Menstrual hygiene: knowledge and practice among adolescent girls in orphanage

INTRODUCTION

Adolescence proves to be the most vulnerable stage in the way of human life cycle after childhood, characterized by accelerated growth and development with a change from childhood to maturity.¹ The adolescent word is taken from Latin word ‘adolescence’ which means to grow into maturity.¹

For girls, menstruation is a physiological process which unprecedented to women that begins in puberty. It is periodic discharge of blood and mucosal tissue from the uterus for 4-5 days (average) occur regularly every 28-30 days of cycle.²

In India there are over 355 million menstruating women and girls but millions of girls across the country still facing significant problems to a comfortable and dignified experience with menstrual hygiene management.³

In India about 88% of women use homemade products (e.g., old cloth or rags) during their menstrual period. The main reasons for using cloth-based product are: personal preference and familiarity, lack of approach to or affordability for good-quality commercial sanitary pads, and lack of adequate information about pads. Some girls also use locally made cotton cloth. The reproductive tract infection (RTI) incidence was 70 percent more common among women and girls if they do not follow hygienic sanitary practices during menstruation.⁴

An orphanage is a residential institution or place faithful to the care of orphans-offspring whose biological parents are dead or otherwise not capable or unenthusiastic to take care of them.⁵

Orphanage girls are vulnerable group in our society. Adolescent girls at the age of menarche usually seek information either from mother or elder sister. Due to unavailability of health counselor, the adolescent girls have no information about menstruation and menstrual hygiene.

With this background study was carried out to evaluate the knowledge and practices regarding menstrual hygiene among adolescent girls residing in selected orphanage of Haryana.

METHODS

Study design, setting, period and participants

This is a descriptive survey done during September 2017 to December 2017. Total 150 adolescent girls selected by purposive sampling technique from selected 7 orphanages in 5 districts of Haryana.

Inclusion criteria

Adolescent girls those who had attained menarche and willing to participate included in the study.

Exclusion criteria

Adolescent girls those who were mentally challenged and not able to read and write Hindi excluded from the study.

Questionnaire

Structured knowledge and practice questionnaires were used for data collection.

The reliability co-efficient for the structured knowledge questionnaire was calculated by using Kuder Richardson (0.68) and reliability of the structured practices questionnaire was calculated by test-retest (0.76) it was found reliable.

RESULTS

Sample characteristics

Data were analyzed using SPSS-20. More than half (62.7%) of adolescent girls were in the age group of 12-15 years. Less than half (44.7%) adolescent girls were having education status between 6^th-8^th standard. Half (50.7%) of adolescent girls had age of menarche at 12 year. Majority of the adolescent girls 112 (74.7%) belonged to Hindu religion. Majority of the adolescent girls 125 (83.3%) had discomfort during menstruation. Nearly three fourth (75.3%) adolescent girls had information regarding menstrual hygiene. Less than three fourth of (70.7%) adolescent girls reported that sanitary facilities are present in orphanages. One third of (34%) adolescent girls reported that waste management facility not available in orphanage.

Table 1 showed the level of knowledge on menstrual hygiene among adolescent girls. Majority of adolescent girls (67.3%) had below average knowledge regarding menstrual hygiene, and only 16% adolescent girls had good knowledge regarding menstrual hygiene.

Figure 1 depict that majority of the adolescent girls in selected orphanages 143 (95.3%) were using sanitary pad during menstruation. More than half (50.7%) of adolescent girls dry the cloth in sunlight exposure, 25.3% dry it in girls bathroom and 26 (17.3%) hidden inside (under bed).

It was found that more than one third of (38.7%) adolescent girls changed pad/cloth more than three times in a day, (35.3%) did change thrice a day, 14.7% did change twice a day and 11.3% did once a day. Figure 2 showed that more than half (67.1%) adolescent girls washed soiled cloths with water only, 10 (14.9%) with soap and water, 13.43% soap and hot water and 4.47% hot water only.

Figure 3 depict that more than third fourth girls (76%) disposed the pad in dustbin, followed by open field 10%, in drain 7.30% and in toilet 6.7%

Less than half 68 (45.30%) adolescent girls did not go to school during menstruation. It was found that half of the girls (50%) girls changed their undergarments daily and 26 (17.30%) girls changed undergarments only after soiling during menstruation. Majority of the girls 148 (98.80%) faced problems during menstruation in which 50 (33.3%) adolescent girls faced religious limitation, 40 (26.7%) girls faced problem related to disposal, 28 (18.7%) faced problem related to availability of sanitary pad and 31 (20.7%) girls faced other problems such as dietary restrictions, personal hygiene like hair wash related problems.

DISCUSSION

In the present study, (62.7%) adolescent girls were between the age group of 12-15 years as this is the normal menarcheal age. These findings were concordance with the study conducted by Hossain et al in which 63% adolescent girls were in the age group of 12-15 years.⁶ These findings were similar with the study conducted by Pandit et al in which 88.5% adolescent girls were in the age group of 12-15 years.⁷

It was observed that half (50.7%) of the adolescent girls had age of menarche at 12 year. These findings were similar with the study conducted by Debnath et al in which (50.4%) girls had age of menarche at 12.06 yrs.⁸

It was found that (74.7%) adolescent girls belonged to Hindu religion because current setting is in northern part where Hindu religion is prominent. These findings were consistent with the study conducted by Rokade et al which showed that more than half (67.5%) of the girls belonged to Hindu religion.⁹

In the present study found that nearly three fourth (75.3%) adolescent girls had information regarding menstrual hygiene. The main source of information about menstrual hygiene was care taker for 45 (39.8%) girls. These findings were consistent with the study conducted by Pradesh et al in which 69% adolescent girls had information regarding menstrual hygiene.¹⁰ Whereas in contrast to these findings with the study conducted by Ibrahim et al in which only 52% adolescent girls had information regarding menstrual hygiene.¹¹

In current study found that more than half of adolescent girls (67.3%) had knowledge level below average, 16% adolescent girls had knowledge level good because they not getting proper information from counselor or their care taker. These findings were consistent with the study conducted by Vandana et al in which half of the adolescent girls 50.5% had knowledge level below average, 19% adolescent girls had knowledge level good regarding menstrual hygiene.¹²

In the present study most (95.3%) of adolescent girls used sanitary napkin during menstruation. These findings were inconsistent with the study conducted by Sudeshna et al in which only 13.24% adolescent girls used sanitary napkin during menstruation.¹³ These findings were inconsistent with another study conducted by Anuradha et al in which only 11.25% adolescent girls used sanitary napkins during menstruation.¹⁴ In current setting pads were made available by counselor. It was observed that 50.76% adolescent girls dry the sanitary cloth in sunlight exposure. These findings were inconsistent with the study conducted by Pradesh et al in which 61.60% adolescent girls dried the sanitary cloth in sunlight exposure.¹⁰ In the present study more than one third of (38.7%) adolescent girls changed pad/cloth more than three times in a day, followed by thrice a day 53 (35.3%), twice a day 22 (14.7%) and once a day 17 (11.3%) because easy availability of the pads. These findings were inconsistent with the study conducted by Pandit et al in which 5.5% adolescent girls changed pad/cloth more than three in a day.⁷

CONCLUSION

The study was conducted to assess the knowledge and practices of adolescent girls who residing in orphanages by using structured knowledge and practices questionnaire. Based on the results of the present study, it was concluded that the knowledge of menstruation and menstrual hygiene among adolescent girls was poor. Almost all girls used sanitary napkins during menstrual period.

ACKNOWLEDGEMENTS

I express my sincere gratitude to the all the adolescent girls for their whole hearted participation and cooperation in the study. I express my sincere thanks and deepest sense of gratitude to Dr. Poonam Sheoran and Mrs. Adiba Siddiqui for their valuable suggestions.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee of MM University, Mullana, Ambala, Haryana

REFERENCES

1. 1. A Study on Impact of Iron Folic Acid along with Vitamin-C on the Hemoglobin status of Adolescent AGs in an ICDS Block. National Institute of Public Cooperation and Child Development Regional Centre, Lucknow, India; 2012: 11. Available at: nipccd.nic.in/reports/rcl_ifa.doc. Accessed on 27 December 2012.
2. 2. PCA, Roy A, Sara AB, Vcm F, Babu GP, Tamrakar A. Knowledge Regarding Menstrual Hygiene among Adolescent Girls in selected school, Mangalore with a View to Develop an Information Booklet. IOSR J Nursing Health Sci. 2014;3(1):55-60.
3. 3. Spot On! Improving Menstrual Health and Hygiene in India. Report. Dasra, Kiawah Trust, and USAID, 2014. Available on 5 July 2017.
4. 4. Garg R, Goyal S, Gupta S. India moves towards menstrual hygiene: subsidized sanitary napkins for rural adolescent girls-issues and challenges. Matern Child Health J. 2012;16(4):767-74.
5. 5. Available at: https://en.wikipedia.org/wiki/ Orphanage. Accessed 29 January 2018.
6. 6. Hossain S, Sharma P, Sen V. A Study of the Knowledge and Practice Regarding Menstrual Hygiene in Rural Adolescent School Going Girls in an Indian Cosmopolitan City. 2017;3(3):185–7.
7. 7. Pandit D, Kumar Bhattacharyya P, Bhattacharya R. Menstrual Hygiene: Knowledge and Practice among Adolescent School Girls In rural areas of West Bengal. IOSR J Dent Med Sci Ver III. 2014;13(6):2279–861.
8. 8. Debnath M, Sarkar J. Pre Menarcheal Knowledge and Some Socio-Behavioral Variables: A Community Based Comparative Study on Bengali Women. IOSR J Dent Med Sci. 2017;16(1):26–31.
9. 9. Rokade HG, Kumavat AP, Gorakh Rokade H. Study of Menstrual Pattern And Menstrual Hygiene Practices Among Adolescent Girls. Natl J Community Med. 2016;7(5):398-403.
10. 10. Pradesh U, Shukla MK, Priya N, Srivastava A. A cross sectional study of knowledge and practices regarding menstrual hygiene, in undergraduate student girls. 2016;3(7):1759–64.
11. 11. Ibrahim El-Mowafy R, Moussa Mohamed Moussa M, Hassan El-Ezaby H. Effect of Health Education Program on Knowledge and Practices about Menstrual Hygiene among Adolescents Girls at Orphanage Home. IOSR J Nurs Heal Sci Ver I. 2014;3(6):48-55.
12. 12. Vandana V, Simarjeet K, Amandeep K. Assessment of knowledge of adolescent school going girls regarding menstruation and menstrual hygiene. International J Applied Res. 2016;2(9):240–6.
13. 13. Sudeshna R, Aparajita D. Determinants of menstrual hygiene among adolescent girls: a multivariate analysis. National J Comm Med. 2012;3(2):294–301.
14. 14. Anuradha, Raghavendra H, Chayal V. A Study on Menstrual Hygiene among rural Adolescent girls. Indian J Health Wellbeing. 2013;4(9).