Short Communication

Menstrual Hygiene Knowledge and Practice among Adolescent School Girls of Urban Slum of Chetla, Kolkata

Chandrashekhar Taklikar*, Madhumita Dobe**, Ram Narayan Mandal***

*Associate Professor, Department of Health Promotion & Education, All India Institute of Hygiene and Public Health
**Director Professor, Dean & Head of the Department of Health Promotion & Education, All India Institute of Hygiene and Public Health
***Faculty, Department of Health Promotion & Education, All India Institute of Hygiene and Public Health
Corresponding Author: Dr. Chandrashekhar Taklikar
e-mail: shekhartaklikar@gmail.com

Abstract:

Background: Many girls face challenges with managing their menstruation safely due to lack of knowledge. A study by UNICEF revealed that 1 out of 3 girls in South Asia knew nothing about menstruation prior to getting it. Objective: To study the knowledge and Practice regarding Menstrual Hygiene among school girls. Methods:The study was conducted in a school of slum area of Chetla, Kolkata in the month of Feb, 2016. All the 50 girls were included in the study. Data were collected by using structured Schedule. Results: 42% girls had no knowledge about menstruation before menarche and almost half (47%) were unaware of the cause of menstruation. 68% of girls did not knew from where bleeding occurs. 61.5% of girls used Sanitary Pad during menstruation Conclusion: The girls should be educated about the causes of menstruation, selection of a sanitary menstrual absorbent and its proper disposal.


Key words: Menstruation, Menstrual Hygiene, Knowledge, Practice

Introduction

Adolescent girls constitute a vulnerable group not only with respect to their social status but also in relation to their health. In this regard, menstruation is regarded unclean or dirty in society.1The issue of menstrual hygiene is inadequately acknowledged and has not received proper attention.2Good hygienic practices, such as use of sanitary pads and adequate washing of the genital areas, are essential during menstruation period. Women and girls of reproductive age need access to clean and soft absorbent sanitary products which in the long run protect their health from various infections.3

Most of the school going and pre-university girls are not aware of the fundamental facts about menstruation and puberty and very little attention is paid to the reproductive health of those girls.4In India menstruation is surrounded with a long list of Do's and Don'ts with women. Most girls are ignorant about the physiology of menstruation and therefore the first experience of menstruation is of fear, shame and disgust. Due to these reasons girl’s attitude and expectations about menstruation have became negative and this may result in poor menstrual hygiene which is associated with high prevalence of Reproductive Tract Infections (RTI’s).5

A study conducted in Delhi revealed that majority (86%) of the girls lack scientific knowledge about menstruation and puberty.6Similarly a study in Tamil Nadu reported that Hygienic practices were found to be not so satisfactory. Only 53.0% of girls mentioned having taken bath every day and 38.2 % girls on alternate days during their last menstruation. More than two third of the girls (68.5 percent) were ignorant about the use of sanitary pads during menstruation.7

In the view of above the present study was conducted with the objective to assess the knowledge and practice regarding menstruation and hygiene among the school girls of an urban slum of Chetla area, Kolkata.

Methodology:

The study was conducted at Shri Arbindo Vidyapitha (Girls’ High school), Chetla, Kolkata, West Bengal. It is situated in the slum areas of Chetla. Majority of the students attending the school resides in the slum. The study was conducted in the month of Feb, 2106. By using Census sampling all the 50 girls studying in class 5 to 10 were included in the study. Necessary permissions were obtained from the School administration prior to the study. Data collection was done by using pre-structured and pre-tested schedule. Students were interviewed in the class rooms maintaining privacy. The schedule contained information regarding scocio-demographic factors, knowledge and practice regarding menstrual hygiene. Statistical analysis was done by Microsoft excel office 2013 and proportions were calculated.

Results:

Majority of the girls were in the age group of 10-12 yrs, belonged to Hindu religion and General by caste and their mothers were primary educated or illiterate. Almost half of their mothers worked as domestic help. 64% of girls had Pucca house and 62% had sanitary latrine facility. (Table-1)

Table – 1: Distribution of Socio demographic characteristics among the girls

Characteristic

No. of Girls n=50

Percentage (%)

Age in Yrs.

10-12

27

54.0

13-15

20

40.0

16-18

03

6.0

Religion

Hindu

43

86.0

Muslim

07

14.0

Caste

General

34

68.0

ST

03

6.0

SC

05

10.0

OBC

04

8.0

Others

04

8.0

Mothers education

Illiterate

18

36.0

Primary

23

46.0

Secondary

07

14.0

H.S

02

4.0

Mothers Occupation

House Wife

22

44.0

Domestic helper

24

48.0

Service & Other

4

8.0

Monthly Per Capita Income8

<1000

23

46.0

1000-2000

21

42.0

>2000

06

12.0

Type Of house

Pucca

32

64.0

Kachha

13

26.0

Mix

05

10.0

Sanitary latrine

Present

31

62.0



42% girls had no knowledge about menstruation before menarche and almost half (46%) were unaware of the cause of menstruation. 72% of girls were aware that sanitary pad should be used during menstruation and most of them got information regarding menstrual hygiene from family members and only 10% from health personnel. (Table-2)

Table-2: Knowledge regarding Menstruation & Menstrual hygiene among the girls.

Knowledge regarding Menstruation & Menstrual hygiene

No. of Girls
N=50

Percentage (%)

Knowledge of menstruation before Menarche

Had knowledge

29

58.0

No knowledge

21

42.0

Knowledge Regarding Cause Of Menstruation

Physiological

16

32.0

God Given

3

6.0

Don’t Know

23

46.0

Other (Natural/Weight Gain/Disease)

8

16.0

Knowledge Regarding Organ From Where Bleeding Occurs

Uterus

7

14.0

Bladder

3

6.0

Don’t Know

34

68.0

Other (Kidney/Stomach)

6

12.0

Knowledge Regarding Protective Material To Be Used During menstruation

Sanitary Pads

36

72.0

Old Washed Cloth

7

14.0

Pad+ Old Washed Cloth

2

4.0

Pad+ New Cloth

5

10.0

Knowledge Regarding Time Interval Of Changing Sanitary Pad/Cloth

Every 3hrs

8

16.0

Every 4hrs

11

22.0

Every 5hrs

8

16.0

Every 6hrs

7

14.0

Others (8/12 hrs)

16

32.0

Knowledge Regarding Methods Of Disposal Of used Material During Menstruation

Wrap & dispose into open

6

12.0

Wrap &dispose into a closed waste bin

28

56.0

Dispose into pond

3

6.0

Drains

2

4.0

Stagnant water

1

2.0

Others ( Wash the cloth and reuse)

10

20.0

Knowledge Regarding Cleaning Of Genital Area During Menstruation

Plain  water

22

44.0

Luke  warm  water

2

4.0

Soap and  water

23

46.0

Others

03

6.0

Sources of information

Family member

25

50.0

Friend

13

26.0

School teacher

6

12.0

Health personnel

5

10.0

Other ( T.V)

1

2.0



61.5% of girls were using Sanitary Pad during menstruation .42.2% of girls were cleansing the genital area with soap followed by 3.9% with antiseptics. 73% of girls observed the taboo of restriction in moving freely and entering kitchen. (Table-3)

Table-3: Practice regarding menstrual hygiene among the girls

Practice regarding Menstruation & Menstrual hygiene

No. of Girls
N=26

Percentage (%)

Practice regarding protective material to be used during menstruation

Sanitary Pads

16

61.5

New cloth

2

7.7

Old Washed Cloth

4

15.4

Pad+ Old Washed Cloth

1

3.8

Pad+ New Cloth

3

11.6

Practice regarding time interval of changing sanitary pad/cloth

Every 3hrs

7

26.9

Every 4hrs

5

19.3

Every 5hrs

3

11.6

Every 6hrs

11

42.2

Practice regarding methods of disposal of used material during menstruation

Wrap & dispose into open

2

7.7

Wrap &dispose into a closed waste bin

17

65.4

Dispose into pond

2

7.7

Drains

1

3.8

Stagnant water

4

15.4

Practice regarding cleaning of genital area during menstruation

Plain  water

13

50.0

Luke  warm  water

1

3.9

Soap and  water

11

42.2

Antiseptics

1

3.9

Practice of following taboos

Yes

19

73.0

No

7

27.0



Discussion:

Majority of the girls were in the age group of 10-12 yrs, belonged to Hindu religion and were general by caste. A study conducted by Jothy K et.al. among the school girls of Cuddalore district Tamil Nadu found that the age of menstruating girls ranged from 11-19 years, maximum (87.9 %) of girls were between 13 and 15 years of age group and (96.1 %) girls were Hindus7

Most of the participant’s mothers were primary educated (46%) followed by illiterate (36%), Secondary educated (14%) and Higher secondary (4%). Similar results were reported by Neginhal, V. S. that majority of the mothers of research participants have attained primary education (40.3%) followed by secondary education (26.4%), illiterate (21.5%) and so on.9Other similar study conducted in Nigeria in 2006 reported that majority of the mothers of adolescent girls have attained tertiary education (47.5%) followed by secondary (30.7%), primary (14.9 %).10Study conducted in Sokoto, Nigeria also revealed that majority of the mothers have attained tertiary level of education (47%) followed by secondary education (28%), primary education (3%) and so on.11

Most of the girls (88%) belonged to families having per capita monthly income of < Rs-1000 Almost half of their mother s worked as domestic help. 64% of girls had Pucca house and 62% had sanitary latrine facility. Similarly, Jothy K et. al. reported in their study that majority of the respondents` (82.5%) monthly household income was below Rs.2000/-. The average monthly household income was Rs.940/-. 67.3 percent of the respondents were residing in Huts thatched roof house. 7

In this study 58% girls had knowledge about menstruation before menarche. Similar to this, a study conducted in West Bengal reported that 67.5% girls were aware about menstruation prior to attainment of menarche.1 Similarly, study conducted in Uttarakhand also reported that 64.5% adolescent girls were aware about menstruation prior to the attainment of menarche.12Similarly in a study performed among adolescent school girls in (Nagpur) Maharashtra by Thakre SB et al 2011 revealed only 36.95% of the girls were aware of menstruation before menarche13About 72% urban girls and 39% rural girls were found to have pre-menarcheal knowledge regarding menstruation. 14A study by UNICEF revealed that 1 out of 3 girls in South Asia knew nothing about menstruation prior to getting it. (Water Aid 2013), while 48% of girls in Iran and 10% of girls in India believe that menstruation is a disease (Water Aid 2013, Menstrual Hygiene Matters). 15

It was observed that almost half (47%) were unaware of the cause of menstruation. 68% of girls did not knew from where bleeding occurs and other 18 % had incorrect knowledge who reported that bleeding occurs from bladder/kidney/stomach. In a similar study it was found that the knowledge on cause of menstruation was poor among participants i.e. only 52.1% of them knew that menstruation is normal physiological process. Similar findings were reported in a study conducted in Zagazig City.16 Another study conducted among the rural adolescent girls of Nepal, 25.3 per cent of the girls reported uterus as the organ of bleeding during menstruation whereas 32 per cent, 26.7 per cent and 16 per cent said the fallopian tube, vagina and urinary bladder respectively.17

In the present study 50 % of girls got information regarding menstrual hygiene from family members (Mother/Sister) and 26 % from friends only 10% from health personnel. Previous studies revealed that mothers of the girls were the major source of information i.e. 70.7 % followed by friends 18.6% and teacher 10.6%. Consequent to our study, a study conducted in South India reported in his study that mother were the main source of information i.e. 54.00% followed by friends 35.3% and so on.18 Similarly study conducted in Gujarat reported that the major source of information was the mother 60.7% followed by older sisters 15.8 %, however teachers and others played a small role in it.1919 Katiyar K. et al 2013documented that 66.9% of urban adolescent females of Meerut learned about menstrual practices from mothers.20

61.5% of girls were using Sanitary Pad during menstruation followed by 15.4% old washed cloth,11.3% pad +new cloth, 7.7% new cloth and 3.8% pad + old washed cloth. Likewise a study by Pokhrel S. et.al reported that, of 303 girls, 56.4% used sanitary pad, 28.7% used new cloth, 13.2% used old cloth and 1.7% used tampon as a absorbent during menstruation.21 21 In a study by Datta A et. al found that 73.5% of urban participants and 45.9% rural respondents used only sanitary napkin during menstruation. Most of the respondents (76.5% in urban area and 90.8% in rural area) changed absorbent two to four times a day.1458.8% of girls were changing Sanitary Pad /cloth within5 hours (ranging from 3 hours to 5hours). Similarly Pokhrel S et.al. Reported 47.2% girls change the pad only twice a day.21

In this study it was observed that 65.4% of girls wrapped and disposed of the used materials during menstruation in a closed container. Study by Pokhrel S et.al. Revealed that 66.7% girls threw it in the dustbin, 19.8% girls burnt it, 10.2% girls drained it and remaining of them threw it by the roads.21Such menstrual practices were also reported in another study among adolescent school girls in Nepal where regarding final disposal of the menstrual materials, 43 per cent of the girls buried their absorbent materials followed by 35 per cent threw with other wastes and 19 per cent burnt the materials.22

Regarding cleaning of genitalia 42.2% of girls was cleansing the genital area with soap followed by 3.9% with antiseptics. A study by Pokhrel S et. al reported that only 24.8% girls reported of cleaning genitalia.21

73% of girls observed the taboo of restriction in moving freely and entering kitchen. Similar results were reported by Jothy K. et. al that 74.5% girls did not attend any religious ceremonies, 64.25% were forbidden from playing 55.2% girls were not allowed to attend social functions like marriage. 60.3% girls were not allowed even to move freely in the house. 7

Conclusion:

This study has highlighted the needs of the adolescents to have accurate, appropriate and adequate information about menstruation and its appropriate management. The girls should be educated about the causes of menstruation, selection of a sanitary menstrual absorbent and its proper disposal.

As mothers and elder sisters were the first line of informant about menstruation among 50 percent of the girls in the study area, it is utmost important that the mothers be equipped with correct and appropriate information on reproductive health.

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