Bioscience Biotechnology Research Communications

An Open Access International Journal

P-ISSN: 0974-6455 E-ISSN: 2321-4007

Bioscience Biotechnology Research Communications

An Open Access International Journal

A.Tamilmozhi1* and D. Sridevi2

1M.Phil Research Scholar, Department of Food Science and Nutrition, Dr. N.G.P. Arts and Science College (Autonomous), Coimbatore affiliated to Bharathiyar University, Coimbatore, Tamil Nadu, India

2Associate Professor, Department of Food Science and Nutrition, Dr. N.G.P. Arts and Science College (Autonomous), Coimbatore affiliated to Bharathiyar University, Coimbatore, Tamil Nadu, India

Corresponding author email: mozhidheran21789@gmail.com

Article Publishing History

Received: 19/11/2020

Accepted After Revision: 25/03/2021

ABSTRACT:

The menstrual hygiene problem is inadequately understood and has not received adequate attention. The use of sanitary pads and genital washing are important practices for preserving menstrual hygiene. The goal of the study is to assess the knowledge and  practice of menstrual hygiene management among the adolescent gilrs in Dharmapuri district of Tamilnadu. This is a cross-sectional study was administered with adolescent girls in Sri Vijay Vidyalaya Arts and Science College, Dharmapuri district, Tamil Nadu. This study was done among 200 adolescent girls under the age group of 19-24 years. A self-administered structured questionnaire was developed to obtain information from school students. Descriptive analysis was done to analyses the knowledge and practice among the adolescents on menstrual hygiene management. The results of that study revealed that, 53% and 41% of them were under the age group of 23-24 years in the control group and experimental group.

The control group subjects secured 44% of them having poor knowledge (30-39) and 36% were having regular (40-49) nutritional knowledge and remaining 16% and 4% were very poor (20-29) and bad nutritional knowledge category. In experimental group, 24% of the adolescent was shifted to a good knowledge, 11% of them were under satisfactory (50-59), and 63% of them were in good knowledge and had a positive attitude towards menstrual hygiene management related issues. From this study it was concluded that, knowledge of menstrual hygiene management among adolescents is very fair, still attitude and practice has to be improve and need a healthy awareness campaigns to improve behavior alongside regular enhancement of school health education schemes.

KEYWORDS:

Knowledge, Attitude, Practice, Menstrual Hygiene, Management.

Download this article as:

Copy the following to cite this article:

Tamilmozhi A, Sridevi D. Assessment of Knowledge and Practice of Menstrual Hygiene Among Adolescent Girls of Tamil Nadu State India. Biosc.Biotech.Res.Comm. 2021;14(1).


Copy the following to cite this URL:

Tamilmozhi A, Sridevi D. Assessment of Knowledge and Practice of Menstrual Hygiene Among Adolescent Girls of Tamil Nadu State India. Biosc.Biotech.Res.Comm. 2021;14(1). Available from: <a href=”https://bit.ly/3v94FUc“>https://bit.ly/3v94FUc</a>


INTRODUCTION

Adolescence has been described as a period between 10-19 years by the WHO (WHO, 1997). The word adolescence comes from the term “to grow to maturity” in Latin. By 2025, the teenage population in developed and developing countries are going to be about 19% and 27%, respectively (Bansal and Mehra, 1998; Kulkamai and Baride, 2002). Adolescent girls constitute not only a vulnerable group in terms of their social standing, but also in terms of their health.

In this respect, in society, menstruation is considered impure or filthy (Dasgupta and Sarkar, 2008). Consistent with the UNICEF (The Status of World’s Children 2011) survey, there are an approximate 1.2 billion teenagers within the world aged 10-19 years, making up 18% of the world’s population, and 88% of them sleep in developing countries.

In Haryana, teenagers structure 21% of the entire population (Census 2011). Adolescence accounts for 20% of the nation’s population in India (UNICEF, 2011). Hygiene-related practices of girls during menstruation are of considerable importance, because it features a health impact in terms of increased vulnerability to reproductive tract infections (RTI).

The interplay of socio-economic status, menstrual hygiene practices, and RTI are noticeable. Today many women are sufferers of RTI and its complications and sometimes the infection is transmitted to the offspring of the pregnant mother (Dasgupta and Sarkar, 2008 Sharma 2017 ICDS 2019).

There are over 355 million menstruating women and girls in India, but many girls across the globe still face major problems with a relaxed and dignified menstrual hygiene management experience. In India, during their menstrual cycle, about 88 percent of girls use homemade items (e.g., old cloth or rags).

The key reasons for using the cloth-based product are personal preference and familiarity, lack of approach to or affordability for good-quality commercial sanitary pads, and lack of sufficient knowledge about pads. A locally produced cotton fabric is additionally employed by some girls.

The incidence of reproductive tract infection (RTI) was 70% more prevalent among women and girls if hygienic sanitary practices weren’t practiced during menstruation (Garg et al., 2012). Menstrual hygiene is an issue that every girl has to deal with in her life, but there is lack of awareness on the process of menstruation, the physical and psychological changes associated with puberty and proper requirement for managing menstruation.

The taboos surrounding this issue in the Indian society prevent girls and women from articulating their menstrual needs. The problems of poor menstrual hygiene management have been ignored or misunderstood by the society as well the policy makers till now (Juyal et al., 2012, ICDS 2019).

Adolescence is that the most vulnerable period within the human life cycle after puberty, marked by rapid development and growth with a transition from infancy to maturity. The teenage term is taken from the Latin word ‘adolescence,’ aiming to mature into adulthood (ICDS, 2012).

For girls, menstruation may be a physiological process which begins in puberty and is unprecedented for ladies . it’s periodic discharge of blood and mucosal tissue from the uterus for 4-5 days (average) occurs regularly every 28-30 days of the cycle (Roy et al., 2014). Women with improved menstrual hygiene skills and good practices are less prone to reproductive tract infections and their effects.

Increased awareness of menstruation right from childhood will also escalate healthy practices and can also alleviate the misery of millions of women. The social stigma attached to menstruation causes dangerous grooming activities to be carried out by many girls and women.

Girls and women frequently suffer from discomfort and infection, avoiding urination during menstruation, and using any kind of cloth available old (or) unwashed as an, but still girls do not visit medical practitioners, lacking a forum to share menstrual hygiene problems. Hence, the present study was planned to assess the menstrual hygiene knowledge and self-care practice among the adolescent gilrs and to seek out the impact of knowledge and practice among the adolescents (Roy et al., 2014 Sharma 2017).

MATERIAL AND METHODS

In phase I clinical trial a quantitative research approach was adopted for the study. The research design chosen for this study was a descriptive cross-sectional research design. The population chosen for this study was, adolescent girls studying in Sri Vijay Vidyalaya Arts and Science College, Dharmapuri district, Tamil Nadu . Adolescent girls who fulfill the sampling criteria were included within the study.

The sample size for the study was 200 (control group n=100; experimental group n=100). The technique adopted for this study was the straightforward sampling technique. an in depth interview schedule was developed by the investigator to elicit information about the socio-economic status, History of menstruation deals with menarche, menorrhea and menstrual duration, health status and private habits of the chosen subjects.

Before starting the study, a pilot was adopted among 10 percent (n=10) of the entire subjects to seek out validation within the formulated interview schedule. In phase II clinical trial , nutrition education was given to the chosen adolescent groups through Power Point presentation and therefore the knowledge and practice were evaluated using the questionnaire.

A nutritional knowledge questionnaire was formulated which consisted of 10 questions of multiple-choice and 10 nutritional practice questions that were developed to seek out the menstrual hygiene knowledge and practice between both the control group and therefore the experimental group.

Within the control group, 100 adolescent subjects were chosen and there was no intervention was adopted during this group. during this experimental group, 100 adolescent subjects were grouped during a big hall. Before starting the assessment of data pretest was assessed using the structured questionnaire. the themes were projected with the PowerPoint presentation about menstrual hygiene and self-care materials. Posttest about menstrual hygiene and self-care was assessed after one week through an equivalent questionnaire.

The collected questionnaire was validated and every correct answer is scored and therefore the total score obtained by each subject is noted right down to test their pre and post nutritional knowledge. The difference between the initial and final scores was assessed to seek out the impact of nutrition education.

Questions were scored as followed 1 mark for the right answer and 0 marks for wrong or no answer. the entire score of every aspect equal 60% or quite → adequate or satisfactory knowledge and practice). the entire of every aspect but 60% → inadequate e or unsatisfactory knowledge and practice.

RESULTS AND DISCUSSION

The results and discussion of this study was discussed below with the relevant tables, which describes the datas in details.

Socioeconomic status of the selected subjects

Table 1. Socioeconomic status of the selected subjects

Socioeconomic details Control group (n=100) Experimental group (n=100)
Number % Number %
Age (years)
19-20 22 22 28 28
21-22 25 25 31 31
23-24 53 53 41 41
Ethnic
OC \FC 10 10 21 21
BC 45 45 40 40
MBC 35 35 35 35
SC\ST 10 10 14 14
Religion
Hindu 68 68 59 59
Christian 24 24 24 24
Muslim 8 8 17 17
Others
Educational qualification of parents
Elementary school 10 10
High school 55 55 74 74
College 35 35 26 26
Illiterate
Employment
Sedentary 49 49 34 34
Moderate 35 35 47 47
Heavy 16 16 19 19

Data about the study revealed that 53 percent and 41percent of them were under the age group of 23-24 years in the control group and experimental group. Nearly 22percent and 28percent of them were belonged to 19-20 years of age. In our society menstruation is considered as very personal and private matter of discussion.

In the present study most of the girls (80.82%) had attained menarche between 13-15 years of age. Other studies by Sharma (2017) showed comparative findings where 57.35 percent of girls had menarche between the ages of 13-15 years. Majority of 40% of the selected subjects were under backward ethnic group.

The religion said that most (above 50%) of the subjects were Hindu. About 35 percent of them under MBC and 45 percent of the girls belonged to BC in the control group. In the experimental group, 40percent of them belonged to the BC category, and 14percent were Sc/ST group (Drakshayani et.al., 1994).

The majority of 68percent of them were Hindu and only 8percent of them were Muslim in the control group and the experimental group 59percent them and 17percent of them were Hindu and Muslim respectively. 10 percent did their elementary level, 55 percent had studied up to high school and 35 percent of them were graduates in the control group.

Whereas in the experimental group, 74 percent of them did their high school level education and 26 percent of them were finished their college studies. 49percent were as sedentary workers, 35percent were as moderate workers and 16 were as heavy workers in the control group and 47percent of them were moderate worker and 19percent of them were a heavy worker in the experimental group. Menstruation-related information and activities are often based on socio-economic circumstances (Drakshayani et.al., 1994).

Percentage of distribution of menstruation and menstrual hygiene knowledge among study participants

Table 2. Percentage of distribution of menstruation and menstrual hygiene knowledge among study participants

S. No Questions Control group (n=100) Experimental group (n=100)
Pre test (%) Post test (%) Pre test (%) Post test (%)
1. Menstruation is a regular process
Physiological process 81 81 50 60
Disease 2 2 31 10
Sin 10 10 2 18
Do not know 7 7 17 12
2. Definition of dysmenorrheal
Painful 34 34 47 50
No periods 44 44 52 42
Do not know 22 22 1 8
3. Definition of menstruation disorder
No periods 30 30 14 15
Normal menstrual cycle 48 48 75 85
Do not know 22 22 11 0
3. Time of ovulation
Yes 85 85 89 92
No 15 15 11 8
4. Signs and symptoms before or during menses
Yes 45 45 62 84
No 55 55 38 16
5. What is the cause of menstruation?
Hormones 50 50 77 67
Diseases 1 1 24 33
 Do not know 39 39 0 0
6. From where does the menstrual blood flow?
Uterus 85 85 73 85
Vagina 15 15 27 10
Abdomen 0 0 0 5
Do not know 0 0 0 0
7. Do food habits affect menstrual cycle?
Yes 67 67 82 88
No 23 23 18 12
8. Have you heard about menstrual hygiene?
Yes 72 72 69 72
No 28 28 31 28
9. Do poor menstrual hygiene practices lead to infections?
Yes 67 67 82 88
No 23 23 18 12
10. Menstruation indicates fertility
Yes 79 79 88 94
No 21 21 12 6

About 81 percent (control) and 50 percent (experimental) of participants were able to answer that Menstruation was a physiological process and 44 percent and 52 percent of girls were knowing about dysmenorrheal. Dysmenorrhea is one of the most common complaints and gynecological problems among worldwide women (George and Bhaduri, 2002;  Harel, 2006 and Agarwal and Agarwal, 2010). Among the study participants, 48 percent and 755 answered the definition of menstruation. About 80 percent of girls able to open up their time of ovulation. In the control group, 55 percent of the girls do not have signs and symptoms of menstruation.

In the experimental group, 77 percent of them know the causes of menstruation. Almost 70 percent of the girls knew about the menstrual flow organ. About 67 percent and 82 percent of the group girls knew that poor menstrual hygiene practices lead to infections. Almost70 percent of girls were aware that menstruation indicates fertility (Sapkota et al., 2014). The knowledge score was demarcated into Poor, Average, and Good and is given in the table.

The pre and post-test Knowledge Mean initial scores were 15, 20, 8, and 18 for poor scores, 75, 70, 32, and 67 for average scores and 10, 10, 60, and 15 were good scores of both groups. In the present study 39 (23.64%) of the adolescent girls were found to be absent from school during their menses in comparison to a study done by Kumar et al where 42.8% adolescent girls were absent from school during menses.

Regarding the percentage of distribution of menstruation and menstrual hygiene knowledge, 48 percent and 75% were answered the definition of menstruation. Nearly about 67% and 82% of girls knew that poor menstrual hygiene practices lead to infections. There is limited knowledge and many misconceptions about menstruation among young women in India before and even after the menarche.

This usually leads to undue fear, anxiety, and undesirable practices (Mahon and Fernandes, 2010). Juyal et al., (2012)  and Sapkota et al., (2014) stated in their study that 83% of the respondent had the idea that menstruation is a physiological process, which is significantly higher than findings (Juyal et al., 2012; Sapkota et al., 2014).

Percentage distribution of menstruation and menstrual hygiene practice among subjects

Table 3. Percentage distribution of menstruation and menstrual hygiene practice among subjects

S,no Questions Control group (n=100) Experimental group (n=100)
Pretest (%) Posttest (%) Pretest (%) Posttest (%)
1. What absorbent do you use during menstruation?
Sanitary pad 76 76 85 92
New cloths 24 24 15 8
Old cloths 0 0 0 0
2. How many times do you change pad/cloths per day?
One time 67 67 82 52
Two time 23 23 18 20
Three time 0 0 0 28
Four time 0 0 0 0
3. Do you change pad/cloth before sleep?
Yes 72 72 69 80
No 28 28 31 20
4. If you are using cloth or absorbent (re-usable), How do you dry it?
Outside room in sunlight 9
Inside room with sunlight 67 67 82 74
Without sun light 23 23 18 17
Not using reusable absorbent 0 0 0 0
5. Type of pads used
Piece of clothes 0 0 0 0
Piece of new cloths 8 8 2 0
Piece of cotton 0 0 0 2
Sanitary pad 92 92 98 98
6. Number of pads per day
Single per day 85 85 89 50
Twice per day 15 15 11 50
Thrice per day 0 0 0 0
Four or more per day 0 0 0 0
7. How do you dispose your sanitary pads?
Buried 30 30 14 30
Burned 48 48 75 65
Dustbin 22 22 11 5
Latrine 0 0 0 0
Throw on road 0 0 0 0
8. When do you clean your genitalia?
Every time use toilet 85 85 89 85
During bathing 15 15 11 15
Do not clean regularly 0 0 0 0
9. Material used for cleaning of external genitalia
Water and antiseptic 22 22 15 10
Soap and water 48 48 75 80
Only water 30 30 10 10
Not cleaning regularly 0 0 0 0
10. Do you practice any restriction during menstruation
Yes 85 85 89 92
No 15 15 11 8

From the above table -3 it was found that about 76 percent and 86 percent of the participants in all two groups use a sanitary napkin during menstruation. Regarding several pads per day, 80 percent of participants answered that they change it more than 3 times in a day.

They were asked whether they change pad before sleep for which 60 percent of participants responded yes. Burying, burning, disposing of in waste bin after proper wrapping was considered to be fair practice and 83.8 percent girls were practicing it. About 80 percent of participants of both groups were cleaning their genitalia regularly. A study conducted by Dasgupta and Sankar (2008) in which just 48.75% knew the use of a sanitary pad.

Mudey et.al., (2010) stated that poor genital hygiene negatively afects adolescents’ health. Most girls are unaware and unprepared for menarche as they are not informed or ill-informed about menstruation. This increment in knowledge indicates the exposure and readiness of school adolescents to adopt hygiene behavior.

Though the majority of students know about menstruation which might be attributed to the inclusion of reproductive health education in school curricula and exposure to a wide range of information media like television, radio, internet; still misperceptions persist in this matter (Dasgupta and Sankar 2008; Mudey et.al., 2010).

Mean comparison of the control group and experimental group regarding menstrual hygiene knowledge and practice

Table 4. Mean comparison of the control group and experimental group regarding menstrual hygiene knowledge and practice

Aspects studied Total scores Groups Pretest

Mean ± SD

Post-test

Mean ± SD

‘t’ value Significance
Nutritional knowledge 10 Control Group 4.48 ± 1.26 6.76±4.26 0.44 0.76NS
Experimental Group 5.36± 2.32 8.23±1.92 47.2 0.00**
Practice 10 Control Group 3.51±0.95 3.95±0.69 12.4 0.81NS
Experimental Group 4.35±0.91 7.52±0.71 1.04 0.02**

*- significant at 5% level, ** -significant at 1% level; NS -not significant

The results of the ‘t’ value of the control group were 0.44 which is more than the 5% level of significance. The two-tailed p-value was 0.76 which means that the mean nutritional knowledge was increased (2.28) which was not significant at a 5% level (Lawan et al., 2010).

The results of the ‘t’ value of the experimental group were 47.2 which is less than a 1% level of significance. The two-tailed p-value was 0.00 which means the mean final nutritional knowledge was increased (2.87) which was significant at a 1% level. Dasgupta and Sankar (2008) pointed out that the increased awareness and knowledge about menstruation from the early days is most likely to inculcate healthy practices and help in lowering the sufferings of millions of women. Results of the ‘t’ value of the control group were 12.4 which is more than the 5% or 1% level of significance.

The two-tailed p-values were 0.81 which means the mean final attitude was increased (0.44) which is not significant at 5% or 1% level. The results of the ‘t’ value of the experimental group were 1.04 which is less than a 1% level of significance (Lawan et al., 2010).

The two-tailed p-value was 0.02 which means the mean final attitude was increased (3.71) which was significant at a 1% level. The promotion of adolescent sexual and reproductive health and the prevention of diseases are among the key reasons for menstrual hygiene. Our study found that the majority of adolescent girls used sanitary pads (commercial or reusable) during their menstruation.

This is similar to reports from Lawan and colleagues from Nigeria but in contrast to the study conducted in India and Adinma’s study where the majority was found to be using toilet rolls to manage menstrual blood (Lawan et al., 2010). Ciccone et al. (2010) study has clearly demonstrated that educating the subject on health and management will have greater impact in reducing the burden of risk.

The outcome of the work warrants a strong partnership between the care manager and the subject and collaboration between the physician and the care manager in the health management. Our results are in agreement with the above study (Ciccone et al., 2010).

Nutrition knowledge of adolescents based on Z scores

Table 5. Nutrition knowledge of adolescents based on Z scores

Standard Mean scores* Control group

(N=100)

Experimental

group I (N=100)

Pre test Post Test Pre test Post test
Excellent >80
Very good 70-79 2
Good 60-69 63
Satisfactory 50-59 11
Regular 40-49 45 24
Poor 30-39 15
Very poor 20-29 56 20 62
Bad 44 20 38

Results of the Z score of adolescents reported that in the control group initially 44 percent of them were in bad nutritional knowledge category and 56 percent came under very poor (20-29) nutrition knowledge and after one week. 44 percent of the subjects were shifted to poor category (30-39) and 36 percent were regular (40-49) nutritional knowledge and remaining 16 percent and 4 percent were very poor (20-29) and bad nutritional knowledge category respectively. Results of the experimental group indicated that initially 44% of the subjects were in the bad nutritional knowledge category and 56 percent were in very poor (20-29).

nutritional knowledge after nutrition education 24 percent of the adolescent were shifted to a regular category, 11 percent to satisfactory (50-59) and 63% of them were in a good category. Following the findings from our study, 55.4% believed menstruating females should not consume poultry and sour food items. Sapkota et al., (2014) done his finding in rural Nepal regarding food taboos and this was agreed.

Despite the expansion of the knowledge horizon, cultural taboos in society prevent a shift of attitude; thus, practice among adolescents on menstrual hygiene management. In the name of history, this case shows the desperate need to counter harmful practices (Sapkota et al., 2014).

CONCLUSION

Nearly three forth of the participants had good knowledge of menstruation and menstrual hygiene but they were not following due to the taboos. The practice of menstrual hygiene was satisfactory (80%). In conclusion, although adolescents’ attitude toward menstruation was relatively positive; they mostly had poor knowledge about menstrual hygiene; consequently, a poor practice was expected. Also, the results indicated that students’ mothers were the main source of their information on mensuration.

It is very important to become aware of the need for knowledge about good menstrual practices. Health data on menstrual hygiene should also be stressed by the mass media. Policymakers and stakeholders should also set up a health education campaign to raise knowledge of good menstrual hygiene and practice. Hence, awareness through the change in curriculum and more friendly relationship between the students and the teachers will contribute significantly to the improvement in the status of menstrual hygiene and overall health of the adolescent.

ACKNOWLEDGEMENTS

Authors are  thankful to the Host Institute research facilitites and Infrastructure with the communication number: DrNGPASC2020-21BS037 for providing oppurtuniites to do this research work in a successful way.

Conflicts of Interest: The authors had no conflict of interest.

REFERENCES                                               

Adhikari P, Kadel B, Dhungel SI and Mandal A (2006) Knowledge and practice regarding menstrual hygiene in rural adolescent girls of Nepal. Kathmandu Univ Med J Vol 5 No 3 pp 382-6.

Agarwal AK and Agarwal A (2010) A study of dysmenorrhea during menstruation in adolescent girls. Indian J Community Med Vol 35 pp 159-164.

Bansal R. D and Mehra M. (1998) Adolescent girls an emerging priority. Indian J Public Health Vol 42 No 1 pp 1-2.

Census (2011), Primary Census Abstracts, Registrar General of India, Ministry of Home Affairs, Government of. India, Available at: http://www.censusindia.gov.

Ciccone MM, Aquilino A, Cortese F, Scicchitano P and Sassara M, (2010) Feasibility and effectiveness of a disease and care management model in the primary health care system for patients with heart failure and diabetes (Project Leonardo). Vasc Health Risk Manag Vol 6 pp 297-305.

Dasgupta A and Sarkar M (2008) Menstrual hygiene: how hygienic is the adolescent girl? Indian J Community Med Vol 33 No 2 pp 77-80.

Devi, K.D. and Ramaiah, P.V., (1994). A study on menstrual hygiene among rural adolescent girls. Indian journal of medical sciences, 48(6), pp.139-143.

Garg R, Goyal S and Gupta S (2012) India moves towards menstrual hygiene: subsidized sanitary napkins for rural adolescent girls-issues and challenges Matern Child Health J Vol 16 No 4 pp 767-74.

George A and Bhaduri A (2002) Dysmenorrhea among adolescent girls- symptoms experienced during menstruation Health Promotion Education Vol 17 No 4 pp 35-39.

Harel Z (2006) Dysmenorrhea in adolescents and young adults: etiology and management. J Pediatr Adolesc Gynecol Vol 19 pp 363-371.

Integradted Child Development Scheme (ICDS) (2012) A study on impact of iron folic acid along with vitamin-c on the hemoglobin status of adolescent AGs in an ICDS Block, National Institute of Public Cooperation and Child Development Regional Centre, Lucknow, India.

Integrated Child Development Services (ICDS) Scheme (2019): Government of India.

Juyal R, Kandpal SD, Semual.J and Negi.NS (2012) Practices of menstrual hygiene among adolescent girls. Indian J Commun Health Vol 24 No 2 pp 124-8.

Kulkarni.A.P and Baride.J.P. (2002) Care of Special Groups (Maternal-Child Health and Care of Old Persons) pp 519-22 (2nd Ed) Textbook of Community Medicine, Vora Medical Publication, Mumbai.

Lawan.U.M, Nafisa.W.Y and Musa.AB (2010) Menstruation and menstrual hygiene amongst adolescent school girls in Kano, Northwestern Nigeria. Afr J Reprod Health., Vol 14 No 3 pp 201-7.

Mahon T and Fernandes M (2010) Menstrual hygiene in South Asia: a neglected issue for WASH (water, sanitation and hygiene) programmes. Gend Dev Vol 18 pp 99–11310.

Mudey AB, Kesharwani N, Mudey GA and Goyal RC  (2010) A Cross-sectional Study on Awareness Regarding Safe and Hygienic Practices amongst School Going Adolescent Girls in Rural Area of Wardha District, India, Global Journal of Health Science, Vol. 2 No. 2 pp 225–231.

PCA, Roy A, Sara AB, VcmF, Babu GP and Tamrakar A (2014) Knowledge Regarding Menstrual Hygiene among Adolescent Girls in selected school, Mangalore with a View to Develop an Information Booklet. IOSR J Nursing Health Sci Vol 3 No 1 pp 55-60.

Sudeshna, R. and Aparajita, D., (2012). Determinants of menstrual hygiene among adolescent girls: a multivariate analysis. Natl J Community Med, 3(2), pp.294-301.

Roy A, Sara AB, Vcm F, Babu GP and Tamrakar A (2014) Knowledge Regarding Menstrual Hygiene among Adolescent Girls in selected school, Mangalore with a View to Develop an Information Booklet. IOSR J Nursing Health Sci. Vol 3 No 1 pp 55-60.

Sapkota D, Sharma.D, Pokharel HP, Budhathoki.SS and Khanal VK. (2014) Knowledge and practices regarding menstruation among school going adolescents of rural Nepal. J Kathmandu Med Coll Vol 2 No 3 pp 122-8.

Sharma ML (2017) To study the knowledge, attitude and practices regarding menstrual hygiene and restrictions imposed upon them during menstruation in the adolescent girls studying in a government and a private school in Sahibzada Ajit Singh Nagar (Mohali City) in Punjab-a comparison pilot study. IOSR J Dent Med Sci Vol 16 No 8 pp 30-37.

United Nations International Children’s Emergency Fund (UNICEF) (2011) The State of World’s Children.

World Health Organization (WHO) (1997) Adolescents, The critical phase, the challenges and the potential published by WHO. Regional office for South-East Asia, New Delhi.