MGHD 2022

Background: Lack of proper menstrual hygiene management (MHM) in schools has exacerbated girls’ school absenteeism and dropout rates. Previous studies in Rwanda have shown that most students receive MHM information from teachers. However, there is a paucity of data on how knowledgeable and aware the schoolteachers (STs) and school administrators (SAs) are, regarding MHM, as the key stakeholders of MHM in schools. The World Food Programme (WFP) in collaboration with World Vision (WV) has contributed to MHM by constructing sanitary rooms for girls in schools. This study was conducted to assess the knowledge, attitudes, and practices (KAP) of menstrual hygiene management among schoolteachers and school administrators, in schools with sanitary room activity (SRA) compared to those without and explore further the perceptions and involvement of male teachers and school administrators on MHM education. Methods: This school based cross-sectional study was a concurrent mixed-method study, conducted in four rural districts of Rwanda. These were Nyamagabe and Nyaruguru from the southern province, Karongi, and Rutsiro from the western province. A survey was done among 538 schoolteachers and 58 school administrators from 45 schools to assess KAP on MHM in schools with SRA compared to those without. In addition, 8 focus group discussions (FGDs) and 8 key informant interviews (KIIs) from 8 schools were conducted to explore the perceptions and involvement of male teachers and administrators on MHM education and associated socio-cultural beliefs. Descriptive analysis, logistic regression, and chi-square tests were used to analyze quantitative data with 95% CI, P<0.05 considered as the level of significance. Inductive content analysis was used to analyze qualitative data. Results: A total of 62.9% of participants had good knowledge scores (≥80%). The mean knowledge score was 82.6% (SD: 2.08). In the bivariate analysis, knowledge score was higher among female schoolteachers/administrators compared with male schoolteachers/administrators (P<0.001). All participants disagreed that “During menstruation, girls should not help in household activities” among other activities, however participants who had poor knowledge were more likely to agree that “During menstruation, girls should be scared” (OR 3.37, 95% CI: 1.80-6.31, P<0.001). Regarding practice, participants who agreed that they support MHM, 46.6% rarely helped students. Both school categories had good knowledge regardless of the presence or absence of a sanitary room. Qualitative findings revealed willingness of male schoolteachers and administrators towards MHM support, however hindered by some socio-cultural norms around menstruation. Conclusion: The good knowledge of schoolteachers and administrators on MHM, demonstrated significant efforts Rwanda has put in MHM for girls compared to other countries. However, there are still some knowledge gaps. Socio-cultural norms have also impeded the transformation of good knowledge into positive attitudes and good practices of MHM, hence increasing menstrual stigma among girls. Alongside advancing MHM training in schools, there’s need to uproot socio-cultural norms/taboos at school and community level through use of multi-media approaches in encouraging open discussions and positive norms on menstruation. This can be accompanied with sensitization of male involvement in MHM since the study highly showed female teachers were more involved in MHM than male teachers.