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Cited by 163Menstrual Health and DisordersAdolescent Sexual and Reproductive HealthHypothalamic control of reproductive hormones

Menstrual hygiene management in rural schools of Zambia: a descriptive study of knowledge, experiences and challenges faced by schoolgirls

Open access
Chinyama, Joyce, Chipungu, Jenala, Rudd, Cheryl, Mwale, Mercy, Verstraete, Lavuun, Sikamo, Charity, Mutale, Wilbroad, Chilengi, Roma +1 more·2019·BMC Public Health
DOI 10.1186/s12889-018-6360-2PMC PMC6321718
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Abstract

INTRODUCTION: While in school, girls require an environment that is supportive of menstrual hygiene management (MHM) in order to ensure regular school attendance and participation. Little is known about schoolgirls access to and practice of MHM in rural Zambia. This study explores girls' experiences of MHM in rural schools of Zambia from the perspectives of schoolgirls, schoolboys and community and school-based adults key to MHM for schoolgirls. METHODS: In July and August 2015, we conducted this qualitative exploratory study in six rural schools of Mumbwa and Rufunsa districts of Zambia. Twelve in-depth interviews (IDIs) and six focus group discussions (FGDs) were conducted among girls ages 14-18 who had begun menstruating. Two FGDs with boys ages 14-18 and 25 key informant interviews were also conducted with teachers, female guardians and traditional leaders to provide the context within which schoolgirls practice MHM. RESULTS: Most girls reported learning about menstruation only at menarche and did not know the physiological basis of menstruation. They reported MHM-related challenges, including: use of non-absorbent and uncomfortable menstrual cloth and inadequate provision of sanitary materials, water, hygiene and sanitation facilities (WASH) in schools. In particular, toilets did not have soap and water or doors and locks for privacy and had a bad odor. Girls' school attendance and participation in physical activities was compromised when menstruating due to fear of teasing (especially by boys) and embarrassment from menstrual leakage. Boys said they could tell when girls were menstruating by the smell and their behaviour, for instance, moving less and isolating themselves from their peers. Girls complained of friction burns on their inner thighs during their long journey to school due to chaffing of wet non-absorbent material used to make menstrual cloth. Girls preferred to dispose used menstrual materials in pit latrines and not waste bins for fear that they could be retrieved for witchcraft against them. Though traditional leaders and female guardians played a pivotal role in teaching girls MHM, they have not resolved challenges to MHM among schoolgirls. CONCLUSION: When menstruating, schoolgirls in rural Zambia would rather stay home than be uncomfortable, inactive and embarrassed due to inadequate MHM facilities at school. A friendly and supportive MHM environment that provides education, absorbent sanitary materials and adequate WASH facilities is essential to providing equal opportunity for all girls.

AI snapshot

Written from the paper’s full text.

TL;DR

This qualitative exploratory study in six rural schools of Mumbwa and Rufunsa districts, Zambia, found that schoolgirls lacked knowledge about menstruation before menarche and faced inadequate menstrual materials and WASH facilities, leading them to skip school or restrict participation while menstruating. Girls preferred to stay home rather than be uncomfortable, inactive and embarrassed at school.

Key findings

  • Most girls learned about menstruation only at menarche and did not know its physiological basis; they reported fear, worry, sadness and devastation at first period (e.g., "I was devastated when I had my first period because I thought my blood was going to run out" — IDI, girl, 14 years).
  • Girls commonly used non-absorbent cloth (old chitenge, blanket or general material); only one of the six schools stocked cotton wool for emergencies, and the rest provided only toilet paper. Cloth filled quickly, did not stay in place, was malodorous, and caused friction burns on inner thighs during long walks to school.
  • School WASH facilities were inadequate: pit latrines had no piped or stored water, no soap, no doors or locks for privacy, and were dirty and foul-smelling. Pupil-to-latrine ratios were 110:1 in one district and 145:1 in the other; toilets in most schools did not meet WHO functional standards.
  • Girls skipped school or avoided class participation and physical activity when menstruating due to fear of teasing (especially by boys) and embarrassment from leakage; boys said they could tell when girls were menstruating by smell and by reduced movement and social isolation. Girls preferred disposing of used materials in pit latrines rather than waste bins for fear of witchcraft.

Methods

  • Exploratory qualitative study conducted in July–August 2015 in six purposively sampled rural schools (primary and secondary, with and without School Led Total Sanitation programmes) in Mumbwa and Rufunsa districts, Zambia.
  • Data collection comprised 12 in-depth interviews and 6 focus group discussions with girls aged 14–18 who had attained menarche, 2 FGDs with boys aged 14–18, and 25 key informant interviews with teachers (SHN coordinators), female guardians and traditional leaders; a structured observation form assessed school WASH characteristics.
  • Thematic analysis was conducted using NVIVO, with indexing to compare data within and between cases and sources; four major themes emerged (knowledge on menstruation and MHM, menstrual materials, school WASH facilities, school attendance and menstruation).

Limitations

  • Stated by the paper: findings are limited to rural schools in Zambia and may not reflect urban/peri-urban settings; no in-depth analysis of differences between schools with and without SLTS beyond running water, space and privacy; no insights into school expenditure on MHM or quantification of effects of poor MHM facilities on attendance; the study did not sample for or assess information saturation, and the 2 FGDs with boys may have been insufficient to reach data saturation.
  • Evident from the text: the study relies on self-report for attendance and behaviour (no attendance records or quantitative measures), and the small number of schools (six) limits generalizability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12889-018-6360-2

Cites

37 of 37 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 39 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Most girls reported that not having access to absorbent menstrual materials was a challenge to managing their menses.

    “Most girls reported that not having access to absorbent menstrual materials was a challenge to managing their menses.”
    Quote in the paperSubstantial claim
  • Findingown data

    Girls reported negative experiences of fear, worry, sadness and devastation at their first period.

    “with the majority reporting negative experiences of fear, worry, sadness and devastation at their first period”
    Quote in the paperNot a substantial claim
  • Findingown data

    Both teachers and girls reported lack of structured teaching on MHM.

    “Both teachers and girls reported lack of structured teaching on MHM.”
    Quote in the paperSubstantial claim
  • Findingown data

    Most girls in the study reported learning about menstruation only at menarche.

    “Most girls reported learning about menstruation only at menarche and did not know the physiological basis of menstruation.”
    • Also stated in: § Knowledge on menstruation and MHM · plain
      “Girls explained that they learned about menstruation at menarche and did not understand why it happened with the majority reporting negative experiences of fear, worry, sadness and devastation at their first period:”
    Quote in the paperNot a substantial claim
  • Findingown data

    Girls preferred to dispose used menstrual materials in pit latrines rather than waste bins for fear that witches and Satanists would use the menstrual blood to bewitch them and rob them of fertility.

    “Girls preferred to dispose used menstrual materials in the pit latrine and not waste bins at school for fear that witches and Satanists would use the menstrual blood to bewitch them and rob them of their fertility:”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 35
  • May combine two claims. 35

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Girls were told that when menstruating they should not add salt while cooking because it causes chronic cough in those who eat the food.

    “girls were told that when menstruating, they should not add salt while cooking as this causes chronic cough in those who eat the food.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Female guardians and traditional leaders revealed that grandmothers, mothers, aunties, older sisters and female teachers taught girls how to behave and take care of themselves during menstruation.

    “Female guardians and traditional leaders revealed that grandmothers, mothers, aunties, older sisters and female teachers taught girls how to behave and take care of themselves during menstruation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Some girls believed that use of certain disposable sanitary pads causes cancer.

    “and that use of certain disposable sanitary pads cause cancer.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most female guardians and traditional leaders held that girls learn about menstruation and its paraphernalia only when they attain menarche.

    “Most female guardians and traditional leaders strongly forwarded the view that girls learn about menstruation and its paraphernalia only when they attain menarche with a view that it is when they will understand what is taught to them:”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Some girls believed that being physically active during menstruation makes a girl menstruate for a longer period.

    “some girls believed that being physically active during menstruation makes a girl menstruate for a longer period”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Some girls revealed that others may not have tight underwear or any underwear at all, making the use of menstrual materials and the menstrual experience very difficult.

    “some girls revealed that others may not have tight underwear or any underwear at all, making the use of menstrual materials and the menstrual experience very difficult.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Boys confirmed that they were able to tell when a girl was menstruating from the smell.

    “which some boys confirmed explaining that they were able to tell when a girl was menstruating from the smell”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Toilets did not have soap and water or doors and locks for privacy and had a bad odor.

    “In particular, toilets did not have soap and water or doors and locks for privacy and had a bad odor.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Despite most girls using cloth, they stated a preference for disposable sanitary pads especially when in school, due to their ability to absorb menstrual blood for longer periods, dry and comfortable feeling, and ease of disposal.

    “Despite most girls using cloth, they stated a preference for disposable sanitary pads especially when they are in school, due to their ability to absorb menstrual blood for longer periods, dry and comfortable feeling, and ease of disposal.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Due to lack of water and soap, most girls avoided use of the toilets, with some opting to wait until the end of the school day to use the toilet at home.

    “Due to this, most girls avoided use of the toilets, with some opting to wait until the end of the school day to use the toilet at home.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Girls commonly used cloth, with only a few being able to access cotton wool from shops or cotton fields or afford disposable sanitary pads.

    “Girls commonly used cloth with only a few being able to access cotton wool from shops or cotton fields or able to afford disposable sanitary pads.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The two schools with SLTS programmes selected in the study had well-constructed toilets connected to the sewer system with enough space and privacy, but they had no running water nor soap for hand washing.

    “While the two schools with SLTS programmes selected in the study had well-constructed toilets connected to the sewer system with enough space and privacy, they had no running water nor soap for hand washing.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The cloth girls used was an old piece of used chitenge, blanket or general material that had to be washed for reuse or could be disposed of and replaced.

    “The cloth they used was an old piece of used chitenge (thick sarong-like colourful multi-purpose fabric), blanket or general material which had to be washed for reuse or could be disposed of and replaced by another piece.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Girls reported that cloth filled up too quickly and did not stay in place by sticking to underwear, leading to stains on their uniforms.

    “Girls reported that cloth filled up too quickly and did not stay in place by sticking to underwear leading to telling stains on their uniforms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Direct observation showed that all schools had tap water, but pit latrines did not have piped or stored water.

    “Direct observation showed that though all the schools had tap water, pit latrines did not have piped or stored water.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Teachers reported that the cloth used may not be fit for purpose.

    “Teachers reported that the cloth used may not be fit for purpose:”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Pupils realized that the quality of their menstrual material was poor and most likely to stain their dresses.

    “Pupils realized that the quality of their menstrual material was poor and most likely to stain their dresses.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Parents knew the difficulties their daughters faced during menstruation and most supported and encouraged girls to keep attending school.

    “It was clear that parents knew the difficulties their daughters faced during menstruation and, most supported and encouraged girls in every way possible to keep attending school.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Female guardians said that while girls were taught matters relating to marriage at menarche, emphasis was placed on the need for them to avoid 'playing' (sex) with boys as this would put them at risk of getting pregnant and drop out of school.

    “Female guardians said that while girls were taught matters relating to marriage at menarche, emphasis was placed on the need for them to avoid ‘playing’ (a euphemism for sex) with boys as this would put them at risk of getting pregnant and drop out of school.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    School girls were unable to practice adequate MHM due to lack of preparedness for menarche, access to absorbent materials, and to water, soap and privacy while at school.

    “School girls were unable to practice adequate MHM due to lack of preparedness for menarche, access to absorbent materials, and to water, soap and privacy while at school.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Boys said it was easy to tell when a girl was on her menses by the way she restricted movements, outdoor play, talking and social interaction.

    “The boys said that it was easy for them to tell when a girl was on her menses just by the way she restricted movements, outdoor play, talking and social interaction.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Cloth inhibits girls' movements because of fear they will stain their dresses, a feeling stemming directly from the inadequate protection offered by menstrual cloth.

    “This study has shown how cloth inhibits girls’ movements because of fear they will stain their dresses, a feeling stemming directly from the inadequate protection offered by menstrual cloth.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Girls did not know anything about menstruation before menarche and only received informal education on MHM when they attained menarche; the study revealed limited knowledge and alternative views on the biological process of menstruation, usually learned after attaining menarche.

    “Our findings show that girls did not know anything about menstruation before menarche and only received informal education on MHM when they attained menarche.”
    • Also stated in: § Discussion · plain
      “Our study revealed limited knowledge and alternative views on the biological process of menstruation, usually learned after attaining menarche by the girls interviewed, findings similar to that reported for India by Thakre et al. [31].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Thakre SB, Thakre SS, Reddy M, Rathi N, Pathak K, Ughade S. Menstrual hygiene: knowledge and practice among adolescent school girls of Saoner. Nagpur district J Clin Diagnostic Res. 2011;5(5):1027–33.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Traditional leaders and female guardians were aware of the many challenges girls faced during menstruation, such as absence of wash rooms at school that tested school attendance.

    “Traditional leaders and female guardians reported that they were aware of the many challenges girls faced during menstruation, such as absence of wash rooms at school that tested school attendance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One male teacher explained that girls leave his class without notice or disappear when on their periods and do not come back to school until the next day.

    “One male teacher explained that girls leave his class without notice or disappear when they are on their periods and do not come back to school until the next day.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Some parents encouraged girls to attend school and taught them how to take care of themselves and maintain personal hygiene to avoid smell and stains.

    “Some parents encouraged girls to attend school and taught them how to take care of themselves and maintain personal hygiene to avoid smell and stains.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Menstrual stains caused a lot of embarrassment for girls and attracted teasing and laughter from other pupils, especially boys.

    “Both girls and teachers revealed that such stains caused a lot of embarrassment for girls and attracted teasing and laughter from other pupils, especially boys.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Schoolgirls rely heavily on cloth due to household poverty, similar to findings in Northeast Ethiopia where girls used pieces of cloth and rags because of lack of money.

    “With respect to menstrual material, schoolgirls rely heavily on cloth due to household poverty, which is similar to that found in Northeast Ethiopia where girls used pieces of cloth and rags because of lack of money [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Tegegne TK, Sisay MM. Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia. BMC Pub Health. 2014;14(1):1118. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    One schoolgirl was teased and never came back to school after that.

    “Pupils highlighted one schoolgirl who was teased and never came back to school after that.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The six schools were purposively sampled in consultation with DEBS staff to include primary and secondary schools at varying distances from DEBS and with and without SLTS interventions.

    “The six schools in the study were purposively sampled in consultation with the District Education Board Secretary (DEBS) staff to include primary and secondary schools located at varying distances from the DEBS and to include those with and without SLTS interventions to understand their impact on girls’ ability to meet their MHM needs.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The field guides used in the study were adapted from the WASH in Schools Empowers Girls' Education-Tools for MHM Booklet.

    “The field guides used in the study were adapted from the WASH in Schools Empowers Girls’ Education-Tools for MHM Booklet [21].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] UNICEF. WASH in Schools Empowers Girls’ Education-Tools for Assessing Menstrual Hygiene Management in Schools. https://www.unicef.org/wash/schools/files/WinS_Empowers_Girls_Education_Tools_For_MHM_Booklet(1).pdf .

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Education of girls directly impacts national health and national development as well as economic and social progress.

    “Education of girls directly impacts national health and national development as well as economic and social progress [15, 16].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [15] DFID. Girls’ education: towards a better future for all. London; 2005. source

      Not checked in the free run.

    • cites [16] King EM, Hill MA. Women’s education in developing countries: barriers, benefits, and policies. World Bank Publications; 1997.

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Traditional leaders and female guardians played a pivotal role in teaching girls MHM, but they have not resolved challenges to MHM among schoolgirls.

    “Though traditional leaders and female guardians played a pivotal role in teaching girls MHM, they have not resolved challenges to MHM among schoolgirls.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Educated women are more likely to practice and seek appropriate preventive and medical services such as personal hygiene, nutrition and immunization, and help reduce infant morbidity and mortality.

    “Being more likely to practice and seek appropriate preventive and medical services such as personal hygiene, nutrition and immunization, they help reduce infant morbidity and mortality in the nation [17, 18].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [17] Ross CE, Wu C. The links between education and health. Am Sociol Rev. 1995:719–45. source

      Not checked in the free run.

    • cites [18] Khan A, Mupuwaliywa M. Policy Brief: Zambia - providing out-of-school girls with skills: Situation Analysis 2015. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Female research assistants were trained in human subjects' protection and research methods by the regulatory and study teams at the Centre for Infectious Disease Research in Zambia.

    “Female research assistants with backgrounds in various social science disciplines were trained in human subjects’ protection and research methods by the regulatory and study teams at the Centre for Infectious Disease Research in Zambia.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Educated women tend to have fewer children, lead healthier lifestyles and raise healthier families by making more informed choices.

    “Educated women tend to have fewer children, lead healthier lifestyles and raise healthier families by making more informed choices [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] UNICEF. The state of the World’s children 2004-girls, education and development. Unicef; 2003.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A study in Kenya found that cleanliness of school latrines reduced the odds of absenteeism.

    “a study in Kenya found that cleanliness of school latrines reduced the odds of absenteeism [3]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Dreibelbis R, Greene LE, Freeman MC, Saboori S, Chase RP, Rheingans R. Water, sanitation, and primary school attendance: a multi-level assessment of determinants of household-reported absence in Kenya. Int J Educ Dev. 2013;33(5):457–65. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Menstrual hygiene management requires availability of and access to clean and absorbent menstrual material, privacy, water and soap, and disposal facilities for used menstrual materials.

    “Menstrual hygiene management requires availability of and access to clean and absorbent menstrual material, privacy, water and soap, and disposal facilities for used menstrual materials [12].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] JMP. Meeting report of JMP post-2015 global monitoring working group on hygiene. Washington, DC; 2012.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most schools in developing countries do not have provision for privacy, soap, sanitary pads and disposal of soiled sanitary pads.

    “Nor do they have provision for privacy, soap, sanitary pads and disposal of soiled sanitary pads [14].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] Sommer M, Caruso BA, Sahin M, Calderon T, Cavill S, Mahon T, et al. A time for global action: addressing girls’ menstrual hygiene management needs in schools. PLoS Med. 2016;13(2):e1001962. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Lowered fertility rates and higher market productivity improve the national economy.

    “This in turn leads to lowered fertility rates and higher market productivity thereby improving the national economy [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] UNICEF. The state of the World’s children 2004-girls, education and development. Unicef; 2003.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    One in ten school-aged girls in low and middle income countries fail to attend school during menstruation or drop out of school at puberty due to absence of MHM facilities.

    “others suggest that one in ten school-aged girls in low and middle income countries fail to attend school during menstruation or drop out of school at puberty due to the absence of menstrual hygiene management (MHM) facilities [4–7].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [4] WHO. Progress on sanitation and drinking water: 2013 update. In: World Health Organization; 2013.

      Not checked in the free run.

    • cites [5] Boosey R, Prestwich G, Deave T. Menstrual hygiene management amongst schoolgirls in the Rukungiri district of Uganda and the impact on their education: a cross-sectional study. Pan Afr Med J. 2014;19. source

      Not checked in the free run.

    • cites [6] Secor-Turner M, Schmitz K, Benson K. Adolescent experience of menstruation in rural Kenya. Nurs Res. 2016;65(4):301–5. source

      Not checked in the free run.

    • cites [7] Tegegne TK, Sisay MM. Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia. BMC Pub Health. 2014;14(1):1118. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Alternate views around MHM impacted girls' choice of menstrual materials, where and how to dispose them, and whether to attend school or not during menstruation, as found in Nigeria, Kenya and India.

    “As found in Nigeria, Kenya and India, alternate views around MHM impacted girls’ choice of menstrual materials, where and how to dispose them, and whether to attend school or not during menstruation [30, 33, 34].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [30] Mason L, Nyothach E, Alexander K, Odhiambo FO, Eleveld A, Vulule J, et al. “We keep it secret so no one should know”–a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural Western Kenya. PLoS One. 2013;8(11):e79132. source

      Not checked in the free run.

    • cites [33] Busari, AO. Menstrual Knowledge and Health Care behavior among Adolescent Girls in Rural, Nigeria. Federal College of Education (Sp) Oyo, Nigeria. 2012. http://www.ijastnet.com/journals/Vol_2_No_4_April_2012/20.pdf

      Not checked in the free run.

    • cites [34] Jordanova T, Cronk R, Obando W, Medina OZ, Kinoshita R, Bartram J. Water, sanitation, and hygiene in schools in low socio-economic regions in Nicaragua: a cross-sectional survey. Int J Environ Res Public Health. 2015;12(6):6197–217. https://doi.org/10.3390/ijerph120606197 . source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    The study's findings are limited to rural schools in Zambia; MHM issues in urban and peri-urban schools may be different but equally important.

    “Our findings are limited to rural schools in Zambia; MHM issues in urban and peri-urban schools maybe different but equally important to understanding the extent of MHM challenges faced by schoolgirls.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The 12 IDIs with girls and the 25 KIIs yielded rich information, consistent with studies reporting on expected information saturation.

    “However, the 12 IDIs with girls and the 25 KIIs yielded rich information, which is consistent with studies reporting on expected information saturation [42, 43].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [42] Hennink MM, Kaiser BN, Marconi VC. Code saturation versus meaning saturation: how many interviews are enough? Qual Health Res. 2017;27(4):591–608. source

      Not checked in the free run.

    • cites [43] Hagaman AK, Wutich A. How many interviews are enough to identify Metathemes in multisited and cross-cultural research? Another perspective on Guest, Bunce, and Johnson’s (2006) landmark study. Field Methods. 2017;29(1):23–41. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In rural Malawi, cost of commercial pads was identified as one of the barriers to school attendance.

    “In rural Malawi, cost of commercial pads was identified as one of the barriers to school attendance [9, 31].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [9] Grant M, Lloyd C, Mensch B. Menstruation and school absenteeism: evidence from rural Malawi. Comp Educ Rev. 2013;57(2):260–84. source

      Not checked in the free run.

    • cites [31] Thakre SB, Thakre SS, Reddy M, Rathi N, Pathak K, Ughade S. Menstrual hygiene: knowledge and practice among adolescent school girls of Saoner. Nagpur district J Clin Diagnostic Res. 2011;5(5):1027–33.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Inadequate MHM affected girls' confidence, psychological wellbeing and ability to perform physical activities.

    “As also shown elsewhere, inadequate MHM affected girls’ confidence, psychological wellbeing and ability to perform physical activities [9, 30].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [9] Grant M, Lloyd C, Mensch B. Menstruation and school absenteeism: evidence from rural Malawi. Comp Educ Rev. 2013;57(2):260–84. source

      Not checked in the free run.

    • cites [30] Mason L, Nyothach E, Alexander K, Odhiambo FO, Eleveld A, Vulule J, et al. “We keep it secret so no one should know”–a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural Western Kenya. PLoS One. 2013;8(11):e79132. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Transcriptions were checked against audio recordings and errors rectified before analysis.

    “The Zambian analysts, also fluent in both languages, checked transcriptions against audio recordings rectifying any errors before commencing analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study did not provide an in-depth analysis on the differences between MHM practices in schools with and without SLTS, except for issues surrounding running water, space and privacy discussed for the two SLTS schools included.

    “The study has also not provided an in-depth analysis on the differences between MHM practices in the schools with and without SLTS, in exception of the issues surrounding running water, space and privacy discussed for the two SLTS schools included in the study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The study did not sample for information saturation nor assess it.

    “Also, we did not sample for information saturation nor did we assess it.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Efforts in school sanitation to address girls' participation in education have largely ignored menstrual management in latrine design and construction, with privacy and water availability remaining a challenge.

    “Efforts in school sanitation to address girls’ participation in education have largely ignored menstrual management in latrine design and construction with privacy and water availability remaining a challenge [39].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Sommer M. Putting menstrual hygiene management on to the school water and sanitation agenda. Waterlines Practical Action Publishing. 2010;29(4):268–78.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study does not provide insights into school expenditure on MHM in relation to other school needs or quantify the effects of poor MHM facilities on school attendance.

    “Further, this study does not provide insights into school expenditure on MHM in relation to other school needs or quantify the effects of poor MHM facilities on school attendance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Girls in the rural study schools could not maintain menstrual hygiene at school, and this restricted their school attendance and participation, often forcing them to skip school.

    “This first qualitative study on MHM in rural Zambia found that girls could not maintain menstrual hygiene in school which restricted their school attendance and participation.”
    • Also stated in: § Conclusion · hedged
      “Our findings suggest that girls in the rural schools are often forced to skip school due to the various challenges they face in practicing menstrual hygiene.”
    • Also stated in: § Discussion · hedged
      “Nonetheless, our study provides compelling evidence that the menstrual hygiene challenges experienced by schoolgirls in rural Zambia compromise their ability to participate in school activities and for some, their ability to attend classes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationnone given

    Comfort during menstruation is essential if girls' attendance is to be consistent for their improved educational attainment.

    “Comfort during menstruation is essential if girls’ attendance is to be consistent for their improved educational attainment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    As reported by McMahon et al. from Kenya, poor WASH facilities deter girls from using the facilities at school, with most girls not using them at all and opting to stay home until they finish menstruating.

    “As reported by McMahon et al. from Kenya, poor WASH facilities deters girls from using the facilities at school, with most girls not using them at all and opting to stay home until they finish menstruating [38].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] McMahon SA, Winch PJ, Caruso BA, Obure AF, Ogutu EA, Ochari IA, et al. “the girl with her period is the one to hang her head”reflections on menstrual management among schoolgirls in rural Kenya. BMC Int Health Hum Rights. 2011;11(1):7. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    Given the need to keep menstruation private, the manner in which sanitary pads are provided may influence uptake.

    “Given the need to keep menstruation private, the manner in which sanitary pads are provided may influence uptake.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The 6 FGDs with girls and 2 with boys may have been insufficient to reach data saturation.

    “We conducted 6 FGDs with girls and 2 with boys and the latter may have been insufficient to reach data saturation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Without absorbent and comfortable menstrual materials to use, girls are not able to perform to their full ability.

    “Without absorbent and comfortable menstrual materials to use, girls are not able to perform to their full ability.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The robust qualitative design allowed the collection of lived experiences from girls and perspectives on MHM from teachers, boys, female guardians and traditional leaders.

    “The robust qualitative design allowed the collection of lived experiences from girls and perspectives on MHM from teachers, boys, female guardians and traditional leaders.”
    Quote in the paperSubstantial claim
58 of 58

  • The paper relies on this without support.

    Little attention has been given to understanding the ways in which MHM contributes to school absenteeism and other gender disparities in Zambia.

    “Little attention has been given to understanding the ways in which MHM contributes to school absenteeism and other gender disparities in Zambia.”

  • The paper relies on this without support.

    Menstruation is a culturally sensitive topic and may not be freely spoken about in a group setting.

    “Menstruation is a culturally sensitive topic and may not be freely spoken about in a group setting.”

  • The paper relies on this without support.

    In Zambia, female literacy levels are approximately 58%.

    “which is reflected in the low female literacy levels of approximately 58%.”

  • The paper relies on this without support.

    This is the first qualitative study on MHM in rural Zambia.

    “This first qualitative study on MHM in rural Zambia found that girls could not maintain menstrual hygiene in school which restricted their school attendance and participation.”

  • The paper relies on this without support.

    The girls' and teachers' self-reports about menstrual experiences and school attendance accurately reflect their actual experiences and practices.

    “Most girls reported that they stayed away from school when they were menstruating for fear of having a “menstrual accident” that stained their uniform.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • India claim cites a Nicaragua study

    Minor

    The cited references cover Kenya (30), Nigeria (33) and Nicaragua (34), not the stated combination of Nigeria, Kenya and India.

  • Nicaragua example cites a Ghana study

    Minor

    The discussion gives Nicaragua as its example and cites reference 37, but reference 37 is a study of sanitary pads in Ghana.

2 of 2

Cites

Flagged first, then by citations

1 of the 38 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Kamaljit K, Arora B, Singh KG, Neki NS. Social beliefs and practices associated with menstrual hygiene among adolescent girls of Amritsar, Punjab. India J Int Med Sci Acad. 2012;25(2):69–70.

Cited by

Sorted by citations

Related

Authors
Chinyama, J., Chipungu, J., Rudd, C., Mwale, M., Verstraete, L., Sikamo, C., Mutale, W., Chilengi, R., & Sharma, A.
Affiliations
  • Centre for Infectious Disease Research in Zambia (ZM)
  • United Nations Children's Fund (US)
  • University of Zambia (ZM)
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2019-01-05
Volume
19
Issue
1
Pages
16-16
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-018-6360-2
PMC
PMC6321718
OpenAlex
W2906739964
Semantic Scholar
37483fab775f9b678d500ce518c2845911468220
Cited by
163
References
38
Citations by year
2026: 23 · 2025: 24 · 2024: 25 · 2023: 34 · 2022: 23 · 2021: 22 · 2020: 9 · 2019: 3
FWCI
13.12
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Canadian Government (ZAMPCA/WASH/001/2015)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
  • Health Sciences › Health Professions › General Health Professions › Adolescent Sexual and Reproductive Health
  • Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
Keywords
menstrual hygiene management, female students, rural schools, menstrual knowledge, sanitary products, school sanitation facilities, school attendance, peer teasing, witchcraft beliefs, traditional leaders, menstrual taboos
MeSH terms
Absenteeism, Adolescent, Female, Humans, Hygiene, Health Knowledge, Attitudes, Practice, Male, Menstruation, Rural Population, Sanitation, Schools, Zambia, Focus Groups, Qualitative Research, Menstrual Hygiene Products

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

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