Predictors Of Proper Menstrual Hygiene Amongst Secondary School Students

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Predictors Of Proper Menstrual Hygiene Amongst Secondary School Students


Abstract


Background: Menstrual hygiene is a significant issue that every girl and woman has to deal with in her life. Unfortunately, health talks surrounding menstrual hygiene are minimal owing to the fact that the topic of menstruation is not discussed at all because teachers choose to avoid the taboo subject. We sought to assess the predictors of proper menstrual hygiene amongst secondary school studentsin Enugu East Local Government Area.
Methods: A descriptive cross-sectional study was carried out among secondary school girls in two selected schools in Enugu East Local Government Area. Stratified sampling method was used to select participants whereas data was collected using a self-administered questionnaire developed by the researcher. Data analysis was performed using SPSS version 20 and a level of significance of 95% was considered in this study.

Results: 193 participants out of 196 invited participants fully completed the study. The mean age of the respondents was 14 years (S. D =2.6). A significantly high number of girls had good knowledge 133 (69%)and good attitude 124 (64.2%) towards menstrual hygiene. Menstrual hygiene practices included: use of sanitary pads, satisfactory facilities for menstrual hygiene at school, disposal of used sanitary materials in the toilet/latrine. Restrictions during menstruation included: not being allowed to read the Bible and cultural practices such as menstruation being seen as a disease and debilitating for women.

Conclusion: The plight of menstrual hygiene among adolescent girls is challenging. There is need to create awareness on healthy menstrual practices. Formal as well as informal channels of communication such as teachers, school senior women, mothers, sisters and friends, need to be emphasized for the delivery of information on menstrual hygiene, however, it is very important that they have the right knowledge, attitude and practices on reproductive health. It is also essential to include menstrual hygiene as part of the package taught in the school curriculums or during health education.


Chapter One


Introduction

1.1 Background to the Study

It is projected that 9% of the global population is in the age group of 10-19 years and while they are transitioning from childhood to adulthood, they undergo a number of physical as well as psychological pressures due to the changes taking place in their bodies (Eswi, Helal and Elarousy, 2012). Adolescence is characterized by physical, psychological, and social changes.

Menstruation is a physiological process in female adolescents which approximately starts at age of 9–12 years old (Balqis, Arya, and Ritonga, 2016). Averagely, 49.6% women of the global population menstruate 6-7 years of their lifetime (Mahon and Fernandes, 2010). Menstrual hygiene is an issue that every girl and woman has to deal with in her life, but there is lack of mindfulness of the process of menstruation and correct necessities for handling menstruation among teenage girls (Channawar and Prasad, 2016).

Menstruation is connected to numerous fallacies and untruthful practices, which sometimes result in negative health outcomes (Sharma et al., 2013). Some of these traditions and restrictions including restrictions on taking a bath, restriction on consuming hot and cold diets, restrictions on exercise, have no scientific backing and need to be disregarded to release menstruation anxiety among teenagers (Boosey, Prestwich, and Deave, 2014).

Menstrual troubles are the commonest presenting complaint in the adolescent age group which makes the frequency of reproductive tract complications like Pelvic Inflammatory Diseases (PIDs) and barrenness 3 times higher among adolescents who practice poor menstrual hygiene(Shanbhag et al., 2012).

Consequently, menstrual hygiene-related practices are considered significant in lessening the danger of infections among women (Sudeeshna and Aparajita, 2012). In order to achieve safe practices, adolescent girls need acceptable knowledge regarding menstruation and menstrual hygiene. This is because females who have good knowledge and practices regarding menstrual hygiene are less exposed to Reproductive Tract Infections (RTIs) and its consequences (Kamaljit et al., 2012).

Generally, women have 13 menses yearly and about 400 menses in their life even though menstruation has been surrounded by secrecy, negativity, and myths in much society (Anusree et al., 2014). 10 % of females are exposed to genital infections including urinary tract infections and bacterial vaginosis, and 75 % of women have a history of a genital infection every year worldwide. Explicitly, the common risk factors for vaginal infections include pregnancy and poor hygiene; both perineal and menstrual hygiene (Sarvade and Nile, 2016).

Kaiser, (2015), revealed that, about 52% of the female population is of reproductive age and most of them are menstruating every month. The largest proportion of them lack access to clean and safe sanitary material, or to a clean and private facility in which to change menstrual cloths or pads and to wash them.

1 out of 3 girls in South Asia lacked information on menstruation prior to getting it while 48% of girls in Iran and 10% of girls in India accept as true that menstruation is a disease (Water Aid, 2013). In Africa, over 70% of adolescents have inadequate information about menstrual hygiene, not more than 50% believed that menstruation is a normal occurrence during life (Boosey, Prestwich, and Deave, 2014). Of the 10 girls in Sub-Saharan Africa, one fails to go to school while they are in their menstrual cycle which is equal to as much as 20% of the school year(World Bank, 2016). Nigeria revealed that 31% to 56 % of the schoolgirls use toilet tissue or cloth to absorb their menstrual blood as opposed to menstrual pads while in Ethiopia, although 92 % of the students were aware of menstruation before menarche, their utilization of sanitary material was as low as 37.6 % and 62.4 % were using rags and pieces of cloth while 11% of girls change their menstrual cloths once a day(Fehintola et al., 2017). The use of sanitary pads is as low as 18 % amongst Tanzanian women with the remainder using cloth or toilet paper (Upashe, Tekelab and Mekonnen, 2015).

Currently, the proportion of women who have consistent menstrual periods is increasing in developing countries including Uganda due to later childbirth hence fewer children. But many lack the financial and social circumstances to satisfactorily manage menstruation sanitation (Thakur et al., 2014). A predominantly susceptible group in this aspect is young women in poor families.

In Uganda, Forum of African Women Educationists (FAWE – Uganda) reported that among three girls one missed all or part of a school day throughout their menstrual cycle(Kirk and Sommer, 2006).

A cross-sectional study that was conducted in Kamuli district in Uganda by Hennegan et al., (2016) found out that 90.5% of the girls had inadequate menstrual hygiene management with no substantial difference between those using reusable pads and those using other existing methods like cloth, disposable sanitary pads, other methods including toilet paper and underwear alone.

Majority of studies on menstrual hygiene have been conducted in the rural setting and very few among urban populations. It is therefore not clear the level of menstrual hygiene among secondary school students in urban areas and whether they have adequate knowledge, therefore, this study aims at investigating knowledge, attitude and practices towards menstrual hygiene among secondary school girls in Enugu East Local Government Area.


1.2 Statement of the Problem

Menstruation is an ordinary reproductive change in teenage females that is anticipated to occur every 28 days. A menstruating teenage girl is supposed to maintain good hygiene by timely padding and taking a regular shower (WHO, 2015). In Nigeria, menstruation is seen as a natural occurrence, a gift from God, and is considered essential as it gives womanhood. Nevertheless, women‟s perceptions of menstruation and related hygiene vary among different cultures, social groups, and religions.

The United Nations introduced the WASH program under Millennium Development Goal 6 which was adopted by all UN countries to improve water and sanitation services and menstrual hygiene management. During menstruation, emphasis is put on the use and regular change of absorbent material and cleaning of the genitalia to ensure menstrual hygiene. This can only be achieved by having safe, private and single gender sanitation facilities in schools, access to water supply and a means of safe disposal of menstrual waste at school.

The girl child is the responsibility of the family, government and the community where she thrives. This implies the parents or even the whole family, the school matrons, teachers and school nurses have an important role in the issues concerning the girls like menstruation. However, based on the researchers‟ preliminary observation, menstrual hygiene knowledge and practices are left for the girl child to discover as a mystery. This lives a knowledge and practical gap. In addition, in the African tradition, issues surrounding menstruation are secretive issues which the girl child should discuss in the privacy with her parents or senior women in the community (Aziato, Dedey and Clegg-Lamptey, 2014).

Unfortunately, majority of the schools especially in resource restricted nations, the topic of menstruation is not discussed at all, because teachers choose to avoid taboo subject (Mahon and Fernandes, 2010; Water Aid, 2009).
Furthermore, even at home, even though mothers are the main source of information concerning menstruation in Africa, the conversation of the topic is discouraged by local culture or religion and mothers often do not wish to talk about it for fear that it will lead to discussions about reproductive health to their teenage girls (Umeora and Egwuatu, 2008). In turn, this leads to unnecessary fear, anxiety, and undesirable practices in a bid to save their fate which could be related to poor knowledge, attitude, and practices.

Consequently, teenage girls turn to using unhygienic practice or staying at home while menstruating which affects their school attendance and performance rates. Poor menstrual hygiene also leads to low self-esteem among girls, school absenteeism and predisposition to PIDs with severe consequences and significant negative outcomes including chronic pelvic pain, dysmenorrhea and infertility in severe cases.


1.3 Objectives of the Study

To determine the predictors of proper menstrual hygiene amongst secondary school students in Enugu East Local Government Area. Specific Objectives

  1. To assess the level of knowledge on menstrual hygiene among secondary school girls in Enugu East Local Government Area.
  2. To determine the attitude towards menstrual hygiene among secondary school girls in Enugu East Local Government Area.
  3. To establish the practices towards menstrual hygiene among secondary school girls in Enugu East Local Government Area.

1.4 Research Questions

  1. What is the level of knowledge on menstrual hygiene among secondary school girls in Enugu East Local Government Area?
  2. What is the attitude towards menstrual hygiene among secondary school girls in Enugu East Local Government Area?
  3. What are the practices towards menstrual hygiene among secondary school girls in Enugu East Local Government Area?

1.5 Significance of the Study

  1. The Government/Ministry of Health may use the research findings to disseminate information to the public to raise awareness about the most appropriates ways they can help adolescent girls maintain good hygiene during the menstrual period. This will be done with basis on the examples drawn from the recommendations of the study.
  2. The study may help researchers and scholars in future who will carry out more insight studies to modify concepts and theories about menstruation and menstrual hygiene. Findings will also contribute to the existing literature and also can be used by future researchers.
  3. Findings of this study may also help school administrators to devise better ways they can help adolescent girls maintain good hygiene during menstruation period. This will focus on describing the knowledge and practices of adolescent girls towards menstrual hygiene among secondary school girls in Enugu East Local Government Area. This will enable the schools to improve on girl education regarding menstruation and menstrual hygiene practices.
  4. Findings may also enable the ministry of health to plan for the girl child by issuing free disposable and re-usable pads to help improve menstrual hygiene
  5. The girls may be educated about the significance of menstruation, selection of ideal sanitary menstrual absorbent and proper disposal depending on the findings of the study.
  6. The findings of the study may enable the researcher to acquire a bachelor‟s degree in Nursing from International Health Sciences University.

1.6 Scope of the Study

This study was conducted among urban and rural secondary school girls from 13 years who have attained menarche, in government girls or co-educational schools in Enugu East Local Government Area. The study is limited to knowledge and management of menstrual hygiene among secondary school girls in Enugu East.


1.7 Limitation of Study

Finance, inadequate materials and time constraint were the challenges the researchers encountered during the course of the study.


1.8 Operational Definitions

Attitude

This is an inclination to respond positively or negatively towards a given idea, object, person, or condition.

Culture

These are the notions, customs, and social behaviour of specific people or society

Knowledge

These are facts, information, and skills achieved through experience or education either as the theoretical or practical understanding of a subject.

Menstruation

Menstruation is the repeated breakdown of the inner lining of the womb, endometrium, which is influenced by hormones of the hypothalamo-pituitary axis.

Menarche

This is the first manifestation of menstruation.

Menstruation Hygiene Management

This is when adult females and adolescent girls use clean material to absorb menstrual blood, whereby the absorbent napkin can be changed in privacy as often as desired for the menstrual period.

Practices

This is the actual application or use of an idea, belief, or method, as opposed to theories relating to it.


1.9 Organizations of the Study

The chapter one consist of the introductory part of the study which includes the study background, the statement of the research problem, the study objective and scope of the study.

The second chapter is a critical review of other literatures relevant to the study and its objectives including the theoretical framework for the study. While the third chapter is methods of data collection, sampling and data analysis used in conducting the study. The fourth chapter centres around the research findings including an analysis of how it relates to previous findings. The fifth chapter consists of the summary of findings, conclusion and recommendations base on the study objectives.


Chapter Five


Conclusion and Recommendations

5.0 Introduction

This chapter presents the conclusion drawn from the study findings and gives recommendations as to the way forward on how the problem of menstrual hygiene among adolescent girls can be handled.


5.1 Conclusion

The study shows that menstrual hygiene among adolescent girls is definitely a challenge. The study establishes that the overall level of knowledge of the adolescent girls on menstrual hygiene was good 133 (69%) although unsatisfactory.

This study also reveals that adolescent girls had generally positive attitude 124 (64.2%) towards menstrual hygiene.
Practices of the adolescent girls towards menstrual hygiene was generally good as it was evident that a large proportion among the adolescent girls practiced safe practices during menstruation.


5.2 Recommendations

Formal as well as informal channels of communication such as mothers, sisters and friends, need to be emphasized for the delivery of such information. In view of the vital role of the mothers, it is very important that the mother is armed with the correct and appropriate information on reproductive health so that she can give this knowledge to her growing girl child. It is also essential for the teachers, who may not have the necessary skills to impart reproductive health education, including menstrual hygiene to their students. They have to be given requisite skills usually through training or workshops. Much more efforts are needed to curb the misbeliefs and taboos among the adolescent school girls.

Schools should highlight issues like the girl child welfare in parent meetings, school days and report days to ensure that every girl child has got enough sanitary pads for the whole term. Matters concerning menstrual hygiene should be discussed with parents and their children and solutions thought to improvise on disposal bins and incinerators.

The government together with the Ministry of Education and Sports should revise policies concerning school construction and settings to suite girl child education for instance in constructing classrooms that have private sanitary facilities.


5.3 Implications for Nursing Practice

Nurses have an important role central to the education of the public on health hygiene and personal growth. These include; the maintenance of optimal menstrual hygiene and self-care practices among female adolescents.
Nurses are always in contact with this vulnerable group and therefore it is necessary for them to have adequate knowledge as well as becoming role models to this deliquescent group of the society. It thus becomes as a role to ensure proper education and encouragement of personal hygiene and optimal self-care practices among female juveniles in the community.


5.4 Limitations of the Study.

There was also low transparency among respondents in answering the questions due to the fact that girls found discussing their menstruation experiences uncomfortable

Some information from some respondents was not reliable since they felt they may be stigmatized when they reveal their true behavioural practices, knowledge and attitude regarding menstrual hygiene.


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Frequently Asked Questions


What are the factors affecting the practice of menstrual hygiene?

Different factors affect the practice of menstrual hygiene such as source of information, access of water and knowledge about menstrual hygiene. … . Multiple logistic regression analysis for Factors affecting the practice of menstrual hygiene among female Mehalmeda high school students in Amhara regional state, Ethiopia, 2013

How does menstrual hygiene affect school dropout rate among female mehalmeda students?

Due to poor menstrual hygiene management the adolescent girls are exposed for reproductive tract infection, school absenteeism and increase school dropout rate. Objectives: To assess the practice of menstrual hygiene and associated factors among female Mehalmeda high school students in Amhara regional state, Ethiopia.

What is the prevalence of good menstrual hygiene in the US?

Results Overall, the magnitude of good menstrual hygiene practice was 52.9% (95%CI: 50.3%-56.5%), which was 65.9% (95% CI: 62.8%-70.7%) among urban and 39.9% (95% CI: 36.2%-44.6%) among rural schoolgirls.

Is menstrual hygiene different in rural and urban girls?

Some menstrual hygiene indices have shown a significant difference in the rural and urban girls. Conclusion: A variety of factors are known to affect menstrual behaviours, the most influential being economic status and residential status (urban and rural).

How does menstrual hygiene management knowledge affect adolescent girls’ practice?
Those adolescent girls who had good overall knowledge about menstruation were almost twice more likely to practice adequate or safe MHM than those who had poor knowledge (AOR=1.94, 95% CI: 1.07–3.52) (Table 4). Table 4 Factors Associated with Menstrual Hygiene Management Practice Among School Adolescent Girls in Holeta Town, Central Ethiopia, 2019

How many women have adequate menstrual hygiene management practices?

The current study found that only 140 (34.7%) (95% CI: 30.1–38.9%) had adequate menstrual hygiene management practices (Table 3). Table 3

What are the factors that affect menstrual behaviour?

Conclusion: A variety of factors are known to affect menstrual behaviours, the most influential being economic status and residential status (urban and rural). Awareness regarding the need for information about healthy menstrual practices is very important.

How often do adolescents change their sanitary products during their periods?

Only about 185 (45.9%) of school adolescents were able to change their sanitary material three times or more per day during their menses. The current study found that only 140 (34.7%) (95% CI: 30.1–38.9%) had adequate menstrual hygiene management practices (Table 3).

How many girls dropout of school due to menstruation related problems?

Regarding school dropout due to menstruation related problems, out of 551 students who had information about menstruation, 136 (24.68%) knew a girl or some girls who had dropped out of school while 140 (25.41%) of school girls reported that they have heard about girls who had dropped out of school.

What do school girls know about menstruation and its hygienic management?

Regarding knowledge about menstruation; 319 (57.89%) of them knew correctly that menstruation is a physiologic process (Figure 1 ). The mean score of the school girls’ knowledge of menstruation and its hygienic management was 6.95 ± 2.03 on a scale of 1–12 (Table 2 ).

How does menstruation affect school absenteeism in girls?

Influence of menstruation on girls school absenteeism. More than half, 248 (54.51%) of the girls were absent from school during their last menstrual period from one to four days. The mean days of school absenteeism were 2.09 and 2.33 among those who used sanitary napkins and those who didn’t respectively.

How does menstruation affect adolescent girls’ school performance?

Menstruation had an influence on adolescent girls’ school performance as over half of the girls reported the perceived effect of menstruation on academic performance. Similar studies had also reported effect of menstruation on girls’ academic performance [ 11, 15 ].

How many women in the world have poor menstrual hygiene?

At least 500 million women and girls globally lack adequate facilities for menstrual hygiene management (MHM). Inadequate WASH (water, sanitation and hygiene) facilities, particularly in public places, such as in schools, workplaces or health centers, can pose a major obstacle to women and girls.

What is Menstrual Hygiene Day and why is it important?

Menstrual Hygiene Day is an annual awareness day on May 28 to help break the silence and build awareness about the fundamental role that good menstrual hygiene management (MHM) plays in enabling women and girls to reach their full potential.

Is menstrual hygiene a necessity or luxury?

Menstrual hygiene is a necessity and not a luxury. Every girl and woman has a right to get all facilities essential for periods hygiene. Lack of awareness and appropriate facilities are increasing the prevalence of infections and disorders associated with menstrual hygiene.

Is menstrual hygiene management quantitative?

The study offers a working example of the quantitative assessment of menstrual hygiene management (MHM), using best available evidence to assess each aspect. The study provides the first prevalence estimate of adequate MHM consistent with its definition.

Do adolescent girls in urban and rural areas follow different hygienic practices?

Satisfactory Cleaning of external genitalia was practiced by only 47.63% of the urban and 37.96% of the rural girls. This study found differences in hygienic practices followed by adolescent girls in urban and rural area.

What is the difference between urban and rural girls’ menstruation awareness?

The difference in the awareness regarding menstruation in urban and rural area was highly significant. Only 36% girls in the urban and 54.88% girls in the rural area used homemade sanitary pads and reused the same in the subsequent period.

What are the hygienic practices during menstruation in rural areas?

Hygienic practices during menstruation were unsatisfactory in the rural area as compared to the urban area. proper hygienic practices during menstruation. It is also required and restrictions. This can be achieved with the help of media, sex education in school curriculum, and focused group discussions.

What is the true proportion of menstrual problems in urban girls’ population?

Assuming menstrual problems in urban and rural girls’ population to be 50-60% (based on pilot study findings), 387 girls were sufficient to estimate the true proportion in the study population with a 10% relative precision and 95% confidence interval. Informed consent was sought from the girls or the parents. 

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