ABSTRACT

 In many societies menstruation is not openly discussed in some families, school and communities leading to a very big gap in knowledge about menstruation and menstrual problems. This gap equally poses problems on issues about menstrual hygiene, menstrual problems and management of those problems. In addition to inadequate information, girls need access to hygienic absorbent sanitary products, water, good toilets that ensure privacy and disposal facilities which can in the long run, protect their health. This study investigated the knowledge and management of menstruation and menstrual problems among urban and rural secondary school girls in Enugu East Local Government Area. A cross sectional descriptive survey was adopted for this study. The sample for the study comprised of 699 secondary school girls. Four Hundred were drawn from the three randomly selected secondary schools in urban area. The remaining 299 girls were from the only government owned secondary school in the rural area. The sample size for the urban schools was determined using Taro Yamane’s formula. A researcher developed questionnaire in questions and optional form was used to generate data. The results were presented in tables with frequencies, percentages and Pearson’s Chi-square was used to test hypotheses. The results showed that 497(87.0%) of the respondents had knowledge before menarche. Mothers were major sources of this information. There was significance difference (p<0.05) in the knowledge of menstruation between Urban and Rural Secondary School girls. Majority of the girls 407(71.2%) use sanitary pads alone or in conjunction wit5h other materials. More than half 308(53.8%) change their menstrual absorbent materials three times a day and 352(61.6) take their bath three times a day. There was no significance difference (p<0.05) in management of menstruation between Urban and Rural Secondary School girl. Majority 384(67.3%) reported they have toilets in their school and 210(54.7%) reported that toilets do not provide privacy for change of menstrual absorbent materials. The commonest menstrual problem experienced by girls is dysmenorrheal 368(64.4%). There was no significance difference (P>0.05) in the menstrual problems experienced by Urban and rural girls. The majority 101(681%) of the respondents, use paracetamol to manage abdominal pains. Only 79(13.8%) of girls that have problems associated with flow consulted a doctor. There was a significance difference (P<0.05) in the management of menstrual problem between Urban and rural Secondary School girls. In conclusion, the findings of this study revealed that girls have information about menstruation but the information was very deficient in the process of menstruation. Some girls do not dispose menstrual wastes properly Environment especially at school do not encourage good management of menstruation. Therefore, it is recommended that there is still need for organized health education in schools to discourage unhealthy strategies for managing menstruation especially as it concerns disposal of menstrual wastes. Also there is need to provide supportive enabling environment both in Schools and homes for girls for effective management of menstruation should also involve screening of girls to detect any serious gynaecological problems, early referral for prompt management.

                              CHAPTER ONE                          

INTRODUCTION

Background to the study

Secondary school girls are in a period of growth and development known as adolescence. Adolescence is a period of transition from childhood to adulthood. It is a stage of human development that is characterized with so many physical, social, emotional and mental changes. There is appearance of secondary sexual characteristics, in girls menstruation is one of these major characteristics. The onset of menstruation represents a landmark event in pubertal development of the adolescent girl. Menstruation is a natural phenomenon that occurs from puberty throughout the reproductive life of every female. It is a periodic vaginal bleeding associated with shedding of uterine mucosa. Every mature woman menstruates on the average of three to five days monthly until menopause (Lawan, Yusuf & Musa 2010).  Esimai and Esan (2010) assert that normal menstruation relies on action and interaction of hormones released from Hypothalamus – pituitary and ovaries and their effects on the endometrium. The normal menstrual pattern is associated with 3 to 7 days length of flow and amount of flow less or equal to 80ml. A woman’s period may not be the same every month and it may not be the same as that of other women. Periods could be light, moderate or heavy and the length of the period also varies.

Menstruation is a normal process of the body and if proper knowledge is given regarding its onset, management and problems associated with it; then it can be handled like all other body functions. However, many girls in developing countries lack appropriate knowledge and sufficient information regarding menstruation and its management (Olayinka 2004). While some information might be available from school and friends, parents should address the practical concerns that puberty brings, for instance, new hygiene needs(e.g., menstrual periods, body odors), clothing and product needs (e.g., cloth vs. napkin brands). In order for girls to live healthy reproductive and dignified life, it is essential that they are able to manage menstrual bleeding effectively (Ahmed & Yesmin 2008). Management of menstruation deals with the special health care needs and requirements like choice of absorbent used, how often and when to change the absorbent used, washing of hands and undergarments, bathing, care of vulva and proper disposal of menstrual wastes. Therefore, menstruation as a regular process needs hygienic management. If poorly managed, menstrual period may be accompanied with discomfort, reproductive tract infections, foul odour and embarrassment among others (Dasgupta & Sarkar (2008).

Despite the fact that menstruation is a normal physiological process, it is often associated with some problems and discomforts. Harlow and Campbell (2007),         stated that menstrual problem is very traumatic experience for some adolescent girls and women and could truncate their life dreams. Titilayo, Agunbiade, Banjo and Lawani (2009) also stated that 40 -49% of menstruating women are affected by menstrual problems in diverse ways. Studies from different cultures in different parts of the world have associated it with one of the most common causes of regular absenteeism among girls in schools, work places, sports participation and other public functions (El-Gilany, Badawi & ELfedawy 2005; Walraven, Ekpo, Coleman, Scherf,  Morrison & Harlow 2002) . Dysmenorrhea is the commonest disorder among girls during menstruation. Others are excessive bleeding, irregular menses, breast pains and fullness. Psychosocial issues surrounding girls during their menstrual periods aggravate these problems (Esimai & Esan 2010; Harlow & Campbell 2007; Antai, Udezi, Ekanem, Okon & Umoiyoho 2004).  

In Nigeria, school girls often struggle to manage their menstruation due to social, cultural and economic constraints.  Adinma  and Adinma (2008) assert that poor knowledge of menstruation and practice engenders reproductive health problems in adolescents such as dysmenorrhoea, depression and reproductive tract infections. In Enugu, girls manage their menstruation and menstrual problems according to the extent of pre menarcheal information they received (Aniebue, Aniebue  & Nwankwo 2009). They further stated that socialization brought by western education; parents’ social class influence information girls receive before menarche and in turn affect management of menstruation and menstrual problems. Other issues associated with menstrual hygiene and practices in the country are lack of infrastructure like water, soap, toilet that ensures privacy. Enugu East Town Planning Authority shows that the Local Government comprising both urban and rural population with many secondary school girls; these girls like their counterparts in other parts of the nation may encounter many challenges on issues relating to their sexuality, principally menstruation. Hence, the researcher decided to undertake this study.

Statement of Problem