Knowledge, attitudes and practices on menstrual hygiene and associated factors among grade 10 schoolgirls in the district of Kalutara, Sri Lanka

Introduction: Menstruation is a natural phenomenon that occurs with sexual maturity of females. However, the topic is taboo for most female adolescents leading to improper practices on menstrual hygiene (MH) management.

Objectives: To assess the knowledge, attitudes and practices on MH and associated factors among Grade 10 adolescent girls in Kalutara District, Sri Lanka

Methods: A descriptive cross-sectional study was conducted. The final sample size computed was 720, applying a design effect of 3.8. As the cluster size decided was 15, 48 clusters/classes were selected using multi-stage stratified cluster sampling applying probability sampling techniques. A validated self-administered questionnaire was administered using Sinhala and Tamil versions. Bivariate and multivariate logistic regression was conducted to determine the associated factors.

Results: Response rate at the time of recruitment was 100%. Satisfactory level of overall knowledge was observed in 25% (95% CI: 21.9, 28.3), attitudes in 67.2% (95% CI: 64.0, 70.9) and practices in 17.3% (95% CI: 14.7, 20.3). Unsatisfactory knowledge was associated with menstrual information not provided by a science teacher (ScT) (p<0.001) school types 1C and 2 combined (p=0.002) and mothers having less than tertiary education (p=0.03). Unsatisfactory attitudes were associated with menstrual information not provided by a ScT (p<0.001) and lack of premenarcheal awareness (p=0.009). Unsatisfactory practices were associated with school types IC and 2 combined (p<0.001), residing in urban sector (p=0.004) and having extended families (p=0.034).

Conclusions & Recommendations: Overall knowledge on menstruation and menstrual hygiene related practices were poor, whereas attitudes were satisfactory. School type, maternal educational level, lack of premenarcheal awareness, menstrual information not being provided by a science teacher, residing in urban sector and living with extended family were the factors associated with unsatisfactory knowledge, attitudes and practices.