WASH facility adequacy and school attendance during menstruation among secondary school girls in Nasarawa West, Nigeria: a cross-sectional study

Abstract

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. 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. 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. 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. 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.