Menstrual hygiene practice among adolescent girls in Ethiopia: A systematic review and meta-analysis

Abstract

Background: Adolescent girls face several challenges relating to menstruation and its proper management. Lack of adequate sanitary products, inadequate water supply, and privacy for changing sanitary pads continue to leave adolescent girls with limited options for safe and proper menstrual hygiene in many low-income settings, including Ethiopia. These situations are also compounded by societal myths, stigmas surrounding menstruation, and discriminatory social norms. This systematic review and meta-analysis aimed to estimate the pooled proportion of safe menstrual hygiene management among adolescent girls in Ethiopia using the available studies.

Methods: We searched PubMed, Google Scholar, African Journal Online (AJOL), Hinari, Science Direct, ProQuest, Direct of Open Access Journals, POPLINE, and Cochrane Library database inception to May 31, 2021. Studies reporting the proportion of menstrual hygiene management among adolescent girls in Ethiopia were considered. The Cochrane Q test statistics and I2 tests were used to assess the heterogeneity of the included studies. Since the included studies revealed considerable heterogeneity, a random effect meta-analysis model was used to estimate the pooled proportion of menstrual hygiene management (MHM).

Results: Of 1,045 identified articles, 22 studies were eligible for analysis (n = 12,330 participants). The pooled proportion (PP) of safe MHM in Ethiopia was 52.69% (95%CI: 44.16, 61.22). The use of commercial menstrual absorbents was common 64.63% (95%CI: 55.32, 73.93, I2 99.2%) followed by homemade cloth 53.03% (95%CI: 22.29, 83.77, I2 99.2%). Disposal of absorbent material into the latrine was the most common practice in Ethiopia 62.18% (95%CI: 52.87, 71.49, I2 98.7%). One in four girls reported missing one or more school days during menstruation (PP: 32.03%, 95%CI: 22.65%, 41.40%, I2 98.2%).

Conclusion: This study revealed that only half of the adolescent girls in Ethiopia had safe MHM practices. To ensure that girls in Ethiopia can manage menstruation hygienically and with dignity, strong gender-specific water, sanitation, and hygiene (WASH) facilities along with strong awareness creation activities at every level are needed.

Fig 1. Flow chart of study selection for systematic review and meta-analysis of menstrual hygiene management and associated factors among adolescent girls in Ethiopia.

Fig 2. Forest plot of the pooled proportion of safe MHM among adolescent girls in Ethiopia, studies published between 2004 and 2021.

Fig 3. Subgroup analysis of menstrual hygiene management among adolescent girls by Ethiopian regions, studies published between 2004 and 2021.

Fig 4. Sensitivity analysis for estimates on safe menstrual hygiene management proportion among adolescent girls in Ethiopia (number of estimates = 22).

Fig 5. Reduction in proportion of safe MHM during 2004–2021 according to meta-regression.

This figure shows a meta-regression analysis of safe MHM proportion based on selected studies’ publication years. The vertical axis represents the log proportion of safe MHM, and the horizontal axis represents the selected studies’ publication year. Each circle demonstrates one selected study, and the size of each circle corresponds to the weight assigned to each study. The slope of the regression line indicates an increase or decrease of the study effect using REML estimation. Given the slope of the regression line is descending in this figure, it can be inferred that as the studies’ publication year has been increased, the proportion of safe MHM has been decreased. However, this association was not statistically significant (p = 0.952).

Fig 6. Proportion of safe MHM among adolescent girls based on the sample size of selected studies by meta-regression analysis.

Circles show the weight of the included studies. The figure indicates the association between the safe MHM and sample size. The proportion of safe MHM was reduced with a rise in sample size. However, this association was not statistically significant (p = 0.853).

Fig 7. Funnel plot showing publication bias of proportion of MHM studies among adolescent girls in Ethiopia.

Fig 8. Publication bias.

Dots show included studies, the horizontal axis represents accuracy, and the vertical axis represents the standardized effect. The line shown in this figure is a regression line related to Egger’s regression test. It shows that whether this line cut the vertical axis at the point near zero or not. If this line distance from zero, it indicates a bias in publishing the results. If there is no publication bias, it is expected that this line passes from origin to a point near the origin. Since intercept (width from origin) is close to 0 in this figure, we conclude that there is no publication bias. Because zero is included in the confidence interval. Therefore, it could be concluded that the publication bias is not significant.