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PATTERN OF REPRODUCTIVE HEALTH PROBLEM

& AWARENESS AMONG ADOLESCENT FEMALE IN


A SELECTED RURAL AREA

PREPARED FOR
Second Professional MBBS Examination July 2015

DEPARTMENT OF COMMUNITY MEDICINE


Sir Salimullah Medical College
Mitford, Dhaka

Roll No

Registration No :
Batch

: SS-40 (C)

Session

: 2011-12

Signature of the batch teacher

Signature of the examiner

Date:

Date:

ACKNOWLEDGEMENT

First of all I am grateful to Almighty, the most merciful and benevolent


by whose boundless grace I have been able to complete the project work.

With great pleasure, I express my sincere thanks to our honorable teacher


professor Dr. Md. Masroor-ul-Alam, Head of the Department of
Community Medicine, SSMC, Mitford, Dhaka for his kind approval and
valuable professional advice on our research work which is of immense
importance in the light of present context of Bangladesh.

I am happy enough to acknowledge my respected teacher Dr. Afshan


Jerin, associate professor, Department of Community Medicine, SSMC,
with best regard, enormous gratitude and indebted from the core of my
heart for her constant supervision, inspiring guidance, enthusiastic
encouragement and cheerful support.

I also offer my gratitude to Dr. Farahid Zeba Shimul, assistant professor,


Department of Community Medicine, SSMC for her continuous
inspiration and valuable suggestion during preparation of this project.

At this moment, I would like to thanks from the innermost part of my


heart to our favorite teacher Dr. Rukshana Jalil who has given enough
time and effort in reviewing and completing the project work. I would
like to extend my thanks to all others teachers of the Department of
Community Medicine, SSMC, Dhaka for their cooperation.

I am obliged to remember the people of Keranigonj for their kind

cooperation. The doctors, staffs of Keranigonj Health Complex also


deserve thanks from me for their generous help.

Finally, it is a great pleasure for me to acknowledge with many thanks


and deep appreciation to all my classmates for taking the responsibility
individually, carrying them out sincerely with perfection and making this
team effort a success.

Name:
Roll No.:
Group:
Batch: SS-40th C

CONTENTS

List of Figures

1-2

List of Tables

Abstract

4-5

Chapter- 1:
1.1 Introduction

6-8

1.2 Rationale

9-10

1.3 Research Question

11

1.4 Objectives

11

1.5 Key Variables

12-13

1.6 Operational Definition of Terms and

14

conditions
1.7 Limitations of the study

15

Chapter-2: Literature review

16-26

Chapter-3: Methodology

27-28

Chapter-4: Results

29-56

Chapter-5: Discussions

57-61

Chapter-6: Recommendation

62

Chapter-7 Conclusion

63

Bibliography

64-66

Questionnaire in English

67-70

LIST OF FIGURES

Figure No.

Title of the Figure

Page
No.

1.

Distribution of the respondents by age

29

Distribution of the respondents by religion

30

Distribution of the respondents by level of

31

education
4

Distribution of the respondents by size of the

32

family
5

Distribution of the respondents by housing

36

condition
6

Distribution of the respondents by age of

37

menarche
7

Distribution of the respondents by type of tampon

38

used during menstruation


8

Distribution of the respondents by type of tampon

39

used during menstruation


9

Distribution of the respondents by re-use of

40

pad/clothes
10

Distribution of the respondents by their procedure

41

of cleaning of pad/clothes
11

Distribution of the respondents by their

42

knowledge about normal menstrual cycle


12

Distribution of the respondent by whether they


have knowledge about menstrual period

44

13

Distribution of the respondent by whether they

46

have knowledge about menstrual problems


14

Distribution of the respondents by whether they

48

have knowledge about the other reproductive


health problems in genital area
15

Distribution of the respondents by source of

50

information regarding reproductive health and its


related problems
16

Distribution of respondents according to the other

51

reproductive health problems in genital area

17

Distribution of respondents according to the other

52

reproductive health problems in genital area


18

Distribution of proportion of consultation about


reproductive health problems

53

LIST OF TABLES

Table

Title of the Table

No.
1

Page
No.

Distribution of the respondents by numbers of family

33

members
2

Distribution of the respondents by occupation of father

34

Distribution of the respondents by monthly family

35

income
4

Distribution of the respondent by knowledge about

43

menstrual cycle
5

Distribution of the respondent by knowledge about

45

menstrual period
6

Distribution of the respondent by knowledge about

47

menstrual problems
7

Distribution of the respondent by knowledge about the

49

other reproductive health problems in genital area


8

Distribution of the personnel with whom the

54

respondents consulted about reproductive health


problems
9

Distribution of the reasons behinds for not consulted on

55

reproductive health problems


10

Distribution of the opinion of the respondents


regarding prevention of the reproductive health
problems

56

ABSTRACT

To determine the pattern of reproductive health problems & awareness


among the adolescent females this cross sectional type of descriptive
study was conducted among 400 adolescent females living in selected
villages of Keranigonj upazilla, Dhaka, Bangladesh. Data were collected
by face to face interview through semi structured questionnaire. The
respondents were between 10 to 19 years of age & most of them were
Muslims (94.25%), primary passed (49.25%) and belonged to nuclear
family(91.75%) with family members between 4-5(31.5%). In most cases
the respondents husbands were businessmen (47.5%).Most of the
families (80.5%) had a monthly family income between 10000-15000 and
lived in semi-pacca house (51.75%). In most cases the respondents were
unmarried (62%) & their age at menarche was between 12-14 years
(77%). Most of them use old clothes (51.25%) during menstruation and
majority (56.25%) is not re users. Most of them use soap (81.25%) while
cleaning of accessories. Most of them (90.25%) had knowledge about
normal menstrual cycle and most of them (55.12%) mentioned that the
cycle was less than 28 days. Most of them (96.42%) said that they had
knowledge about normal menstrual period and majority of them (87.5%)
said that it was 1-5 days normally. Most of them (68.25%) had
knowledge about menstrual problems and in most cases it was excessive
bleeding (40%). Most of them (60.25%) had knowledge about other
reproductive health problems in genital area and in most cases it was
whitish discharge (60.99%). Some (33.59%) had painful bleeding. Most
of them (53.25%) got information about reproductive health from their
mother. Most of them (56%) consulted with other persons about their
reproductive health problems and in most cases it was their mother

(42.6%). Those who didnt consult, in most cases (56%) they thought it
was normal. Most of them (64.5%) gave opinion regarding consultation
with doctor in order to prevent reproductive problems than personal
hygiene maintenance (23%) and health education (12.5%). The study
suggests that measures should be taken to strengthen further the ongoing
programs for improving knowledge and awareness about reproductive
health problems in the adolescent females.

CHAPTER: 1

1.1 INTRODUCTION

Adolescent is a stage of developmental transition i.e. a bridge between


childhood and adulthood. It is a progress from appearance of secondary
sex characteristics (puberty) to sexual and reproductive maturity. It is the
stage of development of adult mental process and adult identity and
transition from total socio-economic dependent to relative independent.
According to the World Health Organization (WHO) expert committee
adolescence is defined as the period between 10-19 years, the second
decade of life which is characterized by physical, psychological and
social changes. It is period between childhood and adulthood, marked by
enhanced food requirements and basal metabolic activities and
biochemical activities, endogenous processes like hormonal secretions
with their influence in on the various organ systems (WHO2001).

Over the last decade or so, there has been an increasing interest in
adolescents throughout the world. In Bangladesh the idea is
comparatively new. Adolescents and youth in Bangladesh are particularly
vulnerable to health risks, especially in the area of reproductive health.
This is due to their lack of access to information and services and social
pressure to perform as adults notwithstanding the physical, mental and
emotional changes they are undergoing. The current information and
services that are not specific to adolescents and the quality of such
information and services is often poor or inappropriate for this age
group.

The adolescent is a distinct group in the society, clearly different from the
children and the adults. This stage is always develops gradually without
proper attention, especially in the developing countries. International
conference on population and development (ICPD) held in 1994,
recognized the fact that the adolescent is a particular vulnerable group
and need special health care. Care of the reproductive organs lays the
foundation for the worlds demographic future.

Adolescent girls constitute about 1/5th of total female population in the


world. These years have been recognized as a special period in the life
cycle of adolescent girls as it requires specific and special attention. This
transition phase makes them vulnerable to a number of problems for
example, psychosocial problems, general and reproductive health
problems, and sexuality related problems. Bangladesh has nearly 27.7
million adolescents among which 13.7 million are girls.

Adolescent girls lack adequate knowledge about sexual matters and


contraception, which results in early pregnancy, increased risk of STD
(sexual transmitted disease) infections, maternal morbidity and mortality
and unsafe abortions.

Menarche marks the beginning of womens menstrual and reproductive


life and occurs during early adolescence when teenage girls are beginning
to emotionally separate themselves from their families, as well as to
grapple with their unfolding female sexuality.

Adolescent girls have very little access to information and health care.
They are vulnerable to reproductive health problems like spasmodic
dysmenorrhoea, irregular menstruation, scanty bleeding, leucorrhoea,

vaginal candidiasis, pruritus vulvae. Due to lack of access to information,


the adolescents cannot protect themselves from different reproductive
health problems. Hence, if the adolescents have these various
reproductive problems, they will face health risk in their future lives. So,
it is very essential to aware about reproductive health problems and raise
the level of awareness among the adolescent girls to create a healthy
future generation and educating other community members and also to
give the guidelines for taking necessary steps for finding and developing
the right kind of reproductive health services.

Adolescents have to be knowledgeable about their health problems


including sexual and reproductive health problems. This study is an
attempt to assess reproductive health problem and awareness among the
adolescent females in a selected rural area of Dhaka city. This study may
help to plan and implement more effective reproductive health status of
adolescent females.

1.2 RATIONALE

In the most parts of the world, reproductive changes begin during


adolescence. It is a critical period which lays the foundation for
reproductive health of the individuals life time. Therefore, adolescent
reproductive health involves a specific set of needs distinct from adult
need.

The health program in Bangladesh is targeted primarily to children,


women and adults not to adolescents. Until now very little effort has
been directed towards adolescent health. The female adolescents are the
future mothers and they are so far identified as the vulnerable group of
population. They need information about physiological conditions and
about how to stay healthy. Important aspects are family welfare,
reproductive health including menstruation, hygienic practices during
menstruation to prepare the girl for the future.

Adolescent reproductive health situation in Bangladesh cannot be


denoted as satisfactory. Menstrual problems are common among
adolescents. Unhygienic practices during menstruation are reportedly
common. The reality is that they do not have clear conception about
different aspects of reproductive health problems including menstruation.
So their reproductive health is at risk which may affect their future.
Hence in Bangladesh there is a merely need for evolving information,
education and communication strategies to focus on raising awareness on
reproductive health and gender related issues.

10

This study is an attempt to find out the reproductive health related


problems among adolescent female and to assess their awareness in the
respect. This study may also help the policy makers to give a guideline
for taking necessary steps for finding and developing the right kind of
reproductive health services to protect the adolescent health and hence to
create future healthy mother.

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1.3 RESEARCH QUESTIONS

1. What is the pattern of reproductive health problems among the


adolescent females in a selected rural area?

2. What is the level of awareness of the adolescent female about


reproductive health problems?

1.4 OBJECTIVES

General objectives
To determine the pattern of reproductive health problems and
awareness among the adolescent females.

Specific objectives
1. To find out the socio demographic characteristics of adolescent
2. To determine the pattern of reproductive health problems among
the adolescent females.
3. To assess the knowledge on reproductive health problems among
the adolescent females.
4. To assess the awareness on reproductive health problems among
the adolescent females.

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1.5 KEY VARIABLES


 Name.
 Age.
 Religion.
 Level of education
 Type of family.
 Number of family members.
 Occupation of the father.
 Monthly family income.
 Housing condition.
 Age at menarche.
 Marital status.
 Use of accessories during menstruation.
 Reuse of accessories.
 Method of cleaning of accessories.
 knowledge about normal menstrual cycle.
 Knowledge about the length of the cycle.
 Knowledge about the duration of normal menstruation period.
 Knowledge about her menstrual period.
 Knowledge about problems arising during menstruation.
 Knowledge about the problems.
 Source of reproductive health related information.
 Inquiry into her having any reproductive health problems.
 Pattern of the problems.
 Inquiry into consulting regarding her problems.
 Consulting person.
 Reasons of not consulting.

13

 Measures (in her view) to be taken for prevention of reproductive


health problems.

14

1.6 OPERATIONAL DEFINITIONS


OF TERMS AND CONDITIONS

Adolescent / Respondents : WHO defines in 1996, Adolescence is the


period of life between ages 10 and 19 years
Age at menarche : The age of respondents ( In years and months ) at
which first menstruation had been started.
Menstrual period : The respondents who could mention, that the period
was from one to seven days were considered as correct.
Menstrual cycle : The respondents who could mention, that the cycle
was 28 days were considered as correct.
Pattern of reproductive health problems : Group of diseases or
reproductive health problems which are usually manifested during
adolescence ( for this study 10-19 years of age ) like : Spasmodic
dysmenorrhoea, irregular menstruation, menorrhogia, scanty
menstruation, per vaginal whitish discharge ( Leucorrhoea ), ulcer on the
inner part of thigh/vulva, itching and redness at vulva ( Pruritus vulva )

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1.7 LIMITATIONS OF THE STUDY

This was conducted among the selected age groups adolescent


females working only a selected garment of Dhaka city. For this
the study results might not represent all the adolescent females of
the all garment industry of the country.
Some of the adolescent females felt shy to give answer.
Short duration of study period.
Sample size small, so the study may not reflect actual
problems/pictures of the adolescent females.

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CHAPTER: 2

LITERATURE REVIEW
Adolescence is a phase of life that can be and is described by others in a
variety of ways. It can be examined chronologically, for it involves
physiological and cognitive maturational process. It can be described
physiological and it involves internal process of change in each
individual. It also can be discussed from the perspective of its
reverberations in the social and cultural worlds for it is during this time of
the that socialization into the rule of the adult takes place.
WHO defines adolescence as the period between 10 and 19 years age
which broadly corresponds to the onset of puberty and the age of
adulthood .In most parts world reproductive changes begin during
adolescence. It is a critical period which lays the foundation for
reproductive health of the individuals life time.
Therefore adolescent reproductive health involves a specific set of needs
distinct from adult need1
In Bangladesh almost one half of the women aged 22-24 years were
married by age 15 and by age 20 as high as 82 % of cohort has married.
Data gathered from the 1989 Bangladesh Fertility Survey indicate that a
relatively large proportion 18% of the adolescent marriages to place even
before the onset of menarche and there was a clustering of majority of
adolescent marriages immediately after the menarcheal period.2
Among all the countries in the region the incidence of adolescent
marriages tend to decrease. For instance, among the older women of aged

17

40-44 in Indonesia 72% were married before age 20 but among 20-24 age
cohort only 48% did the same, thus incidence of adolescent marriages
were declined by 24% points.
However the level of decline noted in Bangladesh, India, Nepal is not
impressive; countries like Thailand and Philippines had a relatively low
proportion of adolescent marriages among the cohort aged 40-44, than the
former countries were nonetheless were further successful in reducing
early marriages by significant properties.2
Adolescents, especially in the urbanity are susceptible to the risk of many
harmful substance like drugs, influences of satellites media etc.as many
of the behavior pattern such as gender relations inappropriate education,
relation gap between parents leading onset of health damaging behaviors
and their future repercussions UNFPA negligence can give rise to
immediate and long term problems with negative effects on individuals
and societies. One of the most important commitments a country can
make for its future economy, social and political progress and stability is
to seriously address and satisfy the health and development of health of
adolescents.3
There are the many adolescent programs in Bangladesh at present a
number of NGOs are involved with adolescents program. In general these
organization can be categorized under two main headings.
NGOs who are providing funding and technical assistant program to
implement adolescents programs and NGOs who are implementing these
programs in the field. Most of the NGOs started their adolescents
program in 1995 and thereafter. Adolescents are the parents, and leaders
of the tomorrow. It requires investigation in the potential of the young
people and helping them to solve problems. Population council conducted

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the survey with the objective to collect information about the organization
working with the adolescents or youth. The survey was conducted into
two phases, initially names and addresses of organizations working in the
fields were collected from various sources (AFLE forum, DAWN forum
ACTION AID, BPHC ADAB,NGO Directory Examinations of these
reports suggests that a total of 188 organizations are working with the
adolescents. These organizations started their adolescents program with
the objectives to promote and support individual development for a better
life, removal of illiteracy. In addition these organization assist
adolescents on legal issues regarding violence and abuse.4
Future

programs

intended

to

incorporate

Reproductive

Health

Educational curriculum, provide curative services and enhance parents


awareness.3
KabirH1, SahaNC, WirtzAL, GaziR's study shows that, The reproductive
health needs of unmarried adolescents in Bangladesh are largely unmet.
This study aimed to explore treatment-seeking behaviour of unmarried
female adolescents for selected reproductive health (RH) concerns in two
low-performing areas of Bangladesh.
As part of a large community based-project, a cross-sectional survey was
conducted from November 2006 to March 2007. From each of two select
study areas, 800 unmarried female adolescents aged 12-19 years were
selected for participation by simple random sampling through household
listing and were recruited into the study. Trained interviewers
administered

structured

questionnaire

to

participating

female

adolescents. Descriptive and bivariate analytic methods were used


compare RH conditions and healthcare seeking behavior of adolescents
across urban and rural settings.

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Approximately 50% of the sample reported experiencing menstrual


problems in the last year. The predominant problems reported by
participants included: lower abdominal pain, back pain, irregular
menstruation, and excessive bleeding during menstruation. Irrespective of
study area, only 40% of the female adolescents with menstrual problems
sought treatment from qualified physicians. Otherwise, utilization of
healthcare facilities and care providers for reported problems varied
significantly by rural and urban areas. Higher proportions of adolescents
in the urban setting (15%) also reported recent symptoms of sexually
transmitted infections (STIs), compared to those in the rural setting (9%;
p<0.001). Across sites, however, self-treatment was the most commonly
reported method of care for those who experienced any symptoms of STI.
In general, treatment-seeking behaviors by unmarried female adolescents
were low for menstrual problems. A vast majority of unmarried female
adolescents practiced self-care for symptoms of STIs while only small
proportions sought treatment from qualified physicians. These findings
emphasize the need for offering relevant information on RH issues and
introducing confidential adolescent-friendly reproductive healthcare
facilities to enable unmarried female adolescents access to RH services
when necessary.5
Adolescents reproductive health has become an important issue for
Bangladesh. Since independence, though Bangladesh has achieved
remarkable progress in important aspects of health and family welfare,
the overall reproductive health status in country remain unsatisfactory.
AKtER stated in 1996 that although reproductive health cover both men
and women the burden of reproductive health related problems where
unequally divided between two sexes only women face the Hazards of
pregnancy and childbirth.RTI ,STD and HIV/AIDS have more serious

20

sequels in women than that in men. Infertility is a problem where usually


both partner are responsible. But most of the societies, the social and
psychological burden is borne by the women. Thus, the vital reproductive
events usually occurred in women life and effect the women much more
than the men. So, the women in our country must be alert and conscious
about their health issues, health problems and health rights. Begum in
1999 stated that high rates of abortion, maternal malnutrition and RTI/
STDs were indicators of poor reproductive health in Bangladesh.6
In Bangladesh, there is limited information and adolescence knowledge
about reproductive health and personal hygiene i.e. 6 in 10 either could
not answer or gave an incorrect answer to a question on symptoms of
reproductive infection.7
So, Bangladesh still faces formidable obstacles in the path to the goals of
health and reproductive well being due to inadequate knowledge or
misconception about reproductive health issues. So, proper knowledge is
a pertinent part of life. The Government of Bangladesh has thus identified
adolescents heath and education both as a priority and a challenge and to
face the challenge ,has incorporated this issue in the health and
population sectors program,HPSP,1998-2003 there were expectations that
with the introduction of the essential services package (ESP ) across
Bangladesh, Though the HPSP ,there will be an overall increase in the
quantity and quality of information and services available for adolescence
through a network of clinics at various levels: community, upazilla and
districts. However, studies conducted by the different agencies concluded
that the potential for improvements directly associated with HPSP service
delivery are unlike to make significant contributions to achieving ARH
results during the HPSP period 1998-2003 without additional efforts from
other agencies.8

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A study conducted by BIRPERHT in 2000 in urban school & college


revealed that about 43% of female respondents did not know what
reproductive health was. About appropriate sources of information about
reproductive health- a larger proportion (35%) of female respondents
reported having had no knowledge. 66% of the respondents thought
mothers were the most appropriate people to counsel girls. Teachers,
friends and close relatives were also considered to be appropriate sources
of information. For, hygienic protection, nearly half of the girls reported
using old clean rags, about 38% used store bought sanitary napkins, 16%
used new cloth and 11% used homemade pads and 9% of them reported
using a dirty cloth. Inclusion of reproductive health education in text
books-the majority of adolescents (76% female) stressed the need. When
asked their opinion on the medium of dissemination information on
reproductive health, over half of the students suggested printed media
such as books or text book. Students also suggested radio or TV for
dissemination of information. Over 42% felt that peer counseling was
appropriate and nearly 20% indicated that teacher could share this
information with students. Regarding menstrual status some of the girls
reported physical problems associated with their first menstruation, this
included 29.9% who reported being weak and 38.9% who reported
having lower abdominal pain, 10.6% having excessive bleeding and
l2.9% having irregular menses.9
Abubakar A Manu, Chuks Jonathan Mba, Gloria Quansah Asare, Kwasi
Odoi-Agyarko and Rexford Kofi Oduro Asante 1024 years aged peoples
represent one-third of the Ghanaian population. Many are sexually active
and are at considerable risk of negative health outcomes due to
inadequate sexual and reproductive health knowledge. Although growing
international evidence suggests that parentchild sexual communication

22

has positive influence on young peoples sexual behaviors, this subject


has been poorly studied among Ghanaian families. This study explored
the extent and patterns of parentchild sexual communication, and the
topics commonly discussed by parents.
About 82.3% of parents had at some point in time discussed sexual and
reproductive health issues with their children; nonetheless, the
discussions centered on a few topics. Whereas child-report indicated that
78.8% of mothers had discussed sexual communication with their
children, 53.5% of fathers had done so. Parental discussions on the 20
sexual topics ranged from 5.2%-73.6%. Conversely, young peoples
report indicates that mother-discussed topics ranged between 1.9%69.5%, while father-discussed topics ranged from 0.4% to 46.0%. Sexual
abstinence was the most frequently discussed topic (73.6%), followed by
menstruation 63.3% and HIV/AIDS 61.5%; while condom (5.2%) and
other contraceptive use (9.3%) were hardly discussed. The most common
trigger of communication cited by parentchild dyads was parents own
initiation (59.1% vs. 62.6% p=0.22).
Parents in the BrongAhafo region of Ghana do talk to children about sex,
but their conversations cover limited topics. While abstinence is the most
widely discussed sexual topic, condoms and contraception were rarely
discussed. Sex educational programmes ought to encourage parents to
expand sexual communication to cover more topics.10
BIRPERHT conducted a study on adolescent health in 1998 in various
rural areas. Their sample size was 1214 female adolescent, data collection
instrument was interview schedule with a pre-structural questionnaire.
Their findings were regarding education of the female guardians- 66%
had no formal education, 23.5% had primary level schooling higher than

23

secondary level. Regarding health status of adolescents over 70% were


found to report no health problems, nearly 30 percent reported existence
of various ill health conditions like weakness, cold, chest and abdominal
symptoms at the time of interview. For majority of them who sought
treatment, sources of treatment were village doctors or pharmacies
(33.9%), government health facility or private doctor/clinic (18%) and
traditional/homeopathy etc (7.5%).9
Reproductive characteristics of adolescents- mean age at menarche was
13.2 years. Nearly 65 percent of those who had menarche reported having
some menstrual problems which includes pain in abdomen, back and
lower extremities in half of them (53%) and other types of pain &
weakness among the rest (1l%). Only 8% reported that mother was their
source of information on menstruation while for 25% female guardian,
for l6% friends were the sources of information about the menstruation
prior to menarche. However, 24% reported that they obtained detailed
information from their mothers, 34% from female guardian and rest of
4l% obtained information from sister, friend, colleagues and others. 6
A study conducted by BRAC in different villages of Manikiganj District
stated that one of the most common reproductive health complaints
among adolescent girls was whitish discharge accompanied by severe
abdominal pain. They did not know how to solve this problem. If the
menstrual rag is not dried properly it may become a vector for fungal
infection leads to vaginal discharge. Another problem was abdominal
cramps during menstruation accompanied by heavy bleeding. Some of
them says the pain was so severe that they can not walk even. Other
problems which were not perceived as a problem by the girls, was the
irregularity of menstruation, scanty menstruation etc. 9

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In Nepal, 23% of the population falls in the age group 13-19 years
according to annual survey, 1997. A study conducted from July 1st 1997
to July 1st 1998 regarding adolescent gynecological problem that needed
hospitalization revealed that among 36 patient 3 of them was suffering
from puberty menorrhagia. In USA adolescents girls suffer commonly of
various problems. Among them commonest are amenorrhoea, DUB,
dymenorrhoea, irregular periods, nutritional anaemia. Nutritional anaemia
is found 8% of adolescent female. They are prone to prolonged and heavy
bleeding during early menstrual period.9
In Bangladesh the reproductive health care needs of adolescents is a
pressing problem, given that approximately 25 percent of the countrys
population of 132 million people are adolescents. To address their needs,
the Population Council, in collaboration with the Urban Family Health
Partnership (UFHP) and with financial support from the US Agency for
International Development (USAID), launched a pilot project in the
northwestern part of Bangladesh to improve the reproductive health of
adolescents (Research Update No 1 for detailed description of the
project). In the project areas, three interventions (community school and
clinic) were introduced to examine the effectiveness of reproductive
health education and an adolescent-friendly service delivery system. This
research update describes the experimental interventions and presents
important findings from surveys of parents and pharmacies. 11
The operations research study additionally implemented the school-based
intervention in eight schools in Dinajpur among students of classes VIII
and X (ages 13 to 16). Students attended 15 participatory sessions (using
a newly developed RH curriculum) taught by school teachers covering
mainly reproductive health and few general topics. The course topics
included changes in adolescence, personal hygiene , environment and

25

safe water, food and nutrition, gender, drug abuse, sexual relations and
sexual abuse, reproductive tract infections (RTIs), STDs, HIV/AIDS,
childbirth and family planning, antenatal care (ANC), post-natal care,
child health and immunization , population, marriage law and legal rights.
The program had effectively used school teachers to deliver the RH
courses in school, instead of NGO workers (as commonly done by other
programs). A total of 24 teachers (19 females and 5 males) were trained
for 4 days of the RH curriculum followed by refresher training on
pedagogical technique after 6 months. 11
Findings from the Parents Survey before introducing the experimental
interventions.(community school and clinic) the study conducted a survey
of parents in the intervention and control areas. The objective of the
survey was to understand perception of parents or guardians about RH
needs of adolescents. The socio demographic characteristics of the
parents or guardians showed that male parents or guardians were better
educated than female parents or guardians. Most of the female parents or
guardians (85%) were housewives and only 5% were engaged in business
and service. Male parents or guardians were primarily engaged in
business and service and they (72%) reported higher levels of
contraceptive use than female parents or guardians (60%). Approximately
68% of parents or guardians reported two as the desired number of
children. The findings showed that education and employment of children
were the two most important goals of parents. Approximately one-third of
the respondents suggested that the activities of children should be
monitored closely to protect them from risky behavior.11

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Responses to particular issues differed according to sex. Approximately


42 % of female parents or guardians discussed reproductive and sexual
health issues with adolescents, whereas only 10 % of male parents or
guardians had discussion with adolescents on these issues. However,
more than 90 % of the male parents or guardians supported sex education
in school while 77 % of female parents or guardians supported the same.
Over 80 % of the parents or guardian thought that health clinic or
pharmacies should provide RH services to adolescents.11

27

CHAPTER: 3

METHODOLOGY
1. Study design
This was a cross sectional type of descriptive study.
2. Study place
Selected villages of Keranigonj Upazilla under the district of
Dhaka.
3. Study period
This study was conducted from 08-03-2015 to 10-03-2015.
4. Study area selection
Selected villages of Keranigonj upazilla under Dhaka district ware
selected for study.
5. Study population.
All the adolescent female of 10 to 19 years of the study area.
6. Sample size.
After giving the consent who are willing to provide the data
constitute the sample size about 400.
7. Sampling technique
Purposive sampling technique was adopted.
8. Research instrument.
Data was collected by using semi-structured questionnaire. Pre
tested semi-structured questionnaire was used keeping in mind the
objective of the study.
9. Data collection procedure.
Each household was visited by student before data collection; the
purpose of the study was explained to the respondents so that they
could understand the aim of study and meaning of the questions of
the questionnaire. After short discussion of the study, face to face

28

interview of the respondents was conducted by asking questions


using semi-structured questionnaire.
10. Data processing and analysis.
After collection of data, they were checked, verified and edited
manually to reduce errors. Master table was prepared first and
tabulation of data was performed by scientific calculator.

29

CHAPTER: 4

RESULTS

Figure 1: Distribution of the respondents by age


N=400

48%

8.75%
9-12
12 years
13-16
16 years
17-20
20 years

43.25%
Figure 1 shows the distribution by age. Among the 400
interviewed respondents of 35(8.75%) are 9-12 years,173
173
(43.25%) are 13-16
16 years,192 are 17-20 years(48%)

30

Figure 2 : Distribution of the respondents by religion


N=400

5.75%
Islam
Hinduism

94.25%

Figure 2 shows the distribution of respondents by religion.


Among 400 interviewed 377(94.25%) were Muslim &
23(5.75%) were Hindu

31

Figure 3: Distribution of the respondents by level of


education
N=400

60%
50%
40%
30%
20%
10%
0%

Figure 3 shows the distribution of respondents by religion.


Among 400 interviewed 47(11.75%) were Illiterate &
197(49.25%) were primary passed, 133(33.25%)were
secondary attended,14 (3.5%)were secondary passed,9 (2.25%)
were higher secondary

32

Figure 4: Distribution of the respondents by size of


the family
N=400

8.25%
Nuclear
family
Joint/extende
d family
91.75%
Figure 4 shows the distribution of respondents by religion.
Among 400 interviewed 367(91.75%) were nuclear family &
33(8.25%) were joint/extended family

33

Table 1: Distribution of the respondents by numbers


of family members
N=400

Number of the family


members

Number

Percentage

2-3
4-5
6-7
8-9
10-11
12
Total

66
126
112
48
37
11
400

16.5%
31.5%
28%
12%
9.25%
2.75%
100%

Table 1 shows distribution of the respondents by numbers of


family members. Among 400 interviewed 66(16.5%)were
consisting of 2-3members,126 (31.5%) were of 4-5,112 (28%)
were of 6-7, 48(12%)were of 8-9,37 (9.25%)were of 10-11,11
(2.75%)were of 12

34

Table 2: Distribution of the respondents by


occupation of father
N=400

Occupation of father

Number

Percentage

Farmer
Day laborer
Rickshaw puller

8
105
13

2%
26.25%
3.25%

Service holder

80

20%

Businessman
Total

194
400

47.5%
100%

Table 2 shows distribution of the respondents by occupation of


father. Among 400 interviewed 8(2%)were farmer,105
(26.25%)were day laborer, 13(3.25%)were rickshaw-puller,80
(20%)were service holder, 194 (47.5%)were Businessman

35

Table 3: Distribution of the respondents by monthly


family income

N=400

Monthly family income

Number

Percentage

5000
5001-10000
10001-15000
15001-20000
>20000
Total

7
48
322
27
6
400

1.75%
12%
80.5%
6.75%
1.5%
100%

Table 3 shows distribution of the respondents by monthly family


income. Among 400 interviewed 7(1.75%) were earners
of5000tk,48 (12%)were 5001-10000tk,322 (80.5%)were
10001-15000tk,27 (6.75%)were 15001-20000tk,
6(1.5%)were>20000tk

36

Figure 5: Distribution of the respondents by housing


condition
N=400

60%
50%
40%
30%
20%
10%
0%
Kacca

Pacca

Semi-pacca

Figure 5 shows distribution of the respondents by housing


condition. Among 400 interviewed 4(1%)were kacca,
189(47.25%)were pacca, 207 (51.75%)were semi-pacca

37

Figure 6: Distribution of the respondents by age of


menarche
N=400

150.00%
100.00%
50.00%
0.00%
9-11years

12-14years

15-17years

Figure 6 shows distribution of the respondents by age of


menarche. Among 400 interviewed 85(21.25%)were 9-11
years,308 (77%)were
12-14years,7 (1.75%)were 15-17years

38

Figure 7: Distribution of the respondents by marital


status
N=400

38%
Married
Unmarried

62%

Figure 7 shows distribution of the respondents by marital status.


Among 400 interviewed 152(38%)were married,248 (62%)were
unmarried

39

Figure 8: Distribution
istribution of the respondents by type of
tampon used during menstruation
N=400

2.50%
%

45%
Sanitary
napkin
Old clothes
Cotton

51.25%

Figure 8 shows distribution of the respondents by type of


tampon used during
uring Menstruation. Among 400 interviewed
180(45%)were
45%)were users of sanitary napkin 205(51.25%)were
51.25%)were users
of old clothes,22 (2.5%)
2.5%) were users of cotton

40

Figure 9: Distribution of the respondents by re-use of


pad/clothes
N=400

43.75%
Yes
No

56.25%

Figure 9 shows distribution of the respondents by re-use of


pad/clothes. Among 400 interviewed 175(43.75%)were reusers,225 (56.25%)were not re-users

41

Figure 10: Distribution of the respondents by their


procedure of cleaning of pad/clothes
N=400

100%
80%
60%
40%
20%
0%
water only

soap

soap&savlon

Figure 10 shows distribution of the respondents by cleaning of


pad/clothes. Among 400 interviewed 46(11.5%)were using
water only,325 (81.25%)were Users of soap,29 (7.25%)were
users of soap & savlon

42

Figure 11:: Distribution of the respondents by their


knowledge about normal menstrual cycle
N=400

3.50%

Yes
No

96.50%
Figure 11 shows distribution of the respondents by knowledge

about normal menstrual cycle. Among 400 interviewed


96.5%(386) had knowledge, 3.5%(14) had no knowledge

43

Table - 4: Distribution of the respondent by


knowledge about menstrual cycle
N = 362

Menstrual cycle

Number

Percentage ( % )

Less than 28 days

187

55.12 %

More than 28 days

175

44.88 %

Total

362

100 %

Table no. 4 shows respondent knowledge about menstrual cycle.


187 respondents (55.12 %) mentioned that the cycle was less
than 28 days , 175 respondents ( 44.88% ) gave the answer of
more than 28 days .

44

Figure 12: Distribution of the respondent by whether


they have knowledge about menstrual period
N = 400

3.58%

Yes

No

96.42%

Figure 12 shows that most of the respondents said Yes 386


(96.42%) , rest said No 14 ( 3.58% )

45

Table 5: Distribution of the respondent by knowledge


about menstrual period
N = 386

Menstrual Period

Number

Percentage ( % )

1-3 days

28

7.25%

1-5 days

336

87.5%

1-7 days

22

5.7%

386

100%

Total

Table 5 shows that 350 respondent ( 87.5%) knew that


menstrual period was 1-5 days normally where as 30 0f them (
7.5% ) gave the answer of 1-3 days . Rest of the 20 respondent (
5% ) gave the answer off 1-7 days .

46

Figure 13: Distribution of the respondent by whether


they have knowledge about menstrual problems
N = 400

31.75%

68.25%

Yes
No

Figure 13 shows that most of the respondents said Yes 273


(68.25%), rest were No 127 ( 31.75% )

47

Table - 6: Distribution of the respondent by


knowledge about menstrual problems

N = 273

Menstrual Problems
Scanty bleeding
Excessive bleeding
Painful bleeding
Total

Number

Percentage (%)

86

31.5%

115

42.12%

72

26.37%

273

100%

Table 6 shows the knowledge of the respondent regarding


problems during menstruation, 40% mentioned about Excessive
bleeding, 38.25% mentioned about Painful bleeding and only
32% mentioned about scanty bleeding.

48

Figure 14: Distribution of the respondent


respondents by whether
they have knowledge about the other reproductive
health problems in genital area

N = 400

39.75%
60.25%

Yes
No

Figure 14 shows that most of tthe


he respondents said Yes 241
(60.25%
60.25% ) , rest were No 159 ( 39.75% )

49

Table 7 :Distribution of the respondent by


knowledge about the other reproductive health
problems in genital area

N = 241

Menstrual Problems
Scanty bleeding
Excessive bleeding
Painful bleeding
Total

Number

Percentage (%)

86

31.5%

115

42.12%

72

26.37%

273

100%

Table 7 shows the knowledge of the respondents regarding other


problems in genital area / reproductive health showed that,
31.5% mentioned about Scanty bleeding , 42.12% mentioned
Excessive bleeding, 26.37% mentioned redness and rest of all
Painful bleeding.

50

Figure 15: Distribution of the respondents by source


of information regarding reproductive health and its
related problems

N = 400
250

53.25%

200

37.25%
150
100
50

5.25%

4.25%

Friends

Relatives

Mother

Elder sister

Figure15 shows information seeking pattern of adolescent


females regarding reproductive health and problems. Among
them 53.25% got information from their mother, 37.25 % from
their Elder sister , 5.25% from Friends and 4.25% from
Relatives .

51

Figure 16: Distribution of respondents by whether


they have other reproductive health problems in
genital area

N = 400

Yes

36.67%

No
63.33%

Figure 16 shows that most of the respondents said Yes 253


(63.33%), rest were No 147 (36.67%)

52

Figure 17: Distribution of respondents according to


the other reproductive health problems in genital
area
N=253
33.59%
29.64%

16.20%

13.04%
7.51%

Scanty
bleeding

Excessive
bleeding

Painful
bleeding

Whitish
discharge

Itching

Figure 17 shows the distribution of respondent according to the

other problems in genital area . Among them majority 85


respondents ( 33.59 % ) had painful bleeding , 75 respondents (
29.64% ) mentioned whitish discharge , 41 respondents (
16.20% ) mentioned scant
scanty
y bleeding and only 19 respondents (
7.51 % ) suffered from itching .

53

Figure 18:: Distribution of proportion of


consultation about reproductive health problems
N =400

44%

56%
Yes
No

Figure 18 shows the distribution of Proportion of consultation


about reproductive
oductive health problems . Among 400 respondents

225 ( 56% ) consulted with personal and 175 ( 44% ) wont


consult .

54

Table - 8: Distribution of the personnel with whom


the respondents consulted about reproductive health
problems
N= 225

Consulted with

Number

personnel

Percentage
(%)

Mother

96

42.6 %

Elder sister

55

24.4 %

Friends

48

21.3 %

Relatives

15

6.6 %

Doctors

11

4%

225

100 %

Total

Table 8 shows that out of 225 respondents 42.6% had consulted


about reproductive health problems with their mothers , 24.4%
with their elder sisters , 21.3% with friends ,6.6% with relatives
and only 4 % with doctors .

55

Table 9: Distribution of the reasons behinds for not


consulted on reproductive health problems.
N = 175
Reasons

Number

Percentage

Its Normal

98

56 %

Felt shy

35

20 %

Not serious through

42

24 %

175

100%

about it
Total

Table 9 shows that out of not consulted 175 respondents 56 %


thought that its normal phenomenon .On the other hand 20% felt
shy for consultation regarding reproductive health problems and
24 % not serious through about it .

56

Table - 10: Distribution of the opinion of the


respondents regarding prevention of the reproductive
health problems

N = 400
Preventive

Number

Percentage

measures
Hygiene Practice

127

23 %

Health Education

50

12.5%

Medical advice

223

64.5%

Total

400

100 %

Table 10 shows about opinion of the respondents regarding


prevention of the reproductive health problems, 64.5 % of the
respondents gave opinion regarding consultation with doctor ,
23% on hygiene practice and 12.5% by the health education .

57

CHAPTER:5

DISCUSSION

It is a descriptive type of cross-sectional study that was conducted in


different villages of Keranigonj Upazila among 400 adolescent females ,
aged between 10 to 19 years to find out the reproductive health problems
and their awareness.
Out of 400 respondents,majority-192 (48%) were of 16-19 years followed
by-173 (43.25%) of 13-15 years and 35 (8.75%) of 10-12 years. Similar
findings were found in a study done by Afrin et al. (2010) which was on
adolescent school girls.12
Majority of the respondents (94.25%) were Muslims and rest (5.75%)
were Hindus. These findings are similar to the national data where
Muslims are 90% and the rest are of other religions.13
Information on the educational status of the mothers reveals that, majority
of them were primary passed (49.25%) .Next large group secondary
attended-(33.25%)-secondary passed-(3.5%) followed by (2.25%)
attending higher secondary. Among them (11.75%) were found illiterate.
Most of them belonged to nuclear family (91.75%) and rest from joint or
extended family (8.25%).Majority (31.5%) had 4-5 family members
followed by 6-7 (28%),2-3(16.5%),8-9(12%),10-11(9.25%) and 2.75%
had more than 12 members.
Study on the occupation of father show that most of them were
businessmen , followed by-(47.5%) ,day laborers (26.25%) ,service
holders (20%) ,rickshaw pullers (3.25%),farmers(2%) and others1%.
Regarding economic status of the respondents, family income level of
80.5% was between the range of 10,001-15,000 tk/month followed by

58

12% ranging from 5,000-10,000tk/month.6.75% had an income ranging


from 15,001-20,000tk/month.1.75% earned less than 5,000 and 1.5% did
more than 20,000 tk/month. This finding is not similar of the study done
by Majumdar and Begum (2000) because the salary structure was
different in different factories at that time.14
According to the study 51.75% of respondents lived in semi-pacca
houses,47.25% in pacca houses and 1% in kacha houses.
In this study, the highest percentage (77%) started their menstruation
between 12-14 years followed by 21.25% who had their menarche at 9-11
years and 1.75% between 15-17 years. These findings were consistent
with the study done by BANS94, where the mean age at menarche was
12.6 years-13.9 years: 90% of the respondents attained menarche.
Another study in Mumbai, India concludes that mean age of menarche
was 12 years (range of 8.2-15) years. This similarity may be due to same
socio-economic status and living standards of the respondents. But other
studies differed and showed that mean age of menarche was 13 years.
This dissimilarity was may be due to variation in geographical
distribution and physical growth of the respondents.19,6,15
Study showed that 59.25% of them were unmarried and 40.75% were
married.
Regarding the knowledge about menstrual cycle, 362 (90.25%) of the
respondents had the correct knowledge and the rest 38 (9.75%) did not.
Among the 362 respondents having the knowledge about menstrual
cycle-187 (55.12%) said that the length was less than 28 days and 175
(44.88%) acknowledged that it was more than 28 days.
Regarding the knowledge about the duration of normal menstrual period,
among 400 respondents, 386 (96.42%) were aware of it and the rest 14
(3.58%) were not.

59

Among the 386 respondents knowing about the normal menstrual


duration-87.5% responded it was ranging from 1-5 days followed by
7.3% who had it from 1-3 days and 5.7% having a menstrual duration of
1-7 days.
According to the study, among 400 respondents 273 (68.25%) knew
about the problems which may arise during menstruation and 127
(31.75%) did not.
Among 273 knowing about menstrual problems-42.12% acknowledged
that they had excessive bleeding , 31.5% experienced scanty bleeding and
26.38% had painful bleeding. According to BIRPERHT study (2000)
conducted in urban school and colleges-29.9% reported being weak
during menstruation and 38.9% reported having lower abdominal
pain,10.6% having excessive bleeding and 12.9% having irregular
menses.6
Study shows that 241 (60.25%) among 400 respondents knew about other
menstrual problems other than menstrual abnormality and 159 (39.7%)
did not.
Among those 241 respondents-61% had whitish discharge followed by
27.76% with itching,6.64% having redness and 4.56% with swelling.
Regarding the type of tampon used during menstruation-205 (51.25%)
used old clothes and 15 (3.75%) used cotton-which was an unhygienic
practice whereas 180 (45%) used sanitary pads-an hygienic practice. But
this result does not correlate with the study conducted by ICDDR,B
(1999),which showed that 60.33%of the respondents used old clothes and
only 8% used sanitary pads. These variations may be due to conducting
studies in both urban and rural areas whereas this study had been
conducted only in urban area. Also because now a days sanitary pads are
available and relatively not so costly and urban people are more
conscious about sanitary measures taken during menstruation. According

60

to BIRPERHT study (2000) which was conducted in urban area-nearly


half of the respondents used old, clean rags,38% used sanitary
napkins,16% used new clothes,11% used homemade pads and 9%
reported using of dirty clothes.9
The study shows that,225 (56.25%) among 400 respondents do not reuse
pads or clothes and 175 (43.75%) reuse them.
Among the 175 respondents who reuse pads or clothes-81.25% uses only
soap to wash them and 11.5% uses water only.7.25% uses soap and
savlon to wash them.
Majority-(53.25%) of the 400 respondents acknowledged that they
received information about reproductive health from their mothers,
37.25% from their elder sisters,5.25% from their friends and 4.25% from
their relatives. This observation is supported by the study conducted by
BIRPERHT(2000) which reflected 66% of the respondents thought that
the most appropriate person to consult with were mothers. According to
this study conducted in urban school andcolleges-43% respondents did
not know what reproductive health was.16
Regarding reproductive health problems, among 400 respondents-253
(63.33%) had them and 147 (36.67%) did not.
Among the 253 having reproductive health problems-33.59% had painful
bleeding,

29.64%

had

whitish

discharge,16.20%

had

scanty

bleeding,13.04% had excessive bleeding and 7.51% had itching. A study


conducted by BRAC in different villages of Manikganj stated that one of
the most common reproductive health complaints was whitish discharge
accompanied by severe abdominal pain and they did not know how to
solve it.17
The study reveals that, 225 (56%) of the respondents consult with others
regarding their problems and 175 (44%) did not.

61

Among those 225 respondents-42.7% consulted with their mothers,24.4%


with elder sister,21.3% with friends 6.7% with relatives and 4.9%
consulted doctors.
Among those 175 respondents who did not consult because they thought
the reproductive problems to be normal (56%),they did not seriously
thought about it (24%) and they felt shy (20%).
Regarding the measures to be taken to prevent reproductive health
problems, among 400 respondents-64.5% prefer taking medical
advice,23% would likely promote hygiene practice whereas 12.5% chose
education as their preference. In the BIRPERHT study (2000)-girls of
urban institutes stressed the need for inclusion of reproductive health
education in text books, printed-media, radio, TV etc for dissemination of
information. Over 42% felt that peer counseling was appropriate and
nearly 20% indicated that the teacher could share this information with
students. These findings are similar with the study conducted by Hasseen
F. And Singh et al.(1999) in India.9,10,16,18

62

CHAPTER: 6
RECOMMENDATIONS
The study findings in respect of reproductive health problems and
awareness among adolescent females lead to make following
recommendations:

Adolescents need more information about reproductive health and


its related problems along with its management.

An adolescent family life education curriculum needs to be


developed.
Counseling services specially for the female adolescents need to be
arranged.
Gatekeepers, formal and informal community leaders and religious
leaders at all levels need to be motivated and trained on adolescent
reproductive health and gender issues.
Additional support should be provided to catalyze increased
knowledge and attitudinal and behavioral change among service
providers with regard to ARH.
Information should be disseminated by using mass media like
TV/Radio, Newspaper/Magazine etc.
Increased networking between all relevant government
organizations and NGOs working with adolescent girls should be
encouraged to ensure the proper implementation of projects
regarding reproductive health.
Female doctors need to be deployed for the provision of ARH
services to adolescent girls.
Behavior change communication and IEC materials need to be
developed and distributed in collaboration with multisectoral
agencies.
Further comprehensive study in this field may play a crucial role for the
improvement of reproductive health of adolescent females in the country

63

CHAPTER: 7

CONCLUSIONS

The study was conducted to assess the pattern of reproductive health


problems and awareness among the adolescent females. Majority of them
belonged to low economic status. Among the adolescent females majority
suffered from menstrual problems. The Common reasons behind this may be
the shyness to disclose their problems, lack of proper knowledge anr
awareness regarding reproductive health problems, inadequate health care
facilities, ignorance and socio-economic status etc. Among the adolescent
females, near about half suffered from other problems in genital tract. The
main reason behind it was the unhygienic protective measures. It was also
observed that most of the adolescents wanted to consult with family
members and rest with doctors to solve their reproductive health problems.
Majority of the adolescent females wanted to get information from TV /
Radio, near about one fourth from news paper & magazine and rest of the
adolescents from school curriculum and health education in syllabus
respectively. No statistically significant associations were found between
economic status and painful menstrual bleeding, vaginal whitish discharge,
also no statistically significant association was found between protective
measures and menstrual bleeding. while statistically significant association
was found between protective measures and per vaginal whitish discharge
during menstruation and offers important guidelines for future work in this
area. This association need to be further studied in depth in order to effective
intervention program

64

BIBLIOGRAPHY

1. UNFPA .handbook for Educating on adolescent Reproductive and


sexual health.Bankok,1998;1
2. Silva I. Emerging reproductive Health Issues among adolescents in
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3. Chowdhury HJ ,Khan AS , Rahman S.A report on Assessment of
existing International Capacities for Training in reproductive Health
.National Institute of Population Research and training ,Bangladesh
1997;18-22
4. HossainSNI, BhuiyaI, Rob AKU, ANAM R. Directory of Organization
Working with Adolescents /youth in Bangladesh. First Edition, Dhaka:
Population Council 1998; 2-16.
5. Treatment-seeking for selected reproductive health problems:
behaviors of unmarried female adolescents in two low-performing areas
of Bangladesh.
6. Akkhter HH, Korim F, MEEK, Rahman MH. A study to identify the
risk factors affecting nutritional status of adolescent girls in Bangladesh.
BIRPERHT, Dhaka, Bangladesh 2000: II-X.
7. UNFPA. Communication and advocacy strategies adolescent
reproductive and sexual health. Bangkok, Thiland, 1999: 13.
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9. Nahar Q , Tunon C , Houvras I , Gazi R ,Reza M, Huq Nl, et al.


Reproductive Health needs of Adolescents in Bangladesh : A Study
report .Dhaka ,ORP:ICDDR,B Bangladesh,1999:17-36.
10. Parentchild communication about sexual and reproductive health:
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11.UBaidur R.Ismat B, Yusuf N, Population Council. Policy Dialouge ,
Dhaka, population council 1998 ;2-17.
12. Afrin S, Rahman MR, Jahan AA, Zaman UKS, Rahman N, Rahman
S. Reproductive health problems among the adolescent girls. Bangladesh
Medical Journal 2010; 39(2): 22-25.
13. Bangladesh Bureau of statistics. Statistical pocket book. Dhaka 1999;
384-404.
14. Maumder PP, Begum A. Policy Research Report on Gender and
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et al. Menstrual pattern and growth of school girls in Mumbai. The
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on Needs Assessment on Reproductive Health Information and care
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18. Singh MM, Devi R, Gupta SS. Awareness and health seeking
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67

Sir Salimullah Medical College


Department of Community Medicine
Patten of reproductive health problems & awareness among
adolescent female in a selected rural area
I am a student of 4th year MBBS class of Sir Salimullah Medical college,
Dhaka. I require some information regarding above mentioned topic. I
would be grateful if you co-operate me by providing me the necessary
information. All information given by you will be kept confidential and
exclusively used for research/academic purpose.

Questionnaire
ID No.:
Village: .. Union: Upazila: Keranigonj

1.Name of the respondent:


2.Age of the respondent (In complete years):
3.Religion:
a. Islam b. Hinduism c. Christianity d. Buddhism
4. Level of education of the respondent:
a. Illiterate b. Primary passed c. Secondary attended d. Secondary passed
e. Higher secondary f. Others (please specify)
5. Type of family:
a. Nuclear family b. Joint/extended family

68

6. Number of the family members:


7. Occupation of the father:
a. Farmer b. Day laborer c. Rickshaw/van puller d. Service holder
e. Businessmen f. Others (please specify)
8. Monthly family income (In taka):
9. Housing condition:
a. Kacha b. Pacca c. Semi-pacca d. Others (please specify)
10. What was the age if your first initiation of menstruation:
11. Marital status:
a. Married b. Unmarried c. Others (please specify)
12. What do you use during menstruation? :
a. Sanitary napkins b. Old clothes c. Cotton d. Others (please specify)
13. Do you re use your pad/ cloth / cotton:
a. yes b. no
14. If yes, how do you clean your pad/ cloth:
a. water only b. soap c. soap & savlon d. Others (please specify)
15.Do you know about normal menstrual cycle?
a. Yes b. No
16. If yes, what is the length?
a. Less than 28 days b. More than 28 days c. Others (please specify)
17. Do you know about the duration of normal menstrual period?
a. Yes b. No
18. If yes, what is the duration?
a. 1 to 3 days b. 1to 5 days c. 1to 7 days d. Others (please specify)
19.Do you know, what are the problems that may arise during
menstruation?
a. Yes b. No

69

20. If yes, what are those?


a. Scanty bleeding b. Excessive bleeding c. Painful bleeding d. Others
(please specify)
21. Do you know the other problem may arise except menstrual
abnormality?
a. Yes b. No
22. If yes, what are those?
a. Whitish discharge b. Itching c. Redness
d. Swelling e. Others (please specify)
23. From whom did you know about reproductive health related
information?
a. Mother b. Elder sister c. Friends d. Relatives e. Others (please specify)
24. Do you have any reproductive health problem?
a. Yes b. No
25. If yes, what are those?
a. Scanty bleeding b. excessive bleeding c. whitish discharge d. Itching
e. Others (please specify)
26.Did you consult regarding your problem with others?
a. Yes b. No
27. If yes, whom did you consult?
a. Mother b. Elder sister c. Friends d. Relatives e. Doctor f. Others
(please specify)
28. If not, why?
a. Its normal b. Felt shy c. Not seriously thought about it d. Others
(please specify)

70

29. What measures you think should be taken for prevention of


reproductive health problem?
a. Hygiene practice b. Education c. Medical advice d. Others (please
specify)

Thank you for your kind co-operation

Date:

...
Name and signature of the interviewer
Roll No.