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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 35  |  Issue : 2  |  Page : 158-164

Association of sociodemographic characteristics with KAP regarding menstrual hygiene among women in an urban area in Delhi


Department of Community Medicine, Maulana Azad Medical College, New Delhi, India

Date of Web Publication17-Aug-2018

Correspondence Address:
Dr. Palak Goel
III-A 167 Nehru Nagar, Ghaziabad, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TJOG.TJOG_58_17

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  Abstract 

Introduction: Menstruation despite being a natural process is linked with several misconceptions and false practices, which sometimes results in adverse health outcomes. The aim of this study was to assess knowledge, attitude, and practices regarding menstrual hygiene and their association with sociodemographic determinants among women in an urban area of Delhi.
Materials and Methods: A community-based cross-sectional survey was conducted for a period of 1 year among 350 women age 18–45 years residing in an urban resettlement colony in Delhi. Semi-structured questionnaire containing questions regarding subject's demographic profile, their knowledge, attitude, and practices pertaining to menstrual hygiene was used. It had seven questions regarding knowledge and eight questions each about attitude and practices regarding menstrual hygiene, respectively. A 5-point Likert scale was used to assess women's responses to attitude questions. Practices satisfactory or unsatisfactory were based on UNICEF guidelines. Data were analyzed using SPSS software version 17.
Results: The mean age of women was 26.53 ± 0.295 years. More than three-fourths (88.3%) women had good knowledge, whereas only 32.3% of women had a positive attitude regarding menstrual hygiene. More than two-thirds of the women were using sanitary pads as menstrual absorbent. Significant association was seen between knowledge and subject's marital status (P = 0.034) and subject's occupation (P = 0.046). A significant association was observed between attitude and socioeconomic status of the participant (P = 0.001).
Conclusion: These findings indicate the need for education about healthy menstrual practices. Health education is an essential requirement to fill the knowledge gap to promote accessibility, availability, and sanitary facilities and products.

Keywords: Attitude; knowledge; menstrual hygiene; practices.


How to cite this article:
Goel P, Kumar R, Meena G S, Garg S. Association of sociodemographic characteristics with KAP regarding menstrual hygiene among women in an urban area in Delhi. Trop J Obstet Gynaecol 2018;35:158-64

How to cite this URL:
Goel P, Kumar R, Meena G S, Garg S. Association of sociodemographic characteristics with KAP regarding menstrual hygiene among women in an urban area in Delhi. Trop J Obstet Gynaecol [serial online] 2018 [cited 2018 Dec 12];35:158-64. Available from: http://www.tjogonline.com/text.asp?2018/35/2/158/239169


  Introduction Top


Menstruation is a phenomenon unique to females. Menstruation is the cyclical shedding of the inner lining of the uterus, the endometrium, under the control of hormones of the hypothalamopituitary axis.[1] Poor menstrual hygiene may lead to problems such as itching or rashes in the perineal region, bad odor, and also major complications such as pelvic inflammatory disease and toxic shock syndrome.[2] To create a world in which every woman and girl can manage her menstruation in a hygienic way – wherever she is – in privacy, safety, and with dignity “Menstrual Hygiene Day” is celebrated every year on 28 May.[3]

The myths and misconceptions regarding menstruation are widespread. Restrictions during menstruation that limit the daily activities and routines of women are widely practiced in India.

Since mother and elder sisters are most common first informants for pubertal girls, it is necessary to enquire their knowledge and attitude toward menstruation. Therefore, this study was conducted in reproductive age group women residing in an urban area in Delhi.


  Materials and Methods Top


Study design:This is a community based cross-sectional study

Study area: Gokalpuri, New Delhi

Study period: January 2016–December 2016

Study population: Women of 18–45 years age.

Inclusion criteria

  1. All women in the age group of 18–45 years who gave informed consent to be part of the study.
  2. The person was a resident of the study area for a minimum of 1 year.


Exclusion criteria

  1. Pregnant women or those in lactational amenorrhea were excluded from the study.
  2. Persons who were unable to give consent because of mental illness or severe illness.


Sample size

At 95% confidence level and taking the prevalence of satisfactory menstrual hygiene as 33.3%,[4],[5] with a relative error of 15%, the sample size came out to be 348 using the following formula:

n = Zα2pq/l2

Therefore, a total of 350 subjects were included in the study.

Methodology

The study was conducted by house-to-house visit using systematic random sampling in an urban area, Gokalpuri. Individuals fulfilling the inclusion criteria were selected from each household. If the eligible candidate was not available at the first contact, another visit was made to the household before declaring the subject unavailable. The investigator first explained the nature and purpose of the study and then interviewed the eligible candidates who agreed to participate in the study after getting written informed consent. After recording preliminary data, the candidate was subjected to interview through semi-structured questionnaire. The questionnaire was administered in local language, Hindi, for their easy understanding. It had seven questions regarding knowledge and eight questions each about attitude and practices regarding menstrual hygiene, respectively. Practices satisfactory or unsatisfactory were based on UNICEF guidelines.[6]

Association of sociodemographic determinants with knowledge, attitude, and practices regarding menstrual hygiene

Seven questions were asked pertaining to knowledge regarding menstrual hygiene. For each correct response, they were awarded a score of 1. Hence, the total possible range of score was 0–7. A subject scoring 4 or more was considered as having good knowledge. Similarly, eight questions were asked regarding attitude and a 5-point Likert scale was used to elicit responses. Hence, the total possible range of score was 8–40. A subject scoring 24 and above was considered to have a positive attitude. For practices regarding menstrual hygiene, eight questions were asked and each correct response was awarded a score of 1 and the possible range of score was 0–8. A subject scoring 4 or more was considered as having good practices.

Statistical analysis

Data were collected, compiled, processed, and analyzed by SPSS software version 17. Quantitative data were expressed by mean and standard deviation, and qualitative data were expressed by percentages; the difference between the proportions was observed by Chi-square test or Fisher's exact test. Confidence interval of 95% was used and P < 0.05 was considered significant.

Ethical considerations

  1. The objectives and procedure of the study were explained to all women.
  2. Informed written consent was taken from all women willing to participate in the study.
  3. The option to opt out of the study was kept open without any clause.
  4. Complete confidentiality regarding patient information was maintained through all stages of the study.



  Results Top


Demographic profile

The largest proportion of women belonged to the age group of 21–30 years, and the mean age came out to be 26.53 ± 0.295 years. The highest proportion of women belonged to Class III (43.1%) of Modified B.G. Prasad scale of socioeconomic status.[7],[8] Most of the women were married (80.5%), homemakers (74.6%), belonging to nuclear families (87.1%), and Hindu (92.9%) by religion [Table 1].
Table 1: Distribution of study subjects according to socio-demographic profile

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Knowledge regarding menstruation

The majority of the women (59.4%) acquired knowledge from their mother. More than two-thirds (69.1%) of women were scared at the time of their first menstruation. Almost all (97.7%) women knew that menstruation is a physiological process. It was seen that 44.0% of women knew uterus is the source of menstrual blood [Table 2].
Table 2: Distribution of study participants according to knowledge about menstruation

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Attitude regarding menstruation

The majority (95.1%) of the study participants strongly disagreed that a woman can enter temple/pray during menstruation. Most of the women agreed that a woman can enter kitchen (82.9%) or take bath (89.1%) during menses. More than half of the women (60.9%) agreed that a woman can wash hair during menses. The majority of the participants (86.8%) agreed that a woman can sleep on the same bed during her menses. Most of the women disagreed that a woman can touch pickle (85.4%) or have sexual intercourse (83.5%) during her menses. More than half of the women (54.6%) subjects disagreed that a woman need not avoid any foods [Table 3].
Table 3: Distribution of study participants according to attitude regarding menstruation

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Practices regarding menstruation

More than two-thirds (74.3%) of the women were using sanitary pads as menstrual absorbent. The majority (86.3%) of women were using satisfactory soakage material (according to UNICEF guidelines).[6] The soakage material was stored satisfactorily by 99.1% of women. The frequency of changing of soakage material was satisfactory in only 13.7%. Disposal of soakage material was satisfactory in 100% subjects. All personal hygiene practices were found to be satisfactory in more than 90% of women, the highest being privacy for changing of soakage material (100%), followed by bathing during menstruation (97.1%). Satisfactory washing of genitals was seen in 95.1% of women, and reuse of soakage material was satisfactory in 96.6% of women [Table 4].
Table 4: Menstrual and personal hygiene practices among study participants

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Association of sociodemographic determinants with knowledge, attitude, and practices regarding menstrual hygiene

A total of 88.3% of women had good knowledge pertaining to menstrual hygiene. Significant association was seen among good knowledge and subject's marital status (P = 0.034) and subject's occupation (P = 0.046) depicting that married women and working women had better knowledge than their counterparts [Table 5]. Only 32.3% of women attained a score of >24 and had a positive attitude regarding menstruation. It was observed that significant association was found between positive attitude and socioeconomic status (P = 0.001) [Table 6]. More than one-third population had satisfactory practices regarding seven of the eight questions asked, hence association was found between frequency of change of soakage material (the remaining question) and sociodemographic determinants. Only 48 (13.7%) women changed the soakage material satisfactorily. Statistically significant association was observed between frequency of change of soakage material and age (P = 0.012), mother's literacy status (P = 0.050), subject's marital status (P = 0.003), and subject's occupation (P = 0.020) [Table 7].
Table 5: Association of socio-demographic determinants with knowledge regarding menstrual hygiene in study participants

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Table 6: Association of socio-demographic determinants with attitude regarding menstrual hygiene in study participants

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Table 7: Association of socio-demographic determinants with frequency of change of soakage material in study participants

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  Discussion Top


The majority of the studies done previously on menstrual problems have been confined to adolescents, and only a few have focused on the knowledge regarding menstruation among women of 18–45 years age group. In this study, the mean age of women was 26.53 ± 0.295 years. In the study conducted by Katiyar et al.,[9] maximum girls belonged to Class II (45.1%), whereas in our study more than one-third (43.1%) of women belonged to Class III Modified B.G. Prasad socioeconomic class.

The role of teachers was negligible in imparting education about various aspects of menstruation; the majority of the women (59.4%) acquired knowledge regarding menstruation from their mothers. Correct information and education regarding menstruation and reproductive health is still a big challenge in India and in most of the developing countries. It was observed that more than two-thirds of the women were scared at the time of menarche which signifies that a majority of the study subjects had no/little knowledge about menstruation before its onset. In a study conducted by Guerry,[10] 78.1% of the girls knew that menstrual blood comes from the uterus, whereas in our study only 44.0% women knew the correct source of bleeding.

In our study, the majority of the study subjects had a negative attitude toward a woman entering temple, touching pickle, or having sexual intercourse during her menses. These findings are in line with the results of several other Indian studies.[1],[9],[11],[12] Nearly half of the subjects disagreed that a women need not avoid any foods during menstruation, whereas they had a positive attitude toward women entering kitchen, taking bath, washing hair, and sleeping on same bed as others during her menses. These findings could be a reflection of the culture and taboos in the society regarding menstruation.

Hygienic menstrual absorbents help manage menstruation effectively, safely, and comfortably. In our study, more than two-third of the women used sanitary napkins, whereas in a study conducted by Mudey et al.,[13] the majority of the girls used cloth (46.67%) and only 15.67% were using sanitary napkins. Mutunda [14] in his study noted that girls had difficulties in maintaining proper standards of hygiene due to inadequate water and unfriendly sanitation facilities in schools and at home. These findings are in contrast to the findings of this study where more than 90% women had satisfactory personal hygiene practices.

A significant association was seen among knowledge and subject's marital status and subject's occupation. In a study conducted by Lawan et al.,[15] a significant association was seen between respondent's age and knowledge. Statistically significant association was seen between attitude and participant's socioeconomic status, whereas no significant association was observed between attitude and other sociodemographic variables. Statistically significant association was observed between frequency of change of soakage material and participant's age, mother's literacy status, subject's marital status, and occupation depicting that respondents whose mothers had secondary or higher education had better practices. Similarly, students or working women had better practices compared to homemakers. In a study done by Kansal et al.,[16] in Varanasi significant association was observed between menstrual hygiene practices and subject's marital status, literacy status, religion, socioeconomic status, and mother's literacy status.

As mothers were observed to be the main source of information, health professional should involve mothers in general discussions about issues related to menstruation and how to deal with them. In addition, the role of teachers in imparting knowledge regarding menstrual hygiene was observed to be negligible, and therefore, it is important to train teachers to provide psychosocial support to girls and to provide regular hygiene promotion classes in every school. Universalized use of sanitary pads needs to be advocated to every woman by making them available easily and affordably through social marketing.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Deo DS, Ghattargi CH. Perceptions and practices regarding menstruation. A comparative study in urban and rural adolescent girls. Indian J Comm Med 2005;30:33-4.  Back to cited text no. 1
    
2.
Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. 19th ed. New York: McGraw-Hill; 2015.  Back to cited text no. 2
    
3.
Menstrual Hygiene Day 2016 Planning Guide. [Internet] (cited 2017 Apr 20). Available from: Menstrualhygieneday.org/wp-content/./2016/05/MHDay2016_Planner_FINAL.pdf. [Last accessed on 2017 Apr 17].  Back to cited text no. 3
    
4.
Baridalyne N, Reddaiah VP. Menstruation: Knowledge, beliefs and practices of women in the reproductive age group residing in an urban resettlement colony of Delhi. Health Populat Perspect Issues 2004;27:9-16.  Back to cited text no. 4
    
5.
Juyal R, Kandpal SD, Semwal J, Negi KS. Practices of menstrual hygiene among adolescent girls in a District of Uttarakhand. Indian J of Comm Health. 2012;2:124-8.  Back to cited text no. 5
    
6.
UNICEF. Sharing Simple Facts: Useful Information about Menstrual Health and Hygiene. New Delhi; 2008.  Back to cited text no. 6
    
7.
Khairnar MR, Wadgave U, Shimpi PV. Updated BG Prasad socioeconomic classification for 2016. J Indian Assoc Public Health Dent 2016;14:469-70.  Back to cited text no. 7
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Government of India. Construction and Maintenance of Index numbers. Available from: http://wwww.labourbureau.nic.in. [Last accessed on 2017 Apr 17].  Back to cited text no. 8
    
9.
Katiyar K, Chopra H, Garg SK, Bajpai SK, Bano T, Jain S, et al. KAP study of menstrual problems in adolescent females in an urban area of Meerut. Indian J Comm Health 2013;25:217-20.  Back to cited text no. 9
    
10.
Guerry E. An Assessment of Menstrual Hygiene Practices and Absenteeism in Western Uganda. Irise. [Online] 2013. Available from: www.irise.org.uk/online-womens-health-library/learn/. [Last accessed on 2017 Apr 17].  Back to cited text no. 10
    
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Geetha P, Chenchuprasad C, Sathyavathi RB, Bharathi T, Reddy SK, et al. Effect of socioeconomic conditions and lifestyles on menstrual characteristics among rural women. J Women's Health Care 2016;5:298.  Back to cited text no. 11
    
12.
Bodat S, Ghate MM, Majumdar JR. School absenteeism during menstruation among rural adolescent girls in Pune. Natl J Community Med 2013;4:212-6.  Back to cited text no. 12
    
13.
Mudey AB, Kesharwani N, Mudey GA, Goyal RC. A cross-sectional study on awareness regarding safe and hygienic practices amongst school going adolescent girls in rural area of Wardha district, India. Global J Health Sci 2010;2:225-31.  Back to cited text no. 13
    
14.
Mutunda A. Factors impacting on the menstrual hygiene among school going adolescent girls in Mongu district, Zambia. Doctoral dissertation, School of Public Health, University of the Western Cape; 2013.  Back to cited text no. 14
    
15.
Lawan UM, Nafisa WY, Musa AB. Menstruation and menstrual hygiene amongst adolescent school girls in Kano, Northwestern Nigeria: Original research article. African J Reprod Health 2010;14:201-7.  Back to cited text no. 15
    
16.
Kansal S, Singh S, Kumar A. Menstrual hygiene practices in context of schooling: A community study among rural adolescent girls in Varanasi. Indian J Comm Med 2016;41:39.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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