MENSTRUAL HYGIENE IS NOT OBVIOUS AMONG ADOLESCENT GIRLS IN LOW-RESOURCE SETTINGS: PROMOTING IT IS A PRIORITY
Abstract
Background: Menstrual hygiene management (MHM) is a vital component of adolescent reproductive health, yet it remains inadequately practiced among girls in many low-resource settings. Cultural taboos, limited access to affordable sanitary materials, and poor water and sanitation infrastructure continue to undermine safe and dignified menstrual practices. This study assessed the knowledge, attitudes, and practices regarding menstrual hygiene among adolescent girls in Lari Sub-County, Kiambu County, Kenya.
Methods: A descriptive cross-sectional study was conducted between 4th and 31st July 2023 among 365 secondary school girls aged 13–20 years, randomly selected from 10 schools in Lari Sub-County. Data were collected using structured questionnaires and analysed using STATA and SPSS.
Results: The study included 365 girls aged 13–20 years (mean 16 years), with most attaining menarche at 14 years (29.6%). Most respondents (86%) had heard about menstrual hygiene and 72.3% received information before menarche, mainly from parents (47.5%) and teachers (45.5%). Overall, 59% were knowledgeable, with knowledge significantly varying by school (χ² = 18.047, p = 0.035). Attitudes were moderately positive (53%), though 29.6% felt embarrassed and 21.4% viewed menstruation as spiritually unclean. Regarding practices, 55.1% cleaned with water only, disposal was mainly via pit latrines (57.8%) and bins (38.1%), and 65.8% avoided places of worship during menstruation.
Conclusion: Despite relatively high access to menstrual hygiene materials, knowledge levels remain moderate and several barriers persist, including inadequate water access, stigma, and unsafe disposal practices. Strengthening menstrual health education, improving WASH infrastructure, and enhancing community sensitization are essential interventions to promote safe menstrual hygiene management and improve the dignity, wellbeing, and school participation of adolescent girls.
Keywords: Menstrual hygiene management, adolescent girls, menstrual stigma, sanitary materials, reproductive health, Kenya
References
Alexander, K. T., Zulaika, G., Nyothach, E., Oduor, C., Mason, L., Obor, D., Eleveld, A., Laserson, K. F., & Phillips-Howard, P. A. (2018). Do water, sanitation and hygiene conditions in primary schools consistently support schoolgirls’ menstrual needs? A longitudinal study in rural western Kenya. International Journal of Environmental Research and Public Health, 15(8). https://doi.org/10.3390/ijerph15081682
Budhathoki, S. S., Bhattachan, M., Castro-Sánchez, E., Sagtani, R. A., Rayamajhi, R. B., Rai, P., & Sharma, G. (2018). Menstrual hygiene management among women and adolescent girls in the aftermath of the earthquake in Nepal. BMC Women’s Health, 18(1). https://doi.org/10.1186/s12905-018-0527-y
Chothe, V., Khubchandani, J., Seabert, D., Asalkar, M., Rakshe, S., Firke, A., Midha, I., & Simmons, R. (2014). Students’ Perceptions and Doubts About Menstruation in Developing Countries: A Case Study From India. Health Promotion Practice, 15(3). https://doi.org/10.1177/1524839914525175
Critchley, H. O. D., Maybin, J. A., Armstrong, G. M., & Williams, A. R. W. (2020). Physiology of the endometrium and regulation of menstruation. In Physiological Reviews (Vol. 100, Issue 3). https://doi.org/10.1152/physrev.00031.2019
Hennegan, J., Dolan, C., Wu, M., Scott, L., & Montgomery, P. (2016). Measuring the prevalence and impact of poor menstrual hygiene management: A quantitative survey of schoolgirls in rural Uganda. BMJ Open, 6(12). https://doi.org/10.1136/bmjopen-2016-012596
Kashyap, V., & Choudhari, S. G. (2023). Menstrual Hygiene Problems and Challenges Faced by Adolescent Females in Rural Areas: A Narrative Review. Cureus. https://doi.org/10.7759/cureus.40438
Korir, E., Okwara, F. N., & Okumbe, G. (2018). Menstrual hygiene management practices among primary school girls from a pastoralist community in Kenya: A cross sectional survey. Pan African Medical Journal, 31. https://doi.org/10.11604/pamj.2018.31.222.13521
Kumbeni, M. T., Otupiri, E., & Ziba, F. A. (2020). Menstrual hygiene among adolescent girls in junior high schools in rural northern Ghana. Pan African Medical Journal, 37. https://doi.org/10.11604/pamj.2020.37.190.19015
MacRae, E. R., Clasen, T., Dasmohapatra, M., & Caruso, B. A. (2019). ’It’s like a burden on the head’: Redefining adequate menstrual hygiene management throughout women’s varied life stages in Odisha, India. PLoS ONE, 14(8). https://doi.org/10.1371/journal.pone.0220114
Manyara, M. B., & Okube, O. T. (2023). Challenges Associated with Menstrual Hygiene among Adolescent Girls Attending Bocharia Primary School in Nyamira County, Kenya. Open Journal of Obstetrics and Gynecology, 13(09). https://doi.org/10.4236/ojog.2023.139135
Michael, J., Iqbal, Q., Haider, S., Khalid, A., Haque, N., Ishaq, R., Saleem, F., Hassali, M. A., & Bashaar, M. (2020). Knowledge and practice of adolescent females about menstruation and menstruation hygiene visiting a public healthcare institute of Quetta, Pakistan. BMC Women’s Health, 20(1). https://doi.org/10.1186/s12905-019-0874-3
Miiro, G., Rutakumwa, R., Nakiyingi-Miiro, J., Nakuya, K., Musoke, S., Namakula, J., Francis, S., Torondel, B., Gibson, L. J., Ross, D. A., & Weiss, H. A. (2018). Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): A feasibility study. BMC Women’s Health, 18(1). https://doi.org/10.1186/s12905-017-0502-z
Mudi, P. K., Pradhan, M. R., & Meher, T. (2023). Menstrual health and hygiene among Juang women: a particularly vulnerable tribal group in Odisha, India. Reproductive Health, 20(1). https://doi.org/10.1186/s12978-023-01603-1
Nyothach, E., Alexander, K. T., Oduor, C., Mason, L., Oruko, K., Odhiambo, F. O., Vulule, J., Laserson, K. F., & Phillips-Howard, P. A. (2015). Handwashing for menstrual hygiene management among primary schoolgirls in rural western Kenya. Waterlines, 34(4). https://doi.org/10.3362/1756-3488.2015.027
Rossouw, L., & Ross, H. (2021). Understanding period poverty: Socio-economic inequalities in menstrual hygiene management in eight low-and middle-income countries. International Journal of Environmental Research and Public Health, 18(5). https://doi.org/10.3390/ijerph18052571
Sahiledengle, B., Atlaw, D., Kumie, A., Tekalegn, Y., Woldeyohannes, D., & Agho, K. E. (2022). Menstrual hygiene practice among adolescent girls in Ethiopia: A systematic review and meta-analysis. In PLoS ONE (Vol. 17, Issue 1 January). https://doi.org/10.1371/journal.pone.0262295
Sharma, A., McCall-Hosenfeld, J. S., & Cuffee, Y. (2022). Systematic review of menstrual health and hygiene in Nepal employing a social ecological model. In Reproductive Health (Vol. 19, Issue 1). https://doi.org/10.1186/s12978-022-01456-0
Singh, A., Chakrabarty, M., Singh, S., Chandra, R., Chowdhury, S., & Singh, A. (2022). Menstrual hygiene practices among adolescent women in rural India: a cross-sectional study. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-14622-7
Sommer, M., Chandraratna, S., Cavill, S., Mahon, T., & Phillips-Howard, P. (2016). Managing menstruation in the workplace: An overlooked issue in low- and middle-income countries. In International Journal for Equity in Health (Vol. 15, Issue 1). https://doi.org/10.1186/s12939-016-0379-8
UNICEF. (2019). Guidance on menstrual health and hygiene. United Nations Children’s Fund. https://www.unicef.org/media/91341/file/UNICEF-Guidance-menstrual-health-hygiene-2019.pdf?utm_source=chatgpt.com
Van Eijk, A. M., Laserson, K. F., Nyothach, E., Oruko, K., Omoto, J., Mason, L., Alexander, K., Oduor, C., Mohammed, A., Eleveld, A., Ngere, I., Obor, D., Vulule, J., & Phillips-Howard, P. A. (2018). Use of menstrual cups among school girls: Longitudinal observations nested in a randomised controlled feasibility study in rural western Kenya. Reproductive Health, 15(1). https://doi.org/10.1186/s12978-018-0582-8
van Lonkhuijzen, R. M., Garcia, F. K., & Wagemakers, A. (2023). The Stigma Surrounding Menstruation: Attitudes and Practices Regarding Menstruation and Sexual Activity During Menstruation. Women’s Reproductive Health, 10(3). https://doi.org/10.1080/23293691.2022.2124041
Winter, S. C., Sommer, M., Obara, L. M., & Nair, D. (2022). “There is no place to dispose them. What would you have me do?’’: A qualitative study of menstruation in the unique physical and social environment in informal settlements in Nairobi, Kenya. Health and Place, 78. https://doi.org/10.1016/j.healthplace.2022.102932
