Abstract
Background:
The onset of menstruation is an important event in a woman’s lifecycle. It is associated with taboos and sociocultural restrictions. Faulty hygienic practices increase the risk of reproductive tract infections (RTI), leading to further complications if left untreated. With this background, the study was planned to assess adolescent school girls’ knowledge of menstruation and menstrual hygiene as well as their practices of menstrual hygiene.
Materials and Methods:
A community-based cross-sectional study was conducted in Nagaon, Barpeta district, Assam, among 170 adolescents aged between 10 and 19 years, using a convenient sampling technique. A predesigned, pretested, semi-structured questionnaire was used to collect the information from the study participants. Data analysis was done using SPSS version 17 and the results were expressed in percentages.
Results:
The study reveals that 91.76% of the adolescents knew that menstruation was normal. About 27.65% of the study participants did not know the cause of menstruation, and 54.12% did not know about the source of menstrual bleeding. Only 33.53% knew that uterus is the source of bleeding. About 61.76% of the study participants knew about the duration of a normal menstrual period. Regarding practices, 74.12% of the adolescents use sanitary pads during menstruation, 18.82% use cloth, and 7.06% use both cloth and sanitary pads. In about 63.53%, the method of disposal of used absorbent was throwing with domestic waste.
Conclusion:
The current study has revealed that menstruation and menstrual hygiene knowledge is poor among adolescent girls and practices regarding menstrual hygiene are not optimal.
Keywords: Adolescents, hygiene, knowledge, menstruation, practice
Introduction
The World Health Organization (WHO) defines adolescents as individuals between 10 and 19 years of age.[1] The adolescent period is important as it is the transition from childhood to adulthood. Adolescents constitute about 21% of the total population in India.[2] The onset of menstruation is an important event in a woman’s lifecycle. In Indian society, it is associated with taboos and sociocultural restrictions, thereby, reinforcing negative attitudes toward menstruation. It is considered dirty and unclean. How a girl receives information about menstruation may have an impact on her response to menarche. Knowledge about menstruation and hygiene practices should be imparted from the early days and should form an important aspect of health education so that it will persist throughout their adult life.[3] But most girls receive information about menstruation after menarche. Faulty hygienic practices increase the risk of reproductive tract infections (RTI), leading to further complications if left untreated. With this background, the present study was conducted to assess the knowledge and practices of menstrual hygiene among adolescent girls of Nagaon, Barpeta District, Assam.
Methods
A community-based cross-sectional study was conducted in Nagaon, Barpeta district, Assam, which comes under the field practice area of the Department of Community Medicine, Fakhruddin Ali Ahmed Medical College. A house-to-house survey was carried out for 3 months (September 2019 to November 2019). A total of 170 adolescent girls were included in the study by convenient sampling method, after taking their informed consent. Adolescent girls who did not attain menarche and those who were not willing to participate were excluded from the study. A predesigned, pretested, semi-structured questionnaire was used to collect the information from the study participants. After explaining the purpose of the study, information regarding the demographic profile, menstrual knowledge, and menstrual hygiene practices was obtained. The data were collected and analyzed in Microsoft Office Excel, by using SPSS version 17, and the results were expressed in percentages. Ethical clearance was obtained before conducting the study from the ethics committee of Fakhruddin Ali Ahmed Medical College, Barpeta.
Results
The demographic characteristics of the adolescents are summarized in Table 1. About 60% of the adolescents belonged to the 13–15-year age group and 40% belonged to the 16–19-year age group. About 40% of them were studying in higher secondary school, 33.53% were studying in high school, and 26.47% were in middle school. About 42.94% of the mothers of the adolescent girls studied till primary school, 34.12% of the mothers studied till middle school, 19.41% of the mothers studied till high school, and 2.35% of the mothers were illiterate. About 52.35% of the adolescents were found to be Muslims and 47.65% to be Hindus. The majority (86.47%) of the adolescents belong to the class IV socioeconomic status.
Table 1.
Demographic profile of the study population
| Demographic variable | Number | Percentage |
|---|---|---|
| Age | ||
| 13-15 years | 102 | 60 |
| 16-19 years | 68 | 40 |
| Education of study participant | ||
| Middle school | 45 | 26.47 |
| High school | 57 | 33.53 |
| Higher secondary | 68 | 40 |
| Mothers’ education | ||
| Illiterate | 4 | 2.35 |
| Primary school | 73 | 42.94 |
| Middle school | 58 | 34.12 |
| High school | 33 | 19.41 |
| Higher secondary | 2 | 1.18 |
| Religion | ||
| Hindu | 81 | 47.65 |
| Muslim | 89 | 52.35 |
| Socio economic status | ||
| Class II | - | - |
| Class III | 20 | 11.76 |
| Class IV | 147 | 86.47 |
| Class V | 3 | 1.76 |
Table 2 reveals that the majority of the adolescents (55.88%) attained menarche at the age of 13 years. Only 48 (28.24%) of the participants knew about menstruation before menarche, the main source of information being a mother in 44.71% of the subjects, followed by friends in 25.88% of the subjects. About 57.06% of the girls said they were frightened and 33.53% were irritated on seeing their first menstruation.
Table 2.
General information regarding menarche and menstruation
| Number | Percentage | |
|---|---|---|
| Age at menarche | ||
| ≤11 | 3 | 1.76 |
| 12 | 23 | 13.53 |
| 13 | 95 | 55.88 |
| 14 | 47 | 27.65 |
| ≥15 | 2 | 1.18 |
| Knowledge about menstruation before menarche | ||
| Yes | 48 | 28.24 |
| No | 122 | 71.76 |
| Source of information about menstruation | ||
| Mother | 76 | 44.71 |
| Sister | 23 | 13.53 |
| Friends | 44 | 25.88 |
| Others | 27 | 15.88 |
| Reaction to first menstruation | ||
| Scared | 97 | 57.06 |
| Irritated | 57 | 33.53 |
| Ashamed | 11 | 6.47 |
| Happy | 5 | 2.94 |
Table 3 shows the distribution of study participants according to their knowledge of menstruation and menstrual hygiene. It reveals that 91.76% of the adolescents knew that menstruation was a normal process. About 27.65% of the study participants did not know the cause of menstruation. About 54.12% did not know about the source of menstrual bleeding. Only 33.53% knew that the uterus is the source of bleeding; 61.76% of the study participants knew about the duration of the normal menstrual period. About 42.94% of the adolescents knew that poor menstrual hygiene predisposes them to infection.
Table 3.
Distribution of study participants according to their knowledge of menstruation and menstrual hygiene
| Number | Percentage | |
|---|---|---|
| Menstruation is a normal process | ||
| Yes | 156 | 91.76 |
| No | 14 | 8.24 |
| Cause of menstruation | ||
| Don’t know | 47 | 27.65 |
| Hormonal process | 105 | 61.76 |
| Others | 18 | 10.59 |
| Source of menstrual bleeding | ||
| Uterus | 57 | 33.53 |
| Bladder | 15 | 8.82 |
| Anal canal | 6 | 3.53 |
| Don’t know | 92 | 54.12 |
| Knew the duration of a normal menstrual period | ||
| Yes | 105 | 61.76 |
| No | 65 | 38.24 |
| Knew that poor menstrual hygiene predisposes to infection | ||
| Yes | 73 | 42.94 |
| No | 97 | 57.06 |
Table 4 shows the menstrual hygiene practices by adolescents. It reveals that 74.12% of the adolescents used sanitary pads during menstruation, 18.82% used cloth, and 7.06% used both cloth and sanitary pads. In about 63.53%, the method of disposal of used absorbent was throwing with the domestic waste, while 25.88% reused the cloth after washing and 63.64% of them dried the cloth outside in the sunlight. The majority (75.29%) of the adolescents stored the unused absorbents with the routine cloth and 18.24% stored them in the bathroom. Cleaning of external genitalia on daily basis was practiced by 67.06% of the adolescents, whereas 32.94% cleaned only during menses. For cleaning purposes, the majority (80%) used soap and water.
Table 4.
Menstrual hygiene practices
| Number | Percentage | |
|---|---|---|
| Absorbent used during menstruation | ||
| Sanitary pads | 126 | 74.12 |
| Cloth | 32 | 18.82 |
| Both pad and cloth | 12 | 7.06 |
| Mode of disposal of absorbent | ||
| Throw with domestic waste | 108 | 63.53 |
| Burn | 13 | 7.65 |
| Burry | 5 | 2.94 |
| Reuse of cloth piece | 44 | 25.88 |
| Place of drying the cloth (n=44) | ||
| Outside house in sunlight | 28 | 63.64 |
| Inside the house | 16 | 36.36 |
| Storage of unused absorbent | ||
| Bathroom | 31 | 18.24 |
| Store with routine cloth | 128 | 75.29 |
| Others | 11 | 6.47 |
| Cleaning of external genitalia | ||
| Daily | 114 | 67.06 |
| Only during menses | 56 | 32.94 |
| Method of cleaning | ||
| Only water | 32 | 18.82 |
| Soap and water | 136 | 80 |
| Antiseptic and water | 2 | 1.18 |
| Restriction practices during menses | ||
| Yes | 143 | 84.12 |
| No | 27 | 15.88 |
Table 5 shows the different restriction practices practiced by adolescents. Around 84.12% of the adolescents practiced different restrictions during menstruation. All the adolescents (100%) avoided attending religious places/religious occasions, 53.85% did not enter the kitchen during menstruation, 45.45% were not allowed to play outside, 34.27% slept separately, and 23.08% were not allowed to touch other family members.
Table 5.
Distribution of adolescents according to restrictions practiced during menstruation
| Restrictions practiced during the menstrual cycle (n=143) | Number | Percentage |
|---|---|---|
| Avoiding religious places/religious occasions | 143 | 100 |
| No entry into the kitchen | 77 | 53.85 |
| Sleep separately | 49 | 34.27 |
| Not allowed to play outside | 65 | 45.45 |
| Touch other family members | 33 | 23.08 |
**Multiple responses
Discussion
The present study shows that the age at menarche of the participants ranged between 11 and 15 years and the mean age of menarche was 13 years which is comparable to the study conducted in Rajasthan by Khanna, et al.,[4] who reported the mean age at menarche to be 13.2 years and a study conducted by Kajal Jain[5] where the mean age at menarche was noted to be 13.16 years while Deo and Ghattargi[6] highlighted that the age of menarche in their study ranged from 12 to 17 years with the maximum number of girls between 13 and 15 years of age. In a study conducted by Patil[7] among adolescent girls of the rural North Karnataka region, the mean age of menarche was found to be 13.45 years. Kailasraj KH, et al.[8] in their study found that the mean age at menarche among urban girls was 12.87 ± 0.946 years, whereas among rural girls it was 12.85 ± 0.869 years.
In the present study, only 28.24% of the adolescents knew about menstruation before menarche and 71.76% did not know about it, which is similar to the study conducted by Barathalakshmi et al.[9] Whereas in a study conducted by Reddy et al.,[10] 13.8% of the girls had prior knowledge of menses. Bobhate et al.[11] in their study conducted in an urban slum area of Mumbai found that only 20.3% of the participants were aware of menstruation before menarche. A higher prevalence of 36.95, 57.9, 69, 64, and 60.53%, regarding knowledge about menstruation before menarche was found in the study conducted by Thakre SB et al.[12] Shanbhag et al.,[13] Anju Ade,[14] Rajni Dhingra,[15] Divya Hagawane,[16] respectively.
The present study reveals that mothers were the first informants for 44.71% of the girls. Similar findings were found in the study conducted by Kailasraj KH et al.[8] Thakre SB et al.[12] AB Mudey et al.[17] Dabade KJ,[18] Dasgupta A and Sarkar M,[19] Omidvar S and Begum K[20] and Ray S and Dasgupta A.[21]
In the present study, 57.06% were scared of their first menstruation. J. Barathalakshmi et al.[9] found that 45.7% of the respondents expressed fear and 30.5% of the girls expressed worry on seeing their first menstruation. Fear and panic were the reactions observed in the study conducted by Shubha Dube and Kirti Sharma.[22]
In the present study, 91.76% of the study participants knew that menstruation is a normal process, which is similar to a study conducted by Arumugam B, et al.[23] About 86.25% believed it to be a physiological process in a study conducted by Dasgupta A and Sarkar M.[19] Whereas 81% recognized menstruation as a normal physiological process in a study conducted in Nepal.[24] On the other hand, in a study conducted by Divya Hagawane,[16] 36.84% of the girls believed that menstruation is a physiological process.
In our present study, 27.65% of the study participants did not know the cause of menstruation. Only 33.53% knew that the source of menstrual bleeding is the uterus and 54.12% did not know the source of menstrual bleeding. However in a study conducted by Thakre SB. et al.,[12] 80.62% did not know the cause of the menstrual bleeding, only 2.5% of the study girls stated that menstrual bleeding came from the uterus, and 76.23% were unaware of the source of the menstrual bleeding. J. Barathalakshmi et al.[9] found that 30.5% of the girls knew that menstruation is due to cyclical uterine bleeding. It was observed that only 12.63% of the girls believed that menstruation bleeding occurs from the uterus in a study conducted by Divya Hagawane.[16]
Our present study showed that 61.76% of the adolescent girls knew the duration of a normal menstrual period and only 42.94% of the adolescents knew that poor menstrual hygiene could predispose them to infection. Similarly, Prateek S. Bobhate et al.[11] found that 75.5% were aware of the duration for a normal period and 69.3% were aware that poor hygiene predisposes to infection.
In terms of practices related to menstrual hygiene, 74.12% of the adolescents used sanitary pads, and 18.82% used cloth as absorbent. Similarly, 75% of the subjects were using sanitary pads regularly, 15.79 and 9.21% of the subjects were using new and old clothes in a study conducted by Divya Hagawane.[16] In a study conducted by Shanbhag et al.[13] and Kamath R et al.,[25] the usage of sanitary napkins (64%) was higher compared to old cloth pieces. Whereas in a study conducted by Khanna et al.,[4] Patil VV,[7] Thakre SB et al.[12] Dasgupta, et al.,[19] and Udgiri R et al.,[26] preference for old cloth pieces was higher compared to sanitary pads.
In the present study, the most common method of disposal of used absorbents was throwing with domestic waste reported by 63.53% of the adolescents. Similar findings were found in the study conducted by Divya Hagawane.[16] Whereas J. Barathalakshmi et al.[9] and Thakre SB, et al.[12] found that burying was the most common method followed by disposal along with domestic wastes. Arumugam B et al.[23] also found that burial, burning, and flushing them in the toilet were the common methods of disposal.
The present study revealed that 25.88% of the adolescents practiced reusing old cloth after washing and 63.64% of them dried the cloth outside in the sunlight and 36.36% dried the cloth inside the house. About 75.29% of the adolescents stored the unused absorbent with routine cloth and 18.24% stored it in the bathroom. J. Barathalakshmi et al.[9] also found that 54.4% of the girls stored it inside the bathroom itself, while 40% of the girls stored it in dress cabinets. Whereas Thakre SB, et al.[12] found that 51.32% dried the cloth outside the house in the sunlight, 47.37% inside the house, and 1.31% outside the house without sunlight. In a study conducted by Omidvar S and Begum K,[20] 21.1%. stored the absorbent in the bathroom.
The present study revealed that 67.06% of the adolescent girls cleaned their external genitalia daily and 80% used soap and water for cleaning purposes. Dabade KJ[18] in their study found that 74.8% in urban areas and 81.3% in rural areas cleaned their external genitalia daily and the majority of them used soap and water for cleaning their external genitalia. A study conducted by AB Mudey et al.[17] also found that the majority (59.3%) of the study participants used soap and water for cleaning. Whereas in the study conducted by Patil VV[7] and Thakre SB et al.,[12] a majority of them used only water for cleaning external genitalia.
Different restrictions were practiced by all the study participants during menstruation like avoiding religious places, restricted entry into the kitchen, sleeping separately, playing outside, and touching other family members. Similar restrictions were also reported in the studies conducted by Khanna A, et al.,[4] Kailasraj KH,[8] Thakre SB, et al.,[12] AB Mudey et al.,[17] and Dasgupta A, and Sarkar M.[19]
Summary
The present community-based cross-sectional study was conducted in Nagaon, Barpeta district, Assam, among 170 adolescents aged between 10 and 19 years for 3 months from September 2019 to November 2019 to assess the knowledge and practices of menstrual hygiene among the adolescent girls.
About 55.88% of adolescent girls attained menarche at the age of 13 years. Only 28.24% of the participants knew about menstruation before menarche, the main source of information being a mother in 44.71% of the subjects.
Regarding knowledge of menstruation and menstrual hygiene, 91.76% of the adolescents knew that menstruation was a normal process. About 27.65% of the study participants did not know the cause of menstruation, and 54.12% did not know about the source of menstrual bleeding. Only 33.53% knew that the uterus is the source of bleeding; 61.76% of the study participants knew about the duration of the normal menstrual period. About 42.94% of the adolescents knew that poor menstrual hygiene predisposes them to infection.
Regarding menstrual hygiene practices, 74.12% of the adolescents used sanitary pads during menstruation, 18.82% used cloth, and 7.06% used both cloth and sanitary pads. The most common method of disposal of used absorbent was throwing with domestic waste (63.53%). Cleaning of external genitalia on daily basis was practiced by 67.06% of the adolescents, whereas 32.94% cleaned only during menses. For cleaning purposes, the majority (80%) used soap and water.
Highlight
This study gives information on the knowledge and practice of menstrual hygiene among adolescent girls. This study has highlighted the need for education regarding menstruation and menstrual hygiene before the onset of menarche to safeguard girls against RTI.
Conclusion
The current study has revealed that menstruation and menstrual hygiene knowledge is poor among adolescent girls and practices regarding menstrual hygiene are not optimal. Health education regarding the importance of menstrual hygiene to avoid various RTI is very important.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- 1.World Health Organization. Adolescent health epidemiology, 2014. Available from: http://www.who.int/maternal_child_adolescent/epidemiology/adolescence .
- 2.Strategy Handbook. Rashtriya Kishor Swasthya Karyakram. Adolescent Health Division Ministry of Health and Family Welfare Government of India. [Last accessed on 2022 May 05]. Available from: http://nhm.gov.in/images/pdf/programmes/rksk-strategy-handbook.pdf .
- 3.Wasserheit JN. The significance and scope of reproductive tract infections among Third World women. Suppl Int J Gynecol Obstet. 1989;3:145–68. doi: 10.1016/0020-7292(89)90115-x. [DOI] [PubMed] [Google Scholar]
- 4.Khanna A, Goyal RS, Bhawsar R. Menstrual practices and reproductive problems:A study of adolescent girls in Rajasthan. J Health Manage. 2005;7:91–107. [Google Scholar]
- 5.Jain K, Garg SK, Singh JV, Bhatnagar M, Chopra H, Bajpai SK. Reproductive health of adolescent girls in an urban population of Meerut, Uttar Pradesh. Health Popul Perspect Issues. 2009;32:204–9. [Google Scholar]
- 6.Deo DS, Ghattargi CH. Perceptions and practices regarding menstruation:A comparative study in urban and rural adolescent girls. Indian J Community Med. 2005;30:33–4. [Google Scholar]
- 7.Patil VV, Udgiri R. Menstrual hygienic practices among adolescent girls of rural North Karnataka region, India. Int J Community Med Public Health. 2016;3:1872–6. [Google Scholar]
- 8.Kailasraj KH, Basavaraju V, Kumar J, Manjunatha S. A study of knowledge and practice of menstrual hygiene among adolescent school girls in rural and urban field practice area of Raja Rajeswari Medical College and Hospital, Bangalore, India. Int J Community Med Public Health. 2020;7:665–72. [Google Scholar]
- 9.Barathalakshmi J, Govindarajan PK, Ethirajan N, John William Felix A. Knowledge and Practice of Menstrual Hygiene among School Going Adolescent Girls. Natl J Res Community Med. 2014;3:138–42. [Google Scholar]
- 10.Reddy PJ, Rani DU, Reddy GB, Reddy KK. Reproductive health constraints of adolescent school girls. Indian J Soc Work. 2005;66:431–40. [Google Scholar]
- 11.Bobhate PS, Shrivastava SR. A cross-sectional study of knowledge and practices about reproductive health among female adolescents in an urban slum of Mumbai. J Family Reprod Health. 2011;5:117–24. [Google Scholar]
- 12.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. [Google Scholar]
- 13.Shanbhag D, Shilpa R, D'Souza N, Josephine P, Singh J, Goud BR. Perceptions regarding menstruation and practices during menstrual cycles among high school-going adolescent girls in resource-limited settings around Bangalore city, Karnataka, India. Int J Collab Res Intern Med Public Health. 2012;4:1353–62. [Google Scholar]
- 14.Ade A, Patil R. Menstrual hygiene and practices of rural adolescent girls of Raichur. Int J Biol Med Res. 2013;4:3014–7. [Google Scholar]
- 15.Dhingra R, Kumar A. Knowledge, and practices related to menstruation among tribal (Gujjar) adolescent girls. Ethno-Med. 2009;3:43–8. [Google Scholar]
- 16.Hagawane D, Kela P, Patel E. Assessment knowledge and practice of menstrual hygiene among the teenage students. Int J Pharm Pract. 2021;14:274–9. [Google Scholar]
- 17.Mudey AB, Keshwani N, Mudey GA, Goyal RC. A cross-sectional study on the awareness regarding safe and hygienic practices among school-going adolescent girls in the rural areas of Wardha district. Glob J Health Sci. 2010;2:225–31. [Google Scholar]
- 18.Dabade KJ, Dabade SK. Comparative study of awareness and practices regarding menstrual hygiene among adolescent girls residing in urban and rural areas. Int J Community Med Public Health. 2017;4:1284–8. [Google Scholar]
- 19.Dasgupta A, Sarkar M. Menstrual hygiene. Indian J Community Med. 2008;33:77–80. doi: 10.4103/0970-0218.40872. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Omidvar S, Begum K. Factors influencing hygienic practices during menses among girls from south India- A cross-sectional study. Int J Collab Res Intern Med Pub Health. 2010;2:411–23. [Google Scholar]
- 21.Sudeshna R, Aparajita D. Determinants of menstrual hygiene among adolescent girls:A multivariate analysis. Natl J Community Med. 2012;3:294–301. [Google Scholar]
- 22.Dube S, Sharma K. Knowledge, attitude and practice regarding reproductive health among urban and rural girls:A comparative study. Ethno-Med. 2012;6:85–94. [Google Scholar]
- 23.Arumugam B, Nagalingam S, Varman PM, Ravi P, Ganesan R. Menstrual hygiene practices:Is it practically impractical? Int J Med Public Health. 2014;4:472–6. [Google Scholar]
- 24.Is menstrual hygiene and management an issue for adolescent school girls? A comparative study of four schools in different settings of Nepal. A report of water aid. Available from:http://www.wateraid.org/nepal. [Google Scholar]
- 25.Kamath R, Ghosh D, Lena A, Chandrashekaran 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. [Google Scholar]
- 26.Udgiri R, Angadi MM, Patil S, Sorganvi V. Knowledge and practices regarding menstruation among adolescent girls in an urban slum, Bijapur. J Indian Med Assoc. 2010;108:514–6. [PubMed] [Google Scholar]