INTRODUCTION:

Menstruation and menstrual practices are still clouded by taboos and socio-cultural restrictions resulting in adolescent girls remaining ignorant of the scientific facts and hygienic health practices, which sometimes result into adverse health outcomes. Menstruation is a major part of life for millions of young girls and women worldwide. Adolescent girls constitute a vulnerable group, particularly in India where female child is neglected one. Menstruation is still regarded as something unclean or dirty in Indian society. The reaction to menstruation depends upon awareness and knowledge about the subject.

Hygiene-related practices of women during menstruation are of considerable importance, as it has a health impact in terms of increased vulnerability to reproductive tract infections (RTI). The interplay of socio-economic status, menstrual hygiene practices and RTI are noticeable. Today millions of women are sufferers of RTI and its complications and often the infection is transmitted to the offspring of the pregnant mother. Women having better knowledge regarding menstrual hygiene and safe practices are less vulnerable to RTI and its consequences.

According to WHO, almost 5% of the global population i.e. 1.5 million are younger than 15 years, who are visually impaired. The visually impaired needs assistance in their day to day activities of living. Menstrual hygiene practices are a turning point among visually impaired adolescent girls. They need assistance in identification; placing menses material, washing menses clothing and disposal of used menstrual material. Therefore, increased knowledge about menstruation right from childhood may escalate safe practices and may help in mitigating the suffering of millions of women.

PROBLEM STATEMENT:

A study to assess the effectiveness of planned health teaching on knowledge and self reported practices of menstrual hygiene among visually impaired adolescent girls in selected blind schools of Pune city.

OBJECTIVES:

1. To assess the knowledge and self-reported practices of visually impaired adolescent girls regarding menstrual hygiene.

2. To find out the effectiveness of planned health teaching on knowledge and self-reported practices of visually impaired adolescent girls regarding menstrual hygiene.

3. To correlate the findings with selected demographic variables.

MATERIALS AND METHODS:

One group pre and post test design was used. The study was conducted in selected blind schools. The reason for selecting these schools was convenience, easy transport, administrative support, cooperation and availability of subjects. The investigator preferred non probability convenient sampling technique as it best serves the purpose by enhancing representativeness. Sample size was 30 visually impaired adolescent girls in the age group of 13- 19 yrs. The selection of subjects depended upon the inclusion criteria. The girls who did not attain menarche were excluded.

Tools and Techniques:

The tool for data collection consists of semi structured questionnaire to assess the knowledge regarding menstrual hygiene and check list for self-reported practices.

Description of the intervention:

Pre test had been conducted by using the semi structured questionnaire to assess knowledge and checklist for self-reported practices regarding menstrual hygiene. Visually impaired adolescent girls were accompanied by nursing students. Each question was read to them. Completed questionnaire were collected back. Following pre-test, planned health teaching had been administered by the investigator on the same day. Post test had been conducted on 5^th day of planned health teaching by administering the same questionnaire and checklist.

Ethical considerations:

· The proposal of the study was sanctioned by Institutional Ethical Committee.

· Permission was obtained from concerned authority of the selected schools in advance.

· Informed written consent was taken from the subjects and guardian.

· Confidentiality of the records was maintained by utilizing code numbers instead of name of the subjects. The raw data was also kept confidential.

Statistical methods:

Data was analyzed with the help of descriptive and inferential statistics. The analysis was based on objectives and the hypothesis to be tested. In section I, the data related to the existing level of knowledge were analyzed in terms of descriptive statistics. In section II of the study, data from pre-test and post-test scores were analyzed to test the significance of the difference between the pre-test and post-test mean scores. Mann-Whitney test for association was used to find out the significant difference between pre-test knowledge and self reported practices with selected demographic variables.

RESULTS:

Section I: Distribution of sample in relation to demographic data & socioeconomic profile:

Out of 30 subjects, majority of 27 (90%) subjects in the age group of 13-15 years and 3 (10%) subjects in the age group of 16-19 years. All of them belong to Hindu religion (100%). Most of the visually impaired adolescent girls i.e. 29 (96.67%) are staying in the hostel and 1 (3.33%) is dayscholar. In the education of mother, 4 (13.33%) mothers are illiterate, 10 (33.33%) mothers are educated up to primary level, majority 13 (43.34%) of girl's mother had secondary education, 3 (10%) mothers are graduated. Majority of 28 (98.33%) mothers were housewives, and 2 (6.67%) are working in private sector. The majority of fathers 13 and 10 were educated up to secondary and primary respectively. 7 were illiterate. The majority of fathers, i.e. 17 worked in the private sector, 3 were government employees, 2 were businessmen, 4 were farmers and 4 were unemployed. Most of the visually impaired adolescent girls received the information regarding menstruation from their teachers as 19 (63.34%), parents 10 (33.33%), and friends only 1(3.33%).

Majority 66.67% of the visually impaired adolescent girls attained menarche at the age of 10-12 years, 33.33% at the age of 13-15 years. The reaction to first menstruation includes as happy 6.67%, scared 63.33%, discomfort 23.33%, anxiety 6.67%. Most of the girls 53.33% had sleeplessness, 36.67% had abdominal pain, 6.67% had back pain and 3.33% had heavy bleeding. More than half of the girls face menstrual problems regularly as abdominal pain 63.34%, weakness 30% & also vomiting and back pain 3.33% each.

Section II: Effectiveness of planned health teaching on knowledge regarding menstrual hygiene

In pre test, 93.34% visually impaired adolescent girls had average knowledge regarding menstrual hygiene, 3.33% had good as well as poor knowledge each. In post test, all visually impaired adolescent girls were (100%) having good knowledge. In relation to self reported practices, the majority 29 (96.67%) of the visually impaired adolescent girls was showing good self reported practices whereas 1 shown poor self reported practices regarding menstrual hygiene. There was highly significant difference between pre and post test knowledge score. The planned health teaching was highly effective in improving the knowledge regarding menstrual hygiene among visually impaired adoleacent girls.

Table 1: Assess the pre and post test knowledge score of visually impaired girls regarding menstrual hygiene in study group

Knowledge score	Pre test (%)	Post test (%)
0 – 5 (Poor)	1 (3.33)	0
6 – 10 (Average)	28 (93.34)	0
11 – 15 (Good)	1 (3.33)	30 (100)
Total	30 (100)	30 (100)

Table 2: Assess the self-reported practices score of visually impaired girls regarding menstrual hygiene in study group

Self reported practices score	No of cases	Percentage
1-6 (Poor)	0	0
7 – 12 (Average)	1	3.33
13 – 18 (Good)	29	96.67
Total	30	100

Graph 1: Bar diagram showing that pre and post test knowledge score wise distribution of subjects

Graph 2: Bar diagram showing that self reported practices wise distribution of subjects in study group

Section III: Comparison of findings with selected demographic variable

There was highly significant difference seen in the self reported practices according to mother’s education in the study group as the P value was <0.05

Table 3: Self-reported practices score according to mother’s education in study group

Mother’s education		Self-reported practices score		F Value	P Value
Mother’s education	n	Mean	SD	F Value	P Value
Illiterate	4	15.25	2.986	5.20	0.006
Primary	10	17.50	.707
Secondary	13	16.85	.987
Graduate	3	14.67	1.155

DISCUSSION:

Krishna Kumari Samantaray et al. (2017) concluded the study that Audio Drama was effective in increasing the knowledge level of Visually Impaired Adolescent Girls. The study included a total of 70 visually challenged women who were selected by purposive sampling method. Majority of visually challenged women 33 (47%) were in the age group of 16 – 18 yrs, 44 (63%) visually challenged women were in the Hindu religion, 36 (51.3%) were in school going girls, 46 (66%) were residing in the rural locality. 38 (54%) were in partially blind women. The result of the study shows that the knowledge of visually challenged women in menstrual hygiene was significantly improved after audio teaching program. Similarly, in this study planned health teaching was very effective in imparting the knowledge of visually impaired adolescent girls regarding menstrual hygiene.

Anna Maria van Eijk, M Sivakami et al. (2015) conducted study on menstrual hygiene management among adolescent girls in India, a systematic review and meta analysis. Data from 138 studies involving 193 subpopulation and 97070 girls were extracted in 88 studies, half of the girls reported being informed prior to menarche, menstruating girls experienced many restrictions, especially for religious activities. Half of the girls' homes had a toilet. The quality of studies imposed limitation on analysis the interpretation of results. In this study, since the subjects were staying in the hostel of the school premises, no religious customs or restrictions hindered adequate self reported positive practices. The hostel had adequate lavatory facilities and also mother's education had a significant difference in positive self reported practices regarding menstrual hygiene.

CONCLUSION:

The strengthening of menstrual hygiene management program in India is needed. Education on awareness, assess to hygienic observant & dispose of menstrual hygiene management items needed to address. The present study concluded that planned health teaching was highly effective in improving the knowledge of visually impaired adolescent girls regarding menstrual hygiene.

REFERENCES:

1. Puneet Misra, Ravi Prakash Upadhyay, Vinita Sharma et al. A community-based study of menstrual hygiene practices. The National Medical Journal of India. 2013; Nov-Dec; 26(6): 335-7.

2. Baishakhi Paria, Agnihotri Bhattacharyya, and Sukes Das. A comparative study on menstrual hygiene among urban and rural adolescent girls. Journal of Family Medicine and Primary Care. 2014; Oct-Dec; 3(4): 413–417.

3. Krishna Kumari Samantaray et al. Effect of audio drama on knowledge regarding personal hygiene practices among visually impaired adolescent girls. Available from: https://www.journalcra.com/sites/default/files/issue-pdf/27726.pdf, 2017; Vol 9, issue 12.

4. Ruchi Juyal et al. Practices of menstrual hygiene among adolescent girls. Available from: http://www.iapsmupuk.org/ journal/index.php/IJCH/article/view/235, 2012; Vol 24 issue 2.

5. Anna Maria van Eijk, M Sivakami et al. Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis. BMJ Open. 2015 ;Vol 6, issue 3.

Received on 06.11.2019 Modified on 18.11.2019

Int. J. of Advances in Nur. Management. 2020; 8(1):53-56.

DOI: 10.5958/2454-2652.2020.00013.X