Effectiveness of Information Education and Communication on Menstrual Hygiene among Adolescent School Girls of

Background Menstruation and menstrual practices are darkened by taboos and different societal as well as cultural restrictions, which results in lack of adequate knowledge in adolescents regarding the scientic facts of menstruation as well as healthy menstrual hygiene practices. The objective of the study was to nd out the effectiveness of information, education and communication (IEC) on menstrual hygiene among adolescents of Jumla district. Materials and Methods Quasi-experimental research design was used for the study. The samples were taken from government school, Shree Janta Secondary Technical school of Chandannath municipality of Jumla District. A total of 112 adolescents girls studying in class 9 and class 10 were selected by using non probability total enumerative sampling technique. Data was collected by using self administered questionnaire. Data analysis was done by descriptive and inferential statistics. Results The study revealed that 8.9% of respondents had high knowledge during pre test which was signicantly increased to 60.7% during post test and 27.7% of respondents had good practice during pre test which was signicantly increased to 51.8% during post test Conclusion The present study concluded that adolescents lacked appropriate knowledge and practices about menstruation in the pre test which signicantly increased in post test. Thus, structured health education program can signicantly bring positive change in healthy menstrual hygiene practices.


Introduction
Menstruation is a fundamental part in life of human, and menstrual hygiene is important to the loftiness and safety of girls. About 52% of the female population is of reproductive age in worldwide, meaning menstruation is part of their normal life [1]. Menstrual hygiene is integral aspect of reproductive health and poor menstrual hygiene may lead to various adverse effects like urinary and reproductive tract infections [2].There is insufcient knowledge regarding menstrual hygiene and no proper attention has been given. In order to sustain menstrual hygiene, use of sanitary pads and cleaning the genital area are important activities. Unhygienic menstrual activities can affect girls' health and the susceptibility to reproductive tract infections and inammatory pelvic diseases and other complications is increased [3]. These practices and lack of knowledge results in absenteeism from school and poor reproductive health in adolescent females of Nepal [4]. Change in knowledge and practices regarding menstrual hygiene can be achieved by providing education on facts of menstruation. This can be provided through information, education and communication (IEC) activities so that she can know appropriate technique in acquiring good menstrual hygiene practices [5].

Materials and Methods
Quasi-experimental research design was used to assess the effectiveness of IEC on menstrual hygiene among adolescent school girls of Jumla District. The study was conducted at government school, Shree Janta Secondary Technical school of Chandannath municipality of Jumla District. The populations selected for the study were all th th adolescent girls who were studying in 9 and 10 standard who attained menarche and who gave consent for enrollment in the study. Non probability total enumerative sampling technique was used to assess the effectiveness of IEC on menstrual hygiene among adolescents school girls of Jumla district. Required sample size was calculated by using the formula for experimental study. To reduce non response error additional 10% was taken so sample size was 112, calculated based on mean value of pretest and posttest as 50.60 and 93.11 respectively, as well as standard deviation of pretest and post test as 13.03 and 7.55 respectively, level of signicance at 5% and power of study at 80% [10]. All adolescent girls attending 9th and 10th class during research study was included. A structured questionnaire was drafted for this purpose and the relevant data was collected from the sample in both the pre test and post test session. The intervention package was a structured teaching programme which was conducted for one hour for two days as two groups were divided, a group a day which consisted of pictures, videos and demonstration related to menstruation, menstrual cycle, menstrual hygiene practices and sanitation. The intervention package was validated by the experts. The intervention was given immediately after the pretest assessment of the participants. Post test was done after 2 months of giving intervention. The content validity of the research instrument was established by subject expert, consultant and linguistic profess -ionals. The reliability of the instrument was done by pretesting of the tool among 10% (11)

Discussion
Menstruation is the biggest pubertal transition that is taking place in adolescent girls and is a cycle of development and maturation and preparing them for motherhood. It is encircled by different customs, myths and taboos.It requires access to effective materials and facilities for proper menstrual hygiene, without which poor health effects can result [6]. Regarding the sociodemographic data, ndings of the current study revealed that the mean age at menarche was 13.2 years. This result is in accordance to the results from other studies conducted in Sunsari, Nepal, which illustrated that the menarche mean age was 13.1 years [4]. Another study done at Belgaum, [7] the mean age of menarche was 13.6 years. However, in a study done among North Indian adolescent girls [8], the mean age was 12.8 years. While in a study conducted in Egypt [9], it was found that the mean age was 12.7 years. The observed differences could be due to difference in geographical area, environmental condition, the nutritional habits and girl's general health condition. The present study revealed that most of the adolescent girls had almost the same source of information regarding their menstruation as 54.2% of the girls conrmed that they got information about menstruation from their mothers. In Nepal, menstruation is hidden topic and it is not appropriate to talk about it because of different cultural beliefs and sensitivity of the topic that may lead to inaccurate, incorrect and incomplete information. A study done in Sunsari, Nepal revealed that 39.3% of girls went to their mothers to get their answers regarding menstrual questions [4]. In regards to regularity of menstruation, the current study showed that 83% of respondents had regular menstruation. This is nearly similar with the study ndings done in Egypt where 66% of respondents had regular menstruation [9]. Concerning the experience regarding the rst menstruation, present study revealed that 40.2% were frightened during their menarche. This is nearly similar to the study conducted in Sunsari, Nepal. Menstruation comes with various problems, where dysmenorrhoea was the most common, which is similar to the ndings from other studies [4].
Menstruation is an important aspect in a girl's reproductive health. Thus, health education in menstrual hygiene is very necessary for adolescence girl to cope with menstruation and maintain good menstrual hygiene [10]. The current study found that the average awareness score of adolescent girls was poor before the menstrual health education program was introduced; whilst it played a crucial role in increasing their level of knowledge after it has been implemented. Their understanding has been signicanty improved in the postintervention process. Such results were consistent with other studies conducted in Egypt, Saudi Arabia and India [10][11][12]. In our study, knowledge on cause of menstruation was poor among participants i.e. only 60.7% of them knew that menstruation is normal physiological process among adolescent girls before health education intervention but later the knowledge was signicantly increased to 83.9% after intervention. Nearly similar ndings were reported in a study conducted in Tamil Nadu, India [13]. Similarly, the present study showed that there was signicant improvement after health education intervention in the knowledge regarding the organ of blood ow 33 percent correctly reported as uterus before intervention which was signicantly increased to 71.4% after intervention which was similar to study ndings of study conducted in India [7]. In the present study, majority of girls felt "menstrual blood is unclean" which is similar to study conducted by Adinma E where 73.1% girls reported menstruation as "release of bad blood" [14]. dustbin, burnt and buried . In the post-test period, 55.4% girls reported that they threw the used pads in the dustbin, burnt and buried. Similar results were also reported in a study done in Bangladesh regarding disposal of the menstrual materials, in the pre test phase 56.5% of the girls burnt and buried absorbent materials and in the post test phase, 82% girls reported that they burnt the absorbent [12]. Maintaining hygiene is very essential during menstruation [1]. Having access to clean genitals and use of soft absorbent sanitary products will protect the health of adolescents girl in the long run. In the present study, during the preintervention phase, only 27.7% of adolescents had good hygiene practices. In the post-intervention phase, there was a signicant improvement in good menstrual practices (51.8%). Numerous studies have found that providing adolescents with educational materials increases their knowledge and build up positive attitude towards puberty and make them accept it as a natural physiological phenomenon [12]. In present study, majority of the respondents were restricted to go in kitchen and visit religious places. In the post-test phase, there was no signicant difference in the restrictions followed by them (P>0.05) [12]. The result showed sociocultural beliefs and taboos had great inuence on menstruation among adolescent girls. Those females who achieved higher education also nd it very hard to go against all the restrictions and they are compelled to believe the cultural beliefs and practices. Some of adolescent girls stated that traditional practices like restrictions on going to other's home, staying at cow shed, taking bath also prevailed in their society. The ndings of the study regarding restrictions during menstruation show that the taboos on menstruation still do exist. Our society is restricted by different cultural beliefs that can develop negative attitude of female on menstruation. As reproductive health is major concern in maintaining overall health of individual, effective intervention should be carried out to avoid the restrictions that affect the menstrual hygiene which are practiced by adolescence. Despite of greater educational change, culture and beliefs are restricting the change in attitude toward menstruation, thence affecting the menstrual hygiene management. This condition seeks urgent need to address the harmful practices in the name of culture. The rst possible limitation is that the study sample was taken from a single setting. The second limitation is that the study was taken from a single setting. The period between pretest and post test was only 2 months

Conclusion
The ndings of the study concluded that there was decit in knowledge and practice regarding menstruation in adolescence girl before the implementation of health education programme. However the knowledge and practices signicantly improved in post test after the intervention. Thus, health education regarding menstruation and menstrual hygiene should be included in the curriculum of each school so that they can manage their menstruation hygienically.