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.

Causal association pathways between fetuin-A and kidney function: a mediation analysis.

OBJECTIVE: Body mass index (BMI), uric acid, diabetes mellitus, and hypertension are risk factors for reduced kidney function and are associated with fetuin-A levels, but their causal pathways remain unclear. The objective of this study was to investigate this knowledge gap. METHODS: A repeated cross-sectional design was used to assess causal pathway effects of fetuin-A on the estimated glomerular filtration rate (eGFR), which is mediated through BMI, uric acid, diabetes mellitus, and hypertension. RESULTS: Among 2305 participants, the mean eGFR at baseline decreased from 98.7 ± 23.6 mL/minute/1.73 m2 in 2009 to 92.4 ± 22.9 mL/minute/1.73 m2 in 2014. Fetuin-A was significantly associated with eGFR , suggesting that increasing fetuin-A levels predict a decrease in eGFR. Additionally, the indirect effect of fetuin-A on eGFR, as assessed through BMI, was also significant. The effects of fetuin-A on eGFR through other mediation pathways showed variable results. CONCLUSIONS: Our study revealed a possible role of fetuin-A in the etiology of declining renal function through mediating body mass index, uric acid, diabetes mellitus, and hypertension via complex causal pathways. Further studies to clarify these mediated effects are recommended.