Journal of Women's Health Care
Open Access
ISSN: 2167-0420
ISSN: 2167-0420
Research Article - (2017) Volume 6, Issue 3
Background: Good menstrual hygienic practices are essential during menstruation period. Young women especially in developing countries often lack information about good menstrual hygiene practices. The objective of this study was to assess the level of menstrual hygienic practice and the associated factors among female high school students in Adama town.
Methods: A cross-sectional, institution based study was conducted from April 11th-25th, 2016. Multistage sampling technique was used to select the participants. Data was cleaned, coded and entered in to Epi-data 3.1 and analyzed using SPSS version 20:00. Binary and multiple logistic regression analysis were done to determine the association between the menstrual hygienic practice and the predicator variables. A p-value of less than 0.05 was taken as significant association.
Result: A total of 398 female students were involved in the study giving a response rate of 94.3%. Of the total respondents about 57% had good level of menstrual hygiene practice. Mothers education status [AOR=0.608; 95% CI=0.374-0.990], source of money for sanitary materials [AOR=2.267; 95% CI=1.076, 4.772], respondents feeling on comfort ability of the school [AOR=0.557; 95% CI=0.366-0.846] were significantly associated with level of knowledge about menstrual hygienic practice.
Conclusion: The study showed that more than half of the respondents had good level of menstrual hygiene practice. Mothers’ educational status, source of money for sanitary materials and respondents feeling on comfort ability of the school were found to be predictors of menstrual hygiene practice among the students. Thus, designing health information and communication programs on awareness about menstruation and menstrual hygiene practice is implicated.
Keywords: Menstruation; Hygiene practice; Adama town
COR: Crude Odds Ratio; AOR: Adjusted Odds Ratio; CI: Confidence Interval; SPSS: Statistical Package for Social Sciences
Good menstrual hygienic practices such as use of sanitary pads and adequate washing of the genital areas are essential during menstruation period. Having a good menstrual hygienic practice will enhance the confidence of females in many aspects. On the other hand, Poor menstrual hygienic practices will increase susceptibility to reproductive health related problems [1,2].
Menstrual hygiene practice is influenced by many factors including female’s knowledge about menstruation [3,4]. In relation to cultural taboos females are often deprived of utilizing the main resources in the community. Furthermore, academic performance and involvement is highly affected by different conditions associated with menstruation [5].
Although the period of adolescence is a healthy part of life, many adolescents are often less informed, less experienced and less comfortable with accessing reproductive health information and services than adults [6,7].
Assessing the menstrual hygiene practice level of females and addressing the gap is essential to reinforce safe and hygienic practice during menstruation [8]. The practical challenges of menstrual hygiene practice are made even more difficult by socio-cultural factors and millions of girls continue to be denied their rights to have sufficient information about menstrual hygiene, water and sanitary health, education, dignity and gender equity. This may result to incorrect and unhealthy behavior during their menstrual period [9,10].
Many schools do not support adolescent girls or female teachers in managing menstrual hygiene with dignity. Inadeqsuate water and sanitation facilities make managing menstruation very difficult, and poor sanitary protection materials can result in blood-stained clothes causing stress and embarrassment. Even at the household level, they generally have little control over access to a private latrine or money for sanitary materials [10,11].
Females of reproductive age group need to have access to clean and soft absorbent sanitary products which in the long run protect their health from various infections [12].
Failure to provide appropriate menstrual hygiene facilities at home or at school level also decrease the level of having good menstrual hygiene practice among female students [11]. Thus, it is important to assess and address the problems related with the menstrual hygiene practice of female students; which in turn is crucial in improving female student’s confidence, academic performance and sexual and reproductive health.
Therefore, this study was conducted to assess the level of menstrual hygiene practice and associated factors among female high school students found in Adama town. The finding of this study will be helpful for school related health policy makers in understanding predictors of menstrual hygiene practice among high school female students and in designing the possible interventions.
Study area and period
The study was conducted in Adama town from April 11-25, 2016. In the study area, there are a total of 9 governmental high schools. According to the data from Adama town education affairs office a total of 15,691 students were enrolled during the academic year of 2015/16 in these schools.
Study design
A cross-sectional descriptive study was conducted.
Source population
The source population was all female governmental secondary schools students in Adama town.
Study population
The study population was selected female governmental secondary schools students in Adama town.
Inclusion and exclusion criteria
All regular female students were included into the study. Female students who were sick and unable to respond were excluded from the study.
Sample size determination
Single population proportion formula was used to calculate the required sample size. Proportion of level of knowledge towards menstruation of 50% [p], margin of error of 5% [d], and 95% confidence level [1.96] and adding non-response rate of 10%, the sample size was determined to be 422.
Sampling procedure
As to the sampling technique, a multistage stratified sampling technique was used; where first, 6 schools were selected among the 9 governmental high schools by lottery method, then, the respective sample was allocated to each high schools proportionally based on the female students population in each high schools.
Finally, the study units were selected from each year of study (grade) using simple random sampling technique considering the list of female students as a sample frame.
Variables
Dependent variable: Menstrual hygiene practice
Independent variable: Socio-demographic characteristics (Age, grade level, ethnic group, religion, mothers educational level, fathers educational level, monthly income of the family) and Students experience (school comfort to keep hygiene, comfort at school time, comfort around male students, feeling unclean and missing class).
Menstrual hygiene practice: To measure the respondent’s menstrual hygiene practice. 10 closed ended menstrual hygiene practice related questions were presented and for each correct answer 1 point and 0 for incorrect ones given.
Respondents who scored 6 and above were considered as having good menstrual hygiene practice and a score of less than 6 was considering as having poor menstrual hygiene practice.
Data collection
Data collection instrument
Data was collected using pre-tested structured self-administered questionnaires. It is composed of ‘closed-end’ questions assessing different variables like the respondents socio-demographic characteristics, menstrual hygiene practice and experience. To ensure its consistency it was translated to ‘Amharic’ and ‘Afan Oromo’ language and back translated to English by language professionals.
Data collection procedure
The questionnaire was distributed to the students by three data collectors with past experience on data collection, the data was collected while students were in class rooms and the instructors cooperated with data facilitators in disseminating the questionnaire.
Finally, the filled questionnaire was checked for completeness and consistency of the data by the data collector’s supervisor on daily basis.
Data quality assurance
To ensure the quality of the data; training was given for the data collectors and supervisors two days ahead of the actual data collection date, the questionnaire were translated by language professionals, pretest were conducted on 5% of the sample and relevant corrections were made.
During data collection supportive supervision were made and data were checked for the completeness.
Data entry and analysis
The collected quantitative data was cleaned, coded and entered in to Epi-data 3.1 software, and then exported to Statistical package for social sciences(SPSS) version 20:00 for analysis.
First descriptive analysis was carried out for each variable. Next, bivariate analysis was done to identify the association between the independent and the dependent variables. Those variables with a pvalue< 0.25 in bivariate analysis were selected for multivariate logistic regression, and then those variables with a p-value<0.05 were considered to be statistically significant in multivariate analysis.
Socio-demographic characteristics
In this study a total of 398 female students were participated giving a response rate of 94.3%. Of these 200 [50.3%] were in the age group 14-16 years and 198 [49.7%] were in 17-19 age groups.
Most of the respondents 139[34.9%] were from Oromo ethnic group, concerning their religion. More than half 233[58.5%] of them are followers of Orthodox religion [Table 1].
| Variables | Response category | Frequency | Percentage (%) |
|---|---|---|---|
| Age | 14-16 years old | 200 | 50.3 |
| 17-19 years old | 198 | 49.7 | |
| Grade | Grade 9 | 199 | 50 |
| Grade 10 | 199 | 50 | |
| Ethnic group | Oromo | 139 | 34.9 |
| Amhara | 98 | 24.6 | |
| Woliata | 94 | 23.6 | |
| Tigre | 23 | 5.8 | |
| Other | 44 | 11.1 | |
| Religion | Orthodox | 233 | 58.5 |
| Muslim | 81 | 20.4 | |
| Protestant | 76 | 19.1 | |
| Other | 8 | 2.1 | |
| Mother educational status | Below and Primary | 276 | 69.3 |
| Secondary and above | 122 | 30.7 | |
| Father educational status | Below and Primary | 228 | 57.3 |
| Secondary and above | 170 | 42.7 | |
| Parents’ monthly income | 700-1500 Birr | 72 | 18.1 |
| 1600-2400 Birr | 84 | 21.1 | |
| 2500-3300 Birr | 124 | 31.2 | |
| >3300 Birr | 118 | 29.6 |
Table 1: Socio-demographic characteristics of female high school students in Adama town, April 2016(n=398).
Experience during menstruation
From the respondents, more than two-third 278(69.80%) of them reported that they are not feeling comfortable on classroom (school time), about 188(47.20%) of them reported that their school is uncomfortable to keep their hygiene during menstruation and 186(46.70%) of them missed class during menstruation time [Figure 1].
Figure 1: Experience during menstruation of female high school students in Adama town, April 2016(n=398).
Menstrual hygiene practice
Based on the finding of this study, 387(97.2%) of the respondents used absorbent during menstruation and from those 21(5.3%) used sanitary pads. The source of money for 360(90.5%) of the students were their parents.
For 204(51.3%) of the students the source of information were their mothers. About 327(82.2%) disposed the used material as protection into latrine. Of the total respondents 211(53.0%) took daily bath during menstruation [Table 2].
| Variables | Frequency | Percentage (%) | |
|---|---|---|---|
| Uses absorbent | Yes | 387 | 97.2 |
| No | 11 | 2.8 | |
| Material used | Rag made | 12 | 3 |
| Sanitary pad | 21 | 5.3 | |
| Tampon | 339 | 85.2 | |
| Other | 26 | 6.5 | |
| Money source to buy materials | Parents | 360 | 90.5 |
| Earn it | 38 | 9.5 | |
| Source of information on menstrual hygiene | Mother | 204 | 51.3 |
| Friends | 67 | 16.8 | |
| Mass media | 62 | 15.6 | |
| Teachers | 52 | 13.1 | |
| Other | 13 | 3.3 | |
| Disposal place | Open field | 17 | 4.3 |
| Latrine | 327 | 82.2 | |
| In waste bins | 41 | 10.3 | |
| Other | 13 | 3.3 | |
| Clean clothes with soap and water | Yes | 210 | 52.8 |
| No | 188 | 47.2 | |
| Clean external genitalia | Yes | 385 | 96.7 |
| No | 13 | 3.3 | |
| Cleaning material used | Water | 156 | 39.2 |
| Water and soap | 229 | 57.5 | |
| Not washing | 13 | 3.3 | |
| Daily bath | Yes | 211 | 53 |
| No | 187 | 47 | |
| Drying place for cloth | Outside the house | 249 | 62.6 |
| Inside the house | 149 | 37.4 | |
| Use paper to dispose Sanitary materials by wrapping | Yes | 219 | 55 |
| No | 179 | 45 | |
| Changing absorbents | ˂3 times | 51 | 12.8 |
| ≥3 times | 347 | 87.2 | |
Table 2: Menstrual hygiene practice of female high school students in Adama town, April 2016(n=398).
Level of menstrual hygiene practice
Concerning the respondents level of menstrual hygiene practice about 171(43.0%) of them had poor level of menstrual hygiene practice, while 227(57.0%) of them had good menstrual hygiene practice [Figure 2].
Figure 2: Level of menstrual hygiene practice of female high school students in Adama town, April 2016(n=398).
Factors associated with practice of menstrual hygiene practice
As shown in the Table 3 below those factors found associated on bivariate analysis with p-value ≤ 0.25 were entered to multivariable analysis. Accordingly, mothers education status, money source to buy sanitary materials, feeling the school as being uncomfortable were found significant predictors of good menstrual hygiene practice.
Accordingly, students who doesn’t felt the school was comfortable 43.3% less likely to had good menstrual hygiene practice than students who felt school was comfortable (AOR=0.557; 95%CI=0.366-0.846).
Furthermore, students whose source of money was their parents were 2.3 times more likely to had a good menstrual hygiene practice as compared to those students who earn the money by themselves (AOR=2.267; 95% CI=1.076, 4.772).
Regarding mothers educational status, students whose mother attended secondary and above level of education were 39.2% less likely to had good menstrual hygiene practice than students whose mother attended below and primary level of education (AOR=0.608; 95% CI=0.374-0.990) [Table 3].
| Variables | Menstrual Hygiene Practice | COR(95% CI) | AOR(95% CI) | ||
|---|---|---|---|---|---|
| Good | Poor | ||||
| Age | 14-16 years old† | 121 | 79 | 1 | 1 |
| 17-19 years old | 106 | 92 | 0.752(0.505,1.120) | 0.784(0.520,1.183) | |
| Mother educational level | Primary and below† | 170 | 106 | 1 | 1 |
| Secondary and above | 57 | 65 | 0.547(0.356,0.841)* | 0.608(0.374,0.990)* | |
| Father educational level | Primary and below† | 138 | 90 | 1 | 1 |
| Secondary and above | 89 | 81 | 0.717(0.480,1.070) | 0.829(0.524,1.311) | |
| School uncomfortable to keep hygiene | Yes† | 120 | 68 | 1 | 1 |
| No | 107 | 103 | 0.589(0.394,0.880)* | 0.557(0.366,0.846)* | |
| Source of money to buy sanitary materials | Parents† | 201 | 159 | 1 | 1 |
| Earn it | 26 | 12 | 1.714(0.838,3.503) | 2.267(1.076,4.772)* | |
Table 3: Factors associated with menstrual hygiene practice of female high school students in Adama town, April 2016(n=398) [†: Reference category, *: Significant association].
This study assessed the menstrual hygiene practice of high school students and associated factors. Concerning the menstrual hygiene practice, more than 40% of the respondents had good menstrual hygiene practice. Presence of gap in educating female students about techniques of keeping sexual health might be the possible explanation for this. Therefore, provision of special education at high school level is required for female students including safe menstrual hygiene practice [13,14].
In this study 57% of the respondents had good practice of menstrual hygiene. This is higher than a finding from a study conducted in western Ethiopia [15] and India in which only 39.9% and 1.82%. This might be due to the difference in the study area in which most of the study participants of participants in this study from urban area. This in its turn will increase the access of getting health information and communication related to menstrual hygiene practice from several medias.
The difference in the study period could also be another possible explanation. Similarly, a research done in Nepal [16] and Lebanon [17] showed that about 46.7% and 50.6% of the students had good menstrual hygiene practices respectively.
Students who don’t felt comfortable in their school environment were found to be 43.3% less likely to had good menstrual hygiene practice than their counterparts. Consequently, their lower level of practice could be related to their felling about the school environment [18].
In this study for about 51.3% of the respondents, mothers were the main source of information about menstrual hygiene. This is in contrast with the study finding from Amhara regional state of Ethiopia [19], in which mothers were the second source of information which accounts about 22.96%. This might be related due to cultural differences in the study areas.
In this study majority of the respondents had good menstrual hygiene practice. According to the findings of this study, source of information about menstrual hygiene practice was their mothers. Majority of the respondents felt uncomfortable during school time while experiencing menstruation. As finding showed that mothers education status, source of money for buying sanitary materials, feeling the school as being uncomfortable were significant predictors of good menstrual hygiene practice.
Therefore, it is recommended that strategy and policy makers should develop appropriate evidence-based strategies and curricula in high schools concerning female’s reproductive health and specifically about menstruation and menstrual hygiene practice. Thus, designing strategies towards awareness creation and attitude changing activities about menstruation and menstrual hygiene practice through provision of different regular health information and communication programs is implicated.
Ethics approval and consent to participate
The study was conducted after obtaining ethical clearance from Adama General Hospital and Medical College. An official letter was obtained from each school. Verbal informed consent was obtained from the participants age 18 and above and for study participants whose age were less than 18 years parental informed consent was obtained.
Personal identification data like respondents name were not included in the questionnaires. Students were informed they have full right either not to participate or terminate their participation at any stage from the study. All the data obtained in due course were confidentially kept.
The authors declared no conflict of interest.
Adama Hospital and Medical College has covered the required fund for the research project.
Haile T conceptualized and designed the study. Haile T, Zeleke B, Olana R and Garoma S analyzed and interpreted the data, drafted the manuscript and critically reviewed the manuscript. All the authors read and approved the manuscript.
We would like to thank Adama General Hospital and Medical College for funding this research project. Our gratitude goes to Adama special zone education office, the respective high schools, supervisors, data collectors, respondent who participated on this study. Finally, we thank for language editing Mr. Mark Demos (Former American peas corps volunteer, in Ethiopia) and Mr. Sefu Bogale (English language teacher in Wolkite university).