), and menstrual history. Ever-menstruated girls were asked about the materials used to manage menstrual flow, materials used to wash their genitals, and how often they washed their genitalia during the most recent menstruation period. Data were collected at the school level, using a structured questionnaire embedded in a mobile KoboCollect application. Inferential analysis was conducted in Stata (version 14.0) using a modified Poisson regression model, with statistical significance set at p < 0.05. Results Of 5,449 AGYW, 2,018 (37.0%) were aged 10–17 years. Of these, 54.4% (n = 1,097) were in school. More than two-thirds (68.3%, n = 749) had ever menstruated (mean age at first menstruation: 13.6 years (SD ± 1.4)). Of these, 88.7% (n = 665) used disposable pads while 11.2% (n = 84) used recyclable pads during their most recent periods. Slightly more than half (52.7%, n = 395) washed their genitals with soap and water; 97.9% (n = 679) washed them two or more times in a day. Disposable pad-use was associated with being in the highest wealth tertile (adjusted prevalence ratio [aPR] = 1.10, 95%CI:1.02–1.18) while washing genitals with soap and water was associated with bathing once in a day (aPR = 1.42, 95%CI:1.05–1.95), using recyclable pads (aPR = 1.45, 95%CI:1.23–1.70), and starting menstruation at 15–17 years (aPR = 1.28, 95%CI:1.00–1.63). Conclusions Most in-school adolescent girls used disposable pads to manage their menses and, on average, frequently cleaned their genitals using soap and water. Wealth status influenced disposable pad use, while the frequency of bathing and the material used to manage menstrual flow determined whether water and soap were used to clean the genitals.