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 Table of Contents  
ORIGINAL ARTICLES
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 46-50

Assessment of knowledge, attitude, and practices (KAP) on menstrual hygiene among adolescent girls residing in govt. social welfare hostels


1 Department of Community Medicine, ESIC Medical College, Hyderabad, Telangana, India
2 Department of Physiology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India

Date of Submission22-Jun-2021
Date of Decision12-Aug-2021
Date of Acceptance28-Oct-2021
Date of Web Publication26-Dec-2021

Correspondence Address:
Surendra Babu
Department of Community Medicine, ESIC Medical College, 7-1-634, Survey No.121/1 & 121/2, National Highway 65 Sanjeeva Reddy Nagar, Sanath Nagar, Hyderabad 500038, Telangana.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/dypj.dypj_36_21

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  Abstract 

Background: Adolescent girls, in particular, should be encouraged toward practicing hygienic methods during menstruation like usage of sanitary pads and they should get access to clean sanitary products to safeguard their healthObjectives: The aim of this study was to assess the level of knowledge, attitude, and practices of menstrual hygiene among the adolescent girls in social welfare hostels and their morbidity pattern during menstruation. Materials and Methods: A cross-sectional study was done among adolescent girls (11–19 years) residing in the government social welfare hostels, Chittoor. The study was started after obtaining the clearance from the institutation ethical committee. A predesigned, pretested, semistructured questionnaire was used and the data were expressed in proportions and frequencies, and appropriate statistical tests were done to see the association with the age category and morbidity profile. Results: A total of 200 were participated amongst them early adolescent age group (10–14 years) 68 and late adolescent age group (15–19 years) of 132 were involved. Majority of them (82 [41.0%]) reported menstruation as a physiological process, 57 (28.5%) as pathological process, 48 (24.0%) as curse of God, and very few did not know the reason. The source of information was the mother 73 (36.5%), sisters 72 (36.0%), and friends, respectively. More than three-fourth (155 [77.5%]) of the students were absent from the classes during menstruation and 45 (22.5%) students attended the classes regularly. Approximately 172 (86%) of the students had restrictions and the remaining 28 (14%) did not have any restrictions during menstruation. Treatment seeking during menstruation as home remedy was 48 (24.0%), consulting doctor was 64 (32.0), and 88 (44.0%) were not seeking any treatment during menstruation. The association between menstrual morbidities and age-wise distribution is found to be highly significant with χ2 = 39.04 and P < 0.001Conclusions: The adolescent school girls had good knowledge and good practices regarding menstrual health among those who had attained menarche. Mothers were the primary source of information and education about menstruation and restrictions should be intensified.

Keywords: Adolescent girls, attitude, knowledge, menstrual hygiene, practice


How to cite this article:
Babu S, Raziya D. Assessment of knowledge, attitude, and practices (KAP) on menstrual hygiene among adolescent girls residing in govt. social welfare hostels. D Y Patil J Health Sci 2021;9:46-50

How to cite this URL:
Babu S, Raziya D. Assessment of knowledge, attitude, and practices (KAP) on menstrual hygiene among adolescent girls residing in govt. social welfare hostels. D Y Patil J Health Sci [serial online] 2021 [cited 2022 Jul 1];9:46-50. Available from: http://www.dypatiljhs.com/text.asp?2021/9/2/46/333771




  Background Top


Menstruation is a natural phenomenon among mature females from the age of maturity until menopause.[1] Puberty is a time of change for all young people, but it is particularly a challenging factor for girls who are often unprepared for changes in their body, which can become a major obstacle to their education. In some parts of the world, two out of three girls reportedly have no idea of what was happening to them when they experienced menarche. This can have many negative effects on their physical and emotional development, leading to a drop in self-esteem and poor performance at school.[2] Majority of the girls have little knowledge of menstruation and they think that menstruation contaminates the body and makes them unclean and dirty.[3] This can be due to lack of appropriate knowledge. As a result, they suffer intense mental stress due to suppression of feelings. Adolescent girls in particular should be encouraged toward practicing hygienic methods during menstruation like usage of sanitary pads and they should get access to clean sanitary products to safeguard their health.[4],[5]

The Ministry of Health and Family Welfare has been implementing this menstrual hygiene scheme[6] for promotion of menstrual hygiene among adolescent girls in the age group of 10–19 years primarily in rural areas as part of the Rashtriya Kishor Swasthya Karyakram. The sanitary napkins were sold to the adolescent girls at Rs. 6 for a pack of six napkins in the village by the Accredited Social Health Activist (ASHA).

Objectives

The aim of this study was to assess the levels of knowledge, attitude, and practices (KAP) of menstrual hygiene among the adolescent girls in social welfare hostels and to see their morbidity pattern during menstruation


  Materials and Methods Top


Study design: Cross-sectional study.

Study period: May 2018–July 2018.

Study population: All the girls aged between 10 and 19 years.

Study sampling: Purposive sampling.

Study sample: 200.

Study area: Residing in the Government social welfare Girls hostels of Chittoor.

Study instruments

Predesigned, pretested, and semistructured questionnaire.

Data collection procedure and analysis

In Chittoor district that was divided into three divisions (Chittoor, Madanapalle, Tirupati), we included social welfare schools present in Chittoor division. There are three government social welfare girls’ hostels in Chittoor division and we included all of them for the study and got the permission from the concerned authorities to take up the study. All the adolescent girls aged between 10 and 19 years were included in the study. A minimum number of not less than 1 year stay in the hostels were taken. Absentees and dropouts of the subjects from the hostel during the period of the survey were excluded from the study. Adolescence begins with the onset of physiologically normal puberty, and ends when an adult identity and behaviour are accepted. This period of development corresponds roughly to the period between the ages of 10 and 19 years, which is consistent with the World Health Organization’s definition of adolescence.[6] Early adolescence might be broadly considered to stretch between the ages of 10 and 14 years. Late adolescence encompasses the latter part of the teenage years, broadly between the ages of 15 and 19 years. The study was started after obtaining the clearance from the institutional ethical committee. All the students between 10 and 19 years of adolescent age group were asked to participate in the study with consent form and participant information sheet. The data were collected by using the aforementioned questionnaire. The data were collected and entered in Microsoft Excel 2010 and analyzed in Statistical Package for the Social Sciences (SPSS, Inc., Chicago, IL, USA) software program, version 20.0. The data were expressed in frequencies and proportions, and appropriate statistical tests were done to see the association in respective factors.


  Results Top


A total of 200 students participated in the study. Among them [Table 1] 68 (34.0%) belonged to the early adolescent age group 10–14 years and 132 (66.0%) belonged to the late adolescent age group 15–19 years and the mean age of the students was 14.2 years with standard deviation (SD) ± 1.13. Majority (178 [89.0%]) were doing their secondary education and the remaining (22 [11.0%]) were in intermediate. More than half of them were (117 [58.5%]) were Hindus, 53 (26.5%) were Christians, and remaining (30 [15%]) were Muslims. More than half (130 [65%]) of the students belonged to the nuclear family, 48 (24%) belonged to three-generation family, and 22 (11%) belonged to joint family, respectively. Almost all the students (187 [93.5%]) were residing in pucca houses at their native place, 12 (6%) students were having semi-pucca houses, and only one student had kaccha houses. Majority {89 {44.5%}} of the students' fathers received secondary education, 35 (17.5) primary education, 29 (14.5%) intermediate, 19 (9.5) degree, and 4 (2%) postgraduate, respectively, and remaining students’ fathers (24 [12%]) were illiterate. Nearly half (89 {44.5}) mothers of the students received secondary education, 57(28.5) primary education, 14 (7%) intermediate, 10(5%) degree and 30 (15%) were illiterate mothers. According to modified BG Prasad socioeconomic scale, majority of the students (83 [41.5%]) belonged to upper lower class, 56 (28%) lower middle class, 49 (24.5) lower class, 11(5.5%) upper middle class, and 1 (0.5%) upper class.
Table 1: Distribution of participants according to their sociodemographic factors (n = 200)

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[Table 2] shows the knowledge about menstruation; the attainment of menarche ranges from 12 to 15 years. Majority (82 [41.0%]) reported that menstruation was a physiological process, 57 (28.5%) reported as pathological process, 48 (24.0%) reported as curse of God, and very few did not know the reason. Half of them (98 [50.0%]) reported the cause of menstruation by hormonal change, one-fourth of them reported it as curse of God and by disease, and very few did not know the cause. More than half (125 [62.5%]) of the students were aware of menstruation before and the remaining (75 [37%]) were unaware of menstruation. The source of information was the mother in 73 (36.5%), sisters in 52 (26.0%), school teachers in 48 (24.0), and remaining got information from their friends. More than half of the students (135 [67.5%]) had regular menstrual cycles and 65(32.5%) had irregular menstrual cycles, and only very few 9 (4.5%) of the students had intermenstrual bleeding. Three-fourth of the students 154 (77%) had a cycle interval of 21–28 days, 39 (19.5%) had of >28 days, and very fewer students 7(3.5%) had <21 days. Most of the students (152 [76%]) had menstrual flow of >3–4 days, 38 (19%) had <3 days, and 10 students had <4–6 days. Most of the students 59 (29.5%) students had correct knowledge of organ of bleeding during menstruation is the uterus, 39 (19.5%) had an opinion from the vagina, 34 (17.0%) had an opinion from the ovaries, 28 (14.0%) students had an opinion of the urinary bladder, and 40 (20.0%) did not have knowledge about the organ from where the menstrual bleeding occurs.
Table 2: Distribution of the participants according to their knowledge about menstruation

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More than three-fourth (155 [77.5%]) of the students [Table 3] were absent from classes during their menstruation and 45 (22.5%) students attended the classes regularly. Approximately 172 (86%) of the students had restrictions during their menstruation, whereas remaining students 28(14%) did not have any restrictions. Among all 172 (86%) students who had restrictions during menstruation, 147 (73.5%) had religious restrictions, 34 (17%) had restrictions from games, and 19 (9.5%) had restrictions from food. Majority 197(98.5%) of the students used sanitary pad and only 3 (1.5%) used cloth during menstruation. For disposal of pads, most of the students 46 (73%) used dust bin, 42 (21%) students used the toilet for the disposal of pads, and 12 (6%) used the burning method as the disposal. The number of students seeking treatment during menstruation as home remedy was 48 (24.0%), consulting doctor was 64 (32.0), and remaining 88 (44.0%) were not seeking any treatment during menstruation. More than half 128 (68.0%) of the students used soap and water for cleaning the genetalia during menstruation and one-third of the students used only water.
Table 3: Distribution of participants according to their attitude and practices during menstruation

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Among all the students, the anemia status was detected by looking at the palpebral conjunctiva, nail bed, and tongue tip, pallor perception was 106 (53.0%), and remaining was normal. [Table 4] shows menstrual morbidities; more than half 107 (53.5%) of the students reported dysmenorrhea as the problem, 26 (13%) reported premenstrual syndrome, and 22 (11.0%) reported menorrhagia as their problem and the remaining reported irregular cycles and spotting. The association between menstrual morbidities and age-wise distribution was found to be highly significant with χ2 = 39.04 and P < 0.001.
Table 4: Distribution of participants according to their menstrual morbidities (n = 200)

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  Discussion Top


This study involved 200 students from three Government social welfare Girls hostels. The mean age of the hostel girls was 14.2 years with the SD of ±1.13 years. More than 90% of the students were residing in the pucca house in their native place and 65% of them were from nuclear family. In our study, majority of the students had information that menstruation was from their mothers, next sisters, and followed by friends. The source of bleeding was reported by majority of the students was from uterus, next bladder, and followed by the vagina; similar findings were also reported by other studies.[7],[8]

The studies by Shoor[9] and Dambhare et al.[10] also had the same mean age group. In our study, majority of the students were Hindus followed by Christians and Muslims; similar studies[11],[12] from different settings also mentioned the same religious distribution. Similarly different studies from India[13] and outside India[14],[15] on different settings on the knowledge about menstruation and source of information was from the mothers next sisters and followed by friends and some studies also mentioned mass media and print media was also the source of information.

This study showed that majority of the students used sanitary pads during the menstruation and only very few used cloth and most of them used water and soap for the cleaning of the genitalia after menstruation and only very few used only water for cleaning. Most of the students did not take any treatment during menstruation as they were aware that it is a natural phenomenon. Similar findings were shown by the Shoor,[9] Kamath et al.,[16] and Sharma et al.[11] who also reported soap and water for cleaning their private parts during menstruation. Compared to the other studies, our study also reported that the disposal of the sanitary pads was mostly (75%) in the dustbins followed by toilet. Similar studies[13],[17] from different settings like urban and rural also reported the same findings.

With regard to the attitude about menstruation, approximately one-fourth of the students were absent from school during menstruation and more than three-fourth of them went to school even during menstruation. Almost all the students had good awareness about the menstruation and took care during that period unless until there was a severe discomfort. Majority of the students reported that there were restrictions during menstruation in their houses and most of them reported the restriction was religious, games, and followed by food items. A similar study by[10],[18] reported that the majority of restrictions were the religious followed by the outdoor games and food.

The present study reported that dysmenorrhea in more than half 119 (59.5%) of the participants, 36 (18%) reported premenstrual syndrome and 30 (15%) reported menorrhagia and the remaining reported irregular cycles and spotting as the different morbidities during menstruation. A similar study from India[9],[17] also reported the association with the menstrual morbidities and the age wise distribution was highly significant.

Strengths and limitations

As our study involved only the adolescent girls residing in the social welfare hostels which were supported by government, had good knowledge and practices about menstruation when compared to the rural and tribal adolescent girls. Hence, the results cannot be generalized to the general adolescent population.


  Conclusion Top


Provision of low-cost sanitary pads to all the adolescent girls in the social welfare hostels by the Government is necessary to avoid school absenteeism, school dropouts and increase in the age of enrolment, and to improve their quality of life. Health education regarding menstrual hygiene should be provided to the students at an early age and continued in all schools on regular basis. As mothers are the first informant to majority of the adolescent girls, the health education activities should be extended to the mothers also.

Acknowledgement

A word of thanks goes to all the participants in the study and all the authors who contributed for the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Singh AJ. The place of menstruation in the reproductive lives of women of rural North India. Indian J Com Med 2006;31:10-14.  Back to cited text no. 5
    
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Sharma N, Sharma P, Sharma N, Wavare RR, Gautam B, Sharma M. A cross sectional study of knowledge, attitude and practices of menstrual hygiene among medical students in North India. J Phytopharmacol 2013;2:28-37.  Back to cited text no. 11
    
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