|Year : 2017 | Volume
| Issue : 2 | Page : 99-103
A descriptive study to assess the knowledge and practice regarding menstrual hygiene among adolescent girls of Government School of Shimla, Himachal Pradesh
Anjali Mahajan1, Kanica Kaushal2
1 Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
2 Department of Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
|Date of Web Publication||14-Mar-2017|
Department of Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan
Source of Support: None, Conflict of Interest: None
Introduction: Adolescent girls belong to vital age group, not only because they are the entrant population to motherhood but also because they are threshold between childhood and motherhood. The girls should be educated about significance of menstruation and development of secondary sexual characteristics, selection of sanitary menstrual absorbent and its proper disposal. Aims and Objectives: The objectives of the present study were to assess the existing knowledge and practice regarding menstrual hygiene among adolescent girls and to determine the co-relation of knowledge and practice score among the adolescent girls. Materials and Methods: The study conducted was a descriptive cross sectional study done on 100 adolescent girls from class 9th to 12th of Govt. Girls School in Shimla, Himachal Pradesh (Convenience sampling). Prior to the commencement of the study, they were explained the purpose and nature of the study. Information on demographic variables which include age, class, type of family, education of mother, family income, age of menarche were collected from the participants. Results: The data on knowledge scores revealed that 29% had adequate knowledge about menstrual hygiene, 71% had inadequate knowledge about menstrual hygiene. The data revealed on practice scores revealed that 19%, 69%, 12% samples had poor, fair and good score of practices regarding menstrual hygiene respectively. Knowledge and practice scores of participants shows positive correlation between the two scores (*P < 0.001). Conclusion: Lack of information about menstrual hygiene can be attributed to various factors which need to be studied separately. The above findings reinforce the need to encourage safe and hygienic practices among the adolescent girls and bring them out of traditional beliefs, misconceptions and restrictions regarding menstruation. The investigators improved the general awareness about cause of menstruation and the organs involved. Use of sanitary napkins was promoted and various schemes regarding menstrual health were briefed to the students. Early awareness can prevent students from suffering from the various reproductive tract infections.
Keywords: Adolescent, Himachal Pradesh, knowledge, menstrual hygiene, Shimla
|How to cite this article:|
Mahajan A, Kaushal K. A descriptive study to assess the knowledge and practice regarding menstrual hygiene among adolescent girls of Government School of Shimla, Himachal Pradesh. CHRISMED J Health Res 2017;4:99-103
|How to cite this URL:|
Mahajan A, Kaushal K. A descriptive study to assess the knowledge and practice regarding menstrual hygiene among adolescent girls of Government School of Shimla, Himachal Pradesh. CHRISMED J Health Res [serial online] 2017 [cited 2017 Sep 24];4:99-103. Available from: http://www.cjhr.org/text.asp?2017/4/2/99/201983
| Introduction|| |
Adolescents belong to vital age group not only because they are the entrant population to parenthood but also because they are threshold between childhood and adulthood. As they attempt to cross this threshold, they face various physiological, psychological, and developmental changes. The word “Adolescent” is derived from the Latin word “adolescere” which means to grow to maturity that indicates the defining features of adolescence.
Menstruation is the first indication of puberty. During puberty, the physical changes occur which transform the body of child into that of an adult, changes in body size, and changes in body proportions. A menstrual taboo is any social taboo concerned with menstruation. In some societies, it involves menstruation being perceived as unclean or embarrassing, extending even to the mention of menstruation both in public (in the media and advertising) and in private (among the friends, in the household, and with men). Many traditional religions consider menstruation ritually unclean. Most of the girls receive their gynecological information from their mothers, religious books, older sister, or a peer. However, such information was generally given after menarche rather than before. Hence, there is a need to provide healthy family life education to the woman particularly the adolescent girls (AGs).
Menstruation is still regarded as something unclean or dirty in Indian society. The reaction to menstruation depends on awareness and knowledge about the subject. The manner in which a girl learns about menstruation and its associated changes may have an impact on her response to the event of menarche. Although menstruation is a natural process, it is linked with several misconceptions and practices, which sometimes result into adverse health outcomes. Isolation of the menstruating girls and restrictions being imposed on them in the family, have reinforced a negative attitude toward this phenomenon. Menstrual practices are clouded by taboos and social cultural restrictions even today, resulting in AGs remaining ignorant of the scientific facts and hygienic health practices, necessary for maintaining positive reproductive health. Women having better knowledge regarding menstrual hygiene and safe practices are less vulnerable to reproductive tract infections and its consequences. Therefore, increased knowledge about menstruation right from childhood may escalate safe practices and may help in mitigating the suffering of millions of women. The social stigma attached to menstruation causes many girls and women to carryout dangerous hygiene practices. Lacking a platform to share menstrual hygiene problems, girls and women often suffer from discomfort and infection, avoiding urination during menstruation, and using any kind of cloth available old (or) unwashed as an, but still girls are not visiting medical practitioners.
Hence, the present study was planned to assess the knowledge and expressed practice regarding menstrual hygiene among AGs of Government Girls Senior Secondary School, Lakkar Bazar, Shimla, Himachal Pradesh.
Aims and objectives
The objectives of the present study were to assess the existing knowledge and practice regarding menstrual hygiene among AGs and to determine the correlation between the two and also to find out the association between the demographic variables and level of knowledge.
| Materials and Methods|| |
Sample size and sampling procedures
The sample size was determined using a formula for estimation of single population proportion with the assumption of 90% confidence interval, 5% margin of error, and prevalence of knowledge about menstruation at 50%, and sample size was calculated using open Epi version 3.01 as 96.
The study conducted was a descriptive cross-sectional study done on 100 AGs from class 9th to 12th of Government Girls School in Shimla, Himachal Pradesh (convenience sampling). Before the commencement of the study, they were explained the purpose and nature of the study. Those who all were present on the day of study and were willing to participate were included in the study. A self-administered, structured, pretested, closed-ended anonymous questionnaire consisting of questions on knowledge and practices regarding menstrual hygiene was used as a study tool.
Information on demographic variables which include age, class, type of family, education of mother, family income, and age of menarche was collected from the participants. The questionnaire consisted of questions regarding knowledge and practices regarding menstruation. Knowledge questions consisted of questions such as source of knowledge of menstrual cycle before menarche, knowledge of organ from where bleeding occurs, and cause of menstruation. Awareness about menstruation including physiological process, sources of information, and the best informant for information on the subject. Practice questions included type of absorbent used while menstruation, for example, sanitary pads, new cloth, old-washed cloth or both, about personal hygiene during menstruation, and frequency of changing pads, personal hygiene methods, for example, daily bath and handwashing (regular/irregular, water/soap). There were 20 multiple choice questions regarding knowledge and 17 multiple choice questions regarding practices on menstrual hygiene among AGs. For each correct response a score of “1” (one) and for wrong “0” (zero) score was given. Adequate knowledge was labeled if the participant scored ≥10/20 and <10/20 was labeled as inadequate knowledge. Similarly, practice scores were labeled as good (>14/17), fair (10-14/17), and poor (<10/17). Following data collection, queries from the participants relating to menstrual and reproductive health were clarified by the investigator. The pretested questionnaire was administered under supervision of the investigator to prevent the participants from sharing responses.
The study protocol was approved by the Ethics Review Board of the Indira Gandhi Medical College, Shimla. Participant's consent was obtained. Participants were recruited after being informed of the purpose of the study and assured of confidentiality. They were also assured of their right to withdraw from the study at any time without consequences and that participation was entirely voluntary.
Data were cleaned and entered in Microsoft Excel 2007 spreadsheet, and frequencies are presented in along with the percentages wherever appropriate. Data obtained were analyzed using SPSS statistical software package, version 16 (SPSS Inc., Chicago, IL, USA), and findings were reported in the form of descriptive statistics, quantitative variables using Chi-square test, and Fischer exact test and Pearson's correlation coefficient to assess the correlation between the knowledge and practice scores. A P ≤ 0.05 was used to indicate a statistically significant association.
| Results|| |
[Table 1] shows frequency and percentage of sociodemographic variables of the sample. The data on knowledge scores revealed that 29% had adequate knowledge about menstrual hygiene, and 71% had inadequate knowledge about menstrual hygiene.
The data revealed on practice scores revealed that 19%, 69%, and 12% samples had poor, fair, and good score of practices regarding menstrual hygiene, respectively.
[Table 2] shows that the education of mother had the significant effect on the knowledge scores of the participants. [Table 3] shows the correlation between the knowledge and practice scores of participants which shows positive correlation between the two scores (*P< 0.001).
| Discussion|| |
Numerous similar studies have been conducted nationally and internationally on the knowledge and awareness regarding menstrual hygiene in the past.,,,,,,, The present study revealed that 29% had adequate knowledge about menstrual hygiene, and 71% had inadequate knowledge about menstrual hygiene. Composite practice scores showed that 19%, 69%, and 12% samples had poor, fair, and good score of practices regarding menstrual hygiene, respectively. Indeed, the findings showed a significant positive association between good knowledge of menstruation and educational status of the mother only. Lack of information about menstrual hygiene can be attributed to various factors which need to be studied separately. The above findings reinforce the need to encourage safe and hygienic practices among the AGs and bring them out of traditional beliefs, misconceptions, and restrictions regarding menstruation. The investigators improved the general awareness about cause of menstruation, and the organs involved. The use of sanitary napkins was promoted, and various schemes regarding menstrual health were briefed to the students. Early awareness can prevent students from suffering from the various reproductive tract infections. Pamphlets were distributed among the AGs regarding the do's and do not's during menses, and they were asked to show the same at home to their mothers to enhance their knowledge about menstruation, menstrual, and personal hygiene so that they can educate their daughters at home.
The issue of menstruation is ignored or misunderstood mainly due to ignorance, taboos and misconceptions, and sociocultural factors that prevent women from articulating their needs. Implications of ignoring this issue are serious and at times life threatening. Sanitary napkins, if manufactured in hygienic manner, are universally accepted as a safe method of menstrual hygiene.
Following are the barriers to use of sanitary napkins:
- Lack of awareness
- Poor health-seeking behavior
- Limited availability of the product at economical prices
- Nonavailability in the rural and interior areas
- No space for cleaning/changing
- Absence of toilets for girls
- Shyness to buy napkin in shops
- Lack of disposal facilities
- Financial constraints.
To a certain extent, the above issues have been addressed in the state of Himachal Pradesh through Convergence of Ministry of Women and Child Development with Health Department. Under Menstrual Hygiene Programme for AGs, sanitary napkins are made available at AWC/Sub Centre Level for further distribution among the AGs at a very nominal cost (under the scheme, a pack of six sanitary napkins is provided under the National Rural Health Mission's brand “Freedays.” These napkins are sold to the AGs at Rs. 6 for a pack of six napkins in the village by the Accredited Social Health Activist (ASHA). On sale of each pack, the ASHA gets an incentive of Rs. 1 per pack besides a free pack of sanitary napkins per month. Anganwadi workers get trained for imparting knowledge regarding menstrual hygiene and get incentivized for distributing sanitary napkins to the AGs and the former. SABLA scheme was introduced as Centrally Sponsored Scheme for benefiting AGs in four districts of Himachal Pradesh, namely, Solan, Kullu, Chamba, and Kangra on November 19, 2010, which aims at covering AGs of the age group of 11–18 years, with main focus on out of school AGs.
Menstruation and puberty hygiene is rarely discussed at home as well as schools; especially in the regions, the current study was conducted. Due to some cultural and religious restrictions, many young girls in this country lack appropriate and sufficient information regarding menstrual hygiene causing incorrect and unhealthy behavior during their menstrual period. The girls should be educated about significance of menstruation and development of secondary sexual characteristics, selection of sanitary menstrual absorbent, and its proper disposal. So that she does not develop psychological upset and received education would indirectly wipe away the age-old wrong ideas and make her feel free to discuss menstrual matters without any inhibition.
The limitation of the study was that a narrower confidence interval was taken for sample size calculation, hence sample size was less. Further due to time constraints, we could not study the factors responsible for low knowledge and practice scores in the present study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Menstrual Taboo. Available from: https://www.en.wikipedia.org/wiki/Menstrual_taboo. [Last accessed on 2016 Sep 20].
Yasmin S, Manna N, Mallik S, Ashfaque A, Paria B. Menstrual hygiene among adolescent school students: An in-depth cross-sectional study in an urban community of West Bengal, India. IOSR J Dent Med Sci 2013;5:22-6.
Kamath R, Ghosh D, Lena A, Chandrasekaran V. A study on knowledge and practices regarding menstrual hygiene among rural and urban adolescent girls in Udupi Taluk, Manipal, India. Glob J Med Public Health 2013;2:1-9.
Santina T, Wehbe N, Ziade F. Exploring dysmenorrhea and menstrual experiences among Lebanese female adolescents. Eastern Mediterr Health J 2012;8:857-63.
Sapkota D, Sharma D, Budhathoki SS, Khanal VK, Pokharel HP. Knowledge and practices regarding menstruation among school going adolescents of rural Nepal. J Kathmandu Med Coll 2013;2:122-8.
Ade A, Patil R. Menstrual hygiene and practices of rural adolescent girls of Raichur. Int J Biol Med Res 2013;4:3014-7.
Thakre SB, Thakre SS, Reddy M, Rathi N, Pathak K, Ughade S. Menstrual hygiene: knowledge and practice among adolescent school girls of Saoner, Nagpur district. J Clin Diagn Res 2012;5:1027-33.
Lawan UM, Yusuf NW, Musa AB. Menstruation and menstrual hygiene amongst adolescent school girls in Kano, Northwestern Nigeria. Afr J Reprod Health 2010;14:201-7.
Dasgupta A, Sarkar M. Menstrual hygiene: How hygienic is the adolescent girl? Indian J Community Med 2008;33:77-80.
] [Full text]
[Table 1], [Table 2], [Table 3]