Prevalence and factors associated with school absenteeism during menstruation among higher secondary female students in Kannur district: a school based cross-sectional study
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20261776Keywords:
Menstruation, Absenteeism, Higher secondary students, AdolescenceAbstract
Background: Adolescence marks transition from childhood to adulthood involving physical, cognitive, psycho-social and emotional changes. School absenteeism is a significant issue that affects academic performance and overall well-being of students. In recent years, there has been growing concern about the prevalence of school absenteeism among adolescent girls, particularly in developing countries. Menstrual disorders have been identified as the leading cause of school absenteeism, which seriously impacted their academic achievement. But, in India there are only limited studies on the topic, especially in Kerala. So, this study aims to estimate the prevalence and factors associated with school absenteeism during menstruation.
Methods: School based cross-sectional study conducted among 624 higher secondary female students in Kannur district. Stratified random sampling was done among all higher secondary schools based on their location and management type. Data was collected using a self-administered pretested semi structured questionnaire and analyzed using SPSS 21. Results were expressed in terms of frequencies, percentages, mean, standard deviation. Chi-square test, Fisher’s exact tests were used to test association.
Results: The median age of the population was 17 (±1) years. Median age at menarche was 13 (±1) years. Among the 624 participants prevalence of school absenteeism during menstruation was 59.8%. Most common reason was pain, followed by tiredness, discomfort etc. Significant factors associated were academic stream, age group, residence, menorrhagia.
Conclusions: Prevalence of school absenteeism during menstruation was 59.8%. Most common reasons for absenteeism were pain and tiredness. Significant associations were noted between age, academic stream, location of school, residence, age at menarche, presence of menorrhagia.
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References
Nanditha SK, Karibeeran S. Perspectives of Women in Kerala on menstruation and menstrual leave. In book: Social Work Education, Social Equity and Development, Chapter: 14, Publisher: Authors Press, New Delhi, India. 2023;130-43.
UNICEF. MHM-Monitoring-Resource.
How Good Menstrual Hygiene Keeps Girls Learning | UNICEF USA. 2023. Available at: https://www.unicefusa.org/stories/how-good-menstrual-hygiene-keeps-girls-learning
Vashisht A, Pathak R, Agarwalla R, Patavegar BN, Panda M. School absenteeism during menstruation amongst adolescent girls in Delhi, India. J Fam Community Med. 2018;25(3):163-8. DOI: https://doi.org/10.4103/jfcm.JFCM_161_17
Sivakami M, Maria Van Eijk A, Thakur H, Kakade N, Patil C, Shinde S, et al. Effect of menstruation on girls and their schooling, and facilitators of menstrual hygiene management in schools: surveys in government schools in three states in India, 2015. J Glob Health. 2019;9(1):010408.
Kumbeni MT, Ziba FA, Apenkwa J, Otupiri E. Prevalence and factors associated with menstruation-related school absenteeism among adolescent girls in rural northern Ghana. BMC Womens Health. 2021;21(1):279. DOI: https://doi.org/10.1186/s12905-021-01418-x
World Bank. Menstrual Health and Hygiene. Available at: https://www.worldbank.org/en/topic/water/brief/menstrual-health-and-hygiene. Accessed on 25 January 2026.
Alenur R, Koteswaramma Ch, Maktha VK, Dayyala S. A study on menstrual hygiene practices and school absenteeism during menstruation among high school girls from an urban area of Hyderabad, Telangana. MRIMS J Health Sci. 2024;12(3):161-5. DOI: https://doi.org/10.4103/mjhs.mjhs_147_22
Gravdahl OF, Svenningsen R, Majak P, Majak G. Menstrual‐related symptoms as red flags for school absenteeism among Norwegian adolescents (MINA): A cross‐sectional study. Acta Obstet Gynecol Scand. 2025;104(4):746-54. DOI: https://doi.org/10.1111/aogs.15062
Yaliwal RG, Biradar AM, Kori SS, Mudanur SR, Pujeri SU, Shannawaz M. Menstrual Morbidities, Menstrual Hygiene, Cultural Practices during Menstruation, and WASH Practices at Schools in Adolescent Girls of North Karnataka, India: A Cross-Sectional Prospective Study. Obstet Gynecol Int. 2020;2020:6238193. DOI: https://doi.org/10.1155/2020/6238193
Gupta S, Agarwal A, Sharma A, Agrawal P. Assessment of Menstrual Hygiene Practices and Their Determinants Among Adolescent Girls in Urban Slums of India: A Community-Based Cross-Sectional Study. Cureus. 2025;17(8):e90505. DOI: https://doi.org/10.7759/cureus.90505
Garg S, Singh MM, Marimuthu Y, Borle A, Bhatnagar N, Basu S. School absenteeism during menstruation among adolescent girls in resettlement colonies of Delhi: a community-based cross-sectional study. Indian J Community Health. 2021;33(1):82-9. DOI: https://doi.org/10.47203/IJCH.2021.v33i01.011
Antherjanam DS. Prevalence and pattern of menstrual disorders among school going adolescents in northern district of Kerala. Public Health Rev Int J Public Health Res. 2016;3(3):109-18. DOI: https://doi.org/10.17511/ijphr.2016.i3.04
Krishnaiah BN, Nanjundaswamy DL, Kulkarni SN, Vasu DP, Kulkarni AG, Kurre B. Prevalence, Socio-cultural Restrictions and Determinants of School Absenteeism during Menstruation among Adolescent School Girls in Bangalore. Indian J Community Health. 2023;35(1):71-6. DOI: https://doi.org/10.47203/IJCH.2023.v35i01.013
Dambhare DG, Wagh SV, Dudhe JY. Age at menarche and menstrual cycle pattern among school adolescent girls in Central India. Glob J Health Sci. 2012;4(1):105-11. DOI: https://doi.org/10.5539/gjhs.v4n1p105
Karthika P, Abedi AJ, Mehnaz S, Tabassum. IJCM_31A: Menstrual characteristics and school absenteeism among adolescent school girls of Aligarh--A Cross-sectional Study. Indian J Community Med. 2024;49(1):S9. DOI: https://doi.org/10.4103/ijcm.ijcm_abstract31
Sangha NK, Kaur P, Sangha FS, Kaur N, Singh S. A cross-sectional study to assess menstrual hygiene and school absenteeism related to menstruation among school going adolescent girls of Jalandhar district. Int J Community Med Public Health. 2022;9(11):4185. DOI: https://doi.org/10.18203/2394-6040.ijcmph20222916
Ahmed S, Nimonkar R, Kalra SK, Singh PMP, Rajiva, Singh S. Menstrual hygiene management and menstrual problems among adolescent girls in an urban area in north India: A cross-sectional study. J Fam Med Prim Care. 2024;13(3):1012-9. DOI: https://doi.org/10.4103/jfmpc.jfmpc_1329_23
van Eijk AM, Sivakami M, Thakkar MB, Bauman A, Laserson KF, Coates S, et al. Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis. BMJ Open. 2016;6(3):e010290. DOI: https://doi.org/10.1136/bmjopen-2015-010290
Vayeda M, Ghanghar V, Desai S, Shah P, Modi D, Dave K, et al. Improving menstrual hygiene management among adolescent girls in tribal areas of Gujarat: an evaluation of an implementation model integrating the government service delivery system. Sex Reprod Health Matters. 2021;29(2):1992199. DOI: https://doi.org/10.1080/26410397.2021.1992199
Maria van Eijk A, Thakur H, Kakade N, Patil C, Shinde S, Surani N, et al. Effect of menstruation on girls and their schooling, and facilitators of menstrual hygiene management in schools: surveys in government schools in three states in India, 2015. J Glob Health. 2019;9(1):010408. DOI: https://doi.org/10.7189/jogh.09.010408
Gold-Watts A, Hovdenak M, Daniel M, Gandhimathi S, Sudha R, Bastien S. A qualitative study of adolescent girls’ experiences of menarche and menstruation in rural Tamil Nadu, India. Int J Qual Stud Health Well-Being. 2020;15(1):1845924. DOI: https://doi.org/10.1080/17482631.2020.1845924
Edet OB, Bassey PEM, Esienumoh EE, Ndep AO. Missing school during period: perspectives of adolescent schoolgirls in Cross River State, Nigeria. Pan Afr Med J. 2022;42. DOI: https://doi.org/10.11604/pamj.2022.42.65.28244
Shah V, Nabwera H, Sonko B, Bajo F, Faal F, Saidykhan M, et al. Effects of Menstrual Health and Hygiene on School Absenteeism and Drop-Out among Adolescent Girls in Rural Gambia. Int J Environ Res Public Health. 2022;19(6):3337. DOI: https://doi.org/10.3390/ijerph19063337
GoI, Ministry of drinking water and sanitation. Menstrual-Hygiene-Management-Guidelines. 2015.
Tegegne TK, Sisay MM. Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia. BMC Public Health. 2014;14(1):1118. DOI: https://doi.org/10.1186/1471-2458-14-1118
Sebert Kuhlmann A, Key R, Billingsley C, Shato T, Scroggins S, Teni MT. Students’ Menstrual Hygiene Needs and School Attendance in an Urban St. Louis, Missouri, District. J Adolesc Health. 2020;67(3):444–6. DOI: https://doi.org/10.1016/j.jadohealth.2020.05.040
Andargie FA, Tinuola FR. Effects of school menstrual hygiene management, water, sanitation, and hygiene interventions on girls’ empowerment, health, and educational outcomes: Lasta district, Amhara regional state, Ethiopia. Parker A, editor. PLOS One. 2025;20(4):e0321376. DOI: https://doi.org/10.1371/journal.pone.0321376
Alam MU, Luby SP, Halder AK, Islam K, Opel A, Shoab AK, et al. Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: results from a cross-sectional survey. BMJ Open. 2017;7(7):e015508. DOI: https://doi.org/10.1136/bmjopen-2016-015508
Miiro G, Rutakumwa R, Nakiyingi-Miiro J, Nakuya K, Musoke S, Namakula J, et al. Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): a feasibility study. BMC Womens Health. 2018;18(1):4. DOI: https://doi.org/10.1186/s12905-017-0502-z
Jahan F, Shuchi NS, Shoab AK, Alam MU, Bashar SkMdK, Islam K, et al. Changes in the menstrual hygiene management facilities and usage among Bangladeshi school girls and its effect on school absenteeism from 2014 to 2018. Glob Health Action. 2024;17(1):2297512. DOI: https://doi.org/10.1080/16549716.2023.2297512
Inthaphatha S, Louangpradith V, Xiong LI, Xiong V, Ly L, Xaitengcha V, et al. Menstrual health and factors associated with school absence among secondary school girls in Luang Prabang Province, Lao People’s Democratic Republic: A cross-sectional study. PLoS ONE. 2021;16(12):e0261268. DOI: https://doi.org/10.1371/journal.pone.0261268
Sawyer G, Fraser A, Lawlor DA, Sharp GC, Howe LD. Associations of adolescent menstrual symptoms with school absences and educational attainment: analysis of a prospective cohort study [Internet]. Epidemiology; 2024. DOI: https://doi.org/10.1101/2024.04.24.24306294
Swe ZY, Mon NO, Than KK, Azzopardi PS, Kennedy EC, Davis J, et al. Adolescent girls’ experiences of menstruation and schooling in monastic schools in Magway Region, Myanmar: A mixed-methods exploration. Front Reprod Health. 2022;4:893266. DOI: https://doi.org/10.3389/frph.2022.893266
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