ABSTRACT
In many societies menstruation is not openly discussed in some families, school and communities leading to a very big gap in knowledge about menstruation and menstrual problems. This gap equally poses problems on issues about menstrual hygiene, menstrual problems and management of those problems. In addition to inadequate information, girls need access to hygienic absorbent sanitary products, water, good toilets that ensure privacy and disposal facilities which can in the long run, protect their health. This study investigated the knowledge and management of menstruation and menstrual problems among urban and rural secondary school girls in Enugu East Local Government Area. A cross sectional descriptive survey was adopted for this study. The sample for the study comprised of 699 secondary school girls. Four Hundred were drawn from the three randomly selected secondary schools in urban area. The remaining 299 girls were from the only government owned secondary school in the rural area. The sample size for the urban schools was determined using Taro Yamane’s formula. A researcher developed questionnaire in questions and optional form was used to generate data. The results were presented in tables with frequencies, percentages and Pearson’s Chi-square was used to test hypotheses. The results showed that 497(87.0%) of the respondents had knowledge before menarche. Mothers were major sources of this information. There was significance difference (p<0.05) in the knowledge of menstruation between Urban and Rural Secondary School girls. Majority of the girls 407(71.2%) use sanitary pads alone or in conjunction wit5h other materials. More than half 308(53.8%) change their menstrual absorbent materials three times a day and 352(61.6) take their bath three times a day. There was no significance difference (p<0.05) in management of menstruation between Urban and Rural Secondary School girl. Majority 384(67.3%) reported they have toilets in their school and 210(54.7%) reported that toilets do not provide privacy for change of menstrual absorbent materials. The commonest menstrual problem experienced by girls is dysmenorrheal 368(64.4%). There was no significance difference (P>0.05) in the menstrual problems experienced by Urban and rural girls. The majority 101(681%) of the respondents, use paracetamol to manage abdominal pains. Only 79(13.8%) of girls that have problems associated with flow consulted a doctor. There was a significance difference (P<0.05) in the management of menstrual problem between Urban and rural Secondary School girls. In conclusion, the findings of this study revealed that girls have information about menstruation but the information was very deficient in the process of menstruation. Some girls do not dispose menstrual wastes properly Environment especially at school do not encourage good management of menstruation. Therefore, it is recommended that there is still need for organized health education in schools to discourage unhealthy strategies for managing menstruation especially as it concerns disposal of menstrual wastes. Also there is need to provide supportive enabling environment both in Schools and homes for girls for effective management of menstruation should also involve screening of girls to detect any serious gynaecological problems, early referral for prompt management.
CHAPTER ONE
INTRODUCTION
Background to the study
Secondary school girls are in a period of growth and development known as adolescence. Adolescence is a period of transition from childhood to adulthood. It is a stage of human development that is characterized with so many physical, social, emotional and mental changes. There is appearance of secondary sexual characteristics, in girls menstruation is one of these major characteristics. The onset of menstruation represents a landmark event in pubertal development of the adolescent girl. Menstruation is a natural phenomenon that occurs from puberty throughout the reproductive life of every female. It is a periodic vaginal bleeding associated with shedding of uterine mucosa. Every mature woman menstruates on the average of three to five days monthly until menopause (Lawan, Yusuf & Musa 2010). Esimai and Esan (2010) assert that normal menstruation relies on action and interaction of hormones released from Hypothalamus – pituitary and ovaries and their effects on the endometrium. The normal menstrual pattern is associated with 3 to 7 days length of flow and amount of flow less or equal to 80ml. A woman’s period may not be the same every month and it may not be the same as that of other women. Periods could be light, moderate or heavy and the length of the period also varies.
Menstruation is a normal process of the body and if proper knowledge is given regarding its onset, management and problems associated with it; then it can be handled like all other body functions. However, many girls in developing countries lack appropriate knowledge and sufficient information regarding menstruation and its management (Olayinka 2004). While some information might be available from school and friends, parents should address the practical concerns that puberty brings, for instance, new hygiene needs(e.g., menstrual periods, body odors), clothing and product needs (e.g., cloth vs. napkin brands). In order for girls to live healthy reproductive and dignified life, it is essential that they are able to manage menstrual bleeding effectively (Ahmed & Yesmin 2008). Management of menstruation deals with the special health care needs and requirements like choice of absorbent used, how often and when to change the absorbent used, washing of hands and undergarments, bathing, care of vulva and proper disposal of menstrual wastes. Therefore, menstruation as a regular process needs hygienic management. If poorly managed, menstrual period may be accompanied with discomfort, reproductive tract infections, foul odour and embarrassment among others (Dasgupta & Sarkar (2008).
Despite the fact that menstruation is a normal physiological process, it is often associated with some problems and discomforts. Harlow and Campbell (2007), stated that menstrual problem is very traumatic experience for some adolescent girls and women and could truncate their life dreams. Titilayo, Agunbiade, Banjo and Lawani (2009) also stated that 40 -49% of menstruating women are affected by menstrual problems in diverse ways. Studies from different cultures in different parts of the world have associated it with one of the most common causes of regular absenteeism among girls in schools, work places, sports participation and other public functions (El-Gilany, Badawi & ELfedawy 2005; Walraven, Ekpo, Coleman, Scherf, Morrison & Harlow 2002) . Dysmenorrhea is the commonest disorder among girls during menstruation. Others are excessive bleeding, irregular menses, breast pains and fullness. Psychosocial issues surrounding girls during their menstrual periods aggravate these problems (Esimai & Esan 2010; Harlow & Campbell 2007; Antai, Udezi, Ekanem, Okon & Umoiyoho 2004).
In Nigeria, school girls often struggle to manage their menstruation due to social, cultural and economic constraints. Adinma and Adinma (2008) assert that poor knowledge of menstruation and practice engenders reproductive health problems in adolescents such as dysmenorrhoea, depression and reproductive tract infections. In Enugu, girls manage their menstruation and menstrual problems according to the extent of pre menarcheal information they received (Aniebue, Aniebue & Nwankwo 2009). They further stated that socialization brought by western education; parents’ social class influence information girls receive before menarche and in turn affect management of menstruation and menstrual problems. Other issues associated with menstrual hygiene and practices in the country are lack of infrastructure like water, soap, toilet that ensures privacy. Enugu East Town Planning Authority shows that the Local Government comprising both urban and rural population with many secondary school girls; these girls like their counterparts in other parts of the nation may encounter many challenges on issues relating to their sexuality, principally menstruation. Hence, the researcher decided to undertake this study.
Statement of Problem
In many societies including ours, menstruation is not openly discussed leading to lack of attention on the issues about menstruation. There is an unspoken ‘culture of silence’ with regard to menstruation among girls. Many girls find difficult to discuss menstrual issues with their mothers and certainly not with their fathers leading to limited information about menstruation. Therefore menstruation becomes something to be ashamed of and to hide, and is ignored in families, schools and communities (Caruso, Freeman, Salim, & Fehr 2012; Thakre, Thakre, Reddy, Pathak, & Ughade 2011; Adinma & Adinma 2008, Burgers & Lhlungpa 2008). Consequently, there is substantial gap in the knowledge of menstruation among adolescent girls that ensure good management of menstruation.
In addition to inadequate information, availability of materials and infrastructure is very crucial to management of menstruation both in homes and schools. Therefore, girls need access to hygienic absorbent sanitary products, water, good toilets that ensure privacy and disposal facilities which can in the long run, protect their health. Unfortunately, these are often lacking in schools and some homes in developing countries (Thakre et al 2011, Mahon & Fernandes 2010). Poor menstrual hygiene practices may engender reproductive health problems in adolescents, such as dysmenorrheal, vulva itching, genital tract infections and may affect quality of life in girls due to shame associated with odour and stains. These reproductive tract infections may lead to serious gynaecological complications if not treated promptly.
The researcher observed in some of the school health outreaches conducted for secondary school students which she participated, girls often complain of severe dysmenorrhea and vulva itching. She equally observed that menstrual wastes were often littered indiscriminately around in the school compound. Poor disposal of menstrual wastes has major impact on environmental conditions of the society. This implies dangers associated with this type of wastes to the plants, animals, soil structure, water and air quality and aesthetic qualities.
Menstrual problems have been reported in about 87 percent of school girls in Nigeria (Abioye-Kuteyi 2000). Though some menstrual problems may be treated with common drugs and reassurance but some could be so severe to confine the woman to bed or interfere with their normal daily activities. Some of these problems may affect school attendance and performance in girls. Sometimes, menstrual problems may be as a result of some underlying problems that need medical investigations and treatment but due to culture of secrecy associated with menstruation, inadequate attention are given to menstrual problems than other health issues in many societies (Caruso, Freeman, Salim, & Fehr 2012). Therefore, girls adopt various ways including use of herbs and concussions, over the counter medications to manage their problems, even in our country (Busari 2012, Aniebue, Aniebue and Nwankwo 2008). Hence the need to carry out this study.
Purpose of the Study
This study investigated the knowledge and management of menstruation and menstrual problems among urban and rural secondary school girls in Enugu East Local Government Area.
Specific Objectives
The specific objectives were to:
- establish the knowledge of menstruation among urban and rural secondary school girls.
- assess management strategies adopted by urban and rural secondary school girls for their menstruation.
- assess common challenges experienced by secondary school girls in managing their menstruation.
- identify common menstrual problems experienced by secondary school girls.
- ascertain how secondary school girls manage their menstrual problems.
Research Questions
- What knowledge do secondary school girls have about menstruation?
- What are the strategies adopted by secondary school girls to manage their menstruation?
- What challenges do secondary school girls experience in managing their menstruation?
- What are the common menstrual problems secondary school girls experience?
- How do secondary school girls manage their menstrual problems?
Hypotheses
- There is no significant correlation in the knowledge of menstruation between urban and rural secondary school girls.
- There is no significant correlation in the management of menstruation between urban and rural secondary school girls.
- There is no significant correlation in menstrual problems experienced by urban and rural secondary school girls.
- There is no significant correlation in the management of menstrual problems between urban and rural secondary school girls.
Significance of the study
The study is relevant because it examined the knowledge of menstruation among secondary school girls and their menstrual hygiene practices. Also the study revealed common menstrual problems among secondary school girls and strategies they have adopted over years in managing those problems. Nurses will utilize the information from the study to plan school health programmes and health promotional activities to include sexuality, menstrual education and proper management of menstrual problems among secondary school girls. Nurses can utilize the information to plan IEC programmes to the girls on how to manage their menstruation in order to improve their wellbeing and optimal functioning during menstruation. Also, it will help them acquire appropriate information on proper method of disposing menstrual waste to avoid environmental nuisance.
It will help nurses organize IEC programmes to parents and members of the society to discourage those beliefs, misconceptions and taboos that jeopardize the health and well being of these girls. It will expose them on the need to discuss issues relating to adolescents sexuality, reproductive health and menstrual problems and where to get help.
Furthermore, educational administrators will see the need to expand information on menstruation to include biological processes, what to do or expect when they start menstruating and some common health problems and management. They will also see the need to plan toilet facilities to be friendly to girls, provide water and soap for adequate personal hygiene and provide a proper menstrual waste disposal facilities (e.g. incinerator) in order to assist them manage menstruation effectively at school.
The study may provide necessary information to policy makers on the need to reduce the cost of sanitary pad, in order to make it affordable to all classes of girls. This can be achieved through subsidizing the price or reducing taxation for companies that produce sanitary materials. Also, they will help in planning and providing structures that help the girls to manage their menses hygienically.
Scope of the Study
This study was conducted among urban and rural secondary school girls from 11years who have attained menarche, in government girls or co-educational schools in Enugu East Local Government Area. The study is limited to knowledge and management of menstruation and menstrual problems among secondary school girls in Enugu East.
Operational Definition of Terms
Knowledge of Menstruation:
These are adequate and correct information given to girls before menarche, which covers process and characteristics of menstruation, menstrual cycle, menstrual hygiene and some common menstrual problems.
Management of menstruation:
This involves various ways secondary school girls handle their monthly periods; this include choice of menstrual absorbent materials, personal hygiene and disposal of menstrual wastes.
Menstrual Problems:
These are all forms of physical and emotional discomforts or ill feelings associated with monthly periods that may affect girls’ normal activities for example; dysmenorrhea, excessive bleeding, scanty bleeding, anxiety, moodiness, depression, etc. Some of these discomforts may start some days before monthly period and some during the monthly period. It could be mild, moderate and severe.
Management of Menstrual Problems:
These are various ways secondary school girls handle all forms of physical and emotional discomforts or ill feelings associated with menstruation such as drugs, home remedies including their health seeking behaviour