Adolescence is a period of transition from youth to adulthood with rapid growth and development which involves physical, physiological and behavioural changes. Menstruation is a cyclical shedding of the endometrium under the hormonal influence controlled by the hypothalamic pituitary axis(1). Although menstruation is a natural process, it is linked with several perceptions and practices within the community, which sometimes may result in adverse health outcomes(2). Menstrual hygiene management refers to the practice of keeping menstrual cycle safe and healthy. It is a taboo which often women are uncomfortable discussing(3). Menstruation is considered unclean in India, and teenage girls face many taboos. Some of the myths and taboos regarding menstruation in our country are the women are not allowed to undertake home chores or engage in religious or cultural events during their period. They are not allowed to touch plants, pickles, sometimes not allowed to wash hair in certain parts and are imposed restrictions on diet and daily activities preventing them from seeking help(4,5). Lack of menstrual hygiene is connected with negative effects such as infections of the reproductive and urinary tract, which may lead to future infertility and birth complications(6). Menstrual hygiene is influenced by a family's educational, social, and cultural status. Since the majority of girls in various regions of the country, particularly in rural, urban slums, and tribal areas, are neither prepared for nor aware of menstruation - in terms of knowledge, attitudes, and skills - they experience various challenges and difficulties at home, in schools, and at work. Therefore, up-to-date knowledge about menstruation, beginning in early adolescence, would improve safe practices and relieve the distress of millions of women(6).

Study Design: This is an observational cross sectional descriptive study to assess the knowledge, attitude and awareness regarding menstrual hygiene among adolescent and young girls. Study Period: This study was carried out for a period of one week from 23rd to 31st March 2025 Study Setting: This study was carried out among girl students of an urban based degree college at Nandyal, Andhra Pradesh, India Incision criteria: All the students who were willing to participate in the study were included in the study. Exclusion criteria: All the students who were not willing to participate in the study were excluded in the study. Sample size: Out of 330 girl students in the college, 282 girls participated in the study. Tools of Data collection: Data were collected using a self administered pretested close ended questionnaire. It was circulated among them as a google form. No name was attached to the questionnaire. Filling up of the questionnaire was considered as consent for participating in study. Statistical Analysis: The collected data were first checked for completeness and consistency. Descriptive statistics were computed to measure the level of knowledge and hygienic practice towards menstruation. We used bi- variable and multi variable logistic analysis to identify factors associated with poor maternal hygienic practice of adolescent college girls. All variables with P - value less than 0.25 in bi-variable analysis were entered together into multi-variable analysis to control the confounders. The strength of the association was also measured by odds ratio with corresponding 95 % confidence interval (CI).IBM SPSS 25 th version was used to do statistical analysis and a p- value of less than 0.05 was considered as statistically significant.

A total of 282 students studying in the degree college participated in the study. Among them majority were 18-19 years(49.3 %) and belonged to muslim religion (57.4%). About one third of fathers were educated upto 12 th standard. Though more than one third of the mothers were illeterates (39.4%), more than two thirds of the girls received the source of information about menstruation from their mothers.(67.3%). About 80% students agree that menstruation is a natural phenomenon, but only 45% know that menstruation is not a life long process. Nearly 80 % of the students agree for the need to change the protective cloth absorbent every 6th hrly and nearly 90 % age that the absorbent has to be disposed by wrapping in a paper before putting it in dustbin. About 90 % agree that its good practice the external genitilia every time before changing the absorbent 6 th hrly. There are misconceptions among the families of the students that they need to follow certain restrictions and its bad to discuss about menstrual hygiene and menstrual complaints with others. Still 30-40 % students believe in these taboos. 74% believe that uterus is the source of menstrual blood,81% believe that normal duration of blood flow is 3-7 days but only 60% agree that normal cycle duration is 21-35 day. 66 % are aware of the hormonal changes as a reason behind menstruation. Table 1: Sociodemographic factors of students Socio-Demographic factors Frequency Percentage Age < 18 years 18-19 years 46 139 16.3 49.3 19-20 years 76 27 20-21 years 17 6 > 21 years 4 1.4 Religion Hindu 101 35.8 Muslim 162 57.4 Christian 19 6.7 Others 0 0 Mother’s educational status Illiterate 111 39.4 Upto 7 th class 75 26.6 8 th to 12 th class 59 20.96 Degree and above 37 13.1 Father’s educational status Illiterate 73 26.1 Upto 7 th class 68 24.1 8 th to 12 th class 98 34.7 Degree and above 43 15.4 Source of information about menstruation No knowledge 47 16.7 Mother 189 67.3 Friends 19 6.7 Media 27 9.6 Table 2: Knowledge regarding menstruation and menstrual hygiene practices Knowledge Strongly agree No.(%) Agree No.(%) Neutral No. (%) Disagree No. (%) Strongly disagree No.(%) Knowledge about menstruation is a normal phenomenon 84 (29.7) 158 (56.0) 19 (6.7) 11(3.9) 9 (3.2) Menstruation is a lifelong process 16 (5.7) 92 (32.6) 46 (16.4) 93 (33.1) 35 (12.5) The protective cloth or absorbent needs to be changed every 6 th hourly. 79 (24.8) 162 (57.4 ) 16 (5.6) 15 (5.3) 10 (3.5) The absorbent is to be disposed wrapped in a paper before putting it into dustbin 98 (34.7) 164 (58.1) 10 (3.5) 6 (2.1) 4 (1.4) Washing external genitalia while changing absorbent every 6 th hourly is a good practice. 84 (29.1) 168 (59.5) 17 (6.0) 6 (2.1) 7 (2.4) The person in menses should not touch others, religious books, not to enter kitchen 25 (8.8) 91 (32.2) 46 (16.3) 80 (28.3) 40 (14.1) It is bad to discuss about menstrual hygiene and menstrual complaints with others 11 (3.9) 46 (16.3) 37 (13.1) 128 (45.3) 60(21.2) Table 3: Knowledge regarding menstruation Knowledge Yes No.(%) May be No. (%) No No.(%) Knowledge that source of menstrual blood is from uterus 209 (74.1) 63 (22.3) 10 (3.5) Normal duration of menstrual flow is 3-7 days 230 (81.5) 39 (13.8) 13 (4.6) Normal cycle length is 21-35 days 171(60..6) 76 (26.9) 35 (12.4) Hormonal changes is reason behind menstruation 187 (66.3) 69 (24.4) 26 (9.2) Table 4: Distribution according to menstrual hygiene practices Practice Frequency Percentage How frequently do you change absorbent 6th hrly 185 65.6 Twice daily 64 22.6 Once daily 33 11.7 Do you wash genitalia every time while changing the absorbent Always 212 75.1 Often 23 8.1 Sometimes 39 13.8 Never 8 2.8 Do you wrap the absorbent in a paper before putting it into dustbin Always 240 85.1 Often 9 3.1 Sometimes 20 7.0 Never 11 3.9 Did you ever discuss about menstrual problems and hygiene with your mother/ friend / doctor Yes 233 82.6 May be 29 10.2 No 20 7.0 Are you allowed to enter kitchen / religious places when you are in menses Yes 143 50.7 No 139 49.2 Are you absent from college during menses Yes 157 55.6 No 125 44.3 Reason for absence from school Fear of staining of clothes/smell 17 6.0 Pain/excess bleeding 119 42.1 Improper sanitation at college 26 9.2 Never absen 120 42.5 Overall menstrual hygiene practice Good 240 85.1 Poor 42 14.8 Only 65.6 % of students change napkins every 6 th hrly, 75% wash genitalia before changing absorbent, 85.1% wrap it in a paper before wrapping it into a dustbin.82.6% are comfortable in discussing menstrual problems and hygeine with their mother, friend or doctor.Nearly 50 % of the students still follow the taboos.50 % were absent to college during menses the main reason being fear of staining of clothes and smell.From the practices- 85.1 % follow good menstrual hygiene practices. Table 4: Bivariable and multivariable analysis of factors associated with poor menstrual hygiene among the students (N=282) VARIABLE CATEGORY POOR PRACTICE n( %) COR (95%Cl) AOR (95%Cl) P- value Age group <18 yrs 29 (63 ) 2.4 (1..1 -5.3 ) 1.9 (0.8-4.3) 0.12 ≥ 18 yrs 88 (39.8 ) 1 1 - Religion Muslim 81 (50.0) 1.8 (1.0-3.2) 1.6(0.9-3.0) 0.09 others 36 (36.0) 1 1 - Mother’s Education Illiterate 71 (64.0) 3.5(1.8-6.7) 2.9(1.4-6.1) 0.004 Upto 7 th class 27(36.0) 1.5(0.7-3.1) 1.3(0.6-2.8) 0.22 ≥ 8 th class 19(28.0) 1 1 - Father’s Education Illiterate 58 (62 ) 2.9(1.5-5.6) 2.4(1.1-5.1) 0.02 Upto 7 th class 34 (41) 1.5(0.8-2.8) 1.4(0.7-2.7) 0.24 ≥8 th class 25 (29) 1 1 - Source of information Mother 78(41.3) 1 1 - Friends 12 (63) 2.4(1.0-5.6) 2.0(0.8-4.9) 0.11 Media 8 (30) 0.6(0.2-1.4) 0.7(0.3-1.8) 0.36 In the bivariable analysis, age, religion and parental education were significantly (p<0.25) associated with poor menstrual hygiene and were entered into multivariable logistic regression model. After adjusting for potential confounders, the study found that : Mothers illiteracy and fathers illiteracy remained statistically significant independent predictors of poor menstrual hygiene practice.

The present study assessed the level of knowledge and awareness regarding menstrual hygiene practices among adolescent and young girls. The findings indicate that substantial gaps remain in their scientific understanding and hygienic management of menstruation. This is consistent with findings from previous studies across India and other developing nations, which reported inadequate menstrual literacy due to cultural taboos, and insufficient school-based education (Dasgupta & Sarkar, 2008; Thakre et al., 2011; Kamath et al., 2013)(10,14) Knowledge Regarding Menstruation In the present study, most participants knew that menstruation is a natural process, but only a limited proportion could correctly explain its physiological basis. Similar observations were reported in studies from West Bengal (Dasgupta & Sarkar, 2008) and Maharashtra (Thakre et al., 2011), where fewer than half of the respondents had correct biological knowledge about menstruation. The primary sources of information were mothers (around two-thirds), followed by peers and media. While mothers serve as the first educators, they often lack accurate knowledge themselves, leading to the continuation of myths and misconceptions (9)(Annapoorani et al., 2020). The relatively minor role of teachers and health workers observed in this study highlights the need for integrating structured menstrual health education into school curricula. Awareness and Practices Awareness about the use of sanitary pads has increased compared to earlier studies; however, some girls continue to use old cloths, tissues, or other absorbent materials. This could be attributed to economic barriers, lack of privacy, or unavailability of sanitary products in rural or low-income settings(11) (El-Gilany et al., 2005; Khanna et al., 2005). Poor disposal methods, such as open dumping or flushing, were also observed, which pose environmental and health risks. Comparable patterns were documented by (8) Ali & Rizvi (2010) in Pakistan and by Upashe et al. (2015) in Ethiopia, where affordability and social stigma limited the adoption of hygienic materials. Impact of Knowledge and Socio-demographic Factors Knowledge was strongly associated with maternal education and urban residence. Girls whose mothers were literate demonstrated better menstrual hygiene practices — findings consistent with similar research conducted in Tamil Nadu (17)(Sudeshna & Aparajita, 2012) and Nepal (7)(Adhikari et al., 2007). Parental education, particularly maternal literacy, often translates into improved communication about reproductive health and access to health resources(13) (Jain et al., 2020). This highlights the intergenerational nature of menstrual health education and the need for community-based interventions targeting both adolescents and mothers. Cultural Beliefs and Restrictions Despite improved awareness, a considerable proportion of participants continued to observe restrictions during menstruation, such as avoiding religious activities, food taboos, or social isolation. These practices reflect deep-rooted sociocultural norms prevalent across South Asia(16) (Kumar & Srivastava, 2011). Such restrictions may lead to feelings of shame and embarrassment, thereby reducing help-seeking behavior. Culturally sensitive interventions and peer-education models have proven effective in overcoming these barriers (12)(Garg et al., 2012). Public Health Implications Government initiatives such as the Rashtriya Kishor Swasthya Karyakram (RKSK) and the Menstrual Hygiene Scheme (MHS) should be expanded to ensure equitable access to sanitary materials, education, and counseling services in both rural and urban settings. LIMITATIONS This study was limited to a specific population, which may restrict the generalizability of findings. Data were self-reported, and hence subject to recall and social desirability bias. However, the study contributes valuable insights into menstrual health education needs among young girls and emphasizes the role of family and educational institutions in shaping healthy practices.

Although awareness about menstruation is gradually improving, misconceptions and unhygienic practices persist. Enhancing menstrual health literacy through school-based education, parental involvement, and mass media campaigns is essential to promote menstrual dignity, reduce school absenteeism, and improve the overall reproductive health of adolescent and young girls.

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