INTRODUCTION:

“Adolescence is the conjugate of childhood and adulthood”

-Lowes J Kaplan

Menstrual hygiene is an issue that every girl and women has to deal with in her life, but there is lack of awareness on the process of menstruation, the physical and physiological changes associated with the puberty and proper requirements for managing menstruation¹.

Because of the lack of knowledge, they end-up with repeated use of unclean menstrual absorbent results in harbouring of micro-organisms that increases susceptibility to urinary, perineal, vaginal and pelvic infections. If these infections left untreated that will lead to several consequences like infertility, ectopic pregnancy, foetal wastage and prenatal infection, low birth weight babies, toxic shock syndrome².

The word adolescent is derived from the Latin word “adolescere”, which means to grow into maturity. The World Health Organization WHO has defined adolescence as the period between 10-12 years of life³. Adolescence in girls has been recognised as a special period which signifies the transition from girlhood to womanhood. This period is marked with onset of menarche. Adolescent girls constitute about 1/5^th of the total population in the world. These also constitute a vulnerable group particularly in India where female child is neglected one³.

The onset of menstruation is called “Menarche” and it is the hallmark of female pubertal development⁴. Menstruation (a period) is an exceptional phenomenon that the nature has planned for women. It is not just a small term but a major stage where a woman undergoes certain reproductive changes from onset of menstruation (menarche) till menopause. Adolescence is the stage of physical, psychological, and reproductive development that generally occurs during the period from puberty to legal adulthood⁵.

The first menstruation is often horrifying and traumatic to an adolescent girl because it usually occurs without her knowledge. Although menstruation is some normal physiological phenomena for females indicating her capability for procreation⁶.

Around the world, one in three girls face inadequate sanitation, and many others face social and cultural limits during their periods. Access to safe sanitation is extremely important for women and girls during their menstrual cycles. A report by Dasra suggests that nearly 23 million girls drop out of school annually due to lack of proper menstrual hygiene management facilities. Sanitation facility in close proximity provides a considerable level of comfort for girls who suffer from severe cramping or dysmenorrhea. Besides, it also ensures that a female gets enough privacy in order to clean up properly, and maintain better hygiene. It has also been suggested by Cleveland Clinic, Ohio that up to 50% of women will experience some form of digestive distress during their periods. This distress also demands the availability of easily accessible sanitation facilities. It is important to prioritise better toilets and washing facilities in schools and homes, and to provide accurate information around menstruation, to ensure the right to education, equality and well-being for girls⁷.

Attitude of parents and society in discussing the related issues are barriers to the right kind of information, especially in the rural areas. Menstruation is thus considered to be a matter of embarrassment in most cultures⁸. It was therefore decided to conduct a study to explore the level of knowledge regarding menstrual hygiene among the adolescent girls.

NEED FOR THE STUDY:

Menstrual hygiene is the hygiene during menstruation explored including information about buying and using sanitary protection products^.Menstruation is a phenomenon unique to females all the girls received advice regarding menstrual hygiene from different sources. Some of their practices were unhygienic before bringing any change in menstrual practices they should be educated about the facts of menstruation and its physical implications. Due to unhygienic practices of menstrual hygiene there are some complications like cervicitis, bacterial vaginitis, fungal infections, inflammatory diseases etc. are prevalent among females⁹.

These younger generations are tomorrow’s parents. The reproductive health decisions that they make today will affect the health and wellbeing of their upcoming generations and their community. Even though all initiatives took place, by government of India, a major section of the adolescent girls do not have a prior awareness about the menstrual cycle and its hygienic practices leading to poor menstrual hygiene. Hence this study was conducted, among adolescent girls regarding their menstrual hygiene and related personal hygiene practices and helps them to prevent, which sometimes results in adverse health outcomes. Women having a better knowledge regarding menstrual hygiene and safe menstrual practice are less vulnerable to reproductive tract infections and its consequences. Therefore, increased knowledge about menstruation right from childhood may escalate safe practices and may help in mitigating the suffering of millions women’s¹⁰.

Menstruation is a natural fact of life and a monthly occurrence for the 1.8 billion girls, women, transgender men and non-binary persons of reproductive age. Yet millions of menstruators across the world are denied the right to manage their monthly menstrual cycle in a dignified, healthy way. Gender inequality, discriminatory social norms, cultural taboos, poverty and lack of basic services often cause girls’ and women’s menstrual health and hygiene needs to go unmet. Adolescent girls may face stigma, harassment and social exclusion during menstruation. Transgender men and non-binary persons who menstruate often face discrimination due to their gender identity that prevents them from accessing the materials and facilities that they need. All of this has far-reaching negative impacts on the lives of those who menstruate: restricting their mobility, freedom and choices; affecting attendance and participation in school and community life; compromising their safety; and causing stress and anxiety. The challenges are particularly acute for girls and women in humanitarian crises¹¹.

The Ministry of Health in 2002, 2005, 2008 and 2012 found out that most problems related to menstrual hygiene in India are preventable, but are not due to low awareness and poor menstrual hygiene management. This resulted in development of some serious ailments for adolescent girls. Roughly 120 million menstruating adolescents in India experience menstrual dysfunctions, affecting their normal daily chores. Nearly 60,000 cases of cervical cancer deaths are reported every year from India, two-third of which is due to poor menstrual hygiene.¹²

Menstruation is still regarded as something unclean or dirty in Indian society. Isolation of the menstruating girls/women and restrictions being imposed on them in the family, have reinforced a negative attitude towards this phenomenon. Menstrual practices are clouded by taboos and socio-cultural restrictions even today, resulting ignorance of the scientific facts and hygienic health practices, necessary for maintaining positive reproductive health¹². During menstruation period, shedding of the blood leaves the genital tract moist and lowered acidity of the vagina making it vulnerable for infections by bacteria and other organisms in reproductive tract. This in turn may lead to discomfort, pain, foul smelling discharge and sense of embarrassment among them. In developing countries like India and other third world countries it is reported that many of the menstruating women/girls do not follow healthy measures for maintaining the menstrual hygiene. Women belonging to lower socio-economic strata, who cannot afford to buy sanitary napkins, use a cotton cloth which is usually a torn piece of cloth from their old sarees or other dresses and use them throughout their periods with infrequent changing, sometimes scarcity of water adds up to them deprives them of washing the cloth. Such unhealthy menstrual practice is associated with many complications of recurrent reproductive tract infections like premature births, stillbirths, miscarriages, infertility problems, carcinoma of cervix etc.¹³

OBJECTIVES:

1. To assess the pre-test level of knowledge regarding menstrual hygiene among adolescent girls at JSS High School, Chamarajanagar

2. To assess the post-test level of knowledge regarding menstrual hygiene among adolescent girls at JSS High School, Chamarajanagar

3. To evaluate the effectiveness of video assisted teaching programme on the knowledge practice regarding menstrual hygiene among adolescent girls at JSS High School, Chamarajanagar

4. To find the association between the pre-test level of knowledge regarding menstrual hygiene among adolescent girls with their demographic variables at JSS High School, Chamarajanagar

5. To find the association between the post-test level of knowledge regarding menstrual hygiene among adolescent girls with their demographic variables at JSS High School, Chamarajanagar

HYPOTHESIS:

H₁: There is a significant difference between the pre-test and post-test knowledge scores of adolescents regarding menstrual hygiene at 0.05 levels

H₂: There is a significant association between the pre-test knowledge scores of adolescents regarding menstrual hygiene with their selected demographic variables at 0.05 levels

H₃: There is a significant association between the post-test knowledge scores of adolescents regarding menstrual hygiene with their selected demographic variables at 0.05 levels

METHODOLOGY:

Source of data:

The data was collected from Adolescent Girls studying at JSS High School, Chamarajanagar

Research Approach:

Quantitative approach was used for the present study

Research Design:

The design adopted is Pre-experimental design.

Settings:

The present study was conducted at JSS High School, Chamarajanagar

Method of Data Collection:

Sampling technique:

Convenient Sample technique was selected.

Sample:

In this study the sample was Adolescent Girls aged between 13-16 years from the JSS High School Chamarajanagar

Sampling size:

The sample size consists of 90 Adolescent Girls at JSS High School Chamarajanagar

Inclusion Criteria:

The study included:

· Adolescence Girls between the age group of 13-16 years

· Adolescence Girls who had attained menarche

· Adolescent Girls who are willing to participate in the study

Exclusion criteria: The study excluded:

· Adolescent Girls those who are not attained menarche

Instrument Used:

Tool I: Demographic data

Tool II: Structured questionnaire consist of multiple choice questions to assess the knowledge and practice on Menstrual Hygiene.

Description of the tool:

Section I: Section I consist of demographic data which includes age in years, age at menarche, educational status of students, educational status of parents, occupation of parents, family income, types of family, religion, dietary pattern any prior information regarding menstrual hygiene.

Section II: Section II consist of multiple choice questions to assess the knowledge on Menstrual Hygiene. Each multiple choice question had four alternatives. For every correct response in each question score ‘1’was given and for wrong answer score ‘0’. The total score of structured questionnaire was 20.

Data Collection Method:

The data collected by using structured questionnaire consist of multiple choice questions to assess the knowledge and practice on Menstrual Hygiene.

RESULTS:

Section I: Demographic characteristics

Table I: Frequency and percentage distribution of adolescents according to their demographic variables n=90

S. No.	Demographic Variables	Frequency	%
1.	Age in years
	a. 13 years	5	5.6
	b. 14 years	26	28.9
	c. 15 years	48	53.3
	d. 16 years	11	12.2
2.	Age at Menarche
	a. 10-12 years	24	26.7
	b. 13-15 years	66	73.3
3.	Class Studying
	a. 9th standard	38	42.2
	b. 10th standard	52	57.8
4.	Education of Parents
	a. Illiterate	14	15.6
	b. Elementary	32	35.6
	c. Higher Secondary	39	43.3
	d. Graduate and post graduate	5	5.6
5.	Occupation of Parents
	a. Coolie	40	44.4
	b. Farmer	25	27.8
	c. Business	14	15.6
	d. Other	11	12.2
6.	Family Income
	a. Below Rs. 8000	29	32.2
	b. Rs. 8001-12000	29	32.2
	c. Rs. 12001-15000	24	26.7
	d. Above Rs. 15000	8	8.9
7.	Type of family
	a. Nuclear family	66	73.3
	b. Joint family	24	26.7
8.	Religion
	a. Hindu	88	97.8
	b. Muslim	2	2.2
9.	Dietary Pattern
	a. Vegetarian	36	40.0
	b. Mixed Diet	54	60.0
10.	Prior Information on Menstrual Hygiene
	a. Yes	17	18.9
	b. No	73	81.1

Table I Shows that among 90 participants majority of the participants are in the age group 15 years that is 48 (53.3%). The majority of the participants attained menarche between the age group of 13 -15 years that is 66(73.3%). The majority of participants are studying in 10^thstandard that is 52(57.8%). The majority of parent’s education is higher secondary that is 39(43.3%). The majority of parent’s occupation is coli that is 40 (49.4%). The majority of participant’s family income is below Rs 8000 thousand that is 29(32.2%) and between Rs 8001 to 12000 that is 29(32.2%). The majority of the participants belong to nuclear family that is 66(73.3%). The majority of the participant’s religion is Hindu that is 88(97.8%). The majority of the participants consuming mixed diet that is 54(60%). The majority of the participants are not having prior information on Menstrual Hygiene that is 73(81.1 %)

Section II: Knowledge level of adolescents

Table II: Frequency and percentage distribution of adolescents according to their knowledge level n=90

Overall Knowledge level	Pre test		Post test
Overall Knowledge level	Frequency	%	Frequency	%
Inadequate knowledge	47	52.2	6	6.7
Moderate knowledge	41	45.6	34	37.8
Adequate knowledge	2	2.2	50	55.6
Total	90	100	90	100

Table II: shows that in the pre -test among 90 participants, The majority of the participants that is 47(52.2%) are having inadequate knowledge, 41(45.6%) are having moderate knowledge, only 2 participants (2.2%) are having adequate knowledge .The knowledge level of participants after the post test is the majority of the participants that is 50(55.6%) are having adequate knowledge, 34 participants (37.8%) are having moderate knowledge, only 6 participants (6.7%) are having inadequate knowledge.

Table III: Mean, Median, standard deviation of pre-test and post-test knowledge scores of adolescent girls n=90

Variable	No of Items	Max Score	Mean	Mean %	Median	SD
Pre test	20	20	10.57	52.85	10	2.61
Post test	20	20	15.23	75.15	16	2.907

Table III: shows that in pre-test among 90 participants out of 20 items the mean score is 10.57(52.85%) and after post-test among 90 participants out of 20 items the mean score was 15.23(75.15%).

Section III: Comparison between pre-test and post-test knowledge scores

Table IV: Comparison between pre-test and post-test knowledge score of adolescent girls n=90

Variable	Mean	SD	Mean difference	t Value	Df	Inference
Pre test	10.57	2.61	4.66	10.16	89	HS
Post test	15.23	2.907	4.66	10.16	89	HS

Table IV: Shows that the mean post-test knowledge score of the adolescent girls is 15.23 (75.15%) is higher than their mean pre-test knowledge score 10.57(52.58%). The obtained’ value is at df (4.66) is (10.16) which is highly significant.

Section IV: Association of pre-test knowledge scores with demographic variables

Table V: Association between pre-test knowledge scores of adolescent girls regarding menstrual hygiene with their demographic variables n=90

S. No.	Variables	Below Median	Median and above	Chi square	Df	P value (0.05)	Inference
1.	Age in years
	a. 13 years	2	3	0.785	3	0.853	NS
	b. 14 years	10	16
	c. 15 years	20	28
	d. 16 years	3	8
2.	Age at menarche
	a. 10-12 years	9	15	0.027	1	0.871	NS
	b. 13-15 years	26	40
3.	Class studying
	a. 9th standard	15	23	0.009	1	0.923	NS
	b. 10th standard	20	32
4.	Education of parents
	a. Illiterate	6	8	0.944	3	0.815	NS
	b. Elementary	12	20
	c. Higher Secondary	16	23
	d. Graduate and post graduate	1	4
5.	Occupation of parents
	a. Coolie	14	26	1.954	3	0.582	NS
	b. Farmer	12	13
	c. Business	4	10
	d. Other	5	6
6.	Family Income
	a. Below Rs. 8000	8	21	3.934	3	0.269	NS
	b. Rs. 8001-12000	11	18
	c. Rs. 12001-15000	13	11
	d. Above Rs. 15000	3	5
7.	Type of Family
	a. Nuclear family	23	43	1.700	1	0.192	NS
	b. Joint family	12	12
8.	Type of Family
	a. Hindu	35	53	1.302	1	0.254	NS
	b. Muslim	0	2
9.	Dietary pattern
	a. Vegetarian	16	20	0.779	1	0.377	NS
	b. Mixed Diet	19	35
10.	Prior information about menstrual hygiene
	a. Yes	15	2	21.475	1	0.000	S
	b. No	20	53

The data presented in the table IV shows that association between pre- test knowledge level of adolescent girls with their demographic variables and the result shows that prior information about menstrual hygiene is significant.

Table V: Association between post-test knowledge scores of adolescent girls regarding menstrual hygiene with their demographic variables n=90

S. No.	Variables	Below Median	Median and above	Chi square	Df	P value (0.05)	Inference
1.	Age in years
	a. 13 years	3	2	3.927	3	0.269	NS
	b. 14 years	15	11
	c. 15 years	17	31
	d. 16 years	5	6
2.	Age at menarche
	a. 10-12 years	11	13	0.026	1	0.873	NS
	b. 13-15 years	29	37
3.	Class studying
	a. 9th standard	23	15	6.889	1	0.009	S
	b. 10th standard	17	35
4.	Education of parents
	a. Illiterate	3	11	6.481	3	0.090	NS
	b. Elementary	14	18
	c. Higher Secondary	22	17
	d. Graduate and post graduate	1	4
5.	Occupation of parents
	a. Coolie	14	26	2.942	3	0.401	NS
	b. Farmer	12	13
	c. Business	8	6
	d. Other	6	5
6.	Family Income
	a. Below Rs. 8000	14	15	0.458	3	0.928	NS
	b. Rs. 8001-12000	12	17
	c. Rs. 12001-15000	10	14
	d. Above Rs. 15000	4	4
7.	Type of Family
	a. Nuclear family	30	36	0.102	1	0.749	NS
	b. Joint family	10	14
8.	Type of Family
	a. Hindu	38	50	2.557	1	0.110	NS
	b. Muslim	2	0
9.	Dietary pattern
	a. Vegetarian	14	22	0.750	1	0.386	NS
	b. Mixed Diet	26	28
10.	Prior information about menstrual hygiene
	a. Yes	4	13	3.713	1	0.054	NS
	b. No	36	37

The data presented in the table V shows that association between post- test knowledge level of adolescent girls with their demographic variables and the result shows that which class at present they are studying is significant.

RECOMMENDATIONS:

Based on the findings of the study the recommendation for the future studies are as follow:

· Similar study can be conducted for longer samples for longer period.

· Similar study can be done in various settings.

· A comparative study can have conducted on menstrual hygiene among urban and rural adolescent girls.

· School health education programme has to be strengthened and education with respect to menstrual hygiene should be major component of health education for adolescent girls.

· Hygiene of menstruation should be included in the teacher training programme, so that they are equipped with adequate knowledge to guide their students.

CONCLUSION:

The result of the study revealed that in pre-test the most of the participants are having inadequate knowledge and only five participants are having adequate knowledge that is 2.2% and the post test revealed that majority of the participants having adequate knowledge that is 55.6% it shows that participants gain knowledge on menstrual hygiene after video assisted teaching programme on menstrual hygiene. Hence forth such education programmes should be conducted regularly at the school level.

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Received on 25.05.2021 Modified on 31.05.2021

Int. J. of Advances in Nur. Management. 2021; 9(3):257-263.

DOI: 10.52711/2454-2652.2021.00059