Original Research Article http://doi.org/10.18231/j.pjms.2019.012 Panacea Journal of Medical Sciences, May-August, 2019;9(2):43-47 43 Knowledge and practices related to menstruation and their relation to school absenteeism among adolescent girls attending tertiary care hospital in Ghaziabad: A cross sectional study Manisha Gupta 1* , Neelima Agarwal 2 , Alpana Agrawal 3 1-3 Professor, Dept. of Obstetrics and Gynaecology, Santosh Medical College and Hospitals, Ghaziabad, Uttar Pradesh, India *Corresponding Author: Manisha Gupta Email: drshalabhgupta@gmail.com Abstract Introduction: Onset of menarche is a special period when adolescent girl undergoes various social emotional and physiological changes. They often lack knowledge regarding reproductive health which can be due to socio-cultural barriers in which they grow up. Though menstruation is a natural process, it is associated with misconceptions and challenges among girls in developing countries. This has led to decrease in school attendance and increasing numbers of school dropouts. With focus on the school girls, this study examined knowledge about menstruation, determinants of menstrual management and its influence on school-attendance in Ghaziabad. Aims and Objectives: To assess the knowledge and the practices of menstrual hygiene among adolescent girls attending Gynecology OPD of a tertiary care hospital. To find out the proportion of school absenteeism in the study group and factors related to it. Materials and Methods: It was an observational study conducted over a period of 3 months from January 2019 to March 2019. All adolescent school going girls who presented in the Gynaecology OPD in Santosh Medical College & Hospital, Ghaziabad, were recruited in the study. They were interviewed after their informed consent using a pretested structured questionnaire which focused on socio- demographic factors, parental factors, knowledge, social restrictions and hygienic management regarding menstruation, problems associated with menstrual health practices and school attendance. Statistical Analysis: Frequencies were calculated for different variables. Data was analyzed and p value of <0.05 was taken significant. Results: The mean age at menarche was 13.67 (±1.17) years. About two thirds, that is 122 (61%) of girls had knowledge about menstruation and its management. Only 64 (32%) of the girls used sanitary napkins as absorbent during menstruation. About 128 (64%) girls were reported to have been absent from school during their menstruation period. Those who did not use sanitary napkins, where there were lack of facilities and restrictions on playing were more likely to be absent from school(p<0.0001). In addition, study indicated that school absenteeism was common among girls who experienced teasing and humiliation by classmates when their clothes were stained with blood. Conclusion: Lack of basic needs like availability of sanitary napkins and their disposal, separate functional wash rooms and running water supply are the most important factors causing drop in girls’ school-attendance. Keywords: Menstrual hygiene, Menstrual knowledge, Menarche, Sanitary napkins, Adolescent school girls, School absenteeism, School dropout. Introduction Menstruation is a milestone event in a girl's life and the beginning of reproductive life. Most of the time adolescent girls are unprepared in terms of knowledge, skills, and attitudes for managing the menstrual cycle. 1 In schools, teachers can help the girls to know physiological changes occurring in the body and to make the school environment more friendly to manage menstruation with dignity. In most of the cases, teacher’s attitude is not supportive towards menstruating girls in schools. This leads to inadequate menstrual hygiene which is a major problem for girls in resource-poor countries including India. Inadequate water and sanitation facilities is a major impediment to maintenance of menstrual hygiene which adversely affects the health and development of adolescent girls. 2 More than half the schools in low-income countries either lack sufficient toilets for girls or they are frequently not very clean. 3 Lack of access to effective absorbents, inadequate facilities to change, lack of privacy and lack of access to soap and water are the major factors causing drop in school attendance. In addition, inadequate social support and presence of taboos can lead to psychosocial consequences like shame, fear, anxiety and distraction from studies which further contribute to school absenteeism. 4–8 With focus on the school girls, this study examined knowledge about menstruation, determinants of menstrual management and its influence on school-attendance among adolescents attending Gynecology OPD in a tertiary care hospital in Ghaziabad. Aims and Objectives 1. To assess the knowledge and the practices of menstrual hygiene among adolescent girls attending Gynecology OPD of a tertiary care hospital. 2. To find out the proportion of school absenteeism in the study group and factors related to it. Materials and Methods The study was an observational cross sectional study conducted in Ghaziabad, Uttar Pradesh, India. After taking ethical clearance from Ethical committee of the Institution, the study was conducted over a period of 3 months from January 2019 to March 2019. Two hundred and seven adolescent girls who came to Gynaecology OPD in Santosh Medical College and Hospital, Ghaziabad, were recruited in the study, out of which seven girls dropped out of the study