Menstrual knowledge, attitudes and behaviours among secondary school students in Uganda: a longitudinal study

Little is known about the effect of menstrual knowledge, and of menstrual education interventions, on broader dimensions of menstrual health. We assessed factors associated with menstrual knowledge and attitudes, and the association of menstrual knowledge with menstrual health related outcomes among female Ugandan adolescents enrolled in the control arm of a menstrual health intervention trial.

We conducted a secondary data analysis of longitudinal data from control arm participants in a cluster-randomised trial conducted in Ugandan secondary schools. Endline data were collected one year after baseline. We identified baseline factors associated with the menstrual knowledge and attitudes at endline, and estimated associations of menstrual knowledge items with menstrual practice needs and menstrual confidence at endline, using random-effects Poisson and linear regression analyses to estimate adjusted incidence rate ratios (aIRR) and mean differences (aMD) respectively.

Among 1453 female and 317 male participants in 30 control arm schools who completed both baseline and endline surveys, there was evidence of small associations between better menstrual knowledge at endline with better baseline knowledge (both male and female participants), and in females only, being in a private school (aIRR = 1.05, 95%CI 1.00-1.11), and knowledge about menstruation prior to menarche (aIRR = 1.08, 95%CI 1.03-1.14). Positive attitudes towards menstruation at endline were associated with baseline positive attitudes (male and female participants), and with knowledge prior to menarche (aIRR = 1.10, 95%CI 1.01-1.21). Participants with better knowledge scores had better menstrual experiences (Menstrual Practice Needs Scale: aMD = 0.19, 95%CI 0.08-0.30, p < 0.001 for high versus low knowledge scores).

Female adolescents who know about menstruation before menarche have slightly greater menstrual knowledge and positive attitudes towards menstruation. In turn, menstrual knowledge is associated with fewer unmet menstrual practice needs. Future interventions should consider tailoring educational content to address specific knowledge gaps and cultural attitudes and include boys.

ISRCTN45461276 Registration date: 16/09/2021.