KNOWLEDGE, ATTITUDE AND PRACTICE OF MENSTRUAL

HYGIENE AMONG FEMALE STUDENTS IN SELECTED SECONDARY

SCHOOLS IN IJEBU NORTH LOCAL GOVERNMENT AREA, OGUN
STATE

BY

STEPHEN ELIZABETH QUEEN

EXAM NO: JCONS/21B/037

A RESEARCH PROJECT
SUBMITTED TO THE DEPARTMENT OF NURSING SCIENCE,
JAFAD COLLEGE OF NURSING SCIENCE, ORU-IJEBU

IN PARTIAL FUFILMENT OF THE REQUIREMENTS OF THE AWARD OF THE

NURSING AND MIDWIFERY COUNCIL OF NIGERIA, FOR THE AWARD OF
REGISTERED NURSE (RN) CERTIFICATE

PROJECT SUPERVISOR

MRS AGHOLOR

JUNE, 2024

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 CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND TO THE STUDY

According to World Health Organization, a person aged 10–19 years is considered as an

adolescent. Adolescence is a transitional stage of physical and psychological development that
generally occurs during the period from puberty to adulthood. Adolescence in girls has been
recognized as a special period in their life cycle that requires specific and special attention.
Menstruation is a physiological process in female adolescent which usually started at age of 9–12
years old. (Hall&Guyton, 2019). First menstruation experience would be different among
adolescent girls but if they were aware about menstruation before menarche, they can prepare
themselves to accept and build good attitude towards menstruation. Mother as the nearest and
capable person to educate their children should give information about menstruation and also
hygiene prior to menarche so that adolescent girls know the importance of taking care of
themselves during menstruation and how to manage menstrual hygiene issues. Menstrual
hygiene is a hygienic practice during menstruation and good menstrual hygiene such as adequate
cleaning of the external genitalia, the use of sanitary pad and frequently change pad every 3–4
hours to prevent odour.

Menstrual hygiene management should be an imperative part of healthcare. The United Nations
defines adequate menstrual hygiene management as “women and adolescent girls using a clean
menstrual management material to absorb or collect blood that can be changed in privacy as
often as necessary for the duration of the menstruation period, using soap and water for washing
the body as required, and having access to facilities to dispose of used menstrual management
materials.” It is recognized as a special period in a girl’s life cycle which requires special
attention. Menarche is an important biological milestone in a woman’s life as it marks the onset
of the reproductive phase of her life. The average age at menarche is mostly consistent across the
populations that is, between 12 and 13 years of age. Unfortunately, due to lack of knowledge on
menstruation preparedness and management or due to shyness and embarrassment the situation
becomes worse for girls. Menstruation is a natural process but it is still a taboo in Indian society
as it is considered unclean and dirty. (Kuhimann, Henry and wall, 2019).

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Puberty and especially the onset of menstruation as a natural aspect of a woman’s life is a very
critical point of a girls’ transition into womanhood. However, the lack of adequate guidance and
social support, male-dominated decision making, on-going gender inequality and taboos around
menstruation leave girls in numerous low and middle income countries (LMIC) experiencing
shame, fear, confusion and discomfort when trying to cope with their monthly period
(McMahon, 2019).

Menstrual Hygiene Management (MHM) is influenced by women’s rights, their role in society,
their guidance and knowledge and the water, sanitation and hygiene (WASH) infrastructure and
materials, the achievement of good menstrual health has an impact on general health and
wellbeing, education, socioeconomic outcomes, dignity and gender equality (Hennegan, Dolan,
Wu, Scott, & Montgomery, 2020).

Assuring the accessibility and affordability of culturally acceptable menstrual health solutions
and knowledge and enabling girls to adequately manage their monthly period and to feel
comfortable about it, is a window of opportunity to influence the way girls see themselves in
society and can empower them to reach their full potential (McMahon, 2020).

The monthly period still puts many girls in Sub-Saharan Africa in very challenging situations,
which have potentially devastating ramifications for their health, wellbeing and empowerment.
The development of adequate and evidence-based measures and programmers requires an in-
depth understanding of the dynamics of this phenomenon, which, however, still lacks in many
geographical and cultural contexts, and particularly in Malawi (Daniela, 2019). May 28 is
considered as the global Menstrual Hygiene Day initiated by WASH United. It was created
mainly to publicly recognize the right of women to hygienically manage their menstruation
wherever they are. Girls in developing countries encounters problems in managing menstruation
properly because they lack the basic facilities of WASH (water, sanitation, and hygiene), proper
information, a suitable environment and support, which ultimately, affect their basic human
rights to education, health’ and privacy. This is due to lack of knowledge, improper awareness,
and poor attitudes and practices towards menstruation and menstrual hygiene.

Teachers leave a positive impact and greatly influence the minds of children. But the issue of
menstrual hygiene is seldom being discussed in the school curriculum. It is also included in

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Millennium Development Goals. Therefore, to understand the consequences and importance of
menstrual hygiene practices among adolescent girls, it is important to study the current practices
about the same so that future interventions can be planned accordingly.

Several studies have demonstrated inaccurate and incomplete information about the menstrual
physiology and hygiene among adolescents. A study conducted in southeastern Nigeria revealed
up to 44.8% of the adolescent girls had no pre menarch training, which resulted in inappropriate
menstrual experiences and poorer menstrual hygiene practice. A preliminary result from the
Performance Monitoring and Accountability (PMA, 2020) survey conducted in Kaduna,
northwestern Nigeria showed that only 37% of women age 15–49 have everything they need
such as clean materials, a facility, pain medication, and places to dispose off used products for
proper menstrual hygiene (Nigeria Health-watch, 2020).

1.2 STATEMENT OF PROBLEM

Menstruation and menstrual practices still face many social, cultural, and religious restrictions
which are a big barrier in the path of menstrual hygiene management. In many parts of the
country especially in rural areas girls are not prepared and aware about menstruation so they face
many difficulties and challenges at home, schools, and work places.

Girls and women have very less or no knowledge about reproductive tract infections caused due
to ignorance of personal hygiene during menstruation time. In rural areas, women do not have
access to sanitary products or they know very little about the types and method of using them or
are unable to afford such products due to high cost. So, they mostly rely on reusable cloth pads
which they wash and use again. Needs and requirements of the adolescent girls and women are
ignored despite the fact that there are major developments in the area of water and sanitation.

Adolescent is a period of transition from childhood to adult and often characterized with
confusion, hatred, disobedience, fear, peer pressure and other psychic conflicts. During this
period, young people undergo substantial physical and emotional changes. These changes bring
about a lot of worries to the adolescents, thus making them confused (Shaffer &Kipp, 2020).

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Santrock, (2020) posted that one of the issues that is most threatening to the average females
adolescent especially student is the issue of menstruation. Unfortunately, perhaps due to the
economic situation in most developing countries, mothers who are supposed to render helps to
the females belong to the working class and have little or no time for them, thereby leaving her
in despair.

Research evidences show that the family alone cannot educate these females; as such schools
should play a complementary role. This seems difficult because many girls would not open up on
issues very personal even when they are facing challenges. Evidence showed that poor personal
hygiene and unsafe sanitary conditions have primarily resulted in gynecological problems among
adolescent girls.

Ademola (2021), argued that apart from feeling shy to discuss menstrual related issues, most
teenagers girls prefer to stay at home during their menstrual period thereby being absent from
school thus making it difficult for school to render the much needed assistance. In the view of the
above, if the knowledge level of females especially teenager about menstruation and menstrual
hygiene could be ascertained, it will be easier for the schools to complement the effort of the
family with a view to improving the practice of menstrual hygiene thereby addressing the
problems associated with menstruation among the females.

1.3 OBJECTIVES OF THE STUDY

Broad objective

To ascertain knowledge, attitude and practice of menstrual hygiene among female students in
selected secondary schools in Ijebu north local government area, Ogun state.

Specific objectives

1. To determine the level of knowledge on menstruation and menstrual hygiene among

female students in selected secondary schools in Ijebu north local government area, Ogun
state.

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 2. To determine the attitude of female students towards menstrual hygiene in selected
secondary schools in Ijebu north local government area, Ogun state.

3. To evaluate the practices of \menstrual hygiene employed by the female students in

selected secondary schools in Ijebu north local government area, Ogun state.

4. To identify the factors that may hinder proper practice of menstrual hygiene among the
female students in selected secondary schools in Ijebu north local government area, Ogun
state.

1.4 RESEARCH QUESTIONS

1. What is the knowledge of female students in selected secondary schools in Ijebu north
local government area, Ogun state on menstrual hygiene?
2. What is the attitude of female students in selected secondary schools in Ijebu north local
government area, Ogun state towards menstrual hygiene?
3. What are the practices of menstrual hygiene employed by female students in selected
secondary school in Ijeubu north local government area, Ogun state?
4. What are the hindrances to proper menstrual hygiene practice among female students in
selected secondary schools in Ijebu north local government area, Ogun state?

1.5 SIGNIFICANCE OF THE STUDY

This study will provide useful information for creating awareness among female students
especially adolescents on menstrual hygiene, school teachers, families, religious practitioners as
well as useful reference material for further research. It will help the government to understand
the issue regarding menstrual hygiene better and provide adequate materials and tools necessary
to adopt good menstrual hygiene practices among females. It will also help the society to have
better knowledge regarding menstrual hygiene and safe practices. Therefore, increased
knowledge about menstruation right from childhood may escalate safe practices and may help in
mitigating the suffering of women.

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1.6 SCOPE OF THE STUDY

The Scope of the Study is limited to female students attending selected secondary schools in
Ijebu north local government area, Ogun State irrespective of their religion, ethnic and
socioeconomic background. It is worth knowing that Ijebu north has a large population. It may
therefore be vogue to venture into an elephantine project in attempting to study the whole
population of ijebu north government, since this is an individual and self-sponsored research.
Due to the factors mentioned above, this research will be conducted on secondary school female
students attending Ijebu-igbo girls’ grammar school, Molusi College and Itamerin
comprehensive junior high school Ago iwoye that are within the age of 11-19 years.

1.7 OPERATIONAL DEFINITION OF TERMS

These include:

1. Knowledge: The information, skills and understanding that have been gained through
learning and experience about menstrual hygiene among female students in selected
secondary schools in Ijebu North local government area, Ogun State.
2. Attitude: The way females behave towards menstrual hygiene during menstruation
among female students in selected Secondary Schools in Ijebu North local government
area, Ogun State.
3. Practice: What females do during menstruation among female students in selected
Secondary Schools in Ijebu North local government area, Ogun State.
4. Female: girls within the age of 11 years old to 19 years among female students in
selected Secondary Schools in Ijebu North local government area, Ogun State.
5. Menstrual hygiene: female students’ specific activities related to safe and correct
menstrual hygiene practice among female students in selected Secondary Schools in Ijebu
North local government area, Ogun State.

6. Secondary school: it is a school intermediate between elementary school and college and
usually offering general, technical, vocational, or college preparatory courses.

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 CHAPTER TWO

LITERATURE REVIEW

2.1 CONCEPTUAL REVIEW

Menstruation is defined as the “periodic discharged of blood from the uterus occurring more or
less at regular monthly intervals throughout the active reproductive life of a female” (Critchley,
2020). The beginning of menstruation in a girl marked the start of reproductive life. The
menstrual period is a natural phenomenon that occurs throughout the reproductive life of every
female. Despite the fact that menstruation is a normal physiological process, it is not often
discussed openly especially in the rural areas. Some women, even in the developed countries,
considered menstruation to be inconvenient or embarrassing (Abrahams, Flazer, Mira&Mcnell,
2019).

Menstruation may be looked at as more than just a physiological process. It may be viewed
either positively or negatively by the society. A positive perception of menstruation would be by
considering it a sign of femininity, fertility, youthfulness or purification of the body. The
negative perceptions include a linkage to being vulnerable and susceptible to different illnesses,
or creating feeling of disgust and shame. In some societies, these negative perceptions become
the basis of certain practices, like placing restrictions on religious, social and domestic activities
of a menstruating woman, a woman usually has two kinds of perceptions of bleeding: one from
her actual experience and the other she learns from her elders and peers (Kamath, Ghosh, Lana &
Chandrassekaran, 2019).

According to Theries and Maria (2020), menstruation is the cyclical shedding of the uterus
lining. The endometrium, under the control of hormones of the hypothalamo-pituitary axis. It is
monthly bleeding which lasts for 3-5 days, coming regularly every 28 days from puberty till
menopause in women’s reproductive life. Menstrual cycle starts at age 12-17 years which marks
the onset of puberty. Menstrual cycle ceases at the age of 45-50 years. A woman spends
approximately 2100 days in menstruating that is almost 6 years of her life. These 6 years spread
over a productive life of 50 years can potentially decide how healthy a woman life will be.

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According to Roche and Morton (2019), adolescents are a large and growing segment of the
world’s population. More than half of the world’s population is below the age of 25, and one in
every two young people in the world is adolescent. During adolescence, young people develop
their adult identity, move toward physical and psychological maturity. Physiologically, the
hypothalamus produces growth hormone and gonadotropins which initiates puberty changes.

Menstrual hygiene deals with the special health care needs and requirements of women during
monthly menstruation or menstrual cycle. These areas of special concern include choice of the
best “period protection” or feminine hygiene products; how often and when to change the
feminine hygiene products; bathing, care of the vulva and vagina as well as the supposed benefits
of vaginal douching at the end of each menstrual period. Provisions for good menstrual hygiene
include home-made remedies like pieces of cotton cloth which are either placed on a woman’s
undergarment or on a home-made belt that wraps around the waist. These cloths can be washed,
sun dried or ironed and used again. Available commercial products for woman’s hygiene during
menstruation include pads, tampons and menstrual cups, panty liners (Adika,Yagba,
Apiyanteide, Ologidi and Ekpo, 2019).

Adolescence in girls signifies the transition from girlhood to womanhood. Good menstrual
hygiene is crucial for the health, education and dignity of girls and women. This is an important
sanitation issues which has long been in the closet and still there is a long standing need to
openly discuss it. The onset of menstruation represents a landmark event in pubertal
development of the adolescent girl. Menstruation, and the menstrual cycle are characterized by
variability in volume, pattern and regularity, which at the earlier stages of the development of the
adolescent can create emotional discomfort particularly to the poorly informed girl. Studies have
shown that although most girls viewed themselves as being prepared for menarche, having
discussed this with their mothers, obvious misconceptions on the true physiological process and
characteristics of menstruation and the menstrual cycle is evident from these studies (Juyal,
Kandpal, Semwal, Negi 2020).

2.1.1 Types of Absorbents Used during Menstruation

The preference of sanitary protection material is based on personal choice, cultural acceptability,
economic status, and availability in local market. Along with basic sanitation facilities, one

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should also be provided with soap and menstrual absorbents to manage menstruation hygiene.
The choice of absorbents varies among rural/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. Chlorine-bleached Kraft or sulphate pulp is used by manufacturers to produce fluff
pulp as absorbent used to make disposable sanitary products. Nowadays, many deodorized and
non-deodorized sanitary products are available in the market made of synthetic fiber rayon.
These deodorized products contain chemicals like organ chlorines which have antibacterial
activity. Due to their chemical composition, these products when buried in the soil they kill the
soils micro flora and delay the process of decomposition.

Reusable and Washable Cloth Pads. 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. These cloth pads are reusable so they are
cost-effective, easily available, and ecofriendly. They also need to be stored in a clean dry place
for reuse to avoid contamination.

Commercial Sanitary Pads. 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.

Tampons: They are the type of absorbent that provides internal protection. They are kind of plug
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.

Reusable Tampons. These are washable tampons made up of natural materials like bamboo,
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.

Menstrual Cups. 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

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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

Bamboo Fiber Pads. Instead of wood pulp, bamboo pulp is used as an absorbing material in
these sanitary pads. It has more absorbing capacity and is safer to use. They are affordable, easily
decomposed, and environment friendly pads which also possess antibacterial properties. This
provides infection and irritation-free menstruation. Also, bamboo charcoal pads are available in
the market with advantage that blood stains are not clearly visible and are also reusable in nature.

Banana Fiber Pads. Nowadays, low-cost sanitary pads for rural women made from waste
banana tree fiber were sold under trade name “Saathi” in India. They are environment friendly
and decompose within six months after use. Besides these products, women in the remote rural
areas also use natural materials like cow dung, leaves, and mud.

Water Hyacinth Pads. Menstrual pads manufactured using water hyacinth is sold under trade
name “Jani.” They are cost-effective, easily biodegradable, and ecofriendly in nature.

2.1.2 Knowledge of adolescent girls towards menstruation and menstrual hygiene

Menstruation and menstrual practices are still clouded by taboos and sociocultural restrictions
resulting in girls remaining ignorant of the scientific facts and hygienic health practices, which
sometimes results into adverse health outcomes. The hygiene-related practices of girls in
adolescent period related to menstruation can have effect on their health. The event of menarche
may be associated with taboos and myths existing in our traditional society which have a
negative implication for women’s health, particularly their menstrual hygiene. Studies have
shown that the girls lack knowledge about menstruation and due to lack of hygiene, they are
likely to suffer from RTI’s (Kamath, 2019).

“Most of the school girls are not aware of the fundamental facts about menstruation and puberty
and very little attention is paid to the reproductive health of those girls. Menstruation has often
been dealt with secretly in many cultures. Such perceptions coupled with poor and inadequate
sanitary facilities have often kept girls from attending schools especially during periods of
menstruation. The consequence of this is that many girls grow up with low self-esteem and

11
disempowered from poor educational attainments. This is to a large extent influences menstrual
practices of these adolescent girls’

It has further been observed that many girls have a faulty knowledge of the location and function
of the reproductive organs and their inter-relationships. Some even perceive events like
menstrual bleeding to be emanating from the abdomen, intestines and kidneys or occurring as a
consequence of curse from god, sin and disease (Dhingra & kumar, 2019).

There is a tendency for girls to associate a variety of negative physical and psychological
changes on their body with menstruation a situation found to be more marked in blacks
compared to white girls. This may indicate an imbibition’s and internalization of cultural myths
stereotypes association with menstruation in many cultures which undoubtedly influence the
adolescence girls.

A study conducted in Haryana, Egypt among 130 students aged 13-17 years reported poor
awareness and health seeking practices during menstruation, the study reported the commonest
reported menstrual problem as dysmenorrhea (40.7%) followed by irregular menses(2.3%) while
only 5.3 percent consulted a doctor, 22.4 percent preferred to take counter medication from
chemist shops.

Other studies have accessed knowledge and practices of menstruation in adolescent girls in urban
areas. In many communities, female students tends to underutilizes health services, and a similar
situation has been reported in the northern part of Oyo state which have a significant impact on
the physical and social health of those affected. By contrast there is little knowledge and
inappropriate health care behavior regarding menstruation. Availability of such information
could be important for appropriate health care services. (Kamath, 2019).

2.1.3 Attitude of adolescent girls towards menstrual hygiene.

Girls often are reluctant to seek help regarding their menstrual problems. Understanding how to
manage hygiene during menstruation is definitely one of the most essential for girls because poor
maintenance of hygiene during menstruation results in several types of diseases such as RTI’s,
pelvic inflammatory diseases, urinary tract infection etc. which may result in infertility of the
girls. The adolescent girls should be educated about the facts of menstruation, physiological

12
implications, and proper hygienic practices with selection of disposable sanitary menstrual
absorbent. This can be achieved through schools and colleges by providing health education to
them. (Patie&Kubde, 2018).

Most girls are ignorant about the physiology of menstruation and therefore the first experience of
menstruation is of fear, shame and disgust. A Fear is deep-rooted in adolescent girls that they
will sin if they break these taboos. Due to these reasons girl’s attitude and expectations about
menstruation have become negative and this may result in poor menstrual hygiene which is
associated with high prevalence of reproductive tract infections (RTI’s), (kamath, 2019).A study
conducted in Kano state of Nigeria revealed that majority (86%) of the girls lack scientific
knowledge about menstruation and puberty (Lawan, Nafisa& Musa 2020)

Faulty perception or misconceptions on menstruation and menstrual cycle will lead to faulty
menstrual practices. Either of these may create reproductive health problems in the adolescent
such as dysmenorrhea, gastrointestinal manifestations; depression, and reproductive tract
infection which may in turn cause congestive dysmenorrhea. Culturally discussion on sexuality,
including menstruation is often shrouded in secrecy, rarely is such discussion carried out even
amongst adults themselves, a situation which may exert little or no influence of mothers on their
daughter’s attitude to menstrual perceptions and practices. This state of affairs however is
changing with increasing socialization between the mothers and their daughter consequent upon
western education, and amongst this group dissimilarities may not exist on menstrual attitudes
and practices between the mothers and their adolescent daughters (Patie and Kubde, 2019).

2.1.4 Practice of menstrual hygiene employed by adolescent girls.

Menstruation often represents an event with social and cultural implications. A number of studies
conducted throughout Asia have specifically reported varying cultural beliefs and practices
related to menstruation. These beliefs and practices include the use unhygienic sanitary
materials, altered bathing, altered nutritional intake and restriction on women’s social mobility
and religious activities. (Dambhare, Wagh&Dudhe, 2019).

Numerous studies, particularly from low income countries, show that a very high number of girls
starts menstruating without having any idea what is happening to them or why. (McMahon,
2020).

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Studies in Africa have found out the use of sanitary pads as low as 18% amongst Tanzanian
women with the remainder using cloth or toilet paper (Baisely, Changulucha, Weiss, Mugeye,
Everett &Hambleton, 2021). Studies of Nigerian schoolgirls have found between 31 and 56%
using toilet tissue or cloth to absorb their menstrual blood as opposed to menstrual pads
(Aniebue, Aniebue&Nwankwo, 2019).

In a study conducted in Egypt by El-Gilanye, Badawi and El-Fedawry revealed that almost half
of the women held this belief that bathing was unhealthy; it either, it prolongs the bleeding
period, stop menstrual bleeding and causes maceration of the skin. However, almost all of the
women in the same study practiced thorough washing of their perinea area and used sanitary
pads. The majority of the women changed their pad at fixed times of the day (i.e. once or twice;
either in the morning, evening, or at night) rather than changing the pad when it was soaked
while half of the women did not change their sanitary protection for more than 9-10hours.

In a south Indian study, approximately 50% of the women abstained from taking shower during
menstruation and avoided perineal care. The reported reason for this abstention were habits of
cleanliness, and the belief that showers increase pain intensity and would lead to discontinuation
of menstrual flow, Endorses this in his study of the number of females that avoid bathing during
menstruation (Shanbhag2019).

According to a literature review report on females and their mothers believed that eating foods
considered to be too hot (dry fruits, liver, and eggs) or too cold (ice cream, yogurt and green
leafy vegetables) should be avoided. Many of the food they avoid are rich in iron; iron deficiency
anemia has thus been reported as a major health concern amongst adolescent females.

Poor menstrual health management (MHM) in schools have been shown to cause adolescent girls
worry and humiliation, contribute to monthly absenteeism and lead to poor performance in
schools (Patie and Kubde, 2019). The united Nation Children’s Fund UNICEF (2020) stresses
the importance of school toilets which are built to accommodate menstruating girls’ specific
needs for privacy, space, washing facilities and correct disposal or cleaning of menstrual pads.
An environment where these hygienic needs are met can lead to improved dignity and
attendance, thus improving girls’ education and consequently the development of a country.

14
Sommer (2019) suggests that acquaintance with a country’s beliefs around menstruation and
providing girls with correct information about puberty are important elements in a holistic school
MHM package. Ignorance about menstrual issues is prevalent not only amongst schoolgirls but
also in organizations and communities. The issue of menstrual hygiene has the growing attention
of women in developing countries; this applies to both individuals and self-help groups.
Menstrual hygiene seems to be an insufficiently acknowledged problem especially in official
programs from research, it become clear that the lack of menstrual hygiene in many counties in
Africa and Asia in perceived as an urgent problem and that several grass roots initiatives are
trying to find a solution. In a pilot project in Kisumu (Kenya), boys and girls not only have the
task to inspect and clean latrines, with clean water, in combination with information about
hygiene issues. This has clearly resulted in a lower rate of school drop-out among girls.

2.1.5 Factors that hinder the adolescent girls from menstrual hygiene practices.

Attitude of parent and society in discussing the related issues are barrier to the right kind of
information, especially in the rural areas. Menstruation is the thus construed to be a matter of
embarrassment in most cultures (Kamath, 2019).

Although adolescence is a healthy period of life, many adolescents are often less informed, less
experienced, and less comfortable accessing reproductive health information and services than
adults. In many parts of the developing countries, a culture of silence surrounds the topic of
menstruation and related issues; as a result many young girls lack appropriate and sufficient
information regarding menstrual hygiene. This may result in incorrect and unhealthy behavior
during their menstrual period. (Devi & Ramiah, 2018).

The relationship between culture and menstruation is expressed in many ways. A variety of
menstrual-related traditions exist. One group of authors has even theorized that menstruation
may have played a key role in the development of symbolic cultures in early human society.
Many religions have menstruation-related traditions; these may be bans on certain actions during
menstruation (such as sexual intercourse in some movements of Judaism and is Islam), or rituals
to be performed at the end of each menses (such as the Mikvah in Judaism and the Ghusi in
Islam). Some traditional societies sequester women in residences called “menstrual huts” that are
reserved for that exclusive purpose. (Devi & Ramiah, 2019).

15
In Hinduism, it is also frowned upon to go to a temple and do Pooja (i.e, prayer) or do pooja at
religious events if you are a woman who is menstruating. Saraswati, the Hindu goddess of
knowledge is associated with menstruation; the literal translation of her name is “flow-woman”.
(Adhikari, Kadal, Dhungel & Mandal, 2019). Young girls often grow up with limited knowledge
of menstruation because their mothers and other women shy away from discussing the issues
with them. Adult women may themselves not be aware of the biological facts or good hygienic
practices, instead of passing on cultural taboos and restriction to be observed. Men and boys
typically know even less, but it is important for them to understand menstrual hygiene so they
can support their wives, daughters, mothers, students, sisters, employees and peers. In the
development sector, there is a lack of documentation for sharing best practice on what works.
Taboos surrounding menstruation exclude women and girls from many aspects of social and
cultural life as well as menstrual hygiene services. Such taboos include not being able to touch
animals, water points, or food that will eat, and exclusion from religious rituals, the family home
and sanitation facilities, as a result, women and girls are often denied access to water and
sanitation when they need it most (Kamath, 2019).

The forum for African Women Educationalists (FAWE, 2019) in Uganda observes that
menstruation is most important factor affecting school dropout among girls. According to them,
the cause lies in a combination of poverty, local customs, cultural traditions and taboos. FAWE
organizes workshops to facilitate discussion and have an open dialogue in which girls and
women feel free to talk about issues such as menstruation and menstrual hygiene. This has led
perceptibly to a wider distribution of sanitary napkins by the retail trade, a fall in prices and a
larger effective demand. Women and girls in rural areas, who are often the poorest and cannot,
afford to buy sanitary napkins, catch their menstruation blood in an extra sari, or in cloths.
Washing the cloth is problematic, because the women most often walk to a distant spots near or
river or a lake. As a result, women and girls run an increased risk of becoming victims of sexual
violence and abuse (UNICEF, 2020).

Frequently, there is no possibility of properly drying the cloth, because nobody, especially men,
should see any of sign of the menstruation (shame-based culture). The consequence is that
women and girls mostly have to hang it in well-hidden, often unhealthy places and use moisture
and damp cloths. Incinerators are of little use if girls continue to use washable cloths, in which

16
case, the availability of water and soap in every school toilet, together with social mobilization,
are vital, in summary, this literature was reviewed according to the specific objectives to enable
the researcher determine the knowledge, attitude and practice of menstrual hygiene among
females Students in selected Secondary in Ijebu North local government area, Ogun State.

2.2 THEORETICAL FRAMEWORK

The health belief model

The health belief model (HBM) is an intrapersonal (within the individual, knowledge and
beliefs) theory used in health promotion to design intervention and prevention programs. It was
designed in the 1950’s by social psychologists: Irwin M. Rosenstock, Godfrey M. Hochbaum, S.
Stephen Kegeles, and Howard Leventhal and it continues to be one of the most popular and
widely used theories in intervention science. The health belief model is a simultaneous process
used to exchange healthy behavior among individuals who put themselves at risk of developing
negative health outcomes. A person must evaluate their perceptions of susceptibility and severity
of developing a disease. Then it is necessary to feel threatened by these perceptions.
Environmental factors can contribute as well as cues to action such as television ads, campaigns
or caring relatives. Lastly the benefits to change must be weighed against the barriers to change
behavior in order to determine that taking action will be worthwhile.

The model was created in reaction to a failed, free tuberculosis screening program. The focus of
Health belief model is to assess health behavior of individuals through examination of
perceptions and attitudes someone may have towards disease and negative outcomes of certain
actions. The Health belief model assumes that behavior change occurs with the existence of the
five constructs at the same time.

Perceived severity: Perceived severity refers to the subjective assessment of the severity of a
health problem and its potential consequences. The health belief model proposes that individual
who perceive a given health problem as serious are more likely to engage in behavior to prevent
the health problem from occurring or reduce it severity.

17
Perceived susceptibility: Perceived susceptibility refers to subjective assessment of risk of
developing a health problem. Health belief model predicts that individuals who are susceptible to
a particular health problem will engage in behaviors to reduce their risks of developing the health
problems.

The combination of perceived severity and perceived susceptibility is referred to as perceived

threat. Perceived severity and perceived susceptibility to a given condition depend on knowledge
about the condition. The HBM predicts that higher perceived threat leads to higher likelihood of
engagement in health promoting behavior

.Perceived benefit: Health-related behavior are also influenced by the perceived benefits of
taking action. Perceived benefits refer to an individual’s assessment of the valve or efficacy of
engaging in health promoting behavior to decrease risk of disease.

Perceived barriers: Health-related behavior are also function of perceived barriers to taking
action. Perceived barriers refer to an individual’s assessment of the obstacles to behavior change.
Perceived benefits must outweigh the perceived barrier in order for behavior change to occur.
Perceived barrier to taking action include the perceived inconvenience, expense, danger (e.g. side
effect of a medical procedure) and discomfort (e.g. pain, emotional upset) involved in engaging
in the behavior.

Cue to action: The health belief model posits that a cue, or trigger, is necessary for prompting
engagement in health-promoting behaviors. Cues to action can be internal or external.
Physiological cues (e.g., pain symptoms) are an example of internal cues to action. External cues
include events or information from close others, the media, or health care providers promoting
engagement in health-related behavior.

2.2.1 Application of health belief model.

1. An individual recognizes that there is enough reason to make a health concern relevant
(perceived susceptibility and severity) knowledge of females students about susceptibility
of the infection during period of menstruation and severity of the infection will serve as a
motivating factor for them to engage in positive health behavior like personal hygiene
during menstruation.

18
 2. That person understands she may be vulnerable to a disease or negative health outcome.
(perceived threat) the knowledge about the vulnerability of female student to contacting
infection and other disease with poor health behavior especially during menstruation and
its negative consequence will motivate them in positive health behavior.

3. The individual must realize that behavior change can be beneficial and the benefits of that
change will outweigh any costs of doing so (perceived benefits and barriers). Knowledge
and awareness about the important and benefits of menstrual hygiene among females will
motivate them to take action actions towards positive health behavior during
menstruation. Knowledge and awareness that menstrual hygiene is easy to practice will
enable develop a positive attitude towards menstrual hygiene.

4. The intensity cues to action needed to prompt action varies for example in promoting
good menstrual hygiene in females, the individual needs a calendar to tract down periods,
provision of sanitary pads, proper disposal of menstrual products.

The diagram below shows the health Belief Model including all of the elements necessary for
behavior for behavior change. This document will discuss each of the three main categories
provided in the model and break them down into the components they are comprised of.

19
FIGURE 1: THEORETICAL FRAMEWORK: HEALTH BELIEF MODEL

20
2.3 EMPIRICAL REVIEW

The empirical review of this study is in line with the study specific objectives.

2.3.1 Knowledge on menstrual hygiene management among female students

According to the data obtained from the participants, in high school girls, Nekemte Town,
Oromia region, Western Ethiopia, 2019, five hundred and four (60.9 %) of the respondents had
good knowledge about menstruation and its hygiene. Out of total six hundred thirty seven
(76.9 %) of girls knew that menstruation was a physiological process, eighty (9.7 %) of the girls
believed that it was a curse from God. Five hundred nineteen (62.9 %) knew that the cause of
menstruation was hormone. More than half, five hundred four (60.9 %) of the respondents knew
the origin of the menstrual blood was from the uterus. Majority six hundred fifty seven (79.3 %)
knew about menstruation before attaining menstruation. Three-fourth six hundred and twenty
two (75.1 %) of girls knew about menstrual hygiene. Five hundred and twenty seven (63.6 %)
knew that there was a foul smell during menstruation (Shivaleela, Upashe, Tesfalidet & Jalane,
2019).

Also the results of the study revealed that, 67.8 % of the respondents got information about
menstruation from their friends, followed by mass media, teachers, from their mothers and
books. Girls whose mother’s education status secondary school and above were 1.51 times more
likely had good knowledge about menstruation and menstrual hygiene than their counterparts
(AOR = 1.51, 95 % CI: 1.03–2.22). Girls from families with radio and/or TV were more likely to
have good knowledge about menstruation and menstrual hygiene when compared to those who
had no radio/TV (AOR = 2.42, 95 % CI: 1.64 – 3.56) (Shivaleela, Upashe, Tesfalidet & Jalane,
2019).

According to Rajinder (2019) in his research on Menstrual Hygiene, Management, and Waste
Disposal: Practices and Challenges Faced by Girls/Women of Developing Countries, while
reviewing literature, we found that little, inaccurate, or incomplete knowledge about
menstruation is a great hindrance in the path of personal and menstrual hygiene management.
Girls and women have very less or no knowledge about reproductive tract infections caused due
to ignorance of personal hygiene during menstruation time. In rural areas, women do not have
access to sanitary products or they know very little about the types and method of using them or

21
are unable to afford such products due to high cost. So, they mostly rely on reusable cloth pads
which they wash and use again.

A cross-sectional study was carried out in urban slum area on menstrual hygiene among
adolescent girls. Data were collected using pre-tested preform during the period of 1 June to 31
August 2019. Among the 100 adolescent girls, 72% were between 15 and 19 years. A maximum
of 47% were having high school education. About 47% mothers were illiterate; 27% girls had
menarche at 14 years and 82% had regular cycles. About 76% had no knowledge of menses
before menarche. The source of information was mother in 84%. Only 16% girls commented that
bleeding is initiated in uterus. About 60% girls used sanitary pad and the rest used cloth pieces.
Results showed that the majority of the girls (76%) had no knowledge of menstruation before
menarche, and 84% obtained information of menses from their mother. Only 16% of the girls
knew that bleeding occurs from the uterus, whereas 84% had no idea of the organ from where
bleeding occurs. Very less number of girls (20%) was found to know that the cause of menses is
physiological, and the maximum (76%) were not aware of anything (Tanvi, 2019).

Omidvar,in 2019 in his study on Menstrual pattern among unmarried women from south India. A
significant number of girls were school dropouts; it was the mother who was the person
responsible in delivering knowledge. Therefore, educational status of the mother played a crucial
role in influencing the adolescent girl in the family, and it was found that a majority of 47% of
the mothers were illiterate, while in a study conducted among school-going adolescent girls in
Nagpur only 7.49% of the mothers were illiterate. This wide difference was because this study
was carried out in a slum area. Another community study in Varanasi showed that 13% of the
mothers were illiterate and were less hygienic.

2.3.2 Attitude of female students towards menstrual hgyiene.

Most girls are ignorant about the physiology of menstruation and therefore the first experience of
menstruation is of fear, shame and disgust. A Fear is deep-rooted in adolescent girls that they
will sin if they break these taboos. Due to these reasons girl’s attitude and expectations about
menstruation have become negative and this may result in poor menstrual hygiene which is
associated with high prevalence of reproductive tract infections (RTI’s), (kamath, 2019).A study

22
conducted in Kano state of Nigeria revealed that majority (86%) of the girls lack scientific
knowledge about menstruation and puberty (Lawan, Nafisa& Musa 2019).

Research conducted by Rizvi, in 2016 in his study on practices of menstrual hygiene among
adolescent girls pakinstan. A significant discovery of 136 (49%) of the respondents had a
positive attitude towards MHM issues whereas 140 (51%) required improvement on their attitude
towards MHM. Data showed that 52.5% of the respondents agreed restrictions for carrying out
household chores during menstruation are significant. Only 47% thought that violation or non-
observance of cultural traditions and taboos during menstruation will not lead to god or deities
cursing their family members. 77% of respondents agreed that, increase in supplementation of
nutrients/food is necessary during menstruation. Only 54% of respondents thought that men do
not become sick if a menstruating female touches him. 65% of respondents agreed that
menstruating females should take bath. Only 45% of respondents agreed that menstruating
females can consume dairy and sour food items.

2.3.3 Practices for menstrual hygiene management employed by female Students.

A cross-sectional study was carried out in urban slum area on menstrual hygiene practice among
adolescent girls. Sanitary pads were wrapped in paper and disposed by 51.67% of the girls. But
an unusual practice of washing the sanitary pad and then disposing it in a carry bag was observed
in our study. About 30% girls used this method of disposal and 18.4% disposed their pads in
open.

All the girls practiced hand washing during menses. They used soap and water in majority
(78%), but a few (22%) used only water to wash. Bathing everyday was found in almost all the
girls and washing of private parts during menses was practiced by them during bathing. Any
special attention to genital hygiene was not found in them. Some of the girls (4%) practiced hair
washing every day during menses. shows that only few (20%) of the girls did not follow any
restrictions, whereas a majority of them had restrictions. (Tanvi, 2020).

According to Tanyi (2020), unhygienic and improper practices during this period can lead to
serious reproductive tract infections, urinary tract infections, and various sexually transmitted
diseases. It can also contribute to developing life threatening conditions such as cervical cancer.
In this study, about 60% of the girls used sanitary pad, whereas 19% used old cotton cloth.

23
Similarly, in a study in Delhi, 63.3% of the girls used sanitary pads, whereas cloth was used by
25.3%. The practice of using pads was found less than that reported from a study by Patavegar
(2019) in which 85.92% used sanitary pads. Many of the girls preferred cloth pieces and the
usual practice was washing the cloth pieces and then drying them in the sun in a private area so
that nobody can see them. Among those who used cloth pieces, the frequency of washing or
reusing the cloth is an important contributor to reproductive tract infections. Therefore, in this
study, 70% of the girls reused the same old cloth after washing, whereas it was 51.3% in one of
the study (Gultie, Hailu, and Workineh, 2019)

In a study conducted among girls in Kenya, cotton wool, plastic bags, mattresses, dried leaves,
cow dung, and paper from school classrooms were used (Jewitt & Ryley, 2020).

In 2020, Dasgupta and Sarkar in their study on menstrual hygiene in India: How hygienic is the
adolescent girl? The adolescent girls had no information about proper method of disposal of
sanitary pad. In our study, only 51.67% of the girls used proper disposal technique of wrapping
the sanitary pad with paper and then throwing it into a dustbin which was similar to a study
where 57.5% of girls disposed the pad properly.

Personal hygiene practices such as hand washing, bathing, and cleaning private parts regularly
play a vital role in safeguarding oneself from infections. Simple hand washing with soap and
water during period of menstruation and after using toilet can be beneficial. In our study, hand
washing with only water was found in 22% of girls, whereas 78% of girls used soap and water
which was found to be similar to a study in which 28.5% girls used only water and 71.5% used
both soap and water for hand washing (Sharma, Mehra, Kohli, and Singh, 2021).

In 2016, another study by Patle and Kubde on Comparative study on menstrual hygiene in rural
and urban adolescent 43.75% of the urban girls and 61.96% of the rural girls used water and
56.25% of urban girls and 38.04% of rural girls used both soap and water to wash hands.

2.3.4 Factors that hinders proper practice and awareness of menstrual hygiene among
female students.

A cross-sectional study was carried out in urban slum area on menstrual hygiene practice among
adolescent girls. Few (27%) believed that the restrictions imposed on them are by Gods

24
commands. Almost a maximum (80%) of girls did not visit temple during menses, separation
from the family members and not entering the kitchen was found in 27% girls, whereas some
(21%) girls said that they were not allowed to touch anyone and had to stay out of the house
during menses (Tanyi, 2019).This study being community-based study in slum area, unhygienic
environmental conditions were observed. Poverty, illiteracy, and ignorance are the major factors
which lead to poor environmental sanitation. Improper sanitation of the surrounding also
contributes to adverse health outcomes. Lack of water supply majorly affects the status of
hygiene. Privacy issues are mainly found in girls using public toilets. Hence, ignorance toward
cleanliness is seen in these girls to avoid embarrassment. Girls using private toilets were found to
practice better hygiene than those using common public toilets. Therefore, in our study a
majority of 79% of girls used common public toilet and only 21% had separate individual toilets,
while in a study by Yasmin, Manna, Mallik, Ahmed, and Paria in 2019, menstrual hygiene
among adolescent school students: An in-depth cross-sectional study in an urban community of
West Bengal, India. 80.3% of the respondents had private toilet and 19.7% girls used common
public toilet.

Tanyi in 2019 observed that different restrictions were practiced by most of the girls in this study
due to their false beliefs and improper perceptions about menstruation. Traditional practices and
superstitions are followed due to lack of knowledge among adolescent girls and their families.
Multiple restrictions were followed by every adolescent girl which included not visiting temples
and not entering kitchen. Restrictions such as separation from the family during menstrual
bleeding, not touching anyone in the family, and sleeping outside the house were also found to
be practiced. Almost every girl followed some or the other restrictions. In another study carried
out in slum and non-slum areas by Rokade and Kumavat, 77% of girls from slum area and
76.61% of girls from non-slum area practiced various types of restrictions, and the commonest
restrict reported in both the groups was related to religious activity – 68% in slum and 70.16% in
non-slum girls.

25
 CHAPTER THREE

RESEARCH METHODOLOGY

This chapter consists of the research method used by the researcher in the collections of data for
the study, which includes the following subheadings; research design, research setting, target
population, sampling technique, instrument for data collection, validity/reliability of instrument,
pilot study, method of data collection, method of data analysis and ethical consideration.

3.1 RESEARCH DESIGN

Non experimental descriptive design will be used as research methodology for this investigation.
Non-experimental descriptive design seeks to characterize features of a population or
phenomenon under study without adjusting any variables. The main purpose of this design is to
record and document spontaneously occurring event and phenomena in their unaltered state,
devoid of any researcher interference or manipulation. As a result, this approach would be used
to access the knowledge, attitude and practices menstrual hygiene among female students in
selected secondary schools in Ijebu North local government area, Ogun State.

3.2 SETTING OF STUDY

This study will be conducted on female Student in Ijebu Igbo grammar school, Molusi College
and itamerin comprehensive junior high school Ago iwoye that are within the age range and
class of 11-19 and JSS3-SS3 respectively in Ijebu North local government area, Ogun State.

Ijebu North is a local government area in Ogun State, Nigeria with it headquarter in town of
Ijebu Igbo. It is bounded by Oluyole local government of Oyo State in the north, in the west by
Ijebu East local government, in the south by Ijebu North East, Odogbolu and Ijebu Ode local
government and in the east by Ikenne local government. The region is partitioned into local
wards: Atikori, Oke Agbo, Ojowo, Japara, Oke – Sopen, Ome, Oru- awa-ilaporu, Osun and Ago
Iwoye. Ijebu North boasts of many secondary schools, amongst which three of the foremost
secondary schools in Ogun State, Molusi College founded on January 28, 1949 Ijebu Igbo girls

26
grammar school founded on February 7, 1955 and Itamrin comprehensive junior high founded in
January, 1958.

3.3 TARGET POPULATION

The study populations are the female students from age 11-19, from Ijebu Igbo girls grammar
school with about eight hundred and seventy five (875) total number of female students, Molusi
college with about seven hundred (700) total number of female students and Itamerin
comprehensive junior high school Ago iwoye, which have the total number of two hundred (200)
females students presently. These schools are selected based on Accessibility and Feasibility,
school population, and Demographic composition.

3.4 SAMPLING SIZE

Taro Yamane’s formula will be used to determine the sample size from the population.

n = n /1+ (Ne2)

Convenience Where, N = population size and e = Signifiance coefficient = 0.05

n=?

875+700+200=1,775

n = N/1+(Ne2)

n = 1,775/1+1775(0.05)2

n = 1775/1+1775(0.0025)

n = 1775/1+4.4375

n = 1775/5.4375

n=326

27
 Attrition rate =10% of 326

Attrition rate =(10/100)*326

Attrition rate = 32.6

Sample size (n) =326 + 32.6

n =348.6

n =349 respondents

3.5 SAMPLING TECHNIQUE

Simple random sampling technique will be used for the study. Simple random sampling is a
fundamental probability sampling technique in which each element in the population has an
equal and independent chance of being selected as part of the sample. 1,775 female students
from the selected secondary schools in Ijebu North local government area, Ogun State will be
purposively selected for the purpose of this study, hence, simple random sampling will be used
in selecting at least 349 respondents from selected secondary schools in Ijebu North local
government area, Ogun State.

3.6 INSTRUMENT FOR DATA COLLECTION

Instrument for data collection will be a well-constructed questionnaire by the researcher and it
contains multiple research items based on the research objectives. Questionnaires will be divided
into the following sections:

Section A: This section comprises the demographic characteristic of respondents which include
the age of students, religion, ethnic group, etc.

Section B: knowledge of menstrual hygiene among female student in selected secondary schools
in Ijebu North local government area, Ogun State.

28
Section C: Attitude of female students toward menstruation in selected secondary schools in
Ijebu North local government area, Ogun State.

Section D: Practice of menstrual hygiene among female students in selected secondary schools
in Ijebu North local government area, Ogun State.

Section E: Hindrances to proper menstrual hygiene practices among female students in selected
secondary schools in Ijebu North local government area, Ogun state.

3.7 VALIDITY OF INSTRUMENT.

In order to ensure a valid research instrument, a well-structured questionnaire will be constructed

by the researcher which will be submitted to the supervisor for corrections, additions and
comments. Thereafter, the corrections will be made and questionnaires will be administered to
the respondents for answering.

3.8 RELIABILITY OF INSTRUMENT

In this study, the test re test method will be employed. A sample of the questionnaire to be used
will be administered to ten (10) female students from Adeola Odutola College, Ijebu Ode. The
given questionnaire will be retrieved immediately. After two weeks, the same questionnaire will
be repeated to the same set of respondents, to compare and assess for consistency of respondents.

3.9 METHOD OF DATA COLLECTION

The data will be collected by the researcher with the help of two (2) research assistants to ensure
high return rate for the period of two weeks. Participants who will participate in the study will
receive elaborated explanation on the purpose of the study, type of questions and how to answer.
Before the participants will give their response, orientation will be given to them on how to fill in
the questionnaire. Filling of the questionnaire will take about 8 -10 minutes. All questionnaires
will be completely filled and returned as the researcher and research assistants ensures that
respondents complete all.

29
3.10 METHOD OF DATA ANALYSIS

Data collected will be analyzed using descriptive method of analysis i.e. frequency table,
percentages, pie chart and graphical representation. Haven gathered the data through the
administration of questionnaires; the collection of data will be coded, tabulated and analyzed
using SPSS statistical software according to the research.

3.11 ETHICAL CONSIDERATION

A letter of introduction will be collected from the acting provost of Jafad College of Nursing
Science, Oru Ijebu, and submitted to the Principals from Ijebu Igbo grammar school, Molusi
College, and Itamerin Comprehensive junior high, Ago Iwoye, Ogun State to obtain
administrative permission. Also a letter will be attached to the questionnaire requesting for
voluntary participation of respondents and assuring respondents that confidentiality will be
maintained as no name nor photographs will be required. Respondents will also be protected
from harm during the study.

30
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 QUESTIONNAIRE

JAFAD COLLEGE OF NURSING SCIENCE, ORU IJEBU, OGUN STATE

Greetings,

I am a final year student of Jafad college of Nursing Science, Oru Ijebu, Ogun State. I am

working on a research study “Knowledge, Attitudes, and Practice of menstrual hygiene

among female students in selected secondary schools in Ijebu North local government area,

Ogun State” Your participation is completely voluntary, and you will not be asked for your

name or any other identifying information. All information given will be kept totally secret and

used solely for academic purpose.

Thank you for taking part.

Stephen Elizabeth Queen

SECTION A: SOCIO DEMOGRAHIC DATA

Instruction: Please tick the response in the appropriate boxes

1. Age: A) 11-13 years [ ] B) 14-16 years [ ] C) 17-18 years [ ] D) 19 years and above [ ]

2. Class: A) JSS1 [ ] B) JSS2 [ ] C) JSS3 [ ] D) SS1 [ ] E) SS2 [ ] F) SS3 [ ]

3. Religions: A) Christianity [ ] B) Islam [ ] C) traditional [ ]

SECTION B: Knowledge on menstrual hygiene

4. Have you heard of menstrual hygiene? A) Yes [ ] B) No [ ]

5. Where did you get the information from? A) School mate [ ] B) school teacher [ ] C) media

[ ] D) health personnel [ ] E) magazine [ ] F) family member [ ] G) parent [ ]

6. Can poor hygiene during menstruation cause infection? A) Yes [ ] B) No [ ]

7. Do you have a menstrual cycle of 26-28 days? A) Yes [ ] B) No [ ]

34
8. Bathing should be done 2-3 times daily during menstrual period? A) Yes [ ] B) No [ ]

9. The place of clothes or pads should be flushed after use in the toilet A) Agree [ ] B) Disagree

[ ]

10. Piece of clothes and tissue paper should be used during menstruation. A) Agree [ ] B)

Disagree [ ]

11. Menstruation that lasted for 3-5 days is considered abnormal A) Agree [ ] B) Disagree [ ]

12. Menstruation is a normal physiological occurring in a women A) Agree [ ] B) Disagree [ ]

13. Menstruation is a curse from gods caused by sin A) Agree [ ] B) Disagree [ ]

14. Menstrual bleeding originated from the uterus (womb) A) Agree [ ] B) Disagree [ ]

15. To ensure adequate menstrual hygiene sanitary pads should be changed at least 2-3 daily A)

Agree [ ] B) Disagree [ ]

16. To ensure adequate menstrual hygiene, private area should be washed at least 2-3 times daily

A) Agree [ ] B) Disagree [ ]

17. Menstruation is a female matter, to be kept for oneself only, it is not to be discussed openly.

A) Agree [ ] B) Disagree [ ]

SECTION C: Attitude on menstrual hygiene

18. Menstruation is sign of maturity of womanhood; therefore every female should embrace it A)

Agree [ ] B) Disagree [ ]

19. Every female student should be exposed to reproductive health education A) Agree [ ] B)

Disagree [ ]

20. Menstruation should not disturb the normal activities of daily living A) Agree [ ] B)

Disagree [ ]

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21. Female student should be allowed to have 1-2 days sick leave to enable them rest during this

period A) Agree [ ] B) Disagree [ ]

SECTION D: Practice on menstrual hygiene

22. Sanitary pads should be used during menstruation A) Yes [ ] B) No [ ]

23. Do you take special bath (bathing more than once daily) during menstruation A) Yes [ ] B)

No [ ]

24. Used sanitary pads should be wrapped and discarded in the dustbin or in a pit toilet A) Yes

[ ] B) No [ ]

25. What materials should be used during menstruation? A) Tampon [ ] B) piece of cloth [ ] C)

tissue [ ] D) sanitary pads [ ] E) others [ ]

26. How often do you clean your private part daily? A) Once a day [ ] B) twice a day [ ] C)

three times [ ] D) four times [ ]

27. Did your parent discuss issues related to menstruation or menstrual hygiene practice with

you? A) Yes [ ] B) No [ ]

28. In your home, is the issue of menstruation freely discussed? A) Yes [ ] B) No [ ]

29. Is there any taboo about menstruation in your culture? A) Yes [ ] B) No [ ]

30. Are you always able to afford the material for menstrual hygiene? A) Yes [ ] B) No [ ]

SECTION E: Hindrances to menstrual hygiene practices

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Please indicate the extent to which the following factors hinder your ability to practice good
menstrual hygiene.

31. Lack of access to affordable menstrual products A) Not at all [ ] B) Slightly [ ] C)

Moderately [ ] D) Extremely [ ]

32. Inadequate water, soap and sanitation facilities in school A) Not at all [ ] B) Slightly [ ] C)
Moderately [ ] D) Extremely [ ]

33. Absence to private spaces to change/ dispose menstrual products A) Not at all [ ] B) Slightly
[ ] C) Moderately [ ] D) Extremely [ ]

34. Restrictive cultural norms, taboos and stigma around menstruation A) Not at all [ ] B)
Slightly [ ] C) Moderately [ ] D) Extremely [ ]

35. Lack of menstrual health education from parents/ teachers A) Not at all [ ] B) Slightly [ ] C)
Moderately [ ] D) Extremely [ ]

36. Financial constraints in the household A) Not at all B) Slightly [ ] C) Moderately [ ] D)

Extremely [ ]

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