Knowledge and Practice of Menstrual Health and Hygiene among Young People in Jos, Plateau State, Nigeria

Background: The periodic shedding of the lining of a woman’s uterus is re-ferred to as Menstruation, or a menstrual period. Over a period of three to five days, the uterine lining breaks down into a bloody substance. It then passes down through the cervix and exits through the vagina. Menstrual health knowledge is regarded as having knowledge of what menstruation is and the need for effective management of health during menstruation and proper menstrual hygiene management. This study seeks to assess the knowledge and practice of menstrual health and hygiene and availability of resources for effective menstrual hygiene management among young people in Jos, Plateau State, Nigeria. Methodology: This was a descriptive cross-sectional study carried out among 169 young males and females of Evangelical Church Winning All (ECWA) Theological Seminary, Jos, North, Plateau State, Nigeria. Simple random sampling technique was used in this study and data was collected using an interviewer-administered structured questionnaire. Data analysis was done using the Statistical Package for the Social Science (SPSS) version 20.0. Findings: Majority of 70 (41.4%) respondents fall within the age range of 20 - 24 years old, 64 (37.9%) were within 25 - 29 years. There were more females (96, 56.8%) than males (73, 43.2%). Twenty (11.8%) were married, 149 tice and the perception of young people to sensitive concepts like menstrual health and hygiene management. Reproductive health programs that reflect this should be taught in schools and communities.


Introduction
Menstruation, or a menstrual period, is the periodic shedding of the lining of a woman's uterus. It is one of the phases of the menstrual cycle. The uterine lining breaks down into a bloody substance. It then passes down through the cervix and exits through the vagina. The process usually lasts from three to five days.
The amount of menstrual blood can vary from period to period and from woman to woman [1]. Menstruation is also known by other names like "menses" or "period". It usually starts at the time of puberty which is typically within the period of adolescence and ends at menopause. Menarche is the onset of menstruation and a stage where knowledge of menstrual health and practice of good menstrual hygiene is important as values and life principles are formed; it is an important physiological and psychological milestone in every woman's life and occurs within the range of ages 10 to 16 years and varies from population to population. Studies suggest that menarche tends to appear earlier as the sanitary, nutritional and economic conditions of a society improve [2] [3].
Young people are the population between ages of 10 and 24 years according to the World Health Organization (WHO) definition and United Nations defines youth as those between the age range of 15 and 24 years [4] while the Nigerian Youth Policy 2009, described youths as those within the ages 18 and 35 years [5].
Personal values and principles are mostly developed and shaped at this stage, the knowledge of menstrual hygiene would affect health and social situation of young people [6]. Knowledge of menstrual hygiene in males will help the males give support to the females during their reproductive cycle rather than making jest of them or stigmatizing them. The knowledge and practice of proper menstrual hygiene management by young adults will also set the pace in achieving overall health of the younger generations. As regards the Sustainable development goals, menstrual hygiene management can be seen to be related to goals 3-Good Health and well-being, Goal 4-quality education, Goal 5-gender equality and Goal 8decent work and economic growth.
Menstrual hygiene has become a problem in most communities since it is not something talked about frequently. This culture of silence and many misconceptions and taboos surrounding menstruation together with lack of sexuality education in most schools has made access to information regarding menstruation and menstrual hygiene limited and, in some cases, non-existent.  [7]. Knowledge of the menstrual cycle and awareness of the likely symptoms associated with it will help a woman be prepared for these periods and the people around her will understand that she is experiencing such changes and so not tag her as being hysterical or sick [8] [9] [10]. Women also will not need to hide under the cover of being sick whenever they are menstruating. Also, the occurrence of reproductive tract infections will decrease as this can affect the health of women greatly. Reproductive Tract Infections are common with improper usage of menstrual management materials [11].
Studies among young people have shown that majority 88.7% had good practice of menstrual hygiene and older age groups had more knowledge than the younger age group [3]. The hygiene related practices of girls and women during menstruation are of considerable importance, as they affect their health by increasing risk of infections especially infections of urinary tract and perineum.  [14]. It was evident that such practice was protective against infection.
Clearly, lower socio-economic status, rural residence, and lack of access to information about and money to buy sanitary products for menstrual hygiene are all related factors that affect the practice of good menstrual hygiene [15] [16] [17]. The problem of lack of privacy may be attributed to overcrowding and poor infrastructures of bathrooms and toilets, especially in the rural settings.
Toilets may be few with broken doors or defective water supply and sewage. of the girls remained absent from school during their menstruation. This was significantly associated with the type of absorbent used, and lack of privacy at school [15].
The use of toilet roll is not an effective absorbent as this will require frequent change, washing of clothes as it may result to staining of clothes and water and soap might not be readily made available for cleaning. Using of clothes is also not a good absorbent, it can result in staining, bad odor if not properly managed and cleaned with adequate soap and water and it will require use of many clothing materials which at the end is also not cost effective [9] [14].
Parents' educational level was significantly correlated with the menstrual practices [17]. This implies that those from families where parents are educated tend to have better information on menstrual health and hygiene and so their attitude towards menstrual health and hygiene is better because they are informed about the dangers of not practicing good hygiene during menstruation [17]. Those who did not have a prior knowledge of menstrual health and hygiene, practiced use of unhygienic menstrual absorbents like tissue paper, while those who had prior knowledge of menstrual health and hygiene used absorbable sanitary pads.
The lack of timely information results in poor knowledge concerning menstrual health and poor menstrual hygiene practices [17]. Factors associated with poor menstrual hygiene practice were age, non-discussions, lack of sanitary pads, lack of latrine privacy, lack of adequate water supply, and teasing by boys. Awareness regarding the need for information about healthy menstrual practices is important not only for the women and girls, but men and boys also need to know the importance of this as colleagues, husbands, brothers, leaders, teachers and classmates to them [14] [17].
Changing pads during nighttime and at school or college is important. Change of napkins/pads at an interval of 3 -4 hours is considered as a healthy behavior for comfort and to prevent odor, regardless of the extent of staining. Frequent changing of used absorbents will not be effectively practiced if there are no private toilets available, and supply of adequate water supply, and also if the girls and women lack the funds to purchase sufficient number of absorbents that will last through out their menstruation. Socioeconomic status of the se- attained menarche [18]. Girls also skipped school due to fear of personal embarrassment and teasing from others, especially the boys. School girls were unable to practice adequate menstrual hygiene due to lack of preparedness for menarche, access to absorbent materials, water, soap, and privacy while at school [19] [20]. This study therefore is to establish the knowledge and practice of menstrual health and hygiene and availability of resources for effective menstrual hygiene management among young people in Jos, Plateau State.

Methodology
This was a descriptive cross-sectional study carried out among young males and Simple random sampling technique was used in this study, with the list of all students as the sampling frame. Data was collected using interviewer-administered structured questionnaire. To protect the privacy of the respondents, the questionnaire did not contain personal information of the respondents like names and area of residence. Data collection for each respondent was also done in privacy to ensure confidentiality. Furthermore, to ensure confidentiality, data collected from respondents were kept and stored in privacy, away from public access. The questionnaire was pretested among 10 young people (5 males and 5 females) in Bingham University Teaching Hospital prior to data collection to check for the duration of time it took to interview a person and to check for corrections such as questions not understood, and this was relevant in making corrections after which the questionnaires were then reviewed. The study protocol was submitted to Bingham University Teaching Hospital Ethics Committee before commencement of the study and approval was granted.
Permission to carry out the study was also taken from the administrator of ECWA Theological Centre. Informed consent was taken from each participant before commencement. Each respondent was informed that there was no punishment for not participating. Health education was given to each respondent at the end of the session.                Almost all (94.6%) of respondents know menstruation to be a normal female reproductive phenomenon which is similar to a study done in Bangalore, Kanartaka, India [23]. This knowledge of the fact that menstruation is a normal reproductive process shapes the thoughts and actions of these young people toward accepting and implementing the needed steps towards Menstrual Hygiene Management (MHM). 1.2% of the respondents stated that menstruation is a curse from God. Majority (91.1%) stated that special hygiene is needed during menstruation. These assertions indicated good knowledge. Strangely, this contrasts with a study done [24] in 2009 where 98% of the girls believed that there should be no regular baths during the menstrual cycle due to cultural practices passed down [24]. This disparity may be due to the deep belief in cultural prac- used sanitary pads, only 11.3% disposed it [25]. Poor disposal of sanitary pad causes huge environmental health issues.

Practice of Menstrual Hygiene
Three quarters of respondents do not believe menstruation is a personal mat-Open Journal of Obstetrics and Gynecology ter to be kept to oneself and that sanitary pads should not be bought secretly.
That is, a woman menstruating can be free to talk about it. This is a positive attitude toward menstrual hygiene and health. This is particularly important in cases where some symptoms are experienced during menstruation and the woman needs relief either from activity or through the aid of drugs like analgesics.
Speaking out helps because a woman can clearly state how she feels and is not tagged as one malingering. This finding contrasts with a study done in Turkey where 48.8% of the women felt they had to keep their menstruation as a secret [26]. A third of respondents say menstruation is a personal matter to be kept to  [9]. Eight in ten of the female respondents wash their body after change of used absorbent, while one in five do not wash their body after use and change of absorbent. This is contrary to a study done in India [12]. The result revealed that 56.8% of the study population wash their private part with soap and water after changing a used menstrual absorbent [12]. The most common method of disposal of used menstrual absorbent was use of disposable polythene bags by 50.0% of the female respondents. This is in contrast to a study done in Swaziland [15] where 71.1% of the respondents wrapped their used napkins with toilet paper, while 26.6% wrapped their used napkins with polythene bags [15].
Two-thirds of the female respondents had good practice of menstrual hygiene, while a third of the respondents had the poor practice of menstrual hygiene.

Recommendations
1) Knowledge influences practice and the perception of people to concepts even as sensitive as menstrual health and hygiene. To boost the knowledge of this population especially within the male population, programs need to be set by schools in academic curricula and social media for the education and dissemination of information on proper menstrual health and hygiene. This will lead to increased support for females, especially during this special period. The role of pre-menarche training and teaching of both males and females about menstruation by parents will help boost knowledge in future generations.
2) From the study carried out, 33.3% of the female respondents had poor menstrual hygiene practice. Awareness regarding the need for good menstrual Open Journal of Obstetrics and Gynecology hygiene practice is required. School programs and mass media should emphasize the importance of good menstrual hygiene practice.

3) Government, Policy makers and leaders at the various tiers of Government
should also set up a structure where menstrual products can be made available and affordable to females, through measures like removing import duties and value added tax on absorbent materials.
They can also support proper and effective practice of menstrual hygiene through strategies like free sanitary pads in schools. An example of support is that which is being implemented recently in Kenya as Government has said all Kenyan schoolgirls are to be provided with free sanitary pads.
There is a need for parents and schools to encourage and strengthen menstrual hygiene management MHM) in reproductive health education to empower girls through detailed menstrual hygiene management information in school.
This can be done through sexual reproductive and health education curriculum so that girls, boys and teachers are equally informed about menstrual hygiene management and can support girls and women to effectively practice good menstrual hygiene [19] [20].