Original Research Article Panacea Journal of Medical Sciences, January-April,2016;6(1): 31-33 31 Menstrual Hygiene: Knowledge and Practice among Adolescent School Girls Channawar Kanchan1,*, Prasad VSV2 1Consultant Paediatrician, 2Chief Pediatric Intensivist and Neonatologist, Dept. of Paediatrics, Lotus Hospital for women and children, Lakadikapul, Hyderabad, Telangana 500035 *Corresponding Author E-mail: drkanchanc@yahoo.co.in Abstract Menstruation is generally considered as unclean in the Indian society. Isolation of the menstruating girls and restrictions being imposed on them in the family, have reinforced a negative attitude towards this phenomenon. There is a substantial lacuna in the knowledge about menstruation among adolescent girls. Good hygienic practices such as the use of sanitary pads and adequate washing of the genital area are essential during menstruation. This cross-sectional, questionnaire-based study was carried out to assess the knowledge and the practices of menstrual hygiene among rural and urban school going adolescent girls in Sharda Vidyalaya, Hyderabad. Two hundred and sixty three adolescent girls of age 13-16 years were involved in this study. A pre-designed pre-tested semi-structured questionnaire was prepared for collection of data. Only 154 (58.5%) of the participants were aware about menstruation before menarche and the most important sources of the information were grandmothers, and friend, while sisters, mother and teachers were the other sources. Majority 226 (85.9%) of the girls were not aware of the cause of the bleeding. There are different types of restrictions which were practiced during menstruation. We concluded that the proper menstrual hygiene and correct perception can protect the women from suffering. The girls should be educated about the facts o f menstruation, physiological implication, about the significance of menstruation and development of secondary sexual characters, and above all about proper hygienic practices and selection of disposable sanitary menstrual absorbent. Keywords: Adolescent girls, Menstruation, Menstrual hygiene and practice. Introduction Adolescents are a major and most developing building block of the world’s population. A culture of silence surrounds the topic of menstruation and related issues; as a result many young girls lack appropriate and sufficient information regarding menstrual hygiene. These social taboos and cultural barriers create various problems for these growing girls. Menstruation is still regarded as something unhygienic or dirty in our Indian society. The reaction to menstruation depends on awareness and knowledge about the problem. 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(1). In many parts of the developing countries, menstruation and related issues are supposed to be invisible and silent. This leads to lack of appropriate information regarding menstrual hygiene. This may result in inaccurate and unhealthy behavior during their menstrual period. Menstrual hygiene deals with the health issues and requirements of young girls during menstruation or menstrual cycle. Attitude of parents and society in discussing the related issues are obstacle to the right kind of information, especially in the rural areas. Menstruation is thus considered to be a matter of awkwardness in most cultures. Menstrual hygiene is an issue that is inadequately acknowledged and has not received enough attention in the reproductive health and Water, Sanitation and Hygiene (WASH) sectors in developing countries including India and its relationship with and impact on achieving many Millennium Development Goals (MDGs) is rarely acknowledged. Studies that make this problem visible to the concerned policymakers and inform practical actions are very much warranted. The interplay of socio-economic status, menstrual hygiene practices and RTI are noticeable. Women having better knowledge regarding menstrual hygiene and safe practices are less vulnerable to RTI and its consequences(2). Therefore, increased knowledge about menstruation right from early days may escalate safe practices and may help in mitigating the suffering of millions of women. With this background our study was conducted to evaluate the knowledge, beliefs, and source of information regarding menstruation among the adolescent girls of the secondary school and also to identify the status of menstrual hygiene among them. Material and Methods A cross-sectional, questionnaire-based study among adolescent school students was conducted in Sharda Vidyalaya in Hyderabad in August 2015. Two hundred and sixty three adolescent girls of age 13-16 years were involved in this study. A pre-designed pre- tested semi-structured questionnaire was prepared for data collection. The school authority was contacted and the purpose of the study was explained. After taking consent from the school the study was started. The girls were explained about the rationale of the study and were assured of privacy. Consent was obtained verbally from the girls before administering the questionnaire which included questions regarding the knowledge and awareness regarding menstruation, the source of information and practices followed to maintain Channawar Kanchan et al. Menstrual Hygiene: Knowledge and Practice among Adolescent School Girls Panacea Journal of Medical Sciences, January-April,2016;6(1): 31-33 32 menstrual hygiene. The demographic data including family details, parent’s education, occupation, housing conditions, house type, toilet facility, and water supply in the toilet were enquired and documented. The menstrual hygiene questionnaire included questions about the type of absorbent used, its storage place, the use of clean or unclean napkins and the frequencies of changing and cleaning them. The data about personal hygiene included washing and bathing during menstruation, the practice of wearing washed clothes. Before filling the questionnaire, they were instructed on how to fill. Adequate time was given to read and fill up the questionnaire. The students were asked to drop their sheets in a drop box provided after completion. This was followed by a talk on the normal physiology of menstruation, the importance of maintaining hygiene and safe hygienic practices during menstruation. Queries and concerns of the participants were also addressed. Data were then compiled in an Excel sheet and were analyzed by using Epi Info™ Version 3.5.1 (Release Date: August 18, 2008). Appropriate statistical tests were applied to study the test of significance. Results In the present study, 263 adolescent girls of age group 13-18 years of class 8- 10 were included. The study population were mainly Hindu (71%), and nuclear family, number of family member being between 5-10, the education of their mothers are mostly secondary. It was evident that only 154 (58.5%) of the participants were aware about menstruation before menarche and the most important sources of the information were grand mothers, and friend, while sisters, mother and teachers were the other sources. Majority 226 (85.9%) of the girls were not aware of the cause of the bleeding, only 22 (8.3%) knew about the source of menstrual blood is uterus and 178 (67.6%) knew that it’s a natural phenomenon. The study on the practices during menstruation showed that 240(91.2%) girls used sanitary pads during menstruation, 18 (6.8%) girls used cloth pieces and 5(1.9%) used tampons. Out of 263 girls who used sanitary napkins or cloths, 5.3% girls changed it once a day, 17.1% twice a day, 49.1% girls thrice a day, 28.5% girls changed it 4 times a day. 74.1% girls threw the pads in house dustbin and 25.8% girls flushed in toilet. 92% girls thought menstruation to be dirty, 87.8% girls bathed daily during menses. 33.4% girls washed the genitals with only water and 66.5% girls with soap and water. 246 (93.5%) girls washed hands regularly after using washroom. There are different types of restrictions which were practiced during menstruation. Among them, 217 (82.5%) girls did not attend any religious activity or visit temples, 46 (17.4%) girls were not allowed to do the household work, 46 (17.4%) girls were not allowed to sleep on the routine bed, 4 (1.5%) girls were not allowed to play outside, and 5 (1.9%) girls were not allowed to attend marriages during menstruation while 14 (5.3%) had food restriction during menstruation. Discussion The present study was conducted in 263 adolescent girls of which majority girls (78.7%) were of age group 13-15 years. Drakshayani DK et al(3) reported the age of menstruating girls as 14-17 years with maximum (76.3%) number of girls between 14-15 years of age which is in accordance with our findings. Though it is desirable to have school teacher or health worker to be the first source of information ensuring that right knowledge has been imparted, it was seen that major source of information in the study was grandmother (41.1%) followed by friends (40.3%) which is also similar to other studies(4-8). It was observed that the most common source of information were mothers which retells the fact that mothers of adolescent girls should be essential part of all programs on adolescent health and especially menstrual hygiene. It was seen that though almost all girls had heard about menstruation, the level of knowledge was poor which is similar to study by Shanbhag D et al(9). It was observed in this study that 67.6 % girls’ believed it to be a physiological process, whereas in a similar study, 86.2% believed it to be a physiological process(7). It was very sad to observe in the study, that most of the girls (85.9%) did not know the cause of the menstrual bleeding. Only 8.3% of the study girls were aware that menstrual bleeding came from the uterus which is accordance with the similar study(10). The hygiene related practices of women during menstruation are of considerable importance, as they affect their health by increasing their vulnerability to infections, especially infections of the urinary tract and the perineum. Studies which were reported from India and other developing countries have highlighted the common practices which have prevailed among the adolescent females(7,11). It was seen in present study that 91.2% used pads and 6.8% used clothes whereas in similar study conducted it was found that 62% girls used clothes while 38% used sanitary pads. The use of pads was higher which was probably due to the fact that availability was high in these areas and also due to influence of television which has increased awareness regarding availability and use of sanitary napkins. Other researchers, in their studies, also reported that more than three fourth of the girls used cotton clothes and reused them after washing(12-14). Privacy for washing, changing or cleaning purpose is something very important for proper menstrual hygiene. In the study, it was found that 66.5% girls washed the genitals with soap and water, 33.4% with only water. A study which was conducted by another author revealed that only 34.3% of the girls satisfactory cleaned their genitalia (13, 15). Soap and water were the commonest materials which were used by 223 girls (57.2%) for cleaning the Channawar Kanchan et al. Menstrual Hygiene: Knowledge and Practice among Adolescent School Girls Panacea Journal of Medical Sciences, January-April,2016;6(1): 31-33 33 external genitalia. In the present study, the commonly practiced methods of disposal of the used absorbent were, house dustbin 74.1%. Different restrictions like 217 (82.5%) girls did not attend any religious activity or visit temples, 46 (17.4%) girls were not allowed to do the household work, 46 (17.4%) girls were not allowed to sleep on the routine bed, 4 (1.5%) girls were not allowed to play outside, and 5 (1.9%) girls were not allowed to attend marriages during menstruation while 14 (5.3%) had food restriction during menstruation, possibly due to the different rituals in their communities; the same were practiced by their mothers or other elderly females in the family, due to their ignorance and false perceptions about menstruation. It emphasizes upon developing healthy attitude towards human reproduction and family life among older school students. Health professionals should organize educative sessions for parents so that they can be trained to give adequate knowledge on reproductive health problems to their children. Conclusion This study was conducted to ascertain knowledge of menstrual hygiene among the adolescent girls. The study revealed that the knowledge on menstruation is poor and the hygiene practiced is often not optimal. We concluded that the proper menstrual hygiene and correct perception can protect the women from suffering. The girls should be educated about the facts of menstruation, physiological implication, about the significance of menstruation and development of secondary sexual characters, and above all about proper hygienic practices and selection of disposable sanitary menstrual absorbent. This can be achieved through educational television programs, compulsory sex education in school curriculum and through school/nurses health personnel. Thus the above findings support the need to encourage safe and hygienic practices among adolescent girls and bring them out of traditional beliefs, misconceptions and restriction regarding menstruation. Menstrual health is an important part of life cycle approach to women’s health, so it is important for all adolescent girls that they should get a loud and clear messages and services on this issue. Conflict of Interest: None Source of Support: Nil References 1. Rao S, Joshi S, Kanade A. Height velocity, body fat and menarcheal age of Indian girls. Indian Pediatr 1998;35:619-28. 2. Wasserheit JN. The significance and scope of reproductive tract infections among Third World women. Suppl Int J Gynecol Obstet 1989;3:145-68. 3. Drakshayani DK, Venkata RP. A study on menstrual hygiene among rural adolescent girls. 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