A Comparative Study to assess the learning needs of Menstrual hygiene among adolescent girls in selected Rural and Urban school, south Gujarat,

Bharuch – 392001

 

Mrs. Karthika¹, Mr. Moses Kandula²

¹Associate Professor, Welfare College of Nursing and Midwifery, Bharuch

²Principal, Welfare School of Nursing and Midwifery, Bharuch

 

ABSTRACT:

Menstrual hygiene is an essential aspect of hygiene for women and adolescent girls between menarche and menopause. Despite being an important issue concerning girls in the menstruating age group menstrual hygiene. Objectives: 1. To assess the learning needs of menstrual hygiene among adolescent girls of urban school, Bharuch. 2. To assess the learning needs of menstrual hygiene among adolescent girls of rural school, Bharuch. 3. To compare the learning needs of menstrual hygiene among adolescent girls of rural and urban School, Bharuch.4. To find out the association between learning needs of menstrual hygiene among adolescent girls of urban and rural school with selected demographic variables. Method: A comparative study was conducted on 11^th march 2019 (urban) and 22^nd February 2019 (rural). Probability stratified random sampling technique was used for study. Total 100 samples was selected 50 from rural school and 50 from urban school. This consists of 30 multiple choice questions. Pretest are taken to assess the learning needs of menstrual hygiene and health education is used to give information regarding menstrual hygiene. Result: 1. Assessment of the level of knowledge of adolescent girls regarding menstrual hygiene that, the in rural, 26% of adolescent girls had poor knowledge whose score range from 1-10, 74% of the adolescent girls had average knowledge whose score range from 11-20 and 0% of the adolescent girls had good knowledge whose score range from 21-30. 2. In Urban 0% of adolescent girls had poor knowledge whose score range from 1-10, 80% of the adolescent girls had average knowledge whose score range from 11-20 and 20% of the adolescent girls had good knowledge whose score range from 21-30. 3. In Rural, there was a significant association between knowledge and score of adolescent girls with their parent occupation and type of family and no significant association between the level of knowledge and score of adolescent girls with their age, education, religion, parent education, income. 4. In Urban, there was a significant association between knowledge and score of adolescent girls with their religion and no significant association between the level of knowledge and score of adolescent girls with their age, education, parent education, parent occupation, type of family, income. Conclusion: The investigator found that adolescent girls knowledge regarding menstrual hygiene can be improved by lesson plan. As per statistical analysis the researcher conclude that after completion the research adolescent girls knowledge increased significantly.

 

INTRODUCTION:

“Let womanhood bloom without gloom”

(The nursing journal of India Jan-Feb 2019)

“ADOLECENCE is a transitional stage of physical and psychological development that generally occurs during the period from puberty to adulthood.” Adolescence period is biological, psychological, sexual and social development during 10-12 years and ends at 19-20 years. In the process of developing from a child into adult. Adolescence is usually associated with the teenage years but its physical, psychological, or cultural expressions may begin earlier and end later. For e.g. puberty now typically begins during preadolescence particularly in Female. (http://en.m.wikipedia.org)

 

There are 1.2 billion young people (UNICEF 2009) in the world and the majority living in developing countries. They are the largest generation of youth in history. Approximately half of them 900 million are adolescence girls.

(https://data.unicef.org >topic>adolescents)

 

“MENARCHE is the beginning of the menstrual function especially the first menstrual period in the adolescence girls.” It may occur between 10-16 years the peak time being 13 years. The first period is usually an ovular. The ovulation may be irregular for a variable period following menarche and may take about 2 years for regular ovulation to occur. (https://en.m.wikipedia.org>wiki>menarche)

 

Menstruation is not an illness. It is a healthy, normal, mature process. Menstruation or menstruation period is normal vaginal bleeding that occurs as part of woman month cycle. If no pregnancy occurs, uterus sheds its lining. The menstrual flow consist of blood mucus and there particles. Average blood loss is about>80 ml. factors may alter the menstrual cycle are stress, fatigue, exercises, acute/chronic illness, changes in climate. Period usually start between 11-14year and continue until menopause at about age 51years. Its lasts from 3-5 days. Besides bleeding vagina, girl may have feeling of abdominal and pelvic pain, lower back pain, bloating and sore breasts, mood swings and irritability, headache and fatigue etc. Premenstrual syndrome (PMS) is a group of symptom that start before the period include emotional and physical symptoms.

(://www.womenshealth.gov>menstruation)

 

“Menstrual hygiene is defined as a women and adolescent girls using a clean menstrual material to absorb or collect blood that can be changed in privacy as often as often as necessary for the duration of the menstruation period, using soap and water for washing the body as required.”Don’t be afraid, It can be scary to see the blood on your underwear, but it is a natural and normal.(https:sswm.info>important>menstrual hygiene)

 

If poor menstrual hygiene practice is there so that time it may lead to the urogenital infection, Yeast infection, cervical cancer. 23 million girls drop out of school every year when they start menstruating in India.
(Saptarshi dutta May 2018)

 

A female is generally having 460 total menstruation cycles throughout her life; On average a pad cost Rs. 15 to 18 and ideally for a complete 5 to 7 days of menstrual cycle a woman should use at least 40 pads per period. However, it depend on individuals, the menstrual flow and the quality of sanitary pad; On average figure she expenses over 1.5 lack rupees throughout her life. (UNICEF 2010)

 

Facts related to menstrual hygiene:

Ÿ  10% of the girls in India believe menstruation is a disease (UNICEF 2019)

Ÿ  Only 13% of the girls are aware of menstruation before their first period (UNICEF/MHM 2019)

Ÿ  56% of girls in and out of school did not receive any information about menstruation (UNICEF/MHM 2019)

Ÿ  66% of the Indian girls do not know anything about menstruation before their first period (UNICEF/ MHM 2019)

Ÿ  87% of the women and girls are completely unaware about menstruation and do not have any knowledge about the purpose of menstruation as a biological process. (UNICEF/MHM 2019)

Ÿ  For 23% of the girls in rural areas of India, having their period is one of the reasons to quit school, with irreversible effects for their personal development, economical status and eventually their health.

Ÿ  28% of the students in India do not go to school during that period, due to lack of facilities and materials (UNICEF 2019)

 

Use of materials:

Ÿ  In India the majority of women in rural area mostly use reusable cloths to absorb menstrual blood (WaterAid 2019)

Ÿ  For the absorption of menstrual blood, 89% use cloth, 2% cotton wool, sanitary pads 2% ash (WaterAid 2019)

Ÿ  Of the women using cloth as absorbents, half use the same cloth for more than a month (WaterAid 2019)

Ÿ  75% of the girls have no idea about what material to use to absorb the flow (UNICEF/MHM 2019)

Ÿ  75% of the girls use cotton cloths during their period (UNICEF/MHM 2019)

Ÿ  27% school girls do not use any material at all (UNICEF/MHM 2019)

Ÿ  Hygiene and access to products: only 16% girls use sanitary napkins (UNICEF/MHM 2019)

Ÿ  43%- 88% girls in urban India use reusable cloth, yet these are often washed without soap available (UNICEF 2019)

Ÿ  In India 14% of the girls report to suffer from menstrual infections (WaterAid 2019)

Ÿ  52% of the female population is in reproductive age and most of them are menstruating every month; majority of them have no access to clean and safe sanitary products (SSWM 2019)

Ÿ  Lack of facility and appropriate sanitary products can push menstruating girls out of the school (SSWM 2019)

Ÿ  60%of girls in India only change their menstrual cloths once a day (UKAID 2019)

Ÿ  High cost and unavailability of sanitary pad is the prime reason for women and girls in India not to use sanitary pads (WaterAid 2019)

Ÿ  Poor menstrual hygiene not only affects physical health, but also social mental wellbeing, thus it is a violation of the human right to health (MenstrualHygieneDay.org)

Ÿ  In rural India, many women and girls use unhygienic material such as old rags, husks, dried leaves, grass, ash, sand or newspaper because they do not have access to affordable, hygienic and safe product and facilities (Menstrual Hygiene day.org)

Ÿ  Shops in villages often do not have sanitary pads for sales, because there is no demand for it (UNICEF/MHM2019)

Ÿ  41% Of adolescents hide their cloth in the room, 22% in the roof and 11% share the cloth with others (UNICEF/MHM2019) (Therese Mahon & Fernandes, 2009)

Ÿ  Now a day’s adolescents girls are 1.2 billion worldwide. In India population of adolescent girls is about 21% or 243 million. In Gujarat total adolescent girls are 16,12, 562. (United Nation 2010)

 

NEED FOR STUDY:

Adolescence is regarded, as a unique phase of human development. Among adolescent girls menarche is an important land mark in the process of growth and maturation. Menstruation is a phenomenon unique to the females. The onset of menstruation is one of the most important changes occurring among the girls during the adolescent years. The first menstruation occurs between 11and 15 Years with a mean of 13 years. Though menstruation is a natural and normal physiological process for all healthy adult women, as ever it has been surrounded by secrecy and myths in many societies^. In India 120 million (2018) girls are adolescent. 88% (2017) of girls not maintain menstrual hygiene. Hence the researcher identified that 88%(2017) are not maintaining proper menstrual hygiene. So researcher interested to take a effort to participate in this study. (https://www.brunet.ca>advices>adolescence)

A descriptive, cross sectional study conducted in Iran, regarding attitudes of female adolescents about menstrual hygiene. A sample of 250 students was selected at cluster random sampling method. Questionnaire was used to collect the data. Seventy seven percent of the subjects claimed that they had adequate knowledge regarding menstrual hygiene. Only 32% of these practiced personal hygiene, such as taking bath, and used hygienic materials (i.e. sterile pads). About 33% of the subjects, avoided any physical activity or even mild exercise during menstrual period.   Most of the students believed in the effectiveness of personal hygiene for the reduction of severe menstrual pain, only 79 (32%) said that they took a bath during the first days of menstrual period, while 162 (65%) reported not taking a bath at the beginning of their menstrual period.In addition, 85 girls (51.5%) reported not taking bath for 8days after the onset of their Menstrual period⁷.(soraya siabani 2018)

 

REVIEW OF LITERATURE:

Pragya Verma (2013) was conducted a descriptive cross sectional study was conducted among 120 adolescent girls of a higher secondary school situated in Varanasi District. Information was obtained with the help of a predesigned and pretested questionnaire in a local language. About half of the girls (58.3%) were aware about menstruation prior to attainment of menarche. The mean age of menarche was found to be 12.98yrs (+0.77). The most common menstrual pattern was 30/3 days. Mother was the first informant regarding menstruation in case of (41.66%) of girls. Most of the girls (85.8%) believed it as a physiological process. Regarding practices, only 61(50.8%) girls informed about the use of sanitary pads during menstruation. Most of the girls 59 (49.16%) used old plain cloth as menstrual absorbent. About (82.5%) girls practiced different restrictions during menstruation. Menstrual hygiene is still a very important risk factor for reproductive tract infections and it is a vital component of the health education to the adolescent girls. Educational television programmes, trained school nurses/ health personnel, motivated school teachers, and knowledgeable parents can play a very important role in transmitting the critical messages of correct practices about menstrual hygiene to the adolescent girls of today.

 

K.A. Narayan et al (2001) was conducted a study on puberty rituals, reproductive knowledge and health of adolescent school girls in South India, carried out in the urban and rural field practice areas of the Jawaharlal institute of post graduate medical education and research center (JIPMER) in Pondicherry, Tamilnadu. A knowledge questionnaire was used for data collection. Sample size was 619 adolescent girls, who attained menarche, out of which 327 are from rural and 292 are from urban. The results showed that knowledge about anatomy of reproductive system is less in rural girls (14.4% n=327) than urban girls (22.35% n=292)  Traditionality was found to be higher among rural girl Regarding hygienic practices (6.5%) used under   garments during menstruation, and using of old cloth as a menstrual absorbent is high in rural (82.5%)than urban (72.2%). Urban girls had a permanent structure for a bath room or wash area (37.9%) how ever in the rural areas, the bathroom with no flooring and a stone for washing clothes. The Pearson correlation co-efficient between the traditionality scale and the hygiene index was (r= -2.44) (p<0.01) indicating the girls who are higher in traditionality have poor hygiene practices. Background: Lack of knowledge and poor personal hygienic practices during menstruation can lead to various gynecological problems in the reproductive life of girls. There is difference in prior awareness about menstruation and menstrual hygiene among rural and urban adolescent girls.

 

METHODOLOGY:

Research approach:

Quantitative research approach

 

Research design:

comparative research design to measure learning needs of menstrual hygiene among adolescent girls

 

Variables of the study:

Dependent variable:

learning need of adolescent girls regarding menstrual hygiene.

 

Independent variable: 

learning needs of menstrual hygiene

 

Setting of study:

The present study will be conducted in VCT Girls secondary school of bharuch city and bhuva of bharuch district which will be selected according to the convenience of the researcher and easy geographical accessibility.

 

Population of study:

Adolescent girls in the age of 12-16 years, who attained menarche.

 

Sample:

A girls (12-16 years) in bhuwa in bharuch district and V.C.T Girls secondary school in bharuch city.

 

Sample size:

100 samples who met the inclusion criteria were will select for the present study.

 

 

 

Sampling Technique:

Probability stratified random sampling technique was used for the present study.

 

Criteria for selection of sample:

Inclusion criteria:

1.     Adolescent girls between 12 -16 years.

2.     Adolescent girls who are present at the time of data collection.

3.     Adolescent girls who are willing to participate in study.

4.     Adolecent girls who are able to read Guajarati.

 

2. Exclusion criteria:

1.     Adolescent girls above the age of 19 years are excluded.

2.     Adolescent girls who are not willing to participate in study.

3.     Adolescent girls who are mentally challenged.

4.     Adolescents girls those who are absent due to menstrual periods.

 

PROCEDURE FOR DATA COLLECTION:

The study will be conduct in the month of December 2018. 100 adolescent girls will included in study. Questionarrie will use for data collection in bhuwa at bharuch district and VCT Girls secondary school in bharuch city.

 

The subjects will be select using the convenient sampling technique.

 

Adolescent girls (12-16 years) willing to participate in the study will identify base on the inclusion criteria.

 

DESCRIPTION OF THE TOOL:

SECTION 1:

This part of questionnaire is to find out the information from adolescent girls (12-16 years) about their age, education, occupation, type of family.

 

SECTION 2:

A structured questionnaire to assess the level of knowledge among adolescent girls (12-16 years) regarding menstrual hygiene.

 

This consist of 30 multiple choice questions, divided into component of personal hygiene, fluid management, diet, education, medication.

 

Each question is having 3 options from which instruments were clearly written to choose the best option.

 

Each correct response item was scored as “1” otherwise scored “0”.

 

ANALYSIS AND INTERPRETATION:

SECTION I: Distribution of samples in relation to demographic data using frequency and percentage of rural adolescent girls.                            N=50

 

SECTION II: Frequency and percentage distribution of urban adolescent girls based on their demographic variables:       N=50

 

 

 

SECTION III: frequency and percentage distribution of learning needs of menstrual hygiene among rural and urban adolesent girls. N=50

 

MEAN, MEAN% & SD OF SELECTED LEANING NEEDS AMONG URBAN & RURAL ADOLESCENT GIRLS

 

SECTION IV: Association of Learning Needs of Urban And Rural Adolescent Girls With Selected Demographic Variables

This section consist of 7 items seeking information on demographic data which include Age, Education, Religion, Parents education, Parents occupation, Type of Family, Income.

S. N.	Demographic variable	DF	Chi2 value URBAN	TV	RESULT	Chi2 value RURAL	TV	RESU LT
1	Age	6	6.65	12.59	NS	2.014	12.59	NS
2	Education	2	5.42	5.99	NS	0.82	5.99	NS
3	Religion	4	105.8	9.94	SIG	9.49	4	NS
4	Parent education	10	6.3	18.31	NS	5.46	18.31	SIG
5	Type of family	2	0.76	5.99	NS	37.6	5.99	SIG
6	Income	6	0.93	12.59	NS	7.48	12.48	NS

 

There was significant association between learning needs of adolescent girls in urban school with their religion, there was no significant association between learning needs of menstrual hygiene of adolescent girls with their age, education, Parents education, Parents occupation, type of family, and income.

 

There was significant association between learning need of adolescent girls in rural with their type of family and parent occupation, there was no significant association between learning needs of adolescent girls with their age, education, religion, parent education, income.

 

Health education prepared on menstrual hygiene and their learning needs based on review of literature and literature and consulting with experts and will be distributed among adolescent girls.

 

REFERENCE:

1.        Prof. Dr.A. Mustafa, Textbook of Nursing Research and Statistics, published by AITBS PUBLISHERS INDIA, page no – 570.

2.        DC Dutt’s “Textbook of gynaecology” 7 th edition, published by Jaypee brothers, page no – 39 to 40.

3.        JeffcoateJeffcoate ' S, Textbook of “jeffcoate' s principles of gynaecology, 8 th edition, published by Jaypee brothers, page no – 72.

4.        B.T. Basavanthappa, “Text book of Nursing Research” 1 st edition, published by Jaypee brothers, page no – 712 to 713.

5.        JacobAnnamma, “A comprehensive textbook of midwifery, “1 St edition, published by Jaypee brothers, page no -72.

6.        Suresh k Sharma, “Nursing research and statistics”, 2nd edition, published by Elsevier, page no – 246 to 293.                  

7.        B.T Basavanthappa, Textbook of community health nursing, 1 St edition, published by Jaypee brothers (p) New Delhi; page no – 205, 206.     

8.        Sunanda. S. Roy, “A Textbook of ' Nursing research and statistics' “, 2 nd edition, published by Kumar publishing house, page no – 57 to 60.

9.        HemaPriya S., Partha Nandi Seetharaman N., Ramya M.R, Nishanthini N., Lokeshmaran A, A study of menstrual hygiene and related personal hygiene practices among adolescent girls in rural Puducherry International Journal of Community Medicine and Public Health HemaPriyaSetal. Int J Community Med publich health.2017 Jul; 2355http://www.ijcmph.com/index.php/ijcmph/article/viewfile/1328/1252

10.      ShivaleelaP.UpashTesfalidetTekelab and JalaneMekonnen Assessment of knowledge and practice of menstrual hygiene among high school girls in Western Ethiopia Receive: 22 Febuary 2015 Accepted: 6 October 2015 Published: 14 October 2015

 

 

 

 

Received on 13.05.2019          Modified on 05.06.2019

Accepted on 25.06.2019     © A&V Publications all right reserved