Introduction

Adolescence is an inimitable period of age characterized by substantial Physical, emotional, cognitive and social changes (Gultie, Hailu, & Workineh, 2014). Menstruation is one of the milestones of puberty and an inimitable event in life (Ameade & Garti, 2016).

Globally, 20% of the total populations were adolescents, and 85% were living in developing countries (Kabir, Saha, & Gazi, 2015). In India, awareness about menstruation before menarche was low. The limited knowledge available was passed down informally from mothers, who were themselves lacking in knowledge of reproductive health and hygiene due to low literacy levels and socioeconomic status (Dasgupta & Sarkar, 2008; Shah et al., 2013). Adolescent girls were the highly vulnerable group with respect to social status and health, and the menstruation is viewed unclean or dirty in society (Ali & Rizvi, 2010; Dasgupta & Sarkar, 2008; Thakur et al., 2014; Upashe, Tekelab, & Mekonnen, 2015). During menstruation, adolescent girls restricted in mobility, from participating in household and spiritual events and extend to eating certain foods like papaya and jiggery (Romm et al., 2010; Shah et al., 2013; Thakur et al., 2014). In rural areas of India, even today’s also menstruation is a secret of mother and daughter in many families (Thakur et al., 2014).

In adolescent girls who attained menstruation for the first time, menstrual hygiene management (MHM) is constrained by social, practical and economic factors such as the expense of sanitary pads, lack of water facilities, lack of private rooms for changing sanitary pads, and limited education about the facts of menstrual hygiene (Gultie et al., 2014). Worldwide 10 % of women are exposed to UTIs, due to lack of menstrual hygiene (Dasgupta & Sarkar, 2008; Phillips-Howard et al., 2016; Reid, 2003; Upashe et al., 2015). In low-income settings, school dropouts increase when the girl reach puberty (Boosey, Prestwich, & Deave, 2014). In India, very limited social and health-related research on menstruation problems (Thakur et al., 2014).

The Ministry of Health and Family Welfare, Government of India, declared a new scheme for raise of menstrual hygiene among adolescent girls in the age group of 10-19 year in rural areas (Matharu, 2011). Good hygienic practices, such as the practice of sanitary pads and adequate washing of the genital areas, are important during menstruation period; the practice of good menstrual hygiene reduces the incidence of reproductive tract infection (Mcgrory, 1995; Narayan, Srinivasa, Pelto, & Veerammal, 2001; Upashe et al., 2015). The present study is planned to assess the impact of menstrual hygiene practice on knowledge and practice of menstrual hygiene among adolescent girls in backward areas of Andhra Pradesh, India.

Materials and Methods

Ethical approval

The study protocol was submitted to the Institutional Review Board (IRB). The study was initiated after ethical clearance from the Institutional Review Board with the approval number: RIPER/IRB/2016/028.

Study design and sample size

An interventional study was carried out at various schools of Anantapur district, AP, India for six months during June – November 2016. The required sample size was calculated by using Epi‑info 7 for Dos version 3.5.1 software (Centers for Disease Control and Prevention, Clifton Road, Atlanta, USA) with an assumption of confidence interval 95%, a margin of error 5% and proportion of knowledge about menstrual hygiene practice 50%. Considering the above assumption, the sample size became 384. Finally, 10 % of the determined sample was added to compensate for the non-response rate, and the sample size was found to be 423.

Study criteria

Adolescent girls in the age group of 10–19 years who had attained menarche, and willing to participate were recruited in the study. Adolescent girls who are sick and not attained menarche were excluded from the study.

Study procedure

The consent was obtained from the head of the school, parents and from the girls by explaining the objectives and details of the study. Privacy was ensured, and nobody was present during the collection of data. To collect the data, a self-administered questionnaire was prepared after a thorough literature review and validated. Finally, questionnaire was translated into local language Telugu. The questionnaire comprised variables on socio-demographic characteristics, knowledge related to menstruation and menstrual hygiene practice. The collected data was analyzed to assess the knowledge related to the menstrual hygiene practice, school attendance during the menstrual period at baseline and after providing education on menstrual hygiene practice.

Statistical analysis

The collected data was checked for the completeness and analyzed to assess the knowledge related to the menstrual hygiene practice, school attendance during the menstrual period at baseline and after providing education on menstrual hygiene. Graph Pad Prism 3.0 software (San Diego, California, USA) was used for the statistical analysis. Descriptive statistics like mean, frequency and percentage were used to represent demographic details of subjects.

Results and Discussion

Total of 423 adolescent girls were participated in the study. The present study revealed that the Mean age of the menarche was found to be 13.52 ± 1.33 years. Among the participants, 87 % were attained the menarche at 13-16 years (Table 1). This is almost similar to the studies from Egypt, Saudi Arabia, Ghana and Japan (Aryeetey, Ashinyo, & Adjuik, 2011; El-Gilany, Badawi, & El-Fedawy, 2005; Fetohy, 2007; Gumanga & Kwame-Aryee, 2012). However, it is lesser with the studies from Ethiopia (Gultie et al., 2014). This may due to variation in heredity, socioeconomic conditions and nutrition of the girls. Most of the students (59.57%) acquire information about menstruation from their friends, followed by mother (22.93%). It indicates that students are more interested and free to talk with their friends rather than mother and teachers. These findings were consistent with the study done at Egypt (El-Gilany et al., 2005).

Among the participants, the majority (73.05 %) of their mothers were housewives, and 26.95 % of mothers have education at primary school level only (Table 1). 26.48% of the participants parents income was below the poverty line (BPL), and only 7.56 % of them have income more than INR 3 lacs (Table 1). In this study, 52.52 % of the participants had good knowledge about menstruation hygiene (Table 2). Majority of the students (64.07 %) knew that menstruation was a physiological process, whereas few of them (20.57 %) believed that it was from a curse of god (Table 2). The results were lesser than previous studies in Ethiopia (Gultie et al., 2014). This may be due to poor literacy among their parents.

The study showed that most of the respondents are unaware about menstrual hygiene and practices, due to social restrictions and lack of knowledge on the physiology of the reproductive system.

At baseline, 44.68% were used old cloths, and 40.42% were used sanitary pads. This was greatly improved after providing an educational program with 93.38% were used the sanitary pads (Table 3). These results states that community-based educational programs could bring significant improvement in awareness of menstrual hygiene and practices.

At baseline, most of the students have a higher rate (55.32%) of absents to schools due to menstrual-related discomfort, Reproductive tract infections, skin abrasions due to improper menstrual hygiene practice. After educational interventional program regarding menstrual hygiene and practice, the rate of absentees for school work was greatly declined to 7.33% (Table 3).

Conclusion

The study concludes that the pharmacist mediated educational program will have a positive impact on menstrual hygiene and practices on adolescent girls in a resource-limited setting of south India. Govt. of India need to take initiation to conduct an educational program on menstrual hygiene and practices at a community level and also need to supply sanitary pads at the secondary school level with free of cost.