A comparative study of direct health intervention and peer-led intervention on menstrual hygiene management of adolescent girls in rural India

Logeswari Krishnamurthy, Jeram Parmar, Deodatt M. Suryawanshi


Background: Menstrual hygiene management (MHM) among adolescents in rural India is negatively influenced by myths and taboos which predispose them to infections which can be dispelled by health education by experts or peers. The study aimed to demonstrate the relative effectiveness of direct health education over peer led health education on MHM.

Methods: A longitudinal follow up intervention study recruiting 486 school going adolescent females divided in three groups I, II and III was conducted. Group I received peer led, while group II received direct health education and group III was control. Pre and post intervention scores of participants were compared.

Results: Direct intervention group demonstrated highest improvement in number of participants having good MHM scores (p<0.05). Mean MHM scores of direct intervention group participants were the highest among all the three groups (p<0.05). Knowledge score of direct intervention group was significantly higher than group 1 (p=0.001) and group III with no difference in practice scores between group I and II (p=0.147).

Conclusions: Direct health education as an intervention is more relatively effective than peer led in MHM of adolescent females.


Adolescent health, Menstrual hygiene management, Health education, Peer led education, Direct health intervention, Myths

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McIntyre P. Adolescent Friendly Health Services. Geneva: World Health Organization; 2002.

Ghongdemath J, Sidhmalswamy A, Mallapur A, Shindholimath V. Impact of adolescent health education on adolescent girls in rural schools and colleges. Int J Reproduct Contracept Obstetr Gynecol. 2016;5(1):53-7.

Haque SE, Rahman M, Itsuko K, Mutahara M, Sakisaka K. The effect of a school-based educational intervention on menstrual health: an intervention study among adolescent girls in Bangladesh. BMJ Open. 2014;4(7):004607.

Das A. Sexuality education in India: examining the rhetoric, rethinking the future. Sex Ed. 2014;14(2):210-24.

Balamurugan S, Shilpa S, Shaji S. A community based study on menstrual hygiene among reproductive age group women in a rural area, Tamil Nadu. J Basic Clinic Reproduct Sci. 2014;3(2):83-7.

UNICEF. Fact sheet: Adolescents Statistics, 2019. Available at: Accessed on 27 March 2021.

Tegegne TK, Sisay MM. Menstrual hygiene management and school absenteeism among female adolescent students in Northeast Ethiopia. BMC Pub Health. 2014;14(1):1118.

El-Mowafy RI, Moussa MMM, El-Ezaby HH. Effect of health education program on knowledge and practices about menstrual hygiene among adolescents girls at orphanage home. IOSR J Nurs Heal Sci. 2014;3(6):48-55.

Dambhare DG, Wagh SV, Dudhe JY. Age at menarche and menstrual cycle pattern among school adolescent girls in central India. Glob J Heal Sci. 2011;4(1):105-11.

Bayray A. Menstrual perceptions and preparation of rural adolescent females in Tigray, North Ethiopia. Univ J Edu Gen Stud. 2012;1(1):9-16.

Zaidi SHN, Sivakami A, Ramasamy JD. Menstrual hygiene and sanitation practices among adolescent school going girls: a study from a South Indian town. Int J Community Med Public Health. 2015;2(2):189-94.

Ministry of Drinking Water and Sanitation. Menstrual Hygiene Management National Guidelines. New Delhi: Government of India; 2015.

Dasgupta A, Sarkar M. Menstrual hygiene: how hygienic is the adolescent girl? .Indian J Comm Med. 2008;33(2):77-80.

Ramachandra K, Gilyaru S, Eregowda A, Yathiraja S. A study on knowledge and practices regarding menstrual hygiene among urban adolescent girls. Int J Contemp Pediatr. 2016;3(1):142-5.

Khubchandani J, Clark J, Kumar R. Beyond controversies: sexuality education for adolescents in India. J Fam Med Primary Care. 2014;3(3):175-9.

Puri S, Kapoor S. Taboos and myths associated with women’s health among rural and urban adolescent girls in Punjab. Indian J Community Med. 2006;31(4):295.

Luz AM, Berni NI, Selli L. Myths and taboos of motherhood: Focusing on the health-disease process. Rev Bras Enferm. 2007;60(1):42-8.

Selvi TK, Ramachandran S. Socio-cultural taboos concerning menstruation: a micro level study in the cuddalore district of Tamil Nadu, India. Int J Scientif Res Pub. 2012;2(8):1-7.

Vandana K Simarjeet VK, Amandeep K. Assessment of knowledge of adolescent school going girls regarding menstruation and menstrual hygiene. Int J App Res. 2016;2(9):240-6.

Bhudhagaonkar J, Shinde M. Impact of structured education regarding menstrual hygiene practices among adolescent girls. Int J Sci Res (IJSR). 2014;3(5):244-52.

Susila C, Kumar SJS, Precilla. Effectiveness of structured teaching programme on menstrual hygiene among the adolescent girls at a selected college-pre-experimental study. Int J Comprehen Nurs. 2014;1(1):7-13.

Boosey R, Prestwich G, Deave T. Menstrual hygiene management amongst schoolgirls in the Rukungiri district of Uganda and the impact on their education: a cross-sectional study. Pan African Med J. 2014;8688:1-13.

Nemade D, Anjenaya S, Gujar R. Impact of health education on knowledge and practices about menstruation among adolescent schoolgirls of Kalamboli, Navi-Mumbai. Health Popul Perspect Issue. 2009;32(4):167-75.

Dongre AR, Deshmukh PR, Garg BS. The effect of community-based health education intervention on management of menstrual hygiene among rural Indian adolescent girls. World Health Popul. 2007;9(3):48-54.

National Health Mission. Fact sheet: Adolescent Friendly Health Services (AFHS), ANM Training Manual, National health mission. Available at: Accessed on 27 March 2021.

Ministry of Health and Family Welfare. Menstrual Hygiene: Training Module for ASHA. New Delhi: National Rural Health Mission; 2012.

Wash & Health Practitioners. MHM training Manual: Water supply and Saniation Colloborative Council. Geneva.2013.

UNICEF. Fact sheet: Training manual for Menstrual Hygiene Management. Available at: Accessed on 27 March 2021.

Michael J, Iqbal Q, Haider S, Khalid A, Haque N, Ishaq R, et al. Knowledge and practice of adolescent females about menstruation and menstruation hygiene visiting a public healthcare institute of Quetta, Pakistan. BMC Womens Health. 2020;20(1):4.

Gold-Watts A, Hovdenak M, Daniel M, Gandhimathi S, Sudha R, Bastien S. A qualitative study of adolescent girls' experiences of menarche and menstruation in rural Tamil Nadu, India. Int J Qual Stud Health Well-being. 2020;15(1):1845924.

Sivakami M, vanEijk MA, Thakur H, Kakade N, Patil C, Shinde S, et al. Effect of menstruation on girls and their schooling, and facilitators of menstrual hygiene management in schools: surveys in government schools in three states in India, 2015. J Glob Health. 2019;9(1):010408.

Ministry of Home Affairs, Government of India. Fact sheet: District Census Handbook, 2011, Office of the General and Census Commissioner, India. Available at: Accessed on 27 March 2021.

National Family Health Survey, India. Fact sheet: International Institute for Population Sciences, Mumbai. Available at: Accessed on 28 March 2021.

Karuppiah AS. Effectiveness of planned teaching programme of menstrual hygiene on knowledge, attitude and practice among the adolescent girls in government school in Chennai, Tamil Nadu. J Sci. 2015;5(1):39-43.

Kansiime C, Hytti L, Nalugya R, Nakuya K, Namirembe P, Nakalema S, et al. Menstrual health intervention and school attendance in Uganda (MENISCUS-2): a pilot intervention study. BMJ Open. 2020;10(2).

Nalugya R, Tanton C, Hytti L, Kansiime C, Nakuya K, Namirembe P, et al. Assessing the effectiveness of a comprehensive menstrual health intervention program in Ugandan schools (MENISCUS): process evaluation of a pilot intervention study. Pilot Feasibility Stud. 2020;6:51.

Ajuwon AJ, Brieger WR. Evaluation of a school-based reproductive health education program in rural South Western, Nigeria. Afr J Reproduct Heal. 2007;11(2):47-59.

Ramaiya A, Malhotra A, Cronin C, Stevens S, Kostizak K, Sharma A, et al. How does a social and behavioral change communication intervention predict menstrual health and hygiene management: a cross-sectional study. BMC Public Health. 2019;19(1):1039.