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Year : 2020  |  Volume : 33  |  Issue : 1  |  Page : 24-28

Menstrual hygiene among secondary school students

1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Family Medicine, Ministry of Health, El Mahallah, Gharbia, Egypt

Date of Submission24-Dec-2017
Date of Decision06-Feb-2018
Date of Acceptance09-Feb-2018
Date of Web Publication25-Mar-2020

Correspondence Address:
Sanaa R El Mawardy
El Mahallah Elkobra, El Gharbia Governorate
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mmj.mmj_883_17

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The aim of this study was to assess menstrual hygiene of secondary school girls in El Mahallah Elkobra, El Gharbia Governorate.
As every level of a woman's health influences the next stage, menstrual hygiene is an important component of adolescent health in women, as poor menstrual hygiene can potentially be a cause of urinary tract contagion, reproductive tract infections, and sexually transmitted diseases like cervical cancer, HIV/AIDS, etc.
Patients and methods
The study was conducted on 704 secondary school female students. They were chosen randomly from four public secondary schools during the scholastic year 2015/2016. A predesigned questionnaire was used to test their menstrual hygiene.
The study showed that 90% of students had acceptable menstrual hygiene. The majority of the selected girls (98.6%) used disposable sanitary pads.
Most of the participants in this study have an acceptable menstrual hygiene. Menstrual hygiene is an issue that needs to be addressed at all levels.

Keywords: adolescent health, hygiene, menstruation, reproductive tract infections

How to cite this article:
El Meselhy HM, Salama AA, El Mawardy SR. Menstrual hygiene among secondary school students. Menoufia Med J 2020;33:24-8

How to cite this URL:
El Meselhy HM, Salama AA, El Mawardy SR. Menstrual hygiene among secondary school students. Menoufia Med J [serial online] 2020 [cited 2020 Aug 15];33:24-8. Available from: http://www.mmj.eg.net/text.asp?2020/33/1/24/281342

  Introduction Top

Menstruation is a physiological process, which is the cyclical shedding of the inner lining of the uterus, the endometrium, under the control of internal secretion of the hypothalamopituitary axis[1],[2]. The name 'menstruation' comes from the Latin 'menses' meaning moon, with reference to the lunar month and lasting also ∼28 days long[3]. It's onset 'menarche' profoundly changes a young woman's life which is a landmark feature of female puberty and signals reproductive maturity[1],[2].

As each and every stage concerning a woman's fitness influences the subsequent stage, menstrual hygiene is an important factor about adolescent health among women, namely bad menstrual hygiene can doubtlessly remain a reason of urinary tract infections, reproductive tract infections, or sexually transmitted diseases such as cervical cancer, HIV/AIDS, etc.,[4]. So it is important to enlighten women regarding menstrual health and hygiene. The issues regarding menstrual hygiene discussed through health education are an indispensable resource because of the need to enhance menstrual hygiene of women specifically within much less flourished countries[5],[6].

Many studies have shown that, as expected, most of the adolescent women had imperfect and inaccurate data with regard to the menstrual physiology and hygiene[7],[8].

This study was conducted to assess menstrual hygiene among secondary school girls.

  Participants and Methods Top

This is a cross-sectional descriptive study conducted in secondary schools for girls in El Mahallah El-Kobra City, Gharbia Governorate.

The study was conducted from the beginning of November 2015 to the end of April 2016.

A pilot study was done on randomly selected 30 students to test the predesigned questionnaire and modifications were done accordingly. These cases were not included in the study sample. The completed questionnaire forms were subjected to a review; all data were recorded and conducted preliminary editing and coding.

The sample size was estimated by assuming that interpersonal healthy hygiene practice by students was 28 as estimated by the pilot study at a 95% confidence level and 80% power of test; the calculated sample size was 735.

The needed sample size was chosen randomly through a multistage random sampling technique to choose the participants:

  1. Stage 1: four schools were selected randomly
  2. Stage 2: one class from each grade (in chosen schools) was recruited
  3. Stage 3: a total of 735 students were registered in the chosen classes. A total of 704 (95.78%) participants completed the study.


The instrument used to assess menstrual hygiene management was designed by all authors in consultation with senior research experts. Most items were developed from a review of literature on practice during menstruation. The final instrument containing 12 items was developed. In addition, internal consistency (reliability) among the items was computed and Cronbach's α was determined to be 0.84. Finally, the respondents who scored 50% and above were considered as having an acceptable menstrual hygienic practice, whereas those with a score of less than 50% were considered as having poor menstrual hygienic practice [Figure 1].
Figure 1: Student‘s menstrual hygiene.

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Ethical considerations were followed during the study, with total confidentiality of any obtained data. The Menoufia Faculty of Medicine Committee for Medical Research Ethics formally approved the study before it began.

An official permission letter was obtained from the authorities of the local Directorate of Education Gharbia Governorate, and both school administrations of eastern and western El Mahallah Elkobra.

A written consent form was obtained from the administrative authorities in the studied schools; and the students were included in the study after taking informed verbal consent, after explaining the aim of the study.

Students were interviewed using a predesigned questionnaire. The questionnaire included personal data such as age, residence, and socioeconomic status (SES) assessment according to El-Gilany et al.[9].

Assessment of students' menstrual hygiene was carried out by using queries about the type of absorbent which was used, its storage place, the use of clean or unclean napkins and changing frequency and cleaning them. The information about personal hygiene included washing and bathing during menses, the practice of wearing stained clothes, etc. The questionnaire was designed in Arabic and the questions were open ended. The girls are supposed to write their answers honestly without discussing.

Statistical design

The data were tabulated and analyzed using the Statistical Package for Social Sciences, version 20 (SPSS Inc., Chicago, Illinois, USA), with a significance level of less than 5%. Quantitative data were expressed as mean and SD and compared using Student's t-test.

  Results Top

The total number of students was 704 girls; their mean age was 16.11 ± 0.853 years. As regards education of parents, most of the girls reported that their parents have secondary and higher education. Also about two-third (67.6%) of the girls reported their mother's to be housewives, and most of their fathers are employed or retired. An overall 55.4% belonged to the high socioeconomic group and 42.6% belonged to the middle socioeconomic group [Table 1].
Table 1: Sociodemographic characters of secondary school female students

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The pattern of use of sanitary napkins by girls, it can be perused that majority of the selected girls (98.6%) used disposable pads. With respect to storage of sanitary napkins and the pattern of use, it was found that 64.5% girls stored the clean (unused) pads in the dress cabinet and 18.8% girls used bathroom. Practice of changing pads during night was mentioned by 20.7%, while changing in school was 65.1%. Majority (67.3%) of the girls changed napkins 1–6 times a day and 30.4% do not remember. Lack of privacy at home was reported by 15.6% [Table 2].
Table 2: Usual personal hygiene related to menstruation in studied girls

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No statistically significant differences were observed between acceptable and poor menstrual hygiene regarding residence, age, SES, and source of knowledge [Table 3].
Table 3: Determinants• of students' menstrual hygiene in the studied group

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  Discussion Top

In this study, which included 704 secondary school students, the mean age of the studied group was 16.11 ± 0.853. Most of the girls reported that their parents have secondary and higher level of education. In Fehintola et al.[10], who included 447 respondents participated in the study, the mean age of the study participants was 14.7 ± 1.4 years, the majority of the respondent's parents' had secondary and tertiary level of education. Also Hennegan et al.[11], who showed that a total of 205 menstruating girls were included in the study, girls ranged from a self-reported age of 10–19 years (mean = 14.20, SD = 1.12). Moreover Upashe et al.[12] found that two-third of the participated girls (65.1%) were in the age group of less than or equal to 16 years with a median age of 16 years; 238 (29%) of the respondents' father completed college and above. A total of 178 (21.6%) of the respondents' mother can read and write. In another study by Ilo et al.[13], who showed that most girls who took part in the study were 16 years of age, have fathers who are farmers, and mothers who are farmers.

This study showed that the majority of the participants belonged to middle (42.6%) and high (55.4%) SES; in the study by Omidvar and Begum[14], the girls belonged to low (20.8%), middle (49.1%), and high (11.7%) SES.

Menarche is an important milestone in the life of a girl as this signifies the fertility of a woman. The age of menarche was found in the studied adolescents to range from 9 to 14 years with about two-thirds of girls between 12 and 14 years. This finding was nearly in the same range that was found by Moronkola[15] in Nigeria, in a Riyadh study (13.1 years)[16], but higher than a study conducted in Egypt[17], and in the study by Abd El-Hameed et al.[18], 67% of the girls reported that 12–14 years is the age of menarche. Alam et al.[19] showed that the average age at menarche was 12 years and 98% of students started menstruation before the age of 14 years. Hennegan et al.[11] showed that the average age at menarche was 12.82 years (SD = 1.28).

Regarding menstrual hygiene the present study showed that 98.6% of girls used sanitary pads which was found to be much higher than the studies in rural Maharashtra (15.67%) and urban South India (68.9%)[20],[21]. Also Dasgupta and Sarkar[8] who conducted a study on menstrual hygiene in Kolkata observed that 51.25% of the girls did not know about the use of sanitary pads. The result of this study is in accordance with the findings from the study by Yasmin and Manna[22], who showed that only 15.7% used old washed cloth.

Regarding disposal of pads, majority (96.6%) of the girls disposed them into a dustbin but the remaining girls burnt them, This concedes with the findings of Thakre et al.[3], Mudey et al.[7], Dasgupta and Sarkar[8], and El-Gilany et al.[23], whose findings were that majority of their respondents burn or wrap the absorbent materials used during menses and disposed it of in a place used for solid waste disposal. This finding was contrary to the findings by Fehintola et al.[10] in which majority of the respondents disposed of the absorbent material without wrapping it and disposed it in the toilet.

Most of the girls (67.3%) in this study practiced changing theirs pads 1–6 times a day. This result was in agreement with the study conducted by Thakre et al.[3], who found that about 200 (57.68%) changing theirs pads 1–6 times per day. In Pandit et al.[24], most of the girls (90.36%) practiced changing their pads 2–4 times.

Only 20.7% girls in this study changed their pads at night. This result compares well with the study in South India with a higher percentage of girls (80%) practiced to changing pads at night[14].

Practice about changing absorbent material while in school was practiced by means of 65.1% students. On other studies like that done in Egypt only 6.7% of girls changed pads at school[23]. Balqis et al.[25] also found that mostly 198 (83.19%) do not change pad at school, while in a study by Omidvar and Begum[14], a small proportion changed pads at school/college hours (20.6%). In a study by Alam et al.[19], 86% of girls reported that they did not change their menstrual cloth during school hours.

According to healthy practices, 73.3% of participated girls had daily bath. El-Gilany et al.[23] also showed that 70.9% of participated girls took showers (baths) during menstruation. Upashe et al.[12] show that two-third [557 (67.3%)] of the respondents were taking bath daily with soap during menstruation. On the other hand in Riyadh, Saudi Arabia, 62.3% of girls abstained from showering for the duration of menstruation, as they believed such would possibly cease the menstrual flow or extend the depth of pain. On the other hand, bathing after menstruation is a religious requirement in order to be able to pray and practice other religious obligations[26]. Similarly, this study shows that 99.1% of students take shower after menstruation.

In this study, 94.6% of girls had the habit of cleaning of external genitalia during their periods. Upashe et al.[12] show that 657 (83.5%) of the girls clean their external genitalia during menstruation with soap and water. In this study, it was found that lack of privacy at home was reported by 15.6% of girls; in a study by El-Gilany et al.[23], it was reported by 24.6% of participants.

In the present study, we found that there was no significant difference between acceptable and poor menstrual hygiene regarding residence, age, socioeconomic, or source of knowledge. Other works have shown lower SES, deficiency of access to information about menstruation, and money to buy sanitary products for menstrual hygiene are all related factors that affect menstrual practices[23],[26]. In Fehintola et al.[10], there was no statistically significant association between the age of adolescents and good practice of menstrual hygiene. In a study by Omidvar and Begum[14], SES of the chosen girls and their age influenced the choice regarding napkin/pads and other practices such as storage location of napkins, change all through nighttime and throughout school or college hours, and personal hygiene.

  Conclusion Top

Most of the participants in this study have acceptable menstrual hygiene. It is essential to design a mechanism to help students to improve their hygienic practices especially during menstruation.

All mothers irrespective of their educational status need to be taught to break their inhibitions in relation to discussing with their daughters about menstruation much earlier than the age regarding menarche.

Girls need to be educated with regard to the selection of sanitary menstrual pads and their proper disposal, and how to look after their menstrual needs.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Figure 1]

  [Table 1], [Table 2], [Table 3]


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