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

backgroundAdequate 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.

methodsA 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.

resultsWASH 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.

conclusionWASH 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.