Reproductive health status of adolescent slum girls, residing in the urban slums of Cuttack City, Odisha

INTRODUCTION

Reproductive health is defined as a state of complete physical, mental, and social well-being and not merely absence of disease or infirmity, in all matters relating to the reproductive system and to its function and processes.^[1] Reproductive tract infection (RTI)/sexually transmitted infection (STI) has become a silent epidemic that devastates women’s life. The annual incidence of RTI and STI in India is estimated at 5% or approximately 40 million every year.^[2] The period of adolescence for a girl is a period of physical and psychological preparation for safe motherhood. Sexual relation during adolescence is often unplanned, sporadic and sometimes as a result of pressure, coercion, or force. Early sexual exposure among the adolescent girls before they have adequate information about self-protection from infections such as syphilis, gonorrhea, and HIV/AIDS increases the risk of such infections which often result in serious consequences such as infertility, pelvic inflammatory disease, cancer cervix, and neonatal/intrauterine infections.^[3] Improper maintenance of menstrual hygiene is also the important cause of ascending infection of genital tract leading to RTI.^[4]. There is no recent information regarding the magnitude of problem of RTI/STI among the adolescent girls of urban slums. Hence, this study was conducted with the objective to assess reproductive health status and menstrual hygiene practices of the adolescent girls residing in the urban slums.

MATERIAL AND METHODS

This was a community-based cross-sectional study, conducted among adolescent girls residing in urban slums situated under the urban health training center(UHTC), Department of the Community Medicine, S.C.B. Medical College, Cuttack, Odisha. The study was conducted during the year 2013. There were 10 Anganwadi Centres (AWCs) under this field training area catering to the needs of 12,163 populations. From the general OPD register of the year 2012, it was observed that of the 259 cases of RTI, 31% were adolescent girls of whom majority (67%) of them were from the four AWCs, namely, Charigharia, Coolie Basti, Pareswar Sahi, and Junus Patna AWCs and it was also observed that the population of these four AWCs constitute nearly half (46.3%) of the total population catered by the urban field training area of the UHTC of the department. These AWCs were purposively selected as the study area. Total list of adolescent girls with their names and their detailed address were obtained from respective Anganwadi workers (AWWs). Adolescent girls who had attained menarche were included in the study population. Girls in the adolescent age group who were absent during the time of field study or not willing to participate were excluded from the study. Informed written consent was taken from the study participants and those study subjects below 12 years the assent were taken from their parents. Symptoms of RTI/STI as per syndromic approach guideline of the WHO were adapted to collect information regarding reproductive morbidity of adolescent girls.^[3] Pre-designed and pre-tested questionnaire was used to collect information regarding the reproductive health status of adolescent girls by house-to-house visit in slum area. Data thus collected were analyzed using SPSS version 16. Mean, standard deviation, and Chi-square test were used to find the association between the variables.

RESULTS

A total of 277 adolescent girls were included for the study. They were between 12 and 19 years with the mean age 15.94 ± 1.95 years. Among them, 77 were in early adolescent (10–14 years) age group and the rest 200 were in late adolescent (15–19 years) age group. The mean age at menarche was 12.53 ± 1.2 years. Among the study subjects, 13 (4.7%) adolescent girls were married. Their mean age at marriage was 17 years and all of them became mothers by 18 years of age.

Out of all adolescent girls those participated in this study, 116 (41.9%) girls had no complaint related to menstruation and reproductive health. Regarding the menstrual problem, 161 (58.1%) adolescent girls had one or the other problem including dysmenorrhea in 161 (58.1%), followed by irregular cycles in 56 (20.2%), menorrhagia in 52 (18.8%), and scanty menstruation in 4 (1.4%) girls, as shown in Table 1. Forty-two (15.2%) adolescent girls had symptoms of RTI/STI which was detected as per syndromic approach [Table1]. The common sociocultural taboos prevalent in urban slums were no entry to the family kitchen and temple during menstruation which were strictly followed by 197 (71.1%) girls.

Table 2 shows the magnitude of menstruation related problem among the two age groups, that is, early versus late adolescent. The most common menstrual problem among early adolescent girls was dysmenorrhea 43 (55.8%) followed by menorrhagia in 23 (29.9%) and irregular cycles in 18 (23.4%) girls. Furthermore, dysmenorrhea (59%) was most common menstrual problem in late adolescent age group followed by irregular cycles in 38 (19%) and menorrhagia in 29 (14.5%) girls. Scanty menstruation was complained by four girls of late adolescent age group.

Regarding knowledge of maintenance of menstrual hygiene, 117 (42.2%) girls were aware of it. From among them, 73 (62.4%) girls had the knowledge of use of clean cloths and only 44 (37.6%) had the knowledge regarding the use of sanitary napkin for maintaining menstrual hygiene. Although very few girls had the knowledge that use of sanitary napkin is ideal for maintenance of menstrual hygiene, 102 (36.8%) were using it on regular basis. Twenty-four (8.7%) were using both sanitary napkin and old cloth (depending on the availability) and 151 (54.5%) girls were using old cloths. From 151 girls who were using old cloth, 37 (24.5%) were discarding it after single use and 114 (75.5%) were reusing the used cloths after cleaning. Regarding their cleaning practices, 100 (87.7%) girls were washing it with detergent while 5 (4.4%) girls were washing it with detergent and pond water and 9 (7.9%) girls were washing it with only pond water without use of any soap/detergent. Instead of sun drying, 105 (92.1%) girls were keeping these clothes to dry in hiding place. Regarding storing, (for reuse of cloths), out of 114 girls having the practice of reuse of used cloths, 103 (90.4%) girls were storing it in clean dry place and rest 11 (9.6%) were hiding these in dirty and unclean places.

Regarding the prevalence of symptoms of RTI/STI in these adolescent girls with their sanitary pad use is shown in Table 3. Symptoms of RTI/STI were present in 11.7% of adolescent girls using sanitary napkins during menstruation while it was 17.1% among those using only old clothes or both (old cloth and sanitary napkin) and there was no statistically significant association with the type of pad or material used during menstruation.

DISCUSSION

In the present study, the mean age at menarche was 12.53 years which is similar to the findings reported by Kumar and Singh at Garhwal, Uttarakhand, where the mean age at menarche was 12.5 years.^[5] Among the study subjects, 41.9% had no menstruation related complain. Most common menstrual problem among the girls was dysmenorrhea (58.1%) followed by irregular cycles (18.8%). A study conducted by Indupalli at Rajapur of Gulbarga, Karnataka, also reported that 56.8% had normal menstrual cycles and 37.2% had menstrual problems where dysmenorrhea (22.4%) was most common followed by irregular cycles.^[6] Agarwal and Agarwal in a study at Gwalior found that 79.7% of adolescent girls had dysmenorrhea.^[7] The present study revealed that only 36.8% of girls used sanitary pads during menstruation which is much lower than a study conducted by Kumar and Singh where 51% used sanitary pads^[5] which may be due to poverty and ignorance of the study population. A Dasgupta and Sarkar in a study at Singur, West Bengal, had reported that 11.25% of girls used sanitary pads during menstruation.^[8] Regarding restrictions during menstruation, 71% were restricted to enter the family kitchen and temple which is similar to a study conducted by Dasgupta and Sarkar where 85% practiced restriction during menstruation.^[8] In the present study, 42 (15.2%) adolescent girls had one or more symptoms of RTI/STI of which majority 26 (62%) girls had foul smelling vaginal discharge. Jain et al. in a study at Merrut, Uttar Pradesh, found 16.42% of the girls suffered from one or the other symptoms of RTI of which 80.3% suffered from excessive vaginal discharge.^[9] Another study by Khanna et al. showed that 27% of the girls who had one or the other symptoms of RTI of which white discharge and pain in the lower abdomen were 41% each.^[10] The present study also showed that more number of girls (17.1%) using old cloths reported the symptoms of RTI as compared to those using sanitary pad (11.7%) during menstruation. A study by Ray and Dasgupta at Singur block of Hooghly district, West Bengal, found that 18.4% of adolescent girls had symptoms of RTI which is seen in more girls using old cloths as menstrual absorbent.^[11]

CONCLUSION

The present study shows that more than 50% of adolescent slum girls were having one or more menstrual problems, the common being dysmenorrhea followed by irregular cycles and menorrhagia. The symptom of RTI/STI was also a common problem encountered among these girls as almost one in seven girls were having these symptoms. More number of girls not using sanitary napkins had the symptoms of RTI/ STI. Furthermore, majority of the girls had no knowledge regarding maintenance of menstrual hygiene and the practice of using sanitary napkin was still less. Information Education and Communication activities and supply of sanitary pads to these adolescent slum girls free or at least at reasonable cost can address these reproductive health issues.