CHAPTER ONE

1.0 INTRODUCTION

This chapter consists of Background of the study, Statement of the problem, objective of the

study, Research question, Significance of the study, Scope of the study and operational definition

of terms.

1.1 Background to the study

Menstruation is the monthly discharge of blood from the endometrium (inner layer of the

uterus).It commences at puberty and end at menopause. The first menstrual period is known as

menarche and its onset varies between one girl and another (Funmi, 2018).

Menstrual hygiene management is jointly defined by World Health Organization (WHO) and

UNICEF as ‘Women and adolescent girls using clean menstrual management materials to absorb

or collect menstrual 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’. In addition, they

understand the basic facts linked to the menstrual cycle and how to manage it with dignity and

without discomfort or fear’ (Wilbur et al, 2019).

Menstrual hygiene is vital to the empowerment and wellbeing of women and girls worldwide.

Poor menstrual hygiene practice have considerable clinical implications for the women

themselves and their future offspring as it is a reason for school absenteeism, poor academic

performance, low self-esteem, reproductive and genitor urinary tract infections and cervical

cancer (Tegegne et al 2018).

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In Africa about 1 in 10 school age adolescent girls absent themselves from school during periods

or drop out at puberty because of lack of private, clean and hygienic sanitation facilities in

schools (UNICEF, 2019). In Nigeria 91 % of the adolescent girls were aware of menstruation

before starting their periods, their use of sanitary protection material was low at 27.6 % and 64.4

% used pieces of cloth and rags, 25% use nothing, and typically isolate themselves during

menstruation and 11% of girls in Nigeria change their menstrual cloths once a day. (Abera Y,

2019).

Worldwide, approximately 52% of the females are of reproductive age; hence menstruation is

part of their normal life. Menstrual hygiene therefore is a fundamental aspect of basic hygienic

practices (House et al., 2017). 56% of the girls are in and out of school and do not receive any

information about menstruation (UNICEF, 2019). Nevertheless, In Africa about 1 in 10 school

age adolescent girls absent themselves from school during menstruation or drop out at puberty

because of lack of private, clean and hygienic sanitation facilities in schools (UNICEF, 2019).

Menstrual hygiene which is defined as the effective management of menstrual bleeding by

females, is a principal aspect of reproductive health, that if not handled properly could facilitate

infections of the urinary tract, vaginal thrush and pelvic inflammatory diseases, along with bad

odour, unclean garments and extreme shame, causing infringement on the girl’s dignity (Oche et

al., 2018)

All of the above indicate poor knowledge, unfavorable attitudes and practice as far as menstrual

hygiene is concerned. Thus, attracts the attention of the investigator to conduct a study that will

find out knowledge and attitudes toward menstrual hygiene among adolescent girls of selected

senior secondary schools in Hadejia metropolis.

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1.2 Statement of Problem

Unpublished reports at some Secondary School in Nigeria indicate that the challenge of

menstrual hygiene is mostly manifested through school absenteeism of adolescent girls and the

awareness of these school girls has not been investigated. This is worsened by lack of efforts by

individual teachers and parents to facilitate menstruating girls through provision of information

and advice hence making menstrual hygiene a difficult topic to talk about. The school has

inadequate water and sanitation facilities hence girls have difficulty in managing menstruation

while at school. Poor menstrual hygiene affects the psychosocial wellbeing of girls for example

increased stress levels, fear and embarrassment, and social exclusion during menstruation that

impact negative on their education and social life (Sanyal et al., 2018).

Despite efforts by non-governmental organizations and other individuals who have tried to

provide sanitary materials to some school going adolescent girls, expansion of sanitation

facilities and the Nigerian education system that promotes menstrual hygiene through health

education programs, menstrual hygiene is still one of the biggest challenges especially among

under privileged adolescent school girls.

Poor hygienic practices can lead to various gynaecological problems in the reproductive life of

girls, accompanied by discomfort, smelling and embarrassment among others. This makes

menstrual hygiene crucial in an attempt to assist a girl child as far education and the future is

concerned therefore this study seeks to investigate the menstrual hygiene related knowledge, and

attitude among the adolescent girls of Usman Bn Affan and Government day senior secondary

school Hadejia.

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1.3 Objectives of the study

1) To determine the level of knowledge towards menstrual hygiene among adolescent girls

of selected senior secondary schools.

2) To examine the attitude of adolescent girls of selected schools towards menstrual

hygiene.

3) To identify the factors affecting menstrual hygiene among adolescents’ girls of selected

schools.

1.4 Research questions

1) What is the level of knowledge towards menstrual hygiene among adolescent girls of

selected senior secondary schools?

2) What is the attitude of the adolescent girls of selected schools towards menstrual

hygiene?

3) What are the factors affecting menstrual hygiene among adolescent girls of selected

schools?

1.5 Significance of the Study

The findings of this study is of immense benefit to nurses and other health care professionals as

it provides an insight to the menstrual hygiene practice of girls and women at large and help

them take all necessary measures to help, improve and prevent menstrual diseases and menstrual

related problems.

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This research breaks the silence on Menstrual Hygiene by creating awareness on the topic and

the impact it has on adolescent secondary school girls, exploring and sharing lessons of the

management aspects and promoting integration of Menstrual Health Management in health and

hygiene sectors of the Ministry of Health and Health related Nongovernmental organization.

The research will provide information that strengthens preventive programs that promote

women’s sanitary health and also this study adds to the existing body of knowledge as far as

menstrual hygiene is concerned.

Also this study critically studies an issue that faces every woman in every society in the world

over including (International Health Sciences Universities); with the aim of providing viable

information for managing menstrual hygiene in girls and women at large.

And finally, this work would serve as reference material for future researchers who intend to

carry out researches that are related to this one in particular. A lot of information can be sourced

from this work and they can be further improved on as well.

1.6 Scope of the study

The study scope was delimited to the knowledge and attitude toward menstrual hygiene among

adolescent girls of selected Senior Secondary Schools at Hadejia town of Jigawa state.

1.7 Operational definitions of the terms

 Menstruation: In this study, menstruation is a periodic discharge of blood from vagina

that is occurring monthly in women and girls of reproductive age.

 Menstrual Hygiene: in this study, menstrual hygiene; Is the act of cleanliness that

women and girls do perform during menstruation.

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 Adolescent girls: in this study, are girls between 10 to 23 years of age

 Attitude: in this study, this is a way that adolescent girls handle menstruation.

 Knowledge: in this study, knowledge refers to the information, understanding and

awareness of adolescent girls regarding menstruation.

 Menarche: This is the first menstrual bleeding.

 Genitalia: in this study, genitalia is the private part of women and girls particularly

vagina.

 Menopause: In this study, it refers to period in which a woman has stopped

menstruating.

 Selected senior secondary schools: the selected schools were Usman bn Affan senior

secondary school and Government day senior secondary school Famfo Goma.

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 CHAPTER TWO

2.0. Literature Review

2.1 Introduction

This chapter presents a review of the literature on the knowledge and attitude toward menstrual

hygiene among adolescent girls, theoretical review and empirical review.

The literature review covered reports by different authors within the context of knowledge, and

attitude of adolescent secondary girls towards menstrual hygiene.

2.1 Conceptual framework

Menstruation is defined as the discharge of blood, tissue debris and secretions from the uterus

which recurs in breeding age females that are not pregnant at approximately monthly intervals. It

is considered to represent a readjustment of the uterus to the non-pregnant state following

proliferative changes accompanying the preceding ovulation (Abioye, 2020). The average age of

menarche is around the globe is 12–13, but menarche can typically occur between ages 9 and 15

years (ACOG, 2018). Among non-pregnant women menstruation lasts from puberty to

menopause. Regular menstruation occurs for a few days, that is usually 3 to 5 days, although if it

lasts from 2 to 7 days, it is considered normal (Women’s health, 2019).

2.1.2 Menstrual cycle

The menstrual cycle refers to the harmonious regular cyclic physiological changes that occur in

the ovaries and uterus from between the first day of one's menstrual period and the next. It starts

from menarche and stops at menopause. These changes are usually under the control of follicle

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stimulating hormone (FSH) from the anterior pituitary gland which act on the ovary to produce

hormones oestrogen and progesterone which affect the cycle. The normal cycle is 28 days and

each cycle consists of three phases (Funmi, 2018).

Phases of menstrual cycle:

1- Menstrual phase:

This is the beginning of menstrual cycle. It is characterized by bleeding from the endometrium

(inner layer of uterus). This phase occurs every 28 or 30 days (28 days on the average). It flows

for 3 to 5 days, the average (in some, it ranges between 3 to 7 days). If the locum is not fertilized;

the corpus luteum disintegrates and causes a decrease in the level of oestrogen and progesterone

in the blood. By the 28th day, there are not enough of these two hormones to keep the lining of

the uterus. The endometrium now lacks hormonal support, breaks down and is shed in the form

of menstrual flow.

2- The proliferative phase

This phase follows immediately after menstruation and last till ovulation. This phase is also

called the regrowth, reform or regenerative phase. It is when the endometrium is undergoing

repair, under the influence of follicle stimulating hormone and leutinizing hormone by the

anterior pituitary gland. During this phase, the endometrium is regenerated. There is regrowth

and repair of the endometrial lining that has been shed during menstruation. This phase

undergoes the regenerative changes when the follicle stimulating hormone stimulates the growth

and maturation of the primordial follicle to ripe to a Graafian follicle. The ripen graafian follicle

produces the female sex hormones oestrogen and progesterone (oestrogen in large quantities).

The effect of oestrogen brings about the repair, proliferation and thickening of the endometrium.

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When the level of oestrogen rises in the blood, this stimulates the release of leutinizing hormone

from the anterior pituitary gland. The release of the leutinizing hormone causes the mature

graafian follicle to rupture and release an egg (ovum). This is called ovulation. Ovulation is the

release of an egg by the ovary.

Ovulation usually takes place 14 days before the onset of the next menstrual period (I.e.

ovulation occurs on the 14th day of the cycle). After the release of egg, the empty graafian

follicle now collapses and becomes the corpus luteum (yellow body) under the influence of

leutinizing hormone to produce progesterone. At this age, the endometrium consists of three

layers as follows:

 Basal layer: this lies immediately over the endometrium and it is about 1mm thick

 Functional or compact layer: this contains tubular glands and is about 2.5mm thick

 Spongy layer: this layer is made up of cuboidal ciliated epithelium. It dips down to line

the tubular glands and is about 3mm thick

3- Secretory phase

This phase starts at ovulation and ends at onset of menses, last 12 to 14 days. Leutinizing

hormone stimulates the growth of the corpus luteum which releases progesterone in increased

amount. The rise in the progesterone stimulates the building of uterine lining. The lining shows

evidence of secretion readiness for the reception of possibly fertilized ovum. If fertilization

occurs, the corpus luteum continues to produce progesterone in large quantities to maintain the

endometrium and the production increases to maintain the pregnancy till term. If fertilization

does not occur, feedback mechanism sets in, the anterior pituitary gland reduces the release of

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leutinizing hormone, the corpus luteum support of hormone is withdrawn and degenerate

gradually. The level of progesterone drops progressively and the endometrium breaks down and

shed to the basal layer as menstruation.

2.1.3 Disorders of menstruation

1- Premenstrual tension

2-Dysmenorrhoea

3-Oligo-menorrhoea

4-Ammenorrhoea

5- Menorrhagia

1- Premenstrual tension: this is a collection of symptoms before menstruation. It occasionally

occurs in the adolescent girls. After menarche, the periods may be irregular or may stop for one

to two years.

Management

 Reassure

 Advice on rest and sleep

 Educate on menstruation

 Advice on reduction of salt intake

 Regular exercise

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2- Dysmenorrhoea: This is a painful menstruation. It may be experienced as severe cramps,

colicky pain in the lower abdomen or dull aches in the pelvis and back.

Management

 Reassure

 Give warm drinks

 Give prescribed analgesics such as paracetamol 1grm thrice daily

 Give prescribed anti-spasmodic e.g Buscopan 3 to 5days

 Encourage regular exercise

3 - Oligo-menorrhoe: this diminished or scanty menstrual flow, less than 50mls. This

occasionally happens in the adolescent girls. The periods may be scanty,irregular, anovular or

stops for one to two years.

Management

 Enlighten on menstrual disorders

 Advice on adequate nutrition

 Give haematenics

 Adequate hydration

4- Amenorrhea: This is absence or ceasation of menstruation. It is usually due to pregnancy.

Other related causes include:

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  Pathological such as ovarian cysts

 Hormonal

 Congenital absence of uterus

Management:

1- Reassure, inform, educate and counsel

2- Refer to obstetrics and gynecologists

5- Menorrhagia: This is irregular, increased and prolonged menstrual blood loss with variation

in the menstrual cycle up to 35 days cycle and menses up to 10 days.

Management

 Reassure and educate patients on the condition

 Correction of anemia if present (Funmi, 2018).

2.1.4 Menstrual hygiene

This handles the special healthcare needs and requirements of females during monthly menstrual

periods. The areas of special concern among female during periods include choice of the best

period protection material, how often and when to change the sanitary protection, satisfactory

cleaning of the vagina and vulva as well as the assumed 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 women’s undergarment or on a

homemade belt that wraps around the waist. These cloths can be washed, dried and used again.

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Available commercial products for women’s hygiene during menstruation include pads, tampons

and cups.

2.1.5 Importance of Menstrual hygiene

The onset of menstruation is one of the most important physiological changes occurring in girls

during the adolescent years. Menstruation held the onset of physiological maturity in girls. It

becomes the part and parcel of their lives until menopause. Apart from personal importance, this

phenomenon also has social significance.

Menstrual hygiene is a hygienic practice during menstruation which can prevent women from the

infection in reproductive and urinary tract. In India, menstruation is surrounded by myths and

misconceptions with a long list of “dos” and “don’ts” for women. Menstruation and menstrual

practices are still clouded by taboos and socio – cultural restrictions resulting in adolescent girls

lacking knowledge and remaining ignorant of the scientific facts and hygienic health practices,

which sometimes results into adverse health outcomes.

Hygiene-related practices of women during menstruation are of considerable importance, as it

may increase vulnerability to Reproductive Tract Infections (RTI’s). Poor menstrual hygiene is

one of the major reasons for the high prevalence of RTIs in the country and contributes

significantly to female morbidity. Lack of knowledge regarding menstruation and menstrual

hygiene lead to poor attitude and practice. There are various issues like awareness, availability

and quality of napkins, regular supply, privacy, water supply, disposal of napkins, reproductive

health education and family support which needs simultaneous attention for promotion of

menstruated hygiene.

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2.1.6 Common repercussions of unhealthy menstrual practices

Irritation of the skin causes discomfort and can possibly result in dermatitis a medical condition

in which the skin swells, turns red, and at times becomes sore with blisters.

Introduction of bacteria into the urethra may cause urinary tract infections (UTIs). It can happen

anywhere in the urinary tract and can be fatal as it can even damage the kidneys if left untreated.

Alteration of the pH of vaginal flora can happen. This can lead to change in environment and

increased tendency to get bacterial vaginosis. It impacts the maximum when the women is trying

to get pregnant.

2.2 Theoretical review

This study will adopt Roy's adaptation model which says

2.2.1 Influencing factors include

 Family

 Education

 Religious background

 Mentors

 Clinical experience

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Theory description

Roy's first ideas appeared in a graduate paper written at UCLA in 1964.

Published these ideas in “nursing outlook “in 1970.

Subsequently different components of her framework crystallized during 1970s, 80s and 90s.

Over the years she identified assumptions on which her theory is based.

Explicit assumptions (Roy 1989; Roy and Andrew's 1991)

 The person is a bio psychosocial being.

 The person is in constant interaction with a changing environment.

 To cope with changing world, person uses both innate and acquired mechanisms which

are biological, psychological and social in origin.

 Health and illness are inevitable dimensions of the person's life.

 To respond positively to environmental changes, the person must adapt.

 The person's adaptation is a function of the stimulus he is exposed to and his adaptation

level

 The person's adaptation level is such that it comprises a zone indicating the range of

stimulation that will lead to a positive response.

 The person has four modes of adaptation: physiologic needs, self-concept, role function

and interdependence.

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  Nursing accepts the humanistic approach of valuing other persons' opinions, and

viewpoints" interpersonal relations are an integral part of nursing.

 There is a dynamic objective for existence with ultimate goal of achieving dignity and

integrity.

Implicit assumptions

 A person can be reduced to parts for study and care.

 Nursing is based on causality.

 Patient's values and opinions are to be considered and respected.

 A state of adaptation frees an individual's energy to respond to other stimuli.

Roy adaptation model concepts: Early and revised

 Adaptation - goal of nursing

 Person - adaptive system

 Environment – stimuli

 Health - outcome of adaptation

 Nursing - promoting adaptation and health.

Concepts - Adaptation

 The process and outcome of individuals and groups who use conscious awareness, self-

reflection and choice to create human and environmental integration.

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Concepts - Person

 The biopsychosocial being in constant interaction with a changing environment

 Uses innate and acquired mechanisms to adapt

Concepts - Environment

 Focal - internal or external and immediately confronting the person

 Contextual - all stimuli present in the situation that contribute to effect of forcal stimulus

 Residual - a factor whose effects in the current situation are unclear

 All conditions, circumstances and influences surrounding and affecting the development

and behaviour of persons and groups with particular consideration of mutuality of person

and earth resources, including forcal, contextual and residual stimuli.

Concepts - health

 Inevitable dimension of person's life

 Represented by a health-illness continuum

 A state and process of being and becoming Integrated and whole.

Concepts - Nursing

 To promote adaptation in the four adaptive modes

 To promote adaptation for individuals and groups in four adaptive modes, this

contributing to health, quality of life and dying with dignity by assessing behaviours and

17
 factors that influence adaptive abilities and by intervening to enhance environmental

interactions.

Concepts - Subsystems

 Cognator Subsystem - a major coping process involving cognitive-emotive channels:

perceptual and information processing, learning, judgement and emotion.

 Regulator Subsystem - a basic type of adaptive process that corresponds automatically

through neural, chemical and endocrine coping channels.

Four adaptive modes

 Physiologic needs

 Self-concept

 Role function

 Interdependence

2.2.2 Application of theory to the study

Influencing factors includes:

 Family: the family of the adolescent girls served as their guidance

 Education: the education and knowledge that adolescent girls are getting from their

school also serves as influencing factors to their cleanliness.

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  Religious background: this also constitutes the ways and guidelines that adolescent girls

can be following to practice good menstrual hygiene.

 Mentors: Teachers served as the mentors of adolescent school girls.

 Clinical experience: this involves how often the adolescent girls received health care in

response to menstrual disorders.

Explicit assumptions

 The adolescent girls are bio psychosocial being.

 The adolescent girls are in constant interaction with menstruation.

 To cope with this menstruation, they have to use both the innate and acquired

mechanisms, which are biological, psychological and social in origin.

 Menstruation is inevitable dimension of the adolescent life.

 To respond positively to the menstruation, the adolescent girls must adapt.

 The adolescent's adaptation is a function of the stimulus (menstruation) they exposed to

and their adaptation level.

 The adolescent adaptation level comprises a zone indicating the range of stimulation that

will lead to a positive response.

 Parents/ guardians should value the opinion and viewpoint of the adolescent and also

interpersonal relationships is the integral part of adolescent life.

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  There is dynamic objective for existence with ultimate goals for achieving good

menstrual hygiene practice.

Implicit assumptions

 Adolescent girls can be reduced to parts for study and care.

 Menstruation is based on causality.

 Adolescent values are to be considered and respected.

 The state of adaptation frees the adolescent energy to respond to other stimuli.

Adaptation model: early and revised

Adaptation: menstrual hygiene practice

Adolescent: adaptive system

Menstruation: stimuli

Good menstrual hygiene practice: outcome of adaptation

Guidance and training- promoting adaptation and health.

Concept - Adaptation

 Responding positively to menstrual hygiene practice

 The process and outcome of parent/guardian and teachers, who are always intermingling

with the adolescent girls, used conscious awareness, self-reflection and choice to create

and promote good menstrual hygiene practice among the adolescent girls.

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Concept - Adolescent

 The biopsychosocial being in constant interaction with the changing body situation.

 Uses innate and acquired mechanisms to adapt.

Concept - Environment

 Forcal - Internal (home) or external environment (school) and places immediately

confronting the adolescent.

 Contextual - The time of menstruation that contribute to effect of forcal stimulus

Concepts - Menstruation

 Inevitable dimension of adolescent life

 Represented by all healthy adolescents and women of reproductive age.

 A state and process by which menstrual blood coming out from the uterus through

vagina.

Concepts - Good menstrual hygiene practice

 To promote adaptation in four adaptive modes

 To promote adaptation of the adolescent girls to good menstrual hygiene practice using

the four adaptive modes, this contributing to health, and quality of life by assessing their

efforts and factors that influence adaptive abilities and by intervening to enhance

environmental interactions.

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Concepts - Subsystems

 Cognator Subsystems - a major coping process involving cognitive-emotive channels:

perceptual and information processing, learning, judgment and emotion.

 Regulator Subsystems: a basic type of adaptive process that corresponds automatically

through neural, chemical and endocrine coping channels.

Four adaptive modes

 Physiologic needs: good nutrition, adequate hydration and care will contribute to healthy

and good meals hygiene practice.

Self- concept: increased quality of social experience leads to increased feelings of adequacy.

Role function: adolescent should ensure cleanliness during menstruation

Interdependence: providing support to adolescent during menstruation can lead to positive

menstrual hygiene practice.

2.3 Empirical review

A descriptive study conducted in Ogun state, Nigeria to assess the awareness of menstrual

hygiene and factors affecting its practice among adolescent girls in Babcock University and

Remo high school, a total of 150 students were selected using purposive sampling technique, a

data was collected by using questionnaire. The result shows that 96% of the respondents were

very much aware and knowledgeable about menstrual hygiene, 61% had moderate knowledge on

menstrual hygiene, it also shows that lack of conducive facilities 36% and religion 24% were

major factors affecting menstrual hygiene practice. It was concluded that information on safe

22
hygiene and sanitary practices should be included in the school’s curriculum. (Ajaegbu et

al,2021)

A descriptive study conducted in Taraba state Nigeria among adolescent school girls to

determine menstrual knowledge and hygiene practice, a total of 297 students were selected using

multi-stage sampling technique and questionnaire was used to assess the participants. The result

reveals that 76.1% knew about menstruation before menarche, mothers (48.1%) were the source

of information, 69.7% had good knowledge about menstruation, 57.58% had good menstrual

hygiene management. It was suggested that knowledge and hygienic practice of the participants

was encouraging, every adolescent girl should be equipped with right knowledge and support for

good menstrual hygiene management (Esther et al, 2021).

A descriptive study was carried out in Ogbomoso, Oyo State Nigeria to determine knowledge,

attitudes and practice about menstruation and menstrual hygiene among adolescent school girls,

a total number of 447 students were selected using multi-stage sampling technique, a semi-

structured questionnaire was used to assess the participants. The result shows that 96.4% heard

about menstruation before menarche, 55.9% had good knowledge of menstruation and menstrual

hygiene; only 25% had good menstrual hygiene practice. It was concluded that majority of the

respondents do not observe good menstrual hygiene practice, effort should be made to ensure

that adolescent are well educated on the importance of menstrual hygiene practice both in school

and home. (Funmilo et al, 2017)

A cross-sectional study conducted in Umunna,Imo state, south east of Nigeria to determine

knowledge, practice and challenges of menstrual hygiene management among adolescent girls. A

total number of 416 girls were selected using multi-stage sampling technique; a semi-structured

23
questionnaire was used to collect the data. The findings shows that 77.9% of the participants had

menstrual hygiene knowledge before menarche and 68.8% of the information sourced from their

mothers, main menstrual disturbances was abdominal pain and malaise, 56.3% uses sanitary pads

and 31.8% uses cloth. In conclusion, there was poor premenarchal awareness and inappropriate

menstrual hygiene practice among adolescent girls (Chika et al, 2021).

A descriptive study conducted in southern Ethiopia to determine knowledge and menstrual

hygiene practice among adolescent school girls. A total number of 791 were selected using

multi-stage sampling technique; a questionnaire was used to collect the data. The result shows

that 68.3% had poor on menstruation, about 48.1% used absorbent material and 69.5% clean

their genitalia. Generally, 60.3% had poor menstrual hygiene practice. In conclusion, this

demonstrates a need to design acceptable awareness, creation and advocacy programme to

improve the knowledge and promote safe hygienic practices of adolescent school girls during

menstruation. (Zelalem et al, 2019).

A cross-sectional study was conducted in Chitwan, Bharatpur, Nepal on 193 students to

determine knowledge on menstruation and menstrual hygiene management, the sample was

selected using consecutive sampling technique, the data was collected using questionnaire. The

result shows that 66.8% had adequate knowledge on menstruation. Regarding practice, 94.8%

cleaned their genitalia properly, 93.8% used sanitary pads. It was concluded that an awareness

and advocacy programme on menstruation and menstrual hygiene practice are needed for the

adolescent girls to safeguard themselves against reproductive tract infections (Kalpana et al,

2020)

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Also a cross-sectional study was carried out in Doti district, Nepal, to determine knowledge,

attitudes and practice on menstrual hygiene management among adolescent girls, a total number

of numbers of 276 students were selected using simple random sampling technique, self-

structured questionnaire was used to assess the participants. The result reveals that 67.4% had

fair knowledge and 26.4% had good knowledge on menstrual hygiene management, around half

the respondents had positive attitude on menstrual hygiene management. It was concluded that,

although knowledge on menstrual hygiene management is fair, still, attitudes and practice need

to be improved (Ram Naresh et al, 2017).

Another study conducted in west of Iran to determine knowledge and practice of menstrual

hygiene among adolescent school girls, a total number of 728 girls were selected using simple

random sampling technique, the data was collected by self-made questionnaire. The result shows

that 92% of the respondents were found to have a relatively positive attitude toward

menstruation, 64% had poor knowledge and 81% Expressed poor practice towards menstruation.

It was concluded that school girls need to be trained regarding menstrual hygiene and developing

their skills to care for themselves during menstruation (Soraya et al, 2018).

A cross-sectional study conducted in rural and urban areas of Rajarajeswari, Bangalore, India to

determine knowledge and practice of menstrual hygiene among adolescent girls. A total number

of 380 students were selected using simple random sampling technique; a self-administered

questionnaire was used to collect the data. The result shows that 43.4% were aware about

menstruation before reaching menarche, 62.4% were aware that menstruation is a natural

process, 58.9% were using sanitary pad and 46.8% change absorbent material twice a day. It was

concluded that knowledge and practice regarding menstrual hygiene is better in rural girls than

urban adolescent girls (Kanchanaganga et al, 2020).

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A cross-sectional study was conducted among intermediate girls schools in Buraidah city, Saudi

Arabia, to determine knowledge of self-hygiene practice during menstruation, a total number of

258 girls were selected using two stage cluster sampling technique. Semi structured self-

administered questionnaire was used to assess the client. The result revealed that 60.5% students

fall in to the category of unsatisfactory self-hygienic practice and 39.5% were categorized as

having good self-hygienic practice toward menstruation. Creating awareness on self-hygiene

during menstruation is recommended (Almutar et al, 2021).

CHAPTER THREE

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 3.0 Research Methodology

This chapter discussed research design, settings, study population, sample size and sampling

techniques, instrument and method of data collection, Reliability of the instrument, validity of

the instrument; methods of data analysis ,and ethical consideration.

3.1 Research Design

A description survey research was adopted to assess the knowledge and attitude towards

menstrual hygiene among adolescent girls of selected senior secondary schools. The descriptive

approach involves data collection at one point in time. It also aimed at collection and analysis of

responses of people who represent the population designed to elicit their opinion about a specific

topic (Chinwuba et al, 2015)

3.2. Research Setting

The research was conducted in Usman bn Affan senior secondary school and Government day

senior secondary school Fanfo Goma. Usman Bin Affan is a school located along the old

barrack's road near Emir's farm in Hadejia Local Government area of Jigawa state. It was

established in the year 1993 and consists of 310 students, 15 teachers as well and 6 classes.

Government day senior secondary school Famfo Goma is located near Fantai primary health care

in Hadejia Local Government, consists of about 800 (eight hundred) students and 24 teachers.

3.3 Target population of the study

27
The study was primarily targeted all adolescent girls studying in Usman Bin Affan and

Government day senior secondary school Famfo Goma. The accessible population were the all

adolescent girls who met the inclusion criteria.

3.4 Sample size

The sample size of this study from the population of 1050 students was obtained using Ali

(2000), formula which says if the total population is less than 1000, 50% will be used as sample

and if the population is greater than 1000, 10% will be used as a sample

Total population = 1110

10% is to be use

1110/100X 10

= 111

Therefore 111 were used

3.5 Sampling technique

The sample used in the study was 111 students from the selected secondary schools and the

sampling technique was simple random sampling technique. Simple random technique was

adopted and all respondent have equal chance of being selected for this study to represent the

whole group.

3.6 Instrument for data collection

28
The instrument used in this study was questionnaire. The researcher's designed questionnaires

was closed ended questions. This is a type of research instrument that gathers data of a large

sample. Questionnaire was administered to students. The questionnaire consisted of four

sections, where section A deals with socio demographic data of the respondents, section B deals

with the knowledge of the respondents towards menstrual hygiene, Section C deals with the

attitudes of the respondents towards menstrual hygiene and section D deals with factors affecting

menstrual hygiene.

3.7 Validity of instrument

The face and content validity of questionnaire was determined by giving the instrument to the

supervisor who read through and made his input and corrections to examine the purpose,

research objectives and research questions in line with the specific items in the questionnaire and

also to a team of 3 tutors in the field of nursing to vet the questionnaire and make corrections

where applicable.

3.8 Reliability of the instrument.

Reliability of the questionnaire was obtained using test and re- test method in which 10% of the

questionnaires was given to 10% of the respondent from the Usman Bin Affan and Government

day senior secondary school Famfo Goma.

3.9 Method of Data Collection

The researcher sought a permission from principals of the selected secondary schools to conduct

the research. The researcher and assistant visited the schools and collect the data. The

questionnaire was administered to the respondents. The researcher assured them of

29
confidentiality to the information they provided, the researcher gave them questionnaire, fill in

and collect them immediately after completion. This is to increase confidence among the

students that the teachers or school administration will use none of the information against them.

Forty questionnaires was distributed daily, therefore the questionnaire was distributed within

three days.

3.10 Method of data analysis

The data was analyzed using statistical parkage for social science (spss) version 20 method using

frequency distribution tables and percentages.

3.11 Ethical consideration

The copy of an introductory letter from the school of Nursing was presented to the schools. The

respondents was treated with respect and their rights to privacy and confidentiality was observed

through autonomity, and informed consent was obtained from the school principals and the

participants in case of those below the consent age, and the respondents have the right to

participate or to withdraw from the study.

CHAPTER FOUR

30
 4.0 Presentation of results

This chapter focused on the presentation of results from data analysis. Out of a total number of

111 questionnaires administered, 100 were correctly completed and returned given a total return

rate of 90%

Table 4.1 socio-demographic data of the respondents (n=100)

VARIABLES FREQUENCY PERCENTAGE

Age
10 - 13 5 5.0%
14 - 16 55 55.0%
17 - 19 34 34.0%
20 - 23 6 6.0%
Current class
SS 1 20 20.0%
SS 2 34 34.0%
SS 3 46 46.0%
Others 0 0
Ethnicity
Hausa 99 99.0%
Yoruba 1 1.0%
Igbo 0 0
Others 0 0

Religion
Islam 99 99.0%

31
 Christianity 1 1.0%
Hindu 0 0%
Others 0 0%
Educational background of their
mother
No formal education 28 28.0%
Primary education 40 40.0%
Secondary education 30 30.0%
Tartiary education 2 2.0%
Educational background of their
father
No formal education 20 20.0%
Primary education 25 25.0%
Secondary education 35 35.0%
Tertiary education 20 20.0%
Name of the school
Usman bn Affan 51 51.0%
Famfo goma 49 49.0%

Table 4.1: Shows that out of 100 girls students that participated, 5 (5.0%) were within the age of

10-13, 55 (55.0%) were within the age of 14-16, 34 (34.0%) were within the age of 17-19

whereas 6 (6%) were within the age of 20-23. The modal age bracket fell within the group with

ages 14-16years 55 (55.0%). 20 (20.0%) were in SS 1, 34 (34.0%) were in SS 2 while 46(46.0%)

were in SS 3. Hausa were the modal distribution under tribal status with 99 (99.0%) respondents

and 1 (1.0%) is Yoruba. 99 (99.0%) were Muslims while 1 (1.0%) was Christian. The

educational background of the respondents's mothers from the result shows that 28 (28.0) had no

formal education, 40 (40.0%) had primary education, 30 (30.0%) had secondary education and 2

32
(2.0%) were educated up to tertiary levels. Then, the educational background of their father

shows 20 (20.0%) had no formal education, 25 (25.0%) had primary education, 35 (35.0%) had

secondary education whereas 20 (20.0%) had tartiary education. 51 (51.0%) were from Usman

bn Affan and 49 (49.0%) were from Government day senior secondary school Famfo goma.

Table 4.2 Knowledge of the respondents towards menstrual hygiene (n=100)

33
 VARIABLES FREQUENCY PERCENTAGE

Ever heard of personal hygiene during menses

Yes 84 84.0%
No 16 16.0%
Source of information about the hygiene
Mother 46 46.0%
Friends 7 7.0%
School 17 17.0%
Social media 30 30.0%
Kind of information do you heard
Bathing at least two times a day 25 25.0%
Changing sanitary material at least two times a day 12 12.0%
Washing hands before and after changing sanitary 31 31.0%
material
Others 32 32.0%
Do you use sanitary material during menses?
Yes 100 100%
No 0 0
Type of the material used
Pads 20 20.0%
Cloth 36 36.0%
Rag 40 40.0%
Others 4 4.0%

Table 4.2 Reveals knowledge of the respondents towards menstrual hygiene. It was shown that

84 (84.0%) heard about personal hygiene during menses while 16 (16.0%) ever heard. The

source of information about the personal hygiene during menses been from the mother about 46

34
(46.0%), 7 (7.0%) got the information from their friends, 17 (17.0%) from school and 30

(30.0%) from social media. The kind of information they heard includes bathing at least two

times a day 25 (25.0%), changing sanitary material at least two times a day 12 (12.0%), washing

hands before and after changing sanitary material 31 (31.0%) and 32 (32.0%) got other

information. The result also shows that all the respondents 100 (100.0%) were using sanitary

material, it shows that 20 (20.0%) were using pads, 36 (36.0) were using cloth, 40 (40.0%) were

using rags and 4 (4.0%) were using other material like tissue. 41 (41.0%) of the respondents

believed that poor menstrual hygiene can result in infection and 59 (59.0%) have no idea.

Table 4.3 Attitudes of the respondents towards menstrual hygiene (n=100)

35
 VARIABLES FREQUENCY PERCENTAGE

Method do you use in disposing sanitary

material

Burning method 12 12.0%

Flushing it in the toilet 24 24.0%

Throwing it in a dust bin 44 44.0%

Others 20 20.0%

How often do you reuse sanitary material?

Frequently 35 35.0%

Always 22 22.0%

Never 29 29.0%

Others 14 14.0%

Table 4.3 Shows attitudes of the respondents towards menstrual hygiene. It shows that 12

(12.0%) were using burning method, 24 (24.0%) were flushing it the toilet, 44 (44.0%) were

throwing it in a dust bin and 20 (20.0%) were using other means of disposing sanitary materials.

It also shows that 35 (35.0%) were reusing sanitary material frequently, 22 (22.0%) always, 29

(29.0%) never reused sanitary material and 14 (14.0%) possessed other attitudes.

Table 4.4 Factors affecting menstrual hygiene (n=100)

36
 VARIABLES FREQUENCY PERCENTAGE

Ever heard of factors affecting menstrual hygiene

Yes 82 82.0%

No 12 12.0%

Which among the following factors?

Sanitary pad is too cost 49 49.0%

It is not easy to get 5 5.0%

Lack of proper information about menstrual hygiene 35 35.0%

Others 11 11.0%

Table 4.4 Shows factors affecting menstrual hygiene where 82 (82.0%) were aware of the factors

and 12 (12.0%) have not known. The cost of the sanitary pads been the most affecting factor

with 49 (49.0%), it is not easy to get 5 (5.0%), lack of proper information about menstrual

hygiene 35 (35.0%), and 11 (11.0%) have other factors.

CHAPTER FIVE

37
 5.0 DISCUSSION OF FINDINGS

5.1. Introduction

The findings of the study are discussed according to the objectives as follows:

5.1.1 Demographic Data of the Respondents

The demographic data of the (girls) respondents reveals that majority were between the age of 14

to 15 with percentage of 55 (55.0%) and majority in SS 3 with percentage of 46 (46.0%),

majority of the respondents were Hausa by tribe with 99 (99.0%), majority were Islam with 99

(99.0%), majority of the respondents have their mother been attended to primary education with

40 (40.0%), secondary education 30 (30.0%), 28 (28.0%) have no formal education and 2% were

educated up to tertiary level. On the side of their father, it shows that 20 (20.0%) were educated

up to tertiary level, 35 (35.0%) have secondary education, 25 (25.0%) have primary education

and 20 (20.0%) have no formal education.

5.1.2 Level of knowledge towards menstrual hygiene among adolescents school girls of

selected senior secondary schools.

The study conducted by (Chika et al,2021) in Imo state Nigeria, which the result revealed that

77.9% of the respondents were very much aware and knowledgeable about menstrual hygiene

and 68.8% of the information sourced from their mother. This is in line with my findings as it is

found that 84 (84.0%) heard about personal hygiene during menses, 46 (46.0%) sourced the

information from their mother, 30 (30.0%) from social media, 17 (17.0%) from school and 7

(7.0%) from their friends. Some of the information included; bathing at least two times a day 25

(25.0%), changing sanitary material at least two times a day 12 (12.0%), washing hands before

38
and after changing sanitary material 31 (31.0%) and 32 (32.0%) with other forms of information.

100% of respondents were using sanitary material. The type of material used involves pad 20

(20.0%), cloth 36 (36.0%), rag 40 (40.0%) and others 4 (4.0%). 41 (41.0%) of the respondents

believed that poor menstrual hygiene can result in infection.

5.1.3 Attitudes of the respondents towards menstrual hygiene

We have seen the attitudes of the respondents towards menstrual hygiene as it was shown that

44 (44.0%) were throwing sanitary material in a dust bin, 24 (24.0%) were flushing it in a toilet,

12 (12.0%) were burning it and 20 (20.0%) were using other methods. We also noticed that 35

(35.0%) were frequently reusing sanitary material, 29 (29.0%) never reused it and 22 (22.0%)

were always reusing it. This is in contrary with the study conducted in Nepal by ( Ram Naresh et

al, 2017) which says around half of the respondents have positive attitude towards menstrual

hygiene management.

5.1.4 Factors affecting menstrual hygiene

It was shown that the most affecting factor was the cost of sanitary material with 49 (49.0%) of

the respondents, lack of proper information about the menstrual hygiene 35 (35.0%), 5 (5.0%)

said it is not easy to get and 11 (11.0%) have other factors. This is in contrary with the study

conducted in Ogun by (Ajaegbu et al, 2021) which revealed that lack of conducive facilities 36%

and religion 20% were the major factors affecting menstrual hygiene practice.

5.2 Implication to nursing

39
The study brought out areas of concentration for everybody and particularly women of

reproductive age who are more likely to be menstruating.

 Implication to practice: The study brought out clearly the methods of management of

menstrual disorders by the Nursing Personnel. So nurses should channel health education

to the appropriate areas mentioned above when in contact with women with menstrual

disorders especially during clinic visits or community outreach programmes.

 Implication to education: This study also breaks the silence on Menstrual Hygiene as it

create awareness on the topic and the impact on adolescent secondary school girls,

exploring and sharing lessons on the management of menstruation.

 Implication to nursing research: this work would serve as referenced material for future

researchers who intend to carry out researches that are related to this one in particular. A

lot of information can be sourced from this work and they can be further improved on as

well.

5.3 Limitation of the study

The researcher encountered certain difficulties in the course of this research and they include:

1. Some of the responses given by the respondents may have been made estimations or even

exaggerations. This has also been reported in similar studies.

2. Despite the effort of the researcher and her assistants to explain the questionnaire, some

respondents may have understood the questions differently. However, these limitations

were taken care of through the analysis of data in a way that ensured validity and

reliability of the study.

40
 3. Huge financial expenses in carrying out this research

5.4 Summary

This study assessed knowledge and attitudes towards menstrual hygiene among adolescent

school girls of selected senior secondary schools. The study was designed to:

Determine the level of knowledge towards menstrual hygiene among adolescent girls of selected

senior secondary schools.

Examine the attitudes of the adolescent girls of selected schools towards menstrual hygiene.

Identify factors affecting menstrual hygiene among adolescent girls of selected schools.

Literature was reviewed under conceptual review and empirical studies which were based on the

objectives and research questions raised. Descriptive survey research design was employed and a

sample of 100 respondents was drawn from the study population. Validated questionnaire was

administered to the respondents and their responses were analyzed using frequecy distribution

table and percentages. The study revealed that there was good menstrual hygiene practice and

positive attitude towards menstrual hygiene management.

5.5 Conclusion

Based on the findings of this study, the following conclusions were made.

There was good menstrual hygiene knowledge adopted by the adolescent girls.

There was good menstrual hygiene management attitudes as only few respondents do bad

attitudes.

41
Cost of the sanitary material, lack of proper information about menstrual hygiene and non

accessibility of the sanitary material were the only demographic factors that had statistically

significant relationships with menstrual hygiene management among the respondents.

5.6 Recommendations

Based on the findings, the following recommendations are made;

It was seen that knowledge and hygienic practice of the participants was encouraging, but still

there is need for information on safe hygiene and sanitary practices should be included in the

schools curriculum. Also Government should look for a way to reduce the cost of sanitary

material.

This will invariably guide the participants into improvement in their quality of life.

5.7 Suggestion for further Studies

Since the study reported good menstrual hygiene practice with minimal corrections and

unhealthy attitudes menstrual hygiene management, there is a need to investigate Teacher's

contribution to those unhealthy attitudes as well as explore more effective ways of improving

lifestyle of the students. This, it is hoped, will significantly improve the outcomes in the

management of menstruation among adolescent school girls and women at large.

The researcher would suggest that any further research on this topic should be directed at:

Factors affecting menstrual hygiene management among women of reproductive age.

REFERENCE

Ajaegbu, V.U, Okwuikpo, M.I, Famuyigbo, F, Leslie, T.A, Maitanmi, J.O & Maitanmi, B.T.

42
 (2021). Awareness of menstrual hygiene and factors affecting its practice African

Journal of Health, Nursing and Midwifery 4(2), 76-87.

doi:10.52589/AJHNMMXRNYNCJ.

Almutairi, C, Hayam, J & Saulat, G.(2021). Knowledge and practice of self hygiene during

menstruation among female adolescents students. Journal of family medicine and

Primary care. 10(4), 1569-1575, doi:10.4103/jfmpc_2321_20.

Chika, O.D, Eugene, M.I & Irene, M. (2021). Knowledge and practice of menstrual hygiene

among adolescent school girls. International Journal of Reproduction,

Contraception, Obstetric and Gynecology, 10(2), 458-465.

https://dx.doi.org/10.18203/2320-1770.ijrcog20210293.

Esther, U.N, Sonnen, A, Somterimmam, P.D & Rimande, J.U. (2021). Menstrual hygiene

management among adolescent girls. African Health Science. 21(2), 842-851.

Doi: 10.4314/ahs.v21i2.45.

Funmi, A.(2018). Reproductive health. (Fourth Edition). AJAOK PRESS. 110-114

Funmito, O.F, Akintunde, O.F, Ayodele, O.A, Ajibola, I, Olumuyiwa, A.O & Idowu, P.O.

(2017). Assessment of knowledge, attitudes and practice about menstruation

and menstrual hygiene among secondary high school girls. International

Journal of Reproduction, Contraception and Gynecology .6(5), 1726-1732.

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Kalpana, S, Archana, P.B, Subash, S & Sandesh, L. (2020). Knowledge on menstruation

and menstrual hygiene practice among adolescent girls. Journal of Chitwan

Medical College. 10(31), 69-73.

Oche, A, Ali T.S, & Rizvi S.N. (2018).The impact of premenarchal training on menstrual

practices and hygiene of Nigerian school girls. Reproductive Health Matters.

15(29) 183-185.

Ramnaresh, Y, Shirijana, J, Rajesh, P & Pawan, P.(2017). Knowledge, attitudes and

practice on menstrual hygiene management among school adolescent. Journal

of Nepal Health Research Council. 15(37), 212-216.

Tegegne, T.K & Sisay, M.M. (2018).Menstrual hygiene management and school

absenteeism among female adolescent students in North east Ethiopia. BMC

Public Health.14(1),1118.

UNICEF, (2019). Menstrual Hygiene Management of Adolescent School Girls and Nuns.

Department of School Education, Ministry of Education in partnership with the

UNICEF, Bhutan.

Wilbur, J,Torondel, B, Hameed, S, Mahon, T & Kuper, H. (2019). Systematic review of

menstrual hygiene management requirements, its barriers and strategies for

44
disabled people. Plus ONE.14(2),0210974.

JIGAWA STATE SCHOOL OF NURSING SCIENCES

COLLEGE OF NURSING HADEJIA

45
Dear respondents,

My name is Khadija Abdullahi, a student of the above institution conducting a research as part of

my Basic exams requirement. The topic is "Knowledge and attitudes towards menstrual hygiene

among adolescent school girls in Usman bn Affan and Government day senior secondary school

Famfo goma". I am hereby requesting you to please kindly participate in this study by

completing the questionnaire. All information collected will be treated with utmost

confidentiality. Right to refuse opt out from the study is ensured at any point in time, but your

participation is essential. There will be no financial benefit at any form to be gained by

participating in this research. Thank you.

Consent: I have understood the importance of the study and I am willing to participate

voluntarily.

Participant's signature

Section A. Socio-demographic data of the respondents

Please tick where applicable

46
1- Age

a-10- 13 ( )

b- 14 to 16 ( )

c-17 to 19 ( )

d-20 to 23 ( )

2- choose your current class

a-ss 1 ( )

b- ss 2 ( )

c- ss 3 ( )

d- others (please specify)

3- Ethnic group

a- Hausa ( )

b-Yoruba ( )

c-igbo ( )

d- others ................................................................(please specify)

4- Religion

a-Islam ( )

47
b-christianity ( )

c- Hindu ( )

d- others ………………………………...(please specify)

5-Educational background of your mother

a- No formal education ( )

b- primary education ( )

c-secondary education ( )

d- tartiary education ( )

6-Educational background of the father

a- no formal education ( )

b- primary education ( )

c- secondary education ( )

d- tartiary education ( )

Section B. Knowledge of the respondents towards menstrual hygiene

Please tick where applicable

7- Have you ever heard of personal hygiene during menses?

a- Yes ( )

48
b- No ( )

8- If yes, what is the source of your information?

a- mother ( )

b- friends ( )

c- school ( )

d- social media ( )

9- Which among the following information do you heard?

a- bathing at least two times a day ( )

b- changing sanitary material at least two times a day ( )

c- washing hands before and after changing sanitary material ( )

d- others ( please specify)

10- Do you use sanitary material during menses?

a- yes ( )

b- No ( )

11- If yes, which of the material do you used?

a- cloth ( )

b- rag ( )

49
c- pads ( )

d- others (please specify)

12- Do you think that poor menstrual hygiene can result in infection?

a- Yes ( )

b- No ( )

Section C- Attitudes of the respondents towards menstrual hygiene

Please tick where applicable

13- what method do you use in disposing sanitary material?

a- burning method ( )

b- flushing it in the toilet ( )

c- throwing it in a dust bin ( )

d- others ( please specify)

14- How often do you reuse sanitary material.

a- frequently ( )

b- always ( )

c- never ( )

d- others (please specify)

50
Section D- factors affecting menstrual hygiene

Please tick where applicable

15- Have you ever heard of factors affecting menstrual hygiene?

a- Yes ( )

b- No ( )

16- If Yes, which among the following factors?

a- sanitary material is too cost ( )

b- It is not easy to get ( )

c- Lack of proper information menstrual hygiene ( )

d- others (please specify).

Thank you for giving your time, wish you success in your study.

51