A study of knowledge, attitude, and practices of menstrual health among adolescent school girls in urban field practice area of medical college, Tumkur : Indian Journal of Health Sciences and Biomedical Research kleu

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Original Article

A study of knowledge, attitude, and practices of menstrual health among adolescent school girls in urban field practice area of medical college, Tumkur

Shoor, Purva

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Indian Journal of Health Sciences and Biomedical Research (KLEU) 10(3):p 249-255, Sep–Dec 2017. | DOI: 10.4103/kleuhsj.ijhs_375_16
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Menstruation is a phenomenon unique to females. In India, limited access to products of sanitary hygiene and lack of safe sanitary facilities could increase the likelihood of resorting to unhygienic practices to manage menstruation.

Materials and Methods: 

A cross-sectional study was conducted from April 2013 to April 2014 by interviewing 452 adolescent school girls using a semi-structured, pretested questionnaire. There were 6 schools and 1 PUC college in the study area. Data were analyzed using Epi Info 3.5.3.


The objectives of this study were (1) to study the knowledge and attitude toward menstruation among adolescent school girls, (2) to study the practices of menstrual hygiene among adolescent school girls, (3) to enumerate the common menstrual morbidities among girls, and (4) to elicit their health-seeking behavior regarding menstrual health.


The mean age and standard deviation of girls included in the study were 13.05 years and 0.09472. Only 37.39% girls knew that infection would occur if they do not clean their vagina regularly during menstruation. Only 34.1% girls had the right perception about menstruation as a normal physiological process. Majority of girls used sanitary pads during menstruation. 35.32% of girls said that they were scared when they first attained menarche. Only 11.08% girls said that they had no restrictions during menstruation.


The school girls had less than satisfactory knowledge, but good practices regarding menstrual health among those who had attained menarche. Religion, mother's education, and socioeconomic status were factors determining knowledge, attitude, and practices of menstrual health among adolescent school girls.


“Every month, more than 350 million women and girls in India are ashamed, uncomfortable, and often unsafe.[1]”

Adolescent girls constitute a vulnerable group, particularly in India. Despite the prominence of the ceremonial attention to “coming of age,” very little is told about the actual facts of menstruation. Much of the information is imparted in the form of restrictions.[2] Menstrual management is associated with adoption of hygienic practices and acceptance of womanhood right from the onset of menarche. All myths and taboos such as not taking bath, avoiding hot and cold foods, avoiding exercise, have no scientific support, and need to be eliminated to release menstruation anxiety among girls.

An adolescent girl should be made aware of the phenomenon of menstruation before menarche, so as to enable her to accept it as a normal developmental process and manage it appropriately.[3]

Need of study

This study was taken up to study the social factors and social pathology of menstruation depending on the knowledge, attitude, and practices (KAP) related to menstrual management among adolescent school girls.

Materials and Methods

Study design

The study was a cross-sectional study.

Study area

This study was conducted in Maralur and Maralur Dinne, the urban field practice area of Sri Siddhartha Medical College, Tumkur, which has 6 schools and 1 preuniversity college and with an urban health center located in it.

Study population

All school going adolescent girls were of age 10–19 years.

Inclusion criteria

All adolescent school going girls of schools under the urban field practice area of SSMC, Tumkur and whose parents had given the consent for interviewing them on menstrual health were included in the study. A verbal consent was taken from the girls too.

Exclusion criteria


Study period

Data were collected from April 2013 to April 2014.

Sampling method

Purposive sampling.

Sample size

Of 507 girls of the age group 10–19 years enrolled in 6 schools and 1 PUC college, 452 gave the consent for the interview based on the questionnaire.

Method of collection of data

There are 6 schools and 1 PUC college in the urban field practice area of Sri Siddhartha Medical College, Tumkur. There were 3 private institutions, 3 government schools, and 1 government-aided school included in the study. All school going adolescent girls studying in these schools, of the age group 10–19 years irrespective of their place of residence were included in the study. Data collection was started after obtaining clearance from the ethical committee and verbal consent from the principals of each school. An informed written consent in Kannada was given to each student. Those whose parents gave the consent were interviewed using a pretested semistructured questionnaire.

List of schools

  1. Vidya Niketan High School (Private)
  2. Vidya Niketan Preuniversity college (Private)
  3. Ankitha Primary and High school (Private)
  4. Sheshadri School (Govt. school)
  5. Banjaara Vidya Vardhaka High School (Govt. aided)
  6. Urdu medium Govt. Model school
  7. Hindi medium Govt. Model School.

Methodology for data analysis

Data were entered onto a computerized Excel (Microsoft Excel 2009) spread sheet, subsequently it was analyzed using Epi info version 3.5.3 (Centre for Disease Control, Atlanta, Georgia, USA) and presented in the form of tables and bar diagrams.

Statistical methods used

Descriptive statistics (means, proportions, percentages), Chi-square test was applied. P < 0.05 was considered statistically significant.


  1. A KAP survey means KAP. To properly carry out this type of survey, it is important to establish a basic premise and provide definitions for each word[4]
  2. K: Knowledge is a set of understandings, knowledge, and “science.” It is also one's capacity for imagining, one's way of perceiving. Knowledge of a health behavior considered to be beneficial, however, does not automatically mean that this behavior will be followed. The degree of knowledge assessed by the survey helps locate areas where information and education efforts remain to be exerted[4]
  3. A: Attitude is a way of being, a position. These are leanings or “tendencies to….” This is an intermediate variable between the situation and the response to it. It helps explain that among the possible practices for a subject submitted to a stimulus, that subject adopts one practice and not another. Attitudes are not directly observable as are practices; thus, it is a good idea to assess them. It is interesting to note that numerous studies have often shown a low and sometimes no connection between attitude and practices[4]
  4. P: Practices or behaviors are the observable actions of an individual in response to a stimulus. This is something that deals with the concrete, with actions[4]
  5. Menstrual hygiene: It includes sanitary napkins, toilets in schools, availability of water, privacy, and safe disposal.[5]


Most of the adolescent girls were in the age group of 10–13 years (44.24%) followed by 13–16 years (42.04%) and 16–19 years (13.72%). The youngest age in the study was 10 and oldest age was 18. The mean age and standard deviation of girls included in the study were 13.05 years ± 0.09472.

Two hundred and fifty-eight (57.08%) girls were Hindus, 193 (42.69%) were Muslims, and 1 (0.22%) was a Christian.

Two hundred and thirty-three girls of 452 attained their menarche before interview, whereas 219 girls did not. Only one girl in the age group of 16–19 years had not attained menarche and only 10.7% girls of 10–13 years attained menarche.

The mean age at menarche was 12.39 years and standard deviation was 1.12. Youngest age of attaining menarche was 10 years, median and mode was 12 years.


[Table 1] notes that 62.39% of girls knew that menstruation occurs only in females. 57.08% were aware that the best sanitary products are pads and only 31.42% girls knew about menstruation before menarche. It was observed that only 37.39% girls knew that infection would occur if they do not clean their vagina regularly during menstruation.

Table 1:
Distribution of adolescent school girls according to knowledge and attitude toward menstruation and its management

Maximum, i.e., 82.9% of girls who did not attain menarche responded as “don't know” for their perception regarding menstruation. 89.7% girls who attained menarche reported that it is a physiological process.

78.8% of Hindu girls considered menstruation as a physiological process. Maximum, i.e., 57.1%, Muslims answered “don't know” as their perception regarding menstruation. There was one Christian girl who considered menstruation as God's curse. This observation is because majority of Muslim girls did not attain menarche and therefore must have responded as “don't know”.

In this study, only 25 girls said that there was health education regarding menstruation in school. Other factors include lower socioeconomic status and education of the mother.

It was observed in this study that 52.11% of girls, who were aware about menstruation before menarche, were informed by their mother. Friends as informants were 33.09% followed by sister.


According to [Table 2], majority of the girls (84.12%) used sanitary pads during menstruation. 10.3% used cloth pieces and 5.58% used both. Out of the girls who used cloth pieces, 70.83% reused them, and of those, 82.35% washed the cloth pieces and dried it in the sun.

Table 2:
Distribution of girls according to practices of menstruation and its hygienic management (n=233)

Maximum, i.e., 76.0%, of school girls changed their material of protection 2–3 times daily. 7.7% of girls changed pads or cloth pieces <2 times/day. Best practice is to change the pad more than or equal to 4 times a day, which was observed in 16.3% girls. 83.26% girls took bath daily during menstruation. Cleaning of external genitalia <2 times/day was found in 43.78% girls.

In this study, 42.92% girls recorded the date of menstruation which is important so that the adolescent school girls take the responsibility of their periods and manage them hygienically and be prepared for them. Thirty-four girls had reported being absent from school during menstruation, which was associated with heavy flow and severe pain in the abdomen.

Majority of the girls (54.89%) discarded the pad or cloth pieces by throwing it into the dustbin. Two girls reported that they throw it in a bush. 13.62% flush the pads in the toilet, which can lead to blocking of the sewerage system. Burning of the material for protection is the best option which was practiced by 36.64% girls. Fifteen girls of lower socioeconomic status used cloth pieces for protection. One hundred and twenty-nine girls of upper and upper middle status used sanitary pads.

It was observed that 35.2% of girls with their mother's level of education at least up to middle school used pads. As the education level of mothers went on increasing, more number of girls used sanitary pads for protection. Where the mother's education was up to primary school or illiterate, only 19% used pads.

Of 37 cloth piece users, 12 (32.4%) used cloth pieces as protection corresponding with mothers' education till primary school.

Of 42.9% girls who recorded their date of menstruation were informed by their mother regarding menstruation. However, this association was not found to be significant.


It was noted that 49.36% girls had celebrations at home when they first attained menarche.

[Table 1] shows that majority of the girls (35.32%) reported that they were scared when they first attained menarche. 28.09% girls responded that they were casual when they attained menarche.

Only 11.08% girls said that they had no restrictions during menstruation. Maximum responses, i.e., 53.98%, indicated that they were not allowed to do pooja or read Quran. One girl was segregated from home during periods. 54.51% girls reported that they were forced by their family members to follow restrictions.

37.7% of school girls had restriction of food during menstruation. The foods avoided were curds, buttermilk, milk products, spicy and salty food, nonvegetarian, cucumber, papaya, sweets, orange, pickles, and eggs.

It was observed that 76.4% of Hindus were not allowed to do pooja. There was one Christian girl who was also not allowed to perform religious rituals; however, no significant association was found between religion and permission to do pooja during menstruation.

56.4% adolescent school girls who practiced restrictions by the force of family were 13–16 years of age and 52.5% girls were in the age group of 16–19 years. It was found that older girls followed restrictions by force as compared to younger age group.

Menstrual problems

Maximum, i.e., 67.9%, girls responded for dysmenorrhea in the present study. Majority of these responses were in the age group of 13–15 years. 7 (2.8%) girls suffered from irregular cycles, with 4 of them in the age group of 10–12 years.

Premenstrual syndrome was found in 12 responses aged 16–18 years.

Menorrhagia was reported by 13.7% responses, maximum in the age group of 13–15 years. Twenty girls reported passage of clots during menstruation, indicating heavy flow.

Spotting which indicates PCOS or infection was a menstrual problem in 13–15 years of age girls.

63.1% of girls suffered from premenstrual syndrome. It was observed that pain abdomen was the most common response of school girls as complaint during menstruation (40%), followed by backache (26.1%) and irritability (17.3%). Two girls reported leg pain. About 3.6% girls responded as no complaints. [Table 3] depicts that the association between menstrual morbidities and age-wise distribution is found to be highly significant.

Table 3:
Distribution of girls according to menstrual morbidities and age

Health seeking behavior

According to Table 4, most of the girls responded that they take mother's help for problems during menstruation, followed by sister and friends.

Table 4:
Distribution of girls according to health-seeking behavior

52.8% responded that they do not take any treatment because of no need and fear of side effects. 18.7% responded for home remedies such as drinking lime juice and hot water fomentation, applying castor oil on stomach, drinking coconut water, avoiding spicy food, eating sesame seeds, applying turmeric water on body, and drinking hot water and milk.

19.1% took doctor prescribed medicines, and of them, majority opted for homeopathic or ayurvedic treatment (57.8%) and preferred females as their doctors (82.2%).

9.4% took over the counter drugs such as paracetamol, she care tonic, domperidone, and volini gel, and some girls (7 girls, i.e., 31.8%) were not aware what they take for treatment.


Dambhare et al.[6] in their study found that the mean age of school girls to be 15.45 ± 1.75 years which was different from girls in our study because of plausible difference in religion, socioeconomic status, and other factors such as community outlook.

The religion-wise distribution result was comparable to another study conducted at Uttarakhand by Juyal et al.[7] where most girls were Hindus (92.1%) while 7.1% were Muslims.

According to Dambhare et al.,[6] 48.1% (519 out of 1080) girls did not attain menarche, which was a similar observation in comparison with this study. Dipali et al.[8] had observed in their study that the mean age at menarche was 13.32 years in the schools under the coverage area of MGM medical college, Navi Mumbai, Maharashtra. Similarly, according to Shanbag et al.[9] in their study conducted by St. Johns Medical college, Karnataka, the mean age at menarche was found to be 13.4 years with standard deviation as 1.013.


Shanbag et al.[9] who in their study found that 73.7% girls perceived menstruation as a normal phenomenon was a much higher percentage in comparison to this study.

It was observed by Shanbag et al.[9] that awareness about menstruation as a process unique to females was 89.1%. This was in accordance to a similar study conducted by Abhay et al.[10] where mother was the informant (40.67%) followed by friends which was 19%.


In the study conducted by Shanbag et al.,[9] it was seen that during menstruation, 34.7% of the study population used cloth, 44.1% used sanitary pad, and 21.2% used both cloth and sanitary pad which was in accordance to the present study.

According to Shanbag et al.,[9] the frequency of change during the time of menstruation revealed that 39.8% changed sanitary pad or cloth twice a day, 29.5% three times a day and 21.7% once a day. This observation was similar to the present study.

According to Shanbag et al.,[9] 53.8% cleaned their external genitalia after voiding every time which was similar to this study.

In a similar study conducted by Abhay et al.,[10] only 1% of the girls burned the material for protection during menstruation. Maximum (55.67%) threw the material in the dustbin. The municipality should be active in taking away the waste and its proper processing in the form of dumping or burning, then only throwing the material in the dustbin is a safe practice.


Abhay et al.[10] noted that 87% girls were restricted to worship during menstruation. According to Shanbag et al.,[9] restrictions to go to the place of worship (94.2%) was greater than what was observed in this study and special functions held on attaining menarche (45.6%) was in accordance to this study.

Similarly, in the study conducted by Shanbhag[9] et al., food taboos were common during menstruation and 42.6% avoided certain food items, common ones being sweets (21.6%), spicy food (3.9%), curd and milk products (9.1%).

Menstrual problems

In a study conducted by Sharma et al.,[11] dysmenorrhea was the most common problem of adolescent girls (67.2%) which was in accordance to the present study.

The observations in the present study were in accordance to the findings of Abhay et al.[10] Pain in abdomen (67%) was found to be the most frequent complaint during menstruation followed by headache/irritation (25.67%), loss of appetite (12.67%), and leg cramps (10.33%).

Health-seeking behavior

Sharma et al.[11] noted that only 4% girls went to doctor for treatment and 14.7% went to a physician or a gynecologist. The severities of symptoms were not related to their health-seeking behavior.


The knowledge about menstruation and menstrual hygiene of school girls was found to be unsatisfactory although the practices were noted to be good. Majority of Hindu girls had attained menarche in this study and they belonged to a better socioeconomic status as compared to Muslim girls.

The knowledge of menstruation was mainly dependent on the education of the mother and socioeconomic status.

Most restrictions were laid down by the force of the family showing a poor attitude in management of menstruation. Schools were not involved in imparting health education regarding periods to adolescent school girls, also depicting a poor attitude of society toward preparing the adolescent school girls for menstrual management.

Healthcare-seeking behavior was satisfactory. Most girls felt no need for seeking help, some followed home remedies and others preferred homeopathic and ayurvedic treatment.


  • This was not a comparative study between rural and urban areas to actually analyze the status of menstrual health among school girls
  • Not all the school girls resided in the urban field practice area of our medical college, so the results cannot be extrapolated to the total population of the field practice area.


  • There is a need of health education in the schools regarding menstrual hygiene
  • Health education can be conducted by health workers, medical college teachers, and nongovernmental organizations
  • As mothers are the first informant to majority of the adolescent girls, the health education activities can be extended to the mothers
  • Provision of water supply and sanitary toilets in schools is must to prevent absenteeism and dropouts of school, and increase the age of enrolment.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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Adolescent school girls; attitude and practices; knowledge; menstrual hygiene

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