Period Product Resources and Needs in Missouri Schools: Focus Group Discussions with School Nurses.

This study explored period product resources and needs in Missouri schools from the perspective of school nurses. We conducted eight focus groups with school nurses (n = 51) across Missouri using purposive sampling. Focus group data were analyzed in Dedoose via multiple coders and achieved strong inter-rater reliability (Cohen's Kappa = 0.92). Several interconnected themes with associated sub-themes were identified. First, school nurses do not have sufficient resources to help students manage menstruation and minimize menstruation-related absenteeism. Second, schools' heavy reliance on donations can lead to inconsistencies in supply and a mismatch between what is donated and what is most needed. Third, school nurses desire additional educational resources around menstruation management for students and caregivers. Nurse-identified themes can help inform recommendations for improving schools' response to students' menstrual hygiene needs by highlighting priorities for educational content, resources, and product acquisition with a goal of ensuring the suitability and sustainability of MHM in schools.

Effectiveness of COVID-19 vaccination against school absenteeism in children and adolescents hospitalized with COVID-19.

BACKGROUND: COVID-19 vaccination has been recommended for children to protect them and to enable in-person educational and social activities. METHODS: We estimated COVID-19 vaccination effectiveness (VE) against school absenteeism in children 5-17 years old hospitalized from September 1, 2021 through May 31, 2023. Full vaccination was defined as two vaccine doses. RESULTS: We studied 231 children admitted to hospital with COVID-19, including 206 (89.2 %) unvaccinated/partially vaccinated and 25 (10.8 %) fully vaccinated. Unvaccinated/partially vaccinated children were absent from school for longer periods compared to fully vaccinated children (median absence: 14 versus 10 days; p-value = 0.05). Multivariable regression showed that full COVID-19 vaccination was associated with fewer days of absence compared to no/partial vaccination on average (adjusted relative risk: 0.77; 95 % CI: 0.61 to 0.98). COVID-19 VE was 50.7 % (95 % CI: -11.3 % to 78.2 %) for school absenteeism above the median duration of absenteeism. CONCLUSIONS: Full COVID-19 vaccination conferred protection against school absenteeism in hospitalized school-aged children with COVID-19.

Effectiveness of interventions to reduce COVID-19 transmission in schools.

School reopenings in 2021 and 2022 coincided with the rapid emergence of new SARS-CoV-2 variants in the United States. In-school mitigation efforts varied, depending on local COVID-19 mandates and resources. Using a stochastic age-stratified agent-based model of SARS-CoV-2 transmission, we estimate the impacts of multiple in-school strategies on both infection rates and absenteeism, relative to a baseline scenario in which only symptomatic cases are tested and positive tests trigger a 10-day isolation of the case and 10-day quarantine of their household and classroom. We find that monthly asymptomatic screening coupled with the 10-day isolation and quarantine period is expected to avert 55.4% of infections while increasing absenteeism by 104.3%. Replacing quarantine with test-to-stay would reduce absenteeism by 66.3% (while hardly impacting infection rates), but would require roughly 10-fold more testing resources. Alternatively, vaccination or mask wearing by 50% of the student body is expected to avert 54.1% or 43.1% of infections while decreasing absenteeism by 34.1% or 27.4%, respectively. Separating students into classrooms based on mask usage is expected to reduce infection risks among those who wear masks (by 23.1%), exacerbate risks among those who do not (by 27.8%), but have little impact on overall risk. A combined strategy of monthly screening, household and classroom quarantine, a 50% vaccination rate, and a 50% masking rate (in mixed classrooms) is expected to avert 81.7% of infections while increasing absenteeism by 90.6%. During future public health emergencies, such analyses can inform the rapid design of resource-constrained strategies that mitigate both public health and educational risks.

Changes in the menstrual hygiene management facilities and usage among Bangladeshi school girls and its effect on school absenteeism from 2014 to 2018.

BACKGROUND: The lack of menstrual hygiene management (MHM) information and facilities in schools is a major contributor to adolescent girls' school absenteeism in low- and middle-income countries like Bangladesh. OBJECTIVES: This paper examines the changes over time in school MHM facilities, knowledge and perceptions among adolescent girls, in relation to school absenteeism between 2014 and 2018 in Bangladesh. METHODS: We examined changes in MHM and school absenteeism among schoolgirls using nationally representative data from the Bangladesh National Hygiene Baseline Survey 2014 and National Hygiene Survey 2018. Given the repetitive nature of our data and its clustering within participants, our method included performing descriptive analysis, bivariate analysis, and multivariate Generalised Estimating Equation (GEE) modelling to analyse these changes. RESULTS: Results showed that adolescent girls' menstruation-related absenteeism decreased between 2014 and 2018. Percentage of adolescents who missed school decreased from 25% to 14% (PD: -11; CI: -16 to -6.1), while the average number of missed days reduced from 2.8 to 2.5 (PD: -0.33; CI: -0.57 to -0.10). In the GEE model, we found that living in rural areas (coef: -5.6; CI: -10.06 to -1.14), parental restrictions on going outside (coef: 4.47; CI: 0.75 to 8.2), education levels of girls (coef: -9.48; CI: -14.17 to -4.79), girl's belief that menstruation affects school performance (coef: 23.32; CI: 19.71 to 26.93), and using old cloths (coef: -4.2; CI: -7.6 to -0.79) were significantly associated with higher absenteeism. However, participant's age, type of school, knowledge of menstruation before menarche, receiving information regarding MHM, separate place for changing absorbents, and separate latrine and urine facility were not significantly associated with the changes in absenteeism over time. CONCLUSION: This paper emphasised the associations between changes in school absenteeism, parental restrictions on students, students' education levels, and menstruation-related misperceptions. Ongoing research, policy reviews, and targeted interventions to improve MHM perceptions among girls are required to provide long-term benefits for adolescent girls in Bangladesh.

Impact of Economic and Family Intervention on Adolescent Girls' Education Performance, School Absenteeism, and Behavior in School: The Suubi4Her Study.

PURPOSE: Attaining education among girls is still a challenge in sub-Saharan Africa. Even those who enroll in school need additional financial and social support to promote attendance, performance, and behavior. We investigated whether (1) adolescent girls receiving an economic empowerment intervention comprising Youth Development Accounts (YDA) or a combination intervention comprising (YDA + Multiple Family Group [YDA + MFG]), participants of the Suubi4Her study, will each display better grade repetition, attendance, and behavior in school compared to girls in the control group and (2) adolescent girls in the YDA + MFG group will have better outcomes than girls receiving the YDA-only intervention. METHODS: We used longitudinal data from 1,260 Ugandan adolescent girls from the Suubi4Her cluster randomized controlled trial. To account for repeated measures at the individual level over time and clustering at the school level, three-level mixed-effects models were fitted. For binary outcomes, we used multilevel logistic regression, while for continuous outcomes, we applied multilevel linear regression. RESULTS: Overall, our findings highlight the positive impact of the Suubi4Her intervention on reducing general and sickness-related absenteeism among school-attending adolescent girls who received the YDA or YDA + MFG intervention but observed no significant group differences on their grade repetition and behavior in school. DISCUSSION: Improving school attendance and reducing illness-related absences can translate to numerous beneficial outcomes for adolescent girls in the long-term and, hence, these interventions should be considered to improve educational outcomes among other adolescent girl populations in similar settings across sub-Saharan Africa.

How to deal with sickness absence among primary school pupils? Adaptation of the "Medical Advice for Sick-reported Students" intervention.

Background: Missing school impacts both education and health. The purpose of this study was to address sickness absence in primary schools by adjusting the 'Medical Advice for Sick-reported Students' intervention for secondary schools. This was necessary because of fundamental differences in relation to the children's age and in the schools' organizational structure. Methods: The intervention mapping approach steps 1 through 4 were used to adapt 'Medical Advice for Sick-reported Students' to primary schools (MASS-PS), including a literature search, stakeholder interviews, establishing a planning group and pre-testing. Results: In step 1, a planning group was formed and a logic model of the problem was created. In step 2, a logic model of change was created. In step 3, a theoretical basis and practical strategies were determined. In step 4, practical support materials were designed, and two pre-tests of the materials were performed. Conclusion: Intervention mapping was successfully used to adapt MASS to primary schools. The main changes were the lowering of the threshold for extensive sickness absence, consultations between teacher and attendance coordinator, and addition of two experts. With MASS-PS, sickness absence can be addressed as a "red flag" for underlying problems.

Changing Trends in School Absenteeism and Identification of Associated Factors in Adolescents with Atopic Dermatitis.

Atopic dermatitis (AD) has a negative influence on school attendance. We aimed to identify factors associated with school absenteeism in adolescents with AD. We used data from the 3rd to 11th annual Korean Youth Risk Behavior Web-based Survey completed from 2007 to 2015. Survey data were obtained from a stratified, multistage, clustered sample. Participants responded to the question "have you ever been diagnosed with AD?" Factors associated with AD-related school absenteeism (ADSA), which is defined as at least one school absence due to AD, were evaluated. Among the 141,899 subjects, the prevalence of AD increased (17.3% to 24.2%), while that of ADSA decreased (7.3% to 2.6%) from 2007 to 2015. Compared to adolescents without ADSA, those with ADSA were more likely to be male, middle school students, and have negative mental health states, including suicidality. In the multivariate logistic regression model, the association of sleep dissatisfaction and depression with ADSA was high (adjusted odds ratio, 6.12; 95% confidence intervals, 4.61-7.95; and 5.44; 5.23-5.67, respectively). The prevalence of ADSA has decreased despite an increase in the prevalence of AD in Korean adolescents; however, it is important for pediatricians to screen for factors associated with ADSA to improve school attendance in adolescents with AD.

Stakeholder perspectives on primary school pupils and sickness absence - exploring opportunities and challenges.

School absenteeism and its underlying causes can have negative effects on the cognitive, psychosocial and health development of a child. Research in primary education shows high rates of sickness absence. Many stakeholders are involved in addressing school absenteeism, including primary school professionals, child and youth healthcare physicians, school attendance officers and parents. This study explores these stakeholders' perspectives, their approaches and what they envisage to be necessary in order to improve. It also aims to unveil opportunities and challenges in addressing sickness absence among primary school pupils. Qualitative research was performed with six semi-structured focus group interviews and involving 27 participants from the West-Brabant and Amsterdam regions of the Netherlands. Thematic analysis was used. The overarching theme was aiming for the child's wellbeing. Each focus group interview started with low awareness of sickness absence as a threat to this wellbeing, but awareness grew during the interviews. The participating stakeholders regarded problematic sickness absence as complex due to a wide variety of causes, and felt that each other's expertise was necessary to reduce sickness absence. Schools registered absence, but only occasionally used planned steps; they based the identification of problematic sickness on gut feeling rather than any agreed-upon criteria. To be able to systematically address sickness absence and thus improve the wellbeing of children, stakeholders felt the need for a clearly structured approach, including monitoring of sickness absence of all pupils, identifying problematic absence and promoting collaboration with other stakeholders. An approach should allow for tailoring solutions to the individual child.

Risk Factor Profile in Inpatients with School Refusal: a Dimensional Model.

BACKGROUND: School attendance problems have an impact on the social, academic, and professional development of young people. School refusal and truancy are described as school attendance problems. Clarifying the developmental trajectory of school refusal would allow a better understanding of the phenomenon including earlier detection and improved management. Following a dimensional model, we can consider school refusal as an internalizing problem and truancy as an externalizing problem implying the existence of different risk factor profiles. SUBJECT AND METHOD: We conducted a retrospective study on four groups of child and adolescent inpatients (school refusal (SR), truancy (TR), behavior disorder without deschooling (BD), and eating disorder (ED). Each subject was included in one of the groups based on a checklist criterion and the diagnoses made at the end of hospitalization. We then compared groups with descriptive statistics (Chi² and Fisher's exact test) to highlight the developmental trajectory and the possible risk factors profile in SR. RESULTS: Delayed language development, attachment disorder, attentional deficit and hyperactivity disorder, physical abuse, and substance abuse were predominantly reported in BD and TR. Learning disorders were mostly present in BD, TR, and SR. Family interactions were more violent and aggressive in BD and TR than in ED and SR. We observed more violent and conflictual relationships with peers in BD and TR. In SR, subjects seemed to experiment with more isolation and rejection. Behavioral disorder non-specified, ODD, and CD seemed more frequent in BD and TR. We found anxiety disorder and mood disorders more frequently in the SR group. CONCLUSION: Inpatients with severe SR are characterized by internalizing problems and difficulties in emotional dysregulation and problems socializing with peers. Inpatients with BD and TR were associated with externalizing problems and difficulties in behavioral regulation skills.

Modelling the impact of a high-uptake bivalent booster scenario on the COVID-19 burden and healthcare costs in New York City.

Background: Uptake of the COVID-19 bivalent booster vaccine (targeting the original SARS-CoV-2 strain and subvariants BA.4 and BA.5 of the Omicron variant) among eligible residents of New York City (NYC) has been modest and declining. Assessing the impact of improved population-level booster coverage with bivalent vaccines in NYC can help inform investment towards vaccination and potential cost-savings. Methods: We calibrated an agent-based model of disease transmission to confirmed and probable cases of COVID-19 in NYC and simulated it to project outcomes under two scenarios. In the base case scenario, we assumed that vaccination continued with the average daily rate of 92 vaccine doses per 100,000 administered during December 2022. In the counterfactual scenario, we modeled a high-uptake scenario between January 1, 2023 and March 31, 2023, with an average daily rate of 296 vaccine doses per 100,000 population that increased bivalent coverage in NYC to match the age-specific influenza vaccine coverage of the 2020-2021 season. Vaccination rate outside the campaign duration remained the same as the base case scenario. Findings: Compared to the base case, the high-uptake scenario averted 88,274 (95% Confidence Interval [CI]: 77,097-100,342) cases, and prevented 2,917 (95% CI: 2,557-3,267) hospitalizations between January 1 through the end of June 2023. Averted outcomes resulted in net savings of $217.2 (95% CI: 190.0-242.2) million in direct healthcare costs. We estimated that the high-uptake scenario would avert 72,879 (95% CI: 63,894-82,228) days of student absenteeism from schools due to COVID-19 illness. Interpretation: Our results illustrate the continued benefits of COVID-19 vaccines in preventing severe health outcomes, averting healthcare costs, and maintaining educational continuity in NYC. Funding: The Canadian Institutes of Health Research, The Natural Sciences and Engineering Research Council of Canada, NIH, Centers for Disease Control and Prevention (CDC), NSF, The Commonwealth Fund, and The Notsew Orm Sands Foundation.

Effect of School Feeding Program on School Absenteeism of Primary School Adolescents in Addis Ababa, Ethiopia: A Prospective Cohort Study.

BACKGROUND: School feeding programs (SFP) in low-income countries are designed to provide food to vulnerable school children to create optimal educational and health conditions for learners. Ethiopia scaled up the implementation of SFP in Addis Ababa. Yet, the utility of this program in terms of school absenteeism has not been monitored thus far. Hence, we aimed at evaluating the effect of the SFP on school performance of primary school adolescents in Addis Ababa, Central Ethiopia. METHODS: A prospective cohort study was carried out from 2020 to 2021 on SFP-beneficiary (n = 322) and non-SFP beneficiary (n = 322). Logistic regression models were done using SPSS version 24. RESULTS: In logistic regression, unadjusted model (model 1), the school absenteeism of non-school-fed adolescents was higher by 1.84 (adjusted odds ratio [aOR] 0.36, 95% confidence interval [CI] 1.28-2.64) as compared to school-fed adolescents. The odds ratio remained positive after adjusting for age and sex (model 2: aOR 1.84, 95% CI 1.27-2.65), and sociodemographic (model 3: aOR 1.84, 95% CI 1.27-2.67). In the final model, adjusted model 4, health and lifestyle, there was a significant increase in absenteeism of non-school-fed adolescents (model 4: aOR 2.37, 95% CI 1.54-3.64). The likelihood of absenteeism in female increase by 2.03 (aOR 2.03, 95% CI 1.35-3.05), whereas being in a low tertile wealth index family decreases absenteeism by (aOR 0.51, 95% CI 0.32-0.82). School feeding was negatively associated with school absenteeism. CONCLUSIONS: The findings imply the need for strengthening school feeding programs.

The Effect of Health Insurance Status on School Attendance.

Introduction Educational achievement is impacted by a student's ability to be present and motivated in the classroom. Since health and education influence one another, disparities in health insurance status among children may exert educationally relevant consequences. However, the association between health insurance coverage and school absenteeism remains poorly understood. Our study aims to assess the association between not having/having gaps in health insurance coverage and an increased number of missed school days. Methods A historical cohort study was performed via secondary analysis of data collected as part of the 2018 National Survey of Children's Health (NSCH). We included children enrolled in school between the ages of 6-17 years and who provided answers to survey questions involving our two variables of interest: health insurance status and missed school days. Our data analysis included 1) a descriptive analysis of the baseline sample characteristics, 2) a bivariate analysis to determine the association between baseline characteristics/confounding variables and the outcome, and 3) a multivariable regression analysis using logistic regression to determine the association of interest while controlling for potential confounding variables. Results A total of 21,498 respondents were included. The unadjusted odds of chronic absenteeism were found to be 16% (OR=1.16) higher in children without insurance or with gaps in insurance compared to children with consistent insurance throughout the year, but the association was not statistically significant (95% CI 0.74 - 1.82, p=0.051). After adjustment by age, sex, race, Hispanic ethnicity, and confounding variables, the odds of chronic absenteeism in children without insurance or with gaps in insurance remained statistically insignificant (aOR=1.05; 95% CI 0.64 - 1.73, p=0.848) compared to those with consistent insurance coverage. Conclusions According to our analysis, the data do not support our hypothesis of a significant difference in missed school days (greater than or equal to 11 missed days of school) among those children who had health insurance compared to those without health insurance/had gaps in insurance coverage.

Monitoring School Absenteeism for Influenza-Like Illness Surveillance: Systematic Review and Meta-analysis.

BACKGROUND: Influenza causes considerable disease burden each year, particularly in children. Monitoring school absenteeism has long been proposed as a surveillance tool of influenza activity in the community, but the practice of school absenteeism could be varying, and the potential of such usage remains unclear. OBJECTIVE: The aim of this paper is to determine the potential of monitoring school absenteeism as a surveillance tool of influenza. METHODS: We conducted a systematic review of the published literature on the relationship between school absenteeism and influenza activity in the community. We categorized the types of school absenteeism and influenza activity in the community to determine the correlation between these data streams. We also extracted this correlation with different lags in community surveillance to determine the potential of using school absenteeism as a leading indicator of influenza activity. RESULTS: Among the 35 identified studies, 22 (63%), 12 (34%), and 8 (23%) studies monitored all-cause, illness-specific, and influenza-like illness (ILI)-specific absents, respectively, and 16 (46%) used quantitative approaches and provided 33 estimates on the temporal correlation between school absenteeism and influenza activity in the community. The pooled estimate of correlation between school absenteeism and community surveillance without lag, with 1-week lag, and with 2-week lag were 0.44 (95% CI 0.34, 0.53), 0.29 (95% CI 0.15, 0.42), and 0.21 (95% CI 0.11, 0.31), respectively. The correlation between influenza activity in the community and ILI-specific absenteeism was higher than that between influenza activity in community all-cause absenteeism. Among the 19 studies that used qualitative approaches, 15 (79%) concluded that school absenteeism was in concordance with, coincided with, or was associated with community surveillance. Of the 35 identified studies, only 6 (17%) attempted to predict influenza activity in the community from school absenteeism surveillance. CONCLUSIONS: There was a moderate correlation between school absenteeism and influenza activity in the community. The smaller correlation between school absenteeism and community surveillance with lag, compared to without lag, suggested that careful application was required to use school absenteeism as a leading indicator of influenza epidemics. ILI-specific absenteeism could monitor influenza activity more closely, but the required resource or school participation willingness may require careful consideration to weight against the associated costs. Further development is required to use and optimize the use of school absenteeism to predict influenza activity. In particular, the potential of using more advanced statistical models and validation of the predictions should be explored.

Longitudinal pathways between emotional difficulties and school absenteeism in middle childhood: Evidence from developmental cascades.

Emotional difficulties are associated with both authorized and unauthorized school absence, but there has been little longitudinal research and the temporal nature of these associations remains unclear. This study presents three-wave random-intercepts panel models of longitudinal reciprocal relationships between teacher-reported emotional difficulties and authorized and unauthorized school absence in 2,542 English children aged 6 to 9 years old at baseline, who were followed-up annually. Minor differences in the stability effects were observed between genders but only for the authorized absence model. Across all time points, children with greater emotional difficulties had more absences, and vice versa (authorized: ρ = .23-.29, p < .01; unauthorized: ρ = .28, p < .01). At the within-person level, concurrent associations showed that emotional difficulties were associated with greater authorized (ß = .15-.17, p < .01) absence at Time 3 only, but with less unauthorized (ß = -.08-.13, p < .05) absence at Times 1 and 2. In cross-lagged pathways, neither authorized nor unauthorized absence predicted later emotional difficulties, and emotional difficulties did not predict later authorized absence at any time point. However, greater emotional difficulties were associated with fewer unauthorized absences across time (ß = -13-.22, p < .001). The implications of these findings are discussed.

Truancy: The relevance of resilience-related internal assets, student engagement and perception of school success in youth living with parents and in residential care.

BACKGROUND: School absenteeism is associated with multiple negative short and long-term impacts, such as school grade retention and mental health difficulties. OBJECTIVE: The present study aimed to understand the role of resilience-related internal assets, student engagement, and perception of school success as protective factors for truancy. Additionally, we investigated whether there were differences in these variables between students living in residential care and students living with their parents. METHODS: This study included 118 participants aged 11 to 23 years old (M = 17.16, SE = 0.26). The majority were female (n = 61, 51.7 %) and Portuguese (n = 98, 83.1 %), with half living in residential care. In this cross-sectional study, participants responded to self-report questionnaires. Hierarchical regression analysis was used to understand the factors associated with truancy. RESULTS: There were no group differences in resilience-related internal assets and their perception of school success. On the contrary, participants in residential care reported more unexcused school absences, more grade retentions, higher levels of depression, and lower levels of student engagement. Moreover, hierarchical linear regression controlling for key variables (i.e., living in residential care or with parents, school grade retention, and depression) showed that perception of school success and resilience-related internal assets significantly contributed to truancy. CONCLUSIONS: Results are discussed in the context of universal and selective interventions. These interventions can foster individual strengths and provide opportunities for every student to experience success. Consequently, they promote engagement and reduce the likelihood of school absences, especially for those in more vulnerable situations such as youth in residential care.

School attendance problems in adolescent with attention deficit hyperactivity disorder.

Introduction: A link between having a neurodevelopmental disorder, such as attention deficit hyperactivity disorder (ADHD) and school absenteeism, has been found in previous studies. Why ADHD poses a risk for absenteeism remains unclear, and insight into the mechanisms of the association is needed. The aim of the present study was to investigate school attendance problems (SAP) and both the symptoms related and the perceived reasons for them, as reported by adolescents with ADHD (n = 95), compared with neurotypical adolescents (n = 1,474). Method: The current study (N = 1,569) was part of the School absence in Finland-project. SAPs were measured with the Inventory of School Attendance Problems (ISAP). The ISAP questionnaire contains a symptom scale (ISAP S) and a function scale (ISAP F), which shows if and how the symptoms impacts school attendance. A linear mixed effects model was used to analyze outcomes on the ISAP factors, controlling for background variables living status, gender, other diagnoses, highest level of education for the parent and age. Results: Results show that adolescents with ADHD had been more absent from school compared to neurotypical adolescents during the prior 12-weeks. Adolescents with ADHD showed significantly more symptoms of agoraphobia/panic, problems within the family and problems with parents than neurotypical peers. The symptoms separation anxiety, agoraphobia/panic, aggression, problems within the family and problems with parents more often were perceived as the reason for SAP (ISAP F). Discussion: The results are in line with our initial hypotheses and previous studies. Because of the low response rate on the ISAP F scale, the results regarding reasons for SAPs should be interpreted with caution. Future research could examine specific preventive actions of SAPs for adolescents with ADHD, and different subtypes of ADHD.

Who is absent from school when? An optimal matching analysis of within-year variation in the timing of school absences.

Although school absenteeism trajectories can be studied through various parameters and dimensions, such as the amount of school absenteeism, sequence, and timing, most studies have only focused on changes in the amount of school absenteeism. However, when investigating the nature of school absenteeism, an analysis cannot be restricted to just changes in the amount of school absenteeism. In this article, I show how applying optimal matching on time-stamped half days of missed school (n = 6260) enables researchers, policy makers, and school professionals to uncover socio-temporal regularities in trajectories of non-attendance (i.e., the degree to which groups of pupils are absent at the same time and in the same rhythm within a given school year). Results indicated that students fall into five types of trajectories, and that these are highly predictive of student's examination results at the end of the school year. In the Discussion, I elaborate on the implications of these findings.

Missing school during period: perspectives of adolescent schoolgirls in Cross River State, Nigeria.

Introduction: adolescent in-schoolgirls often experience stigmatization, physical and psychological stress during their menstrual period that causes them to miss school. Menstruation-induced school absenteeism is preventable. The purpose of the study was to assess the factors associated with school absenteeism by both urban and rural school-going adolescent girls during their period. Methods: adolescent female students in Junior and Senior Secondary classes, who have attained menarche, participated in the study. A researcher designed, pretested and validated self-administered questionnaire, consisting of questions related to perception about menstruation and reasons for missing school during menstruation was used for data collection. Data were analyzed using SPSS software. Descriptive data were presented using percentages, while the association between the variables of interest, were verified using Chi-Square test. Results: mean age of the girls was 14.4 (±1.8) years while mean age at menarche was 12.2 (±1.3) years. Although respondents identified several factors as responsible for school absenteeism, however, only fear of ridicule by other students (p ≤ 0.001) and unavailability of sanitary towels (p = 0.006) were significantly associated with missing school. Lack of sanitary towels was significantly associated with location (p = 0.012) and socio-economic status of mothers (0.006); while perception of menstruation as a disease was associated with feeling of tiredness and discomfort (p = 0.017). Conclusion: findings have shown that school absenteeism during menstruation is a serious problem among respondents capable of adversely affecting their academic performance. Access to sanitary towels and WASH facilities should be provided in schools to create an enabling environment to motivate school attendance by the adolescent girls.

[Risk Factors for School Based Anxiety: An Empirical Study]. / Ergebnisse einer quantitativen Untersuchung an Schulen zu Risikofaktoren bei Schulangst.

Risk Factors for School Based Anxiety: An Empirical Study Abstract. This article deals with the phenomenon of school absenteeism, with a special focus on school refusal behavior and the self-efficacy of students. Risk factors may lead to avoidance and end up in disintegrative processes. For this reason, this quantitative study investigates potential influences on school absenteeism, addressing the hypothesis that anxiety in school and lower self-efficacy may lead to school-attendance problems. To this end, we interviewed students at schools in Lower Saxony.

Evaluation of a menstrual hygiene intervention in urban and rural schools in Bangladesh: a pilot study.

Girls' menstrual experiences impact their social and educational participation, physical and psychological health. We conducted a pilot study to assess the acceptability and feasibility of a multi-component intervention intended to support menstruating girls; improve menstrual care knowledge, practices, and comfort; and increase school attendance.We conducted a pre/post evaluation of a 6-month pilot intervention in four schools (2 urban, 2 rural) in Dhaka, Bangladesh. We selected 527 schoolgirls (grades 5 to 10; aged 10 to 17 years) for a baseline survey and 528 girls at endline. The intervention included: 1) Menstrual Hygiene Management (MHM) packs- reusable cloth pads, underwear, carry bags and menstrual cycle tracking calendars, 2) education curriculum- pictorial flipcharts, puberty related-booklets, and teachers' training to deliver puberty and MHM sessions, 3) maintenance- improvements to school sanitation, provision of disposable pads in the school office, provision of chute disposal systems for disposable pads, and gender committees to promote a gender-friendly school environment and maintenance of intervention facilities. We estimated intervention uptake and intervention effect by calculating prevalence differences and 95% confidence intervals using fixed-effects logistic regression.The intervention uptake was more than 85% for most indicators; 100% reported receiving puberty education, 85% received MHM packs, and 92% received booklets. Reusable cloth pads uptake was 34% by endline compared with 0% at baseline. Knowledge about menstrual physiology and knowledge of recommended menstrual management practices significantly improved from baseline to endline. Reported improvements included more frequent changing of menstrual materials (4.2 times/day at endline vs. 3.4 times/day at baseline), increased use of recommended disposal methods (prevalence difference (PD): 8%; 95% Confidence Interval: 1, 14), and fewer staining incidents (PD: - 12%; 95% CI: - 22, - 1). More girls reported being satisfied with their menstrual materials (59% at endline vs. 46% at baseline, p < 0.005) and thought school facilities were adequate for menstrual management at endline compared to baseline (54% vs. 8%, p < 0.001). At endline, 64% girls disagreed/strongly disagreed that they felt anxious at school due to menstruation, compared to 33% at baseline (p < 0.001). Sixty-five percent girls disagreed/strongly disagreed about feeling distracted or trouble concentrating in class at endline, compared to 41% at baseline (p < 0.001). Self-reported absences decreased slightly (PD: - 8%; 95% CI: - 14, - 2).Uptake of cloth pads, improved maintenance and disposal of menstrual materials, and reduced anxiety at school suggest acceptability and feasibility of the intervention aiming to create a supportive school environment.