Journal Article

The hidden burden of dysmenorrhea among adolescent girls in Palestine refugee camps: a focus on well-being and academic performance

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Background Dysmenorrhea (painful menstruation) is a condition that may have a profound effect on adolescent
girls’ health status and well-being. It can impede their engagement in daily activities and hamper their regular
school attendance. This study aims to explore the relationship between dysmenorrhea, well-being, and academic
performance among adolescent girls living in Palestine refugee camps in the West Bank and Jordan.

Methods We conducted a household survey between June and September 2019, with a total sample of 2737
adolescent girls 15 to 18 years old. Dysmenorrhea severity was assessed using the Working Ability, Location, Intensity,
Duration of pain Dysmenorrhea scale (WaLIDD). The WHO-5 scale was used to evaluate the girls’ overall well-being.
Menstrual academic disruption (MAD) was measured using a self-reported scale. Multiple linear regression models
were employed to evaluate the association between dysmenorrhea, well-being, and academic performance. Directed
Acyclic Graphs (DAGs) were employed to identify variables for control in regression models.

Results The mean dysmenorrhea score was 6.6 ± 2.6, with 37.9% and 41.2% expressing moderate and severe
symptoms, respectively. The mean WHO-5 score was 58.7 ± 25.1, and 34.9% reported a low well-being status. The
mean MAD score was 3.1 ± 3.3. 26% reported missing school due to dysmenorrhea, 36% said dysmenorrhea impacted
their ability to concentrate, and 39% were unable to study for tests, and complete homework. The first regression
analysis showed a reduction of 1.45 units in WHO-5 score for each unit increase in dysmenorrhea. The second
regression analysis showed a non-linear increase in MAD score for increasing dysmenorrhea. For each dysmenorrhea
score less than 4 (mild) there was a modest increase in MAD scores (coefficient 0.08, p-value = 0.006), and for each
dysmenorrhea score above 4 there was a stronger increase in MAD scores (coefficient 0.95, p < 0.001).

Conclusion Dysmenorrhea poses significant challenges to the well-being and academic performance of adolescent
girls living in Palestine refugee camps. Collaborative efforts and multifaceted approaches are crucial to address
dysmenorrhea effectively. This involves research, targeted interventions, culturally sensitive strategies, and fostering a
supportive environment that empowers girls to thrive academically and beyond.

Date Published
BMC Public Health
Journal Name
BMC Public Health
Adolescent girls
Academic performance
Palestinian refugee camps
West Bank and Jordan