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Knowledge, Attitudes, and Practices Regarding Menstrual Hygiene among Girls in Ghizer, Gilgit, Pakistan

Sanober Fazal Shah
Neelam Saleem Punjani
Syeda Naghma Rizvi
Sana Sadiq Sheikh
3 and
Rafat Jan
School of Nursing and Midwifery, Aga Khan University, Karachi 75950, Pakistan
Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
Tabba Heart Institute, Karachi 75950, Pakistan
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2023, 20(14), 6424;
Submission received: 8 May 2023 / Revised: 29 June 2023 / Accepted: 14 July 2023 / Published: 21 July 2023
(This article belongs to the Special Issue Adolescent and Youth Sexual and Reproductive Health and Rights)


Introduction: Menstrual hygiene is a critical issue encountered by women and girls of reproductive age that negatively affects their health and empowerment. It is still deemed a taboo subject in several parts of the world, and girls hesitate to discuss menstruation with their family members, friends, or schoolteachers, which creates hurdles when they experience their menarche. Girls residing in rural areas encounter more problems, since they lack proper resources and knowledge to manage their menstruation in school as well as at home. The purpose of this study was to evaluate the knowledge, attitudes, and practices regarding the menstrual hygiene of girls residing in rural areas of Gilgit, Pakistan. Methods: A descriptive cross-sectional design was used to assess the study questions. The consecutive sampling technique was applied to recruit 300 female participants from remote areas of Gilgit, Pakistan, who were 13 to 22 years old. A pre-tested questionnaire was utilized to collect the data, and SPSS version 21.0 was used to analyze them. Results: The study found that more than half of the participants had a poor level of knowledge and practices and negative attitudes towards menstrual hygiene. This could be due to many cultural and social factors associated with menstrual hygiene. Conclusions: The study concluded that the study participants were not knowledgeable about menstrual hygiene. They had poor practices and attitudes regarding menstrual hygiene. Hence, it is recommended that frequent sessions should be conducted by healthcare workers to enhance the knowledge of parents, teachers, and young girls, to increase their positive attitudes and practices regarding menstrual hygiene.

1. Introduction

According to the World Health Organization (WHO), sexual and reproductive health issues are a rising problem around the globe. Among them, menstrual hygiene is a critical issue encountered by women and girls of reproductive age that negatively affects their health and empowerment [1]. Across the globe, 1.8 billion girls menstruate each month, yet a major portion of this population lacks adequate knowledge as well as basic facilities to handle their menstruation in an appropriate and healthy way [2]. Moreover, menstruation is still deemed a taboo subject in several parts of the world [3,4]. The literature states that young people in low- and middle-income countries (LMICs) confront challenges related to menstruation and menstrual hygiene practices due to religious, cultural, and social constraints and due to incorrect information [5]. Moreover, girls residing in rural areas encounter more problems, since they lack the proper resources, skills, and knowledge to manage their menstruation in school as well as at home [6]. In Pakistan, menstruating girls have insufficient information about practices regarding menstruation and menstrual hygiene and, consequently, this impacts the wellbeing of such girls [7].
The WHO has defined adolescents as those aged 10 to 19 years, whereas young people range from 10 to 24 years of age. Adolescence and adulthood are crucial as such individuals experience major changes in their physical, hormonal, emotional, behavioral, and mental health. Young people are more likely to adopt unhealthy behaviors and encounter many problems related to their sexual and reproductive health [8]. Because of this transition, young girls face difficulties in managing their menstruation and are exposed to societal taboos [9] However, menstruation or menses is a normal process in females when they reach reproductive age [10].There is evidence that, both in developed and underdeveloped countries, girls experience the early onset of menstruation due to changes in lifestyle, environmental factors, and geographical location [11]. A study in Pakistan reported an age of 12 to 14 years for menarche [11]. The literature highlights that a lack of appropriate information at the first menstrual cycle creates many problems for girls in managing their menstrual hygiene [3,12]
The WHO and UNICEF’s joint monitoring program (JMP) has defined menstrual hygiene management as the usage of hygienic material for menstrual management, to absorb the blood of menstruating girls or women every month [13]. This can be changed as per need in an environment that provides privacy, respect, and comfort, and permits the washing of the hands and body, when required, with soap and clean water, as well as the ability to discard of the used materials properly. Improper menstrual hygiene management (MHM) can lead to low self-esteem, negative body image, and unsafe sexual practices [14]. Considering its impact on women’s lives, May 28th is celebrated as “Global Menstrual Hygiene Day”, which was introduced by WASH United to create awareness and to recognize the rights of girls to manage their menstruation hygienically [15].
Girls in developing countries encounter problems in managing menstruation properly because they lack the basic facilities of WASH (water, sanitation, and hygiene), proper information, a suitable environment, and support, which ultimately, affects their basic human rights to education, health, and privacy [16,17]. This is due to a lack of knowledge, improper awareness, and poor attitudes and practices towards menstruation and menstrual hygiene [5,9]. Additionally, several studies have revealed that the lack of availability of WASH facilities at schools, anxiety about blood dripping onto clothes, a lack of access to sanitary pads, and the poor attitudes of male students and teachers towards menstruation are linked with poor menstrual hygiene [18]. Moreover, girls residing in rural areas, and studying in lower classes, have demonstrated poor knowledge of menstruation [17,18] These factors ultimately affect the health of girls, thus becoming an issue of public health [17].
Moreover, another article has identified that insufficient knowledge and awareness about menstruation builds harmful practices and, thus, it can cause pelvic infections, cervical cancer, school dropouts, poor academic outcomes, and low standards of living [19]. The literature also states that more than 500 million females lack access to basic services for menstrual hygiene management, which is why they suffer from substantial challenges in maintaining menstrual hygiene in a safe and respectable manner [6]. This evidence indicates that there is a need to break the silence on menstruation and empower girls and women by educating them and enabling them to achieve their full potential. Thus, this descriptive study sought to evaluate the knowledge, attitudes, and practices (KAP) regarding menstrual hygiene of girls residing in rural areas in Gilgit, Pakistan.

2. Materials and Methods

This study employed a quantitative research design using the cross-sectional descriptive approach. It was conducted at two selected government educational institutions in the district of Ghizer. Ghizer is one of the 10 districts of Gilgit Baltistan, Pakistan. Punyal is the tehsil of Ghizer. The weather in this district is very cold; during the winter season, the temperature falls to 08 degrees Fahrenheit. As per the 2017 census, the total population of Ghizer is 170,000 [20]. Gahkuch is 72 km away from the main city, Gilgit, and it is the capital city of Ghizer. According to UNICEF Pakistan, the majority of the population of Ghizer is in the fourth (34%) quintile [21]. This indicates the poor socioeconomic status of the area. The reason for selecting this region was its convenient location, opportunities, and the availability of many students from different locations, cultures, and socioeconomic backgrounds. Moreover, the only female college in the territory of Punyal is located here. Hence, this allowed the researchers to collect data from a diverse group of students, within a limited timeframe.

2.1. Sampling Strategy and Sample Size

Consecutive sampling was applied to collect data from the participants. The sample size was determined using the Open Epi software version 3.01, with a significance level of 95% and a 5% margin of error. The total population of students from 7th grade to 12th grade was 625. The anticipated frequency taken from the previous literature was 50% [11]. The sample size after calculation was 239 participants, and when a 10% attrition rate was added, the sample size obtained was 265 girls. A total of 300 participants were included in the study.

2.2. Study Population

The participants who were selected for the collection of data were female students from 7th to 12th grade who had reached the age of menarche (the age limit was 13 to 24 years), who were willing to participate in the study and were residents of Ghizer, Gilgit, Pakistan. Moreover, they could easily understand and write in English or Urdu. However, participants who were not prepared to participate in the study and those who did not sign, or their guardian did not sign, the consent form were excluded from the study. To conduct the aforementioned study, approval was obtained from the Ethical Review Committee (ERC) of Aga Khan University, Pakistan. Participants were assured about their privacy, confidentiality, and anonymity throughout the study.

2.3. Data Collection Procedure

For the collection of data, a standardized questionnaire was used. The questionnaire to evaluate the knowledge, attitudes, and practices was taken from a study that was conducted and used in the context of Sindh, Pakistan [22]. However, a few modifications were made in the questions according to the study context, after obtaining permission from the primary author. The tool considered the demographic details of the participants and their knowledge, attitudes, and practices regarding menstrual hygiene. Moreover, multiple responses and single responses were included in the questionnaire. The study questionnaires were translated into the national language, Urdu, by Urdu language experts. Additionally, to eliminate any discrepancies, and to maintain the exact meaning and quality of the questionnaires, back-translation was performed by an independent expert who was not aware of the previous translation in both languages. A pilot study was carried out with 10% of the chosen sample, to rule out any inappropriateness and discrepancies in filling the questionnaire. The questionnaires were distributed and collected by the researchers.
Official permission was obtained from the education directors of Gilgit and the principals of the respective school and college. Eligible participants were asked to give their consent. The participants were thoroughly briefed about the purpose of the study, the risks and benefits, their voluntary participation, and their right to withdraw from the study whenever they wished. Likewise, parents/guardians were approached through the eligible participants and consent was also obtained from them. Furthermore, each guardian or parent’s consent form was checked by the researchers for their signatures and then an assent form was provided to the adolescents. The data collection was completed in three months, from May 2021 to July 2021.

2.4. Data Entry and Data Analysis

After the collection of data, the researchers checked the completed questionnaires for their completeness and accuracy. The data were than analyzed through the Statistical Package for Social Sciences (SPSS) version 21. The mean and standard deviation were calculated for continuous variables and frequencies and percentages for categorical variables. The frequencies and percentages have been presented via tables.

3. Results

3.1. Demographic Details of the Study Participants

In total, 300 young girls participated in the study, and the mean age (±standard deviation) of the study participants was 17.5 (±1.72) years, ranging from 13 to 22 years. The analysis of their fathers’ education showed that 33% (n = 99) had no formal education, whereas, regarding their mothers’ education, 65.3% (n = 196) had no education. Furthermore, participants were also asked if they had attended any class/orientation on menstrual hygiene, and the results showed that only 44.3% (n = 133) had been to an orientation/class on menstrual hygiene, and the provider of the orientation/class was a healthcare provider in 34% (n = 102) and a schoolteacher in 10.3% (n = 31) of cases. The demographic details are provided in Table 1.

3.2. Knowledge of Young Girls Regarding Menstrual Hygiene

It was interesting to observe that at the age of menarche, 51.7% (n = 155) were not aware of menstruation, and, among the participants who were aware, namely 47% (n = 141), their main source of information was their mother, representing 41.8% (n = 59). Most young girls, 48.3% (n = 145), mentioned that they had discussed their first periods with their mothers. With regard to the source of menstrual blood, very few participants, 32.3% (n = 97), knew that menstrual blood originated from the uterus: meanwhile, 59% (n = 177) did not know the answer. Moreover, regarding knowledge about menstrual absorbents, around 30% (n = 146) and 33.9% (n = 165) of the participants had heard about disposable pads and reusable cloths/towels, respectively. In addition, 45.7% (n = 137) of the respondents knew that women of reproductive age experienced menstruation, while 33% (n = 99) believed that only adolescent girls experienced menstruation. Almost an equal number of participants, 29% (n = 89) and 28.3% (n = 87), felt that menstruation was a sign of fertility and uncleanliness, respectively. When asked about the start of menstruation, around 68.8% (n = 207) correctly identified that it starts during adolescence. Table 2 shows the frequency distribution of the participants’ knowledge of menstrual hygiene.

3.3. Attitudes of Young Girls Regarding Menstrual Hygiene

The second aim of the study was to identify the attitudes of the target population. The analysis showed that around 37.6% (n = 141) of participants mentioned that washing the body during menstruation should be avoided, and 17.1% (n = 64) mentioned avoiding exercise. The majority of the girls, 38.2% (n = 137), were comfortable talking about or asking for advice on menstruation from their mothers, and 29% (n = 104) mentioned their sisters. Approximately 67.3% (n = 202) stated that they experienced anxiety and stress at their menarche, and, to solve this issue, the majority, namely 68.3% (n = 205), felt that their mothers/sisters/friends/relatives should tell them in advance. Additionally, 91% (n = 273) agreed that girls should be made aware before their first cycle, and approximately 42.8% (n = 238) stated that their mothers/sisters/friends/relatives should tell them. Table 3 shows the attitudes of young girls regarding menstrual hygiene.

3.4. Practices of Young Girls Regarding Menstrual Hygiene

Most of the study participants, 47.7% (n = 143), used reusable cloths/towels as menstrual absorbents, and 30.7% (n = 92) used disposable pads. Among those who used disposable pads, 24.7% (n = 74) burned them and only 6.3% (n = 19) of them used a dustbin. Among the respondents who used reusable absorbents, the majority of them washed them with soap and water; to dry the washed absorbent, 39.5% (n = 68) chose to dry it in the sun outside, whereas 29.1% (n = 50) hid it under other clothes. A major proportion of the participants, 90.1% (n = 263), reported that they stored the cleaned material in a closed area. During menstruation, nearly half of the young girls, 49.3% (n = 148), changed their absorbents twice a day, while 23% (n = 69) changed them once a day. Regarding the cleaning of the genitals and the area around the genitals, nearly equal numbers of participants, 38.7% (n = 116), mentioned using only water, and 38% (n = 114) mentioned using soap and water. Moreover, more than half, 59.3% (n = 178), reported bathing/washing their bodies when their periods were over. The majority of the girls avoided activities during menstruation, and the analysis showed that around 28.5% (n = 105) avoided washing the body, followed by those who avoided working outside home, at 20.1% (n = 74). Table 4 summarizes the frequency distribution of menstrual hygiene practices.

4. Discussion

A study in Nepal mentioned that 47.5% participants had heard about menstruation when they were at the age of 10–12 years [23], while, in the current study, more than half (51.3%) had heard about menstruation when they were 12–15 years. The current study found that all the participants had toilet facilities and soap at home, and 69.75% had soap at school/college; however, the availability of toilets was 100%. Nevertheless, this is not always the case. Other studies in Asian countries, including Pakistan [24,25] and Ethiopia [26], have found that schools have no proper toilet and sanitation facilities.
In 2019, UNICEF recommended including menstrual hygiene management in the curricula of primary schools, in the Asian and African region, so that young girls can learn about reproductive health and menstruation prior to their menarche [27]. However, this study found that more than half of the participants had not received education regarding menstrual hygiene at school/college. This could be due to a lack of attention towards menstrual hygiene in schools and colleges, as no topics are included regarding menstrual hygiene at the school level and teachers ignore such topics. A study in Quetta, Pakistan, reported that nearly 80% of the respondents had no prior education on menstrual hygiene [28]. A systematic review and meta-analysis in India concluded that there was little menstrual hygiene education in schools and this leads to the development of many misconceptions and poor practices regarding menstrual hygiene [29].

4.1. Knowledge of Young Girls Regarding Menstrual Hygiene

The results of this study revealed that the participants had a poor level of knowledge. This finding is contradicted by other studies carried out in Indonesia, with 66.6% [30], Nepal, with 87.7% [31], and Afghanistan, with 53.3% [32], where participants had good level of knowledge regarding menstrual hygiene. This could be due to the absence of proper sexual and reproductive health education at the school level, and the majority of the mothers (65.3%) being uneducated in the current study area. This was a hurdle in providing correct knowledge to young girls [33].
Moreover, it was also evident in the current study that a significant number of the participants were not aware of menstruation when they experienced their first periods. This finding is in contrast with a study performed in China, where the majority, 78.1%, of the participants already had knowledge of menstruation because their mothers had informed them about it [34]. However, results similar to those of the current study were also reported in India [35] and in Pakistan [36], where 51.7% and 82.5% of the participants, respectively, had no prior information about menstruation when they experienced their menarche. This can also be linked with social taboos and cultural influences in LMICs, where menstruation is still thought of as a shameful event and females are reluctant to discuss it openly [37]. This is why prior information about and awareness of menstrual hygiene is important.
The majority of the respondents (41.8%) in the present study mentioned their mothers as their main source of information regarding menstruation, followed by their sisters (31.6%). This may be because menstruation is a feminine process and girls feel more comfortable discussing it with their mothers and sisters. These findings are also reflected in a systematic review of LMICs, including Pakistan [5]. Moreover, the current study found that 48.3% of girls discussed their first menstruation with their mothers. A study in Ghana also documented that 61.8% of girls preferred to discuss the menarche with their mothers [38]. However, many studies have concluded that mothers and sisters in LMICs possess incorrect information about menstruation and this poor knowledge is transferred to young girls, which negatively affects their levels of knowledge and practices regarding menstrual hygiene [5,39].
Additionally, this study found that 20% of the participants were not aware of what to do at the time of menarche, and this could be because most of the girls were not aware of menstruation before the age of menarche. Almost similar results were mentioned in a study conducted in Ethiopia, South Sudan, Uganda, Tanzania, and Zimbabwe, where almost 66% of girls had no knowledge about the management of menstruation [40]. The root cause of these negative experiences may be the cultural stigma and the social context around menstruation, which is common worldwide [41].
It is very surprising that almost 59% of the respondents were unaware of the source of menstrual blood, and few of them correctly identified that menstrual blood originates from the uterus. This may be due to inappropriate information regarding menstruation obtained from the participants’ mothers/sisters, who were not educated, or because the participants had not attended any educational sessions on menstrual hygiene in their school/college. These results are aligned with other studies [11,28,42]. Almost equal proportions of girls in the study had heard about menstrual absorbents, which included disposable pads (30%) and reusable cloths/towels (33.9%). A similar study was conducted in Gambia, where approximately 97% of girls had knowledge about reusable cloths, while 87% were aware of disposable pads [43].
This study revealed that the majority of the girls (45.7%) knew that women of reproductive age experience menstruation, while 19% did not know. This can be explained by the fact that some students at the intermediate level had attended awareness sessions on menstrual hygiene, so they might have obtained the information from these. This was a unique finding in our study, as no other study was found that had assessed this type of knowledge. In the current study, despite having poor knowledge regarding menstruation, it was found that participants were mostly aware that menstruation was a natural process. Other studies in Pakistan, Ghana, Indonesia, Nigeria, Ethiopia, Bangladesh, and Nepal also found that a high number of girls knew that menstruation was a normal physiological process [12,30,44].
Another interesting finding was that nearly an equal number of participants reported menstruation as a sign of fertility (29%) and uncleanliness (28.3%), while 21.2% believed that it was sign of being ready to marry. The current study also found that only 4.7% of the girls were married. The possible reasons for the aforementioned findings, in the context of Gilgit, are that when girls start menstruating, they are considered to be mature enough to be married and bear children. However, studies from the United States, Ghana, and Pakistan found different results, where the majority of the girls reported that menstruation was a sign of puberty and adulthood [11,39,45]. Moreover, a major proportion of the sample in present study mentioned that menstruation started during adolescence. This is in line with other studies from Bhutan and Pakistan [12,46].

4.2. Attitudes of Young Girls Regarding Menstrual Hygiene

The findings of the current study showed both negative and positive attitudes regarding menstrual hygiene. This can be explained by the fact that many of the young girls had no prior information about menstruation when they experienced it for the first time, and, in rural areas, menstruation is associated with many taboos and the girls had grown up in such an environment. For example, they believe that girls become unclean when they are menstruating and they are not allowed to cook or wash utensils. These results are in line with other studies performed in Saudi Arabia and Nepal, where girls had negative attitudes regarding menstrual hygiene [23,39].
The majority of the participants stated that girls should not take baths or wash their bodies when menstruating, followed by some stating that they should not work outside the home. A possible reason for this could be that in Pakistani society, menstruation is thought to be a dirty process by many, and taking a bath during menstruation is believed to lead to the swelling of the body and to cause more bleeding [47]. Similar findings were reported in studies from Saudi Arabia and India [48,49]. Furthermore, this study found that many of the girls could comfortably talk about menstruation with their mothers and sisters, while approximately 9.7% preferred not to discuss it with anyone. This is because girls in Pakistani society are more connected to their mothers and sisters. Moreover, it is not considered appropriate in this region to discuss feminine topics with anyone else, such as male members of the family, as menstruation is considered a very sensitive topic to discuss. These findings are contradicted in other studies of LMICs [5,21].
This study further found that the girls were aware of their diet during menstruation; however, myths were strongly present, as many of them mentioned avoiding sweets and spicy food, while a few of them mentioned avoiding cold water. The findings about the avoidance of sweets were unique to this study. This could have been because of the belief in the study area that sweets cause more bleeding; meanwhile, many studies have mentioned the avoidance of cold water and sour and spicy foods [47,50]. Furthermore, the present study concluded that more than half of the participants experienced stress and anxiety at the onset of their menarche. A possible explanation for this could be a lack of prior awareness and guidance from parents and educational institutions regarding menstruation and its management, which ultimately creates anxiety, stress, and negative attitudes. The literature also shows similar findings, where girls mention stress, shame, and anxiety during menarche [3,51,52].
Moreover, a large number of girls felt that they should be made aware before menarche, and 42.8% of the girls suggested that their mothers, sisters, friends, relatives, or peers should tell them, while only 1.1% mentioned schoolteachers. This indicates that girls need more and accurate information on this natural phenomenon, which can help them to manage their menstrual hygiene without any problems. The possible reasons for the low percentage of schoolteachers could be that, in Gilgit, there is no concept of sexual and reproductive health in schools/colleges, and teachers are not trained to provide education in this area. They avoid discussions of such topics, although teachers could provide accurate information about menstrual hygiene. A scoping review of LMICs also reported that girls should be informed about menarche by their mothers, sisters, female friends, or teachers [53].

4.3. Practices of Young Girls Regarding Menstrual Hygiene

The current study found that the majority of the participants were using reusable cloths/towels as menstrual absorbents, and a lesser proportion of participants (30.7%) were using disposable pads. This could be due to financial issues, less awareness, the lower availability of disposable pads, hesitation in purchasing them from the market, and issues of disposal. These findings are not consistent with other studies, including those conducted in Pakistan, where the majority of girls were found to use disposable pads ([12,36,54,55,56]). Moreover, of those who used disposable materials, most of them burned them. The reason is that, in Gilgit, there are no proper waste management systems or garbage collectors, and girls are expected to burn their used pads at night.
This study also found that some good practices were followed by many of the participants, such as the use of soap and water to wash the reusable cloths/towels and drying them in the sun. A possible reason for this could be the wide availability of water and soap in schools and at home. These findings concur with other studies [36,42,43,57]. However, one study from Pakistan contradicts the current study’s findings, as it found that the majority of girls dried their reusable pads in dark and hidden places [47]. The present study also found that nearly all young girls stored the clean material in closed areas (box/drawer/closet/clean bag). The findings of a few other studies reflect those of the current study [58,59].
The literature has mentioned that a greater proportion of girls change their soaked pads twice a day [12,54,57]. These results are in alignment with the current study, where the majority of the study participants changed their pads twice a day. Studies in other parts of Pakistan have documented that the majority of girls clean their genitals with water only [12,36]. However, the current study revealed more encouraging findings, where almost equal numbers of girls used water and soap to clean their genitals. This could be attributed to the fact that a few participants from high schools received awareness sessions on menstrual hygiene from healthcare workers, so they might have learnt this practice from them. This study also investigated the bathing practices of young girls during menstruation, and a major proportion of the girls (59.3%) bathed/washed their bodies when their periods were over. This may be because of the social stigma attached to menstruation, the cold weather of Gilgit, and the unavailability of warm water. These findings are supported by a few studies conducted in Pakistan and other countries [12,60]; however, a systematic review of LMICs concluded that girls from Turkey, Nigeria, Kenya, Iran, and Egypt bathed daily [5].
The present study also found that the majority of the participants avoided working outside the home and avoided taking a bath or washing the body when menstruating, while a few participants (19.8%) avoided exercise. This may be due to the restrictions of society, related to the myth that, during menstruation, girls are more vulnerable to evil spirits and disease, and they can bring embarrassment to the family if blood stains are found on their clothes. These findings are also reflected in studies from Pakistan [47,60], India [61], Nepal [62], and Saudi Arabia [63].

4.4. Strengths, Limitations, and Future Research

The findings of this study have provided baseline data in the context of Gilgit about the knowledge, attitudes, and practices regarding menstrual hygiene, which can be used for future studies; to the best of the researchers’ knowledge, this is the first study that has been conducted in Gilgit, Pakistan. However, one of the limitations is that, due to time constraints and a limited budget, this study was conducted only in one district of Gilgit.
The findings of this study can be used to assess the KAP of young girls who do not attend school or who are studying in private institutions. Furthermore, an interventional study should be conducted to assess the results of educational programs on knowledge, attitudes, and practices regarding menstrual hygiene. Nurses and female health workers could play a central role in providing up-to-date and reliable information through outreach programs. This could contribute to improving the sexual and reproductive health of adolescents and young girls, as well as the whole community.

5. Conclusions

This study concludes that menstrual hygiene is a great challenge for young girls residing in rural areas. The study findings show that girls have a poor level of knowledge, attitudes, and practices regarding menstrual hygiene. The health sector and school authorities should play a greater role in creating awareness about menstrual hygiene.

Author Contributions

Conceptualization, R.J. and S.F.S.; methodology, R.J., S.F.S., S.N.R. and S.S.S.; software, S.F.S.; validation, R.J., S.F.S., S.N.R. and S.S.S.; formal analysis, R.J., S.F.S., S.N.R. and S.S.S.; investigation, S.F.S.; writing—original draft preparation, R.J., S.F.S., S.N.R., N.S.P. and S.S.S.; writing—review and editing, R.J., S.F.S., S.N.R., N.S.P. and S.S.S.; supervision, R.J. All authors have read and agreed to the published version of the manuscript.


This research received no external funding.

Institutional Review Board Statement

The ethics approval was obtained from the Aga Khan University, Ethics Review Committee (2021-5981-17619).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.


The authors wish to thank the adolescents who participated in this study, the teachers, and the education department of Gilgit, Pakistan. This research was supported by funding from the HRP Alliance, part of the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored program executed by the World Health Organization (WHO), to complete our studies. This article represents the views of the named authors only and does not represent the views of the World Health Organization.

Conflicts of Interest

The authors declare no conflict of interest.


  1. WHO. Adolescent Health in the South-East Asia Region. 2021. Available online: (accessed on 15 December 2022).
  2. UNICEF. Menstrual Hygiene. Gender Inequality, Cultural Taboos and Poverty Can Cause Menstrual Health Needs to Go Unmet. 2021. Available online: (accessed on 30 January 2022).
  3. Setyowati Rizkia, M.; Ungsianik, T. Improving Female Adolescents’ Knowledge, Emotional Response, and Attitude toward Menarche following Implementation of Menarcheal Preparation Reproductive Health Education. Asian Pac. Isl. Nurs. J. 2019, 4, 84–91. [Google Scholar] [CrossRef] [Green Version]
  4. Medina-Perucha, L.; Jacques-Aviñó, C.; Valls-Llobet, C.; Turbau-Valls, R.; Pinzón, D.; Hernández, L.; Canseco, P.B.; López-Jiménez, T.; Lizarza, E.S.; Berenguera, A.; et al. Menstrual health and period poverty among young people who menstruate in the Barcelona metropolitan area (Spain): Protocol of a mixed-methods study. BMJ Open 2020, 10, e035914. [Google Scholar] [CrossRef]
  5. Chandra-Mouli, V.; Patel, S.V. Mapping the knowledge and understanding of menarche, menstrual hygiene and menstrual health among adolescent girls in lowand middle-income countries. Reprod. Health 2017, 14, 30. [Google Scholar] [CrossRef] [Green Version]
  6. Kaur, R.; Kaur, K.; Kaur, R. Menstrual hygiene, management, and waste disposal: Practices and challenges faced by girls/women of developing countries. J. Environ. Public Health 2018, 2018, 1730964. [Google Scholar] [CrossRef]
  7. Gottlieb, A. Menstrual taboos: Moving beyond the curse. In The Palgrave Handbook of Critical Menstruation Studies; Springer Nature Singapore Pte Ltd.: Singapore, 2020; pp. 143–162. [Google Scholar]
  8. Ali, S.A.; Baloch, M.; Riaz, L.; Iqbal, A.; Riaz, R.; Perveen, B.; Siddiqui, M.; Ali, A.A. Perceptions, practices, and challenges regarding menstrual hygiene among women in Karachi, Pakistan: A comparison between general population and healthcare workers. Cureus 2020, 12, e9894. [Google Scholar] [CrossRef]
  9. Meena, P.; Bhojwani, P.; Verma, G.S. A Kap study on menstrual hygiene in adolescent girls. Hindu 2018, 150, 63–68. [Google Scholar] [CrossRef]
  10. UNICEF Pakistan. UNICEF Launches Campaign to Promote Positive Menstrual Hygiene in Pakistan. 2018. Available online: (accessed on 15 December 2022).
  11. Mansoor, H.; Salman, M.; Asif, N.; Mustafa, Z.U.; Nawaz, A.S.; Mohsin, J.; Arif, B.; Sheikh, A.; Shehzadi, N.; Masood, A.; et al. Menstrual knowledge and practices of Pakistani girls: A multicenter, cross-sectional study. Heliyon 2020, 6, e03157. [Google Scholar] [CrossRef] [Green Version]
  12. Michael, J.; Iqbal, Q.; Haider, S.; Khalid, A.; Haque, N.; Ishaq, R.; Bashaar, M. Knowledge and practice of adolescent females about menstruation and menstruation hygiene visiting a public healthcare institute of Quetta, Pakistan. BMC Women’s Health 2020, 20, 1–8. [Google Scholar] [CrossRef] [Green Version]
  13. UNICEF. Guidance on Menstrual Health and Hygiene. 2019. Available online: (accessed on 15 December 2022).
  14. MacRae, E.R.; Clasen, T.; Dasmohapatra, M.; Caruso, B.A. ‘It’s like a burden on the head’: Redefining adequate menstrual hygiene management throughout women’s varied life stages in Odisha, India. PLoS ONE 2019, 14, e0220114. [Google Scholar] [CrossRef] [Green Version]
  15. UNICEF. A Knowledge, Attitude, and Practices Study in Bhutan. 2018. Available online: (accessed on 15 December 2022).
  16. Human Rights Watch. “Going to the Toilet When You Want” Sanitation as a Human Right. 2017. Available online: (accessed on 15 December 2022).
  17. Kuhlmann, A.S.; Henry, K.; Wall, L.L. Menstrual hygiene management in resource-poor countries. Obstet. Gynecol. Surv. 2017, 72, 356. [Google Scholar] [CrossRef] [Green Version]
  18. Davis, J.; MacIntyre, A.; Odagiri, M.; Suriastini, W.; Cordova, A.; Huggett, C.; Agius, P.A.; Faiqoh; Budiyani, A.E.; Quillet, C.; et al. Menstrual hygiene management and school absenteeism among adolescent students in Indonesia: Evidence from a cross-sectional schoolbased survey. Trop. Med. Int. Health 2018, 23, 1350–1363. [Google Scholar] [CrossRef]
  19. Belayneh, Z.; Mekuriaw, B. Knowledge and menstrual hygiene practice among adolescent school girls in southern Ethiopia: A cross-sectional study. BMC Public Health 2019, 19, 1595. [Google Scholar] [CrossRef]
  20. Planning and Development Department Gilgit-Baltistan. 2017. Available online: (accessed on 15 December 2022).
  21. Unicef Pakistan. Gilgit-Baltistan Multiple Indicator Cluster Survey 2016–2017. Available online: (accessed on 15 December 2022).
  22. Wasan, Y.; Baxter, J.A.B.; Rizvi, A.; Shaheen, F.; Junejo, Q.; Abro, M.A.; Hussain, A.; Ahmed, I.; Soofi, S.B.; Bhutta, Z.A. Practices, and Predictors of Menstrual Hygiene Management Material Use Among Adolescent and Young Women in Rural Pakistan. A Cross-Sectional Study. J. Glob. Health 2020, 12, 04059. [Google Scholar] [CrossRef]
  23. Yadav, R.N.; Joshi, S.; Poudel, R.; Pandeya, P. Knowledge, Attitude, and Practice on Menstrual Hygiene Management among School Adolescents. J. Nepal. Health Res. Counc. 2018, 15, 212–216. [Google Scholar] [CrossRef] [Green Version]
  24. Alam, M.U.; Luby, S.P.; Halder, A.K.; Islam, K.; Opel, A.; Shoab, A.K.; Ghosh, P.K.; Rahman, M.; Mahon, T.; Unicomb, L. Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: Results from a cross-sectional survey. BMJ Open 2017, 7, e015508. [Google Scholar] [CrossRef]
  25. National Institute of Population Studies (Pakistan); Macro International; Institute for Resource Development; Demographic & Health Surveys. Pakistan Demographic and Health Survey; National Institute of Population Studies: Islamabad Capital Territory, Pakistan, 2012. [Google Scholar]
  26. Alemu, G.; Abossie, A.; Yohannes, Z. Current status of intestinal parasitic infections and associated factors among primary school children in Birbir town, Southern Ethiopia. BMC Infect. Dis. 2019, 19, 1–8. [Google Scholar] [CrossRef] [Green Version]
  27. UNICEF. Menstrual Hygiene Management in Ethiopia: National Baseline Report from Six Regions of Ethiopia; UNICEF: New York, NY, USA, 2017. [Google Scholar]
  28. Sommer, M.; Hirsch, J.S.; Nathanson, C.; Parker, R.G. Comfortably, safely, and without shame: Defining menstrual hygiene management as a public health issue. Am. J. Public Health 2015, 105, 1302–1311. [Google Scholar] [CrossRef]
  29. Sharma, S.; Mehra, D.; Brusselaers, N.; Mehra, S. Menstrual hygiene preparedness among schools in India: A systematic review and meta-analysis of 83 system-and policy-level actions. Int. J. Environ. Res. Public Health 2020, 17, 647. [Google Scholar] [CrossRef] [Green Version]
  30. Andani, P.R. Knowledge, Attitude and Practice of Menstrual Hygiene among Primary School Adolescents in Surabaya, Indonesia. Indian J. Forensic Med. Toxicol. 2020, 14, 1109–1114. [Google Scholar]
  31. Bhusal, C.K. Practice of menstrual hygiene and associated factors among adolescent school girls in Dang district, Nepal. Adv. Prev. Med. 2020, 2020, 1292070. [Google Scholar] [CrossRef] [PubMed]
  32. Neyazi, A.; Faizi, G.; Afzali, H.; Ahmadi, M.; Razaqi, N.; Frough, Z.; Bhattacharya, S. Assessment of Knowledge, Attitude and Practice about the Menstruation among Secondary School Girls in Herat, Afghanistan—A Cross Sectional Study. 2021. Available online: (accessed on 15 December 2022).
  33. Deshmukh, V.; Sandhu, G.K.; Rachakonda, L.; Kakde, M.; Andurkar, S. Knowledge, attitudes and practices (KAP) regarding menstruation among girls in Aurangabad, India and their correlation with sociodemographic factors. Int. J. Reprod. Contracept. Obstet. Gynecol. 2019, 8, 980. [Google Scholar] [CrossRef] [Green Version]
  34. Borjigen, A.; Huang, C.; Liu, M.; Lu, J.; Peng, H.; Sapkota, C.; Sheng, J. Status and Factors of Menstrual Knowledge, Attitudes, Behaviors and Their Correlation with Psychological Stress in Adolescent Girls. J. Pediatr. Adolesc. Gynecol. 2019, 32, 584–589. [Google Scholar] [CrossRef] [PubMed]
  35. Mathiyalagen, P.; Peramasamy, B.; Vasudevan, K.; Basu, M.; Cherian, J.; Sundar, B. A descriptive cross-sectional study on menstrual hygiene and perceived reproductive morbidity among adolescent girls in a union territory, India. J. Fam. Med. Prim. Care 2017, 6, 360–365. [Google Scholar] [CrossRef]
  36. Usman, G.; Abbas, K.; Arshad, R.; Muneer, A.; Syed, H.S.; Iqbal, A.; Dar, F.N.; Anum, U.; Ahmed, M.; Tehreem, K.; et al. Knowledge and practice of menstrual hygiene management among women living in a low-income neighbourhood, Karachi, Pakistan. Int. J. Reprod. Contracept. Obstet. Gynecol. 2020, 9, 3953–3958. [Google Scholar] [CrossRef]
  37. Zakaria, M.; Xu, J.; Karim, F.; Cheng, F. Reproductive health communication between mother and adolescent daughter in Bangladesh: A cross-sectional study. Reprod. Health 2019, 16, 1–12. [Google Scholar] [CrossRef] [Green Version]
  38. Ahmad, A.; Garg, S.G.; Gupta, S.; Alvi, R. Knowledge and practices related to menstruation among Lucknow college students in North India: Results from a cross-sectional survey. medRxiv 2021. [Google Scholar] [CrossRef]
  39. Yiadom, A.; Aladago, D.A.; Beweleyir, J.; Mohammed, H.B.; Salifu, M.F.; Asaarik, M. Assessing the knowledge, attitude and practice of menstrual hygiene management among junior high schools adolescent females in the Yendi Municipality in the Northern region of Ghana. ESJ 2018, 14, 467. [Google Scholar]
  40. Tamiru, S.; Mamo, K.; Acidria, P.; Mushi, R.; Ali, C.S.; Ndebele, L. Towards a sustainable solution for school menstrual hygiene management: Cases of Ethiopia, Uganda, South-Sudan, Tanzania, and Zimbabwe. Waterlines 2015, 34, 92–102. [Google Scholar] [CrossRef] [Green Version]
  41. Thomson, J.; Amery, F.; Channon, M.; Puri, M. What’s missing in MHM? Moving beyond hygiene in menstrual hygiene management. Sex. Reprod. Health Matters 2019, 27, 12–15. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  42. Jyothi, B.; Hurakadli, K. Knowledge, practice and attitude of menstrual hygiene among school going adolescent girls: An interventional study in an urban school of Bagalkot city. Med. Innov. 2019, 8, 16–20. [Google Scholar]
  43. Shah Nabwera, H.M.; Sosseh, F.; Jallow, Y.; Comma, E.; Keita, O.; Torondel, B. A rite of passage: A mixed methodology study about knowledge, perceptions and practices of menstrual hygiene management in rural Gambia. BMC Public Health 2019, 19, 277. [Google Scholar] [CrossRef]
  44. Fehintola, F.O.; Fehintola, A.O.; Aremu, A.O.; Idowu, A.; Ogunlaja, O.A.; Ogunlaja, I.P. Assessment of knowledge, attitude and practice about menstruation and menstrual hygiene among secondary high school girls in Ogbomoso, Oyo state, Nigeria. Int. J. Reprod. Contracept. Obstet. Gynecol. 2017, 6, 1726–1732. [Google Scholar] [CrossRef] [Green Version]
  45. Turner, M.; Huseth-Zosel, A.; Ostlund, R. Menstruation Experiences of Middle and High School Students in the Midwest: A Pilot Study. J. Sch. Nurs. 2020, 38, 1059840520974234. [Google Scholar]
  46. UNICEF. Gender Action Plan 2018–2021|UNICEF. Available online: (accessed on 15 December 2022).
  47. Mumtaz, Z.; Sivananthajothy, P.; Bhatti, A.; Sommer, M. “How can we leave the traditions of our Baab Daada” socio-cultural structures and values driving menstrual hygiene management challenges in schools in Pakistan. J. Adolesc. 2019, 76, 152–161. [Google Scholar] [CrossRef] [PubMed]
  48. Gaferi, S.M.; Al-Harbi, M.F.; Yakout, S.M.; Soliman, A.T. Knowledge, attitude and practice related to reproductive health among female adolescents. J. Nurs. Educ. Pract. 2018, 8, 53–65. [Google Scholar] [CrossRef]
  49. Patel, S.; Vernekar, S.P.; Desai, A.M. A Study on the Knowledge, Attitude and Practices Regarding Menstrual Hygiene among Adolescent Girls in Schools in a Rural Area of Goa. J. Clin. Diagn. Res. 2019, 13, 2023050845. [Google Scholar] [CrossRef]
  50. Alharbi, K.K.; Alkharan, A.A.; Abukhamseen, D.A.; Altassan, M.A.; Alzahrani, W.; Fayed, A. Knowledge, readiness, and myths about menstruation among students at the Princess Noura University. J. Fam. Med. Prim. Care 2018, 7, 1197–1202. [Google Scholar] [CrossRef]
  51. AKU. Menstrual Hygiene Management. 2020. Available online: (accessed on 15 December 2022).
  52. Hennegan Shannon, A.K.; Rubli, J.; Schwab, K.J.; Melendez-Torres, G.J. Women’s and girls’ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis. PLoS Med. 2019, 16, e1002803. [Google Scholar] [CrossRef] [Green Version]
  53. Coast, E.; Lattof, S.R.; Strong, J. Puberty and menstruation knowledge among young adolescents in low-and middle-income countries: A scoping review. Int. J. Public Health 2019, 64, 293–304. [Google Scholar] [CrossRef] [Green Version]
  54. Bhatt, M.D.; Kadam, D.M. Knowledge, Attitude and Practice Regarding Menstrual Hygiene among Adolescent Girls in a Rural Private School. 2020. Available online: (accessed on 15 December 2022).
  55. Dwivedi, R.; Sharma, C.; Bhardwaj, P.; Singh, K.; Joshi, N.; Sharma, P.P. Effect of peer educator-PRAGATI (PeeR Action for Group Awareness through Intervention) on knowledge, attitude, and practice of menstrual hygiene in adolescent school girls. J. Fam. Med. Prim. Care 2020, 9, 3593–3599. [Google Scholar] [CrossRef]
  56. Habtegiorgis, Y.; Sisay, T.; Kloos, H.; Malede, A.; Yalew, M.; Arefaynie, M.; Damtie, Y.; Kefale, B.; Tegegne, T.B.; Addisu, E.; et al. Menstrual hygiene practices among high school girls in urban 76 areas in Northeastern Ethiopia: A neglected issue in water, sanitation, and hygiene research. PLoS ONE 2021, 16, e0248825. [Google Scholar] [CrossRef] [PubMed]
  57. Poudel, S.; Gautam, D. Knowledge and Practices on Menstrual Hygiene Management Among Adolescent Girls of Kaski District, Nepal. Int. J. Soc. Sci. Manag. 2020, 7, 169–175. [Google Scholar] [CrossRef]
  58. Enzler, D.M. Knowledge, Attitudes and Practices Concerning Menstrual Hygiene Management (MHM) of Adolescents in Rural Primary Schools in Malawi. 2019. Available online: (accessed on 15 December 2022).
  59. Rastogi, S.; Khanna, A.; Mathur, P. Uncovering the challenges to menstrual health: Knowledge, attitudes and practices of adolescent girls in government schools of Delhi. Health Educ. J. 2019, 78, 839–850. [Google Scholar] [CrossRef]
  60. Rizvi, N.; Ali, T.S. Misconceptions and Mismanagement of Menstruation among Adolescents Girls who do not attend School in Pakistan. J. Asian Midwives 2016, 3, 46–62. [Google Scholar]
  61. Vashisht, A.; Pathak, R.; Agarwalla, R.; Patavegar, B.N.; Panda, M. School absenteeism during menstruation amongst adolescent girls in Delhi, India. J. Fam. Community Med. 2018, 25, 163. [Google Scholar]
  62. Morrison, J.L.; Basnet, M.; Anju, B.; Khimbanjar, S.; Chaulagain, S.; Baral, S.; Hodgkin, M. Girls’ menstrual management in five districts of Nepal: Implications for policy and practice. Stud. Soc. Justice 2018, 12, 252–272. [Google Scholar] [CrossRef]
  63. Al Mutairi, H.; Jahan, S. Knowledge and practice of self-hygiene during menstruation among female adolescent students in Buraidah city. J. Fam. Med. Prim. Care 2021, 10, 1569. [Google Scholar] [CrossRef]
Table 1. Demographic characteristics of the study participants (n = 300).
Table 1. Demographic characteristics of the study participants (n = 300).
VariableFrequency (n)Percentage (%)
Age in years (mean ± SD) 17.55 ± 1.7242
Class of study
            7th–10th grade 9531.70%
            11th–12th grade 20468.20%
Elder sister
            Yes 21270.30%
            No 8829.30%
Father’s education
            No education 9933%
            Primary education 134.30%
            Middle education 4214%
Secondary education 6120.30%
Intermediate 5016.70%
Bachelor’s and above 3612%
Mother’s education
No education 196 65.30%
Primary education 20 6.70%
Middle education 3712.30%
Secondary education 30 10%
Intermediate 13 4.30%
Bachelor’s and above 4 1.30%
Toilet facility at
home 300 100%
Toilet facility at school/college 300100%
Soap for washing at home 300100%
Soap for washing at school/college
Yes 209 69.70%
No 91 30.30%
Facilities at home
TV 266 56.10%
Radio 64 13.50%
Internet 14430.40%
First heard about menstruation
˂10 years 12 4%
10–12 years 99 33%
12–15 years 154 51.30%
˃15 years 35 11.70%
Age at menarche
Before 11 years 5 1.70%
12–14 years 140 46.70%
15–16 years 134 44.40%
Over 16 years 21 7%
Table 2. Knowledge of young girls regarding menstrual hygiene (n = 300).
Table 2. Knowledge of young girls regarding menstrual hygiene (n = 300).
VariableFrequency (n)Percentage (%)
Discussed first periods
            Mother 14548.30%
            Sister 112 37.30%
            Grandmother 1 0.30%
            Friend 30 10%
            No one 12 4%
At first period, were you already aware of it?
            Yes 141 47%
            No 15551.70%
            Do not remember 4 1.30%
If yes, source of information
            I was informed directly by teacher 6 4.30%
I was informed directly by mother 59 41.80%
I was informed directly by sister 45 31.60%
I was informed directly by friends/peers 20 14.20%
I indirectly came to know from mother 4 2.80%
I indirectly came to know from sister 7 5%
Where does the menstrual blood come from?
Uterus 97 32.30%
Abdomen 26 8.70%
I don’t know 177 59%
Who experiences menstruation?
Ill and injured women 4 1.30%
Women of reproductive age 137 45.70%
Adolescent girls only 99 33.30%
Women who have had children 3 1%
Do not know 57 19%
Menstruation is
Natural process 276 96.50%
Disease 7 2.40%
Secret 1 0.30%
Do not know 16 0.70%
Menstruation is a sign of
Something has gone wrong 11 3.60%
Being ready to marry 65 21.20%
Fertility 89 29%
Uncleanliness 8728.30%
Do not know5517.90%
When does menstruation usually start?
When someone is sexually active 22 7.30%
During adolescence 207 68.80%
Do not know 72 23.90%
Table 3. Attitudes of young girls regarding menstrual hygiene (n = 300).
Table 3. Attitudes of young girls regarding menstrual hygiene (n = 300).
VariableFrequency (n = 300)Percentage (%)
Activities to be avoided during menstruation
            Going to school287.50%
            Working outside home5715.20%
            Washing the body/bathing14137.60%
            Touching stored food/utensils71.90%
            Talking to boys154%
            None of these4411.70%
Talk about menstruation comfortably
            No one 359.70%
Other family members/relatives10.30%
Friends/female peers339.20%
Health workers4713.10%
What kinds of problems do girls face at menarche?
Feel anxiety and stress20267.30%
She thinks she has a medical problem175.70%
She is unaware of what to do3411.30%
She does not share with anyone 279%
She does not face any problems206.70%
Girls should be made aware before first cycle
Do not know72.30%
If yes, who should tell her?
Mother, sister, friend, relatives, or peers23842.80%
A health worker397%
Table 4. Practices of young girls regarding menstrual hygiene (n = 300).
Table 4. Practices of young girls regarding menstrual hygiene (n = 300).
VariableFrequency (n)Percentage (%)
Absorbent usually used during menstruation
            New cloth3411.30%
            Disposable pads (available in market)9230.70%
            Tissue/toilet roll186%
Reusable cloth/towel14347.70%
What do you do with the used disposable material (disposable material users only)?
            Get rid of it in a field/bush10.30%
            Put it into the latrine227.30%
            Use waste bin196.30%
            Burn them7424.70%
            Other (bury in the land)82.70%
What do you do with the used reusable material (reusable material users only)?
I wash it with water and soap/detergent and keep it for next use14548.30%
I wash it only with water251.70%
I do not wash10.30%
Dry the washed absorbent (reusable material users only)
In the sun outside6839.50%
In the shade outside1810.50%
Hide under other clothes5029.10%
In the room inside3520.30%
How often do you change the absorbent?
Once a day6923%
Twice a day14849.30%
Three times or more a day8227.30%
I do not change10.30%
Materials used to clean genitals and area around genitals
Water only11638.70%
Soap and water11438%
Plain paper/tissue4113.70%
How often do you bathe/wash your body during your period?
Every second day5217.30%
Every third day 5819.30%
When period is finished17859.30%
Activities avoided during menstruation
Going to school318.40%
Working outside home7420.10%
Washing body10528.50%
Touching stored food/utensils102.70%
Talking to boys102.70%
None of these339%
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MDPI and ACS Style

Shah, S.F.; Punjani, N.S.; Rizvi, S.N.; Sheikh, S.S.; Jan, R. Knowledge, Attitudes, and Practices Regarding Menstrual Hygiene among Girls in Ghizer, Gilgit, Pakistan. Int. J. Environ. Res. Public Health 2023, 20, 6424.

AMA Style

Shah SF, Punjani NS, Rizvi SN, Sheikh SS, Jan R. Knowledge, Attitudes, and Practices Regarding Menstrual Hygiene among Girls in Ghizer, Gilgit, Pakistan. International Journal of Environmental Research and Public Health. 2023; 20(14):6424.

Chicago/Turabian Style

Shah, Sanober Fazal, Neelam Saleem Punjani, Syeda Naghma Rizvi, Sana Sadiq Sheikh, and Rafat Jan. 2023. "Knowledge, Attitudes, and Practices Regarding Menstrual Hygiene among Girls in Ghizer, Gilgit, Pakistan" International Journal of Environmental Research and Public Health 20, no. 14: 6424.

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