Improving knowledge, attitudes and practices of menstrual hygiene among women dwelling in the riverside slums of Chennai, India: a community health education intervention

Abstract

Background: Over 800 million women worldwide menstruate in a day, and about 2.4 billion girls and women in the world do not have access to proper sanitation. Improper Menstrual Hygiene Management (MHM) leads to diseases such as pelvic inflammatory disease and toxic shock syndrome , which may have fatal outcomes. Indian women possess inaccurate MHM knowledge and hold cultural taboos regarding menstruation, and often practice poor MHM; hence, they are susceptible to those diseases associated with poor MHM. Objective: To assess the impact of a community-based health education program aimed to improve MHM knowledge, attitudes and practices amongst women residing in slums along the Cooum river in Chennai, India. Methods: This study implemented a multistage cluster pre-experimental pre-test/post-test design. Out of the 6 zones in Chennai where the Cooum river passes, 2 zones were selected by simple random sampling (SRS) to obtain intervention and control participants; one ward and one slum in each of the zones were selected by SRS. Participants from the identified intervention slum were recruited via snowball sampling, while the control group was obtained via convenient sampling. An evidence-based novel intervention (role-play) was created, which covered MHM topics in a culturally competent manner. To assess participants’ knowledge, attitudes and practices (KAP), we developed a study instrument that was adapted from validated questionnaires published in previous studies. The interviewer administered questionnaire included items on demographics, knowledge, attitudes, practices and barriers regarding MHM. Maximum composite scores of knowledge was 11, attitudes was 4, and practices was 6. Volunteers were recruited and trained to practice cultural competency for the intervention and data collection. We used Mann-Whitney test to compare the baseline KAP composite scores between the intervention and control groups. Additionally, we applied the Wilcoxon signed rank non-parametric test and McNemar’s test to compare the paired composite scores (ordinal data) and paired nominal data, respectively, before and after the educational intervention program. Results: In total, 72 participants enrolled the present study, 36 in intervention and 36 in control groups. The mean age of participants was 32.64±8.81 in the intervention group, and 30.58±7.36 in control group, with no significant differences between them. More participants from the control group reported having pocket money and earnings (91.7% and 80.6% respectively) compared to those from the intervention group (66.7% and 61.1% respectively). The composite scores for knowledge and attitudes, but not for practice, significantly differed between the groups (p values <0.013, <0.001, 0.188 respectively) at baseline. The median of the baseline composite scores for knowledge, attitude and practices among the intervention group were 7 (IQR: 6 to 8), 2 (IQR: 1 to 3) and 4 (IQR: 4 to 5), and for the control group median scores were 8.50 (IQR: 6 to 10), 1 (IQR: 0 to 2) and 5 (IQR: 4 to 5) respectively. In the intervention group, from pre-test to post-testing, the composite scores for all three domains improved statistically significantly. The median of the improvement in knowledge, attitude and practice scores were 2 (95% CI: 1.92 to 3.28); 1 (95% CI: 0.97 to 1.75) and 1 (95% CI: 1.11 to 2) respectively. Conclusion and Recommendations: This research study found that a community-based intervention program has the potential to improve knowledge, attitudes and practices of MHM among women living within the riverside slums in Chennai, India. Self- reported barriers can be ameliorated with government amendments such as providing cost-free sanitary napkins and incinerators in communities for safe disposals. Similar intervention programs are recommended nationwide in order to improve MHM knowledge, attitudes and practices.