Original Research Published on July 1, 2024

 

Knowledge, Attitude and Practices of Menstrual Hygiene among High School Girls in Government Medical College Higher Secondary School, Thiruvananthapuram

Midhusha Mohana, Midhun Sunilkumara, Minnu Sara Thambia, Missiri Nagoorkhani Nizara, Mohammed Alia, Soumya Gopakumarb, Akshay K Rb

a. Final year MBBS Student at Government Medical College, Trivandrum;
b. Department of Community Medicine, Government Medical College, Trivandrum*

ABSTRACT

Menstrual hygiene encompasses practices and knowledge essential for maintaining cleanliness and health during menstruation. A cross sectional study was done to appraise the understanding of menstrual hygiene among 103 adolescent girls (grades 8-12) at Government Medical College Higher Secondary School in Trivandrum, conducted between July and September 2023. Socio-demographic factors, knowledge acquisition, and comprehensive KAP (Knowledge, Attitude, Practice) scores pertinent to menstrual hygiene were captured using a semi structured questionnaire. This encompassed pre-menstrual awareness, comprehension of menstrual blood’s origin, identification of hormonal triggers, familiarity with diverse menstrual products, preferred sanitary provisions, ablution rituals, and disposal methodologies. While 62.1% demonstrated prior knowledge of menstruation, a mere 50.5% understood the genesis of menstrual blood. Despite a commendable understanding of hormonal triggers (86.4%), recognition of items like tampons (34%) and menstrual cups (74.8%) displayed notable variability. Sanitary pads were the predominant choice (95.15%), with minimal utilization of cloth pads (1.94%) or alternative materials (2.91%). Approximately 58.3% conscientiously adhered to using soap and water for ablution, while 66.99% opted for incineration as the disposal method for used items. The study revealed critical disparities in menstrual hygiene comprehension among adolescents, necessitating bespoke educational initiatives to elevate practices and instill heightened awareness.

Keywords:  Menstrual Hygiene, Hormonal Triggers, Sanitation

 

Background and Rationale

Every month, 1.8 billion women across the world menstruate. Millions of these girls and women are unable to manage their menstrual cycle in a dignified, healthy way. 

Many adolescent girls face stigma, harassment and social exclusion during menstruation. Gender inequality, discriminatory social norms, cultural taboos, poverty and lack of basic services like toilets and sanitary products can all cause menstrual health and hygiene needs to go unmet.4,5

WHO calls for three actions:7

Firstly, to recognize and frame menstruation as a health issue, not a hygiene issue.

Secondly, to recognize that menstrual health means that women and girls who menstruate, have access to information and education about it; to the menstrual products they need; to study and work in an environment in which menstruation is seen as positive and healthy.

Thirdly, to ensure that these activities are included in the relevant sectoral work plans and budgets, and their performance is measured.

A proper study on this issue can throw light into the possible preventive strategies aimed at increasing awareness, early screening and lifestyle modifications to decrease the rising burden of diseases associated with unhygienic menstrual practices.2,3

OBJECTIVES

Primary Objective:

To assess the Knowledge, Attitude, Practices of menstrual hygiene among adolescent high school girls in Trivandrum.

Secondary Objective 

To assess the proportion of menstrual hygiene related problems like UTIs, Bacterial vaginosis.

METHODOLOGY

       Those who are absent on the day study is to be conducted.

Sample size:  n= 103

Sampling technique: Participants who meet the study criteria will be consecutively recruited to the study till the sample size is met.

Study Variables:

Outcome variable: Knowledge, Attitude and Practice of menstrual hygiene

Independent variable: Age, Religion, level of education, mother’s education, socioeconomic status etc.

Study Tools:  A semi structured questionnaire will be administered to collect data, which will consist of two parts.

Data collection procedure:  The Principal of Government Medical College Higher Secondary School, Trivandrum will be approached, introduced to the objectives of the study and seek the permission to conduct a study based on Menstrual Hygiene.

After obtaining permission the study procedure will be explained to the adolescent girls of classes 8,9,10 following which a consent for the study will be obtained from the parent through Part 1 of the questionnaire which also includes their biodata.

After taking consent, a questionnaire with questions appropriate to the survey will be provided to the group of students and their responds will be taken up.

Data Analysis: 

ETHICS CONSIDERATIONS

RESULTS

The study was conducted as a school based cross sectional study at Government Medical College Higher Secondary School, Trivandrum. The study subjects were adolescent high school girls of classes 8-12 during the period July 2023 -September 2023.

Estimated Sample size-100 and we collected data from 103 students.

A semi structured questionnaire was administered to collect data which consisted of 2 parts.

Part 1 dealt with socio demographic characteristics and Part 2 included questions to assess basic knowledge, attitude and practices of students regarding menstrual hygiene.

The results were analyzed under the following domains:

Domains 

1. Socio demography

            Mean=12

Standard deviation=1.358

N=103.  Please refer to Figure 4

Figure 1. Showing histogram of age distribution among the study participants (n=103)

Figure 2. Diagram showing the details of religion among the study participants (n= 103

Figure 3. Education status of mothers of study subjects (n=103)s (n= 103)

Figure 4. Histogram showing the age of attainment of menarche

2. Knowledge regarding 

88.3% thinks it is normal to have periods.

11.7% finds it abnormal.

Only 50.5% of the study population knew the correct origin of menstrual blood.  Please refer to Figure 6

86.4% knew that hormonal changes led to menstruation while 13.6% did not.

34% were aware of tampons and 74.8% were aware of menstrual cups.

Figure 5. Source of information about menstruation among the study participants (n=103)

Figure 6. Source of menstrual blood according to study subjects (n= 103)

3. Attitude and Practice

            95.15% of the study population used sanitary pads.

            1.94% used cloth pads 

            And the remaining 2.91% used other materials like menstrual cups. Please refer to Figure 7

            58.3%of the study population used soap and water to wash their external genitalia while 33.1%used only water. Please refer to Figure 9

            About two-thirds of the study population burned the used sanitary material.

            23.3% wrapped the used sanitary material and threw it in a garbage can.  Please refer to Figure 10

Figure 7. Types of sanitary material used (n= 103)

Figure 8. Frequency of washing external genitalia during menstruation (n= 103)

Figure 9. Material used to wash external genitalia (n= 103)

Figure 10. Method of disposal of sanitary pads (n= 103)

4. Total KAP Score

The maximum score attained was 11 out of 11.

The minimum score attained was 4 out of 11.

The mean score was 7.82 with standard deviation 1.412.

Among the study participants 38.8% had a good KAP score. Please refer to Figure 11

Figure 11. Histogram showing KAP scores of study population

5. Univariable analysis

There was no association between educational status of parents and KAP score on menstrual hygiene.  Please refer to Table 2

There was no statistically significant association between KAP scores on menstrual hygiene and symptoms of itching in genitalia or symptoms of Urinary tract infection.  Please refer to Table 3

There was no statistically significant association between KAP score and symptoms of vaginal discharge or pustules over genitalia. Please refer to Table 4

DISCUSSION

Improving menstrual hygiene among school-going children in India requires a comprehensive strategy involving various aspects:8

Majority of the study subjects got information from the mother / family regarding menstruation. Only 1.94 % got the information through schools. Education and Awareness: Implementing comprehensive menstrual health education programs that cover topics like reproductive health, menstrual hygiene, and debunking myths and taboos surrounding menstruation. These programs aim to empower both girls and boys with accurate information.2,3

Engagement of Parents and Teachers: Involving parents, guardians, and teachers in discussions and educational sessions can help create a supportive environment at home and in schools. This ensures that girls feel comfortable discussing menstrual issues and seeking help when needed

Access to Sanitary Products: in our study 2.91% used options other than sanitary pads. They were unaware on other environment friendly options like menstrua cups. Ensuring access to affordable and quality sanitary products is crucial. Initiatives providing free or subsidized sanitary pads or menstrual cups can significantly impact girls’ ability to manage their periods hygienically.

Sanitation Facilities: about 13 % of the study subjects did not frequently wash genital area. Schools should have adequate, clean, and private sanitation facilities. Access to clean water, disposal systems for sanitary waste, and private toilets are essential for maintaining good menstrual hygiene.6

Community Involvement: Engaging community leaders, local organizations, and NGOs in awareness campaigns and initiatives can help in breaking cultural taboos and promoting a supportive atmosphere for menstrual hygiene management. Monitoring and Evaluation: Continuous monitoring and evaluation of these interventions are crucial to assess their effectiveness and make necessary adjustments for better outcomes. By addressing these factors comprehensively, the aim is to create an environment where menstruation is understood as a normal biological process, and girls have the necessary resources, knowledge, and support to manage their periods hygienically and confidently.1

CONCLUSION

 The study highlights a varied landscape of knowledge, attitudes, and practices regarding menstrual hygiene among the school-going population. While a significant proportion had prior knowledge about menstruation, gaps existed in understanding the physiological aspects. Despite diverse practices, the majority maintained good hygiene practices during menstruation. However, there’s a need for enhanced education, especially regarding the physiological aspects of menstruation, proper disposal methods, and awareness about alternative menstrual products. The study didn’t find a direct link between parental education levels and menstrual hygiene scores, suggesting the need for broader interventions beyond family educational background. Additionally, the absence of statistically significant associations between KAP scores and health-related symptoms indicates a need for further investigation or a larger-scale study to elucidate potential correlations or causes. Overall, this study underscores the importance of comprehensive menstrual health education and practices tailored to address the identified knowledge gaps and ensure better menstrual hygiene management among school-going individuals

LIMITATIONS OF THE STUDY

Studying menstrual hygiene knowledge in a single school setting has its limitations:

To gain a more comprehensive understanding and make broader conclusions about menstrual hygiene knowledge, conducting studies across multiple schools or regions with diverse demographics and socio-economic backgrounds would provide a more nuanced and representative view.

End Note

Author Information

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

REFERENCES

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