Knowledge and practice of menstrual hygiene among adolescent school girls in Umunna, Imo State, Southeast Nigeria: implications for parents, healthcare providers and policy makers


  • Chika O. Duru Department of Paediatrics and Child health, Niger Delta University Teaching Hospital, Okolobiri Bayelsa State, Nigeria
  • Eugene M. Ikeanyi Department of Obstetrics and Gynaecology, Niger Delta University Teaching Hospital, Okolobiri Bayelsa State, Nigeria
  • Irene Merenu Department of Community Medicine, Imo State University Teaching Hospital Orlu, Imo State, Nigeria



Adolescent, Menarche, Menstruation, Menstrual hygiene management, School girls


Background: Menstrual hygiene management is critical in the life of the woman. For optimal attendance and participation in school activities, future reproductive and sexual health; quality menstrual hygiene practice is crucial. The objective of this study was designed to assess the knowledge, practice and challenges of menstrual hygiene management among the adolescents

Methods: A cross-sectional study was conducted on a community secondary school girls from 1st May to 30th June 2016.  Data was collected with a semi-structured pre-tested questionnaire and analyzed with statistical software as appropriate.

Results: A total of 416 (97.4%) of the respondents were analyzed. Their mean chronological age and age at menarche were 15±2.1 years and 12.9±0.7 years respectively. Most (77.9%) of the respondents had premenarchal menstrual hygiene knowledge and mothers (68.8%) were the main source of information. Sanitary pad (56.3%) and cloth (31.2%) were the most commonly used absorbents.  Sanitary pad use was higher in respondents whose mothers had higher level education (RR=6.3, p<0.001). Most of the respondents changed absorbent twice or less daily (77.4%), bathed at least twice (77.4%), washed vulvoperineal region with soap and water (50.2%) and wiped perineum front to back (72.8%).  Burning (51.9%) and refuse dump (26.0%) were the main disposal methods and 48.1% washed hands before and after changing menstrual absorbent materials. Main menstrual disturbances were abdominal pain (37.7%) and malaise (18.5%) and main intervention was medication from patent medicine store (47.2%). Menstruation-related school absenteeism was 30.8%.

Conclusions: There was poor premenarchal menstrual awareness and inappropriate menstrual hygiene practices among adolescent schoolgirls.


WHO, UNICEF, JMP. Consultation on Draft Long List of Goal, Target and Indicator Options for Future Global Monitoring of Water, Sanitation and Hygiene 2012. Available from:

Wilbur J, Torondel B, Hameed S, Mahon T, Kuper H. Systematic review of menstrual hygiene management requirements, its barriers and strategies for disabled people. PLoS ONE. 2019;14(2):e0210974.

Sahin M. Guest editorial: Tackling the stigma and gender marginalization related to menstruation via WASH in schools programmes. Waterlines. 2015;34(1):3-6.

UNICEF, University E. WASH in Schools Empowers Girls' Education—tools for assessing menstrual hygiene management in schools. 2013.

UN. Sustainable Development Goal 6: Ensure availability and sustainable management of water and sanitation for all 2015. Available from:

Winkler I, Roaf V. Taking the bloody linen out of the closet: menstrual hygiene as a priority for achieving gender equality. Cardozo Journal of Law and Gender 2015.

Naeem K, Klawitter S, Aziz A. Learning, acting, and learning (LAL) research on schools’ menstrual hygiene management (MHM): Pakistan. Waterlines. 2015;34(1):104-12.

McMahon SA, Winch PJ, Caruso BA, Obure AF, Ogutu EA, Ochari IA, et al. 'The girl with her period is the one to hang her head' Reflections on menstrual management among schoolgirls in rural Kenya. BMC international health and human rights. 2011;11(1):7

SHN ZASD. JR. Menstrual hygiene and sanitation practices among adolescent school going girls: a study from a South Indian town. Int J Community Med Public Health (London). 2015;(2):189-94.

Chinyama J, Chipungu J, Rudd C, Mwale M, Verstraete L, Sikamo C, et al Menstrual hygiene management in rural schools of Zambia: a descriptive study of knowledge, experiences and challenges faced by schoolgirls BMC Public Health 2019;19:16.

Eijk AMV, Sivakami M, Thakkar MB, Bauman A, Laserson KF, Coates S, et al. Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis. BMJ. 2016;6(3):e010290.

WHO, UNICEF. Progress on drinking water, sanitation and hygiene: 2017 update and SDG baselines. Geneva: 2017.

Morgan C, Bowling M, Bartram J, Kayser GL. Water, sanitation, and hygiene in schools: status and implications of low coverage in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia. Int J Hyg Environ Health. 2017; 220(6):950-9.

Cochran WG. Sampling techniques 3rd ed New York: John Wiley & Sons; 1977.

Garba I, Rabiu A, Abubakar IS. Menstrual hygiene among adolescent school girls in Kano. Trop J Obstet Gynaecol. 2018; 35:153-7.

Nwankwo TO, Aniebue UU, Aniebue PN. Menstrual disorders in adolescent school girls in Enugu, Nigeria. J Pediatr Adolesc Gynecol. 2010; 23(6):358-63.

Akinwaare MO, Akindele OM, Oluwatosin OA. Menstrual hygiene practices among adolescents in selected secondary schools around the University of Ibadan, Nigeria. Journal of Medicine and Biomedical Research. 2016;15(1):92-101.

Nayak S, Toppo NA, Tomar SP, Kasar PK. Tiwari R. A study on practices regarding menstrual hygiene among adolescent girls of urban areas of Jabalpur District. Int J Med Sci Public Health. 2016;5:2355-7.

Okafor-Terver IS, Chuemchit M. Knowledge, belief and practice of menstrual hygiene management among in-school adolescents in Katsina state, Nigeria. J Health Res. 2017;31(Suppl.2):S179-87.

Aluko OO, Oluya OM, Olaleye OA, Olajuyin AA, Olabintan TF, Oloruntoba-Oju OI Knowledge and menstrual hygiene practices among adolescents in senior secondary schools in Ile-Ife, South Western Nigeria.Journal of Water, Sanitation and Hygiene for Development. 2014;4(2):248.

Ilo CI, Nwimo IO, Onwunaka C. Menstrual Hygiene Practices and Sources of Menstrual Hygiene Information among Adolescent Secondary School Girls in Abakaliki Education Zone of Ebonyi State Journal of Education and Practice. 2016;7(31):88-95.

Adinma ED, Adinma JI. Perceptions and practices on menstruation amongst Nigerian secondary school girls. Afr J Reprod Health. 2008;12:74-83.

Oche MO, Umar AS, Gana GJ, Ango JT. Menstrual health: the unmet needs of adolescent girls in Sokoto Nigeria. Sci Res Essays. 2012;7:410-8.

Rizvi N, Ali TS. Misconceptions and Mismanagement of Menstruation among Adolescents Girls who do not attend School in Pakistan. J Asian Midwives. 2016;3(1):46-62.

Upashe SP, Tekelab T, Mekonnen J. Assessment of knowledge and practice of menstrual hygiene among high school girls in Western Ethiopia BMC Women's Health. 2015;15:84.

Aniebue UU, Aniebue PN, Nwankwo TO. The impact of premenarcheal training on menstrual practices and hygiene of Nigerian school girls. Pan Afr Med J. 2009;2:9.

Femi-Agboola DM, Sekoni OO, Goodman OO. Dysmenorrhea and its effect on school absenteeism and school activities among adolescents in selected secondary schools in Ibadan, Nigeria. Nig Med J. 2017;58: 143-8.

Boosey R, Prestwich G, Deave T. Menstrual hygiene management amongst schoolgirls in the Rukungiri district of Uganda and the impact on their education: a cross-sectional study. Pan Afr Med J. 2014;19:253.

Tegegne TK, Sisay MM. Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia. BMC Public Health. 2014;14:1118.

Grant MJ, Lloyd CB, Mensch BS. Menstruation and school absenteeism: evidence from rural Malawi. Comp Educ Rev. 2013;57:260-84.

Mason L, Nyothach E, Alexander K, Odhiambo FO, Eleveld A, Vulule J et al. ‘We keep it secrets no one should know’—a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya. PLoS One. 2013;8(11):e79132.






Original Research Articles