Abstract
Background
Adequate Water, Sanitation, and Hygiene (WASH) facilities are essential for menstrual hygiene management (MHM) and school retention among adolescent girls. Many Nigerian schools lack such infrastructure, which has been associated with menstruation-related absenteeism and compromised menstrual wellbeing among adolescent girls. This study assessed WASH facility adequacy in secondary schools in Nasarawa West Senatorial Zone and examined associations with girls’ school attendance during menstruation.
Methods
A cross-sectional study was conducted among 1,250 female students across 25 secondary schools in Keffi, Nasarawa, and Kokona LGAs. WASH adequacy was assessed using a structured observational checklist, scoring 12 facility components (water availability, toilet conditions, privacy, lighting, handwashing facilities, and disposal systems). Student attendance during menstruation was assessed via structured questionnaire using a four-point frequency scale (always, sometimes, rarely, never), with absenteeism defined as reporting sometimes, rarely, or never attending during menstruation. Chi-square analyses with cluster-robust standard errors examined associations between WASH adequacy and menstruation-related absenteeism.
Results
WASH conditions were critically inadequate, approximately 40% of schools had functional water sources, 28% had water available during assessment, and 16% had separate girls’ toilets. Privacy features, handwashing facilities with soap, and covered disposal bins were each present in 16% of schools. No school provided private changing spaces, sanitary waste disposal systems, emergency sanitary supplies, or MHM education materials. Private schools scored marginally higher than public schools (1.2 ± 0.3 vs. 0.9 ± 0.3). Only 36.8% of students consistently attended school during menstruation. Absenteeism was strongly associated with inadequate WASH facilities (χ² = 48.3, p < 0.001), with pain or cramps (32%), lack of pads (23.2%), and fear of staining (19.2%) as the most frequently reported reasons.
Conclusion
WASH facilities in Nasarawa West secondary schools are grossly inadequate and associated with menstruation-related absenteeism. Urgent interventions including improved water supply, private toilets, disposal systems, and access to menstrual materials are required to support girls’ menstrual health and educational equity.
Keywords: Adolescent girls, Menstrual hygiene management, Nigeria, School attendance, WASH
Plain language summary
Many girls in Nigerian secondary schools miss school during their periods because their schools lack basic water and toilet facilities. This study looked at the condition of water, sanitation, and hygiene (WASH) facilities in 25 secondary schools in Nasarawa West, Nigeria, and asked 1,250 female students about their school attendance during menstruation.
We found that school WASH facilities were extremely poor. Only 4 in 10 schools had a working water source, and only 1 in 6 had separate toilets for girls. None of the 25 schools had a private changing space, sanitary waste disposal system, or menstrual health education materials. Private schools were slightly better equipped than public schools, but both fell far short of acceptable standards.
Nearly two-thirds of students (63.2%) missed school at some point during their period. The most common reasons were period pain, lack of sanitary pads, fear of staining their clothes, and lack of clean toilets or water. Girls in schools with poorer WASH conditions were more likely to miss school.
These findings show that menstrual health is being ignored in school planning in this part of Nigeria. To keep girls in school, urgent action is needed to improve water supply, build private toilets, provide sanitary pads, and include menstrual health in school programmes.
Introduction
Menstrual hygiene management (MHM) requires access to clean water, private sanitation facilities, safe disposal systems, and adequate menstrual hygiene supplies [1–4]. For school-aged girls, these resources are fundamental for ensuring comfort, dignity, and uninterrupted school attendance [5–7]. Inadequate WASH infrastructure in schools has been associated with poor menstrual hygiene practices, heightened fear of leakage, emotional distress, and increased absenteeism [7].
Globally, WASH inequalities in schools remain pronounced. UNICEF [3] reported that in Sub-Saharan Africa, fewer than two-thirds of schools have basic sanitation services, and only half provide handwashing facilities with soap. The WHO & UNICEF Joint Monitoring Programme [4] further reports that only 31% of schools worldwide provide bins for menstrual waste disposal in girls’ toilets, and just 39% offer menstrual health education.
In Nigeria specifically, the WASHNORM 2021 report indicates that only 11% of schools meet basic sanitation standards, with rural schools being the most deprived [8]. Ajayi and Olugbo (2024) [9] further estimates that 24% of adolescent girls miss school during menstruation due to stigma, lack of facilities, or inability to afford menstrual materials.
Evidence across Sub-Saharan Africa shows that inadequate school WASH facilities significantly affect girls’ education. Studies in Ethiopia report that 43–54% of girls miss one to four school days during each menstrual cycle due to pain, embarrassment, insufficient facilities, and poor menstrual management skills [10]. However, interventions have demonstrated promising improvements: the World Bank equipped over 5,000 Ethiopian schools with improved WASH facilities and dedicated MHM spaces, reducing dropout rates among girls from 6% to 0% in targeted schools [11]. Similarly, a recent review of West African countries showed that fewer than half of girls receive menstrual education before menarche, contributing to fear, shame, and school absenteeism [12].
Several initiatives are emerging in Nigeria to address these gaps, such as the Always Keeping Girls in School Project [13]. However, there remains limited empirical documentation of school WASH conditions using standardised observational tools, particularly in the North-Central region, and few studies have examined how WASH adequacy relates to school attendance within the same population.
This study assessed the availability and adequacy of WASH facilities in public and private secondary schools in Nasarawa West Senatorial Zone and examined associations between WASH conditions, school type, and girls’ school attendance during menstruation.
Methodology
Study design
A school-based cross-sectional study design was employed, incorporating both facility observations and student self-report, to evaluate the current status of WASH facility conditions and their associations with menstruation-related school attendance among female secondary school students in Nasarawa West Senatorial Zone, Nigeria. Data were collected between March and May 2025.
Study area
The study was conducted in Nasarawa West Senatorial Zone of Nasarawa State, located in North-Central Nigeria. The senatorial zone comprises five Local Government Areas (LGAs): Keffi, Kokona, Karu, Nasarawa, and Toto. The area features a mix of rural and semi-urban communities with diverse socio-cultural backgrounds and varying access to WASH facilities.
For this study, Three LGAs - Keffi, Nasarawa, and Kokona were purposively selected, with 25 schools sampled from the registered secondary schools across these LGAs, purposive selection was based on accessibility, population density, and perceived differences in WASH infrastructure and socio-demographic characteristics across communities. Keffi LGA is semi-urban with comparatively better access to educational resources, while Nasarawa and Kokona LGAs are more rural with limited water and sanitation access. This variation enabled comparative analysis of WASH conditions and school attendance outcomes across diverse socio-demographic and infrastructural settings.
Sample size and sampling technique
The sample size was determined using Cochran’s formula for proportions: n = Z² × p(1 − p) / d², where Z = 1.96 (95% confidence level), p = 0.5 (assumed proportion for maximum variability), and d = 0.05 (margin of error), yielding an initial n₀ = 384. To account for the clustering of students within schools, a design effect (DE) was applied: DE = 1 + (m − 1) × ICC, where m is the average cluster size and ICC is the intra-cluster correlation coefficient. A pilot study conducted in two schools in Karu LGA (n = 20 students per school) yielded a feasible cluster size of 46 students per school and a conservative ICC of 0.05, giving DE = 1 + (45 × 0.05) = 3.25. The adjusted sample size was thus 384 × 3.25 = 1,248, rounded to 1,250 students across 25 schools (approximately 50 students per school).
A multi-stage sampling technique was employed. In the first stage, three LGAs were purposively selected from the five in Nasarawa West Senatorial Zone. It should be noted that purposive LGA selection limits the generalisability of findings, and results should not be assumed to be representative of all five LGAs in the zone or of Nigeria as a whole (see “Limitations”). In the second stage, schools within each LGA were stratified into public and private categories; 10 schools were selected from Keffi LGA (five public, five private), 10 from Nasarawa LGA (five public, five private), and 5 from Kokona LGA (three public, two private), giving 25 schools total, using simple random sampling by balloting. In the third stage, approximately 50 eligible female students were selected per school using simple random sampling stratified by grade level (JSS1–SS3) to ensure representation across age groups.
Inclusion criteria
Participants were eligible for inclusion if they met all the following criteria:
-
i.
Female students aged 10–19 years (typical secondary school age in Nigeria)
-
ii.
Students who had attained menarche, confirmed through self-report during screening
-
iii.
Students enrolled in Junior or Senior Secondary School (JSS1–SS3) in the selected schools
-
iv.
Students who provided written assent
-
v.
Students whose parents or guardians provided written informed consent
Exclusion criteria
Students were excluded if they met any of the following criteria:
-
i.
Students who declined participation or withdrew assent at any point during data collection
-
ii.
Students whose parents or guardians did not provide consent
-
iii.
Students with self-reported medical conditions significantly affecting menstruation (e.g., medically diagnosed amenorrhea) that could confound assessment of typical menstrual experiences
Data collection instruments
A structured, self-administered questionnaire collected data on socio-demographic characteristics and school attendance patterns during menstruation. Attendance was assessed using a four-point frequency scale; always, sometimes, rarely, or never - referring to attendance during menstruation over the current academic term (approximately three months). For analysis, responses were dichotomised: students who reported ‘always’ attending were classified as non-absent, while those reporting ‘sometimes’, ‘rarely’, or ‘never’ were classified as experiencing menstruation-related absenteeism. Students who reported absenteeism were asked to select the primary reason from five categorical options: pain or cramps, lack of pads, fear of staining, lack of water or conducive toilet facilities, or other reasons.
School WASH conditions were assessed objectively using an observational checklist adapted. The checklist comprised 12 variables across three domains: water supply (3 items), sanitation infrastructure (4 items), and hygiene and menstrual hygiene management (5 items). Each variable was scored as present/functional (1 point) or absent/non-functional (0 points), yielding a total WASH adequacy score of 0–12 per school (maximum = 12). Schools scoring 0–4 were classified as having inadequate WASH conditions, 5–8 as partial, and 9–12 as adequate. Table 1 presents the full list of checklist items, their domain classification, and scoring criteria.
Table 1.
WASH Facility Observational Checklist: Items, Domains, and Scoring. (adapted from UNHCR, 2020)
| S/N | Domain | Checklist Item | Scoring |
|---|---|---|---|
| 1 | Water supply | Functional water source on school premises | 1 = present & functional; 0 = absent/non-functional |
| 2 | Water supply | Water available at time of assessment visit | 1 = present; 0 = absent |
| 3 | Water supply | Water source within reasonable distance of classrooms | 1 = ≤ 50 m; 0 = > 50 m or absent |
| 4 | Sanitation | Separate (sex-segregated) toilets for girls | 1 = present & functional; 0 = absent/mixed |
| 5 | Sanitation | Functional girls’ toilets (≥ 1 usable cubicle) | 1 = ≥ 1 usable; 0 = none usable |
| 6 | Sanitation | Privacy features in girls’ toilets (door with lock) | 1 = present; 0 = absent/broken |
| 7 | Sanitation | Adequate lighting and ventilation in girls’ toilets | 1 = adequate; 0 = inadequate/absent |
| 8 | Hygiene & MHM | Handwashing facility with soap near girls’ toilets | 1 = present with soap; 0 = absent or no soap |
| 9 | Hygiene & MHM | Covered disposal bin for menstrual waste in girls’ toilets | 1 = present & covered; 0 = absent/uncovered |
| 10 | Hygiene & MHM | Private changing space for menstrual materials | 1 = present; 0 = absent |
| 11 | Hygiene & MHM | Sanitary waste disposal system (e.g., incinerator or sealed bin) | 1 = present; 0 = absent |
| 12 | Hygiene & MHM | Menstrual hygiene education materials displayed in school | 1 = present; 0 = absent |
Note: MHM menstrual hygiene management. Total score range: 0–12. Classification: 0–4 = inadequate; 5–8 = partial; 9–12 = adequate
Data collection procedure
Data collection was conducted by trained female research assistants with relevant academic backgrounds. Training covered study objectives, ethical considerations, standardised questionnaire administration, management of sensitive discussions, and completion of the observational checklist, with emphasis on confidentiality, neutrality, and procedural consistency.
Eligible female students were assembled in designated classrooms where the purpose of the study was explained in clear, age-appropriate language. Participation was voluntary, anonymity was assured, and students were informed there were no right or wrong answers. Questionnaires were self-administered under supervision and collected immediately upon completion to prevent response sharing. On the same day, trained assessors conducted direct observation of school WASH facilities using the structured checklist.
Data analysis
Data were entered and analysed using IBM SPSS Statistics version 27.0. Descriptive statistics (frequencies, percentages, means, and standard deviations) summarised socio-demographic characteristics, school attendance patterns, and WASH facility conditions. Chi-square tests examined associations between WASH adequacy categories and menstruation-related absenteeism. Independent samples t-tests compared mean WASH scores between public and private schools.
Given that students were clustered within schools, all inferential analyses accounted for the non-independence of observations. Cluster-robust standard errors were applied at the school level for chi-square tests, independent sample t-test and binary logistic regression, consistent with the design effect used in sample size calculation (ICC = 0.05).
Ethical considerations
Ethical approval was obtained from the Health Research and Ethics Committee of the Nasarawa State Ministry of Health (NHREC Protocol No: 18/06/2017, approval date: 7th March 2025). Permission was secured from the Nasarawa State Ministry of Education, each Local Government Education Authority, and school principals. Written informed consent was obtained from parents or guardians of all participants, and written assent was obtained from students prior to data collection. Participants were assigned serial numbers to ensure confidentiality and anonymity; no personal identifiers were recorded on questionnaires. Participants were informed of their right to withdraw at any time without penalty.
Results
A total of 1,250 female students participated in the study across 25 secondary schools. Table 2 presents their socio-demographic characteristics by school type and grade level. Most students were aged 12–14 years (510, 40.8%), followed by those aged 15–17 years (480, 38.4%). These two age groups together represented nearly 80% of the sample, consistent with typical secondary school enrolment ages in Nigeria. Only 80 students (6.4%) were aged 18 years or above.
Table 2.
Socio-demographic Characteristics of Participants by School Type and Grade Level, Nasarawa West Senatorial Zone, Nigeria, 2025 (N = 1,250)
| Variable | Category | Public | Private | Total N (%) | ||
|---|---|---|---|---|---|---|
| JSS (n = 300) | SS (n = 350) | JSS (n = 260) | SS (n = 340) | |||
| Age (years) | 9–11 | 55 (18.3) | 45 (12.9) | 45 (17.3) | 35 (10.3) | 180 (14.4) |
| 12–14 | 130 (43.3) | 140 (40.0) | 115 (44.2) | 125 (36.8) | 510 (40.8) | |
| 15–17 | 105 (35.0) | 145 (41.4) | 90 (34.6) | 140 (41.2) | 480 (38.4) | |
| 18 and above | 10 (3.3) | 20 (5.7) | 10 (3.8) | 40 (11.8) | 80 (6.4) | |
| Mother’s Education | None | 90 (30.0) | 70 (20.0) | 50 (19.2) | 60 (17.6) | 270 (21.6) |
| Primary | 85 (28.3) | 75 (21.4) | 35 (13.5) | 25 (7.4) | 220 (17.6) | |
| Secondary | 105 (35.0) | 165 (47.1) | 110 (42.3) | 140 (41.2) | 520 (41.6) | |
| Tertiary | 20 (6.7) | 40 (11.4) | 65 (25.0) | 115 (33.8) | 240 (19.2) | |
| Father’s Education | None | 35 (11.7) | 30 (8.6) | 25 (9.6) | 30 (8.8) | 120 (9.6) |
| Primary | 55 (18.3) | 65 (18.6) | 35 (13.5) | 95 (27.9) | 250 (20.0) | |
| Secondary | 145 (48.3) | 155 (44.3) | 100 (38.5) | 120 (35.3) | 520 (41.6) | |
| Tertiary | 65 (21.7) | 100 (28.6) | 100 (38.5) | 95 (27.9) | 360 (28.8) | |
| Residential Area | Urban | 75 (25.0) | 110 (31.4) | 110 (42.3) | 165 (48.5) | 460 (36.8) |
| Semi-urban | 95 (31.7) | 115 (32.9) | 85 (32.7) | 105 (30.9) | 400 (32.0) | |
| Rural | 130 (43.3) | 125 (35.7) | 65 (25.0) | 70 (20.6) | 390 (31.2) | |
| Access to Sanitary Pads | Always | 65 (21.7) | 90 (25.7) | 115 (44.2) | 160 (47.1) | 430 (34.4) |
| Often | 75 (25.0) | 120 (34.3) | 65 (25.0) | 100 (29.4) | 360 (28.8) | |
| Sometimes | 90 (30.0) | 80 (22.9) | 60 (23.1) | 50 (14.7) | 280 (22.4) | |
| Rarely | 50 (16.7) | 40 (11.4) | 15 (5.8) | 15 (4.4) | 120 (9.6) | |
| Never | 20 (6.7) | 20 (5.7) | 5 (1.9) | 15 (4.4) | 60 (4.8) | |
JSS Junior Secondary School (JSS 1–3), SS Senior Secondary School (SS 1–3)
Regarding parental education, secondary education was the most common level attained by both mothers (520, 41.6%) and fathers (520, 41.6%). Tertiary education was more prevalent among fathers (360, 28.8%) than mothers (240, 19.2%), reflecting well-documented gender gaps in educational attainment. Urban residence accounted for 460 students (36.8%), semi-urban for 400 (32.0%), and rural for 390 (31.2%). Only 430 students (34.4%) always had access, while 60 (4.8%) reported never having access. Public school students had significantly lower rates of consistent school attendance during menstruation than private school students (χ² = 48.3, p < 0.001), and were more likely to reside in rural areas, Residential area was also significantly associated with attendance outcomes, with rural students performing worse than urban or semi-urban peers (χ² = 7.11, p = 0.008). Differences in parental education and pad access by school type were not formally tested but appeared consistent with these patterns.
Table 3 summarises WASH facility conditions across the 25 assessed schools. Conditions were critically inadequate overall: 10 schools (40%) had functional water sources, and water was available at the time of assessment in only 7 schools (28%). Separate sex-segregated toilets for girls were present in just 4 schools (16%), and toilets with adequate privacy features (lockable doors) were equally scarce (4 schools, 16%). Clean and usable toilets were found in 8 schools (32%), while adequate lighting and ventilation were observed in 9 schools (36%). Handwashing facilities with soap and covered disposal bins for menstrual waste were each present in only 4 schools (16%). Critically, none of the 25 schools, public or private provided private changing spaces, sanitary waste disposal systems, emergency menstrual supplies, or menstrual hygiene education materials.
Table 3.
Observed WASH facility conditions by school type and LGA, Nasarawa West Senatorial Zone, Nigeria, 2025
| S/N | WASH Facility Indicator | Nasarawa | Keffi | Kokona | Total (N = 25) | |||
|---|---|---|---|---|---|---|---|---|
| Public (n = 5) | Private (n = 5) | Public (n = 5) | Private (n = 5) | Public (n = 3) | Private (n = 2) | |||
| 1 | Functional water source available | 1 | 2 | 2 | 3 | 1 | 1 | 10 |
| 2 | Water available at time of visit | 1 | 1 | 2 | 2 | 1 | 0 | 7 |
| 3 | Separate toilets for girls and boys | 0 | 1 | 1 | 2 | 0 | 0 | 4 |
| 4 | Toilets clean and usable | 1 | 1 | 2 | 3 | 1 | 0 | 8 |
| 5 | Toilets provide privacy (lockable doors, no gaps) | 0 | 1 | 1 | 2 | 0 | 0 | 4 |
| 6 | Toilets have adequate lighting and ventilation | 1 | 2 | 2 | 3 | 1 | 0 | 9 |
| 7 | Water and soap available for handwashing | 0 | 1 | 1 | 2 | 0 | 0 | 4 |
| 8 | Covered bins for pad disposal available | 0 | 1 | 1 | 2 | 0 | 0 | 4 |
| 9 | Private space for changing menstrual materials | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 10 | Proper sanitary waste disposal (pit/incinerator) | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 11 | Emergency sanitary supplies available | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 12 | Hygiene/menstrual posters or education materials displayed | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
|
School Type (Public/Private) × WASH Facility Adequacy χ² = 26.5, df = 2, p < 0.001 |
||||||||
Table 4 presents mean WASH facility scores by school type and LGA. Private schools consistently outperformed public schools across all three LGAs, though both categories scored far below the minimum adequate threshold. Private schools, particularly in Keffi LGA, recorded higher availability across most indicators compared to public schools. WASH adequacy differed significantly by school type (χ² = 26.5, df = 2, p < 0.001). Table 3 presents mean WASH scores by school type and LGA. Keffi schools recorded the highest mean score (1.8 ± 0.4), followed by Nasarawa (0.9 ± 0.3) and Kokona (0.4 ± 0.2). Private schools consistently outperformed public schools across all LGAs, though both categories scored far below the minimum adequate threshold, confirming that menstrual hygiene infrastructure is absent regardless of school type or location.
Table 4.
Mean WASH Facility Scores by School Type and LGA, Nasarawa West Senatorial Zone, Nigeria, 2025
| School Type | Nasarawa (n = 10) |
Keffi (n = 10) |
Kokona (n = 5) |
Overall Mean ± SD |
|---|---|---|---|---|
| Public Schools | 0.6 ± 0.2 | 1.5 ± 0.4 | 0.5 ± 0.2 | 0.9 ± 0.3 |
| Private Schools | 1.1 ± 0.3 | 2.1 ± 0.5 | 0.3 ± 0.1 | 1.2 ± 0.3 |
| Group Mean | 0.9 ± 0.3 | 1.8 ± 0.4 | 0.4 ± 0.2 | — |
Figure 1 shows school attendance patterns during menstruation by WASH facility adequacy category. Overall, 460 students (36.8%) reported always attending school during menstruation, 500 (40.0%) sometimes attended, 180 (14.4%) rarely attended, and 110 (8.8%) never attended. Accordingly, 790 students (63.2%) experienced some degree of menstruation-related absenteeism. Public junior secondary students had the lowest rate of consistent attendance (30.0%), while private senior secondary students had the highest (41.2%), though even in this comparatively advantaged group, nearly 60% still experienced menstruation-related absence.
Fig. 1.
School Attendance During Menstruation by WASH Facility Adequacy Category Among Female Secondary School Students, Nasarawa West Senatorial Zone, Nigeria, 2025
Figure 2 presents the distribution of reasons reported by students who missed school during menstruation. Absenteeism was significantly associated with WASH facility adequacy (χ² = 48.3, df = 2, p < 0.001), with students in schools with inadequate WASH conditions being more likely to miss school during menstruation than those in schools with better WASH conditions. The most frequently reported reasons for absence were pain or cramps (400, 32.0%), lack of pads (290, 23.2%), fear of staining (240, 19.2%), and lack of water or toilet facilities (200, 16.0%). Other reasons accounted for 120 students (9.6%). Patterns were broadly similar across school types and grade levels.
Fig. 2.
Main Reasons for Menstruation-Related School Absenteeism Among Female Secondary School Students, Nasarawa West Senatorial Zone, Nigeria, 2025
Discussion
This study assessed WASH facility conditions and their association with menstruation-related school absenteeism among 1,250 female students across 25 secondary schools in Nasarawa West Senatorial Zone. Most participants were aged 12 to 14 years (40.8%), consistent with typical secondary school enrolment patterns in Nigeria [14]. Only 34.4% of students always had access to sanitary pads, while 4.8% reported never having access, reflecting widespread menstrual product insecurity consistent with national data [9].
WASH conditions were critically inadequate across all schools. Only 40% had functional water sources, and water was available at time of assessment in only 28% of schools. These findings compare unfavourably with water availability rates of 55% and 64% reported in Ethiopian secondary schools by Girma et al. [10] and Adane et al. [5, 15] respectively. The gap between existing infrastructure and actual functionality suggests critical maintenance failures rather than solely a construction deficit, a pattern consistent with the WASHNORM finding that only 11% of Nigerian schools meet basic sanitation standards [8].
Separate sex-segregated toilets were present in only 16% of schools, and privacy features such as lockable doors were equally scarce. Betsu et al. [14, 16] found that inadequate WASH infrastructure, particularly lack of privacy, was consistently associated with reduced school attendance and poor menstrual hygiene practices across low- and middle-income country settings. Wada et al. [15, 17] similarly documented toilet-to-student ratios of 1:296 in Nigerian public schools, far exceeding WHO recommendations. None of the 25 schools provided private changing spaces, sanitary disposal systems, emergency menstrual supplies, or menstrual hygiene education materials, suggesting that menstrual health remains largely absent from school planning and budgeting processes [18].
The disparity across school types was notable but insufficient. Private schools scored marginally higher than public schools on the WASH adequacy index (1.2 vs. 0.9), and the association between school type and WASH adequacy was statistically significant (p < 0.001). However, even the highest-scoring schools lacked all MHM-specific infrastructure, indicating that the problem extends beyond resource levels to reflect a systemic gap in recognising menstrual health as a school infrastructure priority.
Menstruation-related absenteeism was widespread, with 63.2% of students experiencing some degree of absence. This is higher than the 23.4% reported in Ethiopia by Adane et al. [5, 15] and the 15 to 45% baseline range reported across intervention studies by Betsu et al. [14, 16]. The higher rate observed here may reflect the compounded effect of poor WASH infrastructure, limited pad access, and inadequate menstrual health education, though the cross-sectional design does not allow these pathways to be confirmed. Public JSS students had the lowest consistent attendance (30.0%), while private SS students had the highest, yet even in this comparatively advantaged group, nearly 60% still experienced menstruation-related absence.
Pain or cramps was the most frequently cited reason for absenteeism (32.0%), consistent with evidence that dysmenorrhea affects 61 to 84% of adolescent girls in Sub-Saharan Africa [19]. Lack of pads (23.2%), fear of staining (19.2%), and lack of water or toilet facilities (16.0%) were also prominent, and reflect rational responses to the structurally inadequate environments documented in this study. These intersecting biological, economic, infrastructural, and sociocultural factors suggest that single-component interventions are unlikely to be sufficient, and that integrated multi-component approaches addressing education, product access, and WASH infrastructure simultaneously may be more effective [20–22].
Limitations
This study has several limitations that should be considered when interpreting the findings. Attendance data were self-reported and may be subject to recall or social desirability bias. The purposive selection of three LGAs limits generalisability beyond the study area. WASH assessments were conducted at a single point in time and may not reflect seasonal variation. Household-level factors, community norms, and school management practices were not assessed but may also influence outcomes. Despite these limitations, the study provides valuable baseline evidence to inform policy and future longitudinal research in this underserved context.
Conclusion
WASH facilities in secondary schools across Nasarawa West Senatorial Zone are grossly inadequate and are associated with widespread menstruation-related absenteeism. The complete absence of MHM-specific infrastructure across all 25 schools highlights that menstrual health is systematically deprioritised in school planning. Absenteeism is driven by intersecting biological, economic, infrastructural, and sociocultural factors, underscoring the need for comprehensive multi-component responses.
Recommendations
At the national level, the Federal Ministry of Education, in collaboration with the Federal Ministry of Water Resources and Sanitation, should mandate gender-segregated toilets, reliable water sources, handwashing facilities with soap, and private changing spaces in all secondary schools. At the state level, a dedicated WASH improvement fund should be established with particular focus on rural public schools. Within schools, menstrual support corners staffed by trained female teachers should provide emergency sanitary pads, pain-relief guidance, and psychosocial support. Future research should prioritise longitudinal studies and intervention trials to establish the effectiveness of specific strategies in reducing menstruation-related absenteeism in similar contexts.
Acknowledgements
The authors acknowledge the support of the school authorities, participants, parents/guardians, and research assistants who facilitated data collection.
Abbreviations
- GHIDI
Global Health and Infectious Diseases Control Institute
- ICC
Intra-cluster correlation coefficient
- JSS
Junior Secondary School
- LGA
Local Government Area
- MHM
Menstrual hygiene management
- NGO
Non-governmental organisation
- NHREC
Nigerian Health Research Ethics Committee
- SD
Standard deviation
- SDG
Sustainable Development Goal
- SS
Senior Secondary School
- UNHCR
United Nations High Commissioner for Refugees
- UNICEF
United Nations Children’s Fund
- WASH
Water, Sanitation, and Hygiene
- WHO
World Health Organization
- WASHNORM
Water, Sanitation and Hygiene National Outcome Routine Mapping
Authors’ contributions
ATK, BI, and DI conceptualized and designed the study and contributed to drafting and revising the manuscript. ATK, DI, and BI, SOA, and AAB contributed to data collection, and manuscript review, All authors participated in study design, and critically reviewed the manuscript for important intellectual content. All authors assisted with the literature review, data visualization, and preparation of initial manuscript drafts, All authors provided methodological expertise, and contributed significantly to manuscript revisions. All authors supported data acquisition and provided feedback on the manuscript drafts. All authors contributed to the manuscript structure, final proofreading, and editing for clarity and coherence; all authors have read and approved the final manuscript.
Funding
No funding was received for this study.
Data availability
The datasets generated and analyzed during the current study are not publicly available due to privacy considerations of the participants but are available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki (2013 version). Ethical approval was obtained from the Health Research and Ethics Committee of the Nasarawa State Ministry of Health (NHREC Protocol No: 18/06/2017, approval date: 7th March 2025). Written informed consent was obtained from parents or guardians of all participants, and written assent was obtained from students prior to data collection. Participation was voluntary. To ensure confidentiality and anonymity, participants were assigned serial numbers, no personal identifiers were recorded on questionnaires, and data were anonymised before analysis in compliance with the Nigerian Data Protection Regulation (NDPR, 2019).
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Niwemukiza T, Mochama M, Andegiorgish AK. Menstrual hygiene management practices and associated factors among primary school girls in Gakenke district, Rwanda. BMC Res Notes. 2025;18(1):366. 10.1186/s13104-025-07429-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Egwuaba EU, Sunday BA. Menstrual hygiene management and educational disruption among adolescent girls in select secondary schools in Ekwulobia, Nigeria. Discov Public Health. 2025;22:668. 10.1186/s12982-025-01060-0. [Google Scholar]
- 3.UNICEF. WASH in schools. New York: UNICEF; 2024. [Google Scholar]
- 4.United Nations Children’s Fund (UNICEF), World Health Organization (WHO). Progress on drinking water, sanitation and hygiene in schools 2015–2023: special focus on menstrual health. New York: UNICEF and WHO; 2024. [Google Scholar]
- 5.Adane Y, Ambelu A, Yenesew MA, Mekonnen Y, Kassahun T. Effect of menstruation on school attendance of girls along with water, sanitation, and hygiene services in Northwest Ethiopia. Pan Afr Med J. 2025;50:28. 10.11604/pamj.2025.50.28.45413. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Kumbeni MT, Otupiri E, Ziba FA. Menstrual hygiene among adolescent girls in junior high schools in rural northern Ghana. Pan Afr Med J. 2020;37:190. 10.11604/pamj.2020.37.190.19015. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Akanzum J, Pienaah CKA. Review of the effects of adequate sanitary facilities on the participation and performance of the school girl child in Ghana. ISABB J Health Environ Sci. 2023;8(1):1–14. 10.5897/ISAAB-JHE2021.0073. [Google Scholar]
- 8.Federal Ministry of Water Resources (Nigeria). National Bureau of Statistics (Nigeria), World Bank, UNICEF. Water, Sanitation and Hygiene: National Outcome Routine Mapping (WASHNORM) 2021: a report of findings. Abuja: Federal Ministry of Water Resources; 2022. [Google Scholar]
- 9.Ajayi P, Oluigbo T. Menstrual Hygiene Day 2024: reducing menstruation stigma in Nigeria. Nigeria Health Watch; 2024. May 31.
- 10.Girma R, Cheru A, Adare Mengistu D, et al. Menstrual hygiene management practice and associated factors among secondary school girls in eastern Ethiopia: the influence of water, sanitation and hygiene facilities. Womens Health. 2024;20. 10.1177/17455057241275606. [DOI] [PMC free article] [PubMed]
- 11.World Bank. Breaking barriers: empowering girls with clean water and sanitation facilities in Ethiopia’s schools. Washington (DC): World Bank; 2024. [Google Scholar]
- 12.Tomlinson MM, Wallis AB, Harris MJ, Dupré NC, Baumgartner RN, Okonofua F. Menstrual hygiene management among adolescent girls in West Africa: a systematic review. Afr J Reprod Health. 2024;28(1):123–56. 10.29063/ajrh2024/v28i1.12. [DOI] [PubMed] [Google Scholar]
- 13.Tabitha Cumi Foundation. Always Keeping Girls in School (AKGIS) Project. Abuja: Tabitha Cumi Foundation; 2024. [Google Scholar]
- 14.Betsu BD, Medhanyie AA, Gebrehiwet TG, Wall LL. Menstrual hygiene management interventions and their effects on schoolgirls’ menstrual hygiene experiences in low and middle income countries: a systematic review. PLoS ONE. 2024;19(8):e0302523. 10.1371/journal.pone.0302523. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Wada OZ, Olawade DB, Oladeji EO, Amusa AO, Oloruntoba EO. School water, sanitation, and hygiene inequalities: a bane of sustainable development goal six in Nigeria. Can J Public Health. 2022;113(4):622–35. 10.17269/s41997-022-00633-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.UNICEF. Guidance on menstrual health and hygiene: promoting a safe and supportive menstrual experience for all. New York: UNICEF; 2019. [Google Scholar]
- 17.Andargie FA, Tinuola FR. Effects of school menstrual hygiene management, water, sanitation, and hygiene interventions on girls’ empowerment, health, and educational outcomes: Lasta district, Amhara regional state, Ethiopia. PLoS ONE. 2025;20(4):e0321376. 10.1371/journal.pone.0321376. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Schoep ME, Adang EMM, Maas JWM, De Bie B, Aarts JWM, Nieboer TE. Productivity loss due to menstruation-related symptoms: a nationwide cross-sectional survey among 32 748 women. BMJ Open. 2019;9(6):e026186. 10.1136/bmjopen-2018-026186. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Nnennaya EU, Atinge S, Dogara SP, Ubandoma RJ. Menstrual hygiene management among adolescent school girls in Taraba State, Nigeria. Afr Health Sci. 2021;21(2):842–51. 10.4314/ahs.v21i2.45. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Chinyama J, Chipungu J, Rudd C, Mwale M, Verstraete L, Sikamo C, et al. Menstrual hygiene management in rural schools of Zambia: a descriptive study of knowledge, experiences and challenges faced by schoolgirls. BMC Public Health. 2019;19(1):16. 10.1186/s12889-018-6360-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Kennedy-Walker R, Welsien K. Improving menstrual health and gender equality: water and sanitation in rural Tanzania. Washington (DC): World Bank; 2024. [Google Scholar]
- 22.Kasali AT, Ishaleku D, Idoko B, Aremu SO, Barkhadle AA, Idoko DO, Akyala AI. Menstrual Hygiene Knowledge and Its Determinants Among Adolescent Secondary Schoolgirls in Nasarawa West Senatorial Zone, Nigeria: A Cross-Sectional Study. Health Sci Rep. 2026;9(3):e72114. 10.1002/hsr2.72114. [DOI] [PMC free article] [PubMed]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets generated and analyzed during the current study are not publicly available due to privacy considerations of the participants but are available from the corresponding author upon reasonable request.