R E S E A R C H Open Access © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit ​h​t​t​p​​:​/​/​​c​r​e​a​​t​i​​ v​e​c​​o​m​m​​o​n​s​.​​o​r​​g​/​l​​i​c​e​​n​s​e​s​​/​b​​y​-​n​c​-​n​d​/​4​.​0​/. Appiah-Agyekum et al. BMC Public Health (2025) 25:1563 https://doi.org/10.1186/s12889-025-22836-8 BMC Public Health *Correspondence: Desmond Dzidzornu Otoo ddotoo@st.ug.edu.gh Full list of author information is available at the end of the article Abstract Background  Menstruation is a natural and inevitable process in females. However, adolescent girls continue to face challenges with several misconceptions and myths. Despite numerous efforts and campaigns, limited knowledge and unhygienic practices persist, leading to various adverse social and health outcomes. This study examined knowledge, practices and factors influencing menstrual hygiene management practices among female senior high school students in the New Juaben Municipality of Ghana. Methods  A descriptive cross-sectional study was conducted among 2 senior high schools. Students were selected using systematic random sampling. Data were collected using a structured questionnaire adapted from literature between August to September 2022. Data was entered into Microsoft Excel Software (2020) and then exported to STATA/MP version 17 (STATA Corp) for analysis. Descriptive statistics and multiple logistic regression were conducted with p-values ≤ 0.05 considered significant. Results  A total of 557 students were included in the study. 61.22% of students demonstrated good knowledge of menstruation, and 57.09% practiced good menstrual hygiene. Disposable sanitary pads were the most commonly used (97.44%) and preferred (93.25%) menstrual products. Most students changed their sanitary pads two or three times per day (47.49% and 47.30%, respectively). Nearly all participants (99%) bathed during menstruation, with water only (61.13%) being the most common method for genital cleaning. Logistic regression analysis revealed that students who lived with their mothers only (AOR = 1.88, 95% CI: 1.16–3.02, p = 0.01), had access to dedicated disposal bins (AOR = 2.20, 95% CI: 1.42–3.39, p < 0.001), and reported adequate facilities for menstrual hygiene needs (AOR = 0.60, 95% CI: 0.39–0.91, p = 0.017) were more likely to practice good menstrual hygiene. Conclusion  Generally, female students had good MHM knowledge and practices with few misconceptions. The study underscores the importance of enhancing menstrual hygiene education, improving school infrastructure, and supporting family-based health education to promote safe and effective menstrual hygiene practices among Menstrual hygiene knowledge and practices among female senior high school students in the new Juaben North municipality of Ghana: a cross-sectional study Nana Nimo Appiah-Agyekum1, Mary Adebi Nyamekye1, Ivy Akushika Agbenu2 and Desmond Dzidzornu Otoo2* http://creativecommons.org/licenses/by-nc-nd/4.0/ http://creativecommons.org/licenses/by-nc-nd/4.0/ http://crossmark.crossref.org/dialog/?doi=10.1186/s12889-025-22836-8&domain=pdf&date_stamp=2025-4-24 Page 2 of 12Appiah-Agyekum et al. BMC Public Health (2025) 25:1563 Background Menstruation is a physiological process that occurs in females when they reach their puberty stage [1, 2], which leads to significant changes in their cognitive, physical, emotional, and social lives [3, 4]. Menstruation remains fundamental in the life of women. It unites the personal, political, intimate, public, socio-cultural and physi- ological aspects of an individual [5]. Menstrual hygiene management (MHM) remains a public health issue in sub-Saharan Africa (SSA), including Ghana. Hygiene Management (MHM) is defined as the “use of clean men- strual management material to absorb or collect blood that can be changed in privacy as often as necessary for the duration of the menstruation period, using soap and water for washing the body as required and having access to facilities to dispose of used menstrual management materials” [6]. While awareness campaigns on men- struation and menstrual hygiene among adolescent girls has been high in recent times, significant gaps persist in MHM. Some of the key challenges include limited access to information, inconsistent use of sanitary products and limited access to water sanitation and hygiene (WASH) facilities [7]. This is further complicated culture, taboos [4, 8] and myths which can lead to stigma, isolation, and absenteeism for schoolgirls [1, 9, 10]. Even though menstruation is a natural and inevitable process that occurs in females, some societies especially in Low-and-middle income countries continue to face challenges with resultant consequences. These challenges contribute to poor menstrual hygiene practices, which may lead to increased risk of reproductive tract infec- tions, isolation, negative impacts on girls’ education and reduced academic performance among many others [3]. MHM can be seen as a major public health issue in addi- tion to its links to human rights, education, and health [6]. MHM has received much attention on the public health agenda to decrease gender inequality in education and to keep school aged girls at school [11], however, major gaps continue to exist in the implementation of this agenda [12]. Research shows that adolescents in most low-and middle-income countries (LMICs) engage in poor men- strual hygiene management practices [13] and this is linked to inadequate knowledge on MHM, cultural prac- tices, lack of WASH facilities among others which pre- vents them from achieving their MHM needs [14–16]. Ghana has 11,782,614 (38.2%) of its total popula- tion classified as young people (15–35 years) according to the 2021 Demographic and Health Survey [17]. This group forms a significant part of the country’s popula- tion and are mostly found at different levels of the educa- tional system. Despite efforts to improve MHM through the educational system, there is limited information on how these efforts translate into improved practices par- ticularly in rural and peri-urban areas. Several female adolescents in the rural and peri-urban areas, still face challenges with managing menstruation effectively [4]. MHM continues to be a personal, hygienic, social, and public health problem for many female students across Ghana. Understanding adolescent girls’ knowledge and practices of MHM is essential to identify hidden gaps, guide interventions, and support the broader goals of improving adolescent’s health. This study, therefore, sought to examine the knowledge, practices and factors influencing and menstrual hygiene management prac- tices among female senior high school students in the New Juaben North Municipality of Ghana. Materials and methods Study design and setting A descriptive cross-sectional survey using the quan- titative research was conducted among 2 Senior High Schools in the New Juaben North Municipality in the Eastern Region of Ghana. According to the recent report from the 2021 population and Housing Census, the population of the municipality stands at 93,201 with 46,799 females and 46,402 males [18]. The municipal- ity was selected due to its average intensity of poverty of 41.7% [18] and its peri-urban nature. The two senior high schools were selected randomly from 5 senior high schools in the Municipality. The first school (school A) had a total female population of 1163 and the second (school B) had a female population of 1637. The study population based on the female population in these schools was 2800. Study population The study population were female students in the two senior high schools who were present during the data collection period. Female students who had experienced menarche were included in the study. Sample size The sample size was determined with the Cochran for- mula n = Z2pq/d2. Where N = sample size, z = z-score of a 95% confidence (1.96), p = proportion of menstrual hygiene knowledge (estimated as 50%). The 50% esti- mation yields the largest sample size. q = 1 − p = 0.5, and adolescent girls. Targeted interventions involving schools, parents, and policymakers are needed to create a supportive environment that ensures menstrual health and educational continuity for all girls. Keywords  Health education, Adolescent wellbeing, Menstrual hygiene, Sanitation Page 3 of 12Appiah-Agyekum et al. BMC Public Health (2025) 25:1563 m = margin of error = 5%. With a non-response rate of 10%, a total of 428 was estimated. However, a total of 557 students were recruited to participate in the study. Since the estimated sample size is the minimum, increasing the number of students recruited could reduce the margin of error and improve the precision of estimates. Sampling technique The participating schools were randomly selected from among the schools in the Municipality. Using a sys- tematic sampling technique, the female students were selected from both schools based on their population until the minimum sample size was achieved. A total of 305 responses were obtained from students in School A and 257 responses from School B. Data collection tools/procedure Data was collected with a structured questionnaire con- sisting of mostly close-ended questions. Questionnaire was adopted from other published studies done on men- strual hygiene management [1, 19, 20]. The questionnaires were administered face-to-face by the researcher and three (3) assistants whiles others were self-completed by the respondents in English since that was the official language of teaching and learning in senior high schools in Ghana. Students were approached during their break times and after the closing of lessons for the day for possible participation in the study. Ques- tionnaires were administered after consent was sought from all respondents. Data collection took approximately 25  min. Data was collected from August to September 2022. Data quality assurance To ensure the quality of data, academic experts in MHM and WASH were made to review the questionnaire to check relevance of questions. Questions were mainly adopted from already published studies as mentioned under the data collection tools. The questionnaire was pre-tested at a senior high school in the Greater Accra Region using 50 female students. All discrepancies and unclear questions from the expert review and the pre-test were corrected before the main study. Data analysis Data collected was entered into Microsoft Excel Soft- ware (2020) for cleaning and validation. Data was then exported to STATA/MP version 17 (STATA Corp) for analysis. In assessing knowledge, 7 questions were used. Out of the total score of 7, the scores were rounded to 100%. Any score less than 50% was graded as “poor” any score between 50 and 70% were graded as “moderate” and scores between 80 and 100% were graded as “good”. A total of 10 statements elicited menstrual hygiene practices with a score of 1 for good practices and 0 for poor practices. The scores were rounded to 100%. Any score less than 80% was considered poor practice and scored 80% and above were considered good practices. Descriptive statistics and multiple logistic regression were performed and reported. All p-values ≤ 0.05 were considered significant. Ethical consideration This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethi- cal approval for the study was sought from the Institute of Statistical and Economic Research Ethics Commit- tee (ECH) of University of Ghana with number ECH 122/22–23 The principles of privacy and confidentiality were upheld during the research and written informed consents were obtained from respondents. Results Background characteristics of respondents A total of 557 participants were included in the study. Table  1 shows the socio-demographic characteristics of participants. The mean age was 16.50 ± 0.96 years with a range between 14 years and 19 years. Out of the total responses, 62.36% (n = 345) of the students were from the Eastern Region followed by the Greater Accra Region at 29.84% (n = 165). The remaining were spread sparingly among all the other regions in Ghana. 57.91% (n = 322) of the students were in their first year and the rest 42.09% (n = 234) were in second year. For their religious affili- ations, 91% (n = 509) of the students were Christians whiles 7.75% (n = 43) were Muslims. More than half of the students, 75.63% (n = 419) who participated in the study, were in the boarding house. 60.36% (n = 335) stayed with both parents while 25.59% (n = 142) stayed with their mothers alone. Most mothers had at least junior high school education 31.05% (n = 172) and 31.39% (n = 172) of fathers had senior high school education. These findings are presented in Table 1 below. Knowledge of students on menstruation In relation to specific menstruation hygiene topic areas, about 95.6% (n = 529) of the students mentioned that menstruation is the natural shedding of blood on a monthly basis. 2.17% (n = 12) mentioned that menstrua- tion was a disease and 2.35% (n = 13) said menstruation was a type of curse to women. It was evident that most of the students, 476 (87.50%) knew that menstruation was caused and regulated by hormones. Very few mentioned that it was a curse of God and caused by diseases while 43 (7.90%) had no idea about the question. Also, more than half 355 (65.38%) knew that the menstrual blood comes from the uterus (womb) while 121 (22.28%) indicated that it originated Page 4 of 12Appiah-Agyekum et al. BMC Public Health (2025) 25:1563 Table 1  Socio-demographic characteristics of respondents Variables Frequencies (n) Percentages (%) Age: Mean: 16.50 ± 0.96 CI: [16.42–16.58] Min: 14 Max: 19 Menarche: Mean: 13.19 ± 1.44 CI: [13.07–13.32] Region of Residence Ashanti Region 7 1.27 Bono East 5 0.90 Brong Ahafo 9 1.63 Central Region 17 3.07 Eastern Region 345 62.39 Greater Accra Region 165 29.84 Northern Region 1 0.18 Western Region 4 0.72 Total 553 100.00 Level of Study Form 1 322 57.91 Form 2 234 42.09 Total 556 100.00 Religion Islam 43 7.75 Christianity 509 91.71 Traditional 3 0.54 Total 555 100.00 Accommodation Status Day 133 24.01 Boarding 419 75.63 Total 554 100.00 With whom do you live with when not in school Both Parents 335 60.36 Mother Only 142 25.59 Father Only 30 5.41 Household without elder female member 7 1.26 Household with elder female member other than mother 35 6.31 Alone 6 1.08 Total 555 100.00 Mother’s Educational Level No Education 30 5.42 Primary 47 8.48 JHS 172 31.05 SHS 147 26.53 Tertiary 98 17.69 Technical/Vocational 59 10.65 Total 554 100.00 Father’s Educational Level No Education 27 4.93 Primary 19 3.47 JHS 90 16.42 SHS 172 31.39 Tertiary 171 31.20 Technical/Vocational 69 12.59 Total 548 100.00 Page 5 of 12Appiah-Agyekum et al. BMC Public Health (2025) 25:1563 from the abdomen. 34 (6.26%) mentioned that the blood was from the bladder while 33 (6.08%) had no idea. On the duration of normal menstruation, 507 (92.01%) indi- cated that it was between two (2) to seven (days) while 29 (5.25%) mentioned greater than 7 days. Also, 12 (2.18%) did not know the duration of normal menstruation. Stu- dents were also asked the normal duration between two menstrual cycles (in days). 333 (61.78%) indicated 20–35 days while 77 (14.29%) indicated less than 20 days. 113 (20.96%) indicated they did not know. 244 (45.10%) men- tioned that menstruation was a lifelong process. The majority of the students 502 (90.61%) indicated that they were told about menstruation before they had their first menstruation. (Table 2). On the source of their information, the majority men- tioned that they had the information from teachers (301; 54.04%), followed by their mothers (236; 42.37%) and friends (210; 37.70%). Other sources stated were their sisters (143; 25.67%), Television (93; 16.70%) the internet (84; 15.08%). (Fig. 1). When asked about menstrual hygiene materials, 524 (94.08%) of the participants knew about disposable pads. 114 (20.47%) knew about menstrual cloth with the least known being menstrual cups. (Fig. 2). We assessed the students’ knowledge using 7 knowl- edge questions on menstruation. Out of the total score of 7, any score less than 3 was graded as poor, scores between 4 and 5 were graded as moderate and scores above 5 were graded as good. Overall, 341 (61.22%) of the students exhibited good knowledge, 119 (21.36%) had moderate knowledge and 97 (17.21%) had poor knowledge on menstruation and its associated practices. (Table 3). Table 2  Knowledge of menstruation Freq. Percent What is menstruation A disease on monthly basis 12 2.17 Natural shedding of blood on monthly basis 529 95.66 Type of curse 13 2.35 It is a Physiological process 42 7.59 Don’t know 5 0.90 None of the above 2 0.36 What is the cause of menstruation Curse of God 20 3.68 Caused by Diseases 4 0.74 Hormones 476 87.50 Don’t Know 43 7.90 Which Organ does the menstrual blood come from? Uterus/Womb 355 65.38 Bladder 34 6.26 Abdomen 121 22.28 Don’t know 33 6.08 What is the duration of normal menstruation? Less than 2 days 2 0.36 2–7 days 507 92.01 > 7 days 29 5.26 Don’t Know 12 2.18 What is the interval between two menstrual cycles? < 20 days 77 14.29 20–35 days 333 61.78 > 35 days 14 2.60 Don’t know 113 20.96 Menstruation of a lifelong process Yes 244 45.10 No 297 54.90 Did anyone tell you about menstruation before your first menstruation occurred? No 39 7.04 Yes 502 90.61 Don’t Know/Don’t Remember 12 2.17 Page 6 of 12Appiah-Agyekum et al. BMC Public Health (2025) 25:1563 Menstrual hygiene management practices The majority of respondents reported using dispos- able sanitary pads (532; 97.44%) as their main absorbent material during menstruation. When given the choice of preference, disposable sanitary pads still remained the preferred choice (511; 93.5%) followed by tampons (16; 2.92%). Menstrual cups, reusable sanitary pads, napkins/ cloths/towels, and cotton were the least preferred. Most students changed their sanitary pads either twice (265; 47.49%) or three or more times per day (263; 47.30%). Nearly all students (99%) bathed during menstrua- tion. For genital cleaning, the most common practice was using water only (324; 61.13%), followed by the use of water and antiseptics (114; 16.79%). Almost half (239; 47.90%) of the students mentioned that they rest during their menstrual periods. 158 (31.66%) of students indi- cated that they take medications as remedies. 74 (14.83%) mentioned that they usually engage in activities while the others, 25 (5%) isolate themselves. Few students indi- cated that they resort to prayers as a remedy. (Table 4). Disposal practices varied between home and school. At home, burning was the most common method (53.14%), followed by dropping in a bin (32.85%), while the low- est practice was dropping in a drain (0.18%). At school, dropping in a bin was most common practice (46.86%), followed by burning (25.67%), and the least practice was also dropping in a drain (0.36%). More students dropped Table 3  Knowledge rating on menstruation Frequency Percentage Poor 97 17.41 Moderate 119 21.36 Good 341 61.22 Total 557 100.00 Fig. 2  Knowledge of menstrual products Fig. 1  Sources of information Page 7 of 12Appiah-Agyekum et al. BMC Public Health (2025) 25:1563 their used sanitary pads in the toilet at school (21.54%) compared to being at home (9.52%). (Fig. 3). Overall, more than half 318 (57.09%) of the students predominantly adopted good hygiene practices during menstruation while 231 (42.91%) were involved in poor practices. (Table 5). Factors influencing menstrual hygiene practices A multiple logistic regression was conducted. In the unadjusted model, students aged ≥ 18 years were 4.24 times more likely to engage in good MHM practices compared to those aged ≤ 14 years (OR = 4.24, 95% CI: 1.191–15.102, p = 0.026). However, this was not signifi- cant in the adjusted model (AOR = 2.85, 95% CI: 0.67– 12.17, p = 0.158). Students who stayed with their mothers only had significantly higher odds of good menstrual hygiene practices compared to those living with both parents, both in the unadjusted (OR = 1.87, 95% CI: 1.24– 2.84, p = 0.003) and adjusted models (AOR = 1.88, 95% CI: 1.16–3.02, p = 0.01). Students in schools where there were specific bins for pad disposal were 2 times more likely to engage in good menstrual hygiene practices in both mod- els (unadjusted OR = 1.99, 95% CI: 1.40–2.82, p < 0.001; adjusted AOR = 2.20, 95% CI: 1.42–3.39, p < 0.001) com- pared to schools with no dedicated bins. Also, girls in schools that have separate toilet facilities on campus and in the dormitories are 1.59 times more likely to adopt good menstrual hygiene practices than those who do not have separate toilet facilities (OR = 1.59, p < 0.05, 95% CI: 1.01–2.53). Additionally, students who reported adequate facilities for menstrual hygiene needs were 40% less likely to engage in poor practices in the adjusted model (AOR = 0.60, 95% CI: 0.39–0.91, p = 0.017). (Table 6). Discussion Knowledge generation and sharing has been a key part of health education and a major factor that influences health beliefs and practices. In this study, more than half of the students showed good knowledge (61.22%) of men- struation and its related hygiene practices with 21.36% exhibiting moderate knowledge, while 17.41% exhibited poor knowledge. The appreciable percentage of students Table 4  Menstrual hygiene management practices Frequency Percentage Main absorbent material you use during menstruation Disposable Sanitary pads 532 97.44 Napkin/Cloth/Towel 2 0.37 Reusable sanitary pads 4 0.73 Tampon 5 0.92 Menstrual cup 2 0.37 Preferred absorbent material Disposable Sanitary pads 511 93.25 Napkin/Cloth/Towel 1 0.18 Reusable sanitary pads 6 1.09 Tampon 16 2.92 Menstrual cup 9 1.64 Cotton 1 0.18 Frequency of changing sanitary pads per day Once a day 29 5.21 Twice 265 47.49 Three or more 263 47.30 Bathing during menstruation Yes 551 99% No 6 1% Materials for genital cleaning Water & Soap 89 16.79 Water only 324 61.13 Only towels/wipes 3 0.57 Water & Antiseptic 114 21.51 Remedies during menstruation Rest 239 47.90 Medication 158 31.66 Involved in activities 74 14.83 Isolation 25 5.01 Prayers 3 0.60 Page 8 of 12Appiah-Agyekum et al. BMC Public Health (2025) 25:1563 with good knowledge in this study aligns with findings from other studies. A study in Ethiopia among both pre- paratory and high school students reported that around three-fourths of students had good knowledge about menstrual hygiene management [21]. A similar study in reported 58.7% good menstrual knowledge among ado- lescents with attribution to effective school-based health education programs [22]. Despite a higher percentage of students with good knowledge in this study, those with poor knowledge in this study (17.41%) was relatively lower compared to other studies. A report in Uganda reported minimal knowledge on menstrual health among females [23]. Also, an evidence synthesis conducted in Africa report in Africa, noted that most adolescent females had low knowledge about menstruation before they experienced it, with few sources of reliable informa- tion [24]. Same way poor knowledge about menstrua- tion was reported among school girls in Ethiopia [25]. These differences in knowledge level seen across differ- ent African countries could be due to the difference in location, demographics, and the period the studies were conducted. It could also be assumed that the recommen- dations by earlier studies [25] were implemented thus improving the knowledge of school girls on menstruation in later studies [21]. Even though there were few miscon- ceptions and knowledge gaps among some students, the majority showed good knowledge. Regarding knowledge of specific areas, most students (95.6%) correctly identified menstruation as the monthly natural shedding of blood. Also, the majority of stu- dents (92.01%) knew that a normal menstrual cycle lasts between 2 and 7 days with 61.78% accurately knowing the normal cycle length as 20–35 days. Only 7% knew that menstruation was a physiological phenomenon. In other LMICs, as many as 83% of respondents knew menstruation as a physiological process [26]. Despite not knowing about menstruation being a physiological process, knowledge about the hormonal regulation of menstruation was high (87.50%), demonstrating a fair understanding of the biological and physiological basis of menstruation. UNICEF notes that knowledge about the biological and physiological nature of menstruation helps to build confidence, contributes to social solidarity and encourages healthy habits [27]. A small percentage of stu- dents believed that menstruation is a disease (2.17%) or a curse (2.35%), which indicates the persisting existence of myths about menstruation. A scoping review [28] reported that cultural perceptions and myths influenced the experience of menstruation among adolescent girls. Also, in the study by Yadav et al. [26], about 1.1% thought menstruation was a curse from God. In the study among adolescent girls in Ethiopia [21], 24.1% mentioned it was a curse from God. These findings underscore the need for accurate and culturally sensitive menstrual health educa- tion in schools and communities. In this current study, most students (90.61%) received information about menstruation before menarche which is higher than proportions reported in some sub-Saharan African contexts. A systematic review among adolescent girls in West Africa reported that less than half knew about menstruation before menarche [29]. Also in Kenya, about 57% of girls had not heard about menstruation before menarche [30]. Marianti et al. [31] notes that early menstrual health education is important for preparing girls positively for menarche and promoting menstrual hygiene management. Results of this study further indi- cates that, teachers (54.04%) were the highest source of information followed by mothers (42.37%). In the study Table 5  Rating of menstrual hygiene practices Frequency Percentage Poor 231 42.91 Good 318 57.09 Total 557 100 Fig. 3  Disposal of sanitary pads Page 9 of 12Appiah-Agyekum et al. BMC Public Health (2025) 25:1563 Table 6  Multivariate logistic regression Variables OR (95% CI) p-value AOR (95% CI) p-value Age ≤ 14 years Ref Ref 15–17 years 2.93(0.89, 9.64) 0.077 2.34(0.62, 8.78) 0.209 ≥ 18 years 4.24(1.19, 15.10) 0.026* 2.85(0.67, 12.17) 0.158 Level Form 1 Ref Ref Form 2 1.28(0.91, 1.80) 0.157 0.98(0.62,1.56) 0.937 Religion Islam Ref Ref Christianity 1.44(0.77, 2.69) 0.248 1.46(0.72, 2.98) 0.294 Traditional 2.10(0.18, 24.87) 0.558 3.89(0.25, 60.91) 0.334 School residency status Day Ref Ref Boarding 1.32(0.89, 1.95) 0.166 1.19(0.75, 1.89) 0.47 Who student stays with Both Parents Ref Ref Mother Only 1.87(1.24, 2.84) 0.003* 1.88(1.16,3.02) 0.01* Father Only 0.64(0.30, 1.37) 0.250 0.51(0.22, 1.22) 0.131 Household without elderly female 0.34(0.064, 1.758) 0.197 0.13(0.01, 1.46) 0.098 Household with elderly female 1.12(0.56, 2.26) 0.750 1.19(0.54, 2.62) 0.67 Alone 0.84(0.17, 4.23) 0.833 0.52(0.09, 3.04) 0.465 Mother’s educational level No Education Ref Ref Primary 0.95(0.38, 2.38) 0.908 0.98(0.34, 2.81) 0.971 JHS 1.06(0.49, 2.32) 0.880 1.48(0.59, 3.69) 0.401 SHS 1.05(0.47, 2.32) 0.907 1.20(0.47, 3.08) 0.706 Tertiary 0.94 (0.41, 2.14) 0.880 0.91(0.34, 2.48) 0.858 Technical/Vocational 1.04(0.43, 2.53) 0.931 1.27(0.42, 3.87) 0.673 Father’s educational level No Education Ref Ref Primary 0.50(0.15, 1.65) 0.254 0.49(0.11, 2.10) 0.335 JHS 0.69(0.29, 1.64) 0.400 0.35 (0.11, 1.10) 0.072 SHS 1.05(0.46, 2.40) 0.905 0.53 (0.17,1.65) 0.271 Tertiary 1.07 (0.47, 2.44) 0.878 0.56 (0.18, 1.72) 0.307 Technical/Vocational 0.75(0.31, 1.85) 0.532 0.42(0.12, 1.44) 0.165 Bins identified for disposal of pads only No Ref Ref Yes 1.99(1.40, 2.82) 0.00* 2.20(1.42, 3.39) 0.00* Separate toilets on campus and in the dormitory No Ref Ref Yes 1.59(1.01, 2.53) 0.048* 1.65(0.96, 2.83) 0.069 Adequacy of facilities for menstrual needs No Ref Ref Yes 0.72(0.50, 1.03) 0.068 0.60(0.39, 0.91) 0.017* Knowledge level Poor Ref Ref Moderate 1.05(0.67, 1.66) 0.830 0.96(0.56, 1.65) 0.893 Good 1.14(0.66, 1.96) 0.641 0.92(0.49, 1.73) 0.795 * Significant at p < 0.05 Page 10 of 12Appiah-Agyekum et al. BMC Public Health (2025) 25:1563 by Bulto [21], about 94% of girls had received informa- tion from their mothers as compared to the majority who received from teachers in this study. Eze et al. [22] from Nigeria corroborated the findings of this study in their reported that 83.8% and 94.6% of girls learnt about men- struation from parents and teachings in school respec- tively. In another Nigerian study, different sources of information were identified. The Media (Radio, Televi- sion, and Print) were reported as the commonest sources with teachers and parents contributing 35.9% and 37.8% respectively [32]. It was noted that about 57% of students were engaged in good menstrual hygiene practices and 43% engaged in poor menstrual hygiene practices. A similar study in Ethiopia among both preparatory and high school stu- dents reported that only 34.7% of the students surveyed were engaged in adequate menstrual hygiene practices [21]. In this study, the schools sampled were mostly in peri-urban areas with quite modern facilities with most of the respondents coming from urban areas and spend- ing their vacations there. It was therefore not surprising that the majority were engaged in good practices. How- ever, owing to the amount of information available to such a group of students, it was concerning that around 43% of students were engaged in poor MHM practices. Good menstrual hygiene practices are associated with improved health outcomes and reduced risk of infections among adolescents [33–35]. Regarding the sanitary materials used, this study revealed that a majority of participants (97.44%) used disposable sanitary pads as their main absorbent mate- rial, and 93.25% preferred them as their top choice. This finding is consistent with studies conducted in sub-Saha- ran Africa and other low- and middle-income countries (LMICs), where disposable pads are often preferred [36] for their convenience, and comfort [21, 37, 38] even though Kambala et al. [37] reported high cost of dispos- able sanitary pads. The study found that most partici- pants changed their sanitary pads twice (47.49%) or three or more times per day (47.30%). Only 5.21% of the partic- ipants changed their pads once daily. It is recommended for females to change sanitary pads at least every 2–3 h to maintain hygiene and reduce the risk of infections [39–41]. The majority of participants (61.13%) used water only for genital cleaning, while 21.51% used water with antiseptics, and 16.79% used water and soap. In Kenya, 68.7% used water with soap while 31.3% used water only [42]. The use of water alone for genital hygiene is com- mon in many LMICs, however using soap along with water is recommended for maintaining genital hygiene [43]. In this study, disposal practices varied between home and school settings. At home, burning (53.14%) and dis- posal in bins (32.85%) were the predominant methods. At school, disposal in bins (46.86%) was most common, followed by burning (25.67%). More students disposed of pads in the toilet at school (21.54%) than at home (9.52%). Inappropriate disposal methods, such as dropping pads in drains (0.18% at home and 0.36% at school) can pose environmental and health hazards and contribute to the spread of diseases and pollution [44]. The study found that students who were 18 years and above were more likely to engage in good menstrual hygiene practices compared to those younger than 14 years, although this association lost significance in the adjusted model. Older girls may have greater awareness and experience in managing menstruation. Students who lived with only their mothers showed significantly higher odds of good menstrual hygiene practices compared to those living with both parents. This finding is consistent with other studies that report mothers as primary sources of menstrual education and support for adolescent girls as well us educational curriculum [45, 46]. The increased influence of mothers in single-parent households could lead to more open communication about menstruation, and better guidance on hygiene practices. The availability of specific disposal bins for menstrual pads and the pres- ence of separate toilet facilities on campus were predic- tors of good menstrual hygiene practices. These findings are supported by studies indicating that adequate facili- ties in schools, such as clean and private toilets, proper waste disposal mechanisms, and access to water and soap, are critical for effective menstrual hygiene manage- ment [20, 34, 36, 45]. In a qualitative study in Zambia, it was revealed that the menstrual health needs of adolescent girls include ade- quate supply of menstrual materials, improved WASH services, safety, and enhanced privacy [47]. Communities and schools needed to provide a supportive environment for girls to manage their periods. Conclusions Most of the adolescent female students exhibited good menstrual hygiene knowledge and practices. However, there are still areas that require improvement particularly in dispelling the myths and misconceptions about men- struation. The presence and access to dedicated WASH facilities, separate toilets, an enabling school environ- ment and parental support significantly influenced good hygiene practices. Thus, there is a need for targeted health education, improved sanitation facilities, and the integration of MHM into school curricula to offer an integrated education. There is a need for collaboration among stakeholders, including schools, parents, and poli- cymakers, to create a conducive environment that sup- ports adolescent girls’ health, well-being, and educational outcomes. It is recommended that stakeholders in the educational sector, especially the Ministry of Education, Page 11 of 12Appiah-Agyekum et al. BMC Public Health (2025) 25:1563 the Ministry of Health, and NGOs develop and imple- ment holistic and comprehensive health education pro- grammes with practicalities to educate students on issues relating to menstruation in order to improve knowledge and dispel all misconceptions. Reproductive health clubs already existent in schools should be made active with new clubs to foster peer education and learning. Heads of educational units should put in place WASH facilities with adequate privacy to create conducive environments for female students to engage in good practices at school. Strengths and limitations The study was conducted among girls who have had menarche has presents first hand information from respondents with experience. The use of multiple logistic regression, allowed for the adjustment of potential con- founders and provides a good estimate for factors influ- encing menstrual hygiene practices. The study, however, could be limited by potential recall bias since information had to be recalled. The cross-sectional nature of the study could limit the ability to infer causality from the study. Abbreviations MHM � Menstrual hygiene management NGO � Non-governmental organization LMICs � Low- and middle-income countries WASH � Water, sanitation and hygiene SDG � Sustainable development goal GDHS � Ghana demographic health survey MHMP � Menstrual hygiene management practices RMP � Reusable menstrual pads SRH � Sexual and reproductive health Acknowledgements The authors are grateful to all participants, the management, and staff of Ghana Senior High School (GHANASS) and Oyoko Methodist Senior High School (OMESS) for their kindness and encouragement and support in carrying out this study. Author contributions Conceptualization: MAN and NNA, Data curation: MAN, Formal analysis: MAN, DDO, IAA Investigation: MAN, DDO, IAA, Methodology: MAN, DDO, NNA, Project Administration: MAN, Supervision: NNA, DDO Validation: NNA, Writing - original draft preparation: MAN, DDO, IAA, Writing - review & editing: NNA, IAA. Funding There was no funding for this study. Data availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Declarations Ethics approval and consent to participate for the study was sought from the Institute of Statistical and Economic Research Ethics Committee (ECH) of University of Ghana with number ECH 122/22–23 The principles of privacy and confidentiality were upheld during the research and written informed consent and assent was sought from all students for data collection. The teachers served as guardians and provided guardian consents for respondents who were under 18 years whiles students provided assent. The teachers only facilitated initial contact with students and had no influence on the data collection process or the responses of the students. Consent for publication Not applicable. Competing interests The authors declare no competing interests. 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Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. https://www.unicef.org/press-releases/fast-facts-nine-things-you-didnt-know-about-menstruation#:~:text=Many%20girls%20do%20not%20have%20complete%20and%20accurate,contributes%20to%20social%20solidarity%20and%20encourages%20healthy%20habits https://www.unicef.org/press-releases/fast-facts-nine-things-you-didnt-know-about-menstruation#:~:text=Many%20girls%20do%20not%20have%20complete%20and%20accurate,contributes%20to%20social%20solidarity%20and%20encourages%20healthy%20habits https://www.unicef.org/press-releases/fast-facts-nine-things-you-didnt-know-about-menstruation#:~:text=Many%20girls%20do%20not%20have%20complete%20and%20accurate,contributes%20to%20social%20solidarity%20and%20encourages%20healthy%20habits https://www.unicef.org/press-releases/fast-facts-nine-things-you-didnt-know-about-menstruation#:~:text=Many%20girls%20do%20not%20have%20complete%20and%20accurate,contributes%20to%20social%20solidarity%20and%20encourages%20healthy%20habits https://doi.org/10.59765/7391rzia https://doi.org/10.59765/7391rzia https://doi.org/10.22214/ijraset.2024.62430 Menstrual hygiene knowledge and practices among female senior high school students in the new Juaben North municipality of Ghana: a cross-sectional study Abstract Background Materials and methods Study design and setting Study population Sample size Sampling technique Data collection tools/procedure Data quality assurance Data analysis Ethical consideration Results Background characteristics of respondents Knowledge of students on menstruation Menstrual hygiene management practices Factors influencing menstrual hygiene practices Discussion Conclusions Strengths and limitations References