Structured Patterns of Multi-Material Menstrual Product Use Among Junior High School Girls in Ghana: A Cluster Analysis.

OBJECTIVE: Menstrual hygiene management among adolescent schoolgirls in low-income settings is shaped by unequal access to menstrual materials and inadequate school sanitation infrastructure. Existing research has focused primarily on the prevalence and predictors of individual menstrual products, with limited attention to whether multi-material use constitutes a structured behavioral phenomenon. We examined patterns of multi-material menstrual product use among junior high school girls in the Ashanti Region of Ghana and assessed whether these patterns varied across economic, institutional, and infrastructural conditions. METHODS: We employed a quantitative cross-sectional survey design involving 416 menstruating girls purposively selected from five junior high schools in the Ashanti Region. We collected data using structured questionnaires and analyzed them using frequencies, crosstabulations, Pearson chi-square tests, K-means cluster analysis, and one-way analysis of variance. RESULTS: We found statistically significant associations between tissue and toilet roll use (χ² = 48.424, p < .001), cloth and toilet roll use (χ² = 45.779, p < .001), and tampon and cotton use (χ² = 201.393, p < .001), indicating structured patterns of co-use. Our cluster analysis identified three distinct behavioral profiles: Minimal Multi-Material Users (72.4%), High Multi-Material Users (19.5%), and Selective Multi-Material Users (8.2%). Access to private toilet facilities differed significantly across clusters (χ² = 7.317, p = .026), whereas access to personal financial resources and school support showed limited variation. CONCLUSIONS/IMPLICATIONS: Menstrual health interventions should prioritize improvements in private sanitation infrastructure alongside material provision to support safer menstrual management experiences for adolescent girls.