School-based interventions of menstrual hygiene management in Indonesia: systematic literature review

Adolescence represents a critical phase in which menstrual hygiene management (MHM) significantly affects the health, education, and psychosocial development of girls. In Indonesia, poor MHM is prevalent due to limited knowledge, cultural taboos, inadequate school-based education, and insufficient Water, Sanitation and Hygiene (WASH) facilities. Although various school-based MHM interventions have been introduced, their designs and outcomes are heterogeneous, and a comprehensive synthesis of their effectiveness is lacking. Schools represent a strategic platform for implementing health education and promoting practical change. However, evidence specific to Indonesia, as this country has its cultural diversity, educational system, and national health policies, has not been systematically reviewed. This review aims to synthesise current evidence on school-based MHM interventions in Indonesia, focusing on their impact on adolescent girls’ knowledge, attitudes and practices related to menstruation. This systematic review is registered with PROSPERO (ID: CRD420251082789) and follows the PRISMA 2020 reporting guidelines. A manual search was conducted across three Indonesian national journal databases: Garuda, Perpusnas, and ISJD, from June 15 to July 2, 2025. Eligible studies were peer-reviewed, full-text original articles in Bahasa Indonesia or English, published between 2019 and 2024, with quantitative experimental designs. Inclusion criteria focused on MHM interventions conducted in formal educational settings targeting girls aged 10–19. Studies not conducted in Indonesia, not school-based, or lacking an experimental design were excluded. Titles and abstracts were manually screened, followed by independent full-text review and quality appraisal by multiple reviewers to ensure the rigorous selection and minimise bias. Out of 687 initially identified articles from three Indonesian national databases, a total of 13 articles were included in this review. The educational level of participants in the included studies was junior high school (9), senior high school (2), and primary school (2), with an age range from 10 to 18 years old, and the total sample was 960 students. The studies were conducted in most areas of Java (10), and the other three were from Bengkulu, Maluku, and South Sulawesi, respectively. The interventions in the included studies were experimental designs, with 7 studies being pre-experimental and 6 being quasi-experimental. Most interventions demonstrated improvements in knowledge and attitudes. However, evidence of sustained practical change remains weak due to reliance on self-reported, non-validated instruments. The review suggests the potential effectiveness of school-based interventions in improving knowledge, attitude and practice of adolescents regarding menstrual hygiene practice. However, a thorough evaluation of these studies revealed significant methodological limitations that must be acknowledged in interpreting these results. Future studies could explore the other effective interventions of MHM and use more rigorous instrument methods. PROSPERO registration number: CRD420251082789.