infections are common in rural women thus affecting their health & productivity. 2 In most societies the basis of conduct norms & communication about menstruation is the belief that menstruation must remain hidden. Menstruation must be concealed verbally. Different religions have different beliefs about menstruation. Some religion describes a menstruating woman as ritually unclean. The taboo is so great that not only the woman. women are prohibited inparticipating in routinue life activities. during periods. She must be purified before she is allowed to return to her family. South Indian women who are menstruating are not allowed in the household for a period of 3 nights. Hygienic practices during menstruation remains poor in rural India. Government of India, under NRHM made arrangements to provide 322 lakh sanitary napkins but only 34% of these have been utilized in the country. When the data of State wise uptake was analyzed an astonishing fact was found out; >80% of these low cost sanitary pads were distributed in the state of Kerala. 3 Thus the present study was conducted among rural women in the Anjarakandy Panchayat, Kannur district of Kerala. It is a descriptive type of cross section study done at the field practice area of Kannur Medical College Anjarakandy.

To measure the knowledge, attitude, & practice regarding menstrual hygiene among the adolescent girls & women in rural area aged between 15-50 years, in Anjarakandy Panchayat of Kannur district of Kerala.

The data collection lasted for 2 months (April-May 2009). Women in the age group of 15-50 years of age were interviewed by 12 MBBS students. There were 217 women who could be contacted during our visit to 3 clusters (in 3 wards) of households of Anjarakandy Panchayat. We obtained the ethical consent from the institutional ethics committee of Kannur Medical College Anjarakandy. The first house was randomly chosen & subsequently each adjacent house was taken. All the Volume XIV Issue III Version I Year ( ) Pie chart 1 clearly states that most (76%) ladies have a positive attitude towards menstrual hygiene. 1% said that it was not important to know about menstrual hygiene.

Table 2 describes the Knowledge, attitudes and practices about the ideal absorbent used by the girls.Main reason (35%) for not using sanitary napkins was economic reasons. However 29% of the women opined that they were not aware about it & another 29% opined that they did not like it. Further probing questions indicated that they were not aware regarding the method of its disposal. These points need to be addressed before suggesting the use of sanitary napkins.68% of the women of the study population reuse their cloth during their periods.43.67% of the women of the study population use soap to clean the reused cloth during their period. Also 31% of women were using dettol for cleaning the cloth before re-use. 76.5% of the women of the study population took bath twice per day during their periods. 99% of women were taking bath atleast once a day during the periods.100% of the women clean their genitalia as well as wash their hands after changing pad/cloth. eligible women of these houses who could be contacted during the allotted time were included. Pre-tested questionnaire consisting of both open ended & closed ended questions was used for the study. Data was collected by questionnaire filled by participant under the supervision of investigators. The collected data was tabulated in Microsoft excel and it was analyzed in SPSS version 11.0 Table 1 shows the baseline demographic characteristics of the study population. 33.64% of the population belonged to 25-34 years age group. 76.1% were educated till high school and above. 42.8% were very poor. 74% were housewives. 76.5% were married. V.

Menstruation is an extremely complex process involving different hormones, sexual organs, and nervous system. The present study has been compared in the light of literature available on the subject. Dasgupta A et al conducted a community based cross sectional study in 2008 among 160 women in West Bengal and found that 108(67.5%) girls were aware about menstruation prior to attainment of menarche. Mother was the 1 st informant regarding menstruation in case of 60(37.5%)girls.138(86.25%)girls believed that it is a physiological process.78 (48.75%) girls knew the use of sanitary pads during menstruation. Regarding practices only 18(11.25%) girls used sanitary pads during menstruation. For cleaning purpose, 156(97.5%) girls used both soap& water. Regarding restrictions practiced 136(85%) girls practiced different restrictions during menstruation. 1 In the current study we did not study the different restrictions, but 76% had a positive attitude towards menstrual bleeding. 30% of women in the current study who reused the cloth, cleaned it with dettol and/or soap. Using dettol is not an advisable practice nor is it necessary. Use of chemicals like dettol may be harmful if traces are left behind as it may cause rash/inflammation. So also if the soap is not thoroughly rinsed out by washing, it may cause irritation. There is a need to educate the women on these points.

75.6% of women of the study population know that menstrual hygiene is very important. Another 21.7% opined that it was important. The attitude towards menstrual hygiene is favorable in the study population. This may be due to universality of education even in the remote rural area of Kerala state. The study also shows that there is a statistically significant difference in the use of sanitary napkins as compared to cloth in educated and uneducated group of ladies but not according to the occupation or marital status. The attitude needs to be reinforced through health awareness programmes to have sustained behavioral impact. These can be carried out at Primary health centres, subcentres, Maternal and Child Health clinics and also through medical auxiliaries like ASHAs and Anganwadi workers. Women from different neighbourhoods/ towns/ cities from the same state should be studied to come to a more authentic conclusion. Due to feasibility and time constraints we could not do this as a part of our exercise. Such mulitcentric studies can be done which will prove to be of great interest for the scientific community as a whole.

We did not use qualitative methods of data collection due to paucity of time and money. We also did not use random sampling but since the population of Anjarakandy area was homogeneous there is no reason for bias in results.

The study thus clearly states the utilization of these services by the women even among rural women of Kerala. 60% of those women who did not use sanitary pads cited the reason as either they did not know or because they did not like it. The main reason that we later found was that they were unaware of the disposal of these pads. They can thus be educated on these issues of pad disposal.

Although the current study was quantitative study and not a focus group discussion still the findings can be of wide scientific interest.

Adhikari P et al conducted a study in 2007 among 150 female students in Nepal &found that 94 % of them were not properly maintaining menstrual hygiene. Only 6% of them knew that menstruation is a physiological process.36.7% knew that it was caused by hormones.94% of them used pads during periods but only 11.3% disposed it appropriately. Overall knowledge & practice were 40.6% &12.9% respectively. They also recommended that most of the girls spray water by touching onto gold; thus in turn following the age-old ancestral rules. 4 We found that such practices were not so common in our study setting in rural Kerala. The ladies in the current study setting disposed their pads appropriately.

Rao R et al conducted an interventional studyin 2003-2004 among a stratified cluster of 791 students belonging to 29 colleges in Karnataka & it was found that awareness regarding menstrual hygiene was about 77.2% before started & it increased to 95.6% after the awareness program. 5 This study clearly showed that an educational intervention program can bring about a desirable change in knowledge. 5 In the current study due to resource constraints, in terms of funding we could not manage to take up any sort of interventions.

Fernandes M has authored a report titled Menstrual Hygiene in South Asia a neglected issue for wash programmes (water, sanitation, and hygiene) in 2008. The study was conducted on 2579 women in north India & was found that 89% used cloth, 2% used cotton wool, 7% sanitary pads, & 2% ash as an absorbent. Majority of participants quoted high cost & unavailability for not using sanitary pads.14%of women suffered from menstrual infection.41%of women were unaware of menstrual hygiene. 7 The current study states that there was a statistically significant difference in the use of sanitary napkins as an absorbent as compared to cloth in educated and uneducated group of ladies but not according to the occupation or marital status. We 75.6% of women of the study population know that menstrual hygiene is very important. Another 21.7%