The Effect of Commercial Sanitary Pad Use on School Attendance and Health of Adolescents in Western Kenya

This mixed-method cross-sectional study evaluated the effect of commercial sanitary pads on school attendance and symptoms of vaginal infections in rural Kenyan adolescents aged 11-18. It also provides contextual information that situates the data gathered on school attendance and vaginal infections in the broader experience of girls managing their menstruation. A sequential design was used for this study with a total of 8 qualitative focus groups and a quantitative survey. A total of 482 girls were surveyed, with 321 who were currently attending school and 151 who had dropped out of school. Qualitative data from focus groups was analyzed using applied thematic analysis, while the effect of commercial sanitary pads as well as the effect of using other items on school attendance and symptoms of vaginal infections was estimated using logistic regression analysis. Overall, girls reported that menstruation negatively affects their experience at school and in the classroom and causes an array of negative emotions. Girls also conveyed having to often leave school to change or bathe due to menstrual leaks and missing class lessons as a result. Poor concentration in class attributed to menstrual pain and worry over potential leaks was also mentioned. Lastly, the practice of transactional sex to obtain money to purchase pads was a theme within the data. It was found through the quantitative data that the prevalence odds of missing one or more days of school over a two-month period when using commercial sanitary pads is 1.6 times as high as the odds of missing one or more days of school over a two-month period when using other items (p = 0.02, 95% C.I. = 1.03-2.07). There was no statistically significant difference found in the number of school days missed when comparing those who used reusable pads, many underwear, homemade items, and nothing each to those using commercial sanitary pads. The overall prevalence of symptoms of vaginal infections among all girls in this study was found to be 9.4%. There is no statistically significant difference between the odds of having symptoms of a vaginal infection when using commercial sanitary pads as compared to using any other item to control menstruation.