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\def\RunningAuthor{KalaBarathi S and Akshaya R}
\firstPage{139}
\articleType{Original Article}
\receivedDate{03 Nov 2020}
\acceptedDate{08 Dec 2020}
\revisedDate{07 Dec 2020}
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\title{\textbf{Effectiveness of information booklet regarding knowledge of menstrual hygiene among higher secondary school girls}}
\author{KalaBarathi~S\textsuperscript{*}, 
            Akshaya~R~\\[5pt]{Department of Obstetrics and Gynecological Nursing, Saveetha College of Nursing, Saveetha Institute of Medical \& Technical Sciences, Thandalam, Chennai, TamilNadu, India}}

\begin{abstract}
The menstrual cycle is the physiological wonder which is remarkable to females that starts with a high school. Feminine cycle is likewise appropriately called menses (or) all the more regularly a time of the month to month stream. The periods of beginning are from 9 to 16 years and end happens roughly like clockwork and keeps going for around five days feminine stream consists of blood, bodily fluid, and tissue particles. This is a cycle of a lady releasing blood and other material from the coating of the uterus at time spans one lunar month from pubescence until the menopause, besides during pregnancy. A quasi experimental design conducted among 50 people regarding knowledge assessment about menstrual hygiene. Convenient sampling technique was used to select samples. A structured questionnaire was used to collect demographic data and knowledge regarding menstrual hygiene was assessed. Booklet was given to the samples. After an hour, the knowledge was reassessed using the same structured questionnaire. The present study result states that there is a significant increase in the knowledge of the higher secondary school girls regarding menstrual hygiene at p{\textless}.05 level. This indicates that booklet teaching is an effective and easy method to improve knowledge among higher secondary school girls regarding menstrual hygiene that helps to improve the practice of menstrual hygiene.
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Effectiveness,\newline Information Booklet Teaching,\newline Programme,\newline Knowledge,\newline Menstrual Hygiene
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ KalaBarathi~S~\\ Phone:\ 9443544381~\\  Email:\ principalnursing@gmail.com
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\section{Introduction}
Menstruation is a physiological process that starts with the onset of puberty in females. The puberty starts in an adolescence age group. According to WHO, the adolescent is the phase between the 10-19 years of age. The young lady encounters a few issues during pre-adulthood, and menarche is one among them. Feminine cycle is commonly considered as messy in the Indian culture \unskip~\citep{953090:20947890}. Menstrual hygiene practices are always an important issue for all adolescent girls. Good menstrual hygiene practices include the use of sanitary pads, its proper disposal and then proper washing of the genital area and then hand wash. Lack of education and communication about good hygiene practices and reproductive problems furthers add to the problem \unskip~\citep{953090:20947900}. 

Feminine cycle Hygiene Management (MHM) centers around viable procedures for adapting to a month to month time spans. MHM alludes to ways ladies themselves keep spotless and solid during a feminine cycle and how they secure, utilize and discard blood-engrossing materials \unskip~\citep{953090:20947896}. 


\begin{table*}[!htbp]
\caption{\boldmath {Frequency and percentage distribution of level of knowledge on practice on menstrual hygiene among higher secondary school girls} }
\label{tw-f2bf501120ee}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.2681\linewidth-2\tabcolsep}p{\dimexpr.1917\linewidth-2\tabcolsep}p{\dimexpr.1751\linewidth-2\tabcolsep}p{\dimexpr.18340000000000003\linewidth-2\tabcolsep}p{\dimexpr.18169999999999998\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}{\multirow{2}{*}{Level of knowledge}} & \multicolumn{2}{p{\dimexpr(.3668000000000001\linewidth-2\tabcolsep)}}{\cAlignHack Pre-test} & \multicolumn{2}{p{\dimexpr(.36510000000000005\linewidth-2\tabcolsep)}}{\cAlignHack Post-test}\\
\rowcolor{kwdboxcolor} & \cAlignHack Frequency & \cAlignHack Percentage & \cAlignHack Frequency & \cAlignHack Percentage\\
\tblmidrule 
Inadequate knowledge &
  \cAlignHack 44 &
  \cAlignHack 88\% &
  \cAlignHack 0 &
  \cAlignHack 0\%\\
Moderately adequate &
  \cAlignHack 6 &
  \cAlignHack 12\% &
  \cAlignHack 3 &
  \cAlignHack 6\%\\
Adequate knowledge &
  \cAlignHack - &
  \cAlignHack - &
  \cAlignHack 47 &
  \cAlignHack 94\%\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Comparison of the mean score and standard deviation score of knowledge on practice on menstrual hygiene among higher secondary school girls between pre-test and post-test} }
\label{tw-f26ad3041f9d}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.24990000000000002\linewidth-2\tabcolsep}p{\dimexpr.15350000000000001\linewidth-2\tabcolsep}p{\dimexpr.2215\linewidth-2\tabcolsep}p{\dimexpr.14349999999999996\linewidth-2\tabcolsep}p{\dimexpr.2316\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}{\multirow{2}{*}{Level of knowledge}} & \multicolumn{2}{p{\dimexpr(.375\linewidth-2\tabcolsep)}}{\cAlignHack Pre-test} & \multicolumn{2}{p{\dimexpr(.3751\linewidth-2\tabcolsep)}}{\cAlignHack Post-test}\\
\rowcolor{kwdboxcolor} & \cAlignHack Mean & \cAlignHack Standard deviation & \cAlignHack Mean & \cAlignHack Standard deviation\\
\tblmidrule 
Inadequate knowledge &
  \cAlignHack 8.59 &
  \cAlignHack 1.0414 &
  \cAlignHack 0 &
  \cAlignHack 0\\
Moderate knowledge &
  \cAlignHack 11.5 &
  \cAlignHack 0.8366 &
  \cAlignHack 14.66 &
  \cAlignHack 0.577\\
Adequate knowledge &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack 18.425 &
  \cAlignHack 1.2466\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Comparison of the mean score, standard deviation, mean difference and paired t value of knowledge on practice on menstrual hygiene among higher secondary school girls} }
\label{tw-9615a3d03aed}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.13690000000000001\linewidth-2\tabcolsep}p{\dimexpr.11199999999999998\linewidth-2\tabcolsep}p{\dimexpr.2417000000000001\linewidth-2\tabcolsep}p{\dimexpr.2212999999999999\linewidth-2\tabcolsep}p{\dimexpr.2880999999999999\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Variables & \cAlignHack Mean & \cAlignHack Standard deviation & \cAlignHack Mean difference & \cAlignHack Paired 't' test 't' value \mbox{}\protect\newline p-value\\
\tblmidrule 
\cAlignHack Pre-test &
  \cAlignHack 8.94 &
  \cAlignHack 1.39 &
  \cAlignHack  &
  \cAlignHack T = 35.8594\\
\cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack 9.28 &
  \cAlignHack p = {\textless}.05\\
\cAlignHack Post-test &
  \cAlignHack 18.22 &
  \cAlignHack 1.46 &
  \cAlignHack  &
  \cAlignHack df = 49 (s)\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\bgroup
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\centering \makeatletter\IfFileExists{images/b5caf6c0-d7a7-4365-82f3-4cbd86a74937-ucover.png}{\includegraphics{images/b5caf6c0-d7a7-4365-82f3-4cbd86a74937-ucover.png}}{}
\makeatother 
\caption{\boldmath {Frequency and percentage distribution level of overall knowledge practice on menstrual hygiene among higher secondary school girls}}
\label{f-1d12ec5507e3}
\end{figure}
\egroup
Poor feminine cleanliness is a danger factor for regenerative parcel disease and cervical neoplasia.

Finding out about cleanliness during a monthly cycle is an imperative part of well-being schooling for juvenile young ladies as examples that are created in youth are probably going to continue into grown-up life \unskip~\citep{953090:20947893}. And the unhygienic menstrual practices will increase the risk of reproductive health problems. The unhygienic practices are further exacerbated by insufficient access to water, clean toilets and soap \unskip~\citep{953090:20947894}. The reasonable difficulties are made more troublesome by socio-social factors, for example, the period being considered as messy, separation of the bleeding young ladies etc. Failure to give feminine cleanliness offices at home or at school level additionally decline the degree of having great feminine cleanliness practice among female students. So, it is imperative to address such issues of juvenile young ladies which is generally speaking significant for their well-being \unskip~\citep{953090:20947891}.

Likewise, mindfulness programs are significant for advancing feminine cleanliness the executives (MHM) both at network just as at school level \unskip~\citep{953090:20947888}. The poor feminine sterile practices additionally lead to a few issues among School young ladies which incorporate exiting from the school, powerlessness to proceed with the Education and decrease of self-esteem \unskip~\citep{953090:20947895}. It happens in light of the fact that the school young ladies don't Practice feminine cleanliness and don't approach for a clean napkin \unskip~\citep{953090:20947897}. The greatest hindrance to embrace the nature of clean napkin in India are the absence of Affordability and availability as revealed by Inder Jeet Singh there are about 70\% of students and their the family can't manage the cost of a clean napkin \unskip~\citep{953090:20947889}.

It is additionally Supported by the report of seasons of India which disclosed that half of the school young ladies who exited the school in optional classes are because of an absence of Sanitary napkin, combined with an absence of isolated latrine offices and water assets Within the school grounds. In this way, the absence of information on feminine cleanliness practice and sterile napkin is the significant reason for non-attendance among school girls\unskip~\citep{953090:20947899}. The purpose of study 1) To assess the knowledge regarding practice on menstrual hygiene among higher secondary school girls. 2) To determine the effectiveness of the information booklet on pretest and post test knowledge regarding practice on menstrual hygiene among higher secondary school girls. 3) To find out the association between level of knowledge regarding practice on menstrual hygiene among higher secondary school girls with selected demographic variables.
    
\section{Materials and Methods}
A quantitative approach by using a quasi experimental research design was adopted for the present investigation. A study was conducted after obtaining formal permission from the selected schools in Chennai. 60 Samples who met the inclusion criteria were selected by using a nonprobability convenience sampling technique. The participants who consented for willing to participate were informed about the purpose of the study. Demographic variables were collected by using multiple choice questionnaires followed by pretest was done by multiple choice questionnaire. Booklet was given to the samples. After an hour, the knowledge was reassessed using the same structured questionnaire. The data were tabulated and analyzed by descriptive and inferential statistics.
    
\section{Results and Discussion}
Out of 50 samples 25 (50\%) belong to the age group of 15 years, 26 (52\%) are been Hindu, 22 (55\%) had secondary education, 28 (56\%) live in the nuclear family, 23 (46\%) are single child and 30 (60\%) mothers have primary education. Out of 50 samples in the pretest, (88\%) had inadequate knowledge, (12\%) had moderate knowledge. In the post-test, (6\%) had moderately adequate knowledge and (94\%) had adequate knowledge of the practice of menstrual hygiene among higher secondary school girls Table~\ref{tw-f2bf501120ee} \& Figure~\ref{f-1d12ec5507e3}.

The present study is supported by Belayneh, Z. conducted a study to assess the Knowledge and menstrual hygiene practice among adolescent school girls in southern Ethiopia: a cross-sectional study. Results depict that from a total of 791 adolescent girls participated in this study, 68.3\% had poor knowledge of menstruation \unskip~\citep{953090:20947898}.

Out of 50 samples, the mean score of knowledge for inadequate (8.59), moderate (11.5) and standard deviation score for inadequate (1.0414), moderate (0.8366) in pretest respectively. And in post test out of 50 samples, it shows the mean score of knowledge for moderate (14.66) and adequate (18.425) and standard deviation score for moderate (0.577) and adequate (1.2466) respectively Table~\ref{tw-f26ad3041f9d}.

The present study is supported by Bajracharya S, et al., (2020) conducted an investigation to assess the effectiveness of structured teaching program on menstrual hygiene among adolescent school girls. Meta analysis depicts that meta analysis was used to estimate the pooled prevalence of MHM practices in schools. Less than half of the girls were aware of menstruation before menarche (PP 0.45, 0.39 to 0.51, I\ensuremath{^{2}} = 100.0\%, n = 122). Teachers were a less common source of information about menstruation to girls (PP 0.07, 0.05 to 0.08, I\ensuremath{^{2}} = 100.0\%, n = 86) \unskip~\citep{953090:20947892}.

The pretest score mean is 8.94 and standard deviation score is 1.39. The post-test score mean is 18.22 and standard deviation score is 1.46. The pretests mean score is 8.94 lower than the post test mean score is 18.22. The mean difference was 9.28 and the paired value was 35.8594, the p-value is {\textless}0.5. The results were significant Table~\ref{tw-9615a3d03aed}.

There is no significant association between the level of knowledge regarding the practice of menstrual hygiene among higher secondary school girls with demographic variables like age, religion, educational status, mother occupation, types of family and number of siblings. There is a significant association between numbers of education of the mothers.
    
\section{Conclusions}
Booklet has essentially expanded the Knowledge appraisal with respect to feminine cleanliness among the higher optional school young ladies. The training program with powerful instructing procedures rouses puberty young ladies to follow solid practices in everyday life and forestall grimness and mortality identified with the absence of sterile practices. The booklet is a successful and simple technique to improve information among young adult young ladies with respect to feminine cleanliness.

\textbf{Funding Support}

 The authors declare that they have no funding support for this study.

\textbf{Conflict of Interest}

 The authors declare that they have no conflict of interest for this study.
    

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