Menstrual Hygiene Management and associated factors among adolescent girls in Tapac Sub county, Moroto district, Karamoja region

Abstract

Background: An estimated 1.8 billion women menstruate globally each month, including adolescent girls in and out of school. Despite being a natural biological process, poor menstrual hygiene management (MHM) exposes adolescent girls to adverse health and social outcomes such as urinary tract infections, reproductive tract infections, HIV infection, mental health challenges, school absenteeism and dropout, and increased risk of adolescent pregnancy. These challenges are more pronounced in Uganda, particularly in the Karamoja sub-region, where access to menstrual hygiene information, materials, and supportive environments remains limited. However, there is limited empirical evidence on MHM adequacy and its associated factors in Tapac Sub-county. Objective: To assess menstrual hygiene management and its associated factors among adolescent girls in Tapac Sub-county, Moroto District, Karamoja region. Methods: An analytical cross-sectional study design was used among adolescent girls aged 13–18 years in Tapac Sub-county. A multistage sampling technique involving stratification of parishes, random selection of villages, and systematic household sampling was employed. Data were collected using a pre-tested structured questionnaire translated into Ngakarimojong. Data were analyzed using SPSS version 26 using descriptive statistics and log-binomial regression to determine factors associated with adequate MHM. Results: The proportion of adolescent girls who adequately practiced menstrual hygiene management was 21%. Factors associated with lower MHM adequacy included younger age (13–15 years) (aPR = 0.313; 95% CI: 0.211–0.465; p < 0.001) and menstrual duration of fewer than five days (aPR = 0.523; 95% CI: 0.341–0.802; p = 0.003). Factors positively associated with adequate MHM included being currently in school (aPR = 2.099; 95% CI: 1.388–3.174; p < 0.001), primary education level (aPR = 2.247; 95% CI: 1.207–4.183; p = 0.011), knowledge of appropriate menstrual materials (aPR = 3.284; 95% CI: 2.274–4.743; p < 0.001), and regular menstrual cycles (aPR = 2.180; 95% CI: 1.141–4.165; p = 0.018). Parental factors such as having an educated mother (aOR = 2.424; 95% CI: 1.394–4.214; p = 0.002), educated father (aOR = 1.909; 95% CI: 1.105–3.295; p = 0.020), and parental education on MHM – especially from fathers (aPR = 4.283; 95% CI: 2.870–6.392; p < 0.001) – were significantly associated with improved MHM. Additional factors included smaller household size, presence of other menstruating schoolgirls, and supportive school policies allowing menstrual management during school hours. Conclusion: Menstrual hygiene management among adolescent girls in Tapac Sub-county is inadequate, with only 2 in 10 girls practicing adequate MHM. This places the majority at risk of adverse health and social outcomes. There is a need for integrated, multi-level interventions targeting intrapersonal, interpersonal, and community factors to improve menstrual hygiene practices in the region.