Vol. 5(5), pp.

99-105, August 2013

DOI: 10.5897/IJNM2013.0102 International Journal of Nursing
ISSN 2141-2456 © 2013 Academic Journals
http://www.academicjournals.org/IJNM
and Midwifery

Full Length Research Paper

Self care practices of menstrual hygiene among

adolescents school going girls in Amassoma
Community, Bayelsa State
Adika, V. O.1*, Ayinde M. O.2 and Jack-Ide I. O.3
1
Department of Medical Surgical Nursing, Faculty of Nursing, Niger Delta University, Wilberforce Island,
Bayelsa State, Nigeria.
2
Faculty of Nursing, College of Health Sciences, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria.
3
Department of Mental and Psychiatry Nursing, Faculty of Nursing, Niger Delta University, Wilberforce Island,
Bayelsa State, Nigeria.
Accepted 21 May, 2013

Self care practices as well as menstrual hygiene are basic requirements for promoting a satisfied life
and personal esteem in a woman. It is therefore necessary to investigate the self care practice of
menstrual hygiene among female school going adolescents who have attained menarche in Amassoma
community, Bayelsa State. A survey was designed with systematic sampling which involves selection
of girls from government and private secondary schools. A total of two hundred and nine (n = 209)
students participated in the study after the aim of the study was explained, and their consent obtained.
A carefully constructed questionnaire was administered to the related classes. Results indicated that
adolescent’s girls have an average level of self care and menstrual hygiene, even though age and
educational status did not significantly impact on the effect of self care practice and menstrual hygiene.
This therefore calls for more education about this special aspect of these adolescent school girls’ life
and reproductive life.

Key words: Menstrual hygiene, self care practice, adolescent girls, Bayelsa.

INTRODUCTION

Adolescent has been defined by the World Health self-care practices are major determinants of morbidity
Organization (WHO) as the period between 10 to 19 and other complications among this age group (McCaleb
years of age, in their second decade of life (WHO, 2007). and Cull, 2000). However, some girls have developed
Adolescent girlhood is a critical time of identity formation their own strategy to cope. Globally, different forms of
and a period of transition from childhood to womanhood beliefs and perception of menstruation have been found
(Kirk and Sommer, 2005) and of great challenge to the which either negates or promotes the adolescent females
parents, as well as the child and those concerned for the health. Studies have shown that superstitions, illogical
upbringing of the adolescent. It is characterized by beliefs and misinterpretation are more common than
physical, psychological, mental and social changes that accurate understanding of the process of menstruation,
are critical to wellbeing (Szilagyi, 2003). menstrual hygiene and self care practices (Uzochukwu et
Adolescent menstrual hygiene and self care is a critical al., 2009).
issue that determines the health status of the adolescent In view of this, it becomes important for parents, tea-
and the eventual practices that are inculcated into adult chers and health care practitioners especially nurses to
life (Uzochukwu et al., 2009). Poor hygiene and inadequate be adequately involved in the promotion of adolescent

*Corresponding author. E-mail: [email protected]. Tel: +2348069711622.

100 Int. J. Nurs. Midwifery

menstrual hygiene and self care practices to reduce were then informed about the aim of the study. The study tool was
disease burden and poor health outcome associated with a carefully designed, tested, self-structured questionnaire
developed and written in English language by the researchers to
poor menstrual hygiene and self care among these elicit information aimed at meeting the criteria of the purpose for the
group. study. It is made up of three (3) sections: A, B and C.
Among the Ijaw people of south-south Nigeria, Bayelsa Section A obtains information on socio-demographic variable of
state data on adolescent menstrual hygiene and care respondents while section B on menstrual hygiene and section C
practices are scarce, except the work of Adika et al. obtains information related to self care practices. The validity of the
(2011) on use of sanitary pads among adolescent girls. In instrument was ascertained from the information gathered from the
literatures that met the study criteria, and also involving an expert in
other to curtail diseases such as vaginal infections that research for the questionnaire suitability and its applicability for the
may result to pelvic inflammatory diseases with dare study gave credibility of the instrument. The reliability of instrument
consequences, it becomes eminent to investigate was determined through a test-retest method involving carrying out
adolescents’ menstrual hygiene and self care practices in a pilot study using 20 questionnaires in a nearby community
Amassoma community of Bayelsa. (Ogobiri) under the same local government as Amassoma and
including newly observed facts while discarding ambiguous items of
Menstruation and menstrual hygiene are still clouded
the initially constructed questionnaire. Then, 120 questions were
by taboos and socio-cultural restrictions resulting in administered face to face to all respondents and were retrieved
adolescent girls remaining ignorant of the scientific facts immediately by the investigators. This lasted for 1 month from June
and hygienic practices which sometimes results into ad- to July, 2012. Data obtained from the field work were analyzed by
verse health outcomes (Dasgupta and Sarkar, 2008; El- means of the statistical package for social sciences (SPSS) version
Gilany and Nadawi, 2005; Poureslami and Osateashtiani, 17 Chicago IL. Descriptive and inferential statistics were calculated
for socio-demographics, respondents’ level of menstrual hygiene
2002). Poor menstrual hygiene and self care practices and self care practices while chi-square was used for inferential
are synonymous to poor health outcome and health statistics of studied parameters. A letter of authority seeking
status of the adolescent female (Uzochukwu et al., permission to undertake the study was issued to the schools and
2009).Unlike in previous generations where adolescent is chief of the community, respectively, who gave the researchers a
seen as a period of cleanliness and spotlessness, this verbal consent to conduct the study and explained also to the
observation rarely applies to adolescents of these days. adolescent school girls to comply. The purpose of the study was
explained to the participants and confidentiality was assured.
The increasing rise in female genital tract infections
among women in recent times really speaks of poor
hygiene and self care practices. This trends and observa-
tions may be similar to what is obtainable in Amassoma, RESULT AND DATA PRESENTATION
Bayelsa state. Therefore, there is the need to investigate
adolescent menstrual hygiene and self care practices Socio-demographic data
among this group. The main objectives for this study are:
Table 1 shows the socio-demographic data of
1. To determine the self care practices associated with respondents. A total of two hundred and nine (n = 209)
menstrual hygiene among adolescents in Amassoma adolescents were involved in the study whose age range
community. was 10 to 19 years, and a mean age of 13.7 years. 190
2. To determine their perception of menstruation. (90.9%) of the adolescents were Christians, 14 (6.7%)
were Muslims, 3 (1.4%) belong to African traditional
To determine what factors influence their self care religion while, 2 (1.0%) belonged to other religion; 100
practice of menstrual hygiene. The formulated hypothesis (47.8%) are in senior secondary school while 109
to be investigated in this study is; (52.2%) are in junior secondary school; age of menarche
are 77 (36.8%) at 9 to l2 years, 115 (55.0%) at 13 to 15,
H0: There is no statistical significant relationship between 16 (7.7%) at 16 to 17 and 1 (0.5%) attained menarche at
age and effect of menstruation on self care the age of l8 to 19 years.

MATERIALS AND METHODS

Perception of menstruation
Amassoma community is where the Niger Delta University is
located, in the south-south geo-political zone, Nigeria. There are
different cadres of workers and their families living in the
Table 2 shows respondents knowledge on the meaning
community, from native fisher men and business men, to other of menstruation: 114 (54.5%) perceived that menstruation
government workers. There are bustling activities because of the is regular monthly flow of blood from the female genital
site of the university, primary schools and secondary schools in this tract while the remaining (45.5%) did not know this, 123
area. In this descriptive survey study, 209 adolescent girls were (58.9%) thought menstruation means bleeding from the
purposefully selected at random from two schools, from a list of
vagina while the remaining 86 (41.1%) did not know this.
schools in Amassoma community. The inclusion criteria were that
they have attained menarche and are taking care of themselves Also, 101 (48.3%) knew that menstruation is also referred
during menses. The classes of Junior Secondary School (1 to 3) to as “the period” while the remaining 108 (51.7%) did not
and Senior Secondary School (1 to 3) were targeted, and students know this among the adolescent female respondents.
 Adika et al 101

Table 1. Socio-demographic data of respondents (n = 209). self care practice. 129 (61.7%) reported yes to promote
health as reason for self care practice while 80 (38.3%)
Variable Frequency Percentage said no to promote health, as not a reason for self care
Age practice, 181 (86.6%) said yes to avoid body odour as a
10-11 11 5.2 reason for self care while 28 (13.4%) said no to avoid
12-13 89 42.6 odour as a reason for self care practice.
14-15 70 33.4
16-17 36 17.2
18-19 2 1.4 Factors that influences self care practices

Religion Table 5 shows the various factors that influence

Christian 190 90.9 adolescent self care practice; 144 (68.9%) of the adole-
scent girls said yes to be influenced by underage while
Muslim 14 6.7
the remaining 65 (31.1%) said no to be influenced by
African tradition 3 1.4
underage, 131 (62.7%) stated yes to be influenced by ill
Others 2 1.0 health of the adolescent girls while the remaining 78
(37.3%) said no to be influenced by ill health or illness, 91
Education (43.5%) of the adolescent girls reported busy schedule to
Junior Secondary School 109 52.2 influence self care practice while the remaining 118
Senior Secondary School 100 47.8 (56.5%) said no to be influenced by busy schedules, 89
(42.6%) stated yes to be influenced by financial
Menarche age constrains while 120 (57.4%) said no be influenced by
9-12 77 36.8 financial constrains, and 96 (45.9%) said yes menstrual
13-15 115 55.0 cycle influence self care practices whereas the other 113
16-17 16 7.7 (54.1%) said no to the influence of menstrual cycle.
18-19 1 0.5

Relationship between age and effect of menstruation

self care
Self care practice during menstruation
Table 6 shows the relationship between age and effect of
Table 3 shows the self care practice during menstruation: menstruation on self care. There was no statistical
63 (30.1%) stay at home during menstruation while 146 significant relationship between adolescent age and the
(69.9%) do not stay at home during menstruation. 112 impact of menstruation on self care practices as p-value
(53.6%) use sanitary pads during menstruation whereas = 0.65.
97 (46.4%) do not use sanitary pads, 96 (45.9%) uses
deodorant while 113 (54.1%) do not use deodorants,185
(88.5%) wash their underwear while 73 (34.9%) do not DISCUSSION
wash their under wears, 161 (77.0%) change their under
wears while 48 (23.0%) do not change their under wears Optimal care of menstrual hygiene are synonymous to
during menstruation.139 (77.0%) said yes they shave good hygiene practices and inevitably to a healthy living
their genital area during menstruation, while73 (34.9%) in an adolescent girl`s life (Adika et al., 2011). The result
do not shave their genital areas. However, 127 (60.8%) from this study was drawn from adolescent females
engage in regular bathing to preserve their genital resident in Amassoma, Bayelsa state, Nigeria. The
hygiene while 31 (14.8%) used regular bathing during discussions of findings are:
menstruation to preserve their hygiene while the remain-
ing 51 (24.4%) engage both in frequent bath and regular
change of sanitary pads to preserve their menstrual
hygiene. Social demography

A total of two hundred and nine (n = 209) adolescent

Reasons for self care practice females who have attained menarche were included in
the study, 109 were in Junior secondary school and 100
Table 4 shows reasons for self care practices: 142 in Senior secondary school, whose age range was from
(67.9%) of the adolescent girls reported yes to prevent 10 to 19 years and were mostly of 12 to 13 years old, and
infections as reason for their self care practice while 67 were Christians by religion, resident in Amassoma
(32.1%) say no to prevent infection, as not a reason for community (Table 1).
102 Int. J. Nurs. Midwifery

Table 2. Perception of menstruation among female adolescents (n = 209).

Variable Frequency Percentage

Menstruation is regular monthly flow of blood
Yes 114 54.5
No 95 45.5

Menstruation is bleeding from vagina

Yes 123 58.9
No 86 41.1

Menstruation is the period

Yes 101 48.3
No 106 51.7

Table 3. Self care practice during menstruation among adolescent (n = 209).

Variable Frequency Percentage

How do you preserve your hygiene during menstruation
Regular bathing 127 60.8
Frequent pad/toilet 31 14.8
Both 51 24.4

Stay indoors at home

Yes 64 30.6
No 145 69.4

Use of sanitary pads

Yes 112 53.6
No 97 46.4

Use of deodorant
Yes 96 45.9
No 113 54.1

Washing under wears

Yes 185 88.5
No 24 11.5

Shaving the genital area

Yes 139 65.1
No 73 34.9

Changing under wear

Yes 161 77.0
No 48 23.0

Self care practice of menstrual hygiene a woman (Singh et al., 2011), as adoption of high quality
menstrual hygiene will play an important role in
The practice of healthier behavior like menstrual hygiene prevention of reproductive tract infections (RTI) and
and self care practices during normal menstruation, cancer of cervix among the women population. There-
menorrhea (heavy bleeding) and dysmenorrheal (painful fore, promoting positive attitudes towards management of
bleeding) are important indicators of health and deter- menstruation and related problems among the adole-
minant of health especially during the reproductive age of scent girls is the need of the hour (Ray and Dasgupta,
 Adika et al 103

Table 4. Reasons for self practice (n = 209).

Variable Frequency Percentage

Prevent infection
Yes 142 67.9
No 67 32.1

Promote health
Yes 129 61.7
No 80 38.3

Avoid body odour

Yes 181 86.6
No 28 13.4

Table 5. Factors that Influence self care practices.

Variable Frequency Percentage

Under age
Yes 144 68.9
No 65 31.1

Ill health
Yes 131 62.7
No 78 37.3

Busy schedule
Yes 89 43.5
No 120 56.5

Financial constrains
Yes 89 42.6
No 120 57.4

Menstrual cycle
Yes 93 45.9
No 113 54.1

Table 6. Relationship between age and effect of menstruation on self care.

Do menstruation affect self care practice 2-

Age distribution X Value Df P-Value
Yes No

10
1 2
11 8 2
12 18 19
13 23 29
14 17 35
17.471 10 0.65
15 11 7
16 13 9
17 4 10
18 0 1
19 0 1
20 1 0
104 Int. J. Nurs. Midwifery

2012), which concurs with the results of this study. Table relationship was observed between age, educational
3 reveals that self care practice during menstruation status and adolescent menstrual hygiene and self care
includes: regular washing of under wears (88.5%), practice. These findings are in concordance with the
regular changing of under wear (77.0%), shaving the study by Adika et al. (2011) in their study on use of
genital area (65.1%), regular bath (60.8%), use of sanitary pad among adolescent girls in Amassoma
sanitary pads (53.6%), use of deodorant (45.9%) and community, Bayelsa state, Nigeria. The findings are also
relaxation at home (30.1%) but however, this indicate a supported by the study of McCaleb and Cull (2000) on
sub-optimal level of care during menstruation. socio-cultural influence and self care practices of middle
A similar finding was observed by Singh and Maya aged adolescents. However, Ravindran (2008) found that
(2006) in their study on knowledge assessment regarding there was a significant association between menstrual
puberty and menstruation among adolescent school girls hygiene maintenance and education, socioeconomic
in Varanasi district, India. Again, Adika et al. (2011) status, knowledge prior to menarche, type of protection,
observed a poor perception and behavior towards the accessibility to water, bathroom facilities and menstrual
use of sanitary pads during menstruation among disorders. These findings shows the essence of proper
adolescent school going girls which is similar to the result premenacheal training in schools to ensure acceptable
of this study, as they noted that lack of finance was levels of menstrual hygiene among adolescent school
responsible for non-usage of sanitary pads and hence the going girls to enable them obtain optimal self care
use of ether absorbent such as clothes. Regardless of practice and also for reforms and maintenance of good
this findings, many of the studied females did not have health and development.
appropriate knowledge about the menstrual period
hygiene, and did not practice health-oriented behavior in
this regard (Ray and Dasgupta, 2012). This also supports Nursing implication
our study finding.
Nurses play a key role central to public education on
health hygiene and personal development, including the
The perception of menstrual hygiene maintenance of optimal menstrual hygiene and self care
practices among female adolescents. They always come
Table 2 showed perception of menstruation among in contact with this vulnerable group and therefore it is
female adolescents. The results indicated that 54.5% of necessary for them to have adequate knowledge as well
respondents perceive menstruation to mean regular as becoming role models to this deliquescent group of
monthly flow of blood from the female genital tract. the society. It thus becomes as a role to ensure proper
Furthermore, (48.3%) of the respondents perceive education and encouragement of personal hygiene and
menstruation to mean what is called period while another optimal self care practices among female adolescents in
group of respondents (58.9%) perceived menstruation to our society.
mean the same thing as bleeding from the vagina. This In summary, our results suggest that despite, the
implies that some adolescent girls in Amassoma majority use of sanitary pads, there are no adequate self
community have poor perception of the meaning of men- care practices and menstrual hygiene among the
struation, as almost (45.5%) of them do not know that adolescent girls. Factors such as their financial status, ill
menstruation is the physiological menstrual flow of blood, health conditions and busy schedules were indicated to
and over half (58.9%) of them thought menstruation is influence self care practice and menstrual hygiene. Our
bleeding from vagina, and less than half (48.3%) knew results further suggest that to promote health, avoid
menstruation to be synonymous with the period. This infections and prevent odors were reasons for self care
finding is in concordance with a study conducted by Ali et practice and menstrual hygiene. Self care habits and
al. (2010) in Pakistan that reported a 50% level of know- practices have the potential to hamper the adolescent
ledge on menstruation among adolescent girls. Similarly, girls’ reproductive development, thus highly important for
Uzochukwu et al. (2009) found similar poor knowledge their reproductive health and wellbeing. Self care prac-
among adolescents and the need to provide pre- tices in menstrual hygiene may help us not only to better
menarcheal training on menstrual practices and hygiene understand self care practices, but to also find the most
for Nigerian school girls. effective intervention among these vulnerable groups of
adolescent girls and reduce their burden on menstrual
hygiene.
Factors influencing care practice of menstrual
hygiene
Conclusion
Factors such as under age (68.9%), ill health (62.7%),
busy schedule (43.5%), financial constrains (42.6%) and Menstrual hygiene and self care practices have been
menstrual cycle (45.9%) were stated to influence menstrual investigated among adolescent school going girls in
hygiene habits and practices. No statistical significant Amassoma community, Bayelsa State. The findings indicate
 Adika et al 105

an average level of practice of self care among Ray S, Dasgupta A (2012). Determinants of Menstrual Hygiene among
Adolescent Girls: A multivariate analysis. Natl. J. Commun. Med.
adolescent during menstruation. Factors such as age,
3(2):294-301.
religion and educational status were known to have no Singh SP, Singh M, Arora M, Sen P (2006). Knowledge Assessment
effect among respondents of this study. Improved level of regarding Puberty and Menstruation among School Adolescent Girls
menstrual hygiene and practice is encouraged among the of District Varanasi, (U.P.). Indian J. Prev. Soc. Med. 37(1,2): 9-1.
study group.
Singh S, Kandpal SD, Roy D (2011). Menstrual Hygiene Practices and
RTI among ever-married women in rural slum. Indian J. Commun.
Health 22:2, 23:1
RECOMMENDATION Szilagyi PG (2003). Care of Children with special health care needs.
Future Child 13(1):137-151.
Uzochukwu UA, Patricia NA, Theophilus 0N (2009). The impact of pre-
The findings from this study made the researchers to menarcheal training on menstrual practices and hygiene of Nigerian
make the following recommendation. school girls. Pan Afr. Med. J. 22:9.
World Health Organization (WHO) (2007). Adolescent pregnancy –
Unmet needs and undone deeds. A review of the literature and
1. Menstrual hygiene and self care practice guide should
programmes. Issues in Adolescent Health and Development, WHO,
be taught by teachers and easily practicable at home by Geneva.
their parents (mothers), sisters and experienced neigh-
bors with a provision of listenable ears to the adolescents
girls needs to avoid poor health outcome due to poor self
care practices.
2. Menstrual hygiene and self care practices should be
included in the curriculum of secondary school training.
3. Campaigns and seminars to improve adolescent
menstrual hygiene and self care should be organized by
teachers and parents association, as well as health care
organization.
4. Sanitary pads should be made available by the govern-
ment, the office of women affairs and gender matters to
all adolescent females, and the need for regular bathing
and change of pads should be emphasized by their
teachers and school health visitors.

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