Assessment of knowledge, attitudes and practices of Menstrual Hygiene Management among school teachers and administrators in schools with sanitary room activity compared to those without.

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.