Menstrual Pain Management, School Absenteeism and Educational Performance Among Adolescent Students: Cross-Sectional Mixed-Methods Analysis Nested Within a Cluster Randomised Trial.

Abstract

To describe menstrual pain and pain management, and the associations of pain relief with school absenteeism and educational performance, among Ugandan adolescents. Cross-sectional mixed-methods study, nested within a school-based cluster randomised controlled trial. Adolescent girls in 60 secondary schools in Uganda. Quantitative surveys, focus group discussions and in-depth interviews were conducted. Data were analysed using thematic framework analysis for qualitative data, and random-effects regression analysis for quantitative data. Self-reported pain during the last menstrual period (LMP), school absenteeism and educational performance. Among 2683 participants, the majority (n = 2227; 83.0%) reported pain during their LMP and were more likely to miss school than those without pain (mean days missed per month 2.1 vs. 1.4; adjusted incidence rate ratio [aIRR] = 1.46, 95% CI 1.30-1.65). Participants reported that menstrual pain hindered their ability to engage at school, leading to reduced class attendance and participation. Pain management strategies (painkillers, warm water bottles, stretching, or exercise) were reported by 1587 (71.3%) participants with pain at LMP, and were less commonly reported among participants with mental health problems and poorer menstrual self-efficacy. Participants who did not report pain relief missed more school days than those who did report pain relief (aIRR = 1.39, 95% CI 1.11-1.74). Menstrual pain without effective relief was associated with increased school absenteeism. There is a need to improve the uptake of effective pain relief strategies in Ugandan schools and similar settings.