ABSTRACT
In many societies menstruation is not openly
discussed in some families, school and communities leading to a very big gap in
knowledge about menstruation and menstrual problems. This gap equally poses
problems on issues about menstrual hygiene, menstrual problems and management
of those problems. In addition to inadequate information, girls need access to
hygienic absorbent sanitary products, water, good toilets that ensure privacy
and disposal facilities which can in the long run, protect their health. This
study investigated the knowledge and management of menstruation and menstrual
problems among urban and rural secondary school girls in Enugu East Local
Government Area. A cross sectional
descriptive survey was adopted for this study. The sample for the study
comprised of 699 secondary school girls. Four Hundred were drawn from the three
randomly selected secondary schools in urban area. The remaining 299 girls were
from the only government owned secondary school in the rural area. The sample
size for the urban schools was determined using Taro Yamane’s formula. A
researcher developed questionnaire in questions and optional form was used to
generate data. The results were presented in tables with frequencies,
percentages and Pearson’s Chi-square was used to test hypotheses. The results
showed that 497(87.0%) of the respondents had knowledge before menarche.
Mothers were major sources of this information. There was significance
difference (p<0.05) in the knowledge of menstruation between Urban and Rural
Secondary School girls. Majority of the girls 407(71.2%) use sanitary pads
alone or in conjunction wit5h other materials. More than half 308(53.8%) change
their menstrual absorbent materials three times a day and 352(61.6) take their
bath three times a day. There was no significance difference (p<0.05) in
management of menstruation between Urban and Rural Secondary School girl.
Majority 384(67.3%) reported they have toilets in their school and 210(54.7%)
reported that toilets do not provide privacy for change of menstrual absorbent
materials. The commonest menstrual problem experienced by girls is dysmenorrheal
368(64.4%). There was no significance difference (P>0.05) in the menstrual
problems experienced by Urban and rural girls. The majority 101(681%) of the
respondents, use paracetamol to manage abdominal pains. Only 79(13.8%) of girls
that have problems associated with flow consulted a doctor. There was a
significance difference (P<0.05) in the management of menstrual problem
between Urban and rural Secondary School girls. In conclusion, the findings of
this study revealed that girls have information about menstruation but the
information was very deficient in the process of menstruation. Some girls do
not dispose menstrual wastes properly Environment especially at school do not
encourage good management of menstruation. Therefore, it is recommended that there
is still need for organized health education in schools to discourage unhealthy
strategies for managing menstruation especially as it concerns disposal of
menstrual wastes. Also there is need to provide supportive enabling environment
both in Schools and homes for girls for effective management of menstruation should
also involve screening of girls to detect any serious gynaecological problems,
early referral for prompt management.
CHAPTER ONE
INTRODUCTION
Background to the study
Secondary school girls are in a period of growth and
development known as adolescence. Adolescence is a period of transition from
childhood to adulthood. It is a stage of human development that is
characterized with so many physical, social, emotional and mental changes.
There is appearance of secondary sexual characteristics, in girls menstruation
is one of these major characteristics. The onset of
menstruation represents a landmark event in pubertal development of the
adolescent girl. Menstruation is a natural phenomenon that occurs from
puberty throughout the reproductive life of every female. It is a periodic
vaginal bleeding associated with shedding of uterine mucosa. Every mature woman
menstruates on the average of three to five days monthly until menopause
(Lawan, Yusuf & Musa 2010). Esimai
and Esan (2010) assert that normal menstruation relies on action and
interaction of hormones released from Hypothalamus – pituitary and ovaries and
their effects on the endometrium. The normal menstrual pattern is associated
with 3 to 7 days length of flow and amount of flow less or equal to 80ml. A
woman’s period may not be the same every month and it may not be the same as that
of other women. Periods could be light, moderate or heavy and the length of the
period also varies.
Menstruation is a
normal process of the body and if proper knowledge is given regarding its
onset, management and problems associated with it; then it can be handled like
all other body functions. However, many girls in developing countries lack
appropriate knowledge and sufficient information regarding menstruation and its
management (Olayinka 2004). While some information might be available from
school and friends, parents should address the practical concerns that puberty
brings, for instance, new hygiene needs(e.g., menstrual periods, body odors),
clothing and product needs (e.g., cloth vs. napkin brands). In order for girls
to live healthy reproductive and dignified life, it is essential that they are
able to manage menstrual bleeding effectively (Ahmed & Yesmin 2008). Management
of menstruation deals with the special health care needs and requirements like
choice of absorbent used, how often and when to change the absorbent used,
washing of hands and undergarments, bathing, care of vulva and proper disposal
of menstrual wastes. Therefore, menstruation as a regular process needs
hygienic management. If poorly managed, menstrual period may be accompanied
with discomfort, reproductive tract infections, foul odour and embarrassment
among others (Dasgupta & Sarkar (2008).
Despite the fact
that menstruation is a normal physiological process, it is often associated
with some problems and discomforts. Harlow and Campbell (2007), stated that menstrual problem is very
traumatic experience for some adolescent girls and women and could truncate
their life dreams. Titilayo, Agunbiade, Banjo and Lawani (2009) also stated
that 40 -49% of menstruating women are affected by menstrual problems in
diverse ways. Studies from different cultures in different parts of the world
have associated it with one of the most common causes of regular absenteeism among
girls in schools, work places, sports participation and other public functions
(El-Gilany, Badawi & ELfedawy 2005; Walraven, Ekpo, Coleman, Scherf, Morrison & Harlow 2002) . Dysmenorrhea is
the commonest disorder among girls during menstruation. Others are excessive
bleeding, irregular menses, breast pains and fullness. Psychosocial issues
surrounding girls during their menstrual periods aggravate these problems
(Esimai & Esan 2010; Harlow & Campbell 2007; Antai, Udezi, Ekanem, Okon
& Umoiyoho 2004).
In Nigeria,
school girls often struggle to manage their menstruation due to social,
cultural and economic constraints.
Adinma and Adinma (2008) assert
that poor knowledge of menstruation and practice engenders reproductive health
problems in adolescents such as dysmenorrhoea, depression and reproductive
tract infections. In Enugu,
girls manage their menstruation and menstrual problems according to the extent
of pre menarcheal information they received (Aniebue, Aniebue & Nwankwo 2009). They further stated that
socialization brought by western education; parents’ social class influence
information girls receive before menarche and in turn affect management of
menstruation and menstrual problems. Other issues associated with menstrual
hygiene and practices in the country are lack of infrastructure like water,
soap, toilet that ensures privacy. Enugu East Town Planning Authority shows
that the Local Government comprising both urban and rural population with many secondary
school girls; these girls like their counterparts in other parts of the nation may
encounter many challenges on issues relating to their sexuality, principally
menstruation. Hence, the researcher decided to undertake this study.
Statement of Problem
KNOWLEDGE AND MANAGEMENT OF MENSTRUATION AND MENSTRUAL PROBLEMS AMONG URBAN AND RURAL SECONDARY SCHOOL GIRLS IN ENUGU EAST LOCAL GOVERNMENT AREA
