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African Journal of Reproductive Health Sept. 2010 (Regular Issue); 14(3): 201
ORIGINAL RESEARCH ARTICLE
Menstruation and Menstrual Hygiene amongst Adolescent
School Girls in Kano, Northwestern Nigeria
Lawan UM1*, Nafisa Wali Yusuf2, Aisha Bala Musa3
1Department of Community Medicine, Bayero University Kano (B.U.K) & Aminu Kano Teaching Hospital (AKTH), Kano
State; 2Department of Physiology, Bayero University, Kano (B.U.K), Kano State; 3Department of Obstetrics and
Gynaecology, Aminu Kano Teaching Hospital (A.K.T.H), Kano State
*For Correspondence: Muhammad Lawan Umar. E-mail: drlawanumarus@yahoo.com.
Abstract
This study examined the knowledge and practices of adolescent school girls in Kano, Nigeria around menstruation and
menstrual hygiene. Data was collected quantitatively and analyzed using Epi info version 3.2.05. The mean age of the
students was 14.4 ± 1.2 years; majority was in their mid adolescence. The students attained menarche at 12.9 ± 0.8
years. Majority had fair knowledge of menstruation, although deficient in specific knowledge areas. Most of them used
sanitary pads as absorbent during their last menses; changed menstrual dressings about 1-5 times per day; and three-
quarter increased the frequency of bathing. Institutionalizing sexuality education in Nigerian schools; developing and
disseminating sensitive adolescent reproductive health massages targeted at both parents and their adolescent children;
and improving access of the adolescents to youth friendly services are veritable means of meeting the adolescent
reproductive health needs in Nigeria (Afr. J. Reprod. Health 2010; 14[3]: 201-207).
Résumé
Mensuration et l’hygiène menstruelle chez les étudiantes adolescentes à Kano, au nord du Nigéria. Cette étude a
examiné la connaissance et les pratiques des étudiantes adolescentes à Kano, au Nigéria à l’égard de la menstruation
et l’hygiène menstruelle. Des données ont été recueillies quantitativement et ont été analysées à l’aide de la version info
Epi 3, 2,05. L’âge moyen des étudiantes était 14±1,2 ans. La majorité étaient dans la mi-adolescence. Les étudiantes
ont subi la première apparition des règles à l’âge de 12,9±0,8 ans. La majorité avaient une connaissance considérable
de la menstruation, quoique insuffisante, dans les domaines des connaissances spécifiques. La plupart des étudiantes
se servaient des serviettes hygiéniques comme des absorbants pendant leurs dernières menstruations; elles
changeaient les pansement menstruels à peu près 1-5 fois par jour; et trois quarts ont augmenté la fréquence des
besoins. L’institutionnalisation de l’éducation sexuelles dans les écoles nigérianes, le développement et la diffusion des
messages sensibles de santé de la reproduction chez les adolescentes qui visent à la fois les parents et leurs enfants
adolescentes et l’amélioration de l’accès aux services qui favorisent les jeunes gens par les adolescentes sont de vrais
moyens pour satisfaire les besoins de santé de la reproduction chez les adolescents au Nigéria (Afr. J. Reprod. Health
2010; 14[3]:201-207).
Key words: Menstruation; menstrual hygiene; adolescents; school girls.
Introduction
Adolescents are a large and growing segment of the
world’s population. More than half of the world’s po-
pulation is below the age of 25, and one in every
two young people in the world is adolescent1. Du-
ring adolescence, young people develop their adult
identity, move toward physical and psychological
maturity. Physiologically, the hypothalamus produ-
ces growth hormone and gonadotropins which initia-
tes pubertal changes2. Menstruation, the periodic
vaginal bleeding that occurs with the shedding of
the uterine mucosa is one of the signs of puberty,
and occurs one or two years following appearance
of secondary sexual characteristics3. Once establi-
shed, every mature female menstruates on the ave-
rage 3-5 days (minimum 2 days, maximum 7 days)
each month until menopause4. A woman’s period
may not be the same every month and it may not be
the same as that of other women. Periods can be
light, moderate or heavy and the length of the period
also varies5. If poorly managed, menstrual period
may be accompanied by discomfort, reproductive
tract infection, smelling and embarrassment among
others6.
Menstrual hygiene deals with the special health
care needs and requirements of women during
monthly menstruation or menstrual cycle7. These
African Journal of Reproductive Health Sept. 2010 (Regular Issue); 14(3): 202
areas of special concern include choice of the best
“period protection” or feminine hygiene products;
how often and when to change the feminine hygiene
products; bathing care of the vulva and vagina as
well as the supposed benefits of vaginal douching at
the end of each menstrual period7. Provisions for
good menstrual hygiene include home-made reme-
dies like pieces of cotton cloth which are either
placed on a woman’s undergarment or on a home-
made belt that wraps around the waist. These cloths
can be washed, dried and used again7,8. Available
commercial products for women’s hygiene during
menstruation include pads, tampons and cups8.
Although adolescence is a healthy period of life,
many adolescents are often less informed, less ex-
perienced, and less comfortable accessing repro-
ductive health information and services than adults1.
In many parts of the developing countries, a culture
of silence surrounds the topic of menstruation and
related issues9,10; as a result many young girls lack
appropriate and sufficient information regarding
menstrual hygiene. This may result in incorrect and
unhealthy behaviour during their menstrual period.
Also, many mothers lack correct information and
skills to communicate about menstrual hygiene
which they pass on to their children, leading to false
attitudes, beliefs and practices in this regard1. Re-
cent discuss on the introduction of sexuality educa-
tion into secondary schools in Nigeria generated a
lot of tension amongst parents and religious scho-
lars particularly in northern parts of the country.
Learning about hygiene during menstruation is
a vital aspect of health education for adolescent
girls as patterns that are developed in adolescence
are likely to persist into adult life. It was against this
background that this study was planned to evaluate
adolescent secondary school girls’ knowledge of
menstruation and menstrual hygiene, as well as
their practices of menstrual hygiene. It was envisa-
ged that findings from the study will be a pointer to
some adolescence reproductive health needs in
northern Nigeria, and will also provide foundation for
policy makers and programme managers to make
rational decision on improving adolescence repro-
ductive health in Nigeria.
Methodology
A cross-sectional design was used to study a sam-
ple of 400 adolescent female secondary school stu-
dents (10-19 years old) estimated using an appro-
priate sample size formula for descriptive studies11.
The field work was conducted in October and No-
vember 2009. The students were selected using the
multistage sampling technique: A list of all secon-
dary schools within the eight metropolitan LGAs of
Kano State was compiled and was stratified into
mixed public school; mixed private school; girls’ only
public schools and girls’ only private schools; and a
school was randomly chosen from each of the four
categories using simple random sampling. This re-
sulted in the selection of Samadi International Sch-
ool (Mixed private); Maryam Abatcha Girls’ Secon-
dary School (Girls’ only public); Maitama Sule Girls’
Academy (Girls’ only public) and Federal Govern-
ment College (FGC) Kano (Mixed public). Systema-
tic sampling method was used at the next stage to
select 100 eligible students from each of the selec-
ted schools. This was achieved using a sampling
interval (S.I) of 3, 9, 2 and 5 for Samadi, Maryam
Abatcha, Maitama Sule and FGC respectively. The
sampling intervals were obtained by dividing the
number of eligible students in each school by the
required sample (100). This was used for the res-
pective schools to recruit subjects until the required
sample was completed. Permission and ethical
clearance for the study were obtained from Ministry
of Education Kano State and the Institutional Re-
view Board of Aminu Kano Teaching Hospital res-
pectively; and informed consent was sought and
obtained from the students before the interviews.
Data on the students’ knowledge of menstruation
and menstrual hygiene and their practices of men-
strual hygiene was collected using pretested self
administered questionnaires. Generated data were
entered into the computer system and analyzed
using Epi-info 3.2.05 computer statistical software.
Quantitative data were summarized using mean and
standard deviation, whereas qualitative data were
summarized using percentages and frequencies.
The students’ knowledge and practices were
scored using a scoring system adopted from a past
study12. Each correct response under knowledge
attracted one point, whereas any wrong or don’t
know answer attracted no mark. In scoring the stud-
ents’ practices of menstrual hygiene however, stud-
ents that used sanitary pad during their last mens-
truation (adjudged best product for adolescents)
were scored two (2) points whereas those that used
any other sanitary method were scored one (1)
point. Correct responses for the other questions un-
der practice attracted one (1) point each and the
wrong answers attracted no mark. This gave a total
score of six (6) points for practice and 15 points for
knowledge. Respondents that scored 0-4 points un-
der knowledge were adjudged as having poor know-
ledge; whereas those that scored 5-8 and 9-12 were
adjudged as having fair and good knowledge res-
pectively. Similarly those students that scored 4-6
points and 0-3 points under practice were adjudged
as having good and poor practices respectively.
Results
All the 400 school girls that were approached to
participate in the study responded positively giving a
response rate of 100%.
African Journal of Reproductive Health Sept. 2010 (Regular Issue); 14(3): 203
Table 1. Socio-demographic characteristics of
respondents.
Characteristics
Frequency (n =
400)
Percent
(%)
Age group
10 – 13
14 – 15
17 – 19
Ethnicity
Hausa
Fulani
Yoruba
Igbo
Others
Religion
Islam
Christianity
Marital status
Married
Single
78
262
60
293
86
10
2
9
392
8
8
392
19.5
65.5
15.0
73.2
21.5
2.5
0.5
2.3
98.0
2.0
2.0
98.0
* Others include Kanuri; Idoma; Igbira.
Fig 1: Respondents' first source of information
on menstruation and menstrual hygiene
35.3
20.0
21.5
14.3
9.0
0.0 10.0 20.0 30.0 40.0
Parents
Friends
Sisters
Teachers/matrons
Others
Source
%
Figure 1. Respondents’ first source of information on
menstruation and menstrual hygience. *Others = elec-
tronic media; books.
Respondents’ personal data
Respondents’ personal data are summarized in
Table 1. Their mean age was 14.4 ± 1.2 years. The
majority (65.5%) were in their mid adolescence.
Three hundred and seventy one (92.7%) students
had attained menarche. The students attained me-
narche between 11 to 15 years of age. Their mean
age at menarche was 12.9 ± 0.8 years. The stud-
ents were mostly of Hausa and Fulani tribes
(94.8%); Muslims (98.0%) and were never married
(98.0%).
Respondents’ knowledge of menstruation and
menstrual hygiene
When the students were asked questions to elicit
their knowledge of menstruation and menstrual hy-
giene, it was observed that most of them (97.0%)
were aware that mature women experience monthly
/cyclical flow of blood (menstruation), and knew that
girls attain menarche around the ages of 11 to 16
years (77.8%). Few (6.5%) of the girls correctly
knew that menstruation is normal when it occurs in
early adolescence; and about half of the subjects
(58.8%) knew that the duration of a normal menses
is 2 to 7 days. Similarly, majority (87.0%) of the
school girls have heard of menstrual cycle, but only
one-third (33.8%) knew that a menstrual cycle ex-
tends from the first day of a period to the beginning
of the next period; and only 2.5% of the subjects
knew correctly that normal menstrual cycles vary
between 21 to 35 days. However, the majority
(94.0%) reported that menstrual cycles last exactly
30 days. Although more than half of the subjects
(56.5%) knew that a woman can conceive when she
mates at a certain period in her menstrual cycle,
none of them knew that the fertile period spans for
about nine (9) days around the middle of the men-
strual cycle. However, most of the respondents
(94.0%) knew that sanitary products are available
for menstrual protection (Table 2). Almost all
(86.5%) the school girls knew correctly that sanitary
pad is the best sanitary absorbent recommended for
adolescents. Also, about half of the students
(57.0%) knew that poor hygiene predisposes to
infection; and that personal hygiene has a place in
the prevention of menstrual pain (57.0%). Table 2
captures the parameters used in assessing the
knowledge of respondents and the proportion of
positive responses. The mean score of the school
girls’ knowledge of menstruation and menstrual hy-
giene was 8.0 ± 2.1, with the majority 350 (87.5%)
having fair knowledge of the subject. Detailed grad-
ing of the respondents’ knowledge of menstruation
and menstrual hygiene is depicted in Table 3. The
respondents’ knowledge was significantly associa-
ted with the age group of the respondents (ᵡ2 =
19.96, p<0.05) but not with the type of school they
attended or their religion as shown in Table 4).
The distribution of respondents by their first
source of information on menstruation and mens-
trual hygiene is also illustrated in Figure 1. The ma-
jority, 136 (35.3%) first heard of menstruation and/or
menstrual hygiene from their parents. Few subjects
however (14.3%) learnt about the topic from the
school teachers and matrons. The remaining had
their first contact with the information through fri-
ends (either in school or at home), sisters; or
through other relatives.
Respondents’ practices regarding menstrual
hygiene
Three hundred and fourty eight (93.8%) of the sch-
ool girls that have commenced menstruation used
African Journal of Reproductive Health Sept. 2010 (Regular Issue); 14(3): 204
Table 2. Parameters used for assessing respondents’ knowledge of menstruation and menstrual hygiene.
Parameter
Positive response
(Frequency)
Percentage
(%)
Aware that mature women experience monthly/ cyclical flow of blood
(menstruation)
Knew correctly that menstruation in early adolescence is normal
Aware of expected age range for starting menstruation
Aware of the duration for a normal period
Have heard of menstrual cycle
Knew correct description of menstrual cycle
Knew duration of a normal menstrual cycle
Knew sanitary products exits for menstrual protection
Awareness of sanitary products used for menstrual protection
Sanitary pad
Reusable cloth
Tampons
Aware of the best sanitary product for adolescent
Aware that poor hygiene predispose to infection
Knew that personal hygiene has a place in prevention of menstrual pain
Aware of age of normal cessation of menstruation
-
388
26
311
235
348
135
10
376
347
13
6
346
228
228
141
-
97.0
6.5
77.8
58.8
87.0
33.8
2.5
94.0
86.8
3.3
1.5
86.5
57.0
57.0
35.3
Table 3. Knowledge and practice grading on
menstruation and menstrual hygiene.
Grading
Frequency
Percentage
(%)
Knowledge (n = 400)
Good (9-12 points)
Fair (5-8 points)
Poor (0-4 points)
Practice (n = 371)
Good (4-6 points)
Bad (0-3)
16
350
34
329
42
4.0
87.5
8.5
88.7
11.3
sanitary pads as absorbent during their last mens-
trual period. The remaining 23 (6.2%) used either
designated pieces of cloth that they washed/ boiled,
dried and re-used; or used any available piece of
cloth that they discarded after use. When the stu-
dents that did not use sanitary pads as absorbent
during their last menses were asked why they opted
for another alternative, 21 (91.3%) claimed it was
expensive and as such they could not afford it while
the remaining 2 (8.7%) claimed that sanitary pad
causes vaginal discharge.
The number of times the students changed any
form of the menstrual protection dressings ranged
from one (1) to five (5) times with a mean of 2.6 ±
0.8. Three hundred and twenty three (87.1%) and
barely more than half (56.5%) of the students chan-
ged the dressings at night and during school hours
respectively. Although 72.5% of the students increa-
sed the number of times they took bath during men-
struation. The parameters used for assessing the
students’ practice of menstrual hygiene are summa-
rized in Table 5. Overall, 329 (88.7%) of the stud-
ents examined had good practice of menstrual
hygiene. The mean practice score of the subjects
was 4.7 ± 1.1. Table 3 also shows the summary of
respondents’ grading on menstrual hygiene. The
students’ practices was also associated with res-
pondents’ age group (ᵡ2 = 61.85, p<0.05) and their
knowledge of menstruation and menstrual hygiene
(Fisher’s exact p<0.05); but not with the type of sch-
ool they attended or religion (Table 4).
The various methods the students used for dis-
posing used menstrual absorbents include disposal
with domestic wastes (71.2%); burning (24.3%); bu-
rial (4.3%) and flushing in toilet (0.3%).
Discussions
Menstruation is a normal physiology in females.
Poor hygiene during menstruation has been asso-
ciated with serious ill-health ranging from repro-
ductive tract infection, urinary tract infection, bad
odour and many more6. Females are generally exp-
ected to exercise good hygienic practices during
menstruation to prevent themselves from these pro-
blems. However, remaining stable during menstrua-
tion requires that females especially the adole-
scents are prepared psychologically to develop the
associated power and mastery over the physiolo-
gical changes that occur during this period. They
should have sufficient knowledge surrounding men-
struation, menstrual cycle and of menstrual hygiene
even before they attain menarche. In this study
however, majority of the students had fair
African Journal of Reproductive Health Sept. 2010 (Regular Issue); 14(3): 205
Table 4. Factors influencing respondents’ knowledge and practices regarding menstruation.
Characteristic
Knowledge
A. Knowledge
(n = 400)
Good
(n= 34)
Fair
(n=350)
Poor
(n=16)
Total
Test
p-value
Significance
Type of school
Private
Public
21
13
173
177
6
10
200
200
ᵡ2 = 2.93
0.231
Not significant
Religion
Islam
Christianity
32
2
346
4
14
2
392
8
ᵡ2 = invalid
Age group
Early adolescence
Middle adolescence
Late adolescence
6
19
9
63
239
48
9
4
3
78
262
60
ᵡ2 = 19.96
0.001
Significant
B. Practice (n =371)
Good
(n=329)
Bad
(n=42)
Knowledge
Good/fair
Poor
323
34
4
10
327
44
Fisher’s
exact
0.001
Significant
Type of school
Private
Public
174
155
17
25
191
180
ᵡ2 = 2.30
0.129
Not significant
Religion
Islam
Christianity
322
7
41
1
363
8
Fisher’s
exact
0.621
Not significant
Age group
Early adolescence
Middle adolescence
Late adolescence
46
233
50
27
9
6
73
242
56
ᵡ2 = 61.85
0.001
Significant
knowledge of menstruation and menstrual hygiene.
Specifically, majority of the students knew that
mature females normally experience monthly/cycli-
cal flow of blood per vagina, they knew correctly
that age at menarche ranged from 11 to 14 years
and that sanitary pads are used for menstrual
protection. However, almost half of the students did
not know the average duration of the normal
menstrual flow; and about one-third of the school
girls could correctly describe the menstrual cycle or
knew the average duration of the menstrual cycle
(2.5%). Further-more, none of the school children
knew the timing of the fertile period albeit the fact
that more than half of them were aware that a
woman can conceive when she mates at a certain
period in her menstrual cycle. These findings are
similar to those reported in past studies13-16 but
contrary to those of Drak-shayani17 and Abioye-
Kuteyi18 where sufficient knowledge of menstruation
and menstrual hygiene was reported amongst their
study subjects. The similarities in findings of this
study with that of Irinoye13, Adinmas14, Poures-
lami15 and the Abraham16 studies may perhaps be
due to the fact that the studies were conducted
among schooling adolescent who are expected to
have some exposure to this knowledge either
through school/teachers or the print media. This is
clearly indicated by our finding that a significant
proportion of the respondents first learnt about
menstruation and/or menstrual hygiene from tea-
chers or matrons in school and/or from friends in
school. The differences however between our study
findings and those of the other studies17,18 may not
be unconnected with cultural differences since
some cultures encourage parents to discuss freely
with their children on their cognitive development.
This is reflected by the fact that only about one-third
of our respondents first heard of menstruation and/
or menstrual hygiene from their parents or close
relatives. This does not augur well for the future
mothers who are expected to have good practice of
menstrual hygiene and are expected to carry on the
message to their young ones.
Learning about menstrual cycle is important for
adolescents for the purpose of knowing about fertile
periods and of contraception. Collective knowledge
of age at menarche, menstrual cycle and duration of
menstrual flow in adolescents is also useful for
African Journal of Reproductive Health Sept. 2010 (Regular Issue); 14(3): 206
allaying fears and psychological trauma that may
arise from an unexpected appearance of blood per
vagina at menarche. In addition, sufficient know-
ledge of menstruation is expected to empower the
adolescents to delineate between physiologic and
abnormal uterine bleeding. Further more, it is a well
known fact that adolescence is a period of increa-
sed risk-taking and therefore susceptibility to beha-
vioural problems at the time of puberty. This asser-
tion is corroborated by findings of a qualitative sur-
vey from southwestern Nigeria10 that illustrated the
different cognitive development of the girls by the
type of questions they asked during the session.
While the late adolescents focused on coping with
relationships and demands for sex, the early and
middle adolescents focused on their feelings, rela-
tionships, menstruation and breast size. Those in
childhood (7-11 years) appeared totally ignorant
about parts of their body; and myths and miscon-
ceptions were identified in all age groups. This is a
clear indication for the need of sexuality education
amongst the adolescents. While learning about
menstruation and what surrounds it, the girls should
also be exposed to consequences of intimate rela-
tionships with their male counterparts and of contra-
ceptive knowledge to prevent unwanted abortions
and STIs including HIV and AIDS.
Promotion of healthy sexual maturation and
prevention of diseases are among the key reasons
for menstrual hygiene. Our study found that majority
of the school girls used sanitary pads during their
last menstruation. This is similar to reports from El-
Gilany and colleagues from Egypt19 but in contrast
to the Adinmas study where the majority was found
to be using toilet rolls followed by sanitary pads to
catch menstrual blood14. The use of sanitary pad as
absorbents is simple, hygienic and convenient as
the pads come in different sizes that a female can
choose from depending on her menstrual flow. Soi-
led pads are easily discarded and as such saves
the trouble of re-treatment for future use. Although
the use of designated re-useable cloth is hygienic
for adults, it may not be the best product for adole-
scents where the requirements for maintaining its
hygiene in terms of time, effort and resources may
not be assured. Our study however found that few
of the school girls used re-useable pieces of cloth or
any old piece of cloth to catch menstrual blood du-
ring their last menstruation. The main reason given
by these students for using re-useable pieces of
cloth was they could not afford sanitary pads. Other
respondents practices like regular changing of all
forms of menstrual absorbents, changing menstrual
dressings at nights and during school hours; and
increasing frequency of bathing during menstruation
which prevail amongst the majority of our respon-
dents signify good state of menstrual hygiene prac-
tices albeit their insufficient knowledge of the sub-
ject.
In summary, this study observed that the majo-
rity of the school girls examined incidentally had
good practices of menstrual hygiene albeit having
fair knowledge of the subject. In view of the salient
findings of this study therefore, we recommend as
follows:
1. Sexuality education is a formidable strategy
for ensuring healthy sexual maturation and hygiene
amongst school adolescents. The government sho-
uld therefore not relent in its efforts to institutiona-
lize sexuality education in both public and private
secondary schools and in tertiary institutions of
learning in Nigeria.
2. Information is power, and knowledge is well
known to influence attitude over time. The govern-
ment and development partners should therefore
work towards developing and disseminating sensi-
tive programmes targeted at both parents and the
adolescents on the unmet needs of adolescents in-
cluding sexuality education. The electronic and print
media, community organizations and faith-based
organizations are veritable means of disseminating
these messages
3. Parents should be made to acknowledge
the need to support their children at school with
sanitary menstrual absorbents in addition to other
basic hygienic products. The government and/or
schools administrations should on the other compli-
ment these provisions as part of the school health
programmes.
4. Youth friendly services provide good milieu
for the adolescents to interact and learn more about
their health. The government and developing part-
ners should tap from these wealth of experience
and facilitate access to these services for all adole-
scents both in school and at homes.
References
1. WHO/UNFPA/UNICEF. Programming for Adolescent
Health and Development. Report of a WHO / UNFPA
/UNICEF Study Group on Programming for Adole-
scent Health. Technical Report Series. Geneva. 1999
No.886.
2. Roche J. and Morton NE. Reproductive System.
Microsoft ® student 2007 [DVD] 2007. Redmond WA.
Microsoft Corporation.
3. Oyebola DO. Female Reproduction. Essential Phy-
siology for Students of Medicine, Pharmacy and
Related Disciplines. Nihort Press, Ibadan. 2002: 232-
244.
4. William F and Ganong MD. The Female Reproduc-
tive System. Review of Medical Physiology. Lange
21st Ed. 2003: 437-451.
5. The National Women’s Health Information Center.
Menstruation and the Menstrual Cycle. U.S Depart-
ment of Health and Human Services Office on
Women’s Health. 1-800-994-9662 TDD: 1-888-220-
5446. http://www.womenshealth.gov
African Journal of Reproductive Health Sept. 2010 (Regular Issue); 14(3): 207
6. Dasgupta A, Sarkar M. Menstrual hygiene: How
Hygienic is the Adolescent Girl? Indian J. Comm.
Med. 2008;33:77-80
7. Menstrual Hygiene. Feminine Hygiene, Gynaecology
and Menstruation Information, Resources and Pro-
sducts for Dads and Husband. http://www.mens-
trualhygiene.com
8. The INFO Project. Key Facts about the Menstrual
Cycle. John Hopkins Bloomberg, School of Public
Health, Centre for Communication Programs. http://-
www.infoforhealth.org/inforeports/menstruation.pdf
9. Suneela G, Nandini S and Ragini S. Socio-cultural
Aspects of Menstruation in an Urban Slum in Delhi,
India. Reprod. Health Matters. 2001; 9 (17): 16-25.
10. Olayinka OO and Akinyinka OO. Unmet Need for
Sexuality Education among Adolescent Girls in
Southwest Nigeria: A Qualitative Analysis. Afr. J.
Reprod. Health. Dec 2004 ; 8 (3) : 27-37.
11. Lwanga SK, Lemeshow S. Sample Size Determi-
nation in Health Studies, A Practical Manual. World
Health Organization. 1991: 1-3.
12. Ekanem EE, Gbadeyesin A. Voluntary Counselling
and Testing (VCT) for Human Immunodeficiency
Virus: A Study on Acceptability by Nigerian Women
Attending ANC. Afr. J. Reprod. Health. 2004; 8 (2):
91-100.
13. Irinoye OO, Ogungbemi A and Ojo AO. Menstruation:
Knowledge, Attitude and Practices of Students in Ile-
Ife, Nigeria. Nig. J. Med. 2003 Jan- Mar; 12(1): 43-51
14. ED Adinma. Perceptions and Practices of Menstrua-
tion amongst Nigerian Secondary School Girls. Afr. J.
Reprod. Health. 2008; 12 (1): 74-83.
15. M Poureslami and F Osati-Ashtiani. Attitudes of Fe-
male Adolescent about Dysmenorrheal and Men-
strual Hygiene in Tehran Suburbs. Arch. Iranian Med.
2002; 5(4): 219 – 224.
16. Abraham S, Fraser I, Gebski V, Knight C, Llewellyn-
Jones D, Mira M et al. Menstruation, Menstrual Pro-
tection and Menstrual Cycle Problems. The Knowled-
ge, Attitude and Practice of Young Australian Wo-
men. Med. J. Australia. 1985 February 18; 142(4):
247-251.
17. D K Devi and V P Ramiah RR.A Study on Menstrual
Hygiene among Rural Adolescent Girls. Indian J.
Med. Sci. 1994; 48 (6):139-143.
18. Abioye –Kuteyi EA. Menstrual Knowledge and Prac-
tices amongst Secondary School Girls in Ile-Ife Nige-
ria. J. Reprod. Soc. Health. 2000 Mar; 120 (1): 23-26.
19. AE Gilany, K Badawi, S El-Fedawy. Menstrual Hy-
giene among Adolescent School Girls in Man-soura
Egypt. Reprod. Health Matters. 2005; 13(26): 147-
152.
African Journal of Reproductive Health Sept. 2010 (Regular Issue); 14(3): 208