CHAPTER ONE

INTRODUCTION

1.1 Background of Study

This study is carried out to determine the factors influencing the menstrual hygiene practices

among adolescent girls in Queen elizabeth secondary school in Ilorin.

Adolescence is a transitional phase of physical and physiological development. During puberty

in girls, it signifies the transition from girlhood to womanhood and has been recognized as a

special period in life cycle which is marked with onset of menarche. (Budhathoki, Bhattachan,

Castro- Sanchez, Sagtani, Rayamajhi., 2018)

The World Health Organization, WHO, (2018) referred the age range of person between 10- 24

years as young people and define adolescence as the age group of 10-19 years. Adolescent girls

constitute about 1/6th of total female population in the world. It was estimated that over 30

million Nigerians are between the ages of 10-19 years and nearly one third of Nigeria’s

population is between the ages of 10-24 years i.e. about 50 million people. In these societies the

term adolescence typically refers to the period between ages 12-20 and is roughly equivalent to

the word TEEN. (WHO, 2018)

Adolescent girls constitute a vulnerable group that requires specific and special attention.

(Kumari, Sheoran &Siddiqui, 2018) Adolescence stage is a significant stage that needs adequate

information prior the stage as menstruation is one of the main events that occurs in this stage.

(Budhathoki, Bhattachan, 2018)

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Menstruation is a normal physiological process that occurs in females during their reproductive

age from adolescence stage till menopause. It is the regular discharge of blood and mucosal

tissue (menses) from the inner lining of the uterus through the vagina that normally lasts for 3-5

days and occasionally up to 7 days (Kaur, Kaur & Kaur, 2018).

Menstruation necessitates the availability of material resources to absorb or pack menstrual

blood then ensure personal hygiene and dispose of waste in appropriate place with adequate

privacy. The materials used as adsorbents during menstruation in low income countries including

Nigeria, vary from reusable clothes torn from dresses of women to commercial disposable

sanitary pads (Budhathoki, Bhattachan, 2018). Menstruation can predispose women to life

threatening RTI (Reproductive Tract Infection) if hygiene is not maintained. (Tundia & Thakrar,

2018)

Menstrual hygiene practices is described as a process where women and adolescent girls uses a

clean absorbable materials to take in blood and can be changed in privacy as often as necessary

for the duration of menstruation period, using soap and water for washing their bodies as

required and have access to facilities to dispose the used material (Salau, 2018).

There is a need for menstruating girls to have adequate menstrual hygiene practices and is crucial

for their health, education, and dignity of girls. Poor personal hygiene and unsafe sanitary

conditions mostly result in gynecological problems. Menstrual hygiene management is practiced

differently in accordance with cultural, social, educational and economic status of the community

(Azage, Ejigu & Mulugeta, 2018). Millions of women suffer from RTI (Reproductive Tract

Infection) and its complications even leading to the infection being transmitted to the offspring

from the pregnant mother. Women and girls who have better knowledge regarding menstrual

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hygiene practices are less vulnerable to RTI and its consequences. Therefore, increased

knowledge about menstruation right from childhood may increase safe practices and may help in

reducing the suffering of millions of women. Hence, the need for this study.

1.2 Statement of the problem

Globally, over 500 million women and girls lack adequate knowledge, facilities such as

Inadequate water, sanitation, and hygiene facilities, mainly in public places, includes school,

workplace for menstrual hygiene management and create major challenges to women and girls.

In Nigeria, 25 percent of women lack washing facilities and adequate privacy for menstrual

hygiene management. (Salau, 2018)

Menstrual hygiene practices may be unhygienic and inconvenient, particularly in resource-

constrained settings, with poor facilities (water, sanitation and hygiene (WASH)) access, and

have been found associated with different reproductive tract infections such as bacterial

vaginosis, vulvo- candidiasis and with psychosocial stress outcomes.

Reproductive tract infections are global major public health concern as it has adverse effect on

pregnancy outcomes such as preterm birth, acquisition of sexually transmitted infections and

development of pelvic inflammatory diseases and are particularly common in the low- income

settings. There is a report that girls with higher socio economic status generally had both safer

menstrual hygiene practices and fewer gynecological problems regarding menstrual hygiene.

(Torondel, Sinha, Mohanty, Swain, Sahoo, Panda,2018)

Anecdotal reports suggest that most adolescent girls have little knowledge about menstrual

hygiene prior the onset of menstruation and they are in their early stage of life they practice poor

3
menstrual hygiene and for these reasons the researcher chose to determine the factors influencing

menstrual hygiene practices among adolescent girls attending Queen Elizbeth secondary school

in Ilorin.

So, this study was intended to provide details information on practices of menstrual hygiene

regarding reusable pads for those that can’t afford disposable sanitary pads and how frequent

they will be changing the pads to prevent any form of related complications faced by adolescent

girls if menstrual hygiene is not properly practiced and method of disposing used materials

1.3 Objectives

The General Objective of the Study is to determine the factors influencing the menstrual hygiene

practices among adolescent girls in Queen elizabeth secondary school, Ilorin.

The Specific Objectives of This Study are:

1. To assess the knowledge on menstrual hygiene among the adolescent girls in Queen

elizabeth secondary school in Ilorin.

2. To assess the extent at which adolescent girls in Queen elizabeth secondary school in

Ilorin practice menstrual hygiene.

3. To identify the factors influencing the menstrual hygiene practices at home among

adolescent girls in Queen elizabeth secondary school in Ilorin.

4. To identify the factors influencing the menstrual hygiene practices at school among

adolescent girls in Queen elizabeth secondary school in Ilorin.

1.4 Research Questions

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1. What is the level of knowledge of adolescent girls in Queen elizabeth Secondary School in

Ilorin on menstrual hygiene?

2. To what extent do the adolescent girls in Queen elizabeth secondary school in Ilorin practice

menstrual hygiene?

3. What are the factors influencing the menstrual hygiene practices at home among adolescent

girls in Queen elizabeth secondary school in Ilorin?

4. What are the factors influencing the menstrual hygiene practices at school among adolescent

girls in Queen elizabeth in secondary school in Ilorin?

1.5 Research Hypothesis

 There is no significant relationship between knowledge of respondents regarding

menstrual hygiene and their practice

 There is no significant relationship between age of respondents and their menstrual

hygiene practices

 There is no significant relationship between religion of respondents and their menstrual

hygiene practices.

1.6 Significance of the study

The research will provide useful information regarding menstrual hygiene to the adolescent girls

and women of child bearing age. Consequently the information may form the basis for possible

intervention programs towards improvement of menstrual hygiene practices among adolescent

girls.

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This study will also help the health workers especially nurse to plan program on menstrual

hygiene practices.

The study will serve as resource material for future referencing for researcher on related study.

Hence, this study will add to the body of knowledge on the issue of inappropriate menstrual

hygiene practices among adolescent girls and women of child bearing age. Other researchers

interested on this study can build on these findings for a more full-bodied research.

1.7 Scope of the Study

The study is limited to determine the factors influencing the menstrual hygiene practices among

in- school adolescent girls in Queen elizabeth secondary school in Ilorin.

1.8 Operational Definition of Terms

Factors: These are situations or things that control the menstrual hygiene practices

Adolescent girl: This is the female student between the age 11 to 20 that attends Queen elizabeth

secondary school in Ilorin west.

Menstrual hygiene: This is the ability to practice safe and clean act during menstruation

Sanitary pad: Is a commercial absorbable material used by menstruating females to prevent

being stained by the menstrual blood.

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7
 CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This chapter discusses the conceptual review, concept of practice, concept of adolescents,

concept of adolescence, concept of menstrual hygiene, empirical review on knowledge of

menstrual hygiene, practices of menstrual hygiene and factors influencing menstrual hygiene

practices and theoretical framework.

2.1 Conceptual review

Knowledge is an abstract concept without any reference to the tangible world. It is a very

powerful concept, yet it has no clear definition so far. From the Greek philosophers up to present

experts in knowledge management, people tried to define knowledge but the results are still very

unclear. According to Bolisani & Bratianu, (2018) Definition of knowledge incorporates three

basic conditions, fact for which some authors call it the tripartite account of knowledge. These

conditions are:

The Truth Condition: It requires that if one knows a proposition then that proposition must be

true. If the proposition is not true, then that person does not know what he claims to know. The

truth condition makes the difference between opinion and knowledge.

The Belief Condition: This condition demands that if one knows a proposition then he believes

that proposition.

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The Justification Condition: This condition requires a practical way of justifying that the belief

one has is true.

Putting together these conditions for knowing, one may conclude that “the necessary and

sufficient conditions for knowing something is this case are; first that what one is said to know to

be true, secondly that one be sure of it, and thirdly that one should have the right to be sure”.

2.2 Concept of practices

According to Merriam Webster, (2018) practice is the act of performing regular activities as part

of life. This is the regular way of doing something with the use of an idea, belief or method

individual has.

2.3 Concept of Adolescence

According to WHO, (2019) Adolescence is a transitional phase of growth and development

between childhood and adulthood. And is defines as person between ages of 10 and 19.

According to American Academics of pediatrics, AAP, (2019) Adolescence is divided into 3 age

groups – early (ages 11-14), middle (ages 15-17) and late (ages 18-21)

2.3.1 Characteristics of Adolescents

According to Stanford Children Health, (2019) Sexual and other physical maturation that occurs

during puberty is a result of hormonal changes.

In boys, it is difficult to know exactly when puberty is coming. There are changes that occur, but

they occur gradually and over a period of time, rather than as a single event. While each male

adolescent is different, the following are average ages when puberty changes may occur:

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  Beginning of puberty at 10 to 14 years old.

 First pubertal change: enlargement of the testicles.

 Penis enlargement: begins approximately 1 year after the testicles begin enlarging.

 Appearance of pubic hair at 13.5 years old.

 Nocturnal emissions (or "wet dreams") at 14 years old.

 Hair under the arms and on the face, voice change, and acne at 15 years old.

Girls also experience puberty as a sequence of events, but their pubertal changes usually begin

before boys of the same age. Each girl is different and may progress through these changes

differently. The following are average ages when puberty changes may occur:

 Beginning of puberty at 8 to 13 years.

 First pubertal change: breast development.

 Pubic hair development: shortly after breast development.

 Hair under the arms at 12 years old.

 Menstrual periods at 10 to 16.5 years old.

According to Stanford Children Health, (2019) There are specific stages of development that

both boys and girls go through when developing secondary sexual characteristics (the physical

characteristics of males and females that are not involved in reproduction such as voice changes,

body shape, pubic hair distribution, and facial hair). The following is a brief overview of the

changes that occur:

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  In boys, the initial puberty change is the enlargement of the scrotum and testes. At this

point, the penis does not enlarge. Then, as the testes and scrotum continue to enlarge, the

penis gets longer. Next, the penis will continue to grow in both size and length.

 In girls, the initial puberty change is the development of breast buds, in which the breast

and nipple elevate. The areola (dark area of skin that surrounds the nipple of the breast)

increases in size at this time. The breasts then continue to enlarge. Eventually, the nipples

and the areolas will elevate again, forming another projection on the breasts. At the adult

state, only the nipple remains elevated above the rest of the breast tissue.

 Pubic hair development is similar for both girls and boys. The initial growth of hair

produces long, soft hair that is only in a small area around the genitals. This hair then

becomes darker and coarser as it continues to spread. The pubic hair eventually looks like

adult hair, but in a smaller area. It may spread to the thighs and, sometimes, up the

stomach. (Stanford Children Health, 2019)

2.4 Concept of Menstrual Hygiene

2.4.1 Menstruation and menstrual cycle

Menstruation is an important biological process that occurs when blood and tissue from the

uterus comes out of the vagina. It happens every month. Menstrual cycle is the period at which

the uterus undergoes changes under the influence of hormones such as follicle stimulating

hormone, luteinizing hormones estrogen and progesterone. The length of menstrual cycles varies

from 21- 35 days with average of 28 days. Some women are regular while other women may find

their cycles frequently change. There are medical condition such as polycystic ovarian syndrome

and thyroid conditions which can cause fluctuation in cycle lengths. (Gray, 2019)

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According to Thiyagarajan, Basit & Jeanmonod, (2019) Phases involve in menstrual cycle

includes the following:

PHASE 1: This is the follicular or proliferative phase. It occurs from day 0 to day 14 of

menstrual cycle, based on the average of 28 days cycle. The main hormone during this phase is

estrogen. There is release of follicle stimulating hormone which act on the primordial follicles

for their maturation to graafian follicle whereby the developing ova response by releasing

estrogen. The increase of estrogen occurs by regulation of follicle stimulating hormone receptors

within the follicle at the beginning of this phase. The estrogen function in the growth of the

endometrial lining of the uterus to create environmental that is helpful for fertilized ovum. The

surrounding follicles begins to degenerate which is when the graafian follicle becomes mature

follicle and is set up for ovulation. Ovulation is the release of matured ovum, it occurs at 14th

day of menstrual cycle.

PHASE 2: This is luteal or secretive phase. This occurs from 14- 28 days of the cycle. There is

release of luteinizing hormone that act on the corpus luteum. After ovulation there is corpus

luteum formed in the ovary at the site of mature follicle rupture to produce progesterone, which

is predominate at the end of the phase due to negative feedback system. The endometrial

prepares by increasing its vascular supply and stimulating more mucous secretions. Contrary to

the cervical mucous changes seen during the proliferative phase and ovulation, progesterone

decreases and thicken the cervical mucous making it non elastic. However if no fertilization

occurs then the corpus luteum regresses.

PHASE 3: This is menstrual phase. When the hormone levels decrease, the endometrium layer

sheds and the menstrual bleeding involve the sloughing of the endometrial lining and the blood.

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2.4.2 Menstrual Hygiene

Menstrual hygiene occurs when women and adolescent girls are using clean absorbable materials

to take in or collect blood that can be changed in privacy as often as necessary for the duration of

the menstruation period, using clean water to wash the vaginal and soap and water for washing

the body as required, having access to facilities to dispose used menstrual management materials.

(Sommer, 2018)

Essential Components of Menstrual Hygiene includes; Information & Support, materials &

Supplies, Facilities (Toilets with water, bathing & laundering/drying spaces) and Disposal &

Waste Management.

2.4.3 Source of information for Adolescent girls regarding Menstrual Hygiene

Mothers were most often reported as the first and main source of information. Sisters and peers

were the next most common sources. Nearly all studies reporting on teachers and health

professionals reported them as the least common source (Egypt, Ghana, India, Jordan, Malaysia,

Nepal, Nigeria, Sri Lanka, and Turkey). Some girls have access to media and the Internet.

2.4.4 Types of Absorbents used during Menstruation

The preference of sanitary material is based on personal choice, cultural acceptability, economic

status, and availability in the market. Also availability basic sanitation facilities, one should be

also provided with soap and water and menstrual absorbents to manage menstruation hygiene.

(Kaur et. al, 2018) The choice of absorbents varies among rural and urban women and girls. In

rural areas, the most preferred absorbents are reusable cloth pads and in urban areas women

prefer to use commercial sanitary pads. There are:

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 COMMERCIAL SANITARY PADS: These are rectangular hygiene absorbent products

that are preferred by women on light-flow days or when spotting is present. The absorbent

pad is the most important component of a sanitary napkin, which is made of wood pulp

mixed with super absorbent polymers for enhancing fluid holding capacity (Meštrović,

2019). They are easily available at many stores, chemist shops, or online. They are

expensive compared to cloth pads, non reusable, and not very environment-friendly. The

cotton used in their making is not 100% natural and may contain pesticides. (Kaur 2018)

 REUSABLE AND WASHABLE CLOTH PADS: These cloth pads are reusable so they

are cost-effective, easily available, and are economic friendly. (Kaur et. al, 2018) They

may be sustainable sanitary option but must be hygienically washed and dried in the

sunlight. The sun’s heat is a natural sterilizer and drying the cloths/cloth pads under it

sterilizes them for future use it can also be ironed (Meštrović, 2019). They also need to be

stored in a clean dry place for reuse to avoid contamination.

 TAMPONS: They are the type of absorbent that provides internal protection. They are

kind of plugging of soft material (cotton) which is inserted into the vagina to absorb the

menstrual flow before it leaves the body. They are expensive, not easily degradable in

nature and, hence, not very environmental friendly. Nowadays, sea sponge tampons are

available in the market which is a natural alternative to synthetic tampons.

(Kaur,kaur,Kaur,2018)

 REUSABLE TAMPONS: Tampons absorb the menstrual fluid inside the body (vagina)

after it has left the uterus, thus offering very discreet protection. They are mainly

composed of rayon or cotton cellulosic absorbent material, or a mixture of these fibers

(Meštrović, 2019).These are washable tampons made up of natural materials like bamboo,

14
 wool, cotton, or hemp. They are also knitted or crocheted using the natural absorbent

material like cotton or wool. They are inserted into the vagina to absorb menstrual flow

same as the disposable tampons. (Kaur,Kaur,Kaur, 2018)

 MENSTRUAL CUPS: Menstrual cups are small, flexible items worn inside the vagina

that capture the menstrual fluids during menstruation (Meštrović, 2019). They may be a

new technology for poor women and girls and an alternative to sanitary pads and tampons.

They are like cups made of medical grade silicone rubber which makes the cup easy to

fold and get inserted into the vagina to collect menstrual blood. They can be worn up to 6–

12 hours depending upon the amount of menstrual flow, so it needs to be removed and

emptied less frequently. They are reusable and environment-friendly. It offers sustainable,

practical, and cost-effective alternative where sanitation conditions are not good.

(Kaur,kaur,Kaur,2018)

2.4.5 Tips to maintain Menstrual Hygiene

According to Satpathy, (2019) Nigeria still has a long way to go as several thousand women

still use cloths, reusable pads other unsanitary substances during their periods. Even the use of

sanitary pad requires proper personal hygiene to prevent any complications as it affect their

health. Here are some tips every woman should follow to maintain menstrual hygiene practices:

CHANGE PADS EVERY FOUR HOURS: Change sanitary napkins or tampons every 4-6

hours to reduce the chance of having irritation, rashes or urinary tract infections. (Srivastava,

2019) If sanitary pad is used to soak the flow during your periods, remember to change it often.

Ideally, changing it every four hours is good. If not every day, do this on the first two days when

the flow is heavier. On other days too, don’t wear the same pad for more than eight hours.

(Satpathy, 2019)

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CLEAN REUSABLE PADS PROPERLY: There are sanitary napkins that can be reused for

several menstrual cycles. If used ensure that you clean them thoroughly after every use so that

they are free from germs. (Srivastava, 2019)

KEEP YOUR VAGINAL AREA CLEAN: It is important to keep vagina and the surroundings

clean especially during periods. The vagina also has a self-cleaning mechanism. Wash your

vagina regularly with lukewarm water to avoid organisms clinging to your body after you have

removed your sanitary napkin or tampon. (Srivastava, 2019) Don't use vagina hygiene products

during menses as during these days the self-cleaning mechanism of the vagina activates and

these artificial hygiene products can hamper the natural process, leading to infections and growth

of bacteria.

NEVER USE TWO PADS SIMULTANEOUSLY: Fix to one method of sanitation. Using

tampons and sanitary napkins, or two sanitary napkins simultaneously may keep you dry and

stain free but can cause severe infections. (Srivastava, 2019) No, two is not better than one.

Some women who experience heavy flow and tend to use two sanitary pads at one go to control

the flow and prevent staining of clothes. This, however, is a bad idea as it can cause infections in

the vaginal region. Stick to one and keep changing it often if the flow is more. ( Satpathy, 2019)

WEAR COMFORTABLE, CLEAN UNDERWEAR: While changing your sanitary pad is

essential, it is also important to wear something comfortable during these days. Tight thongs or

underwear made of fabric that doesn’t allow your skin to breathe will also lead to infections.

Stick to clean and comfortable cotton underwear that do not stick to your skin.

HAVE A BATH REGULARLY DURING YOUR MENSES: To get relief from those monster

backaches and cramps.

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WASH YOUR HANDS BEFORE AND AFTER CHANGING YOUR PAD, TAMPON, OR

CUP: To ensure maximum cleanliness as your hands come in contact with all kinds of stuff

throughout the day.

2.4.6 Menstrual Waste Disposal Techniques Used By Girls and Women

The menstrual material used was disposed according to the type of product, cultural beliefs and

location of disposal such as urban and rural area. (Kaur,Kaur,Kaur, 2018)

Appropriate disposal of used menstrual material is still lacking in many countries of the world

especially developing countries. Most of the countries have urbanized techniques to manage their

fecal and urinary wastes but lack of menstrual management practices in the world which make

most of the women to dispose their sanitary pads or other menstrual articles into domestic solid

wastes Bins even sewage system. Most Toilets facilities in schools, work places lack Bins for the

disposal of sanitary pads and hand washing facilities for menstruating girls and women to handle

menstrual hygiene. (Kaur,Kaur,Kaur, 2018)

In urban areas, where modern disposable menstrual products are used they dispose of them by

flushing in Toilets and throwing in dustbins or through solid waste management, while In rural

areas, mostly women use reusable and noncommercial sanitary materials like reusable pads or

cloths. Thus, they generate lesser amount of menstrual waste as compared to women in urban

areas who rely on commercial disposable pads. There are many options for disposing menstrual

waste such as by burying, burning, and throwing in garbage or in pit latrines.

In schools, due to lack of sanitary facilities, girls throw their pads in Toilet. In some cases, girls

threw away their used menstrual clothes without washing them. Also many were reported being

absent from school due to lack of disposal system, broken lock/doors of Toilet, lack of water tap,
17
bucket, and poor water supply. In some schools, incinerators or “feminine hygiene Bins” are

used for disposing menstrual waste material but due to shyness or fear of being seen by others

they refrained from using it.

2.4.7 The behavior of women regarding disposal is different when being at home and away

from home.

At home, they dispose the waste by wrapping and throwing in the dustbin along with other

domestic waste. In public places, prior to having knowledge about the consequences of flushing

the pads, they flush them in the Toilets or wrap and throw them in the dustbins. Where dustbins

are not placed they leave the soiled pads wrapped or unwrapped in the Toilets corners. This

makes the Toilets dirty, breeding place for flies and mosquitoes, and also unhygienic for other

Toilets users and cleaners. In many cities, the persons who manage the public Toilets always

complain of blockage of sewage system because of flushing of sanitary pads or rags in the

Toilets. (Kaur,Kaur,Kaur., 2018)

2.4.8 Consequences of Inappropriate Menstrual Waste Disposal

According to Womena, (2019) one estimate is that menstrual products form around 6.3% of the

sewage-related debris along rivers and beaches. In the European Union, plastics in products like

tampons and pads were among the five most commonly found items in marine debris. One

estimate is that 252 million menstrual pads will clog European seas and beaches by 2030.

These absorption materials clog the gutter pipelines as they are unable to pass through and cause

backflow of the system. Materials like tampons, cotton wool, Toilets paper, and other organic

materials used for menstrual management might be decomposed in pit latrines except the plastic

18
inlay of the commercial sanitary pads. Sanitary napkins might decompose over a period of about

one year except its plastic lining in on-site sanitation.

In rural areas, pit latrines once full they were covered with soil and new pit was dug but due to

space limitations this was not practiced in urban areas. It was reported that some women and

girls wrap their used menstrual cloths and packs in polythene bags before disposing in pit latrines

which prevents them from decomposition.

Nowadays, mostly women/girls prefer commercial sanitary pads and tampons which are made up

of super absorptive materials like polyacrylate. Disposable menstrual pads and tampons made

from super absorbent polymers (SAP) cause problems because they swell up once they are

saturated with fluid and when flushed down the Toilets can block pipes Moreover, when

disposed of, used menstrual products are often wrapped in plastic which further reduces

decomposition. (Womena, 2019).

Sanitary products soaked with blood of an infected women/girl may contain hepatitis and HIV

viruses which retain their infectivity in soil and live up to six months in soil. The clogged

drainage with napkins has to be unblocked and cleaned manually by conservancy workers with

their bare hands without proper protection and tools. This exposes the workers to harmful

chemicals and pathogens. Incineration is a better technique to dispose of menstrual waste but

burning of pads releases harmful gasses that affects health and environment. (Kaur, et. al., 2018)

2.4.9 Role of School Authority and Teachers in Creating Awareness Regarding

Menstruation and Menstrual Waste Management

Teachers should make the school environment friendly to girl to handle menstruation with

dignity through sex education. It helps adolescents to discover their sexual identity, to protect

19
themselves from sexual abuse, unwanted pregnancies, and sexually transmitted diseases, and to

know physiological changes occurring in the body and how to take care of personal hygiene.

Sex education is often neglected from the school curriculum which have harmful impacts on the

student’s life in such that information about puberty, sexual intercourse, menstruation, and other

physiological changes in one’s body are getting from books, friends, and Internet which may be

imperfect or incorrect. Due to lack of knowledge and social interaction, teasing and taunting with

hurtful nicknames are common in schools and makes it difficult for a girl student to survive in

this environment, so they remain absent from school. . (Kaur,Kaur,Kaur,2018)

The teacher need to do proper education on how to avoid all sort of stain and the duration of

using one material related to the type of material use.

In some reported cases, parents do not allow girls to go to schools upon reaching puberty in fear

of sexual harassment by boys and male teachers in schools. To overcome these issues the

following should be done:

 Male teachers and employees in the schools and institutes should be well educated on

menstruation and menstrual hygiene management so that they support girls and women

by providing safe environment and privacy.

 Also committee of teachers including both male and females should be made in schools

to collect funds for providing sanitary napkins, soaps, water, and Toilets facilities in

schools so that girls manage their menstruation with ease and safety.

 Committee should also provide dustbins for menstrual waste disposal.

 Provision of separate Toilets for girls and boys with proper doors and locks should be

built in the schools.

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  Teachers should educate girls about menstrual health management and its link to their

health.

 They should also make girl students aware of how to dispose of used menstrual products

at home and in schools

 They should also let them know the consequences of throwing them in open or flushing

them in Toilets.

 Open discussions on puberty, sex education, menstruation, and the likes should be

organized by schools in every class to make students aware of it. And also it will solve

their uncertain queries by providing them correct knowledge, promote social interaction,

and also develop a trust relationship with fellow friends and teachers.

 School-level health policies should be made by school management committee to

promote and educate students regarding health and safety and ensure adequate water and

sanitation facilities.

 Protect female students and staff from bullying and sexual harassment. .

(Kaur,Kaur,Kaur, 2018)

2.4.10 Strategies for the Management of Menstrual Waste

Disposal of menstrual waste is of major concern as it affects health and environment. There is a

need for effective menstrual materials which is needed to be cost-effective and body pleasant.

Manufacturing companies of sanitary pads should disclose information on the pads regarding the

chemical composition of the pads so that appropriate technologies could be used for their

disposal and treatment. . (Kaur,Kaur,Kaur., 2018)

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The Toilets must be designed and built to be girl friendly for instance, In Kerala, some schools

have installed sanitary napkin vending machines in Toilets which are semiautomatic and operate

by inserting a coin in it. It contains 30–50 sanitary napkins to meet the emergency needs of the

girls/women in schools.

There should be a separate collection system for the menstrual wastes without affecting the

privacy and dignity of women. Also there should be sufficient space for washing, cleaning

private parts and hands and for changing or dealing with stained clothes through adequate water

availability, Toilets paper, dustbin, and a sink to wash menstrual products. Dustbins should be

covered by lid and emptied from time to time to keep the Toilets clean from flies, mosquitoes,

and bad odor. Covered containers and dustbins have advantage of hiding the waste being seen by

others. They are placed in a place that offers privacy. . (Kaur,Kaur,Kaur,2018)

Gloves and proper safety tools should be provided to the cleaners so that they are not exposed to

pathogenic organisms and harmful gasses.

Government should introduce new rules for the safe disposal and treatment of menstrual wastes,

Incinerator installed in the Toilets for easy sanitary products disposal. Appropriate policy and

legal framework is necessary for the management of menstrual wastes. Government and non-

Government organizations should come forward for making the people aware of management of

menstrual wastes. Government should give the funds to the Municipal Corporation or NGOs for

the construction of women friendly Toilets.

Financial support should be given to the institutions to carry out the research in the management

of menstrual wastes. Scientific research should be encouraged for the most suitable techniques of

disposal of sanitary pads or other menstrual products also allocation of budget in schools to

22
support menstrual hygiene management studies should be conducted. Collaborative efforts (trash

Bins) should be made.

2.4.11 Appropriate Ways of Disposing Menstrual Wastes

According to kaur,kaur,kaur (2018) the following are the appropriate ways of disposing

menstrual wastes.

 INCINERATORS: Incinerators are a better option for disposal when commercial sanitary

pads are used but should be operated in a controlled environment so that harmful gasses

emitted will not harm larger area. They should be operated at certain specific temperature

around 800∘ C so that they emit less harmful gasses. They should be installed in schools,

institutions, and slum areas and at community level

 LATRINES WITH CHUTES: These are special kind of Toilets in which a shoulder level

Chute was made in the usual deep pit. A chemical agent was added to the pit five times in

a month to enhance the decomposition process of used napkins.

 REUSABLE CLOTH PADS: Using these reusable cloth pads is a better option as they

have less chemical and plastic content. So they are easily decomposable as compared to

other commercial products.

 BIODEGRADABLE PRODUCTS: Commercial sanitary product manufacturing

companies must manufacture products having lesser chemical and plastic content. Pads

made from bamboo fibre, banana fibre, water hyacinth, and sea sponges should be

encouraged.

 CLAY OR CEMENTED INCINERATORS: Clay and cement incinerators used in Gujrat

villages by “Vatsalya Foundation” are a welcomed step in menstrual hygiene

management. A lady named “Swati” designed this incinerator and named it

23
 “Ashudhinashak” which burns many sanitary napkins at a time without creating any

smoke. This economic friendly and cheap innovation is appreciated by rural women who

find it difficulty in disposing them.

 BETTER DISPOSAL TECHNIQUES: Special covered Bins should be installed to handle

menstrual waste. Disposal bags should be provided by manufacturing companies with

color indication for disposing these products. These bags should be freely distributed

among schools and institutions. Menstrual waste should not be disposed of along with

domestic waste. Pads should be properly wrapped in newspaper and then thrown in the

dustbins. By this it should also be safe for rag pickers as it does not expose them to any

disease-causing pathogens.

2.5 Empirical Review

2.5.1 Knowledge on Menstrual Hygiene

A descriptive survey was conducted on knowledge and practice of menstrual hygiene among 150

adolescent girls residing in selected orphanages of Haryan, which showed that more than half of

adolescent girls (62.7%) were in age group of 12-15 year. half (50.7%) of adolescent girls had

age of menarche at 12 year. only 16% adolescent girls had good knowledge regarding menstrual

hygiene. 95.3% were using sanitary pad during menstruation. This finding showed that

adolescent girls had poor knowledge of menstruation and menstrual hygiene. (Kumari, Sheoran

& Siddiqui, 2018)

This cross-sectional study on knowledge, attitude, and practice on menstrual hygiene

management among school adolescents in Doti district, Nepal was carried out by Yadav, Joshi,

Poudel & PPandeya, (2017). This study was done among 276 students from grade seven and

24
eight of 11 schools. The study showed that 67.4% respondents had fair knowledge and 26.4%

respondents had good knowledge on menstrual hygiene management. However, out of 141

female adolescent respondents, only 56 (40%) were engaged in good menstrual hygiene

practices. Around half of the respondents had positive attitude towards menstrual hygiene

management related issues and concluded that knowledge on menstrual hygiene management

among school adolescents is fair, still attitude and practice need to improve.

2.5.2 Practice on menstrual hygiene

A community based, cross sectional study was conducted on menstrual attitude and practices

among 150 adolescent girls in tribal area of faqeergujari, district Srinagar and the study showed

that (83.9%) of study participants use cloth as an absorbent during menstruation and (78.2%)

reuse it in subsequent periods. Only 16.3% of participants took bath during menstruation and

93.3% of participants miss school during periods. (Nelofar, Choudhary & Masoodi, 2018) This

concluded that the knowledge and practice of menstrual hygiene is low. Awareness regarding the

need for information about good menstrual practices is very important. Menstrual hygiene is an

issue needs to be addressed at all levels.

A cross-sectional study was conducted in the rural field practice area of the Department of

Community Medicine, Andhra Medical College, Visakhapatnam among 400 high school

adolescent girls who had attained menarche and were present in the schools during the days of

survey by Madhavi & Paruvu (2019) shows that Mean age of study participants was 14.2yrs

±1.05. About 206 (48.4%) knew about menstrual cycle before their menarche. Majority of study

participants (78.3%) used sanitary pad as protective material. Regarding hygienic practices

during menstruation 78.8% had daily bath. Awareness before menarche was still poor in rural

areas but the practices is still fair.

25
2.5.3 Factors Influencing Menstrual Hygiene Practices

A cross sectional study was carried out in two schools of Udaipur on menstrual hygiene practices

and problems among 440 adolescence girls by Tundia & Thakrar, (2018). The study revealed

that 68.41% girls gave history of abdominal pain as premenstrual symptoms (PMS). School

absenteeism was found 44.54% due to menstruation related problems. Sanitary Napkins were

used by 50.22% girls. And 66.54% girls were using water to clean genitals during menstruation.

Restriction from attending religious functions was high (91.59%). Associations of absorbents

used by participants with absorbents used by their mothers and sisters were statistically

significant.

An explorative study design was conducted by Lahme, Stern & Cooper (2018) with 51

respondents, aged 13–20 years, from three secondary schools. Their age at menarche was 11–15

on factors impacting on menstrual hygiene and their implications for health promotion revealed

that the girls suffer from poor menstrual hygiene, originating from lack of knowledge, culture

and tradition, and socio-economic and environmental constraints, leading to inconveniences,

humiliation and stress. This leads to reduced school attendance and poor academic performance,

or even drop outs, and ultimately infringes upon the girls’ human rights.

A community based comparative cross-sectional study design was employed in urban and rural

kebeles of Bahir Dar city administration. By Azage, Ejigu, &Mulugeta, (2018) revealed that Safe

Menstrual Hygiene Management practice was 24.5% and did not show significant variation

between urban and rural adolescent girls. However, significantly higher numbers of adolescent

girls in the urban area used sanitary pads than the rural adolescent girls. Being older, attending

formal education and educational status of participants’ mother were factors associated with safe

MHM practice.

26
2.6 Theoretical Framework

2.6.1 Health Belief Model

The Health Belief Model (HBM) is one of the first theories of health behavior. It was developed

in the 1950s by a group of U.S public Health service social psychologists in order to understand

the failure of people to adopt disease prevention strategies or screening tests for early detection

of diseases. Later uses HBM were patients’ responses to symptoms and compliance with medical

treatments. (Lamorte, 2018)

HBM is derived from psychological and behavioral theory with the foundation that the two

components of health related behavior are: the desire to avoid illness, or conversely get well if

already ill and the belief that a specific health action will prevent, or cure, illness. Ultimately, the

individual’s course of action often depends on the person’ perceptions of the benefits and

barriers related to health behavior. There are six construct of the HBM. The first four constructs

were developed as original tenets of HBM. The last two were added as research about the HBM

evolved. (Lamorte, 2018)

 Perceived Susceptibility

 Perceived severity

 Perceived benefit

 Modifying variables

 Cue to action

 Self-efficacy

HBM is popular model applied in nursing especially in issues focusing on patient compliance

and preventive health care practices. It postulate health seeking behavior is influenced by the

27
person’s perception of a threat posed by the health problem and the value associated with actions

aimed at reducing the threat. It addresses the relationship between a person’s behavior and belief.

It provides a way to understanding and predicting how clients will behave in relation to their

health and how they comply with health care therapies.

The major concepts of Health Belief Model are:

 Perceived susceptibility: refers to patient perception that a health problem is personally

relevant or that a diagnosis of illness is accurate. This means people will not change their

behavior unless they believe that they are at risk. There is wide variation in a person’s

feelings of personal vulnerability to an illness or diseases. (Lamorte, 2018)

 Perceived severity: even when one recognizes personal susceptibility, action will not

occur unless the individual perceives the severity to be high enough to have serious

organic or social complications. Meaning there will be increase probability of changing

their behavior when they are aware of the severity of the disease.

 Perceived benefits: refers to the patient’s belief that a given treatment will cure the illness

or help to prevent it. That is, is difficult to convince people to change a behavior if there

isn’t something in it for them.

 Perceived barriers: refers to the complexity, duration and accessibility and accessibility of

the treatment. One of the major reason people don’t changes their health behavior is that

they think that doing it is going to be hard. Sometimes it’s not just a matter of physical

difficulty as well. Changing your health behavior can cost effort, money, and time.

 Cues to action or motivation: the external events that prompt a desire to make a health

change. A cue to action is something that helps to move someone from wanting to make a

28
 health change to actually making the change. It includes the desire to comply with the

treatment and belief that people should do what.

 Modifying variables: individual characteristics, including demographic, psychosocial,

and structural variables, can affect perceptions (perceived seriousness, susceptibility,

benefits and barriers) of health related behaviors. Demographic variables includes: age,

sex, race, ethnicity and education among others.

Self efficacy: this refers to the level of a person’s confidence in his or her ability to successfully

perform a behavior. It directly relates to whether a person performs the desired behavior. This

construct was added to the model most recently in mid 1980

Individual Modifying factors Likely hood of

perception action

Demographic factor
Perceived benefits
Age, sex, ethnicity,
versus
socio economics
Perceived barriers

Perceived
severity/
Perceived Perceived threat of
disease Likelihood of
susceptibility
behavioral changes

Cues to action
Education
symptoms
Perceived
media information
efficacy

Figure 2.1: Health belief model

29
2.6.2 Application of the Model

The health belief model has been used to develop effective interventions to change health- belief

related behaviors by targeting various aspects of the health belief model of aim to increase

perceived susceptibility to and perceived seriousness of health condition by providing education

about prevalence and incidence of disease, individualized estimation of risk, and information

about the consequences of diseases (Wikipedia, 2019)

The model involves assessment of menstrual hygiene practices among adolescents, to identify

the factors (girls’ socio economic characteristics such as low socioecomic status and high socio

economic, level of education) influencing menstrual hygiene practices among adolescent girls

and the implication of inappropriate menstrual hygiene that may prone the girls to UTI, BV even

death. The cues to action are adequate knowledge on menstrual hygiene from teachers, health

personnel, friends, family and media and so on, which increase the likelihood that the girls will

take necessary action regarding menstrual hygiene practice to prevent the implication of

inappropriate menstrual hygiene practices.

Also if the perceived benefits is more than the barriers there would be likelihood that the

necessary action to assess the level of practices menstrual hygiene by the girls and initiate proper

menstrual hygiene practices will be taken by the girls to prevents the UTI, BV and complication

on pregnancy. In other word, the adolescence girls are likely to adopt positive health practice

such as to timely changing of soaked pad, proper securing of used pad before throwing away,

proper washing of vaginal (front to back) and hand after using Toilets with adequate soap and

water.

30
Furthermore interventions based on health belief model may provide cues to action to remind

and encourage Individual to engage in health- promoting behaviors. Intervention may also aim to

boost self- efficacy by providing training in specific health- promoting behaviors, particularly for

complex life style changes (frequent bathing, washing of reusable pads and spread under

sunlight). Intervention can be aimed at individual level to increase engagement in health-related

behaviors. (Wikipedia, 2019)

31
 CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Introduction
This chapter focused on the method adopted by the researcher to collect data and to solve

problems on the findings using the following headings: Research design, setting of the study,

Target population, sample and Sampling techniques, Instrument for data collection, Validity and

Reliability of the instrument, Method of data collections, Data analysis, Ethical consideration.

3.2 Research Design

A descriptive research design method was used to determine factors influencing menstrual

hygiene practices among adolescent girls attending Government secondary school Ilorin. This

method involves the collection of information concerning problems from the representative

sample of the group and based on the information collected, conclusions was drawn on the entire

population.(Bhat, 2019) This designed was considered most appropriate for this study because it

was useful to gather information from in-school adolescent girls in Ilorin on factors influencing

menstrual hygiene practices.

3.3 Research Setting

This study was conducted in Queen Elizabeth School Ilorin. It is a Government secondary school

located in Ilorin west local Government of Kwara State along Taiwo Oke road opposite old

general Hospital. This is the first female school in the Northern region. It was established in

1956. It is a full boarding school for girls only. It consist both the junior and senior secondary

school.

32
3.4 Target Population

The target populations for this study were the adolescent girls between ages 11 to 20 years

attending the Queen Elizabeth School, Ilorin.

3.5 Sampling

A sample size of the adolescent girls were selected using purposive sampling technique

Using Taro yamene's formula of sample size calculation

n= sample size

N = Target population ( 1,210)

e = Maximum difference between sample or level of error = 0.05

n= N÷1+N(e)2

n = 1,210÷1+1,210(0.05)2

n = 1,210÷1+1,210(0.0025)

n = 1,210 ÷1+3.03

n = 1,210÷4.03

n = 300.2

Sample size = 300.2

Approximately 300 questionnaires were administered to the adolescent girls in Queen Elizabeth

School Ilorin.

33
3.6 Sampling Techniques

Sampling technique was used to select in-school adolescent girls of Queen Elizabeth School

Ilorin, in which 300 girls were used for the study.

3.7 Instrument of Data Collection

The data for the study was collected using a structured questionnaire developed by the researcher

from variables in the literature reviewed for the literate ones. The questionnaire consists of 5

sections with a total of 36 question items. Section A contains demographic information of the

respondents, while section B contains information on the level of Knowledge about menstruation

and menstrual hygiene; section C contains question on menstrual hygiene practice. Section D

contains factors influencing the menstrual hygiene practices at home. Section E contains factors

influencing the menstrual hygiene practices at school.

3.8 Validity of the Instrument

Validity is the ability of an instrument to measure what it ought to measure. The face and content

validity of instruments was ensured by the researcher by giving the structured instruments to the

supervisor and other lecturers of the department for critique and suggestion. The suggestions was

effected accordingly to ensure this doesn’t result in being the point of view of the researcher

alone but also generalized.

3.9 Reliability of the Instrument

Reliability refers to the accuracy and consistency of information obtained in a study. To ensure

consistency of the instrument, a pre-test was conducted using 20 respondents attending

34
Government secondary school, Oke ose community. This category of respondents has similar

characteristics with the population of this study. After the test-retest, the instrument were further

refined.

3.10 Method of Data Collection

Data were collected using structured questionnaires. The researcher administered 300

questionnaires to adolescence girls in queen Elizabeth secondary school, Ilorin in a Conducive

environment, i.e class in order to achieve maximum co-operation and reliable responses also

adequate time was given to fill the questionnaire before collection. This serves as the primary

data. Secondary data was obtained from websites, journals, textbooks and other study relevant to

the study.

3.11 Method of Data Analysis

The completed questionnaire was collected and input into the computer using Statistical Product

for Service Solution (SPSS) version 22 for data analysis and results was presented using

descriptive statistics in form of table, percentage, pie chart and bar chart. Inferential statistics in

form of Chi square was used to test the hypotheses.

3.12 Ethical consideration

The researcher obtained a letter of introduction from the Department of Nursing Science which

was taken to the principal of the school to obtain a permission letter to conduct the research.

Information about the research was discussed in detail with the respondents; informed consent

35
was obtained from each participant. During the conduct of the research the following ethical

principles regarding each participant were respected:

Autonomy: The purpose of the research and the extent to which the participants will be involved

in the research was explained to all participants. Written informed consent was obtained from

willing participant before their participation in the study. Their participation was made voluntary.

No one was deceived or coerced to participate in the study. Besides, withdrawal from the study

at any stage will be allowed without any form of discrimination

Confidentiality: Information provided by the participant was made confidential. Thus,

participants’ names were not required while filling the questionnaires. The identities of the

respondents were not disclosed during report and article publication.

Beneficence: The findings of the study were based on reducing complication that may arise from

inappropriate menstrual hygiene practices.

Non- maleficience: This study did not employ any invasive procedure and the identities of the

respondent. Each participant was protected from physical harm and unnecessary psychological

trauma or embarrassment. No one was harmed during the period of data collection. Question

items in the questionnaires were structured in such a way that protects the culture of the

participants.

36
 CHAPTER FOUR

DATA ANALYSIS

4.1 Introduction

This chapter presents the analysis of data obtained. Out of the 300 questionnaires administered to

respondents, 293 were retrieved and same was analyzed using Statistical Product Service

Solutions (SPSS) version 22. Details of the results obtained are presented in tables and charts

which are shown below and testing of hypotheses generated

Table 4.1: Socio- demographic characteristics of respondents (n=293)

Variable Responses Frequency Percentage

11-13 109 37.2

Age 14-16 162 55.3

X=14.56 17-19 22 7.5

Total 293 100.0

JSS 1-3 128 43.7

Class SSS 1-3 165 56.3

Total 293 100.0

Yoruba 223 76.1

Hausa 46 15.7

Ethnicity Nupe 10 3.4

Igbo 14 4.8

Total 293 100.0

37
 Muslim 232 79.2

Christian 46 15.7
Religion
Others 15 5.1

Total 293 100.0

Student 6 2.0

Housewife 39 13.3

Trader 121 41.3

Occupation status of the mother
Civil servant 98 33.4

Others 29 9.9

Total 293 100.0

Table 4.1 shows that 162 (56.0%) of the respondents were between 14-16years of age, 109

(37.2%) were between 11-13 years while 22 (18.0%) were between 17-19 years. 165 (56.3%) of

the respondents were in SSS 1-3 class while 128 (43.7%) of the respondents were in JSS 1-3

class. Majority of the respondents 223 (76.1%) were Yoruba, 46 (15.7%) were Hausa, 10 (3.4%)

were Nupe while 14 (4.8%) were Igbo. Most of the respondents 232 (79.2%) practiced Islam, 46

(15.7%) practiced Christianity while 15 (5.1%) of the respondents were of other religions. Most

of the respondents’ mothers were 121(41.3%) were traders, 98 (33.4%) were civil servants, 39

(13.3%) were full housewife, 29 (9.9%) belonged to other occupations, while the remaining 6

(2.0%) were students.

38
 Student
6.1%
Artisan Others
5.8% 13.7%

Trader
27.6%

Civil servant
46.8%

Figure 4.1: Occupational Status of Respondents’ mother

Figure 4.1 shows that more than half of the respondents’ mother were 137(46.8%) were Civil

servants, 81 (27.6%) were traders, 40 (13.7%) belonged to other occupations, 18 (6.1%) were

students, while the remaining17 (5.8%) were artisans.

Table 4.2: Respondents’ Menstrual History (n=293)

Variable Responses Frequency Percentage

Have you started menstruating YES 293 100.0

If yes, at what age 9 2 .7

X=12.68 10 8 2.7

SD=1.007 11 13 4.4

39
 12 104 35.5

13 99 33.8

14 67 22.9

Total 293 100.0

Heavy 43 14.7

How is your menstrual flow Valid Moderate 250 85.3

Total 293 100.0

Table 4.2 shows that all of the respondents 293 (100.0%) have started menstruating. Majority of

the respondents 102 (96.0%) attained menarche at the age of 12years, followed by 99 (33.8%)

who attained menarche at the age of 13years 67 (22.9%) attained menarche at the age of 14

years, 13 (4.4%) attained menarche at the age of 11years, 8 (2.7%) attained menarche at the age

of 10years while only 2 (0.7%) attained menarche at the age of 9years.Most of the respondents

250 (85.3%) had moderate menstrual flow while 43 (14.7%) had heavy menstrual flow.

Table 4.3: Respondents’ Knowledge on Menstrual Hygiene (n=293)

Variable Responses Frequency Percentage

Hormonal changes in the body 280 95.6

Menstruation is caused by
Infection 13 4.4

YES 273 93.2

Menstruation occurs every month
NO 20 6.8

Menstruation occurs in both male and YES 30 10.2

40
female NO 263 89.8

Uterus 88 30.0

Bladder 41 14.0
Source of menstrual blood
Abdomen 16 5.5

Don’t know 148 50.5

Did you hear about menstruation YES 287 98.0

before you start menstruating Valid NO 6 2.0

Healthcare personnel 10 3.4

Teacher 45 15.4
If yes, what is the source of
Mother 215 73.4
information about menstruation Valid
Friends 6 2.0

Books 17 5.8

YES 264 90.1

Menstruation has foul smell
NO 29 9.8

YES 177 60.4

Menstrual blood is unhygienic
NO 116 39.6

Have you been taught how to take

care of yourself during menstrual YES 293 100.0

period

If “Yes” who taught you Teachers 34 11.6

Parent(s) 201 68.6

Peers 31 10.6

41
 Healthcare provider 17 5.8

Relatives 10 3.4

Do u know what menstrual hygiene

YES 293 100.0
is

Wrong answer 21 7.2

What is menstrual hygiene Correct answer 272 92.8

Total 293 100.0

Table 4.3 shows that majority of the respondents 280 (95.6%) knew that Menstruation is caused

by hormonal changes in the body while 13 (4.4%) did not know. Majority of the respondents 273

(93.2%) maintained that Menstruation occurs every month while 20 (6.8%) did not know. 263

(55.0%) of the respondents knew that Menstruation occurs only in female while 30 (10.2%)

believed Menstruation occurs in both male and female. Most of the respondents 148 (50.5%) said

they don’t know the source of menstrual blood, 88 (30.0%) knew it is from the uterus, 41

(14.0%) mentioned Bladder while 16 (5.5%) said abdomen. Majority of the respondents 287

(98.0%) have heard about menstruation before you start menstruating while 6 (2.0%) have not.

Majority of the respondents 215(73.4%) stated that they first learned about menstruation from

their Mother, 45 (15.4%) heard from Teacher, 17 (5.8%) learned from books, 10 (3.4%) heard

from Healthcare personnel while the remaining 6 (2.0%) of the respondents heard from friends

Majority of the respondents 264 (90.1%) claimed that Menstruation has foul smell while 29

(9.8%) said otherwise. More than half of the respondents 177 (60.4%) said that Menstrual blood

is unhygienic while 116 (39.6%) of the respondents disagreed. All of the respondents 293

(100.0%)said that they have been taught on how to take care of themselves during menstrual
42
period., of this, 201 (68.6%) were taught by Parent, 34 (11.6%) were taught by Teachers, 31

(10.6%) were taught by Peers, 17 (5.8%) were taught by Healthcare provider, while 10 (3.4%)

were taught by relatives. All of the respondents 293 (100.0%) claimed they knew about

menstrual hygiene and only 272(92.8%) could define menstrual hygiene correctly while 21

(7.2%) could not.

Table 4.4: Menstrual Hygiene Practices among Respondents (n=293)

Variable Responses Frequency Percentage

What material do you apply to your Sanitary Pads 259 88.4

vaginal during your menstrual period Toilets roll 34 11.6

Parent(s) 246 84.0

Who provide you the material used for
Relatives 20 6.8
the menstrual period
Others 27 9.2

How often do you change your pad per Twice 135 46.1

day Thrice 158 53.9

Do you wash your genital area before YES 283 96.6

using new pad Valid NO 10 3.4

Water only 172 58.7

Water and soap 101 34.5

If yes, what do you wash the genital
Antiseptics, soap and
area with 10 3.4
water

NO 10 3.4

How many times do you take your bath Once 21 7.2

43
 Twice 254 86.7
per day when menstruating
Thrice 18 6.1

Latrine 12 4.1

Burn 247 84.3

How do you dispose the used pads Water closet 28 9.6

Others 6 2.0

Total 293 100.0

Table 4.4 shows that most of the respondents 259 (88.4%) used Sanitary pads during menstrual

period while 34 (11.6%) used Toilets roll during menstrual period. Most of the respondents 246

(84.0%) said Parents provided the material used for their menstrual period, 27 (9.2%) mentioned

others while 20 (6.8%) mentioned Relatives. More than half of the respondents 158 (53.9%) said

that they change their pad thrice per day while 135 (46.1%) said twice. Majority of the

respondents 283 (96.6%) said they wash genital area before using new pad during menstruation

while 10 (3.4%) did not. Most of the respondents 182(62.1%) wash the genital area with only

water, 101 (34.5%) wash the genital area with Water and soap while the remaining 10 (3.4%)

wash the genital area with Antiseptics, soap and water. Majority of the respondents 254 (86.7%)

said they had their bath twice per day when menstruating, 21 (7.2%) said once per day while 18

(6.1%) said thrice per day. Most of the respondents 247 (84.3%) disposed the used pads by

burning, 28 (9.6%) disposed in water closet, 12 (4.1%) said latrine while 6 (2.0%) disposed the

used pads by other means.

44
 100

90

80

70

60
FREQUENCY

50
94
40

30 60
54
20 37
29
10 19

0
Absorb well More Safe Comfortable Preference Good
hygienic

Figure 4.2: Reason for Respondents’ Choice of Material for Menstruation

Figure 4.2 shows that 94 (32.1%) of the respondents choose the material for menstrual period

because it absorb well, 60 (20.5%) choose it because it is comfortable, 54 (18.4%) choose it

because it is safe, 37 (12.6%) choose it because it is more hygienic, 29 (9.9%) choose it because

they prefer it, while 19 (6.5%) choose it because it is good

45
Table 4.5: Factors Influencing Menstrual Hygiene Practices At Home among Respondents

(n=293)

Variable Responses Frequency Percentage

YES 10 3.4
Non-availability or inadequate
NO 283 96.6
water supply
Total 293 100.0

YES 49 16.7
Accessibility to waste disposal
NO 244 83.3
facility
Total 293 100.0

Lack of or inadequate fund to YES 59 20.1

purchase adequate number of NO 234 79.9

sanitary pads Valid Total 293 100.0

YES 50 17.1

Lack of privacy NO 243 82.9

Total 293 100.0

YES 29 9.9
Lack of or inadequate money by
NO 264 90.1
the parent to purchase sanitary pad
Total 293 100.0

Table 4.5 shows that majority of the respondents 283 (96.6%) stated that availability of water

supply did not influence menstrual hygiene practices at home while 10 (3.4%) disagreed. 244

(83.3%) of the respondents stated that accessibility to waste disposal facility did not influence

their menstrual hygiene practices at home while 49 (16.7%) said that it did. 234 (79.9%) of the

46
respondents agreed that lack of or inadequate fund to purchase adequate number of sanitary pads

did not influence menstrual hygiene practices at home while 59 (20.1%) disagreed. Majority of

the respondents 243 (82.9%) stated that Lack of privacy did not influence menstrual hygiene

practices at home while 50 (17.1%) disagreed. 264 (90.1%) of the respondents agreed that lack

of or inadequate money by the parent to purchase sanitary pad did not influence menstrual

hygiene practices at home while 29 (9.9%) said otherwise .

Table 4.6: Factors Influencing Menstrual Hygiene Practices at School (n=293)

Variable Responses Frequency Percentage

YES 256 87.4
Non-availability or inadequate water
NO 37 12.6
supply
Total 293 100.0
YES 250 85.3
Accessibility to waste disposal facility NO 43 14.7
Total 293 100.0
YES 287 98.0
Inadequate structured Toilets facility NO 6 2.0
Total 293 100.0
YES 287 98.0
Fear of being seen by peers or teachers NO 6 2.0
Total 293 100.0
YES 43 14.7
Present of males at school. NO 250 85.3
Total 293 100.0

Table 4.6 shows that majority of the respondents 256 (87.4%) stated that non-availability or

inadequate water supply influences menstrual hygiene practices at school while 37 (12.6%)

47
disagreed. 250 (85.3%) of the respondents stated that accessibility to waste disposal facility

influence menstrual hygiene practices at school while 43 (14.7%) disagreed 287 (98.0%) of the

respondents agreed that inadequate structured Toilets facility influences menstrual hygiene

practices at school while 6 (2.0%)said no. Majority of the respondents 287 (98.0%) stated that

fear of being seen by peers or teachers influences menstrual hygiene practices at school while 6

(2.0%) disagreed. 250 (85.3%) of the respondents stated that Present of males at school did not

influence menstrual hygiene practices while 43 (14.7%) disagreed

4.2 Test of Formulated Hypotheses

Formulated hypotheses were tested during the course of the study and the results obtained were

presented in tables below.

The research hypotheses were:

Hypothesis 1

Null hypothesis 1 (H0): There is no significant relationship between knowledge of respondents

regarding menstrual hygiene and their practice

Alternate hypothesis 1 (H1): There is significant relationship between knowledge of respondents

regarding menstrual hygiene and their practice

Table 4.7: Statistical illustration of relationship between knowledge of respondents regarding

menstrual hygiene and their practice (n=293)

Variable Responses Menstrual Hygiene Chi- df P-

Practice Square Value

48
 Good Poor Total X2

(n=247) (n=46)

Good 237 31 268 34.173a 1 0.001 Significant

Knowledge regarding Ho rejected

Poor 10 15 25
menstrual hygiene

247 46 293

Table 4.7 shows a significant association between knowledge of respondents regarding menstrual

hygiene and their practice with P-value=0.001< 0.05. Since the P-value is lesser than the

significance value (0.05), the null hypothesis was rejected and the alternate hypothesis accepted

Hypothesis 2

Null hypothesis 2 (H0): There is no significant relationship between age of respondents and their

menstrual hygiene practices

Alternate hypothesis 2 (H1): There is significant relationship between age of respondents and

their menstrual hygiene practices

Table 4.8: Statistical illustration of relationship between age of respondents and their menstrual

hygiene practices (n=293)

49
Variable Menstrual Hygiene Chi- df P-

Responses Practice Square Value

Good Poor Total X2

(n=247) (n=46)

Not
11-13 95 14 109 16.351a 2 0.022
Significant

Ho rejected
Age 14-16 134 28 162

17-19 18 4 22

Total 247 46 293

Table 4.8 shows a significant association between age of respondents and their menstrual

hygiene practices with P-value=0.022< 0.05. Since the P-value is lesser than the significance

value (0.05), the null hypothesis was rejected and the alternate hypothesis accepted

50
 CHAPTER FIVE

DISCUSSION OF FINDINGS

5.1 Introduction

This chapter also dealt with summary, nursing implication, conclusion and recommendation

based on the research findings on factors influencing menstrual hygiene practices among in-

school adolescents in Queen elizabeth secondary school in Ilorin

5.2 Socio demographic Profile of respondents.

More than half of the respondents were between 14-16years of age with mean age of 14.56. This

is because the population used for the study is adolescents also more than half of the respondents

were in SSS 1-3 class while Majority of the respondents was Yoruba. This implies that, Yoruba

dominate the study setting and majority practiced Islam. This study also revealed that most of the

respondents’ mothers were traders then only one- third were civil servants as this revealed the

economic status of the mothers. All of the respondents have started menstruating because the

focus is on adolescents. More than one- third of the respondent attained menarche at the age of

12years and majority had moderate menstrual flow. This result is similar with the study

conducted by Kumari, Sheoran & Siddiqui, (2018) in Haryan, where more than half of

adolescent girls were in age group of 12-15 year and half of adolescent girls had age of menarche

at 12 year.

51
5.3 Respondents’ Knowledge on Menstrual Hygiene

The findings of the study revealed that more than 95% of the respondents knew that

menstruation is caused by hormonal changes in the body and most of the respondents maintained

that menstruation occurs every month and majority of the respondents knew that menstruation

occurs only in female. More than 98% of the respondents have heard about menstruation before

they start menstruating. Yet majority of the respondents do not know the source of menstrual

blood. This is in line with study conducted by Balat, Sahu & Patel, (2019) in Ahmedabad City,

India where 91.9% of girls did not know the source of blood during menses, but it is in contrary

to the study done by Kamath, Ghosh, Lena & Chandrasekaran (2015) where around 34%

respondents were aware about menstruation prior to menarche. More than 70% of the

respondents stated that they first heard about menstruation from their mother and they have been

taught on how to take care of themselves during menstrual period. This implies that mother is the

most common source of menstrual information; this is in line with study done by Kamath,

Ghosh, Lena & Chandrasekaran (2015) where mother is the main source of information. More

than half of the respondents still claimed that menstruation has foul and said that menstrual

Blood is unhygienic. All of the respondents claimed they knew about menstrual hygiene however

higher percentage were able define menstrual hygiene. The result from this study is in contrast

with a study conducted by Yadav, Joshi, Poudel & Pandeya (2017) in Doti district, Nepal carried

out among 276 students from grade seven and eight of 11 schools, where 67.4% respondents had

fair knowledge and 26.4% respondents had good knowledge on menstrual hygiene management.

This finding showed that adolescent girls had good knowledge of menstrual hygiene; there is still

need to increase the effort to improve their level of knowledge through health education. (Balat,

52
Sahu & Patel, 2019); Kamath, Ghosh, Lena & Chandrasekaran, 2015) & Yadav, Joshi, Poudel &

Pandeya, 2017)

5.4 Menstrual Hygiene Practices among Respondents

The findings of the study showed that more than 88% of the respondents used sanitary pads

during menstrual period while only about 11% used toilets roll during menstrual period. The

result is in accordance with study carried out by Mathiyalagen, Peramasamy, Vasudevan, Basu,

Cherian & Sundar (2017) in a union territory, India where 78.1% used only sanitary pads. Most

of the respondents said Parents provided the material used for their menstrual period. More than

half of the respondents said that they change their pad thrice per day while less than half said

twice. This is in contrast with study conducted by Balat, Sahu & Patel, (2019) in Ahmedabad

City, India where 7% changed pads or clothes more than three times a day. Majority of the

respondents said they wash genital area before using new pad during menstruation. Most of the

respondents wash the genital area with only water. Majority of the respondents said they had

their bath twice per day when menstruating. Most of the respondents disposed the used pads by

burning. The result is in accordance with study carried out by Mathiyalagen, Peramasamy,

Vasudevan, Basu, Cherian & Sundar (2017) in a union territory, India where unsatisfactory

cleaning of the external genitalia was practiced by 12% of respondents. Based on these findings

it was observed that majority of the respondent have fair knowledge and good practice about

menstrual hygiene. (Balat, Sahu & Patel, (2019) & Mathiyalagen, Peramasamy, Vasudevan,

Basu, Cherian & Sundar (2017)

53
5.5: Factors Influencing Menstrual Hygiene Practices at Home among Respondents

The study showed that majority of the respondents stated that non availability of water supply

did not influence menstrual hygiene practices at home and more than 83 % of the respondents

stated that accessibility to waste disposal facility did not influence their menstrual hygiene

practices at home. Also more than 79% of the respondents agreed that lack of or inadequate fund

to purchase adequate number of sanitary pads also more than 90% of the respondents agreed lack

of or inadequate money by the parent to purchase sanitary pad did not influence menstrual

hygiene practices at home. Majority of the respondents stated that Lack of privacy did not

influence menstrual hygiene practices at home. This result is in contrast with the study conducted

by Suhasini and Chandra, (2016) among 625 late adolescent girls between age 16-19 in an urban

area of Belgium where factors like age, religion, socio-economic status and mothers’ literacy

were significantly associated with both the use of sanitary pad and practice of perineal hygiene.

Based on this result the menstrual hygiene practice at home is good due of the availability of

facilities such as water, toilet facilities fund to purchase sanitary pads needed for the menstrual

hygiene practices.

5.6: Factors Influencing Menstrual Hygiene Practices at School

The results from this study revealed that more than 80% agreed that non-availability or

inadequate water supply and accessibility to waste disposal facility influences menstrual hygiene

practices at school. Also more than 90% of the respondents agreed that inadequate structured

toilets influences menstrual hygiene practices at school. This is in accordance with a study

conducted by Lahme, Stern & Cooper (2018) with 51 respondents, aged 13–20 years, from three

secondary schools where the girls suffer from poor menstrual hygiene as a result environmental

54
constraints, leading to inconveniences, humiliation and stress. Majority of the respondents stated

that fear of being seen by peers or teachers influences menstrual hygiene practices at school.

Majority of the respondents stated that present of males at school did not influence menstrual

hygiene practices because the school is female only.

In summary in- school adolescent girls in the Queen elizabeth secondary school were said to

have good knowledge and fair practice of menstrual hygiene and the following factors was

identify to influence the menstrual practices: Inadequate waste disposal facilities, inadequate

supply of water and inadequate structured toilets and fear of being seen by peers or teachers are

observed to influences menstrual hygiene practices at school.

5.7 Hypothesis Testing

Hypothesis 1 testing showed a significant association between knowledge of respondents

regarding menstrual hygiene. In the table 4.3 more than 90% could define menstrual hygiene

correctly while only about 7% could not and this is statistically significant with P-value=0.001<

0.05. Since the P-value is lesser than the significance value (0.05), the null hypothesis was

rejected and the alternate hypothesis accepted

X2 (1, 293) = 34.173, P = 0.000

Hypothesis 2 testing revealed a significant association between age of respondents and their

menstrual hygiene practices. In the table 4.2 more than half of the respondents were between 14-

16years of age and only 30% were between 11-13 years with P-value=0.022< 0.05. Since the P-

value is lesser than the significance value (0.05), the null hypothesis was rejected and the

alternate hypothesis accepted

X2 (1, N= 293) = 16.351, P= 0.000

55
5.8 Implication of the Study to Nursing

The nurses play a vital role in educating females through specially designed learning programs in

the health care settings, as well as through community outreach approaches that suit the social

cultural settings.

Nurses and midwives should educate adolescents about the need of primary prevention of

reproductive tract infection through proper menstrual hygiene practices, and adopting general

personal hygiene such as frequent changing of pads and proper washing of vaginal with clean

water only, prompt medical intervention when experiencing some symptoms such as vaginal

itching.

5.9 Limitation of the findings

Financial constraint was challenge faced in the course of the study as the researcher had to pay

for transportation in order to reach the target population. Also most respondents were not willing

to fill the questionnaire as majority of JSS students see menstruation as embarrassing practice

5.10 Summary

The research was carried out to identify factors influencing menstrual hygiene practices among

in-school adolescent girls attending Queen elizabeth secondary secondary School, Ilorin. And

the study comprises of background of study, statement of problem, objectives of the study,

research questions, scope of the study, and definition of terms.

Afterwards previous studies on this study were examined. The overview of concept of

knowledge, concept of practices and menstrual hygiene was discussed. The study utilized health

belief model as theoretical framework upon which the study is based.

56
Furthermore, the methodology of the study, study population and sampling technique were also

discussed. It also included the research instrument used, validity of the instrument and reliability

tools data analysis and ethical consideration.

A total of 300 subjects were used from the school using purposive sampling techniques and

structured questionnaire was used to obtain data from respondents. Analysis of data was done

using SPSS 22 and hypotheses were tested using Chi square.

Also the study contained discussion of findings, nursing implication, summary, conclusion,

nursing implication and recommendations.

The study revealed that most of the respondents had good knowledge of menstrual hygiene and

menstrual hygiene practice is fair. Based on the findings from the study there is significant

association between knowledge of respondents regarding menstrual hygiene and their practices.

Also there is a significant association between age of respondents and their menstrual hygiene

practices.

5.11 Conclusion

Conclusion was drawn based on the findings of the study as regard these adolescents students

should be properly educated on menstruation, proper menstrual hygiene practices and personal

hygiene. Also, creating awareness on effect of improper menstrual hygiene practices such as

reproductive tract infection based on the factors influencing the practice of menstrual hygiene

among adolescent girls, there should be provision of water; good toilets and waste disposal

facilities in the school environment. Appropriate health education programs and social marketing

of sanitary pads and availability of (WASH) facilities lead to better menstrual hygiene practices

among adolescents not only in school and also public places.

57
5.12 Recommendations

In view of the above study, the following recommendations and suggestions were made to

improve and motivate adolescent students towards proper menstrual hygiene practices.

Government:

 Government should make provision of adequate facilities such as (water supply, well

structured toilet and appropriate waste disposal facilities) in the school to promote their

menstrual hygiene practices.

 Awareness should be created about the importance of proper menstrual hygiene amongst

female especially young adult.

Health workers:

 Menstrual hygiene information should be made available to everyone.

 Seminars and Health talk programs should be organized to address the topic.

 Health education should be developed to empower young women with sufficient

knowledge so that they shift to appropriate health-taking behaviors.

Individuals/families:

 Mothers should provide adequate information regarding menstruation, menstrual hygiene

for their female children and siblings.

Teachers/school:

 Teachers can play an influential role in informing students about changes during

adolescence, especially about menarche and other issues related to menstruation.

58
 As per this present study mothers were the major source of information. Therefore, there

is a need for the provision of comprehensive family life education for the parents also.

 Knowledge on menstruation, menstrual and personal hygiene should be included in

school curriculum.

 The school should create awareness about the importance of proper menstrual hygiene

practices.

 School should also provide facilities that improve menstrual hygiene practices such as

provision of water, well structured toilets, appropriate waste disposal bins.

59
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 APPENDIX

QUESTIONNAIRE

KWARA STATE COLLEGE OF NURSING OKE ODE

Dear Respondent,

I am a student of the above named institution. The aim of this research is to collect data for academic purpose

and all information given will be treated as confidential. I am conducting a study on “ factors influencing

menstrual hygiene practices among adolescent girls in Queen Elizabeth government secondary school,

Ilorin, Kwara State”.

I therefore solicit for your support on this project, your honest and sincere responses to these questions will be

highly appreciated as it will contribute to the success of this study. Thanks for your cooperation

Yours faithfully

Sunday Oluwatoyin Comfort

Instruction: Do not write your name but tick the appropriate option applicable to you.

SECTION A : DEMOGRAPHIC DATA.

1. Age: (a)11-13 years( ) (b) 14-16 years ( ) (c) 17-19 years( )

2. Class: (a)JSS 1-3 ( ) (b) SSS 1-3( )

3. Ethnicity: (a) Yoruba ( ) (b) Hausa ( ) (c) Igbo( ) (d) Nupe ( )

4. Religion : (a) Muslim ( ) (b) Christian ( ) (c) Others ( )

5. Occupation status of the mother: (a) Student ( ) (b) Housewife ( ) (c) trader ( ) (d) civil servant( ) (e)

others( )

6. Have you started menstruating: (a) Yes ( ) (b) No ( )

7. If yes, at what age: (a) 9( ) (b) 10( ) (c) 11 ( ) (d) 12 ( ) (e) 13 ( ) (f) 14( )

65
8. How is your menstrual flow valid: (a) Heavy ( ) (b) Moderate ( )

SECTION B: KNOWLEDGE OF STUDENTS ABOUT MENSTRUAL HYGIENE

9. Menstruation is caused by (a) Hormonal changes in the body ( ) (b) Infection ( )

10. Menstruation occurs every month (a) Yes ( ) (b) No ( )

11. Menstruation occur in both male and female (a) Yes ( ) (b) No ( )

12. Sources of menstrual blood (a) uterus ( ) (b) bladder ( ) (c) abdomen ( ) (d) don’t know ( )

13. Did you hear about menstruation before you start menstruating valid (a) Yes ( ) (b) No( )

14. If yes, what is the source of information about menstruation (a) health care personnel ( ) (b) teacher ( )

(c) mother ( ) (d) friend ( ) (e) book ( )

15. Menstruation has foul smell (a) Yes ( ) (b) No ( )

16. Menstrual blood is unhygienic (a) Yes ( ) (b) No ( )

17. Have you been taught how to take care of yourself during menstrual period (a) Yes ( ) (b) No ( )

18. If yes, who taught you (a) teachers ( ) (b) parents ( ) (c) peers ( ) (d) health care providers ( ) (e)

relatives ( )

19.Do you know what menstrual hygiene is (a) Yes ( ) ( b) No ( )

20. What is menstrual hygiene ?

SECTION C : MENSTRUAL HYGIENE PRACTICE AMONG RESPONDENTS

21. What material do you apply to your vagina during your menstrual period (a) Sanitary pads ( ) (b)

toilet roll ( ) (c) others ( )

22. Who provide you the material used for the menstrual period (a) parents ( ) (b) relatives ( ) (c) others

( )

66
23. How often do you change your pad per day (a) twice ( ) (b) thrice ( )

24. Do you wash your genital area before using new pad (a) Yes ( ) (b) No ( )

25. If yes, what do you wash the genital area with? (a) water only ( ) (b) water and soap ( ) (c)

antiseptics, soap and water ( ) (d) others ( )

26. How many times do you take your bath per day while menstruating? (a) once ( ) (b) twice ( ) (c)

thrice ( )

SECTION D: FACTORS INFLUENCING MENSTRUAL HYGIENGE PRACTICE AT

HOME AMONG ADOLESCENT

27. Non availability or inadequate water supply (a) yes ( ) (b) no( )

28. Accessibility of waste disposal facility (a) yes ( ) (b) no( )

29. Lack of inadequate fund to purchase adequate number of sanitary pad (a) yes ( ) (b) no( )

30. Lack of privacy (a) Yes (b) No

31. Lack of inadequate money by the parent to purchase sanitary pad (a) yes ( ) (b) no ( )

SECTION E: FACTORS INFLUENCING MENSTRUAL HYGIENE PRACTICE AT

SCHOOL AMONG ADOLESCENCE

67
 STATEMENT STRONGLY AGREE DISAGREE STRONGLY

AGREE DISAGREE

Non availability or inadequate water supply

Accessibility to waste disposal facility

Inadequate structured toilet facility

Fear of being seen by peers or teachers

Presence of males at school

68