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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 21  |  Issue : 1  |  Page : 30-34

Determinants of pre-menarcheal knowledge of menstruation and sociocultural implications in college going girls: A community-based cross-sectional study from Latur, Maharashtra


Department of Preventive and Social Medicine, Government Medical College, Latur, Maharashtra, India

Date of Web Publication4-Mar-2016

Correspondence Address:
Namrata Arvind Thakur
C/o Dr. Jyoti Rajesh Patil, Flat No 13, Shriniwas Sankul, Near Big Bazaar, Sawewadi, Latur - 413 512, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9903.178102

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  Abstract 

Introduction: Adolescence marks the onset of female puberty. The first menstruation is often horrifying and traumatic to an adolescent girl because it usually occurs without her knowing about it. Implications of a girl's response to menarche have a socio-cultural and religious significance. Aim and Objective: To study the sociocultural and physiological implications of menstruation in college going girls. Materials and Methods: This was a community-based cross-sectional observational study undertaken among college girls. All the girls (n = 252) of the college were enrolled in the study. A structured questionnaire was used as the study tool. The questionnaire included topics related to sociodemographic information, sociocultural implications and first informant about the physiological process of menstruation along with its timing. Results: Majority of the study subjects (77.40%) observed restrictions for religious/holy things. Sleep disturbances were the most common (59%) disturbance faced by the study subjects. Of a total of 252 respondents, majority [104 (41.30%)] had leg cramps. The first informant of menstruation was the mother in 196 (77.78%) girls. Of 252 girls, 86 (34.12%) had pre-menarcheal knowledge of menstruation. Mothers from the urban area and with better education tend to give knowledge of menstruation prior to menarche of her daughter. An increasing trend was observed with increasing educational status of the mother and proportion of them giving pre-menarcheal knowledge of menstruation to their daughter. Conclusions: Menstruation is associated with a high burden of sociocultural implications. Pre-menarcheal knowledge of menstruation is poor. Mothers from the urban area and with better educational level tend to give knowledge of menstruation prior to menarche of their daughter.

Keywords: Disturbances, first informant, menarche, pre-menstrual symptoms, restrictions


How to cite this article:
Thakur NA, Holambe VM. Determinants of pre-menarcheal knowledge of menstruation and sociocultural implications in college going girls: A community-based cross-sectional study from Latur, Maharashtra. J Mahatma Gandhi Inst Med Sci 2016;21:30-4

How to cite this URL:
Thakur NA, Holambe VM. Determinants of pre-menarcheal knowledge of menstruation and sociocultural implications in college going girls: A community-based cross-sectional study from Latur, Maharashtra. J Mahatma Gandhi Inst Med Sci [serial online] 2016 [cited 2020 Jul 6];21:30-4. Available from: http://www.jmgims.co.in/text.asp?2016/21/1/30/178102


  Introduction Top


Adolescence in girls is a phase of transition from girlhood to womanhood that marks the onset of female puberty. This period of attaining reproductive maturity between the ages of 10 and 19 years is marked by a number of physiological, behavioral and psychological changes, the most notable being the onset of menstruation. [1] The first menstruation is often horrifying and traumatic to an adolescent girl because it usually occurs without her knowing about it. [2]

Implications of a girl's response to menarche are not only restricted to current and future health concerns but also have a socio-cultural and religious significance. [3]

Aim and Objective

  1. To study the sociocultural and physiological implications of menstruation in college going girls.
  2. To identify the first informant of menstruation to a girl along with its timing (pre- or post-menarcheal) and factors associated with it.

  Materials and Methods Top


This was a community-based cross-sectional observational study undertaken among the girls of a polytechnic college. All the girls (n = 252) of the college were enrolled in the study. A structured questionnaire was used as the study tool.

After taking permission from the college authority, the girls were explained the purpose of the study. Informed consent of the girls was taken and briefing of the questionnaire was performed. Confidentiality was maintained throughout the study by using an anonymous questionnaire. The questionnaire included topics related to sociodemographic information, restrictions observed and disturbances faced by the study subjects during menstruation and pre-menstrual symptoms among the study subjects. The first informant about the physiological process of menstruation was asked along with its timing (i.e., pre- or post-menarcheal).

Counseling was offered to those girls who had complaints and referral was advised to the Government Medical College, Latur to those in need.

Data were summarized with proportions. Chi 2 test and Fischer's exact test were used as the tests of significance. Odds ratio was calculated as applicable. Statistical software, Epi info 3.5.1, 2008 was used for analysis of data.

Ethical clearance was obtained from the institutional ethical committee.


  Results Top


The mean age of the girls was 17.11 ± 1.40 years. The proportion of rural and urban background of the girls was equivalent. Most of the parents had secondary school education. Nearly 90% of the mothers were housewives. All the girls had attained menarche. The mean age at menarche was 14.25 ± 0.98 years, with a range of 11-17 years.

Majority of the study subjects (77.40%) observed restrictions for religious/holy things. About one-fifth of the families observed strict restrictions to the extent of not allowing touching anything during menstruation. In 16.70% of the study subjects, no restrictions were observed during menstruation [Table 1]. Sleep disturbances were the most common (59%) disturbance faced by the study subjects, followed by missing social functions (07.94%) and college absenteeism (7.14%). During routine activities, 35% of the study subjects did not face any disturbances [Table 1].
Table 1: Restrictions observed and disturbances faced during menstruation

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Of a total of 252 respondents, 56 (22.22%) girls were free from pre-menstrual symptoms, 104 (41.30%) had leg cramps and 67 (26.66%) had abdominal pain. The next common symptoms were low backache and bodyache in 16% of the girls. Other less common symptoms were depression, breast discomfort and headache [Table 2].
Table 2: Pre-menstrual symptoms among the study subjects

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[Table 3] shows the association between first informant and the pre-menarcheal knowledge of menstruation. The first informant of menstruation was the mother in 196 (77.78%) girls, followed by sister and friend. Doctor, mass media and teacher were other first informants. Of the 252 girls, 86 (34.12%) had pre-menarcheal knowledge of menstruation. Among these 86 girls, the mother was the first informant in 61.63% of the girls, followed by sister (11.63%) and friend (18.60%). When the proportions of pre- and post-menarcheal knowledge of menstruation were compared with the source of information, the difference was found to be statistically significant (P-value = 0.0001). This indicates that if the girl has pre-menarcheal knowledge of menstruation, then it is significantly more likely to be from mother.
Table 3: First informant and the pre-menarcheal knowledge of menstruation

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[Table 4] shows determinants of mother giving pre-menarcheal knowledge of menstruation to her daughter. Mothers from urban areas and with better education tend to give knowledge of menstruation prior to menarche of her daughter. An increasing linear trend was observed with increasing educational status of the mother and proportion of them giving pre-menarcheal knowledge of menstruation to her daughter, as indicated by the increasing Odds ratio in [Table 4] and [Figure 1]2 for linear trend = 7.743, P-value = 0.00539). No significant association was found with the working status of the mother.
Figure 1: Linear trend of education of mother with giving pre-menarcheal knowledge of menstruation to her daughter

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Table 4: Determinants of mother giving pre-menarcheal knowledge of menstruation to her daughter

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  Discussion Top


In the present study, 34.12% of the girls had pre-menarcheal knowledge of menstruation. This means that about 65% of the girls were unaware of menstruation before menarche, which is quite unfortunate. The findings are comparable with the studies of Jogdand et al. [4] and Ray Sudeshna et al., [5] in which 36.19% and 42.1% of the girls, respectively, had knowledge about menstruation before menarche. In a study conducted in Rajasthan by Khanna et al., [6] nearly 92% of the girls were not aware about the natural phenomenon of menstruation during menarche, while awareness was nearly 97% in a study carried out in Kano, Nigeria and 92% in Nepal. [7],[8] Notably, studies from India report a lower proportion of girls having correct knowledge of menstruation. The secondary school curriculum in many states of India does not include information on menstruation; even at the family level silence surrounds the issue of menstruation, which can explain the comparatively lower knowledge in the Indian studies.

The mother was the first informant of menstruation in 77.78% of the girls, followed by the sister and friend. Similar findings are noted by Jogdand et al. (61.29%) [4] and Singh et al. (64.9%). [9] However, Dasgupta et al. [10] observed that the mother was the first informant only in case of 37.5% girls. Close relation and better communication between mother and daughter may be the reason for the findings of the present study.

In the present study, it was noted that mothers from the urban area and with better education tend to give knowledge of menstruation prior to menarche. Datta et al. [3] in their study from Howrah district of West Bengal also found a significant relationship with residential status. About 72% of urban girls and 39% of rural girls were found to have pre-menarcheal knowledge regarding menstruation (P = 0.00001). A study conducted by Deo et al. [11] reported that 40 (42.5%) urban and 41 (55.4%) rural girls were aware about menstruation prior to attainment of menarche.

Many restrictions were imposed on the girls in the present study, like avoiding religious things (77.40%), not touching anything (19.00%), avoiding certain food, etc. This is very similar to the study conducted by Ray Sudeshna et al. [5] and Dasgupta et al. [10] Datta et al. [3] noted that most of the participants in both urban (54.4%) and rural (76.1%) areas refrained from religious activities, followed by playing (40.4%) in urban areas and restriction of food (22.5%) and sleeping separately (22.5%) in rural areas.

Sleep disturbances were the most common (59%) disturbance faced by the study subjects, followed by missing social functions (07.94%) and college absentism (7.14%). The proportion of school absentism varied from 16% to 45.6% in other studies. [3],[5],[10]

Leg cramp was the leading (41.30%) pre-menstrual symptom noted in the present study, followed by abdominal pain (26.66%). Patil et al. [12] also had similar findings: 44.6% had cramps followed by 22.7% with abdominal pain.

Limitations

As this study was undertaken among a special study group of adolescent girls, the findings may not be generalized to adolescent girls from different educational and social backgrounds. Also, recall bias can occur as it was a cross-sectional study, but because menarche is an important milestone in the female reproductive life, the chances to recall age at menarche are good.


  Conclusions Top


Menstruation is associated with a high burden of sociocultural implications. Pre-menarcheal knowledge of menstruation is poor. If a girl has pre-menarcheal knowledge of menstruation, the source of information is more likely to be mother. Mothers from the urban area tend to give knowledge of menstruation prior to menarche of her daughter. Also, as the educational level of the mother increases, chances of giving pre-menrcheal knowledge of menstruation to her daughter also increase.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no potential conflicts of interest and no sponsors.

 
  References Top

1.
Adolescents in India. A Profile. World Health Organization 2003. Available from: http://www.whoindia.org/LinkFiles/Adolescent_Health_and_Development_(AHD)_UNFPA_Country_Report.pdf. [Last accessed on 2012 Jul 12].  Back to cited text no. 1
    
2.
Gupta J, Gupta H. Adolescents and menstruation. J Fam Welf 2001;47:1-12.  Back to cited text no. 2
    
3.
Datta A, Manna N, Datta M, Sarkar J, Baur B, Datta S. Menstruation and menstrual hygiene among adolescent girls of West Bengal, India: A school based comparative study. GJMEDPH 2012;1:50-7.  Back to cited text no. 3
    
4.
Jogdand K, Yerpude PA. Community based study on menstrual hygiene among adolescent girls. Indian J Matern Child Health 2011;13:1-6.  Back to cited text no. 4
    
5.
Sudeshna R, Dasgupta A. Determinants of menstrual hygiene among adolescent girls: A multivariate analysis. NJCM 2012;3:294-301.  Back to cited text no. 5
    
6.
Khanna A, Goyal RS, Bhawsar R. Menstrual practices and reproductive problems: A study of adolescent girls in Rajasthan. J Health Manag 2005;7:91-107.  Back to cited text no. 6
    
7.
Lawan UM, Yusuf NW, Musa AB. Menstruation and menstrual hygiene amongst adolescent school girls in Kano, Northwestern Nigeria. Afr J Reprod Health 2010;14:201-7.   Back to cited text no. 7
    
8.
Water Aid, Anita Pradhan: Is menstrual hygiene and management an issue for adolescent school girls? A comparative study of four schools in different settings of Nepal, 2009. Available from: http://www.nepal.wateraid.org. [Lastaccessed on 2012 Mar 20].  Back to cited text no. 8
    
9.
Singh SP, Singh M, Arora M, Sen P. Knowledge assessment regarding puberty and menstruation among school adolescent girls of district Varanasi, UP. Indian J Prev Soc Med 2006;37:9-14.  Back to cited text no. 9
    
10.
Dasgupta A, Sarkar M. Menstrual hygiene: How hygienic is the adolescent girl? Indian J Community Med 2008;33:77-80.  Back to cited text no. 10
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11.
Deo DS, Ghattargi CH. Perceptions and practices regarding menstruation: A comparative study in urban and rural adolescent girls. Indian J Community Med 2005;30:33-4.  Back to cited text no. 11
    
12.
Patil MS, Angadi MM. Menstrual pattern among adolescent girls in rural area of Bijapur. Al Ameen J Med Sci 2013;6: 17-20.  Back to cited text no. 12
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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