Background:- Menstrual hygiene management is a critical aspect of reproductive health, particularly for women and girls who are vulnerable to reproductive tract infections during menstruation. This study aimed to investigate the knowledge and practices of menstrual hygiene among secondary school girls in Nnewi, South-Eastern Nigeria. This descriptive cross-sectional study aimed to determine the knowledge of menstrual hygiene among secondary school girls in Nnewi, South-Eastern Nigeria. Specifically, the study sought to investigate the sources of information on menstrual hygiene, the level of knowledge and practices of menstrual hygiene, and the associations between these variables.

Methodology: - The study employed a multistage sampling technique to select 320 female secondary school students in Nnewi, South-Eastern Nigeria. Data was collected using self-administered questionnaires and analysed using SPSS V.22. Statistical associations between variables were tested using Chi square at p-value < 0.05.

Results:- The study found that 65.6% of the respondents were in the 14-17 years age group, and 91.3% had heard of menstruation prior to menarche. Most respondents (63.4%) reported receiving information on menstrual hygiene from their mothers, followed by school (27.1%), friends/peers (7.5%), and media sources (1.4%). The study revealed that 88.8% of the respondents had good knowledge of menstrual hygiene, and 92.5% had good practices of menstrual hygiene. There were statistically significant associations between the level of knowledge and the practice of menstrual hygiene (p < 0.01), as well as between age and year of study and the practice of menstrual hygiene (p < 0.01).

Conclusion:- This study highlights the importance of mothers as a primary source of information on menstrual hygiene for secondary school girls in Nnewi, South-Eastern Nigeria. The study also reveals high levels of knowledge and good practices of menstrual hygiene among secondary school girls in the region. These findings have implications for the development of effective menstrual hygiene education programs that can be tailored to the specific needs and contexts of secondary school girls in Nnewi and other similar regions.

Menstrual hygiene, knowledge, secondary school girls

Alekhya, G., Sahu, D.P. and Behera, P., 2023. The top 100 cited articles in menstrual health among adolescent girls: a citation analysis. Reproductive Health, 20(1), p.118.

Jeon, B. and Baek, J., 2023. Menstrual disturbances and its association with sleep disturbances: a systematic review. BMC Women's Health, 23(1), p.470.

Jalali, R., 2023. Global Health Priorities and the Neglect of Menstrual Health and Hygiene: The Role of Issue Attributes. Sociology of Development, 9(4), pp.317-345.

Betsu, B.D., Medhanyie, A.A., Gebrehiwet, T.G. and Wall, L.L., 2024. Menstrual hygiene management interventions and their effects on schoolgirls’ menstrual hygiene experiences in low and middle countries: A systematic review. Plos one, 19(8), p.e0302523.

Maulingin-Gumbaketi, E., Larkins, S., Whittaker, M., Rembeck, G., Gunnarsson, R. and Redman-MacLaren, M., 2022. Socio-cultural implications for women’s menstrual health in the Pacific Island Countries and Territories (PICTs): a scoping review. Reproductive health, 19(1), p.128.

Sugita, E.W., 2022. Gender and Culture Matters: Considerations for Menstrual Hygiene Management. The Sanitation Triangle, 65.

Robinson, H.J. and Barrington, D.J., 2021. Drivers of menstrual material disposal and washing practices: A systematic review. Plos one, 16(12), p.e0260472.

Elledge, M.F., Muralidharan, A., Parker, A., Ravndal, K.T., Siddiqui, M., Toolaram, A.P. and Woodward, K.P., 2018. Menstrual hygiene management and waste disposal in low- and middle-income countries—a review of the literature. International journal of environmental research and public health, 15(11), p.2562.

Masturo, N.F. and Prasetyo, B., 2024. Factors Affecting Personal Hygiene Practice During Menstruation: A Literature Review. Factors Affecting Personal Hygiene Practice During Menstruation: A Literature Review, 140(1), pp.3-3.

UNICEF, 2019. Guidance on menstrual health and hygiene [online] Available at: https://www.unicef.org/media/91341/file/UNICEF-Guidance-menstrual-health-hygiene-2019.pdf, [Accessed: 02/12/2024].

Panda, N., Desaraju, S., Panigrahy, R.P., Ghosh, U., Saxena, S., Singh, P. and Panda, B., 2024. Menstrual health and hygiene amongst adolescent girls and women of reproductive age: a study of practices and predictors, Odisha, India. BMC Women's Health, 24(1), p.144.

Pednekar, S., Some, S., Rivankar, K. and Thakore, R., 2022. Enabling factors for sustainable menstrual hygiene management practices: a rapid review. Discover Sustainability, 3(1), p.28.

Hennegan, J., Brooks, D.J., Schwab, K.J. and Melendez-Torres, G.J., 2020. Measurement in the study of menstrual health and hygiene: A systematic review and audit. PloS one, 15(6), p.e0232935.

Hall, N.L. and Creamer, S., 2021. Menstrual Health and Hygiene in Sustainable Development Goal 6. In Clean Water and Sanitation (pp. 1-9). Cham: Springer International Publishing.

Chidya, R., Kachuma, O., Thole, T., Banda, L., Loewenberger, M. and Nicholson, J., 2024. Evaluation of knowledge, attitude, practices and effectiveness of menstrual hygiene interventions in rural schools from Lilongwe, Malawi. BMC Public Health, 24(1), p.1435.

Gujarathi, J. and Asokan, V., 2021. A SYSTEMATIC REVIEW STUDY OF CONTEMPORARY AND HISTORICAL PERSPECTIVE OF MENSTRUAL PRACTICES ACROSS CULTURES. GAP Interdisciplinarities, 4(4): Oct-Nov 2021.

Pandey, N., Desul, S., Patra, R.K. and Sethy, M., 2023. Menstrual health and hygiene (MHH): a bibliometric analysis. Global Knowledge, Memory and Communication. Available at: https://www.emerald.com/insight/content/doi/10.1108/gkmc-07-2023-0234/full/html, [Accessed: 03/12/2024]

Masturo, N.F. and Prasetyo, B., 2024. Factors Affecting Personal Hygiene Practice During Menstruation: A Literature Review. Factors Affecting Personal Hygiene Practice During Menstruation: A Literature Review, 140(1), pp.3-3.

Schmitt, M.L., Gruer, C., Clatworthy, D., Kimonye, C., Peter, D.E. and Sommer, M., 2022. Menstrual material maintenance, disposal, and laundering challenges among displaced girls and women in Northeast Nigeria. Journal of Water, Sanitation and Hygiene for Development, 12(7), pp.517-528.

IKHAPP. (2024). Tackling plastic pollution at the source through ecofriendly menstruation products. Available at: https:// ikhapp.org/stories-and-research-brief/tackling-plastic-pollution-at-the-source-through-ecofriendly-menstruation-products/, [Accessed: 03/12/2024]

Elledge MF, Muralidharan A, Parker A, Ravndal KT, Siddiqui M, Toolaram AP, Woodward KP. Menstrual Hygiene Management and Waste Disposal in Low- and Middle-Income Countries—A Review of the Literature. International Journal of Environmental Research and Public Health. 2018; 15(11):2562. https://doi.org/10.3390/ijerph15112562

Elledge, M.F., Muralidharan, A., Parker, A., Ravndal, K.T., Siddiqui, M., Toolaram, A.P. and Woodward, K.P., 2018. Menstrual hygiene management and waste disposal in low- and middle-income countries—a review of the literature. International journal of environmental research and public health, 15(11), p.2562. Cranfield University.

Olson, M.M., Alhelou, N., Kavattur, P.S., Rountree, L. and Winkler, I.T., 2022. The persistent power of stigma: A critical review of policy initiatives to break the menstrual silence and advance menstrual literacy. PLOS Global Public Health, 2(7), p.e0000070.

Munro, A.K., Hunter, E.C., Hossain, S.Z. and Keep, M., 2021. A systematic review of the menstrual experiences of university students and the impacts on their education: a global perspective. PloS one, 16(9), p.e0257333.

Anaba EA, Udofia EA, Manu A, Daniels AA, Aryeetey R. Use of reusable menstrual management materials and associated factors among women of reproductive age in Ghana: analysis of the 2017/18 Multiple Indicator Cluster Survey. BMC Women's Health. 2022 Mar 26;22(1):92.

Belayneh, Z. and Mekuriaw, B., 2019. Knowledge and menstrual hygiene practice among adolescent schoolgirls in southern Ethiopia: a cross-sectional study. BMC public health, 19, pp.1-8.

UNICEF. (2024). Girls' education. Available at: https://www.unicef.org/education/girls-education, [Accessed: 01/12/2024]

World Health Organization. (2024). Adolescent health. Available at: https://www.who.int/health-topics/adolescent-health/, [Accessed: 30/11/2024]

Africa Check. (2024). Do more than 37 million women and girls experience period poverty? Fact-checking two major claims about reproductive health in Nigeria. Available at: https:// africacheck.org/fact-checks/reports/do-more-37-million-women-and-girls-experience-period-poverty, [Accessed: 30/11/2024]

Premium Times. (2024). SPECIAL REPORT: Rising cost of sanitary pads impedes menstrual hygiene among Nigerian women. Available at: https://www. premiumtimesng.com/gender/698340-special-report-rising-cost-of-sanitary-pads-impedes-menstrual-hygiene-among-nigerian-women.html, [Accessed: 01/12/2024]

PATH. (2015). Managing menstruation in low-resource settings: are cups the key? Available at: https:// www.path.org/our-impact/articles/managing-menstruation-in-low-resource-settings-are-cups-the-key/, [Accessed: 01/12/2024]

Brookings. (2024). How cultural factors shape economic outcomes. Available at: https://www. brookings.edu/collection/how-cultural-factors-shape-economic-outcomes/, [Accessed: 01/12/2024]

Nnewi Community Portal, 2024. Living in Nnewi. Available at: https://nnewi community.com/living-in-nnewi/, [Accessed: 03/12/2024]

Sadiq, I.Z., Usman, A., Muhammad, A. et al. Sample size calculation in biomedical, clinical and biological sciences research. J.Umm Al-Qura Univ. Appll. Sci. (2024). https://doi.org/10.1007/s43994-024-00153-x

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 Ogbomosho, Oyo state, Nigeria. Int J Reprod Contracept Obstet Gynecol. 2017;6(5): 1726-32.

Senapathi P, Kumar H. A comparative study of menstrual hygiene management among rural and urban adolescent girls in Mangaluru, Karnataka. International Journal of Community Medicine and Public Health. 2018;5(6):2548-56.

Mohammed Gena H., 2020. Menstrual hygiene management practices and associated factors among secondary school girls in East Hararghe Zone, Eastern Ethiopia. Adv Public Health. 2020:1-7.

Ray, S. and Dasgupta, A., 2012. Determinants of menstrual hygiene among adolescent girls: a multivariate analysis. National journal of community medicine, 3(02), pp.294-301.

Uzoechi, C. A., Parsa, A. D., Mahmud, I., Alasqah, I., & Kabir, R. (2023). Menstruation among In-School Adolescent Girls and Its Literacy and Practices in Nigeria: A Systematic Review. Medicina, 59(12), 2073.

Duru, C. O., Ikeanyi, E. M., & Merenu, I. (2021). Knowledge and practice of menstrual hygiene among adolescent school girls in Umunna, Imo State, Southeast Nigeria: implications for parents, healthcare providers and policy makers. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 10(2), 293.

Anbesu, E. W., & Asgedom, D. K. (2023). Menstrual hygiene practice and associated factors among adolescent girls in sub-Saharan Africa: a systematic review and meta-analysis. BMC Public Health, 23, 33.

PSI. (2018). Access to Pads: Five Takeaways from Menstrual Hygiene Management (MHM) Research with Adolescent Girls and Young Women in India and Ethiopia. Available at: https://www.psi.org/2018/10/access-to-pads-five-takeaways-from-menstrual-hygiene-management-mhm-research-with-adolescent-girls-and-young-women-in-india-and-ethiopia/, [Accessed: 01/12/2024]

Babbar, K., & Garikipati, S. (2023). What socio-demographic factors support disposable vs. sustainable menstrual choices? Evidence from India’s National Family Health Survey-5. PLOS ONE, 18(8), e0290350.

Elledge, M. F., Muralidharan, A., Parker, A., Ravndal, K. T., Siddiqui, M., Toolaram, A. P., & Woodward, K. P. (2018). Menstrual Hygiene Management and Waste Disposal in Low and Middle Income Countries—A Review of the Literature. International Journal of Environmental Research and Public Health, 15(11), 2562.

Belayneh, Z., & Mekuriaw, B. (2019). Knowledge and menstrual hygiene practice among adolescent schoolgirls in southern Ethiopia: a cross-sectional study. BMC Public Health, 19, 1595.

Demmu, Y. M., Shifera, G. M., Ayana, G. M., Adare, D., Yazew, B., Damtew, Y. T., & Geremew, A. (2023). Menstrual hygiene management and associated factors among adolescent school girls in Gursum district, Eastern Ethiopia: Institution-based a cross-sectional study. BMC Women's Health, 23, 328.

Tegegne, T. K., & Sisay, M. M. (2014). Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia. BMC Public Health, 14, 1118.

Citron Hygiene. (2023). Menstrual Hygiene Management - Waste Disposal Techniques. Available at: https://www.citronhygiene.com/resources/menstrual-hygiene-management-waste-disposal-techniques/, [Accessed: 28/11/2024]

CDC. (2024). Healthy Habits: Menstrual Hygiene. Available at: https://www. cdc.gov/hygiene/about/menstrual-hygiene.html, [Accessed: 27/11/2024]

Mehta, N. (2024). 10 Hygiene Tips During Periods For Women. Available at: https://drnehamehta.com/hygiene-tips-during-periods-for-women/, [Accessed: 27/11/2024]

Gebre, W., Kidane, E. M., Negussie, Y. M., Getahun, M. S., Bekele, N. T., & Gurara, A. M. (2023). Assessment of menstrual hygiene management knowledge, practice, and associated factors among girls in Boset District, Ethiopia: a school-based cross-sectional study. Contraception and Reproductive Medicine, 8, 34.

Fennie, T., Moletsane, M., & Padmanabhanunni, A. (2022). Adolescent girls’ perceptions and cultural beliefs about menstruation and menstrual practices: A scoping review. African Journal of Reproductive Health, 26(2), 88-105.

Herbert, A., 2018. The Growing Girls Project: Experiences of Puberty and Menstruation in a Low-Income, Minority US Context (Doctoral dissertation, Johns Hopkins University).

UNICEF. (2024). Period Poverty – why millions of girls and women cannot afford their periods. Available at: https://www. unwomen.org/en/news-stories/explainer/2024/05/period-poverty-why-millions-of-girls-and-women-cannot-afford-their-periods, [Accessed: 20/11/2024]

Sommer, M. and Mason, D.J., 2021, August. Period poverty and promoting menstrual equity. In JAMA Health Forum (Vol. 2, No. 8, pp. e213089-e213089). American Medical Association.

Chandra-Mouli, V., & Patel, S. V. (2017). Mapping the knowledge and understanding of menarche, menstrual hygiene and menstrual health among adolescent girls in low- and middle-income countries. Reproductive Health, 14, 30.

Moon, G., Kim, I., Kim, H., Choe, S., Jeon, S., Cho, J., & Hong, S. (2020). How can we improve knowledge and perceptions of menstruation? A mixed-methods research study. BMC Women's Health, 20, 214.