Effect of health education on knowledge and beliefs about menstruation among adolescent girls studying in a tribal school of Mysore – A quasi-experimental study

INTRODUCTION

One of the most challenging times of human life is puberty, when the body goes through multiple changes all at once as it makes the transition to adulthood. Puberty is simply a time of accelerated physical growth and sexual development experienced by every human. These developments can be accompanied by the added pressure of cultural expectations.¹ By facing this pivotal phase of life unprepared, adolescents are left startled and unsupported, which in turn affects the quality of their life. The onset of menstruation is one of the most important changes occurring among girls during the adolescent years. Most of the adolescent girls lack proper information about menstrual physiology and hygienic care. Sometimes the information they receive originates primarily from mothers, friends and relatives and it is often selective and surrounded by taboos.² Thisinadequacy of knowledge establishes the need to have education programs in educational institutions to enlighten adolescent girls on issues surrounding menstruation. A healthy school environment is the one in which healthy norms and practices can be created and reinforced helps to achieve the goal.

Materials & Method

A Quasi experimental study was conducted among all the adolescent girls studying in 7th to 10th standard constituting about 62 participants of a tribal school of Mysore in the month of October to November 2018. Permission was obtained from the school authority for educational intervention being conducted. Informed assent was obtained from the study participants & confidentiality was assured with regards to their participation. A face validated semi structured questionnaire translated into Kannada language was used. Principles of health education intervention on puberty & menstrual hygiene was adopted from tool developed by UNESCO1 was used as interventional tool. Three sessions were held consisting of 20 participants in each session. Pre-test was conducted (self-administered) to assess the existing knowledge and beliefs. Before administration of the questionnaire, all the items were explained and clarified doubts if the study participants had any. Based on assessment of existing knowledge, education interventional tool was fine-tuned according to the areas of concern. An interactive session for an hour with audio- visual aids was conducted covering the topics of anatomy of female reproductive system, puberty, hormonal changes, menstruation, hygienic practices during menstruation (disposal of menstrual materials), pre-menstrual syndrome & myths surrounding. A post-test was administered to assess the effectiveness of the educational intervention after a gap of 1 week. Ethical approval was obtained from the ethical committee of Bangalore Medical College & Research Institute.

Inclusion criteria: All the adolescent girls irrespective of attainment of menarche were included in the study.

Exclusion Criteria: Adolescent girls who were not present on the day of visit to the school were excluded.

Sampling: Universal Sampling.

Data analysis: Data was entered in MS Excel & coded. Analysis was done using statistical software SPSS version 20.0. Results were expressed in terms of percentages, tables and graphs using appropriate statistical tests.

Results

Mean age of the participants was 13.69±1.30. 75% of the participants have attained menarche.

Fig. 1 illustrates the distribution of study participants according to their caste. Majority that is 50% of them belong to JenuKuruba (JK) caste.

Table 1 shows the pre-test answers by the study participants where 95.1% of them had correctly answered the normal age of menarche; 45.2% of them for whether pregnant women menstruate; 75.8% have answered uterus as the source of menstrual blood; 50% and 37.1% of them correctly answered the normal duration of blood flow and normal duration of menstrual cycle respectively.

Table 2 Shows the means of pre-test knowledge scores & post-test knowledge scores compared using paired T test which showed statistically significant difference with ‘p’ value of <0.05. 

Table 3 shows that there is positive correlation between age and pre-test knowledge score & it is statistically significant with p value of <0.05.

Table 4 & 5 illustrates change in pre & post-test religious and cultural beliefs among the study participants which is statistically significant with p-value of <0.05 after the intervention being given.

Note: In table 4 & 5 the total percentage doesn’t add up to 100% because multiple answers/responses could be chosen for those questions.

Discussion

Menstruation is a normal physiological process that occurs to all women during their reproductive life. Inadequate hygienic practices during menstruation can affect adolescent girl’s health. In the present study the mean age of the participants was 13.69±1.30 years. Among the total 62 participants 74.2% of the girls had attained menarche & mean age at menarche was 12.34±0.79 years which was in accordance to the results from other studies conducted byAburshaid FAH et al (2017)2 which illustrated mean age at menarche was 12.7 ± 1.3 years where as it was 13.32 years and 13.62±0.913 years in the studies conducted by Nemade D et al(2009)3 and Pokhrel S et al (2014)⁴ respectively.

In the present study the source of menstrual blood was correctly identified as Uterus by 75.8% and others like bladder, stomach was identified as source by 12.9% and 8.1% respectively and 3.2% of the study participants mentioned they didn’t know about the same. Whereas it is illustrated that the organ from where menstrual blood comes was correctly reported as uterus by 33.64% girls whereas 52.07%, 7.38%, and 6.91% reported urethra, ovary and stomach respectively in a study conducted by Nemade D et al (2009). In a study conducted by SP Singh et al (2006)⁵ 43.5% of the girls correctly responded uterus as the organ from where the menstrual blood comes. In the study conducted by Adhikari P et al (2007)⁶ 25.3 % of the girls reported uterus as the source of menstrual bleeding whereas 32%, 26.7% and 16% said the fallopian tube, vagina and urinary bladder respectively.

There was a significant improvement in knowledge on menstruation relevant issues in pre-test compared to post-test from 62.9% to 95.2% which was similar to the study conducted by Pokhrel S (2014) et al and showed 52.1% had correct knowledge before the intervention where as it increased to 96% after the health education intervention. In the present study, 66.1 % believed that menstruation is a “physiological process” whereas 27.4% of them felt that menstrual blood is “impure” and 3.2% of them considered that it was “Curse/God’s gift”. But when compared with studies conducted by - Nemade D et al, 72.35% girls felt that “menstrual blood is impure”. 73.1% girls reported menstruation as “release of bad blood” in a study conducted by Echendu D A7 among Nigerian secondary school girls. In the pre-test phase, 69.3% girls reported that they should avoid going to religious places during menstruation and 25.8%, 29% & 1% said avoid physical exercise & playing, avoid going to others houses & avoid going to school respectively. After the educational intervention in the post-test phase, there was significant difference seen with regards to the socio-cultural beliefs and taboos regarding menstruation(P>0.05). In the study conducted by Pokharel S et al the restriction during menstruation, there was no significant difference observed in restriction on household works and religious activities from pre-test to post-test. However significant difference was observed in restriction in moving freely and entering kitchen from pretest to post-test. Such different types of restrictions practiced during menstruation were also reported by Das Gupta in their study where 70.59% of the girls did not attend any religious occasion, 42.65% did not play, 33.82% of them did not perform any household work and 10.29% of the girls did not attend any marriage ceremony during the menstrual period.

Shyness and fear to talk about menstruation was evident among the study participants when educational intervention was being given to the study participants. Emphasis was laid on to talk freely about the same with their mothers, teachers and peer educators to clarify the doubts regarding the same.

Conclusion and Recommendations

In this study mean age of the participants was 13.69 ± 1.30 years. 75% of the participants have attained andmenarche mean age at menarche was 12.34±0.79 years. Pre-test showed that 62.9% of them had good knowledge (Score of 5-7) compared to that of posttest having good knowledge in 95.2%.The means of pre-test knowledge scores & post-test knowledge scores were compared using paired t test which showed statistically significant difference with ‘p’ value of <0.001. Interpersonal & interactional educational intervention had a positive effect on knowledge regarding menstruation. Improvement in knowledge regarding menstruation that resulted after educational intervention will help these adolescent girls to cope up with their difficulties in their menstrual hygiene management. This study also made sure that these girls begin to prepare mentally and physically to the physiological changes that their body will be going through. To sustain the adolescent health programme peer educators should be trained for the same & mothers should be encouraged to talk freely to their daughters regarding menstruation.

Source of funding: None.

Conflict of interest: None.