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ORIGINAL ARTICLE |
https://doi.org/10.5005/jogyp-11012-0032 |
Prevalence and Assessment of Knowledge and Practices Regarding Menstrual Hygiene among Adolescent Girls (Age Group 13–18 Years) in Rural Areas of Bishnugarh, Hazaribagh, Jharkhand
1Department of Pediatrics, Division of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
2Mind-Body Health Division, PsychoTech Institute, New Delhi, India
3Department of Psychology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
Corresponding Author: Subodh Kumar, Department of Psychology, Banaras Hindu University, Varanasi, Uttar Pradesh, India, Phone: +91 8285826763, e-mail: bhu.subodh@gmail.com
How to cite this article: Kumari K, Sharma M, Kumar S. Prevalence and Assessment of Knowledge and Practices Regarding Menstrual Hygiene among Adolescent Girls (Age Group 13–18 Years) in Rural Areas of Bishnugarh, Hazaribagh, Jharkhand. J Obstet Gynaecol Pract POGS 2024;2(2):46–54.
Source of support: Nil
Conflict of interest: None
Received on: 25 April 2024; Accepted on: 7 June 2024; Published on: 14 August 2024
ABSTRACT
This study aimed to assess the knowledge and practices regarding menstrual hygiene among adolescent girls (age-group 13–18 years) in rural areas of Bishnugarh, Hazaribag, Jharkhand. A total of 100 female adolescent respondents were randomly selected for data collection. A pretested schedule was employed to gather information on their general profiles, anthropometric assessments, 24-hour dietary recalls, knowledge, and practices related to menstrual hygiene. The study found that a substantial proportion of respondents (78%) fell within the 16–18 age-group, while 22% were aged between 13 and 15. Additionally, 99% of the respondents identified as Hindu, with 72% belonging to nuclear families and 28% to joint families. In terms of education, 44% were in the 11th grade, 23% in the 12th grade, 22% in the 10th grade, and 11% in the 9th grade. Furthermore, 67% of the families engaged in business, while 33% were involved in agriculture. The study revealed that 95% of the respondents’ mothers were illiterate, and 93% of the respondents had a non-vegetarian diet, while only 7% were vegetarian. Anthropometric assessments indicated that 42% of respondents had a normal body mass index (BMI), while 10% and 26% experienced Grade III and Grade I undernutrition, respectively. Dietary patterns showed that cereals, fats, and oils were consumed daily by all respondents, with lower frequencies of pulse, fruit, meat, and poultry consumption. Most respondents consumed roots and tubers daily. Regarding knowledge of menstruation, 56% of girls were aware of it before their menarche. The study found that 49% of girls experienced menarche at the age of 13, with 31, 15, and 5% experiencing it at ages 14, 15, and 16, respectively. Friends and mothers were identified as the primary sources of information about menstruation. In terms of menstrual hygiene practices, 40% of girls used cloth, 35% used sanitary napkins, and 25% used both cloth and sanitary napkins as menstrual absorbents. Most respondents (52%) changed their absorbent every 3 hours during the first 2 days of menstruation, and 92% changed their undergarments daily. The majority (91%) bathed daily, 92% washed their hands properly after changing the absorbent, and only 22% cleaned their pubic hair regularly. Among girls who washed their vaginal area daily during menstruation, 62.8% used soap for washing. Additionally, 54% of girls reported lower abdominal pain, and 17% reported fatigue and weakness during menstruation. Only 20% of respondents were aware of restrictions during menses. Notably, girls using cloth as menstrual absorbents were highly prone to menstrual morbidities, with 62.5% experiencing both fever and irritation in the vaginal area. Among those using sanitary napkins, 25.7% suffered from both fever and irritation and among those using both cloth and sanitary napkins, 16% experienced these symptoms. The study did not find significant results in the Analysis of Variance (ANOVA) tables for various nutritional aspects. In conclusion, this study highlights significant issues related to poor knowledge of menstruation biology, the presence of menstrual symptoms among girls, and low usage of sanitary napkins. It underscores the need for adolescent girls to receive accurate and adequate information about menstruation and its proper management. Formal and informal channels of communication, such as mothers, sisters, and friends, should be utilized to provide this information.
Keywords: Health, Hygiene, Menstruation, Nutrition.
INTRODUCTION
Menstruation is a natural biological process that occurs in females from the onset of puberty to the cessation of menopause. This phenomenon involves the periodic shedding of the uterine lining and the subsequent discharge of blood and mucosal tissue through the vaginal canal.1 It is a vital component of the female reproductive cycle, serving as an indicator of a woman’s fertility and overall health.2 However, it is important to note that menstruation is not solely a physiological process but is also intertwined with social, cultural, and religious beliefs and practices, which can significantly impact the well-being and dignity of women and girls, particularly in low-resource settings.3
The concept of menstrual hygiene encompasses a range of practices aimed at maintaining cleanliness and well-being during menstruation. This includes the use of safe and effective menstrual products, regular changes of these products, proper hygiene measures for the genital area, appropriate disposal of used products, and the management of menstrual pain and discomfort.3 Menstrual hygiene is a critical aspect of women’s empowerment, as it enables them to actively participate in education, employment, and social activities without the burden of fear, shame, or stigma.3 Additionally, it plays a significant role in the prevention of reproductive tract infections (RTIs), which can lead to serious health issues, including infertility, pelvic inflammatory disease, ectopic pregnancy, cervical cancer, and maternal and neonatal morbidity and mortality.4
Amongst those who face particular challenges in terms of menstrual hygiene, adolescent girls stand out as a vulnerable group. This critical period of transition in their lives comes with a multitude of challenges. Many adolescent girls, especially in rural areas, lack adequate knowledge, information, and guidance about menstruation and its management. They also face barriers in accessing affordable, appropriate, and quality menstrual products and facilities, such as sanitary pads, toilets, water, soap, and waste disposal systems.5 Moreover, they encounter various social and cultural restrictions and taboos that limit their mobility, freedom, and opportunities during menstruation, which can negatively affect their physical, mental, emotional, and social health and development.6
For instance, in India, a country with more than 120 million adolescent girls, menstruation is often a subject shrouded in secrecy and taboos, making open and positive discussions about it rare. Many adolescent girls rely on myths and misconceptions for their understanding of menstruation, which can lead to fear, anxiety, embarrassment, and isolation during their first menstrual period.7 Challenges in managing menstrual hygiene are common due to the lack of availability and accessibility of suitable menstrual products and facilities. Furthermore, discriminatory practices, rooted in cultural and religious beliefs, prohibit these girls from entering temples, kitchens, or attending weddings or other social events during menstruation, violating their human rights and limiting their education, empowerment, and potential.
Despite these challenges, there is a lack of comprehensive research on the prevalence of knowledge and practices related to menstrual hygiene among adolescent girls in rural India. Most existing studies focus on urban or semi-urban settings and often examine specific aspects of menstrual hygiene, such as product use and disposal.8 Therefore, there is a critical need for holistic studies that encompass the various dimensions of menstrual hygiene among adolescent girls in rural areas, including their knowledge, attitudes, beliefs, behaviors, experiences, challenges, needs, preferences, and outcomes.9
To bridge this research gap, this study was conducted using a cross-sectional survey among adolescent girls aged 13–18 years in the rural areas of Bishnugarh block in the Hazaribag district of Jharkhand, India. The primary objectives of the study were:
To assess the level of knowledge and awareness about menstruation and menstrual hygiene among adolescent girls in rural areas of Bishnugarh block.
To evaluate the current practices and behaviors related to menstrual hygiene among adolescent girls in rural areas of Bishnugarh block.
To identify the factors influencing knowledge and practices regarding menstrual hygiene among adolescent girls in rural areas of Bishnugarh block.
To explore the challenges faced by adolescent girls in managing their menstrual hygiene in rural areas of Bishnugarh block.
To propose recommendations for enhancing the menstrual hygiene status and overall well-being of adolescent girls in rural areas of Bishnugarh block.
MATERIALS AND METHODS
Participants
A total of 100 female adolescents (age-group 13–18 years) were selected using a purposive sampling method from Bishnugarh College and Konar High School of Hazaribagh, Jharkhand.
Tools for Data Collection
For data collection, a structured program was developed that consisted of General information, Anthropometric assessment, Dietary survey, and Assessment of knowledge and practices in that order.
General Information
The data regarding the general profile of respondents were collected using the first part of the schedule which included the respondent’s name, age, family type, family member, monthly income of the family, and literacy level of the respondents.
Anthropometric Assessment
Anthropometric assessment is an essential factor for the evaluation of the nutritional status of any particular individual, that is, normal nutritional status, underweight, malnourished, overweight, or obese with the help of an individual’s height and weight. It also helps to identify the required nutritional requirements of any individual. Anthropometric assessment includes weight measurement, height measurement, and BMI.
Dietary Survey
In the present study, the 24-hour dietary recall method10 was adopted and nutrient intake/day was calculated. Calculation of nutrient intake was done with the help of a book named “Nutritive Value of Indian Foods”11 and compared with the recommended dietary allowance given by The Indian Council of Medical Research (ICMR). The food consumption frequency was recorded in terms of cereals and their products, pulses and legumes, green leafy vegetables (GLVs), other vegetables, roots and tubers, milk and milk products, meat and poultry, egg, fruits, oils, and sugar and jaggery. Information related to dietary patterns, food habits, food intake, food frequency, and nutrient intake with references to energy, protein, fat, iron, thiamine, riboflavin, niacin, vitamin A, and folic acid was recorded. Respondents were asked to provide information regarding the menu as well as ingredients and amount used for meal preparation.
Assessment of Knowledge and Practice
A set of schedules including mixed questions was used to assess the knowledge and practices of the respondents regarding menstruation and menstrual hygiene. Questions such as knowledge about menses before menarche, by whom they were introduced, at what age they attained menstruation, do they know anything about menstrual hygiene practices, etc. were used for knowledge assessment. Questions related to their regular menstrual habits, that is, the material used as absorbent, frequency of changing absorbent, hand washing, etc. were used for the assessment of practice. The answers to these questions were then evaluated and the result was concluded accordingly.
Statistical Analysis
The data collected were tabulated and subjected to analysis at the end of the study. The statistical techniques used were described by Mahajan12 which included mean, standard deviation, standard error, and analysis of variance (ANOVA).
RESULTS
General Information
Table 1 provides a summary of the general information gathered from the respondents.
| Demographic variables | n = 100 | % |
|---|---|---|
| Age (years) | ||
| 13–15 | 22 | 22 |
| 16–18 | 78 | 78 |
| Religion | ||
| Hindu | 99 | 99 |
| Muslim | 1 | 1 |
| Family type | ||
| Nuclear | 72 | 72 |
| Joint | 28 | 28 |
| Education level of respondents | ||
| Class 9th | 11 | 11 |
| Class 10th | 22 | 22 |
| Class 11th | 44 | 44 |
| Class 12th | 23 | 23 |
| Family occupation | ||
| Agriculture | 33 | 33 |
| Business | 67 | 67 |
| Literacy level of respondent’s fathers | ||
| Literate | 71 | 71 |
| Illiterate | 29 | 29 |
| Literacy level of respondent’s mothers | ||
| Literate | 5 | 5 |
| Illiterate | 95 | 95 |
| Family income (Rs) | ||
| 5,000–10,000 | 23 | 23 |
| 11,000–15,000 | 42 | 42 |
| 16,000–20,000 | 25 | 25 |
| 21,000–25,000 | 8 | 8 |
| 26,000–30,000 | 2 | 2 |
| Mean Rs. 17,500; Range Rs. 5,000–30,000 | ||
| Per capita income (Rs) | ||
| 101–1,000 | 8 | 8 |
| 1,001–2,000 | 31 | 31 |
| 2,001–3,000 | 35 | 35 |
| 3,001–4,000 | 17 | 17 |
| 4,001–5,000 | 8 | 8 |
| 5,001–6,000 | 1 | 1 |
| Mean Rs. 3,050.5; Range Rs. 101–6,000 | ||
| Food habits | ||
| Vegetarian | 7 | 7 |
| Non-vegetarian | 93 | 93 |
The survey revealed that 78% of the respondents were aged between 16 and 18 years, while only 22% were aged between 13 and 15 years. In terms of religion, 99% of the respondents belonged to the Hindu religion, and only 1% belonged to the Muslim religion. It was found that 72% of the respondents came from nuclear families, and 28% came from joint families.
Regarding education, 44% of the respondents were in class 11th, 23% were in class 12th, 22% were in class 10th, and only 11% were in class 9th. In terms of family occupation, 67% of the families were involved in business, while 33% were involved in agriculture.
The survey also revealed that 71% of the fathers were literate, while the remaining 29% were illiterate. On the other hand, 95% of the mothers were illiterate, and only 5% were literate. The mean family income per month surveyed was Rs. 17,500, with a range of Rs. 5,000–30,000. The mean per capita income surveyed was Rs. 3050.5 with the range of Rs. 101–6,000. Finally, the survey showed that 93% of the respondents were non-vegetarian, while only 7% were vegetarian.
Anthropometric Assessment
Table 2 indicated that 42% of the respondents were in a normal nutritional status, 26% were classified as Grade I undernutrition, 16% were classified as Grade II undernutrition, and 10% were classified as Grade III undernutrition. Additionally, 5% of the respondents were classified as Grade I overnutrition, while only 1% were classified as Grade II overnutrition.
| Nutritional status | n = 100 | % |
|---|---|---|
| Grade III undernutrition (<16.0) | 10 | 10 |
| Grade II undernutrition (16.0–16.99) | 16 | 16 |
| Grade I undernutrition (17.0–18.49) | 26 | 26 |
| Normal (18.50–24.9) | 42 | 42 |
| Grade I overnutrition (25.0–29.9) | 5 | 5 |
| Grade II overnutrition (30.0–39.9) | 1 | 1 |
| Grade II obese (>40) | – | – |
Nutritional Assessment
In Table 3, it was observed that all the respondents (100%) consumed cereals daily. A portion of the respondents, specifically 12%, were consuming pulses daily. Furthermore, 43% of the respondents were consuming milk and milk products daily, with an additional 19% doing so occasionally.
| Food groups | Daily | Weekly | Occasionally | Never | ||||
|---|---|---|---|---|---|---|---|---|
| n = 100 | % | n = 100 | % | n = 100 | % | n = 100 | % | |
| Cereals | 100 | 100 | – | – | – | – | – | – |
| Pulses | 12 | 12 | 28 | 28 | 34 | 34 | 26 | 26 |
| Milk and milk products | 43 | 43 | 27 | 27 | 19 | 19 | 11 | 11 |
| Green leafy vegetables | 63 | 63 | 24 | 24 | 9 | 9 | 4 | 4 |
| Other vegetables | 66 | 66 | 26 | 26 | 8 | 8 | – | – |
| Roots and tubers | 89 | 89 | 11 | 11 | – | – | – | – |
| Fruits | 2 | 2 | 13 | 13 | 68 | 68 | 17 | 17 |
| Meat/Poultry | 3 | 3 | 46 | 46 | 44 | 44 | 7 | 7 |
| Fats and oils | 100 | 100 | – | – | – | – | – | – |
| Sugar and jaggery | 57 | 57 | 32 | 32 | 11 | 11 | – | – |
In terms of vegetable consumption, 63% of the respondents were daily consumers of GLVs, while 24% partook in them weekly and 9% occasionally. Similarly, 66% of the respondents were daily consumers of other vegetables, and 26% consumed them weekly.
As for roots and tubers, a significant 89% of the respondents included them in their daily diet. However, only 2% of the respondents consumed fruits daily, while the majority (68%) did so occasionally.
Regarding meat and poultry consumption, 3% of the respondents included them in their daily diet, while 44% did so occasionally and 46% every week.
All the respondents (100%) were found to consume fats and oils daily. A majority, which accounted for 57% of the respondents, included sugar and jaggery in their daily diet, while 32% consumed them weekly, and the remaining 11% did so occasionally.
Assessment of Knowledge and Practices
The information gathered from the respondents has been summarized in Table 4, which outlines their knowledge and practices related to menstrual hygiene.
| Knowledge and practices | n = 100 | % |
|---|---|---|
| Knowledge of menstruation before menarche | ||
| Yes | 56 | 56 |
| No | 44 | 44 |
| Age of attaining menstruation (years) | ||
| 13 | 49 | 49 |
| 14 | 31 | 31 |
| 15 | 15 | 15 |
| 16 | 5 | 5 |
| By whom and where were they got introduced to menstruation? | ||
| Sister | 29 | 29 |
| Mother | 31 | 31 |
| Friends | 33 | 33 |
| Television | 5 | 5 |
| Teacher | 2 | 2 |
| None | – | – |
| Material used as menstrual absorbent | ||
| Sanitary napkins | 35 | 35 |
| Clothes | 40 | 40 |
| Both (sanitary napkins, and clothes) | 25 | 25 |
| Others | – | – |
| How often do they change their absorbent during first 2 days of menstruation? | ||
| After every 2 hours | 17 | 17 |
| After every 3 hours | 52 | 52 |
| After every 4 hours | 19 | 19 |
| After every 6 hours | 4 | 4 |
| After every 8 hours | 6 | 6 |
| Once a day | 2 | 2 |
| How often do they change their undergarments during menstrual days? | ||
| Once a day | 92 | 92 |
| Twice a day | 8 | 8 |
| Never | – | – |
| Bath daily during menstruation? | ||
| Yes | 91 | 91 |
| No | 9 | 9 |
| Washed their hands after changing the absorbent? | ||
| Yes | 92 | 92 |
| No | 8 | 8 |
| Cleaned their pubic hair during menstruation? | ||
| Yes | 22 | 22 |
| No | 78 | 78 |
| Washed their vaginal area daily during menstruation? | ||
| Yes | 70 | 70 |
| No | 30 | 30 |
| Had any premenstrual syndrome? | ||
| Headache | – | – |
| Lower abdominal pain | 54 | 54 |
| Mood swings | – | – |
| Backache | 3 | 3 |
| Fatigue and weakness | 17 | 17 |
| Any other | – | – |
| None | 26 | 26 |
| Felt irritation in the vaginal area during menstrual days? | ||
| Yes | 63 | 63 |
| No | 37 | 37 |
| Had fever during menstruation? | ||
| Yes | 43 | 43 |
| No | 57 | 57 |
| Aware of any restrictions during menstruation? | ||
| A. Not allowed to enter in the kitchen | 5 | 5 |
| B. Not allowed to bath daily | 13 | 13 |
| C. Not allowed to sleep on the bed | – | – |
| Both A and B | 2 | 2 |
| Both B and C | – | – |
| None | 80 | 80 |
Knowledge of menstruation before menarche: 56% of respondents knew about menstruation before menarche while 44% of respondents did not know about it.
Age of attaining menstruation (years): The majority of the respondents (49%) attained their menses at the age of 13, 31% attained at 14 years, 15% attained at 15 years, and only 5% at 16 years.
By whom and where were they got introduced to menstruation: 33% of respondents were introduced to menstruation by their friends, 31% by their mother, 29% by their sisters, 5% by television, and 2% by their teacher.
Material used as menstrual absorbent: 40% of respondents used clothes as menstrual absorbent, 35% of respondents used sanitary napkins, and 25% used both (clothes and sanitary napkins) as absorbent.
How often they change their absorbent during first 2 days of menstruation: 52% of respondents changed their absorbent every 3 hours, 19% of respondents changed it every 4 hours, 17% of respondents changed it every 2 hours, 6% of respondents changed it every 8 hours, 4% respondents changed at every 6 hours while 2% respondents changed once a day.
How often they change their undergarments during menstrual days: The majority of the respondents (92%) changed their undergarments once a day during menstrual days while 8% of respondents changed twice a day.
Bath daily during menstruation: The majority of respondents (91%) bath daily during their menstrual days while 9% of respondents did not bathe during their menstrual days.
Washed their hands after changing the absorbent: 92% of respondents washed their hands properly after changing the absorbent whereas 8% of respondents did not wash their hands after changing the menstrual absorbent.
Cleaned their pubic hair during menstruation: Only 22% of respondents cleaned their pubic hair during menstruation whereas a majority of respondents (78%) did not clean their pubic hair during those days.
Washed their vaginal area daily during menstruation: The majority of the respondents (70%) washed their vaginal area during menstruation whereas 30% of respondents did not wash their vaginal area properly.
Had any premenstrual syndrome: 54% had lower abdominal pain, 17% had fatigue and weakness, and 3% had backache whereas the remaining 26% had no premenstrual syndrome.
Felt irritation in the vaginal area during menstrual days: 63% of respondents felt irritation in their vaginal area during their menstrual days whereas 37% of respondents did not feel any kind of irritation in their vaginal area during those days.
Had fever during menstruation: 43% of respondents had fever during menstruation whereas 57% had no fever during menstruation.
Aware of any restrictions during menstruation: 13% of respondents were not allowed to bath daily during menstrual days, 5% of respondents were not allowed to enter the kitchen, and 2% of respondents were not allowed to bath daily as well as to enter the kitchen whereas the remaining 80% were not aware of any kind of restrictions during those days.
Issues of Using Clothes/Sanitary Napkins/Both as a Menstrual Absorbent
Table 5 summarizes the prevalence of irritation in the vaginal area and fever among the respondents using clothes/sanitary napkins/both as a menstrual absorbent.
| Issues | ||
|---|---|---|
| Out of girls using cloth as a menstrual absorbent, how many had | n = 40 | % |
| Only irritation | 10 | 25 |
| Only fever | 1 | 2.5 |
| Both (irritation and fever) | 25 | 62.5 |
| Not any | 4 | 10 |
| Out of girls using sanitary napkins as a menstrual absorbent, how many had | n = 35 | % |
| Only irritation | 5 | 14.2 |
| Only fever | 2 | 5.7 |
| Both (irritation and fever) | 9 | 25.7 |
| Not any | 19 | 54.2 |
| Out of girls using both (clothes and sanitary napkins) as menstrual absorbent, how many had | n = 25 | % |
| Only irritation | 10 | 40 |
| Only fever | 2 | 8 |
| Both (irritation and fever) | 4 | 16 |
| Not any | 9 | 36 |
Out of girls (n = 40) using cloth as a menstrual absorbent: 25% of respondents had only irritation in their vaginal area, 2.5% respondents had only fever, and 62.5% respondents had both (irritation and fever) whereas 10% of respondents had none during their menstrual days.
Out of girls (n = 35) using sanitary napkins as a menstrual absorbent: 14.2% of respondents had only irritation in their vaginal area, 5.7% respondents had only fever, and 25.7% respondents had both (irritation and fever) whereas 54.2% respondents had none during their menstrual days.
Out of girls (n = 25) using both (clothes and sanitary napkins) as menstrual absorbent: 40% of respondents had only irritation in their vaginal area, 8% of respondents had only fever, and 16% of respondents had both (irritation and fever) whereas 36% respondents had none during their menstrual days.
Table 6 showed that the intake of nutrients by both age-groups was comparatively less than the Recommended Dietary Allowance (RDA) published by the ICMR (2010). The daily average intake of nutrients as well as how much they vary from the RDA daily intake can be seen in this table and the following list of Figure 1.
| Groups | Energy (Kcal) | Protein (gm) | Fat (gm) | Iron (mg) | Thiamine (mg) | Riboflavin (mg) | Niacin (mg) | Vitamin C (mg) | Carotene (µg) | Folic acid (µg) |
|---|---|---|---|---|---|---|---|---|---|---|
| 13–15 years | ||||||||||
| Average intake | 1,520 | 42 | 15 | 10 | 1.8 | 0.8 | 16 | 60 | 2,252 | 204 |
| RDA | 2,330 | 51.9 | 40 | 27 | 1.2 | 1.4 | 14 | 40 | 2,800 | 150 |
| Difference | −810 | −9.9 | −25 | −17 | +0.6 | −0.6 | +2 | +20 | −548 | +54 |
| 16–18 years | ||||||||||
| Average intake | 1,516 | 40 | 15 | 10 | 1.4 | 0.7 | 15 | 74 | 2,432 | 230 |
| RDA | 2,440 | 55.5 | 35 | 26 | 1.0 | 1.2 | 14 | 40 | 2,800 | 200 |
| Difference | −924 | −15.5 | −20 | −16 | +0.4 | –0.5 | +1 | +34 | −368 | +30 |
Figs 1A to F: (A) Average daily energy (Kcal/day) intake of the respondents; (B) Average daily protein (gm/day) intake of the respondents; (C) Average daily fat (gm/day) intake of the respondents; (D) Average daily iron (mg/day) intake of the respondents; (E) Average daily thiamine (mg/day) intake of the respondents; (F) Average daily riboflavin (mg/day) intake of the respondents
Figs 1G to J: (G) Average daily niacin (mg/day) intake of the respondents; (H) Average daily vitamin C (mg/day) intake of the respondents; (I) Average daily carotene (µg/day) intake of the respondents; (J) Average daily folic acid (µg/day) intake of the respondents
On applying the ANOVA test, it was found that there was a non-significant difference with respect to the average daily intake of nutrients that is, protein and fat, iron and thiamine, niacin and riboflavin, and carotene and folic acid.
SUMMARY
This research pursued several objectives mentioned in the introduction section.
The study involved 100 female adolescent participants, randomly selected from the rural regions of Bishnugarh in Hazaribag district. Data collection encompassed a range of aspects, including participants’ general profiles, anthropometric assessments, 24-hour dietary recalls, and their knowledge and practices regarding menstrual hygiene.
The study revealed that a significant portion of the participants (78%) fell within the 16–18 age-group, with the remaining 22% between 13 and 15 years. Almost all of the participants (99%) identified with the Hindu religion. Family structures varied, with 72% belonging to nuclear families and 28% to joint families. The educational distribution among the respondents showed that 44% were in class 11, while 23, 22, and 11% were in classes 12, 10, and 9, respectively. Family occupations were diverse, with 67% involved in business and 33% in agriculture. The literacy rate among the mothers of the respondents was quite low, with 95% being illiterate. Dietary preferences leaned toward non-vegetarian options, as 93% of the respondents identified as non-vegetarian, while only 7% adhered to a vegetarian diet.
Body mass index revealed that 42% of the respondents were within the normal range, while 10 and 26% were categorized as Grade III Undernutrition and Grade I Undernutrition, respectively.
Cereals, fats, and oils were daily dietary staples for all respondents. However, the consumption frequency of pulses, fruits, meat, poultry, and roots and tubers varied.
The study also uncovered that 56% of the girls were already aware of menstruation before experiencing menarche. The age at which girls attained menarche was diverse, with 49% reaching it at 13 years, and 31, 15, and 5% attaining it at 14, 15, and 16 years, respectively. Friends and mothers emerged as the primary sources of information regarding menstruation.
Regarding menstrual hygiene practices, 40% of the girls used cloth, 35% used sanitary napkins, and 25% used both cloth and sanitary napkins as menstrual absorbents during their menstrual cycles. A majority of the respondents (52%) changed their absorbent every 3 hours during the first 2 days of menstruation. Additionally, 92% of the girls changed their undergarments daily during menstruation. Bathing daily was a common practice among 91% of the participants, and 92% of them properly washed their hands after changing the absorbent. Only 22% of the girls cleaned their pubic hair regularly. Among those who washed their vaginal area daily during menstruation, 62.8% used soap for washing. It was also found that 54% of girls experienced lower abdominal pain, 17% experienced fatigue and weakness, and 20% were aware of specific restrictions during menses.
The study findings indicated that girls using cloth as a menstrual absorbent were more susceptible to menstrual morbidities and associated symptoms such as fever and vaginal irritation. This was evidenced by the observations of 62.5% of respondents using cloth, 25.7% of those using sanitary napkins, and 16% of those using both cloth and sanitary napkins.
The ANOVA tables indicated non-significant results for various nutritional components, such as protein and fat, iron and thiamine, riboflavin and niacin, and carotene and folic acid.
CONCLUSION
The findings from this study indicate three primary areas of concern: inadequate knowledge regarding the biology of menstruation, the prevalence of menstruation-related symptoms among the majority of girls, and the limited usage of sanitary napkins. Notably, the research reveals that a significant number of rural girls rely on cloth pieces as menstrual pads and often reuse them after washing them with soap and water.
This study underscores the critical necessity for adolescent girls to access accurate and comprehensive information regarding menstruation and its proper management. To facilitate this, both formal and informal communication channels, including mothers, sisters, and friends, should be actively utilized to disseminate such knowledge. Recognizing the pivotal role of mothers, it becomes essential to equip them with the correct and relevant information on reproductive health, enabling them to pass on this vital knowledge to their growing daughters. Encouraging daughters to maintain personal hygiene should also be a focus.
Furthermore, educators, including teachers, who may lack the requisite skills to impart reproductive health education, including menstrual hygiene, should receive support and training. Schools represent a valuable platform for enhancing menstrual health by integrating menstrual hygiene into the curriculum, ensuring the availability of suitable restroom facilities, and even providing sanitary napkins.
Menstrual health is a fundamental component of the life cycle approach to women’s health. Unequivocal messages and services related to this topic must be accessible to adolescent girls to support their well-being and overall health.
Limitations of the Study
The study’s brevity and the restricted number of subjects hindered in-depth interaction with the participants.
Limited interaction with subjects calls for caution when attempting to generalize the findings to a larger population.
The single-day survey of food consumption may not offer a comprehensive representation of the subjects’ typical dietary patterns.
Due to time constraints, food analysis and biochemical assessments were omitted.
Recommendations
Future research should consider conducting a more extensive investigation over an extended period with a larger sample size to enhance the overall authenticity of the results.
The inclusion of biochemical assessments is essential for accurately identifying the number of respondents afflicted by malnutrition.
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