INTRODUCTION:

Adolescence spans through the years of transition from childhood to adulthood, which is usually between the ages of 11 to 18 years. The adolescent experiences drastic changes in physical, cognitive, psychosocial and sexual areas. With rapid growth during the adolescence, the development of secondary sexual characteristic and interest in opposite sex also develops (Marlow 1998). Menstruation is phenomena unique to the females. Menstruation is natural process that is part of women’s reproductive health.

It is process in women of discharging blood and other materials from the lining of uterus, occurring monthly from puberty to menopause (Terry Kyle 2008). In total, women spend around 6-7 years of their lives in menstruating. A key priority for women and girls to have the necessary knowledge, facility and cultural environment to manage menstruation hygienically and with dignity. Yet the importance of menstrual hygiene management is mostly neglected by health related sectors. Despite major development in the hygiene and sanitary sector, in recent years, the menstrual requirement of adolescent girls have been ignored. Overcoming this gap is vital. Though the menstruation is normal and natural, many girls suffer and die because of ignorance and shame. Hence this study was conducted to assess the effectiveness of structured teaching programme on knowledge regarding menstrual hygiene for adolescent girls studying in Little Flower High school, Tirupathi, Andhra Pradesh.

NEED FOR THE STUDY:

Today healthy adolescent girls are tomorrow’s mothers, who are strength of nation. Most of the adolescent girls tend to be extremely unaware of their own body i.e. physical changes. Half of the adolescents age between 12-15 years studying 8^th- 10^th standard do not know about menstruation until its onset. Menstrual hygiene has come to occupy an increasing important place in discussions of women’s health. Attention is again focusing on impact of the onset of menarche. Studies on girl’s responses to menarche have determined that it is highly salient intensely experience event and turning point in female development. They also have demonstrated that more adequate preparation is associated with more positive initial response. Despite a sense of being prepared and even excited about impending event, most girls still find menarche mildly stressful. A study conducted by Adhikari et al (2007) reported that due to lack of information on the natural phenomena and culturally divergent believes and practices, rural adolescent girls in India often manage menstruation in an unsafe manner, that leads to reproductive tract infections and other reproductive health problems. Menstrual hygiene is rarely discussed at home as well as schools, especially in this area. Due to some cultural and religious restrictions many young girls in the country, lack appropriate and sufficient information regarding menstrual hygiene, causing incorrect and unhealthy behavior during their menstrual period. Menstruation and menstrual practices are still clouded by taboos and socio-cultural restrictions resulting in adolescent girls remaining ignorant of the scientific facts of hygienic health practices, which sometimes result into adverse health outcomes. Poor personal and menstrual hygiene can cause urinary and reproductive tract infections and other illness. A descriptive cross sectional study was conducted in the districts of Nepal to determine the prevailing knowledge and experiences of menstrual hygiene and management of the adolescent girls in rural and urban setting of the Nepal among 204 adolescent girls studying 8^th, 9^th and 10^th grades of Government schools concluded that the menstrual knowledge and perceptions are poor and practices are unhygienic. On the basis of above literature, it is evident that knowledge of adolescent girls on menstrual hygiene is inadequate and the girls are still ignorant of the scientific facts, which result into adverse health outcomes. Keeping in the view of above information the present study was design with the following objectives.

OBJECTIVES:

· To assess the level of knowledge on menstrual hygiene among adolescent girls.

· To determine the effectiveness of STP regarding menstrual hygiene among adolescent girls.

· To analyze the association between pre test knowledge scores with their demographic variables.

METHODOLOGY:

Pre experimental with one group pre test and post test without control group was adopted for present study

O₁ Day-1: pre test followed by STP on menstrual hygiene

O₂ Day-7: post test

Variables of the study:

Independent variables:

is structured teaching programme on menstrual hygiene

Dependent variable:

knowledge level on menstrual hygiene among adolescent girls

Extraneous variables:

demographic variables are age, educational level, occupation of parent, religion, family income and source of information. 50 students studying 8^th, 9^th and 10^th grades were selected as study sample. It was conducted at Little Flower High school, Tirupati. Convenient sampling technique was used to select the sample. The questioner on menstrural hygiene developed by investigation was used to collect the data. The tool was divided into 2 sections.

Section-I:

Deals with demographic data and section-II: consists of 30 questions related to knowledge on menstrual hygiene in different areas i.e. pubertal changes, menstrual hygiene and management and ill effects of poor menstrual hygiene.

Validity:

Developed tool was given to 5 experts from field of community health nursing, obstetric nursing and Pediatric nursing for validation.

Procedure for data collection:

Formal permission was obtained from the Head Master, Little Flower High School, Tirupathi. Written consent was taken on behalf of students. Pre test was conducted on day 1, students answered the questions for 20-30 minutes. This was followed by structured teaching programme with the help audiovisual aids such as charts, flash cards and models. Post test was conducted on day 7. The collected data was analyzed and interpreted by using stastical techniques such as percentages, mean, standard deviation, t-test and Chi-square.

Section-I

Table-1:Percentage distribution on demographic variables of adolescent girls

S. No	Demographic variable	N	%
1	Age in years
	a) 8-10	0	0%
	b) 11-13	10	20%
	c) 14-16	40	80%
	d) 17-18	0	0%
2	Religion
	a) Hindu	45	90%
	b) Christian	0	0%
	c) Muslims	5	10%
	d) Others	0	0%
3	Grade
	a) 8^th Grade	11	22%
	b) 9^th Grade	14	18%
	c) 10^th Grade	25	50%
4	Occupation of parent
	a) Agriculture	16	32%
	b) Business	15	30%
	c) Employee	14	28%
	d) Others	5	10%
5	Income of the family
	a) Rs.3,000/- to 5,000/-	18	36%
	b) Rs.5,001/- to 8,000/-	18	36%
	c) Rs.8,001/- to 11,000/-	14	28%
	d) Rs.11,001/ and above	0	0%
6	Source of information
	a) T.V.	11	22%
	b) Magazines	8	16%
	c) Health personnel	5	10%
	d) Family members	16	32%
	e) Friends	9	18%

The above table I shows that 80% of adolescent girls were in the age group of 14-16 years and 20% of them were in 11-13 years of age. Regarding religion, majority of them 90% belong to Hindu religion and only 10% were Muslims. With regard to grade, 50% of them were 10^th grade, where as 28% from 9^th grade and 22% from 8^th Grade. Coming to parents occupation 32% engaged in agriculture, 30% engaged in business, only 28% were employees. Others i.e. 10% were from other occupations. Regarding income of the family, 36% reported their family income between Rs.3,000/- to 5,000/- and 36% Rs.11,000 and above and remaining 28% had income between Rs.8,001/- to 11,000/-. Coming to source of information, it reveals that, 32% subjects received information through teachers, 22% from TV, 18% from friends, 16% from magazines, only 10% from their family members.

Table-2. Level of knowledge of adolescent girls on menstrual hygiene in pre- test and post test

S. No.	Knowledge level	Pre-test		Post-test
S. No.	Knowledge level	F	%	F	%
1	Very poor	12	24%	0	0%
2	Poor	38	76%	0	0%
3	Adequate	0	0%	5	10%
4	Good	0	0%	21	42%
5	Very good	0	0%	24	48%

Shows the level of knowledge on menstrual hygiene in pre and post test. Most of the adolescent girls 76% had poor knowledge, 24 had very poor knowledge in pre test. Whereas in post test majority 48% of adolescent girls gained very good knowledge scores, 42% had good knowledge and 10% of them had adequate knowledge after structured teaching programme. This shows that structured teaching programme has very effective in enhancing the knowledge of adolescent girls on menstrual hygiene. Similar results were reported by Rita T, Sijo K (2009).

Table-3. Significant difference between pre and post test knowledge scores of adolescent girls

Test	mean	SD	Mean difference	SD difference	t- test	Table value	Level of significance
Pre test	8	2.28	15.7	0.38	30.49	1.96	P<0.05
Post test	23.7	2.73	15.7	0.38	30.49	1.96	P<0.05

Table-4. Association between post test knowledge scores of adolescent girls regarding menstrual hygiene and selected variables

S. No	Demographic variable	Chi- square	Df	Table value	Level of significance
1	Age	0.4551	1	3.84	P>0.05 NS
2	Religion	2.007	1	3.84	P>0.05 NS
3	class	1.272	1	3.84	P>0.05 NS
4	Occupation of parent	1.236	1	3.84	P>0.05 NS
5	Family income	1.252	1	3.84	P>0.05 NS
6	Source of information	1.28	1	3.84	P>0.05 NS

Findings reveals that the difference between mean pre test (8+2.28) and post test (23.7+ 2.73) knowledge scores of adolescent girls found to be statistically significant at 0.05 level.

From the above table it was proved that there is no significant association between post test knowledge scores and any of demographic variable like age, religion, class of study, occupation of the parent, family income and source of information.

RESULTS:

From the findings of the study it was revealed that out of 50 sample during pre test, majority 76% of the sample had poor knowledge and 24% of them had very poor knowledge regarding menstrual hygiene whereas in the post test 48% of the sample had very good knowledge and 42% of them had good knowledge and only 10% had average knowledge regarding menstrual hygiene. In pre test the mean score of the sample was 8 (Standard deviation =2.28) and the post test mean score was 23.7 (standard deviation=2.27) with paired t test value of 30.49. It is found from the results structured teaching programme was effective in enhancing the knowledge level of adolescent girls regarding menstrual hygiene. No significant association was found between post test knowledge scores of the samples with any of their characteristics like age, educational level, religion, family income, occupational status of guardian and source of information.

CONCLUSION:

The present study attempted to assess the effectiveness of STP on knowledge regarding menstrual hygiene among adolescent girls and found that the STP was effective in improving the knowledge in High school children about menstrual hygiene.

RECOMMENDATION:

· The study can be replicated in a large sample for better generalization

· Follow up studies can be conducted to evaluate the effectiveness of self instructional module on menstrual hygiene.

REFERENCES:

1. Marlow and Dorathy “Text book of Paediatric Nursing” W B Saunders company, Philadelphia, 1988.

2. Terri Kyle. Essentials of Paediatric Nursing. South asian edition, Wolter kluwer Publishers, 2008, P 72, 184

3. Nkadi Onyegedu. Menstrual hygiene among women and young females in rural Eastern Nigeria 2011 Oct 21

4. Annama Jacob, A comprehensive text book of midwifery. 2^nd edition. New Delhi, Japee Publications, 2008. P 63.

5. Mandal, Kalapana. Adolescent girls and need for teaching on menstrual hygiene. Virginia Henderson International Nursing Library 2011 October 17

6. Adhikari P, et al. (2007) the effect of community based health education intervention on management of menstrual hygiene among rural Indian adolescent girls of Nepal. Kathmandu University Med J (KUMJ) July-September; 5(3) : 382-6

7. Paul Dinesh et al. knowledge and practices of adolescent girls regarding reproductive health with special emphasis on hygiene during menstruation, New Delhi: NIPCCD-130

8. EI, Gilany et al (2005) menstrual hygiene among adolescent girls in Mansoura, Egypt. Repord health matter 2005 November 13(26);147-52

9. Moawed S. indigenous practices of Saudi girls in Riyadh during menstrual period. East mediater health j 2001 jan- mar; _1-2): 197-203.

10. Mohammed Poureslami, et al assessing knowledge, attitude and behavior of adolescent girl in sub urban districts of Teharan about dysmenorrheal and menstrual hygiene. Dysm Teharn. 2002 June.

11. Rita. J, Sijo. K et al (2009) Effective-ness of planned teaching programme on knowledge regarding menstrual hygiene among adolescent girls Waghodia Taluk International Journal of Applied Research, May-June 2016.

Received on 05.10.2016 Modified on 21.12.2016

Int. J. Adv. Nur. Management. 2017; 5(1): 55-58.

DOI: 10.5958/2454-2652.2017.00012.9