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This study explores how menstruation is perceived, experienced and navigated by school-going adolescent girls living in low-to-middle income settings in South Africa. Existing research from developing countries suggest that the onset of menstruation has implications for school attendance and academic performance. There is evidence that menstrual cycle–related symptoms (primarily physical) lead to difficulties in, or interference with, and disengagement from school, social relations, and physical activities (van Iersel et al., 2016; Steiner et al., 2011; Kiesner and Pastore, 2010; Taras, 2005). The onset of menstruation can be shame-inducing and has been associated with anxiety and confusion. Few studies have been conducted on menstruation in countries with a history of sectarian violence and characterised by substantial socio-economic disparities and high levels of gender-based violence. Understanding the experiences of girls in these contexts is important in generating contextually-grounded knowledge and appropriate interventions.

A qualitative, exploratory, descriptive and contextual research design was used to collect data from 48 adolescent girls aged 13–16 year-old. A total of six focus group discussions (FGDs) were conducted using a semi-structured questionnaire among a purposive sampling method. Data collected were transcribed verbatim and thematically analysed. Written parental consent was obtained for participants under 18 years old.

The findings illustrated complex psychological experiences in response to menarche and menstruation. Experiences of shame in relation to menstruation were aggravated by unsupportive responses from school teachers. Challenges such as scarcity of sanitary products were experienced as creating a barrier for girls' school attendance.

Existing research from developing countries suggests that the onset of menstruation has implications for school attendance and academic performance. The research data includes the views of adolescent learners and their negative reactions and positive experiences towards menstruation within the school environment.

Given the comparative paucity of research emerging from developing countries in sub-Saharan Africa, this paper addresses an important gap in the literature by providing contextually-nuanced information about the menstrual experiences of adolescent girls. The study can further provide information for efforts made by the Department of Education and Department of Health regarding the impact of menstruation on adolescent girls' school attendance.

This study provides important insights regarding the experiences of South African school girls in relation to menstruation. Although dominant feelings of shame, confusion and disgust may surround menstruation, the study also highlighted potential positive experiences associated with menstruation. Teachers and school administrators need to be oriented towards the needs of adolescent girls if issues regarding poor school attendance are to be addressed.

To reduce absenteeism in schools and ensure learners are provided with improved allocation of sanitary products in schools, there is a need for the advocacy regarding sexuality education and resources to promote the psychological health of adolescent girls.

Adolescents are a vulnerable age group in the human life cycle for the development of anemia. Despite limited health infrastructures, there are limited studies in the pastoral community of the Afar region. Thus, this study aims to assess anemia and associated factors among adolescent school girls in the Aysaita district, the pastoral community of the Afar region, Ethiopia.

An institution-based cross-sectional study was conducted among 522 randomly selected adolescent girls in the Aysaita district. A pretested structured questionnaire was used to collect data, and a systematic random sampling technique was used using school registration rosters. Hemoglobin was measured using a complete blood count machine from the vein blood sample. Anthropometric measurements were done to assess the nutritional status of adolescents. Descriptive logistic regression analysis was used to summarize the results and identify the factors associated with anemia.

In this study, the prevalence of anemia among adolescent school girls was 109 (21.7%) [95% CI: (18.1%, 25.3%)]. School adolescent girls from rural residence [adjusted odds ratio (AOR) = 3.42, 95% CI (1.97, 5.94)], who had a minimum dietary diversity score less than 4 [AOR = 3.4, 95% CI (2.1, 5.42)] and menstrual duration 5 and above days [AOR = 2.34, 95% CI (1.36, 4.01)] were associated with increased odds of anemia.

This is original manuscript. Not submitted and published elsewhere.

Around one in five girls in Kenya, aged 15 to 19 years old are either pregnant or have given birth. Of 47 counties, adolescent pregnancy is highest in Narok, where about 40% of girls aged 15 to 19 years old have begun childbearing. This study aims to explore drivers to sexual activity, access to sexual and reproductive health (SRH) services and barriers to contraceptive use among adolescents in Narok County, Kenya to inform the design of SRH interventions and safeguard young people’s rights to sexual health.

A cross-sectional mixed methods study was conducted in December 2019. Quantitative data were collected through structured questionnaires among girls aged 15 to 19 years old who were either pregnant or had given birth and those who had not and boys aged 15 to 19 years old. Qualitative data were collected through focus group discussions with adolescent girls and boys and through structured key informant interviews with parents, community leaders and health workers.

The mean age at first sexual intercourse for both genders was 15 years. While the majority of girls and boys knew where to access SRH services, few used contraception during their last sexual activity. There was no significant difference in the condom or other contraceptive methods use between girls who had begun child bearing and those who had not (p = 0.549 and p = 0.563, respectively). Key drivers for sexual activity among young people were poverty and peer pressure. Cultural practices such as female genital mutilation and early marriage contributed to early sex. Community attitudes toward contraception discouraged young people from taking up contraceptives.

This mixed methods study explores the drivers of adolescent pregnancy in Narok, Kenya, the county with the highest rates of adolescent pregnancy; twice the national pregnancy rates. Understanding the drivers of pregnancy and the underlying human rights violations will help policymakers and health leaders to design interventions which will improve outcomes.

Menstruation is a normal physiological process that occurs in adolescent girls, but it is often shrouded in taboo and stigma in Indian society. Socio-cultural norms and restrictions imposed by families and society can lead to ignorance and lack of access to accurate information and hygienic practices, which can negatively impact women’s physical and mental health throughout their lives. This study seeks to understand adolescent girls’ knowledge and awareness regarding menstruation, including their source of information, changes in their behavior and routine during their menstrual period, socio-cultural beliefs and norms they follow, and the impact of menstruation on their lives. This study was conducted in the state of Haryana, located in northwest India, in 2013. The sample consisted of 376 rural adolescent school-going girls. The study employed a mix-methods approach, using a self-administered structured close-ended questionnaire survey and semi-structured in-depth interviews as the data collection method. In order to enrich the study, additional data were collected through interviews with university-level girl students in 2016. And, further in 2022, during my PhD fieldwork, I got opportunity to discuss informally on the issue with the women in rural areas of the same region. The results found a lot of challenges for menstrual women which impact women’s physical and mental health. The enforcement of a lot of restrictions on the menstrual body makes them feel inferior and create hurdles in women’s growth and capabilities.

Iron deficiency anaemia is widely prevalent amongst women and children in India. The aim of the paper is to study the effect of supplementation of micronutrient fortified biscuits on haemoglobin and serum iron levels of adolescent girls (n = 46, 10‐16 years) studying in a government school in Jaipur city, India.

The study was designed to be an intervention study. The intervention was with biscuits fortified with 30 mg iron, 100  μg folic acid, 600  μg vitamin A, 40 mg vitamin C and 150  μg iodine. The iron status of adolescent girls was determined through haemoglobin and serum iron levels.

The results revealed that 95.7 per cent of the adolescent girls suffered from anaemia of which 28.3 per cent had “mild” deficiency and 67.4 per cent had “moderate” deficiency. Anaemia was more prevalent in the older age groups. On supplementation, there was a significant increase in the haemoglobin levels. There was a three‐fold increase in the percentage of adolescent girls in the “normal” category of anaemia from 4.3 to 13.0 per cent and more than two‐fold decrease in the “moderate” category of anaemia from 67.4 to 28.3 per cent. Moreover, 21.7 per cent of the subjects had “normal” levels while the rest (78.3 per cent) had low levels of serum iron; the percentage of adolescent girls in the normal category increased to 93.5 per cent after intervention on the basis of serum iron levels.

Supplementation with iron and folic acid with other micronutrients improved the haemoglobin and serum iron levels of the adolescent girls significantly.

The paper recommends that the school system can be used for micronutrient supplementation to improve the nutritional status of children and adolescents as the students are more regimented here for distribution of nutrient fortified food products.

In Bangladesh, girls’ ability to complete schooling is compromised by poverty and the practice of early marriage. Although most girls enroll in school, rates of dropping out are high around puberty. This paper uses a panel survey (2001 and 2003) of nearly 3,000 adolescent girls in rural Bangladesh to predict schooling outcomes. The analysis explores household and community factors to explain school enrollment, dropping out and marriage. Girls in poor households are more likely to drop out before reaching secondary school. Girls in wealthier households are more likely to drop out later, because of marriage, and having more siblings increases this possibility.

This paper aims to evaluate the effects of a school-based obesity prevention program targeting Brazilian adolescent girls on dietary intake and meal frequency.

It was a six-month school-based group randomized controlled trial with female adolescents. The intervention was based on the Social Cognitive Theory and focused on ten nutrition and physical activity key messages. Diet intake was measured using a validated food frequency questionnaire, and the food items were aggregate into the eight food groups of the Brazilian Food Guide Pyramid. The meals frequency assessed were breakfast, lunch, dinner and snack-in-between-meals, the frequency ranged from never to everyday. Linear mixed models were used to examine the dietary effects and chi-squared test to identify proportional differences among groups in meal frequency. All analyses followed intention-to-treat principles and alpha levels of p ≤ 0.05 were set.

After six months from baseline, changes in the fruits (mean [SE] 12.48 kcal [7.86], p = 0.005), vegetables (8.80 kcal [7.11], p = 0.006) and sugar (−55.98 kcal [50.70], p = 0.036) groups were demonstrated. Proportional difference was shown for snack-in-between-meals (p = 0.001), and the frequency most cited was for “five to six days” per week.

The “Healthy Habits, Healthy Girls-Brazil” showed promise in the adolescents’ dietary intake and could be used as framework for future interventions. Also, the methods used for dietary intake can be enhanced and implemented for future studies.

This paper aims to evaluate the impact of the groups from the Brazilian Food Pyramid on macro and micronutrient content of food consumed by adolescent girls from a school-based study.

Baseline data from “Healthy Habits, Healthy Girls” school-based randomized control trial was used for this study. A sample of the girls aged 14 to 18 years old (n = 253) from ten schools in Brazil was evaluated. Participants completed validated food frequency questionnaire, from which, the total kilocalories and/or grams from each food groups were calculated. Descriptive statistics, t-student test and linear regression were used for the analysis with a significant level of p < 0.05.

Mean daily intake of the girls was 2,887.09 (standard error 91.50) kcal/day. There was a positive significant association between relative intake of the “Oil and Fats” group and protein (ranged from 24.95 to 96.12 kcal/d), fats (48.36 to 192.62 kcal/d), iron (56.93 to 162.85 kcal/d) and sodium (208.08 to 699.69 kcal/d) contents. In regards to the intake of “Sugars and Sweets” group, there was a positive significant association for carbohydrates (97.53 to 491.70 kcal/day), total fiber (0.56 to 2.64 kcal/d), iron (0.85 to 4.40 kcal/d) and sodium (175.59 to 838.48 kcal/d) content.

Findings demonstrate that girls over consumed the “Oils and Fats” and “Sugars and Sweets” groups reflecting on increased of important macro and micronutrients of their diet. Therefore, consuming up to 1 serving size of these groups is a good way to promote healthy eating among this population.

This study aims to explore whether socio-economic factors determine the level of menstrual knowledge and perceptions of schoolgirls in Bangladesh. The aim of this study is to understand how knowledge and perceptions vary with variations in the different socio-economic factors in a schoolgirl’s life such as place of residence, religion, age, grade, parents’ education, parents’ occupation, family income and even family size.

Data were collected from four schools (two in urban areas and two in rural areas). A total of 450 schoolgirls from grades V–X were interviewed to examine how knowledge and perceptions varied with different socio-economic aspects. Multiple logistic regression models were used to measure the associations between various socio-economic variables and perceptions of and knowledge about menstruation.

Respondents from urban areas were 4.75 times more likely and those 14–16 years old were two times more likely to report higher levels of knowledge about menstruation compared to their counterparts. Based on the father’s occupation, respondents whose father was engaged in a professional occupation were 1.983 times more likely to have a higher level of knowledge on menstruation compared to those whose fathers were in an unskilled profession. Similarly, the odds of positive perceptions on menstruation were 1.456 and 1.987 times higher, respectively, among respondents living in urban areas and those 14–16 years old, compared to their counterparts.

This study provides evidence that different socio-economic and even demographic factors are important in the development of menstrual knowledge and perceptions. Policy formulation and development actions related to adolescent girls’ physical and reproductive health development need to consider these factors in Bangladesh and in other developing countries, where poor knowledge and perception related to menstruation are hindering girls’ mental and physical development. This is expected that better knowledge and perception will facilitate girls’ right to have better health and social lives.

Over the years, efforts to ensure equal participation of girls in school in Nigeria have been met with some setbacks, amidst significant progress in mobilising communities for gender equality and mainstreaming. The purpose of this paper is to explore a number of features associated with sexual maturation that affect girls’ non-enrolment, limited attendance, performance at school and gender inequality in primary and secondary education in Nigeria.

The analytical engagement with the capability approach draws out elements of inequalities and demonstrates that issues of sexual maturation do not just constitute personal health challenge for adolescent girls, but bring up wider issues of socio-cultural, community and institutional deprivation and injustice.

Though laudable initiatives have been in place to improve girls’ participation and attainment in education, there is a dire need for appropriate policy and actions to address the supply and demand barriers to meeting girls’ needs, including making schools more girl-friendly and safe, providing school-based health programmes, sex education and sanitation facilities, train teachers against gender-stereotype, flexible school schedules and enforce re-admission policy. But beyond school policy and environment, there is also the need to respond to opportunity costs of schooling and leverage collective capabilities.

This paper argues that cultural and socioeconomic factors surrounding sexual maturation are implicated in gender differentials in participation and performance of girls and gender inequality in education. It suggests the need for the application of collective capabilities for action towards addressing girls’ sexual maturation issues and education in the society.