Table 1 Study description
From: Systematic review of menstrual health and hygiene in Nepal employing a social ecological model
SN | Study | Journal | Purpose | Study design | Setting | Sample | Results |
|---|---|---|---|---|---|---|---|
1 | Buaman et al. 2019 | Global Public Health | To explore the role of caste/ethnicity in menstrual knowledge, attitudes and practices in Nepal | Community-based, cross sectional | Doti, Dang, Kapilvastu, Lalitpur, Chitwan, Tanahun, Makwanpur, Saptari, and Jhapa districts | 679 women | Caste/ethnicity was a significant predictor of menstrual knowledge and practices. The caste/ethnic groups Tarai/Madhesi/Other, Newar, Janajati, and Muslim all had statistically significant fewer odds of positive menstrual practices compared to Brahman/Chhetri (high caste groups), with Janajati (indigenous ethnic groups) having the poorest outcomes |
2 | Amatya 2018 | PLoS One | To assess the prevalence of Chhaupadi practice among adolescent girls, observe the physical conditions and sanitation of the living spaces during Chhaupadi, assess the lived experience of Chhaupadi among adolescent girls and the perceptions of local stakeholders towards Chhaupadi | Mixed methods study | Accham district | 107 adolescent girls | Majority of the girls practiced exile during menstruation. Around 4% were exiled to traditional Chhau sheds, 82% to livestock sheds and 11% to outside courtyards. Around 3% stayed inside the house but practiced some form of menstrual taboos. Only 30% of girls who stayed outdoors had toilet facilities Participants reported having various psychological problems, including loneliness and difficulty sleeping while practicing Chhaupadi. Notably high proportions of the living spaces lacked ventilation/windows, electricity and a warm blanket and mattress for sleeping. Three of the girls were physically abused; nine were bitten by a snake |
3 | Budhathoki 2018 | BMC Women's Health | To describe the experiences and perceptions of women and adolescent girls on menstrual hygiene management in post-earthquake Nepal | Mixed methods study | Sindhupalchok district | 127 women and girls living in temporary shelters | During a disaster, menstrual hygiene was rated as the sixth highest overall need and perceived as an immediate need by 18.8% of the respondents. Reusable sanitary cloth were used by about 66.7% of the respondents before the earthquake and remained a popular method (76.1%) post-earthquake. None of the respondents reported receiving menstrual adsorbents as relief materials in the first month following the earthquake. Women who were in the age group of 15–34 years, did not go to school, were married and previously used reusable sanitary cloth were more likely to use the reusable sanitary cloth |
4 | Cardoso 2018 | BMJ Sexual Reproductive Health | To record the prevalence of menstrual restrictions experienced by married women and examine potential associations between IPV in the past year and menstrual restrictions imposed by husbands and/or in-laws among women in three districts of Nepal | Baseline data from a larger randomized control trial | Nawalparasi, Kapilvastu and Chitwan districts | 1800 women | Nearly three out of four women (72.3%) reported experiencing high menstrual restriction, or two or more types of menstrual restriction. When controlling for demographic variables and IPV, no type of IPV was associated with high menstrual restrictions |
5 | Yadav 2018 | Journal of Nepal Health Research Council | To assess the current knowledge, attitude and practice of school adolescents on menstrual hygiene management | Cross-sectional study | Doti district | 276 students from grade seven and eight of 11 schools | Majority of the respondents had fair to good knowledge on menstrual hygiene management However, more than half the respondents did not engage in good menstrual hygiene practices. Around half of the respondents had positive attitude towards menstrual hygiene management related issues |
6 | Parajuli 2018 | Bibechana | To find knowledge and practice on menstrual hygiene; and perspective of Chaupadi (menstrual shed) among the reproductive age group female | Community based mixed methods study | Pyuthan district | 109 participants | Although majority of the respondents were aware of menstruation and menstrual hygiene, there was a gap in practice. Around 40% used sanitary pad during their menstrual flow but most (65.1%) of them did not dispose them; 16.5% bury in nearby ground and 18.4% burn. Different traditional practice followed were use of separate utensils, not allowed to see sun, restriction to- go outside, cook food, usual food intake, worship, eat with others, sleep in usual bedroom and touch male members. Most (94.5%) of them experienced Chhaupadi during their menarche |
7 | Rajbhandari et al. 2018 | Nepal Medical Journal | To explore the existing knowledge and practices on menstrual hygiene among adolescents | Descriptive study | Bhaktapur district | 168 adolescent girls | Majority of the respondents were aware of menstruation as physiological process and used commercially available sanitary pads. The primary source of information on menstruation was their mother. However, 35.1% of them reported that they had no prior knowledge on menarche The major reasons for school absenteeism were discomfort, lack of continuous water supply and shame or fear of staining |
8 | Parajuli 2016 | Journal of Kathmandu Medical College | To assess the knowledge and practices regarding menstrual hygiene among adolescent girls | A descriptive study | Morang district | 102 adolescent girls | It was found that majority (83.3%) of girls knew that menstruation is a physiological process. More than half of the respondents (53.9%) were taught about menstruation by their mother. Only 33.3% of the respondents used sanitary pad during menstruation. Adolescent girls had different type of restrictions during menstruation like not being allowed to cook food, visit holy places and sleep in own house during menarche |
9 | Katwal 2016 | Kathmandu University Medical Journal | To assess the relationship between stress and dysmenorrhea amongst the Nepalese medical students | Cross-sectional descriptive study | Kavre district | 184 female medical students | 65% of participants considered medical education to be stressful. Around 67% of the participants experienced dysmenorrhea. Of them, 85% experienced increase in frequency and severity of dysmenorrhea after joining medical college. Of participants experiencing dysmenorrhea, 29.45% missed classes and 17.39% participants had positive family history of dysmenorrhea |
10 | Sharma 2016 | BMC Women's Health | To determine menstrual pattern among adolescent girls | Cross sectional study | Kaski district | 260 adolescent girls | Around 64.2% girls had irregular menstrual cycle and significant association was found between regularity of menstruation and ethnicity. Dysmenorrhea was reported by more than half of the girls and significant association was found between severity of dysmenorrhea with school absenteeism and treatment needed |
11 | Lui 2016 | International Journal of Gynaecology and obstetrics | To describe findings from a validated survey examining access to care, contraceptive needs, access to surgical care, menstruation-related healthcare needs, and barriers to receiving reproductive health care in Nepal | Two‐part population‐based, cross‐sectional, cluster‐randomized survey | 15 districts | 876 female of reproductive age (12-50 years) | The most common form of sanitary products used were non-reusable sanitary pads and reusable towels. Urban residents and educated women had increased odds of using pads. Every year increase in age and non-motorized transport to a primary healthcare facility had decreased odds of using a pad. About one forth women reported dysmenorrhea |
12 | Ranabhat 2015 | Asia Pacific Journal of Public Health | To determine the factors of reproductive health problems related to Chhaupadi | Cross-sectional study | Kailali and Bardiya districts | Women of menstrual age (N = 672) | One fifth of the households practiced Chhaupadi. Livelihood conditions, access to water facilities, food restrictions during menstruation and Chhaupadi stay were significantly associated with reproductive health problems in women such as burning micturition, abnormal vaginal discharge, itching in genital part, painful and foul smelling menstruation |
13 | Crawford 2014 | Culture, Health and Sexuality | To understand menstrual stigma in the context of religiously-based menstrual restrictions imposed on women, we conducted qualitative research with women in Nepal | Qualitative study | Kathmandu district | Female students and NGO workers [Focus group 1 (n = 4), Focus group 2 (n = 4), Individual interviews (n = 11)] | Women reported being unprepared for menarche that then led to distress and stigmatization |
14 | Shrestha 2013 | International Journal of Nursing Education | To assess the knowledge, attitude and practice of adolescent girls on menstrual hygiene | Interventional study | Kaski district | 60 adolescent girls | Educational intervention showed significant increase in knowledge, attitude and practice towards menstrual hygiene |
15 | Sapkota 2013 | Journal of Kathmandu Medical College | To assess the knowledge and practices regarding menstruation among school going adolescents | A descriptive study | Sunsari district | 61 female adolescents | Dysmenorrhea was the commonest problem faced during menstruation (78.7%) followed by back pain and excessive blood loss. More than half of respondents (54.1%) used sanitary pads and frequency of changing pads twice a day was highest (50.8%). Initial reaction was of fear/apprehension at menarche by 36.1% of girls whereas 44.3% perceived it as an expectant process. Girls still faced different types of restrictions like not being allowed to visit holy places, not being allowed to cook and touch male family member etc |
16 | Paneru 2013 | Asian Journal of Medical Sciences | To identify prevalence and factors associated with RTIs among married women of reproductive age | Cross-sectional study | Kaski district | 282 participants | Prevalence of RTI symptoms was estimated to be 78.9 percent. Common reported symptoms were backache (71%), low abdominal pain (67%), watery vaginal discharge (56%), genital itching (51%), burning urination (44%) and curdy discharge per vagina (26%). Illiterates, those who had sexual contacts during menstrual periods and those who do not clean genitalia after sexual act were significantly more at risk (OR = 5.35,8.33 and 3.11) of having RTIs than those who do not have these attributes |
17 | Oster 2011 | American Economic Journal—applied economics | To evaluate the causal impact of providing modern sanitary products on girls’ schooling | Randomized controlled trial | Chitwan | 198 (99 control, 99treatment) | Menstruation has a very small impact on school attendance. Girls miss an estimated total of 0.4 days in a 180 day school year. Improved sanitary technology has no effect on reducing this (small) gap: girls who randomly received sanitary products were no less likely to miss school during their period |
18 | Pramanik 2010 | Journal of Institute of Medicine | To assess the relationship between the degree of stress and incidence of dysmenorrhea amongst the young Nepalese medical students | Prospective study | Kathmandu district | Young, unmarried, non-smoker female medical undergraduate students (age: 18-20 years, n = 104) having no pelvic pathology | Result indicated that the stress score is significantly higher (31.30 vs. 18.81) in women suffering from dysmenorrhea compared to women with normal menstruation |
19 | Adhikari 2007 | Kathmandu University Medical Journal | To evaluate the knowledge and practice on different aspects of menstrual hygiene among adolescent girls | Cross sectional study | Chitwan district | 150 young girls | Only 6.0% of girls knew that menstruation is a physiologic process, 36.7% knew that it is caused by hormones. Majority of them used disposable pads but were not aware of proper disposal practices |
20 | Padhye 2003 | Kathmandu University Medical Journal | To find out the incidence of Menstrual Morbidity and their mode of presentation | Prospective study | Kathmandu district | 525 female patients with menstrual problems | Menstrual morbidity was found to be 43.75%. More than 90% of women followed traditional rituals during menarche and more than 75% followed discriminating traditional rituals during every cycle |