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

The DOI matches its Crossref record; 37 of the 38 references it cites were found in a registry or an index; 2 of the 39 sources its claims cite were checked for support.

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

Open access

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.

Overview

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.

Verification

Claims the paper makes

61 Own result · 24 Not checked yet · 10 Own method · 7 Own interpretation · 1 Partly supported · accuracy not yet measured

Verify all 37 references — free account

Show all 45 claims

  • Probably not a substantial claim. 35
  • It may state two separate claims as one. 35
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.

2 of 2

Citations

Cites

Show all 38 references

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

See all 163

Metadata

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)
Venue
BMC Public Health
Published
2019-01-05
Volume
19
Issue
1
Pages
16-16
ISSN
1471-2458 (ISSN-L)
OpenAlex
W2906739964
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
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 › Medicine › Public Health, Environmental and Occupational Health › 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.

A language model drew the claims from the paper on 2026-10-08, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-08 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Cited sources are checked with a language model’s help (gpt-6-sol).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review