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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 35  |  Issue : 3  |  Page : 281-285

Menstrual hygiene practices among female adolescents seen in general outpatient clinic


1 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
2 Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria

Date of Web Publication11-Feb-2019

Correspondence Address:
Dr. Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TJOG.TJOG_31_18

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  Abstract 


Introduction: Menstruation is a normal physiologic phenomenon which is indicative that a woman is ready for her reproductive roles. Adolescents are often uninformed and inexperienced on most health-related issues including menstruation. This study therefore hopes to determine the common menstrual hygiene practices among adolescent females.
Materials and Methods: This was a cross-sectional study involving women aged 14–18 years. A pretested questionnaire was administered by trained female clinical assistants to those who cannot read and write; however, literate respondents self-administered the questionnaires.
Results: Three hundred and ninety-six (95.4%) of the respondents were aware of menstruation before their first period. Four hundred and two (96.9%) respondents believed menstruation was caused by the age of maturity, while 13 (3.1%) reported failure of fertilization of the ovum resulted in menstruation. Close relations were common source of information on menstruation; however, the age of menarche ranged from 9 to 18 years, with a mean age of 13.4 ± 1.5 years. Sixty-one (14.7%) respondents used clean cloth for menses, 271 (65.3%) used sanitary pad, while 83 (20.0%) used tampon. However, 55 (13.3%) reused their sanitary wares. Most respondents changed their sanitary wares twice in a day; they mostly bath twice in a day even during their periods.
Conclusion: Most respondents were aware of menstruation before their menarche and their close relatives were their common source of information on menstruation, 13 years was the mean age of menarche; most respondents used sanitary pads; however, 20% of them still used tampons.

Keywords: Female adolescents; menstrual hygiene; menstruation; sanitary wares.


How to cite this article:
Aliyu I, Grema BA, Michael GC. Menstrual hygiene practices among female adolescents seen in general outpatient clinic. Trop J Obstet Gynaecol 2018;35:281-5

How to cite this URL:
Aliyu I, Grema BA, Michael GC. Menstrual hygiene practices among female adolescents seen in general outpatient clinic. Trop J Obstet Gynaecol [serial online] 2018 [cited 2019 Feb 18];35:281-5. Available from: http://www.tjogonline.com/text.asp?2018/35/3/281/251945


  Introduction Top


Menstruation is a normal physiologic phenomenon which is indicative that a woman is developed and ready for her reproductive roles.[1],[2],[3] This involves menstrual bleeding at the end of the menstrual cycle. Adolescences are often uninformed and inexperienced on most health-related issues including menstruation. Knowledge of the menstrual process which is part of sex education is often clouded with secrecy in some cultures, and these are not often discussed in public, as such, topics relating to sexual development are, therefore, avoided from school curriculum. Therefore, such knowledge is passed mostly from mothers, sisters, aunts, and grandmothers to daughters.

Menstrual hygiene is an important aspect of a female's personal hygiene which if not properly handled may predispose to reproductive tract infection with its attendant complications. Therefore appropriate knowledge of the menstrual process is essential for a good menstrual hygiene. This study therefore hopes to determine the perception of menstruation and common menstrual hygiene practices among adolescent females.


  Materials and Methods Top


This was a cross-sectional study. A pretested questionnaire was administered by trained female medical doctors and female clinical assistants to those who could not read and write; however, literate respondents self-administered the questionnaires. It was pretested among 20 selected volunteers, and internal consistency was maintained with a Cronbach's alpha score of 0.80. Relevant questions including knowledge of menstrual hygiene and common menstrual hygiene practices were contained in the questionnaire. Ethical approval was obtained from the Research Ethics Committee of Aminu Kano Teaching Hospital, Kano.

Considering the usage of sanitary napkin as 64% from the previous study [4] and relative precision of 5% at 95% confidence interval (CI) using the formula n = Z 2 × pq/d 2, the sample size was calculated as 355; however, 415 respondents were recruited for this study. However, 415 female adolescents seen in the general outpatient clinic of Aminu Kano Teaching Hospital, Kano, were consecutively recruited over a 5-month period from September 2017 to January 2018.

Consent was obtained from the respondents.

Inclusion criteria

  • All female adolescents between the ages of 14 and 18 years who had achieved menarche were included.


Exclusion criteria

  • Respondents who declined consent
  • Those in urgent need of care/acute illness.


Data analysis

The obtained data were cleaned and entered into Statistical Package for the Social Sciences (SPSS Inc. Chicago, IL, USA) version 16. The data were presented in tables as frequencies and percentages. Test of significance using the Chi-square test was deplored for comparing categorical variables, with P < 0.05 being set as statistically significant.


  Results Top


Four hundred and fifteen respondents were recruited; among these, 36 of the respondents (8.7%) had completed primary school education, 108 (26.0%) had secondary school certificate, 197 (47.7%) had tertiary school education or were in tertiary school, while 73 (17.6%) had no formal education.

One hundred and sixty-two (39.0%) lived within Kano city, 118 (28.4%) lived within the surrounding towns, while 135 (32.5%) of the respondents lived in the villages.

Most respondents were unemployed (50.4%) with majority not having monthly income (28.1%); however, majority had less than 1000 Naira as their monthly upkeep [Table 1].
Table 1: Sociodemographic characteristics of the respondents

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Three hundred and ninety-six (95.4%) of the respondents were aware of menstruation before their first period while 19 (4.6%) were not. Four hundred and two (96.9%) respondents believed menstruation was caused by the age of maturity, while few 13 (3.1%) reported the failure of fertilization of the ovum resulted in menstruation.

Close relations such as mothers, sisters, and grandmothers were common source of information on menstruation; surprisingly, a respondent reported that her father was her source of information on menstruation; however, the age of menarche ranged from 9 to 18 years, with a mean age of 13.4 ± 1.5 years; 13 years was the most common age of menarche. Sixty-one (14.7%) respondents used clean cloth for menses, 271 (65.3%) used sanitary pad while 83 (20.0%) used tampon. However, 55 (13.3%) reused their sanitary wares, while 360 (86.7%) of them did not [Table 2].
Table 2: Source of information on menstruation and age of menarche of the respondents

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Most respondents changed their sanitary wares twice in a day; they mostly bath twice in a day even during their periods [Table 3].
Table 3: Menstrual hygiene of the respondents

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Irrespective of their monthly upkeeps, place of abode, and level of education, the sanitary pad was mostly used by the respondents; however, the use of clean cloth was mostly observed among those without monthly upkeep and those with >1000 Naira monthly upkeep, those who lived in the villages, and those without formal education. These observations were statistically significant (Fisher's exact test = 46.959, P = 0.000; Chi-square test = 90.798, df = 4, P = 0.00; Chi-square test = 58.813, df = 6, P = 0.00, respectively) [Table 4].
Table 4: The relationship between the demographic characteristics of the respondents and their choice of sanitary wares

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Similarly, irrespective of their monthly upkeeps, place of abode, and level of education, most respondents did not re-use their sanitary ware; however, among those who re-used their sanitary wares, majority had no monthly upkeep, while a few had >1000 Naira as monthly upkeep; majority lived in the villages and they were without formal education. These observations were statistically significant (Fisher's exact test = 21.889, P = 0.000; Chi-square test = 15.594, df = 2, P = 0.00; Chi-square test = 25.737, df = 3, P = 0.00, respectively) [Table 5].
Table 5: The relationship of the demographic characteristics of the respondents with their menstrual hygiene practices

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Irrespective of their place of abode, most respondents bath twice in a day during and after menstruation; this observation were also statistically significant (Fisher's exact test = 16.718, P = 0.01; Chi-square test = 24.712, df = 6, P = 0.00) [Table 6].
Table 6: The relationship of the demographic characteristics of the respondents with their frequency of bathing during menses

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  Discussion Top


The mean age of menarche in our study was comparable to those observed by Ramachandra et al.,[5] Khanna et al.,[6] Tegegne and Sisay,[7] and Lawan et al.[8] but was lower than that reported by Parajuli et al.[9] in Nepal. Majority of respondents in our study were aware of menstruation. This observation was also observed by Lawan et al.[8] in an earlier study among adolescent secondary schooling girls in Kano. However, our figure was higher than their report of 87%, and 86.75% reported by Tegegne and Sisay [7] in Ethiopia, but 34% was reported by Ramachandra et al.[5] in India; this disparity may be attributed to differences in the educational qualification; we had 47% respondents who were already in tertiary school; therefore, they were better exposed with good knowledge of menstruation,

Contrary to the report by Lawan et al.,[8] most respondents in our study were first informed on menstruation and menstrual hygiene by their mothers and other close relations; this observation was similarly reported by Parajuli et al.,[9] Ramachandra et al.,[5] Drakshayani Devi and Ventaka Ramaiah [10] and Abraham et al.[11] Issues of sexuality and sexual development are often closely guided and may not be open for public discussion in some African society; teaching of sex education are strongly resisted by parents, with the perception that it may breed immorality.[12] Therefore it was not surprising observing that only 27.95% of respondents in Tegegne and Sisay [7] study was comfortable discussing about menstruation. However, Upashe et al.[13] reported that most respondents got information on menstruation from friends, mass media and school. This further highlights cultural diversity, which in their case showed minimal communication between the family and the girl child on matters of sexual development; while girls discussed freely among themselves about menstruation.

Use of sanitary pad was most common among the respondents, irrespective of their educational status, their place of abode, and monthly upkeep; this may be attributable to their awareness, cheapness, and availability of sanitary wares; this observation differed from that of Upashe et al.,[13] who stated that respondents who had permanent pocket money from their fathers were three times more likely to have good menstrual hygiene than those who did not have upkeeps. Furthermore, 20% of respondents in our study still used tampons; this is a cause for concern, considering the risk of toxic shock syndrome associated with its use.[14] However, our finding was better than the only 33.3% respondents reported using sanitary pad in Parajuli' et al.'s [9] study; again, the use of cloth and re-use of sanitary napkins were mostly observed among those from the rural setting; this observation was similarly reported by Tegegne and Sisay;[7] a poor financial standing may be responsible for this observation. All respondents in our study believed that menstruation was a physiologic process; while 96.9% attributed it to maturity of the girl child, only 3.1% related it to failure of fertilization of the ovum; their perception was better than that reported by Upashe et al.,[13] who reported that 9.7% of their respondents believed menstruation was a curse from God; while Adhikari et al.[15] reported only 6% of their respondent believed menstruation was physiologic. We observed increasing frequency of bathing during period of menstruation and most of them changed their sanitary wares at least twice in a day; this observation was also reported by Lawan et al.[8]


  Conclusion Top


This study showed that the respondents had an overall good menstrual hygiene; however, majority reported their mothers and close relations as source of information. The 20% of respondents that used tampon was worrisome, considering the associated risk of toxic shock syndrome following its use; therefore, sexual education should be readily discussed in the public domain. This will ensure the better information is made available and safer choices of menstrual wares are practiced.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Oyebola DO. Female reproduction. Essential Physiology for Students of Medicine, Pharmacy and Related Disciplines. Ibadan: Nihort Press; 2002. p. 232-44.  Back to cited text no. 1
    
2.
William F, Ganong MD. The Female reproductive system. Review of Medical Physiology. 21st Ed. New York: Lange Medical Books/McGraw-Hill 2003. p. 437-51.  Back to cited text no. 2
    
3.
The National Women's Health Information Center. Menstruation and the menstrual cycle. U.S Department of Health and Human Services Office on Women's Health. Available from: https://www.womenshealth.gov/. [Last accessed on 2017 Jul 15].  Back to cited text no. 3
    
4.
Kamath R, Ghosh D, Lena A, Chandrashekaran V. A study on knowledge and practices regarding menstrual hygiene among rural and urban adolescent girls in Udupi Taluk, Manipal, India. Global J Med Public Health 2013;2:10-23.  Back to cited text no. 4
    
5.
Ramachandra K, Gilyaru S, Eregowda A, Yathiraja S. A study on knowledge and practices regarding menstrual hygiene among urban adolescent girls. Int J Contemp Pediatr 2016;3:142-5.  Back to cited text no. 5
    
6.
Khanna A, Goyal RS, Bhawsar R. Menstrual and reproductive problems: A study of adolescent girls in Rajasthan. J Health Manage 2005;7:91-107.  Back to cited text no. 6
    
7.
Tegegne TK, Sisay MM. Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia. BMC Public Health 2014;14:1118.  Back to cited text no. 7
    
8.
Lawan UM, Yusuf NW, Musa AB. Menstruation and menstrual hygiene amongst adolescent school girls in Kano, Northwestern Nigeria. Afr J Reprod Health 2010;14:201-7.  Back to cited text no. 8
    
9.
Parajuli P, Paudel N, Shrestha S. Knowledge and practices regarding menstrual hygiene among adolescent girls of rural Nepal. J Kathmandu Med Coll 2016;5:23-7.  Back to cited text no. 9
    
10.
Drakshayani Devi K, Venkata Ramaiah P. A study on menstrual hygiene among rural adolescent girls. Indian J Med Sci 1994;48:139-43.  Back to cited text no. 10
[PUBMED]  [Full text]  
11.
Abraham S, Fraser I, Gebski V, Knight C, Llewellyn-Jones D, Mira M, et al. Menstruation, menstrual protection and menstrual cycle problems. The knowledge, attitudes and practices of young Australian women. Med J Aust 1985;142:247-51.  Back to cited text no. 11
    
12.
Mbugua N. Factors inhibiting educated mothers in Kenya from giving meaningful sex-education to their daughters. Soc Sci Med 2007;64:1079-89.  Back to cited text no. 12
    
13.
Upashe SP, Tekelab T, Mekonnen J. Assessment of knowledge and practice of menstrual hygiene among high school girls in Western Ethiopia. BMC Womens Health 2015;15:84.  Back to cited text no. 13
    
14.
Shands KN, Schmid GP, Dan BB, Blum D, Guidotti RJ, Hargrett NT, et al. Toxic-shock syndrome in menstruating women: Association with tampon use and Staphylococcus aureus and clinical features in 52 cases. N Engl J Med 1980;303:1436-42.  Back to cited text no. 14
    
15.
Adhikari P, Kadel B, Dhungel SI, Mandal A. Knowledge and practice regarding menstrual hygiene in rural adolescent girls of Nepal. Kathmandu Univ Med J (KUMJ) 2007;5:382-6.  Back to cited text no. 15
    



 
 
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