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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 3  |  Page : 35-40

Knowledge, attitude, and practices related to reproductive and sexual health among adolescent girls in a rural community of Telangana


1 Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India
2 Department of Community Medicine, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
3 Primary Health Care Center, Ibra, Oman
4 Department of Community Medicine, ESI-PGIMSR and ESIC Medical College, Kolkata, West Bengal, India
5 Masters in Public Health, Indian Institute of Public Health, Hyderabad, Telangana, India

Date of Submission10-Mar-2021
Date of Decision05-May-2022
Date of Acceptance19-Jun-2022
Date of Web Publication28-Jul-2022

Correspondence Address:
Arun Kiran Soodi Reddy
Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjhs.mjhs_20_21

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  Abstract 


Background: The majority of adolescents lack basic knowledge about puberty, growth during puberty, safe sex, and hygiene. Unawareness about safe sex and protection and contraceptives may increase the risk of sexually transmitted diseases (STDs), unwanted pregnancies, etc.
Objective: The objective of this study was to study knowledge, attitude, and practices related to reproductive and sexual health among adolescent girls in a rural community of Telangana.
Methods: A community-based cross-sectional study was conducted in secondary schools which were located in the rural field practice area of a medical college. All schools in the village were included in the study. Study participants were 6th–10th standard adolescent school girls, with the age group of 10–19 years. A questionnaire regarding knowledge, attitude, and practices related to reproductive and sexual health was used.
Results: The mean age was 13.6 ± 1.386 years. Eighty-four percentage were from nuclear families and only 10% were from below poverty line families, with a mean per capita income of 2626 ± 1708 international normalized ratio. Seventy-five percentage were aware about puberty; source of information was mothers (67%). Ninety percentage did not know how women become pregnant, STDs, and HIV/AIDS. Only 30% said that oral pills were effective against pregnancy and 95% did not know that condoms prevent STDs. Sixty percentage said their schools covered classes regarding normal anatomy, physiology, menstrual hygiene, and reproductive health, of which only 52% attended this topic. About 82.4% of the subjects felt that it is necessary to maintain cleanliness during menstruation. Seventy-five percentage were using sanitary napkins, and 80% were washing hands after changing sanitary napkins with soap and water. Twenty percentage were throwing directly into drainage or dustbin.
Conclusion: Knowledge related to reproductive and sexual health among adolescent girls in these adolescent girls was poor and their attitude and practices were also poor.

Keywords: Adolescent girls, attitude, knowledge, practices, reproductive, sexual health


How to cite this article:
Soodi Reddy AK, Varanasi S, Ameer SR, Paul KK, Reddy AA. Knowledge, attitude, and practices related to reproductive and sexual health among adolescent girls in a rural community of Telangana. MRIMS J Health Sci 2022;10:35-40

How to cite this URL:
Soodi Reddy AK, Varanasi S, Ameer SR, Paul KK, Reddy AA. Knowledge, attitude, and practices related to reproductive and sexual health among adolescent girls in a rural community of Telangana. MRIMS J Health Sci [serial online] 2022 [cited 2022 Aug 18];10:35-40. Available from: http://www.mrimsjournal.com/text.asp?2022/10/3/35/352625




  Introduction Top


Puberty is the attainment of sexual maturity involving physical, hormonal, and psychological changes. Hormonal changes involve a rise in the secretion of estrogen and progesterone leading to maturity of ovarian follicles, endometrial thickening, and menstrual cycle. The majority of adolescents lack basic knowledge about puberty, growth during puberty, safe sex, and hygiene. The unawareness about safe sex and protection and contraceptives may increase the risk of sexually transmitted diseases (STDs), unwanted pregnancies, etc., Childhood to adulthood transition takes place during the adolescence period which is characterized by major biological changes such as physical growth, sexual maturation, and psychosocial development. As per the World Health Organization, adolescence is the age group of 10–19 years. It is marked by enhanced food requirement, increased basal metabolic and biochemical activities, and endogenous processes such as hormonal secretions with their influence on the various organ systems, of which menarche is the most important event in the case of adolescent girls that requires specific and special attention.[1],[2]

It marks the beginning of woman's menstrual and reproductive life which occurs between 11 and 15 years with a mean of 13 years. It is a qualitative event of major significance in woman's life, denoting the achievement of major functional state. During this phase of growth, the girls first experience menstruation and related problems marked by feelings of anxiety and eagerness to know about this natural phenomenon.[3]

Adolescent girls constitute a vulnerable group, particularly in India. They do not get the proper knowledge due to the lack of appropriate health education programs in schools. Moreover, traditional Indian society considers talks on such topics as prohibited and discourages open discussion on these issues. This leads to intense mental stress and they seek health advice from quacks and persons who do not have adequate knowledge on the subject.[4]

Menstruation is still regarded something unclean or dirty in Indian society.[5] The reaction to menstruation depends upon awareness and knowledge about the subject. The manner in which a girl learns about menstruation and its associated changes may have an impact on her response to the event of menarche. Moreover, the routine health services do not have provisions for adequate care of adolescent health problems which in turn exaggerate the problems in multiple. Understanding the health problems related to menstruation, the health-seeking behavior of adolescent girls, their awareness about pregnancy, and reproductive health will help us in planning programs for this vulnerable group. Hygiene-related practices of menstruation are of considerable importance as it has health impact increased vulnerability to reproductive tract infections (RTIs). The interplay of socioeconomic status, menstrual hygiene practices, and RTIs is noticeable. Today, millions of women are sufferers of RTI and its complications and often the infection is transmitted to offspring of the pregnant mother.[5]

Women having better knowledge regarding menstrual hygiene and safe practices are less vulnerable to RTI and its consequences. Therefore, increased knowledge about menstruation right from childhood may escalate practices and may help in mitigating the suffering of millions of women. With this in mind, the present study was carried out to gather information regarding menstruation, hygiene-related practices of menstruation, and its related problems among adolescent girls along with to review perceptions, beliefs, and expectations regarding menstruation among adolescent girls.


  Methods Top


A community-based cross-sectional study was conducted in the secondary schools which are located in the rural field practice area of Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad, from November 2018 to December 2018. All the schools in the Gummadidala village were included in the study. Study participants were 6th–10th standard adolescent school girls, within the age group of 10–19 years were included in the study.

Institutional Ethics Committee permission was obtained. Informed assent was obtained from the parents of the adolescent girls. Health education was imparted at the end of the study.

All the study subjects who were willing to participate in the study were included in the study and those who were not willing to participate were excluded from the study. All the study participants were interviewed using a preformed semi-structured, preformed, and pretested questionnaire, which included questions on basic demographic details; information included awareness regarding menstruation and source of information regarding menstruation. An informed written incent form was collected from the principal of each school.

Reproductive and sexual health knowledge, attitude, and practices regarding menstruation as well as hygienic practices during menstruation were assessed.

Statistical analysis

All the data were entered into an MS-Excel sheet. The data were analyzed using SPSS 20.0 (IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp). Their knowledge, attitude and practices related to reproductive and sexual health were analyzed by using percentages and Chi-square test is used to compare categorical variables. Statistical significance of differences between the groups was tested. P < 0.05 was considered as statistically significant.


  Results Top


[Table 1] shows the distribution of study subjects as per sociodemographic characteristics. Out of the 324 adolescent girls who were interviewed majority, more than 70% were young adolescents in the age group of 10–14. The mean age of the study population was 13.6 years (SD ± 1.386). Among the study population, around 90% belonged to Hindu religion and most of them were from backward caste (70.4%). Among the study participants, majority (84%) were from nuclear families, the mean family members in the study were 4.78 (SD ± 1.912). Only 10% of the participants were from below poverty line (BPL) families, with a mean per capita income of 2626 (SD ± 1708), ranging from 500 to 16,000 rupees. Around half of the family members of the study participants are into farming and private jobs in the nearby industries.
Table 1: Distribution of study subjects as per sociodemographic characteristics

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[Table 2] shows the distribution of study subjects as per knowledge regarding reproductive and sexual health. When asked about puberty, three-fourths of the study participants were aware of it and the source of information was from their mothers in 67% of the subjects, followed by friends, sisters, teachers, and others. Only few subjects (13.3%) did not know about menstruation, and in majority, the source of information was their mothers. Almost 90% of the subjects did not know how women become pregnant, STDs, and HIV/AIDS, and even 6% of the subjects felt there is a cure for HIV/AIDS.
Table 2: Distribution of study subjects as per knowledge regarding reproductive and sexual health

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[Table 3] shows the distribution of study subjects as per knowledge regarding the prevention of STDs and pregnancy. When asked about how to prevent pregnancy, only 30% of the study participants answered as oral contraceptive pills are effective against pregnancy, but among them, only 6% said that condoms also prevent pregnancy. Around 95% of the subjects did not know that condoms prevent STDs.
Table 3: Distribution of study subjects as per knowledge regarding prevention of sexually transmitted diseases and pregnancy

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[Table 4] shows the distribution of study subjects as per attitude and practices of adolescent girls toward menstrual hygiene. Around 60% of the participants said their schools covered classes regarding normal anatomy, physiology, menstrual hygiene, and reproductive health, of which only 52% attended this topic. About 82.4% of the subjects felt that it is necessary to maintain cleanliness during menstruation. While 73.8% know not maintaining cleanliness leads to genital infections. Almost three-fourths of the subjects were using sanitary napkins, while others are using both cloth and sanitary napkins. Around 80% were washing hands after changing sanitary napkins with soap and water. Regarding safe disposal of sanitary napkins, around 20% of the subjects were throwing directly into the drainage or dustbin.
Table 4: Distribution of study subjects as per attitude and practices of adolescent girls toward menstrual hygiene

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  Discussion Top


Out of the 324 adolescent girls who were interviewed majority, more than 70% were young adolescents in the age group of 10–14. The mean age of the study population was 13.6 years (SD ± 1.386). Among the study population, around 90% belonged to Hindu religion and most of them were from backward caste (70.4%). Among the study participants, majority (84%) were from nuclear families, the mean family members in the study were 4.78 (SD ± 1.912). Only 10% of the participants were from BPL families, with a mean per capita income of 2626 (SD ± 1708), ranging from 500 to 16,000 rupees. Around half of the family members of the study participants are into farming and private jobs in the nearby industries. When asked about puberty, three-fourths of the study participants were aware of it and the source of information was from their mothers in 67% of the subjects, followed by friends, sisters, teachers, and others. Only few subjects (13.3%) did not know about menstruation, and in majority, the source of information was their mothers. Almost 90% of the subjects did not know how women become pregnant, STDs, and HIV/AIDS, and even 6% of the subjects felt there is a cure for HIV/AIDS. When asked about how to prevent pregnancy, only 30% of the study participants answered as oral contraceptive pills are effective against pregnancy, but among them, only 6% said that condoms also prevent pregnancy. Around 95% of the subjects did not know that condoms prevent STDs. Around 60% of the participants said their schools covered classes regarding normal anatomy, physiology, menstrual hygiene, and reproductive health, of which only 52% attended this topic. About 82.4% of the subjects felt that it is necessary to maintain cleanliness during menstruation. While 73.8% know not maintaining cleanliness leads to genital infections. Almost three-fourths of the subjects were using sanitary napkins, while others are using both cloth and sanitary napkins. Around 80% were washing hands after changing sanitary napkins with soap and water. Regarding safe disposal of sanitary napkins, around 20% of the subjects were throwing directly into the drainage or dustbin.

Nair et al.[6] carried out a comparative study among girls and boys of age 10–24 years in Kerala. They found that knowledge about condoms was better in boys while knowledge about the copper T was better in girls. Ninety-one percentage of the girls correctly told about the legal age of marriage. About 89.7% of the girls correctly told about the problem of infertility that both the genders are responsible for it. About 60.4% of the girls told that the gender of the baby was determined by the male sperm. Counseling services were demanded by more than 90% of the boys and girls.

Gothankar et al.[7] carried out a cross-sectional study among 323 adolescent girls. The mean age was 13.35 years which is comparable to the mean age in the present study. About 86.65% of the girls had correct knowledge on menstruation and 68% of them received this information from their mothers; these findings also are comparable to the present study findings. About 50% of the girls expressed religion as the cause for restrictions during menstruation. The prevalence of RTIs was 11%. Only 3% of the girls used cloth while 96% of them used the sanitary napkin. These findings are also similar to the findings of the present study.

Dogra et al.[8] included 1000 girls in their cross-sectional study in Jammu. Eighty-one percentage of them were found to be aware about the sex education and 88% expressed their willingness that it should be included in the curriculum. Fifty-two percentage told that it should be initiated at 13–15 years of age. Only 28% were found to be aware about emergency contraception while only 34.6% of them were aware about the STDs. Majority (95.6%) heard about HIV/AIDS, but in the present study, only 31.5% heard about it.

Kuberan et al.[9] studied 464 secondary school students to assess knowledge and attitude related to reproduction, contraception, and HIV/STD. It was found that 38.5% of them had average knowledge on reproduction, 34.75% had average knowledge on contraception, and 45.5% had average knowledge on STD/HIV. Eighty percentage of them knew that ovum is fertilized by ovum. About 50% were not aware about the possibility of having more than one STD.

Jaffer et al.[10] examined knowledge, attitudes, and practices of Omani adolescents which included 1670 boys and 1675 girls. Only half of them told correctly about the puberty changes. Boys were found to get married earlier than girls. On an average, they desired 4.9 children in their life. Positive attitude was found in about two-thirds of the participant regarding modern contraceptive methods. Knowledge related to fertility, STD, and AIDS was poor which was also poor in the present study.

Gaferi et al.[11] assessed the knowledge of 350 adolescent girls. Good knowledge on reproductive health was found in only 33.7% of the girls. About 95.4% of the girl's practices on menstruation hygiene were found to be correct which is comparable to the present study findings. About 88.3% had a positive attitude related to reproductive health.

Gabriela[12] carried out a study in Peru involving 315 students of secondary schools. The authors found that among them, one-fourth were already sexually active which was more in boys compared to girls. The participant told that the teachers were the source of information on sexual health, while in the present study, it was mothers. Significantly higher knowledge was found among those who had good communication with teachers.

Mattebo et al.[13] studied 160 students in four schools in Kathmandu. Two-thirds of the girls and 60% of boys told that they can get STI during sexual intercourse. One-third of them thought that pregnancy may not occur with one sexual intercourse. Knowledge was found to be better in girls compared to boys.

Malleshappa et al.[14] studied effectiveness of “reproductive health education intervention program in improving the knowledge of adolescent girls aged between 14 and 19 years.” They found that there was a significant increase in the knowledge after this program.


  Conclusion Top


Strengthening of menstrual hygiene and management (MHM) programs in India is needed. Although knowledge was better than practice, both were not satisfactory. Hence, the girls should be educated about process and significance of menstruation, use of proper pads or absorbents, and its proper disposal. This can be achieved by giving them proper health education (by teachers, family members, health education, and media) so that there will not be any misconception to the adolescent girls regarding menstrual hygiene. The management of menstruation presents significant challenges for women in lower income settings; the effect of poor MHM can affect the reproductive tract, but the specific infections, the strength of effect, and the route of transmission remain unclear. Due to poor knowledge, the practices were not optimal for pain management, which affected their school attendance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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