INTRODUCTION:

According to the report by UNICEF (2016) there are 243million adolescence comprising 20% of total population in India, which clearly shows that India has got more young people. It includes 10% of school girls aged between 12 to 14 years and major it you them lives, in rural areas. They do not know to take care of themselves in hygienic way during the time of menstruation which adversely themselves in hygienic way during the time of menstruation which adversely affects their health. .When the girl attains menarche, menstrual hygiene is the real challenge for them to practice. The good menstrual hygiene prevents. themselves in hygienic way during the time of menstruation which adversely affects their health. .When the girl attains menarche, menstrual hygiene is the real challenge for them to practice. The good menstrual hygiene prevents reproductive tract infection among girls which ultimately promote there productive health. The current trend of antenatal care starts from puberty. This concept was emphasized by Kumari (2014) who conducted a study among girls regarding menstrual hygiene revealed that only few girls were using sanitary napkin and many did not practice the same. Menstrual hygiene involves the personal hygiene measures to be adopted by women and adolescent girls, it includes the use of clean material to absorb or collect menstrual blood and these materials can be changed in privacy as often as necessary for the duration of menstruation. Menstrual hygiene management also includes, using soap and water for washing the body as required and having access to facilities to dispose of used menstrual management material.

To highlight the menstrual hygiene awareness among girls 28^th May is observed as menstrual hygiene day, which aims to break taboos and raise awareness about the importance of good menstrual hygiene management for women and adolescent girls worldwid

NEED FOR THE STUDY:

Menstrual hygiene is important to be practiced by the school girls to promote their health and prevent illness. Inadequate menstrual hygiene management is connected with the use of cloth, ashes and husk sand during menstruation, thereby it causes severe reproductive health problem. According to World Health Organization (2015) there are about 74% of schoolgirls had suffered with reproductive tract infection due to improper menstrual hygiene. The poor menstrual hygienic practices also leads to several problem among school girls which include dropped out from the school, inability to continue the education and reduction of self-esteem. It occurs because the school girls don’t practice menstrual hygiene and don’t have accessibility for sanitary napkin. The biggest barrier to adopt the quality of sanitary napkin in India are lack of affordability and accessibility as reported by In Derjeet Singh (2013) there are about 70% of school girls and their the family cannot affords sanitary napkin. It is further supported by the report of Times of India (2014) which unveiled that 50% of the school girls who dropped out the school in secondary classes are due to lack of sanitary napkin, coupled with lack of separate toilet facilities and water resources within the school campus. Thus the lack of knowledge on menstrual hygiene practice and sanitary napkin are the major cause for absenteeism among school girls.

METHODOLOGY:

A quantitative research approach was used for this study. Research design adopted was pre experimental one group pretest and post test method. The sample selected based on the inclusion and exclusion criteria in selected school. The sample size was adopted for the study is 50 School girls those who attained menarche aged between 12and14 years and studying in VIII(or) IX standard in Govt. Higher Secondary School. Sample technique used for the study Purposive sampling technique. Structured questionnaire was used to assess the knowledge of the school girls and Assessment of expressed practice. Questionnaire is considered as the most appropriate instrument to elicit the response from the literate subjects. The study proceeded after the sanction by institutional ethic committee and permission was opted from the government officials to conduct the study in selected school. Informed consent was taken from all the participants and confidentiality and anonymity was maintain throughout the procedure. Tool used for the study was divided under four sections with consent forms.

RESULTS:

Section–A:

Table 1: Distribution of demographic variables among school girls N=50

S. No.	Demographic Variables		N	%
1.	Age in years	12.1-13years	24	48
1.	Age in years	13.1-14years	26	52
2.	Education	VIII standard	26	52
2.	Education	I X standard	24	48
3.	Religion	Hindu	14	28
		Christian	14	28
		Muslim	10	20
		Others[specify]	12	24
4.	Type of family	Nuclear family	20	40
		Joint family	17	34
		Broken family	13	26
5.	Residence	Urban	21	42
5.	Residence	Rural	29	58
6.	Educational Status of father	Illiterate	22	44
		Primary	15	30
		High school	5	10
		Higher secondary	4	8
		Graduate	4	8
7.	Educational status of mother	Illiterate	23	46
		Primary	14	28
		High school	6	12
		Higher secondary	4	8
		Graduate	3	6
8.	Occupational status of father	Employed	25	50
		Unemployed	16	32
		Self-employed	9	18
9.	Occupational status of mother	Employed	26	52
		Unemployed	17	34
		Self-employed	7	14
10.	Family income per month (Rs.)	Upto5,000	23	46
		5,001to7,500	17	34
		7,501to10,000	5	10
		Morethan10,000	5	10
11.	Number of siblings	1	25	50
		2	16	32
		3	9	18
12.	Source of information	Mother	21	42
		Relatives	17	34
		Mass media	4	8
		Friends	8	16

The table depicts the distribution of demographic variables among schoolgirls:

It reveals that among 50 school girls, 24(48%) were in age group of 12.1-13 and 26(52%) of them were in the age group of 13.1-14 years. With regard to the education of the girls, 26(52%) were in VIII standard and 24(48%) were in IX standard, Most of the 14(28%) belongs to Hindu, 14(28%) belongs to Christian, 10(20%) belongs to Muslim and 12(24%) belongs to others.

Distribution of regarding type of family revealed that most of the 20(40%) were in Nuclear Family, 17(34%) were in Joint Family and, 13(26%) were in Broken Family. Most of the 21(42%) had their residence in urban and 29(58%) were in rural area.

The level of education of father revealed that 22(44%) were illiterates, 15(30%) had primary education,5(10%) had high school education and, 4(8%) had Higher Secondary school education and 4(8%) were graduate.

The educational status of mother revealed that 23(46%) were illiterates, and 14(28%) had primary education out of 50 participants 6(12%) 4(8%) and 3(6%) had high school education, higher secondary school education and under graduation respectively.

Occupational status of father revealed that 25(50%) were employed,16(32%) were unemployed, 9(18%) were self-employed. Occupational status of mother revealed that most of the 26(52%) were employed, 17(34%) were unemployed and 7(14%) were self-employed.

Among 50 school girls 23(46%) had a monthly income up to Rs.5, 000, 17(14%) of them had a monthly income between Rs.5001 to 7500, 5(10%) of them had a monthly income of Rs.7501 to Rs.1000, and remaining 5(10%) had a monthly income above Rs.10000. With regard of number of sibling 25(50%) had one sibling, 16(32%) had two siblings and, 9(18%) had three and above.

With regard to source of information regarding health 21(42%) participants got the information by mother, 17(34%) by relatives, 4(8%) by mass media and 8(16%) by friends.

Table 2: Distribution of health related variables among schoolgirls

N= 50

S. No.	Health related variables		N	%
1	Age at menarche	12.1-13years	26	52
1	Age at menarche	13.1-14years	24	48
2	Nature of practice during menstruation	Cloth	25	50
		Sanitary napkin	20	40
		Others	5	10
3	Frequency of changing napkin per day	Once a day	25	50
		Twice a day	17	34
		Thrice a day and above	8	16
4	Perception of pain during menstruation	Never	25	50
		Sometimes	17	34
		Always	8	16
5	Source of water supply	Well Water	25	50
		Municipal Water	18	36
		Bore Water	7	14
6	Methods of disposal	Directly burn	25	50
		Throw outside	15	30
		Dumped	10	20
7	Toilet practice	Open Field	30	60
7	Toilet practice	Sanitary latrine	20	40

The above table depicts the distribution of health related variables among school girls with regard to the age at menarche 26(52%) and 24(48%) participants were aged between 12.1-13 years and 13.1-14 years respectively.

Regarding nature of practice during menstruation, 25(50%) used cloth, 20(40%) used sanitary napkins and, 5(10%) used others.

While looking the frequency of changing napkin per day, most of them 25(50%) change the napkin once a day, 17(34%) change the napkin twice a day,8(16%) change the napkin thrice a day and above.

Regarding perception of pain during menstruation it was found that 25(50%) never feels pain, 17(34%) sometimes feels pain and 8(16%) always feels pain.

The most of the study participants 25(50%) had the source of water supply from well,18(36%) had from the municipal water,7(14%) had from bore water.

Regarding methods of disposal 25(50%) were directly burn,15(30%) were throw outside and 10(20%) were dumped.

With regard to usage of toilet practices 30(60%) adapted open field defecation and 20(40%) adapted sanitary latrine practices.

Section-B

Table 3: Distribution of level of knowledge regarding sanitary napkin among school girls in pre and post test N=50

S. No.	Level of knowledge	Pre-test		Post-test
S. No.	Level of knowledge	N	%	N	%
1	In adequate knowledge	48	96	-	-
2	Moderately adequate knowledge	2	4	3	6
3	Adequate knowledge	-	-	47	94
Total		50	100	50	100

The above table reveals that 48(96%) and 2(4%) participants in pre-test had inadequate and moderately adequate knowledge respectively. In post-test 47(94%) and 3(6%) study participants had adequate knowledge and moderately adequate knowledge respectively.

Fig. No. 1: Percentage distribution of level of knowledge regarding sanitary napkin among schoolgirls.

Table 4: Distribution of level of expressed practice regarding sanitary napkin among school girls in pre and post test N=50

S. No.	Level of practice	Pre-test		Post-test
S. No.	Level of practice	N	%	N	%
1	In adequate practice	42	84	5	10
2	Moderately adequate practice	8	16	12	24
3	Adequate practice	-	-	33	66
Total		50	100	50	100

The above table reveals that 42(84%) and 8(16%) if study girls participants had inadequate and moderately adequate practice respectively in pre-test. In post-test 33(66%) and 12(24%) had adequate practice and moderately adequate practice and only 5 (10%) had inadequate knowledge among study participants respectively.

Fig. No. 2: Percentage is attribution of level of expressed practice regarding sanitary napkin among school girls.

Section-C:

Table 5: Comparison of pre and post-test knowledge score regarding sanitary napkin among school girls N=50

S. No.	Observation	Mean	SD	Paired ‘t’ value	p-value
1	Pre-test	6.62	1.86	38.339***	0.001
2	Post-test	17.9	1.23	38.339***	0.001

*** P <0.001

The above table unveils that there was a statistically significant difference between pre and post knowledge score regarding sanitary napkin among school girls at P<0.001.

Table 6: Comparison of pre and post-test expressed practice score regarding sanitary napkin among school girls N=50

S. No.	Observation	Mean	SD	Paired ‘t’ value	p-value
1	Pre-test	6.48	3.62	13.504***	0.001
2	Post-test	15.52	2.59	13.504***	0.001

*** P<0.001

The above table illustrates that there was a statistically significant difference test between pre and post-test expressed practice score regarding sanitary napkin among school girls at P < 0.001.

Section-D:

Table 7: Association of socio demographic variables with level of knowledge regarding sanitary napkin among school girls N=50

S. No.	Demographic variables		Post-test knowledge score
			Inadequate		Moderatelyad equate		Adequate		chisquare	Pvalue
			No	%	No	%	No	%
1	Age in years	12.1-13	-	-	2	4	22	44	0.446 NS	0.504
1	Age in years	13.1-14	-	-	1	2	25	50	0.446 NS	0.504
2	Education	VIII standard	-	-	1	2	24	48	1.051 NS	0.789
2	Education	IX standard	-	-	2	4	23	46	1.051 NS	0.789
3	Religion	Hindu	-	-	-	-	14	28	5.374 NS	0.146
		Christian	-	-	-	-	14	28
		Muslim	-	-	2	4	8	16
		Others [specify]	-	-	1	2	11	22
4	Type of family	Nuclear family	-	-	1	2	19	38	0.102 NS	0.95
		Joint family	-	-	1	2	16	32
		Broken family	-	-	1	2	12	24
5	Residence	Urban	-	-	3	6	26	52	2.311 NS	0.128
5	Residence	Rural	-	-	-	-	21	42	2.311 NS	0.128
6	Educational status of father	Illiterate	-	-	2	4	20	40	1.214 NS	0.876
		Primary	-	-	1	2	14	28
		High school	-	-	-	-	5	10
		Higher secondary	-	-	-	-	4	8
		Graduate	-	-	-	-	4	8
7	Educational status of Mother	Illiterate	-	-	3	6	20	40	3.747 NS	0.441
		Primary	-	-	-	-	14	28
		High school	-	-	-	-	6	12
		Higher secondary	-	-	-	-	4	8
		Graduate	-	-	-	-	3	6
8	Occupational status of Father	Employed	-	-	-	-	25	50	6.782*SS	0.034
		Unemployed	-	-	3	6	13	26
		Self-employed	-	-	-	-	9	18
9	Occupational Status of Mother	Employed	-	-	3	6	23	46	2.946 NS	0.229
		Unemployed	-	-	-	-	17	34
		Self-employed	-	-	-	-	7	14
10	Family income per month (Rs.)	Upto 5,000	-	-	1	2	22	44	1.751 NS	0.626
		5,001to7500	-	-	2	4	15	30
		7,501to10,000	-	-	-	-	5	10
		Morethan10,000	-	-	-	-	5	10
11	Number of sibling	1	-	-	1	2	24	48	1.95 NS	0.377
		2	-	-	2	4	14	28
		3andabove	-	-	-	-	9	18
12	Source of information	Mother	-	-	-	-	21	42	5.413 NS	0.144
		Relatives	-	-	2	4	15	30
		Mass media	-	-	1	2	3	6
		Friends	-	-	-	-	8	16

NS = not significant SS=statistically significant* P<0.05

The above table shows that there was a statistically significant association of occupational status of father with the level knowledge regarding sanitary napkin among study participants at level P<0.05

Table 8: Association of health-related variables with level of knowledge regarding sanitary napkin among school girls N=50

Sr. No.	Health related variables		Post-test knowledge score						Chi Square	P- value
			Inadequate		Moderately Adequate		Adequate
			No	%	No	%	No	%
1	Age at menarche	12.1-13years	-	-	2	4	31	62	2.62 NS	0.457
1	Age at menarche	13.1-14years	-	-	1	2	16	32	2.62 NS	0.457
2	Nature of practice during menstruation	Cloth	-	-	1	2	24	48	1.95 NS	0.377
		Sanitary napkin	-	-	1	2	19	38
		Others	-	-	1	2	4	8
3	Frequency of changing napkin per day	Once a day	-	-	1	2	24	48	6.383* SS	0.041
		Twice a day	-	-	-	-	17	34
		Thrice a day and above	-	-	2	4	6	12
4	Perception of pain during menstruation	Never	-	-	1	2	24	48	0.777 NS	0.678
		Sometimes	-	-	1	2	16	32
		Always	-	-	1	2	7	14
5	Source of water supply	Well water	-	-	3	6	22	44	3.191 NS	0.203
		Municipal water	-	-	-	-	18	36
		Bore water	-	-	-	-	7	14
6	Methods of disposal	Directly burn	-	-	-	-	25	50	5.083 NS	0.079
		Throw out side	-	-	1	2	14	28
		Dumped	-	-	2	4	8	16
7	Toilet practice	Open field	-	-	1	2	29	58	0.946 NS	0.331
7	Toilet practice	Sanitary latrine	-	-	2	4	18	36	0.946 NS	0.331

NS=not significant SS= statistically significant *P<0.05

The above table shows that there was a statistically association of frequency of changing napkin with level of knowledge regarding sanitary napkin among study participants at level P<0.05.

Table 9: Association of demographic variables with level of expressed practice regarding sanitary napkin among school girls N=50

S. No.	Demographic variables		Post-test expressed practice score						Chi square	P-value
			Inadequate		Moderatel adequate		Adequate
			No	%	No	%	No	%
1	Age in years	12.1-13	3	6	6	12	15	30	0.393 NS	0.821
1	Age in years	13.1-14	2	4	6	12	18	36	0.393 NS	0.821
2	Education	VIII standard	3	6	4	8	21	42	10.657 NS	0.167
2	Education	IX standard	2	4	8	16	12	24	10.657 NS	0.167
3	Religion	Hindu	2	4	3	6	9	18	2.922 NS	0.819
		Christian	2	4	2	4	10	20
		Muslim	-	-	3	6	7	14
		Others[specify]	1	2	4	8	7	14
4	Type of family	Nuclear family	1	2	4	8	15	30	9.263 NS	0.321
		Joint family	2	4	5	10	10	20
		Broken family	2	4	3	6	8	16
5	Residence	Urban	3	6	7	14	19	38	0.011 NS	0.994
5	Residence	Rural	2	4	5	10	14	28	0.011 NS	0.994
6	Educational status of Father	Illiterate	1	2	4	8	17	34	9.263 NS	0.321
		Primary	4	8	4	8	7	14
		High school	-	-	1	2	4	8
		Higher secondary	-	-	1	2	3	6
		Graduate	-	-	2	4	2	4
7	Educational Status of Mother	Illiterate	2	4	4	8	17	34	5.077 NS	0.749
		Primary	1	2	5	10	8	16
		High school	1	2	2	4	3	6
		Higher secondary	1	2	1	2	2	4
		Graduate	-	-	-	-	3	6
8	Occupational Status of Father	Employed	3	6	5	10	17	34	0.911 NS	0.923
		Unemployed	1	2	5	10	10	20
		Self-employed	1	2	2	4	6	12
9	Occupational Status of Mother	Employed	3	6	5	10	18	36	1.122 NS	0.891
		Unemployed	1	2	5	10	11	22
		Self-employed	1	2	2	4	4	8
10	Family income per month (Rs.)	Upto5,000	2	4	4	8	17	34	3.283 NS	0.773
		5,001to7500	1	2	5	10	11	22
		7,501to10,000	1	2	1	2	3	6
		More than10,000	1	2	2	4	2	4
11	Number of sibling	1	3	6	5	10	17	34	2.064 NS	0.724
		2	2	4	5	10	9	18
		3 and above	-	-	2	4	7	14
12	Source of information	Mother	3	6	4	8	14	28	7.022 NS	0.319
		Relatives	-	-	7	14	10	20
		Mass media	1	2	-	-	3	6
		Friends	1	2	1	2	6	12

NS = not significant

The above table shows that there was no association of demographic variables with level of expressed practice of regarding sanitary napkin, among study participants.

Table 10: Association of health-related variables with level of expressed practice regarding sanitary napkin among school girls N=50

S. No	Health related variables		Post-test expressed practice score						Chi Square	P-value
			Inadequate		Moderately Adequate		Adequate
			No	%	No	%	No	%
1	Age at menarche	12.1-13 Years	2	4	4	8	21	42	7.216 NS	0.301
1	Age at menarche	13.1-14 Years	3	6	8	16	12	24	7.216 NS	0.301
2	Nature of practice during menstruation	Cloth	3	6	5	10	17	34	1.373 NS	0.849
		Sanitary Napkin	2	4	6	12	12	24
		Others	-	-	1	2	4	8
3	Frequency of changing napkin per day	Once a day	3	6	8	16	14	28	2.591 NS	0.628
		Twice a day	1	2	3	6	13	26
		Thrice a day and above	1	2	1	2	6	12
4	Perception of pain during menstruation	Never	2	4	5	10	18	36	1.43 NS	0.839
		Sometimes	2	4	4	8	11	22
		Always	1	2	3	6	4	8
5	Source of water supply	Well water	3	6	5	10	17	34	1.018 NS	0.907
		Municipal Water	1	2	5	10	12	24
		Bore water	1	2	2	4	4	8
6	Methods of disposal	Directly burn	5	10	7	14	13	26	6.818 N S	0.146
		Throw Outside	-	-	3	6	12	24
		Dumped	-	-	2	4	8	16
7	Toilet practice	Open field	2	4	9	18	19	38	2.039 NS	0.361
7	Toilet practice	Sanitary Latrine	3	6	3	6	14	28	2.039 NS	0.361