Assessment of Knowledge, Attitude, and Practice Regarding Menstruation and Menstrual Hygiene among School Going Girls in Rural Areas of Lahore, Punjab
DOI:
https://doi.org/10.61919/0pp2kf55Keywords:
menstruation; menstrual hygiene management; adolescent girls; school health; WASH; rural Pakistan; Lahore; dysmenorrheaAbstract
Background: Menstrual hygiene management (MHM) is fundamental to adolescent health and school participation, yet in rural settings it is frequently constrained by incomplete knowledge, sociocultural stigma, and suboptimal school WASH resources. Objective: To assess knowledge, attitudes, and practices regarding menstruation and MHM among school-going girls in rural areas of Lahore, Punjab, Pakistan. Methods: A descriptive cross-sectional observational survey was conducted among 385 school-going adolescent girls aged 10–19 years in rural Lahore. Participants completed a structured, close-ended questionnaire adapted for context, assessing socio-demographics, menstrual knowledge, attitudes (Likert-scale), hygiene practices, disposal behaviours, school-based pad changing, dysmenorrhea, and reported access to washing soap at school. Data were analyzed using descriptive statistics (frequencies, percentages). Results: Knowledge was mixed: 44.2% (n=170) identified menstruation as a normal physiological process, 36.6% (n=141) attributed it to hormones, and 41.8% (n=161) did not know the cause; 22.6% (n=87) incorrectly reported the bladder as the origin of menstrual blood. Only 23.6% (n=91) were aware of menstruation at menarche, and mothers were the predominant information source (84.2%, n=324). Attitudes largely supported hygienic practices (e.g., 88.6% agreed that handwashing after genital cleaning prevents reproductive tract infections). Practices were comparatively favourable: 68.6% (n=264) used sanitary pads, 44.2% (n=170) changed absorbents ≥3 times/day, and 93.8% (n=361) reported genital cleansing; however, only 14.8% (n=57) changed pads at school. Soap access at school was reported by 63.4% (n=244). Dysmenorrhea was common (83.1%, n=320). Conclusion: Rural schoolgirls in Lahore reported generally positive menstrual hygiene practices and supportive attitudes, but substantial knowledge gaps and low preparedness at menarche persist alongside incomplete school enabling conditions, underscoring the need for school-based MHM education integrated with reliable WASH and disposal supports.
References
1. Hennegan J,Sol L. Confidence to manage menstruation at home and at school: findings from a cross-sectional survey of schoolgirls in rural Bangladesh. Culture, health & sexuality. 2020;22(2):146-65.
2. Hunter EC-Murray SM-Sultana F-Alam M-U-Sarker S-Rahman M, et al. Development and validation of the Self-Efficacy in Addressing Menstrual Needs Scale (SAMNS-26) in Bangladeshi schools: A measure of girls’ menstrual care confidence. PloS one. 2022;17(10):e0275736.
3. Marques P-Madeira T,Gama A. Menstrual cycle among adolescents: girls’ awareness and influence of age at menarche and overweight. Revista Paulista de Pediatria. 2022;40:e2020494.
4. Dasgupta A,Sarkar M. Menstrual hygiene: how hygienic is the adolescent girl? Indian journal of community medicine. 2008;33(2):77-80.
5. Sharma N-Sharma P-Sharma N-Wavare R-Gautam B,Sharma M. A cross sectional study of knowledge, attitude and practices of menstrual hygiene among medical students in north India. The Journal of Phytopharmacology. 2013;2(5):28-37.
6. Malhotra A-Goli S-Coates S,Mosquera-Vasquez M. Factors associated with knowledge, attitudes, and hygiene practices during menstruation among adolescent girls in Uttar Pradesh. Waterlines. 2016:277-305.
7. Bachloo T-Kumar R-Goyal A-Singh P-Yadav SS-Bhardwaj A, et al. A study on perception and practice of menstruation among school going adolescent girls in district Ambala Haryana, India. Int J Community Med Public Health. 2016;3(4):931-7.
8. Patavegar BN-Kapilashrami M-Rasheed N,Pathak R. Menstrual hygiene among adolescent school girls: an in-depth cross-sectional study in an urban community. Int J Health Sci Res. 2014;4(11):15-21.
9. Sultan S,Sahu DS. Knowledge, attitude and practices about menstruation and related problems in adolescent girls. Int J Reprod Contracept Obstet Gynecol. 2017;6(12):5235-40.
10. Sommer M-Chandraratna S-Cavill S-Mahon T,Phillips-Howard P. Managing menstruation in the workplace: an overlooked issue in low-and middle-income countries. International journal for equity in health. 2016;15(1):86.
11. Ajaegbu Victoria U-Okwuikpo Margaret I-Famuyigbo Oreoluwa F-Amere LT-Olatade MJ,Titilope MB. Awareness of Menstrual Hygiene and Factors Affecting its Practice Among Adolescent Girls in two Selected Senior Secondary Schools in Ogun State, Nigeria. Midwifery. 2021;4(2):76-87.
12. Wilson E-Haver J-Torondel B-Rubli J,Caruso BA. Dismantling menstrual taboos to overcome gender inequality. The Lancet Child & Adolescent Health. 2018;2(8):e17.
13. Balqis M-Arya IFD,Ritonga MNA. Knowledge, attitude and practice of menstrual hygiene among high schools students in Jatinangor. Althea Medical Journal. 2016;3(2):230-8.
14. Hennegan J-Shannon AK-Rubli J-Schwab KJ,Melendez-Torres GJ. Women’s and girls’ experiences of menstruation in low-and middle-income countries: A systematic review and qualitative metasynthesis. PLoS medicine. 2019;16(5):e1002803.
15. Tuli AG-Dhar T,Garg N. Menstrual Hygiene--Knowledge and Practice among Adolescent School Girls in Rural Areas of Punjab. Journal of Evolution of Medical and Dental Sciences. 2017;6(83):5793-7.
16. Wagh RV-Upadhye AJ,Upadhye JJ. Menstrual hygiene practices in young girls of urban India. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2018;7(5):1897-902.
17. Javed S-Sheraz A-Khan M-Syed R,Tanweer B. Reproductive health of youth: perceptions, attitudes and practices. NIPS Islamabad. 2003.
18. Yagnik AS. Knowledge (K), attitude (a), and practice (P) of women and men about menstruation and menstrual practices in Ahmedabad, India: implications for health communication campaigns and interventions: Bowling Green State University; 2015.
19. Usman G-Abbas K-Arshad R-Muneer A-Syed HS-Iqbal A, et al. Knowledge and practice of menstrual hygiene management among women living in a low-income neighbourhood, Karachi, Pakistan. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2020;9(10):3954.
20. Shah SF-Punjani NS-Rizvi SN-Sheikh SS,Jan R. Knowledge, attitudes, and practices regarding menstrual hygiene among girls in Ghizer, Gilgit, Pakistan. International Journal of Environmental Research and Public Health. 2023;20(14):6424.
21. Fehintola FO-Fehintola AO-Aremu AO-Idowu A-Ogunlaja OA,Ogunlaja IP. Assessment of knowledge, attitude and practice about menstruation and menstrual hygiene among secondary high school girls in Ogbomoso, Oyo state, Nigeria. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017;6(5):1726-32.
22. Parle J,Khatoon Z. Knowledge, attitude, practice and perception about menstruation and menstrual hygiene among adolescent school girls in rural areas of Raigad district. Int J Community Med Public Health. 2019;6(6):2490-7.
23. Yadav RN-Joshi S-Poudel R,Pandeya P. Knowledge, attitude, and practice on menstrual hygiene management among school adolescents. Journal of Nepal Health Research Council. 2017;15(3):212-6.
24. Mohammed Gena H. Menstrual hygiene management practices and associated factors among secondary school girls in East Hararghe Zone, Eastern Ethiopia. Advances in Public Health. 2020;2020(1):8938615.
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Copyright (c) 2026 Abu Talha, Nazia Ahmad, Talha Abdullah, Amina Bibi, Maryam Anwar (Author)
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