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Effect of School-Based Menstrual Disorder Screening on Menstrual Health Problems Detection among Adolescent Girls in Nigeria

Abstract

Menstrual health problems are an important health and educational concern among adolescent girls in Nigeria and may include dysmenorrhoea, irregular menstruation, heavy menstrual bleeding, amenorrhoea, premenstrual symptoms, menstrual-related anaemia, and other menstrual disorders. These conditions may negatively affect girls' physical and psychological well-being, school attendance, concentration, academic participation, and social activities. However, menstrual health problems may remain undetected because of stigma, embarrassment, inadequate menstrual health education, cultural beliefs, limited communication between adolescents and caregivers, and restricted access to adolescent-friendly health services. School-based menstrual disorder screening provides an opportunity to identify girls experiencing menstrual health problems within a familiar educational environment through confidential assessment, health education, and appropriate referral mechanisms. Early detection may facilitate timely clinical evaluation, menstrual health counselling, appropriate treatment, nutritional support, and referral to healthcare professionals where necessary. Against this background, this study investigates the effect of school-based menstrual disorder screening on menstrual health problems detection among adolescent girls in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Health Promotion Model. The Health Belief Model explains how adolescent girls' perceptions of susceptibility to menstrual health problems, perceived severity, perceived benefits of screening, perceived barriers, and cues to action may influence participation in school-based menstrual health screening and healthcare-seeking behaviour. The Social Ecological Model emphasizes the influence of individual, family, peer, school, community, cultural, socioeconomic, and healthcare-system factors on menstrual health, disclosure, and access to appropriate services. The Health Promotion Model emphasizes individual knowledge, perceived benefits, interpersonal influences, and health-promoting behaviours that may encourage adolescent girls to participate in preventive health assessment and seek appropriate care. Collectively, these theoretical perspectives provide a suitable framework for explaining how school-based menstrual disorder screening may influence menstrual health problems detection among adolescent girls in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise adolescent girls aged approximately 10 to 19 years enrolled in selected public and private secondary schools across Nigeria. A multistage sampling technique will be used to select states, local government areas, schools, classes, and eligible participants. School-based menstrual disorder screening will be measured using indicators such as availability of screening programmes, screening coverage, frequency of screening activities, menstrual history assessment, age at menarche, menstrual cycle regularity, menstrual duration, menstrual flow, dysmenorrhoea assessment, heavy menstrual bleeding assessment, amenorrhoea assessment, premenstrual symptoms, menstrual-related anaemia risk assessment, menstrual health education, availability of trained female health personnel, privacy and confidentiality arrangements, and referral pathways. Menstrual health problems detection will be assessed using indicators such as newly identified dysmenorrhoea, irregular menstruation, heavy menstrual bleeding, amenorrhoea, menstrual-related anaemia risk, severe premenstrual symptoms, menstrual symptoms requiring further clinical assessment, girls referred for medical evaluation, and documented menstrual disorders where appropriately established. Data will be collected using structured questionnaires, validated menstrual health assessment instruments, confidential menstrual history forms, school health records where available, and referral documentation. Descriptive statistics will be used to summarize participants' demographic and menstrual characteristics, screening coverage, menstrual patterns, identified problems, and detection rates. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the effect of school-based menstrual disorder screening on menstrual health problems detection. Where appropriate, detection rates before and after implementation of school-based menstrual disorder screening activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that school-based menstrual disorder screening has a significant positive effect on menstrual health problems detection among adolescent girls in Nigeria. Girls who participate in systematic school-based menstrual screening are expected to have a higher likelihood of previously unrecognized menstrual health problems being identified than girls without access to such screening. Routine assessment may facilitate early recognition of dysmenorrhoea, irregular menstrual cycles, heavy menstrual bleeding, amenorrhoea, severe premenstrual symptoms, menstrual-related anaemia risk, and other menstrual concerns. Early detection may provide opportunities for appropriate clinical assessment, menstrual health education, nutritional counselling, pain-management strategies, treatment, and timely referral. Conducting screening within schools may reduce some geographical, financial, cultural, and access barriers and provide a familiar environment in which adolescent girls can discuss sensitive menstrual concerns confidentially. Menstrual health education may also improve knowledge, reduce stigma, and encourage girls to seek appropriate healthcare rather than normalize severe or persistent symptoms. Conversely, embarrassment, stigma, inadequate privacy, cultural beliefs, shortage of trained female health personnel, limited access to appropriate healthcare services, financial constraints, and weak referral and follow-up systems may reduce the effectiveness of school-based menstrual disorder screening. The study therefore expects confidential, adolescent-friendly, and systematically implemented school-based menstrual disorder screening to contribute significantly to improved detection and early management of menstrual health problems among adolescent girls in Nigeria. The study is expected to contribute to the literature on school-based menstrual disorder screening, menstrual health problems detection, adolescent girls' health, menstrual health, reproductive health, school health services, adolescent-friendly healthcare, women's health, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Federal Ministry of Education, National Primary Health Care Development Agency, state ministries of health and education, secondary school administrators, school nurses, community health workers, midwives, gynaecologists, adolescent health practitioners, parents, development partners, and policymakers regarding strategies for improving adolescent menstrual health. The study will also provide evidence-based recommendations for expanding school-based menstrual disorder screening, improving menstrual health education, strengthening school health services, increasing access to trained healthcare personnel, ensuring privacy and confidentiality during screening, improving referral and follow-up systems, reducing menstrual stigma, promoting appropriate nutritional and reproductive health support, and integrating menstrual health screening into appropriate school-based adolescent and reproductive health programmes across Nigeria.

Keywords: School-based menstrual disorder screening, menstrual health problems detection, adolescent girls, menstrual health, dysmenorrhoea, irregular menstruation, heavy menstrual bleeding, amenorrhoea, reproductive health, school health services, adolescent health, Nigeria.