The association between WASH, menstrual hygiene management, attendance and learning outcomes among girls in Ghana

Despite progress in girls’ school enrolment in many low-and-middle-income countries, gendered inequalities in educational outcomes persist, partly driven by school conditions. This study examines the relationships between school-based water, sanitation, and hygiene (WASH) facilities, school attendance, menstrual hygiene management (MHM), and learning outcomes among girls in Ghana. The study utilises cross-sectional data from 875 primary and junior high school girls across six districts, analysed using descriptive statistics and ordered logistic regression models. Findings show that access to basic school WASH facilities, particularly drinking water is significantly associated with improved learning outcomes. Girls attending schools with access to drinking water had more than three times higher odds of achieving better academic performance (OR = 3.223, 95% CI: 2.119–4.903], p < 0.001). Regular attendance was also positively associated with learning outcomes, increasing the odds of improved performance by 71.5% (OR = 1.715, 95% CI: 1.304–2.257, p < 0.001). In contrast, MHM was not independently associated with learning outcomes (OR = 0.766, 95% CI: 0.576–1.018], p < 0.067). The findings highlight the critical role of school WASH infrastructure and attendance in shaping girls’ learning outcomes and accentuate the need for integrated, gender-responsive education policies.