ABSTRACT
Background
Menstruation is a phenomenon unique to all females and its onset is a landmark event in the pubertal life of the adolescent girl. Menstrual hygiene deals with the specific health care needs and requirements of women during monthly menstruation. Menstrual hygiene is an issue that every girl and woman has to deal with when she enters adolescent until she reaches menopause
AIM:
To assess the menstrual hygiene practices amongst adolescent girls in secondary schools in Imo state, Nigeria
Materials and methods:
A cross sectional descriptive study carried out among 600 secondary school girls in Imo state, they were selected using the multistage sampling technique and Data was collected using a pretested semi-structured and interviewer administered questionnaire and analyzed using a computer software, Statistical Package for Social Sciences (SPSS IBM,USA). Descriptive statistics was presented in summary indices and frequency tables and percentages. Association between variables was carried out using Chi Square and the P-value was set at 0.05 significance level.
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND TO STUDY.
Globally about 52% of the female population is of reproductive age. Meaning menstruation is part of their normal life and menstrual hygiene is therefore an essential part of basic hygienic practices.1 Adolescent is a stage in the lives of females which indicates their transformation from girlhood to womanhood2. Adolescence in girls has been recognized as a special period in their lifecycle that requires due attention this period is marked by onset of menarche which occurs between 11 and 15 years.3
Adolescents are a large and growing segment of the world’s population. More than half of the world’s population is below the age of 25 and one in every two young people in the world is adolescent4.During adolescence young people develop their adult identity move, toward physical and psychological maturity. Physiologically, the hypothalamus produces growth hormone and gonadotropins initiate pubertal changes.5 Menstruation, the periodic vaginal bleeding that occurs with the shedding of the uterine mucosa is one of the signs of puberty can occur one or two years following appearance of secondary sexual characteristics6. Menstrual hygiene deals with the specific health care needs and requirements of women during monthly menstruatin5. These areas of special concern include choice of best feminine hygiene products, how often and when to change the feminine hygiene products, bathing, care of the vulva and vagina as well as the supposed benefits of vaginal douching at the end of each menstrual period.7 Menstrual hygiene is an issue that every girl and woman has to deal with once she enters adolescence around the age of 12 until she reaches the menopause. Menstruation is a monthly occurrence that requires access to appropriate materials and facilities without which females suffer from poor menstrual hygiene which restricts movement and self-confidence. Goodmenstrual hygiene is therefore crucial for health and dignity of girls and women.8
1.2 DEFINITION OF TERMS
Menstrual hygiene: Refers to the ways women keep clean and healthy during menstruation and how they acquire, use and dispose of blood absorbing materials.9
Menstruation: The cyclic, physiologic discharge through the vagina of blood and endometrial tissues from the non-pregnant uterus.10
Menarche: Is the first menstrual period, or the first menstrual bleeding indicating transition from girlhood to womanhood.11
Adolescent: Transitional stage of physical and psychological human development from childhood to adulthood. It’s between 13-19 years.5
Menopause: Is the time in most women’s lives when menstrual periods stop permanently and they are no longer able to bear children.12
Hygiene: Refers to conditions and practices that help to maintain health andprevent the spread of diseases.13
Menstrual cycle: Is the natural change that occurs in the female that makes pregnancy possible.14
Irregular cycles: Unpredictable long and short cycles with varying degrees of blood loss.15
Menorrhagia: Excessive, very heavy and prolonged bleeding (this can lead to anemia and be fatal if not treated).15
Polymenorrhea: Frequent periods or short cycles (<21days).15
Amenorrhea: No bleeding for three or more months.15
Oligomenorrhea: Light or infrequent periods (menstrual cycles of 35-90days). 15
Dysmenorrhea: Pain, backache, abdominal pain or cramps during menstruation.15
Spotting/Intermenstrual bleeding: Blood loss (even slight) between periods.15
Menstrual Hygiene Day (MHD): Is an annual awareness day on 28th May that aims to break taboos and raise awareness about the importance of good menstrual hygiene management for adolescent and girl’s worldwide16.
Other names of menstruation: Period.17
Taboos: Vehement prohibition of an action/behavior based on the belief that such actions/behavior is contradictory to socio-cultural norms. Violation of such laws norms is punishable.11
1.3 STATEMENT OF PROBLEM
Although, adolescence is a healthy period of life, many adolescent are often less informed less experienced and less comfortable accessing reproductive health information and services than adults.1 In many parts of developing countries, a culture of silence surrounds the topic of menstruation and related issues.18,19 Thus many girls lack appropriate and sufficient information regarding menstrual hygiene. This may result in incorrect and unhealthy behavior during their menstrual period. Also many mothers lack correct information and skills to communicate about menstrual hygiene which they pass onto their children, leading to false attitudes, beliefs and practices in this regard.4
Hygiene related practices of women during menstruation are of considerable importance as it has a health impact in terms of increased vulnerability to reproductive tract infections. The interplay of socio-economic status, menstrual hygiene practices and reproductive tract infections are noticeable. Today millions of women are sufferers of reproductive tract infections and its complications and often the infection is transmitted to the offspring of the pregnant mother3.
Women having better knowledge regarding menstrual hygiene and safe practices are less vulnerable to reproductive tract infections and its consequences.20 Therefore increased knowledge about menstruation right from childhood may escalate safe practices and help in mitigating the suffering of millions of women. In adolescents who experienced menstruation for the first time, menstrual hygiene management is constrained by practical, social, economic and cultural factors such as the expense of commercial sanitary pads, lack of water and latrine facilities, lack of private rooms for changing pads and limited education about the facts of menstrual hygiene.21 Adolescents enter puberty unprepared and the information they receive is often selective and surrounded by taboos. In many curricula, there is emphasis on the reproductive process but not on the practical issue.22
During menstruation, adolescent girls are faced with challenges related to the management of menstrual hygiene in public places united nations children fund estimates that 1 in 10 school age African girls do not attend school during menstruation23. The onset of menstruation represents a landmark event in pubertal development of the adolescent girl studies have shown that although most girls viewed themselves as being prepared for menarche having discussed this with their mothers, obvious misconceptions on the true physiological process and characteristics of menstruation and the menstrual cycle is evident from these studies.24, 25 This to a large extent influences menstrual practices of these adolescent girls. Faulty perceptions or misconceptions on menstruation and menstrual cycle will lead to faulty menstrual practices. Either of these may engender reproductive health system in the adolescent.4 In Bangladesh, a study showed 95% of women and 90% of adolescent girls use rags during menstruation to absorb flow of blood. The same study showed 40% of women change their rags only once a day. About 60% of women wash the rags in unsafe water and 80% of adolescent girls reuse the rag.26 In Egypt because of cultural and religious beliefs menstruation is not considered an appropriate topic of discussion leading to lack of accurate information for girls to manage menstruation hygienically. In poor areas of Egypt there is a problem of overcrowding and poor infrastructure both in schools and homes. Toilet may betotally absent or few in number with broken doors or defective water supply or sewerage.27 Menstrual hygiene needs to be addressed holistically and in context as a package of services that includes voice and space to talk about the issue, Adequate water, privacy, facilities for washing and disposal of used sanitary pad.28 The accessibility of private place to change their sanitary towel, clean water for washing hands and used cloths and facilities for safety disposing used materials affect the practices of menstrual hygiene. It is known that there are potential risks of poor menstrual hygiene certain practices are more likely to increase the risk of infection. Using unclean rags, especially if they are inserted into the vagina can introduce or support the growth of unwanted bacteria that could lead to infection.29 prolonged use of pads will also increase the risk of infection. Douching upsets the normal balance of yeast in the vagina and makes infection more likely also wiping from back to front following defecation or urination causes contamination with harmful anal bacteria such as Escherichia coli15. The burden of reproductive tract infection is major public health concern worldwide and is widespread in low income settings.30The proportion of this burden that can be attributed to poor menstrual hygiene management as opposed to sexually transmitted infection. Reproductive tract infections thought to be of most relevance to menstrual hygiene management are bacteria vaginosis and vulvovaginal candidiasis they can occur through materials used for absorbing menstrual blood or by poor menstrual hygiene during the menstrual period. Bacteria vaginosis has been associated with an increased risk of HIV infection.31Vulvovaginal candidiasis has also been associated with HIV infection. Bacteria vaginosis and Vulvovaginal candidiasis have similar asymptomatic displays with vaginal discharge and irritation although many infections remain asymptomatic.32 Disorders of menstruation include menstrual cycle irregularities (of duration or length), hyper or hypomenorrhoea, poly or oligomenorrhoea, dysmenorrhea, amenorrhea, menorrhagia and premenstrual syndrome. The disorders in cycles or its irregularities are major gynecological problems among women in their reproductive years and a major source of anxiety to them and their families.33 Menstrual disorders are associated with psychological stress, regular absenteeism from school, work places, sports participation and other public functions.34 Studies has shown that not less than 10% of menstruating young women are incapacitated for up to 3 days because of monthly menstrual disorders.35 Female students may possess little understanding of management of menstrual disorders. As a result this, they develop a feeling of fear towards the last days to the onset of their monthly period because of the great pain and discomfort that they have experienced previously. Due to debilitation experienced by most students, they are unable to carry on with their daily activities and may end up missing a class or more.36 Absence from school or dropout from school has been of particular interest to International Organization and research bodies working in this area such as Water aid, the water research commission and Plan International. These Organizations report that in their experience girls absence from school during menstruation can have both physical and psychological causes.37 Study carried out in North East Ethiopia revealed that all participants perceived that menstruation had an influence on Girls performance. During menstruation, girls did not come to school or even if they came, they did not attend class attentively thinking of the sudden leakage or the pain associated with menstruation they did not come to school even they have an exam or did not do the test with concentration when menstruation days coincide with Exam days.38
1.4 JUSTIFICATION OF STUDY
This research work is significant for the following reasons.
To help break the silence of menstrual hygiene management by creating awareness on the topic and the impact it has on women and girls, exploring and sharing lessons of the management aspect in order to ensure better adult for adolescent. It also discusses ways of supporting the sanitary campaign for women and girls, by informing the society for need for female access to appropriate, decent, affordable and quality health care, information and related services. Providing information that strengthens preventive programs that promotes women’s sanitary health Also this research critically studies an issue that faces every woman in every society in the world over including ours as well; with the aim of proving viable information for managing menstrual hygiene in girls and women at large.
1.5 SCOPE OF THE STUDY
The scope of study will comprise menstrual hygiene and practices among adolescent girls in selected secondary schools in Imo state.
1.6 OBJECTIVES
1.6.1 GENERAL OBJECTIVES
To assess the menstrual hygiene practices amongst adolescent girls attending secondary Schools in Imo state, Nigeria.
1.6.2 SPECIFIC OBJECTIVES
- To assess the awareness and level of knowledge of the students about menstrual hygiene.
- To assess the attitude of the adolescent girls towards good menstrual hygiene.
- To identify the pattern of menstrual hygiene practices prevalent among the adolescent girls.
- To determine factors influencing menstrual hygiene practices among the adolescent girls in secondary schools in Imo state.
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