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

Abstract

Menstrual health is an important component of adolescent girls' health and well-being, yet menstrual health problems may remain undetected because of limited knowledge, stigma, embarrassment, cultural beliefs, inadequate access to adolescent-friendly healthcare, and reluctance to discuss menstrual concerns. Problems such as severe menstrual pain, heavy menstrual bleeding, irregular menstrual cycles, prolonged menstruation, and other menstrual abnormalities may interfere with school attendance, concentration, participation in physical activities, social interaction, and overall quality of life. School-based menstrual health assessment provides an accessible opportunity to identify menstrual health problems among adolescent girls within the school environment and may facilitate timely health education, counselling, clinical evaluation, and referral. However, limited school health services, inadequate privacy, shortage of trained healthcare personnel, insufficient menstrual health education, cultural sensitivity, and weak referral systems may limit the effectiveness of school-based menstrual health assessment in Nigeria. Against this background, this study investigates the effect of school-based menstrual health assessment on menstrual health problems detection among adolescent girls in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and the Health Systems Framework. The Health Belief Model explains how adolescent girls' perceptions of susceptibility to menstrual health problems, perceived severity, perceived benefits of assessment, perceived barriers, and cues to action may influence their participation in school-based menstrual health assessment. The Social Ecological Model emphasizes the influence of individual, family, peer, school, cultural, socioeconomic, and environmental factors on menstrual health knowledge, menstrual practices, healthcare-seeking behaviour, and access to appropriate services. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, privacy, and accessibility as essential components of effective school-based menstrual health assessment and referral programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how school-based menstrual health assessment may influence menstrual health problem 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 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, communities, schools, classes, and eligible adolescent girls. School-based menstrual health assessment will be measured using indicators such as availability of menstrual health assessment services, assessment coverage, frequency of assessment activities, menstrual history assessment, evaluation of cycle regularity, assessment of menstrual pain and bleeding patterns, assessment of menstrual hygiene practices, availability of trained healthcare personnel, privacy and confidentiality arrangements, menstrual health education, counselling, and referral services. Menstrual health problems detection will be assessed using indicators such as identification of severe menstrual pain, heavy menstrual bleeding, irregular cycles, prolonged menstruation, missed or abnormal menstrual periods, symptoms associated with anaemia or other menstrual health concerns, newly identified menstrual health problems, severity of reported symptoms, referrals for clinical assessment, confirmed menstrual or reproductive health conditions where appropriate, and linkage to appropriate healthcare services. Data will be collected using structured questionnaires, menstrual health assessment forms, school health records, screening registers, healthcare facility records, referral registers, and relevant adolescent health programme documents. Descriptive statistics will be used to summarize participants' characteristics, menstrual patterns, assessment coverage, menstrual health findings, and patterns of problem detection. 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 health assessment on menstrual health problem detection. Where appropriate, menstrual health problem detection rates before and after implementation of school-based assessment 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 health assessment has a significant positive effect on menstrual health problem detection among adolescent girls in Nigeria. Girls who participate in school-based menstrual health assessment are expected to have a higher likelihood of having previously unrecognized menstrual health problems identified than girls without access to such services. Routine assessment may facilitate early recognition of severe menstrual pain, heavy bleeding, irregular cycles, prolonged menstruation, and other menstrual abnormalities that may otherwise be normalized or ignored. Early detection may provide opportunities for menstrual health education, counselling, appropriate clinical assessment, nutritional support where indicated, and referral for further investigation or treatment. Providing assessment within schools may reduce geographical, financial, and time-related barriers to healthcare and create a more accessible setting for adolescent girls to discuss menstrual concerns. Menstrual health education may also improve knowledge about normal menstrual patterns, warning signs, menstrual hygiene, appropriate healthcare-seeking behaviour, and when professional medical assessment is necessary. Conversely, embarrassment, stigma, lack of privacy, inadequate school health services, shortage of trained personnel, cultural misconceptions, low participation, and weak referral and follow-up systems may reduce the effectiveness of school-based menstrual health assessment. The study therefore expects accessible, confidential, and well-organized school-based menstrual health assessment 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 health assessment, menstrual health problem detection, adolescent girls' health, menstrual health, menstrual hygiene, school health services, adolescent reproductive health, preventive healthcare, health education, 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 schools, nurses, midwives, community health workers, adolescent health practitioners, parents, development partners, and policymakers regarding strategies for improving menstrual health among adolescent girls. The study will also provide evidence-based recommendations for expanding school-based menstrual health assessment, strengthening menstrual health education, ensuring privacy and confidentiality during assessments, improving access to trained healthcare personnel, developing appropriate referral and follow-up systems, increasing access to adolescent-friendly health services, addressing menstrual stigma and misconceptions, and integrating comprehensive menstrual health assessment into school health programmes across Nigeria.

Keywords: School-based menstrual health assessment, menstrual health problem detection, adolescent girls, menstrual health, menstrual hygiene, menstrual disorders, adolescent reproductive health, school health services, preventive healthcare, health education, Nigeria, public health.