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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Menstrual Hygiene Practices, Social Taboo and Attitude towards it- A Community-based Cross-sectional Study among Young Women in a Rural Area of West Bengal, India
Correspondence Address :
Dr. Amrita Samanta,
10/7, Jyangra Ghosh Para Road, Merlin Daffodil, Flat No: 1F, Kolkata-700059, West Bengal, India.
E-mail: amritasmnt@yahoo.co.in
Introduction: In developing countries like India, awareness about menstrual hygiene is limited among women leading to stigma, restriction of social activities and various menstrual and urogenital ill-health among women.
Aim: To find out the menstrual hygiene practices, social taboos and attitude towards it among 15-24 years aged women of a rural area of West Bengal, India.
Materials and Methods: This observational descriptive study with cross-sectional design was conducted during September-December 2019, among 110 young women in the age group of 15-24 year residing in Amdanga community development block. Multistage sampling technique was adopted and data was collected by interviewing study subjects with a predesigned, pretested and semi-structured questionnaire. Data were analysed with the Statistical Package for the Social Sciences (SPSS) software (version 20.0). Proportion and Chi-square test were applied where applicable. The p-value <0.05 was taken as significant.
Results: Nearly 80% of the study subjects used only sanitary napkins. Disposal of used pads under the soil was most common practice. Restrictions to social activities like taking part in religious activity, going outdoor, kitchen and household work were reported by 100%, 85.45%, 58.18% and 74.54% participants, respectively. A 64% of study subjects were unaware of menstruation before menarche. Statistically significant association was observed between socio-economic condition and number of sanitary pad use, (p<0.0001) and school absenteeism, (p=0.011634). Education above primary level was positively associated (p<0.00001) with awareness about menstruation before menarche.
Conclusion: The study conveyed that wide spread social stigma, restrictions and poor attitude still exists in this rural community about menstruation which is affecting safe disposal of used absorbents and overall health of women.
Menarche, Menstruation, School absenteeism, Stigma
Menarche begets the reproductive period in a women’s life. It is the beginning of a multitude of physical, physiological and psychological changes in the lives of girls (1). Menarche and menstruation is special event in every girl’s life which is related to various hygiene, health and social aspects of life. In developing countries like India, awareness about health and hygiene related to menstruation and its social determinants is very limited among women (2). Large number of girls has little knowledge about menstruation until their first experience because menstruation is something that is usually kept secret in the homes and outside (3),(4). Better understanding of the good menstrual hygiene is crucial for the overall and reproductive health of the women, as researches worldwide showed that unhealthy MHM during menstruation have been associated with serious ill-health ranging from genital tract infections, urinary tract infections, and bad odour (5). Unhealthy menstrual practices encompass inadequately washing genitalia regularly, using unclean cloth etc., (6).
Menstrual hygiene is a multisectoral issue that requires an integrated approach from the Department of Education, Health, Women and Child Development and Water Sanitation Hygiene (WASH) (7). Recently Government of India (GOI) has taken different steps addressing this public health issue. In National Rural Health Mission in 2005, menstrual hygiene promotion was formally included as a key responsibility of the community health workers (Accredited Social Health Activist; ASHA) followed by the implementation of menstrual hygiene promotion scheme for girls in rural areas in 2011 (8). The Ministry of Drinking Water and Sanitation published guidelines on MHM 2015 (9). At the same time at national and international level there is a lot of push to address this issue at various social media platforms resulting in wide spread menstrual hygiene campaigns, commencement of trials on eco-friendly menstrual products, implementation of comprehensive sexuality education in schools, etc., (10). Different qualitative research worldwide reported that the factors affecting school absenteeism are multiple like girls’ fear and humiliation from leaking of blood, body odour etc., (10),(11),(12). Variety of cultural taboos increase young women’s difficulties, preventing them from seeking help (12),(13), and impose various restrictions on their diet and social personal activities like taking part in religious activities, cooking, bathing, sex during menstruation (13),(14). Study conducted in South India showed that during rituals on attainment of puberty, young girls are imparted with knowledge about menstruation which mostly consists of restrictions on her movements and behaviour during menstruation along with some superstitions (15).
According to National Family Health Survey-4 (NFHS-4) (16), in West Bengal, the proportion of women aged between 15-24 years using hygienic methods during menstruation was 72.9% in urban area and 47.6% in rural population. Same findings have been found in similar studies (3),(17). Poverty, poor access to sanitary pads are common factors that lead to poor menstrual hygiene and these are more profound in rural areas compared to urban areas (18). Although many studies have been conducted (2),(19),(20),(21),(22),(23),(24) on menstrual hygiene in rural West Bengal, very few threw light on social stigma and taboo related to the issue (25). With this background, the current study was conducted to find out the practices and social taboo related to menstrual hygiene and attitude towards it among 15-24 years aged women of a rural area of West Bengal, India.
This observational descriptive study with cross-sectional design was conducted during September-December 2019 among 110 young women in the age group of 15-24 year residing in the Amdanga community development block which is field service area of Department of Community Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India.
Study protocol was sent to the Institutional Ethics Committee (IEC) and after their approval data collection was started. (Letter No. RKC/Ethics/25, dated 19.5.18). Informed written consent was taken from every study participant prior interview. Measures were taken to ensure the confidentiality and privacy of the all study participants, while intervening and examination.
Inclusion criteria: Those women, who were residing in the area atleast for last one year, aged 15-24 years and attained menarche, were included into the study.
Exclusion criteria: Young women who were severely sick and unable to understand the questionnaire and who did not gave informed written consent were excluded from the study.
Sample size calculation: According to NFHS-4 (16), the proportion of women aged between 15-24 years using hygienic methods during menstruation in rural area was 47.6%. Using this proportion in the formula N=(z?)2pq/l2, the sample size comes to be 100 (z?=standard normal deviate, p=proportion, q=1-p, l=absolute precision=10%), taking the 10% extra for non response, the final sample size calculated was 110.
Study Procedure
The Amdanga community development block consists of 25 sub-centres and 81 villages. For the feasibility purpose from 81 villages, 10% i.e., 8 villages were randomly selected. From this eight villages, list of households were collected from the local administration with the help of ASHA workers. From eight villages, 110 households were selected randomly from all the households according to probability proportion of population size (ppps). From each household one woman of 15-24 age group was asked to participate in the study. In case where in one household more than one woman aged 15-24 years were found, there one was selected randomly from them and in such households where no such woman was found, the next household was visited for eligible participant.
Data were collected by house to house visit during November and December, 2019 by interviewing the selected study subjects with a predesigned, pretested questionnaire. The questionnaire was prepared by the authors after thorough literature review (2),(3),(9),(10),(12) and translated into local language (Bengali). Back translation exercise was done by two language experts. It was pretested among 20 young women and modified accordingly and those 20 women were excluded from the final study. The validity and internal reliability (Cronbach’s alpha=0.84) of the questionnaire were found to be high. The questionnaire had three parts and total 36 questions (Annexure I). The first part contains 10 questions about background information, the second part had 10 questions related to menstrual history and menstrual problems and the third part had 16 questions on knowledge, attitude and hygiene and social practices related to menstruation. For attitude section, there are 10 statements about menstruation seeking the opinion of study participants on three point Likert scale. Socio-economic status of the study participants was analysed on the basis of modified BG Prasad’s scale, August 2020) (26).
Statistical Analysis
Data were entered into Microsoft Office Excel and then transferred into the SPSS software version 20.0 (Chicago, Illinosis, USA). Categorical data was expressed by frequency and percentage. Appropriate bivariate analysis was performed using Chi-square test to find out the association between various socio-demographic factors and knowledge attitude and practice of study subjects. The p-value <0.05 was taken as significant.
Out of total 110 participants, majority of the study population (42.73%, n=47) belonged to adolescent age group (i.e., 15-18 years), Muslim religion (n=73, 66.36%) and of general caste (n=84, 76.36%). About half (n=58, 52.73%) of the study subjects were married and majority was from nuclear family (n=74, 67.27%). Nearly half of the study subjects were school drop-out (n=53, 47.27%, not in table). Thirty one subjects (28.18%) completed graduation during time of data collection. By occupation, 51 (46.36%) of the study subjects were students and 49 (44.55%) were house wives. Socio-economic status showed 39 (35.45%) in class IV (Table/Fig 1).
Mean age of menarche of the study population was 13.04±1.3 years. Currently, most of the study subjects had regular cycle (n=95, 86.36%), moderate flow (n=42, 38.18%) and 3-5 days of duration (n=66, 60%) (Table/Fig 2). It was found that out of total 75 women who reported dysmenorrhoea, only 11 (14.67%) used medicine and 6 (8.0%) used hot water bag compress for pain relief (Table/Fig 3).
Regarding personal hygiene practice during period, it was seen that 88 (80%) of study subjects used only safe sanitary napkins, 16 (14.55%) used only cloths and 6 (5.45%) used both. Among 16 girls who used cloth, 13 girls (81.25%) reported washing the cloth with detergent and water and 10 (62.5%) reported repeated use of cloth after washing and drying. Six girls who reported to use both cloth and sanitary pads, told that they never reused the clothes so, never wash them but dispose them after single use. Majority (N=87, 92.55%) of study subjects who used sanitary napkins, needed 1-3 napkins per day (Table/Fig 4). Majority (90.80%, N=79) who used 1-3 napkins per day told that the number of napkins depends on the flow of menstruation while rest told they could not afford more sanitary pad (not in table).
The most common disposal practice was disposal of used absorbents under the soil after digging the soil (N=42, 44.68%).Throwing to bathroom chamber, in dustbin or pond, in or nearby bushy area after wrapping with plastic were the other reported mode of disposal. Only 11 subjects (11.7%) reported that they disposed used sanitary napkins after wrapping with newspaper (Table/Fig 4).
Other personal hygiene practices during menstruation was found to be adequate as all study participants reported to take bath, wash garments and wash hands with soap and water after using toilet and cleaning during menstruation. However restriction in daily activities during menstruation was revealed by many study subjects. All reported that they abstain from any religious activities during period and 94 (85.45%), 82 (74.54%) and 64 study subjects (58.18%) told that they were not allowed to do outdoor activities like playing, walking with friend, going to market etc., ‘household work’ and kitchen work respectively during menstruation (Table/Fig 5).
Seventy study subjects (63.64%) were not aware about menstruation before menarche. Although 93 participants (84.55%) reported at least one female person shared about experience of menstruation during their lifetime, only 27 (24.55%) reported that at least one female person had shared that with them before menarche. Sixty percent of study subjects told that they never discussed with or revealed menstrual status to any of the male family members whereas 71 (64.54%) subjects told that they could discuss with their mothers only. Twenty participants (18.18%) reported that they did not even discuss about monthly bleeding with any female members of the family. Sixty six study subjects (60.0%) reported school absenteeism at least for one or two days during menstruation (Table/Fig 5).
When they were asked about the cause of menstruation, majority (N=93, 84.55%) could not say anything whereas only 11 (10%) could rightly point out as monthly ovulation is the cause. Misbeliefs like ‘releasing of bad blood’ or ‘excess blood’ coming through menstruation also found to be existed among 6 study subjects (5.45%).
While exploring attitude of study population towards menstruation only 36 subjects (32.73%) agreed that it is a natural phenomenon. Forty-two women (38.18%) felt that ‘revealing menstrual status to male person except doctor is shameful’. Majority of study population (n=93, 84.55%) opined that women should not take part in religious activity during menstruation. Only 31 (28.18%) women thought that regular daily activities should be continued during menstruation. Most of the study women (n=95, 86.36%) were of opinion of using sanitary napkins if cost permits. When opinion sought on ‘menstrual irregularities is a disease and not due to sin of women’ majority (n=78, 70.91%) did not say anything and only 15 women (13.64%) agreed. Fifty one subjects (46.36%) opined that women should go to doctors if she has any menstrual problem while 54 (49.1%) did not have any opinion (Table/Fig 6).
Statistically significant association was observed between S-E condition and number of pad use (p<0.0001), school absenteeism during menstruation (p=0.011634) and higher socio-economic condition being more favourable. Education above primary level was positively associated with awareness about menstruation before menarche (p<0.00001). At the same time education above primary level had statistically significantly associated with lesser stigma regarding revealation of menstrual status to men (p=0.000602). However, education above primary level was not associated with knowledge about scientific basis of menstruation. Religion was found to be unassociated with school absenteeism, restriction in household or kitchen activity and outdoor activity during menstruation and awareness about menstruation before menarche (Table/Fig 7).
This cross-sectional descriptive study, conducted in a rural community of West Bengal revealed that use of sanitary pad and other hygienic measure during period among young women was good but there is persistence of stigma, misconception, lack of knowledge related to menstruation and restriction of daily activity during monthly bleeding. Inspite of good MHM of study participants, lack of awareness and poor attitude towards menstrual hygiene and reproductive tract infection was noted to be existed among study population. The present study found that number of pad use depended on S-E condition of the study population. The attitude and some practices of study population showed that the stigma towards menstruation is deeply rooted among them. Majority of them (70.91%) thought menstrual irregularities as ‘sin not merely disease and less than half (46.36%) opined for going to doctors for any menstrual problem. In current study, majority (77.33%) of women who experienced dysmenorrhoea and did nothing to relieve pain which was also an indication of the stigma and secrecy associated with period. In current study, it was seen that the taboo and stigma about menstruation can lead to multiple outcomes namely secrecy, shame, decreased mobility, social and religious restrictions, which corroborate different study findings (4),(19),(20),(21),(27),(28),(29).
Regarding disposal of used pad, indiscriminate throwing into open field, pond, behind bush etc. was reported by study participants. The reasons behind such finding might be lack of proper safe place for disposal. Frequent use of plastic for wrapping before disposal is another finding in current study that needs special mention as it may be seen from perspective of environmental pollution.
The present study findings were compared with few similar studies are mentioned in (Table/Fig 8) (1),(2),(3),(4),(16),(18),(19),(30),(32),(33),(34),(35),(36).
Limitation(s)
The current study was conducted by house to house visit and the incorporation of out-of school girls has helped the researchers to ascertain the actual behaviour and practices related to menstruation among young women of the community. However, better understanding about social issues and barriers related to menstruation, could have been ensured by qualitative assessment which was not done in current study.
The study conveyed that inspite of overall better MHM inappropriate disposal of used pads, inadequate knowledge, wide spread stigma, secrecy, taboos and restriction in activities during menstruation still exists in the rural community across all religions. Inclusion of menstruation in school syllabus, free supply of safe sanitary napkins through school and general rationing system, widespread awareness campaign through existing national program about menstrual hygiene and safe disposal may help to reduce stigma and restrictions faced by women and will improve menstrual health as well.
The authors thank all ASHA workers, Public Health Nursing (PHN) staffs and all the study participants of Amdanga block for their whole hearted cooperation.
DOI: 10.7860/JCDR/2022/52939.16012
Date of Submission: Oct 19, 2021
Date of Peer Review: Nov 18, 2021
Date of Acceptance: Jan 15, 2022
Date of Publishing: Feb 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
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