Knowledge, attitude and practice about menstruation and menstrual hygiene among adolescent school girls of rural field practice area of tertiary care hospital, Nandyal, Andhra Pradesh: a cross-sectional study

INTRODUCTION

Menarche is the most important event take place in adolescent girl; generally, it starts age between 10-15 years and menstruation is the onset of puberty, it is a physiological process among females who experience shedding of blood for 1-7 days from uterus, in every month from the age of maturity until menopause.¹ Due to lack of knowledge on menstruation and due to shyness and embarrassment they won’t gather the information regarding menstruation. Menstruation is a natural process but it is still a taboo in Indian society as it is considered unclean and dirty.² Hygiene-related practices of women during menstruation are of considerable importance, as it has a health impact in terms of increased exposure to reproductive tract infection (RTI) and sexually transmitted infections and its complications.³

Adequate washing of the genital areas and use of sanitary pads are good hygienic practices, which are essential during menstruation period and as practices of menstrual hygiene may reduce the occurrence of RTI and its complications.⁴ women’s perceptions of menstruation in India may vary among different religions. As an women have to face number of taboos in her lifetime during the menses, there is lack of knowledge and misunderstanding about menstruation among women in India before and after occurring the menarche.⁵ menstrual hygiene is a great challenge for young girls residing in rural areas.⁶

Studying the knowledge and the practices of menstruation are beneficial for planning a program for improving the awareness to their life processes and promoting their quality of life.⁷

Aim

Aim of the study was to estimate the knowledge, attitude and practice about menstruation and menstrual hygiene.

Objectives

Objectives were to study their knowledge about menstruation and to know the attitude and practice of menstrual hygiene.

METHODS

A school based cross sectional study was conducted among high school girls of 8^th, 9^th and 10^th classes of population of RHTC field practice area of Santhiram medical college and general hospital, Nandyal during August-September 2023 (2 months) by using Simple random sampling method with sample size 230, study tool was pre-designed, pre-tested, semi structured questionnaire. Data was collected by interview method and analysed by SPSS 25 version. Ethics committee clearance was obtained before conducting the study.

Inclusion criteria

Girls who are present at the time of data collection in the school in RHTC area, who are willing to participate voluntarily and give written informed assent were included in study.

Exclusion criteria

Those who are not present at the time of data collection. Who are not willing to participate and not give written informed assent, were excluded.

Data was analysed by using SPSS 25 version.

RESULTS

Figure 1 shows age distribution, out of 230, majority were under 13 years of age it’s about 43%, 28% were under the age group of 15 years, about 27% under the age group of the 14 years and about 2% were under the age group of 16 years.

Here, Figure 2 shows the distribution according to the religion out of 230, majority of 49% were following the Hindu religion, about 31% were Muslim religion and about 20% were following Christianity.

Here, the Figure 3 shows the distribution according to the education, majority with 41.3% were studying 8^th class, about 33% were in 9^th class and about 25.7% were in 10^th class.

Figure 4 shows the educational status of girl’s father’s and mothers’ education, regarding father’s education majority of 67.40% are underwent schooling, 20% were illiterate, 10% were studied intermediate and 2.60% were with professional degree.

Regarding mother’s education majority of 60.90% are underwent schooling, 23.90% were illiterate, 12.60% were studied intermediate and 2.60% were with professional degree (Figure 4).

Table 1 shows the knowledge about menstruation and menstrual hygiene, about 57.8% having the knowledge that 5->5 days are the normal physiological bleeding days of menstruation per cycle, 54.8% having the knowledge of normal duration of menstrual cycle that is 20-30 days, about 57.8% having the knowledge that menstruation is a normal process, about 74.8% their mother is the first source of information.

About 54.3% and 60% don’t having the knowledge regarding the cause of menstruation and origin of blood during menstruation respectively.

About 94.8 are aware of seeking knowledge regarding the menstrual education in school.

Table 2 shows the attitude about menstruation and menstrual hygiene, about 76.1% are Attending school during the menses, about 79.6% bathing daily during menses and about 60% Performing household activities during menses

About 78.7% and 60% following the cultural activities like not visiting the holy places and not attending social activities during menstruation.

About 68.7% are not embarrassed to buy pads, but about 31.3% still feel shy and embarrassed to buy pads openly.

Table 3 shows the practice about menstruation and menstrual hygiene, about 76.5% were using sanitary pads during menses, about 73% are practicing the hygienic process by cleaning the external genitalia after changing the pad, about 41.3% were changing the pads thrice a day and about 67% using the school washroom for changing the pads.

About 51.7% were practicing the disposal of used materials in dust bin.

P<0.05 is considered significant.

Table 4 shows there is significant association between education and buying pad is embarrassing with p=0.001.

DISCUSSION

In this study about 43% were under the age 13 years, 27% are in 14 years and 28% in 15 years and 2% in 16 years whereas 47% in the age of 13 years, 16% in 14 years and 3% are more than 15 years of age in Thakre et all study.⁷

Regarding knowledge majority of girls in the present study shows that their first source of information regarding menstruation if from their mother’s constituting about 74.8% which is less when compared to the study conducted by Murthy et al is 77.2%, where as in Syed et al it is about 48.6%.^2,8 where regarding the religion distribution in this study shows the majority with Hindus with 49%, Christians with 20% and Muslims with 31% whereas in Murthy et al is 80.8% were Hindus, 14% were Christians and 1.2% were Muslims.² in this study about 60% do not know the origin of blood during the menstruation whereas in Syed et al a majority of 91.2% don’t know the origin of blood.⁸

Regarding the attitude majority of girls in the present study shows the material used while menstruation is sanitary pads with 76.5%, whereas in Kotian et al its about 58%.⁵

Regarding practice majority of girls in the present study shows the number of times pad changes/day were trice is about 41.3% which is 42.3% in a study conducted by Parle et al the disposal of used sanitary pads were majority in dustbins with 51.7% in this study which is less when compared to the study conducted by Parle et al is 77%, and in this study regarding the cultural activities with majority of girls are not visiting holy places during the menstruation is 78.7% whereas in Parle et al is 88.9%, in this study about 67% changing the pad in school whereas 12.45% in urban and 9.59% in rural area in Thakre et all study.^1,7

In this present study majority of girls have aware that menstruation is a natural process about 57.8% whereas in Murthy et al is 90%, whereas in 96.50% in Shah et al.^6,9-17

Limitations

Follow up of each student was difficult as time period and sample size were less.

CONCLUSION

This study concludes that the information about menstruation and menstrual hygiene is a challenging factor in young age girls in rural areas. This study results shows that girls have a poor knowledge, attitudes and practices regarding menstruation and menstrual hygiene. The school administration and health facilities should conduct various awareness programmes regarding menstruation and menstrual hygiene.

Recommendations

This study suggests that knowledge, attitude and practice towards the menstruation are need to be improved by health education, frequent training activities and IEC activities can improve their practice hygiene and avoid the occurrence of any disease.

ACKNOWLEDGEMENTS

Authors would like to thank professor and HOD, co-authors, of the institute also, to department MSW’s, the school faculty and the participants for their participation and kind co-operation.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Parle J, Khatoon Z. Knowledge, attitude, practice and perception about menstruation and menstrual hygiene among adolescent school girls in rural areas of Raigad district. Int J Community Med Public Health. 2019;6(6):2490-7.
2. 2. Murthy SKK, Mounika S, Hanumanth N, Kolli B. Knowledge and practice of menstrual hygiene among tribal adolescent girls in Visakhapatnam district, A. P. Int J Community Med Public Health. 2022;9(8):3269-73.
3. 3. Sultan S, Sahu DS. Knowledge, attitude and practices about menstruation and related problems in adolescent girls. Int J Reprod Contracept Obstet Gynecol. 2017;6(12):5235-40.
4. 4. Nelapati SS. Knowledge, attitude, and practices assessment of menstrual cycle and management of menstrual hygiene among adolescent girls. Int J Community Med Public Health. 2022;9(3):1453-8.
5. 5. Kotian SM, Chaudhary VK, Mutya VS, Sekhon AS, Sriraman S, Prasad P. Assessment of knowledge, practice and perception of menstruation among adult women in the reproductive age group, in Mangalore, India. Int J Reprod Contracept Obstet Gynecol. 2017;6(10):4595-01.
6. 6. Shah SF, Punjani NS, Rizvi SN, Sheikh SS, Jan R. Knowledge, Attitudes, and Practices Regarding Menstrual Hygiene among Girls in Ghizer, Gilgit, Pakistan. Int J Environ Res Public Health. 2023;20(14):6424.
7. 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. 2011;5(5):1027-33.
8. 8. Syed AUY. Practices of Menstrual hygiene among urban adolescent girls of Hyderabad. Indian J Basic Appl Med Res. 2014;4(1):478-86.