Assessing the usage and factors affecting usage of sanitary rooms (Menstrual Hygiene Management Services) among adolescent school girls in four districts (Rutsiro, Karonji, Nyamagabe and Nyaruguru) in Rwanda.

Background
Rwanda is a low-middle income country and a majority of the population cannot afford the
monthly expenditure of over 1 dollar to buy sanitary pads for good menstrual hygiene management
(MHM). Schools in rural areas are often unable to provide safe and clean environments for MHM.
This has translated to poor menstrual hygiene among other consequences such as missing school,
poor concentration during lessons, and increased risk of infections. The Universal Declaration of
Human Rights on gender equality highlighted the ability to manage menstruation with dignity as a
human and woman’s right. This led to the global community incorporating the provision of MHM
services as part of WASH interventions since 2012. This study was conducted to identify the usage
of availed MHM services in schools and factors that contribute to the uptake of the same.
Methods
The study used a cross-sectional quantitative design. A multi-cluster sampling technique was used
to select study participants from government primary school girls in four rural districts of Rwanda.
A total of 476 responses fulfilling selection criteria were analyzed. Data were analyzed using
SPSS and logistic regression was used to analyze the association of utilization of sanitary rooms
and independent variables. Variables of significance were reported with a 95% CI and P-value of
< 0.05.
Results
The level of usage of sanitary rooms was high at 92% (n=437) and was determined if the
participants used one or more services offered in the sanitary rooms. The service mostly used was
privacy for changing sanitary material (n= 415, 87.2%) followed by receiving sanitary pads from
school(n=312, 65.7%). The mean age of respondents was 14.6 (SD=1.378) years and those from
the Rutsiro district were less likely to use the sanitary rooms compared to those from Nyaruguru
(OR=0.273; 95%CI: 0.10-0.78, P=0.015). Moreover, we found that schoolgirls were more likely
to use the sanitary rooms if mothers were a source of menstrual information (OR 3.6, 95%CI: 1.66-
7.92, p=0.001) and if teachers were a source of menstrual information (OR 2.8, 95%CI: 1.22-6.78,
p= 0.016). Furthermore, experiencing menses for the last 2-3 years lead to a higher likelihood of
using the sanitary room compared to those that reported <1 year of menses (OR 3.36, 95%CI:
1.23-9.20, p= 0.016).
Conclusion
This study emphasized the importance of incorporating MHM interventions when designing
WASH programs in schools as the high usage highlights the need for these services among
adolescent girls. Furthermore, open discussions with teachers and parents about menses should be
encouraged as the study shows the source of MHM information has an impact on the usage of
sanitary rooms.
Moreover, there should be the continued provision of sanitary pads to the girls to optimize hygienic
practices as it will ensure the frequency of changing pads and reduce the usage of pieces of cloth
that can lead to increased risk of infections for girls