FACTORS AFFECTING MENSTRUAL HYIGENE MANAGEMENT AMONG PRIMARY

SCHOOL GIRLS (CLASS5, 6, 7 and 8) IN THIKA PRIMARY SCHOOL.

BY

ANN WANJIKU WAWERU

D/UPHRIFT/19028/254

A RESEARCH PROJECT SUBMITTED TO DEPARTMENT OF HEALTH RECORDS

AND INFORMATION TECHNOLOGY AS PARTIAL FULFILMENT FOR AWARD OF

DIPLOMA IN HALTH RECORDS AND INFORMATION TECHNOLOGY

KENYA MEDICAL TRAINING COLLEGE, KITUI,

711

KITUI

FEBRUARY,2021
DECLARATION.
This research project is my original work and has not been presented for diploma in any other
institution.

Name: Ann Wanjiku Waweru.

College No: D/UPHRIFT/19028/254.

Signature:………………………………….

ii
APPROVAL
This research project has been submitted for review with our approval as college supervisors.

Internal supervisor;

Name: Patricia Nzioka

Designation: Lecturer health records and information technology

Signature:…………………………………………………………….

Date:…………………………………………………………………..

External supervisor;

Name: Peninah Kithome

Designation: Lecturer nursing department

Signature:………………………………………………………..

Date……………………………………………………………..

iii
DEDICATION
This work is dedicated to my beloved mother Mrs. Waweru, my father Mr. waweru who
provided moral and financial support towards this work.

iv
ACKNOWLEDGEMENT

I would like to acknowledge my gratitude to the people who made this project a success.

First and foremost, to God Almighty for the gift of life, good health and knowledge. Great
appreciation to my research supervisor Madam Patricia Nzioka for her continuous support and
encouragement despite her busy schedule throughout the project.

Finally, I thank my family for their great financial help in carrying out this research project.

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TABLE OF CONTENTS
DECLARATION........................................................................................................................................ii

APPROVAL..............................................................................................................................................iii

DEDICATION...........................................................................................................................................iv

TABLE OF CONTENTS...........................................................................................................................vi

LIST OF TABLES.....................................................................................................................................ix

LIST OF FIGURES.....................................................................................................................................x

LIST OF ABBREVIATIONS.....................................................................................................................xi

DEFINITIONS OF KEY TERMS.............................................................................................................xii

ABSTRACT.............................................................................................................................................xiii

1.0 Introduction...........................................................................................................................................1

1.1 Background of the study........................................................................................................................1

1.2 PROBLEM STATEMENT....................................................................................................................3

1.3 JUSTIFICATIONOF THE STUDY......................................................................................................4

1.4 OBJECTIVES.......................................................................................................................................5

1.4.1 BROAD OBJECTIVE........................................................................................................................5

1.4.2 Specific objectives..............................................................................................................................5

1.5 RESEARCH QUESTIONS...................................................................................................................5

1.6 SCOPE AND LIMITATION.................................................................................................................5

CHAPTER TWO: LITERATURE REVIEW..............................................................................................6

2.1Menstrual waste disposal practices.........................................................................................................6

2.1.1 Reusable and Washable Cloth Pads....................................................................................................6

2.1.2 Commercial Sanitary Pads..................................................................................................................6

2.1.3Tampons..............................................................................................................................................6

2.1.4Bamboo Fiber Pads..............................................................................................................................7

2.1.5Banana Fiber Pads...............................................................................................................................7

2.1.6Water Hyacinth Pads...........................................................................................................................7

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2.2 LEVEL OF KNOWLEDGE AND AWARENESS................................................................................9

2.3ACCESSIBILITY OF SANITARY PRODUCTS................................................................................11

2.3.1Accessibility:.....................................................................................................................................11

2.3.2Availability........................................................................................................................................12

2.3.3Quality...............................................................................................................................................12

2.3.4Acceptability......................................................................................................................................13

CHAPTER THREE: MATERIALS AND METHODS............................................................................14

3.1 Study design........................................................................................................................................14

3.2Study area.............................................................................................................................................14

3.3Study population...................................................................................................................................14

3.3.1Inclusion criteria................................................................................................................................14

3.3.2 Exclusion criteria..............................................................................................................................14

3.4 Variables..............................................................................................................................................14

3.4.1 Dependent variables..........................................................................................................................14

3.4.2 Independent variables.......................................................................................................................14

3.5 Sampling technique.............................................................................................................................14

3.6 Sample size determination...................................................................................................................15

3.7 Development of data collection tools...................................................................................................16

3.8 Data collection process........................................................................................................................16

3.9Pre-testing /piloting..............................................................................................................................16

3.10 Validity..............................................................................................................................................16

3.11. Reliability.........................................................................................................................................16

3.12 Data analysis and interpretation.........................................................................................................16

3.13. Ethical consideration........................................................................................................................17

CHAPTER FOUR: RESULTS .................................................................................................................18

CHAPTER FIVE: DISCUSSION OF THE STUDY FINDINGS..............................................................24

5.1 CONCLUSION...................................................................................................................................26

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5.2 RECOMMENDATION.....................................................................................................................276

REFERENCES..........................................................................................................................................27

APPENDIX I: STRUCTURED QUESTIONNAIRES..............................................................................30

APPENDIX III: WORKPLAN..................................................................................................................36

APPENDIX IV: NACOSTI LETTER.......................................................................................................37

APPENDIX III: LETTER OF APPROVAL..............................................................................................39

APPENDIX VI: LIST OF STUDENTS TOPICS......................................................................................40

LIST OF TABLES

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Table 4.1 Age (n=100)...................................................................................................................18
Table 4.2Source of information(n=100)........................................................................................21
Table 4.3 Hours of change of sanitary (n=100).............................................................................22

LIST OF FIGURES
Figure 4.1 Class (N=100)..............................................................................................................18

ix
Figure 4.2 Occupation (n=100)......................................................................................................19
Figure4.3 Religion affiliation. (n=100).........................................................................................19
Figure 4.4 Girls in the family (n=100)...........................................................................................20
Figure 4.5 Waste disposal practices (n=100).................................................................................20
Figure 4.6 Distance to the nearest shop(n=100)............................................................................21
Figure 4. 7Sanitary towels per day (n=100)..................................................................................22
Figure 4.8 cost of sanitary (n=100)................................................................................................23

x
LIST OF ABBREVIATIONS
MHM Menstrual hygiene Management.

UNICEF United Nations child emergency fund.

WASH Water, sanitation and hygiene.

NGOs Non-governmental organizations.

WHO World health organization.

MHH Menstrual health hygiene.

SDGs Sustainability development goals.

FAWEK Forum for African Women Educationalists Kenya.

GCN Girl child network.

UNESCO United Nations Educational Scientific and Cultural Organizations.

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DEFINITIONS OF KEY TERMS
Adolescence Is a period of transition from childhood to adulthood beginning

From the age of 10-19 years.

Health: Is a state of complete physical, mental and social wellbeing and not

Merely absence of disease.

Hygiene: Is a condition and practices that help maintain health and prevent spread

of diseases.

Menarche Is the first menstrual period in girls.

Menstruation Is a normal vaginal bleeding when there is shedding of inner lining

of uterus.

Sanitary towels are absorbent materials used by females during their menstruation to

absorb blood.

Accessibility Is a situation whereby the sanitary towels are made available to the girls.

xii
ABSTRACT
The broad objectives of the study are to identify the factors affecting menstrual hygiene
Management among primary school girls in Thika Primary School. The specific objectives are to
find out menstrual waste disposal practices of sanitary products, level of knowledge of girls and
to identify the accessibility of sanitary products among primary school girls. The study area was
class five, six, seven, and eight girls in Thika Primary School. A sample size was 100
respondents selected. Questionnaires of data collection were used to gather information. The data
tool used during the study was questionnaires and questions were closed ended. Data was
analyzed by using descriptive statistics e.g. counts, tables, figures that is bar graph and pie charts,
percentages. Permission to carry out the research was granted by National Commission for
Science and Innovation (NACOSTI) and was approved by deputy county commissioner, Kiambu
County and also the information from the client was considered confidential. The validity was
ensured by making sure that the research questions were clear and instruction on instrument were
in order and easy to follow. The researcher also ensured reliability by being present at the time of
data collection to clarify concern and questions from the respondents, the results in the pretest
were used to enhance structuring of the questionnaire and enhance clarity in the data collected.
According to the study findings more than half of the respondent (60%) said that the cost of the
sanitary pad were expensive, 36% said that they were cheap and 4% said they didn’t know the
cost. Less than a half of the respondent (40%) their parents were an unemployed, 35% of their
parents were employed and 27% self-employed. The researcher concluded that the cost of
sanitary products was high. The researcher also recommended that dustbin bin with proper lids
should be placed in toilets and toilets should have lockable doors for privacy during changing of
sanitary pads.

xiii
CHAPTER ONE
1.0 Introduction
1.1 Background of the study.
Menstrual hygiene management is the process by which women and adolescent girls using
menstrual materials to absorb or collect blood that can be changed in privacy and often as
necessary for the duration of menstruation period, using soap and water for body as required and
having access to facilities to dispose of used menstrual materials (Joint Monitoring Program,
2012)
Globally, at least 500 million women and girls lack proper access to menstrual hygiene facilities.
Several factors influencing difficult experiences with menstruation, including inadequate
facilities and materials, menstrual pain and fear of disclosure and inadequate knowledge about
menstrual cycle (World Bank, 2018).

There are strategies varying greatly due to the personal preferences, availability of resources,
economic status, cultural traditions and beliefs, education status, and knowledge about
menstruation. Practices related to menstruation hygiene are of major concern as it has a health
impact; if neglected, it leads to toxic shock syndrome, reproductive tract infections (RTI), and
other vaginal diseases. (Rajaratnam and Hallad,2010).

There is growing attention to menstrual health and hygiene in the development and humanitarian
communities. Good menstrual means that women and adolescent girls are using clean Menstrual
Management materials to absorb or collect menstrual blood that can be changed in privacy often
as necessary for the duration of menstruation period using soap and water for washing body as
required and having access to safe and convenient facility to dispose menstrual Management
materials. In Nepal, there are cultural taboo which discourage women from teaching during
menstruation its very likely that women teachers elsewhere frequently absent during
menstruation period due to inability of school infrastructure to meet their hygiene and needs.
(Swedish international development).

In southern Ethiopia revealed that, the school environment is not conducive for menstrual
hygiene management because of 90%of the schools lacks water supply, separate toilets for boys
and girls and existing toilets lacks privacy (Zinash et a, 2011).

1
In Tanzania, 52%of all schools had no doors on their latrines, 92% had no functional hand
washing facilities and 99% had no soap. Increase in number of pupils was not accompanied with
increase in sanitary facilities, including menstrual facilities. This is partly because until recently
MHM has been largely overlooked by water sanitation and hygiene sector in general, and
Tanzania in particular (Guya, 2013).

In Kenya it is estimated that girls miss nearly 3.5 million learning days per month because of
limited access to reliable hygienic sanitation and sanitary products. School attendance is further
limited by lack of access to private toilets, running water, facilities for disposal or cleaning,
sanitary pad and extra clothing and funding for sanitary products (Crofts and Fisher, 2012)

2
1.2 PROBLEM STATEMENT.
Adolescent girls who experienced menstruation for the first time, menstrual hygiene
management is constrained by a practical, social, economic and cultural factors such as the
expenses of commercial pads, lack of enough water, lack of private room for changing sanitary
pads and limited education about the facts of menstrual hygiene. Adolescent girls enter puberty
unprepared and the information the information they receive is often selective and surrounded by
taboos (UNESCO, 2014 and Loughborough University, 2012)

During menstruation adolescent girls are faced with challenges related to the management of
menstrual hygiene in public faces. UNICEF estimate that one in ten African school girls do not
attend school during menstruation period. Similarly, world bank statistics indicate that students
have been absent from school four days every four weeks because of menstruation (UNESCO,
2014)

3
1.3 JUSTIFICATIONOF THE STUDY
The research will be structured to collect data from teachers and girls regarding issues affecting
girls, their attendance with or without their menses and performance. A platform will be created
to school to discuss and address menstrual and reproductive health issues which is most not
discussed at school or home. These platforms will empower girls with the knowledge on
menstrual and reproductive health. The Findings of this study may be used by GCN, FAWEK
and other stakeholders in the formulation of projects that will help the dissemination of
emergency sanitary towels, education on use of locally available resources to produce sanitary
towels and provision of water and sanitation in rural public primary schools.

4
1.4 OBJECTIVES

1.4.1 BROAD OBJECTIVE

To determine factors affecting menstrual hygiene Management among primary school girls in
Thika primary school.

1.4.2 Specific objectives

1. To find out menstrual waste disposal practices of sanitary products

2. To describe level of knowledge of girls in menstrual hygiene Management

3. To identify the accessibility of sanitary products among primary school girls.

1.5 RESEARCH QUESTIONS

 How do they dispose menstrual waste absorbents?
 What is the level of knowledge of girls about menstrual hygiene management?
 What is the accessibility of sanitary products among primary school girls?

1.6 SCOPE AND LIMITATION.

 The geographical place of the school was far.
 Some respondents did not cooperate to give the needed information.
 Some of the respondent did not understand the question well.

5
CHAPTER TWO: LITERATURE REVIEW
2.0 INTRODUCTION

The main objective of this review was to summarize the concern and possible methods of
menstrual waste management in low-income countries. The review aimed at understanding the
menstrual practices, product design, demands, and disposal strategies. It includes both a
summary of the existing menstrual hygiene needs and management and also an analysis of the
current knowledge in the fields of public health, water and sanitation, and solid waste
management. Menstrual hygiene management, water and sanitation sector is not formally
defined in the Sustainable Development Goals (SDGs). However, clear linkages are framed here
to include: SDG3 (physical health and psycho-social well-being for Menstrual waste disposal
women and girls), SDG4 (quality education for girls), SDG5 (gender empowerment and
equality), SDG6(water and sanitation), and SDG12 (responsible consumption and production for
the environment) (Mahon et.al, 2011).

2.1Menstrual waste disposal practices.

Safe disposal will prevent exposure, human contact and achieve a harmless destruction of soiled
materials. Another important factor for MHM is menstrual products and supplies.

Different menstrual products used by women/girls are discussed below:

2.1.1 Reusable and Washable Cloth Pads-

must be hygienically washed and dried in the sunlight. The sunshades a natural sterilizer and
drying the cloths/cloth pads under it sterilizes them for future use. These cloth pads are reusable
so they are cost-effective, easily available, and eco friendly. They also need to be stored in a
clean dry place for reuse to avoid contamination. (Arthur et al, 2010).

2.1.2 Commercial Sanitary Pads

- They are easily available at many stores, chemist shops, or online. They are expensive,
compared to cloth pads, non-re-usable, and not very environment-friendly. The cotton used in
their making is not 100% natural. (Crowset, al.2010)

6
2.1.3Tampons- They are the type of absorbent that provides internal protection. They are kind of
plug of soft material (cotton) which is inserted into the vagina to absorb the menstrual.
(Pedezertet, Al 2010).

2.1.4Bamboo Fiber Pads

Instead of wood pulp, bamboo pulp is used as an absorbing material in these sanitary pads. It has
more absorbing capacity and is safer.

They are affordable, easily decomposed, and environment friendly pads which also possess
antibacterial properties. This provides infection and irritation-free menstruation. Also, bamboo
charcoal pads are available in the market with advantage that blood stains are not clearly visible
and are also reusable in nature. (Arthur et, al.2010).

2.1.5Banana Fiber Pads-

Nowadays, low-cost sanitary pads for rural women made from waste banana tree fiber were sold
under trade name “Saatchi” in India. They are environment friendly and decompose within six
months after use.

Besides these products, women in the remote rural areas also use natural materials like cow
dung, leaves, and mud. (Crow et, al.2010).

2.1.6Water Hyacinth Pads-

Menstrual pads manufactured using water hyacinth is sold under trade name “Jani. Women and
girls face constrain during menstruation that determine how and where they dispose menstrual
absorbents. Ways that women and girls currently dispose used menstrual absorbent include
throwing them in the open space, in latrines, burning, burying them and through routine waste
disposal system, with disposal practice that influence deeply embedded socio-cultural norms and
taboos about menstruation and menstrual blood. (Jones and Thomas,2013)

In some schools, due to lack of sanitary facilities, girls throw their pads in toilets. In some cases,
girls threw away their used menstrual clothes without washing them. Also, many were reported
being absent from school due to lack of disposal system, broken lock/doors of toilets, lack of
water tap, bucket, and poor water supply (Mahon and Fernandez,2010).

7
Incineration is an option for managing disposal of menstrual waste, particularly in worksites,
schools and dormitory settings. It is a manner to achieve pathogen treatment, waste reduction and
waste management. Incinerators properly vented and directly connected to the toilet room by a
chute provide an effective and discrete way of disposing of menstrual absorbents. In some
schools, incinerators or “feminine hygiene bins” are used for disposing menstrual waste material
but due to shyness or fear of being seen by others they refrained from using it (Croftsand
Fisher,2012).

Incineration is a better technique to dispose of menstrual waste but burning of pads releases
harmful gasses that effects health and environment. Burning of inorganic material at low
temperature releases dioxins which are toxic and carcinogenic in nature. (Sommer et al, 2013).

In rural areas, pit latrines once full they were covered with soil and new pit was dug but due to
space limitations this was not practiced in urban areas. It was reported that some women and
girls wrap their used menstrual cloths and packs in polythene bags before disposing in pit latrines
which prevents them from decomposition. Nowadays, mostly women/girls prefer commercial
sanitary pads and tampons which are made up of super absorptive materials like polyacrylate.
These pads and tampons when flushed in the toilets they get saturated with liquid and swell up,
thus resulting in sewage backflow, a serious health hazard. The adhesive wings and the
perforated plastic layers in the commercial sanitary napkins are not easily biodegradable. The
sewage blockages were mostly due to accumulation of excessive quantity of solid waste or sand
which results in hardening of the sludge in the pits. Blockage of sewage system is a global
problem and major contributing factor is flushing of menstrual products in toilets. Deodorized
sanitary products used by women/girls contain chemicals used in bleaching such as organo-
chlorines which when buried in the soil disturb the soil microflora and decomposition takes time
(Kroesa, 2010).

Materials like tampons, cotton wool, toilet paper, and other organic materials used for menstrual
management might be decomposed in pit latrines/landfills except the plastic inlay of the
commercial sanitary pads. Sanitary napkins might decompose over a period of about one year
except its plastic lining in on-site sanitation (Patkar, 2010).

8
People living alongside river banks throw menstrual waste into water bodies which contaminate
them. These materials soaked with blood were breeding places for germs and pathogenic
microbes. Sanitary products soaked with blood of an infected women/girl may contain hepatitis
and HIV viruses. (Sommer, 2013).

2.2 LEVEL OF KNOWLEDGE AND AWARENESS.

Knowledge and awareness around menstruation are relatively well researched area of menstrual
hygiene management. this refers especially to the situation analysis, with less research on the
impact and quality of the intervention to address issues.

Lack of knowledge leads to misconceptions, taboos and negative cultural and social norms
around menstruation. For example, in the Topos’ tribe in South Sudan, it is believed that wearing
underwear can lead to a woman’s husband dying, meaning only widows should wear underwear.
Some girls fear disclosing menarche even to mothers, teachers and peers, because it is believed
to be associated with sexual behavior, which is considered improper. (House et al.,2012).

There is very extensive and rapidly growing literature describing the knowledge and perception
of menstruation, especially among adolescent girls in low- and middle-income countries. Girls
are generally uninformed, faced with “menarche shock” deeply ashamed, fearful, and afraid to
seek medical attention when is required. (Chandra et al, 2017).

Menarche education, including seemingly that from UNESCO, focuses on the facts that
menstruation can take many forms, and reassures girls that is variety is ‘normal’. This seems
reasonable approach in order to reduce stigma and shame. However, given that irregularity
maybe linked to gynecological issues such as fibroids, cancers, or terrible dysmenorrhea, which
may indicate that girls should seek medical advice, information on such condition might also be
included in MHM education. This is all the more so sincere several studies (Chandra el al,
2017).

In schools, teachers can make the school environment girl/women friendly to manage
menstruation with dignity. Sex education in schools helps adolescents to discover their sexual
identity, to protect themselves from sexual abuse, unwanted pregnancies, and sexual transmitted
diseases, and to know physiological changes occurring in the body and how to take care of

9
personal hygiene. In most of the cases, teacher’s attitude is not good and supportive towards
menstruating girls in schools. Different views of parents, teachers, and society affect sex
education being taught in schools and colleges. Cultural, religious, and social barriers also create
hindrance in the path of sex education. (Pokharel et, al. 2012).

In Nigeria find that both children and parents welcome puberty education, but parents want an
emphasis on how to avoid risk taking behavior, whereas children are interested in understanding
bodily changes. Additionally, the extent to which information not only on the menstrual cycle
but also on availability and use of menstrual products, good hygiene practices, menstrual
irregularities throughout the lifecycle, and dealing with physical and emotional symptoms and
addressing misconceptions and negative perceptions varies greatly. Distinguishing between
personal or ‘contextual’ beliefs with medical, evidence-based knowledge can be difficult. (Bello
et, Al. 2017)

In many schools, both male and female teachers are not ready to discuss menstruation and
menstrual hygiene management with students. The female teachers are also not available in
many schools. Teachers often skip such topics in books as they do not want any open discussion
in the class or to escape from the questions asked by students. Teachers also feel shy and
embarrassed to discuss such topics in class due to language barrier. In most schools, English is
not a compulsory subject so teachers have to discuss them in local language and using vernacular
words in front of students is an embarrassing thing. (Puri, 2010).

Teachers report that they do not always feel it is their role, nor that they have skills, to educate
girls on topic and girls report that male teachers at times tease them. A study from Rwanda notes
that students are keen to be taught by someone else than their home room teacher, as they are
afraid to be punished and cannot speak freely (MEDSAR IMCC, 2015).

Due to unsupportive environment in the schools, it was also found that some girls hesitate to
stand to answer teacher’s questions in fear of leakage or smell and also hesitate to write on
blackboard in fear of any menstrual accident and blood stains on clothes seeing by others. In
some reported cases, parents do not allow girls to go to schools upon reaching puberty in fear of
sexual harassment by boys and male teachers in schools (Goldman, 2010).

10
Very few mothers are ready to share the information regarding menstruation which is of
paramount significance of their daughters. A key priority for women and girls is to have the
necessary knowledge, facilities and the cultural environment to manage menstruation
hygienically and with dignity. (Salve and Dase, 2012)

Adolescent is an essential period where females are preparing and adjusting themselves to
manage their menstrual bleeding in safe and clean way. This is also the ideal time that girls often
join different environments including high schools and tried to plan for their next adulthood life.
The view in which girls perceive towards menstruation also affects their hygienic practice during
their menstrual bleeding. Women with better understanding of menses often have safe and clean
way of managing their menstrual bleeding and vice versa. (Ghattargi et, al. 2015)

Lack of infrastructure and support in schools can jeopardize this developmental process and
make girls abandon education trajectories. Examples are poor quality and the inadequate supply
of water, the lack of latrines and of sanitary infrastructure and of access to adequate sanitary
hygiene products, which leave girls with limited options for MHM. (Sommer, 2010).

2.3ACCESSIBILITY OF SANITARY PRODUCTS

2.3.1Accessibility:

This includes the issue of cost, which is a key consideration mentioned by both end girls and
women and husbands, policy makers, program staff, engineers. Cost estimates vary widely,
depending on the source. Disposable pads generally cost ksh. 70 - 100 per cycle (with 13 cycles
per year), reusable pads (for example AFRI pads) are marketed as costing around 500 shillings
for a double package, lasting at least 12 months, menstrual cups are sold at between 500 -1500
shillings and marketed as lasting up to ten years. Menstrual panties are marketed as costing
around 3000 – 4000 shillings per pair, with a need for 2-3 per menstrual cycle, and lasting
approximately 2 years. Some of these costs may be reduced over time with global competition.
Homemade menstrual pads are also being produced, but we could find little information on the
cost, quality or durability, yet It would seem important to assess that also. To reduce cost of
menstrual products, and sometimes. (Mason et, Al. 2015)

The inaccessibility of menstrual products results in embarrassment, anxiety and shame when
girls and women stain clothes which is stigmatizing. Elsewhere in some rural areas, girls use old

11
cloth, leaves, cow dung or even dug a hole on the ground to sit on for the whole period as a
means to manage their menstrual flow. In an ethnographic study conducted in primary school in
Bungoma District it was noted that menstruation is not just a private affair but has the potency to
become public embarrassing and often a source of stigma for the girls (Lukalo,2010).

Focusing more on dynamic in the school space the federation of Africa women educationist
discovered that lack of conducive school environment was a leading cause of the low retention of
girls in school with poor sanitation being specifically cited as a leading determinant of where
adolescent girls turn up for class or not ,in addition lack of security and long distance to school
yet according to FAWEK girls education is the most important investment for women in
developing countries ,because its contribution towards better health for their families alongside
increasing the women and potential as well as lowering fertility rates (FAWEK,2010)

The cost of sanitary towels is beyond the reach of youngest girls who are unemployed and those
living in poverty index since they can’t afford therefore it is difficult for them to access. Lack of
information and management for the adolescent girls is a problem (Dalton, 2014).

Water requirement are the highest for washing clothes or reusable pads (several liters per
period). They are lower for reusable cups but they require boiling once per recycle. Dying
facilities are needed for reusable cloths or pads, and this is reported by some women and girls to
be the rainy season, as well as for privacy reasons. (Mason et al, 2015).

2.3.2Availability:

Information on availability comes mainly from anecdotal report on what is available on market,
as well as reports on prevalence use from individual studies. Market availability of both cloth,
disposal and reusable menstrual pads as well as cups have been distributed to girls and women,
particularly in humanitarian situation in Uganda, Kenya, Tanzania and Malawi. (Hyttel et al
2016)

2.3.3Quality:

Quality includes both effectiveness in dealing with MHM (controlling leaking, odor, comfort and
dignity), as well as safety.

12
Numerous studies attest to increase the level of comfort, freedom and general satisfaction
experienced focused on providing locally produced, low cost and high-quality disposal pads,
often combined with other intervention such as “empowerment clubs” and inter-based MHM
learning. (House et al, 2012).

More recently, reusable menstrual products are becoming increasingly commercially available
and popular. Reusable pads are produced locally and sometimes home-made as well as by social
business. The most successful brands are highly-quality, low cost, comfortable and have water
proof material to prevent leaking of blood. A commonly reported disadvantage of reusable pads
is the increased need for, water, and space for washing and drying, in which some context can be
challenging reproductive tract infections. (Montgomery et al, 2016).

2.3.4Acceptability
Is an important factor for menstrual product is acceptable? It is important to identify drivers and
barriers in environment for long term use, including those which go beyond WASH. For a new
product such as cups, pilot study from refugee settlement in Uganda (Gade etal. 2017).

Several small scale studies in Uganda indicate that a theory of change which includes discussion
with community leaders, including both teaches and parents and others, sometimes providing
MHM products for them so that they can help young girls once products for them so that they
can help young girls once products are introduced to them, involving boys in the education can
be extremely effective in ensuring long term continuation of products. (Hyttel,2017).

With respect to safety there is limited information on the impacts of traditional methods on
reproductive tract infection (RTI). Disposal of pads seems to have high level of safety. There
seems to be slightly higher rates of RTIs for reusable absorbents (pads or cloths), particularly on
how they are washed and dried, while there re indicators of lower rates of RTIs and STIs for
cups. (Sommer et al., 2013).

The menstrual cups cost approximately 15-4 USD and some brands ae sold to NGOs for
approximately 5-8 USD. The main concern related to menstrual cups is acceptability, including
hymen concern for young girls. However, several studies from Kenya, Uganda and south Africa
reported high acceptability of menstrual cups among school girls. (Mason et al.,2015).

13
In order to increase acceptability and availability of menstrual products, numerous intervention
have been reported in the region, as well as globally, on teaching and supporting local home
made products of reusable pads, such as Uganda’s National strategy for Girl’s Education which
targets 18,400 primary school girls, 3,000 secondary school and 500 tertiary institutions and aims
to include handicraft lessons to make reusable pads in primary school (Sommer, et al., 2015).

14
15
CHAPTER THREE: MATERIALS AND METHODS

3.1 Study design

A Cross- sectional study design was done throughout the study by interviewing the clients.

3.2Study area
The study was conducted in Thika primary school it is located in Kiambu county. It's located in
Thika sub county Thika west constituency in Kiambu County.

3.3Study population
The study consists of class 5, 6, 7, 8 primary school girls at Thika primary school.

3.3.1Inclusion criteria
All class 5, 6, 7, 8 primary girls participated during the study

3.3.2 Exclusion criteria

This excludes the girls those who were absent during the study.

3.4 Variables

3.4.1 Dependent variables

Menstrual hygiene management among primary school girls (class 5, 6, 7, 8)

3.4.2 Independent variables

1. Level of knowledge.
2. Menstrual waste disposal practices.
3. Accessibility.

3.5 Sampling technique

Simple random sampling was used to allow girls to have equal chance of participating. Random
numbers were written on a piece of paper after which the researcher placed them in a box and the
respondents were requested to pick the paper randomly. Those who picked YES were selected to
participate in the study and those who selected NO were not selected to participate in the study.
Simple random sampling was used to ensure that there is no basis in the data collected.

16
3.6 Sample size determination
The sample size was determined by using the Fisher et al Formula with the degree of accuracy
set of 0.05

N = z²pd/d²;

N = Estimated minimum sample size for population more than 10,000)0

Z = the standard normal deviate

P= the proportion of the target population estimated to have a particular characteristic, usually
measured at 0.46

Q =1-p

D = degree of accuracy desired, usually set at 0.05

n.=1.96²x0.5x0.5/ (0.05)

384.16.

384

Since the study population is less than 10,000 the sample size will be conducted as follows.

Nf =n/1+n/N

Where by: -

Nf = desired sample size for population less than 10,000

n = constant of 384

N = estimated population size 135

Therefore,

Nf= 384/1+384/13

= 384/3.8

17
Nf= 100

3.7 Development of data collection tools.

Data was collected using questionnaires. Information collected was cross checked for accuracy
after the respondent answered correctly. The structure of questionnaires was based on specific
objectives of the study which enables the researcher to get accurate information from respondent.

3.8 Data collection process

The researcher used questionnaires to gather information because it is simple and covers a large
numbers of people. This method is more reliable because it is able to yield quantitative data that.
3.9Pre-testing /piloting

Questionnaire was pre tested in Kitui Primary School to identify the faults and weakness of tools
in order to validate the same.
3.10 Validity
Validity of the instrument was to check in terms of how questionnaires were constructed and the
content of the questionnaires. The validity was ensured by making sure that the research
questions were clear and instruction on instrument were in order and easy to follow. The validity
was ensured in that the content of the format of questionnaire was consistent with the objectives.

3.11. Reliability
The researcher also ensured reliability by being present at the time of data collection to clarify
concern and questions from the respondent. Pilot survey was carried out to ascertain the
reliability. The results in the pretest were used to enhance structuring of the questionnaire and
enhance clarity in the data collected.

3.12 Data analysis and interpretation

The data obtained was analyzed by the use of descriptive statistics of counts, frequencies, and
percent frequency.

The data was presented in form of pie charts, and bar charts.

18
3.13. Ethical consideration
Permission to carry out research will be granted by the national commission for science and
innovation (NASCOTI) and be approved by Deputy county commissioner Kiambu county.
Dignity will be maintained to the clients and the researcher to ensure that there will be no
physical or physiological harassment. Information from the clients will be treated with
confidentiality

19
CHAPTER FOUR: FINDING OF THE STUDY.
This chapter is about data analysis, presentation and interpretation from 100 respondents who
took part during the study.

Table 4.1 Age (n=100)

Age Frequency Percentage frequency
13-15 86 56
16-18 12 12
TOTALS 100 100
Majority of the respondents (86%) were aged 13-15 years, 12% of the respondent were 16-18
years.
Figure 4.1: Class (n=100)

Less than a half of the respondents (45%) were in class 8, 30% were in class 7, 20% were in
class 6 and 5% were in class 5.

20
Figure 4.2: Occupation (n=100)
45

40

35

30

25 employed
self employed
20
unemployed
15

10

0
employed self employed unemployed

Less than a half of the respondent (40%) their parents were unemployed, 33% of their parents
were employed and 27% of their parents were self- employed.

Figure 4.3: Religion affiliations. (n=100)

50
45
40
35
30
catholic
25 protestant
20 muslim

15
10
5
0
catholic protestant muslim

Slightly less than a half of the respondents (48%) were protestant, 28% were Catholics and 24%
were Muslims.

21
Figure 4.4: Girls in the family

Majority of the respondents ( 80%) were 1-3 girls in the family while 20% were 4-6 girls in the
family.

Figure 4.5 Waste disposal practices (n=100)

18%

DUSTBIN
LATRINE

82%

Majority of the respondent (82%) used latrines while 18% used dustbin.

Table 4.2: Source of information

Source Frequency Percentage frequency
Teacher 26 26
Mother 44 44
Media 30 30

22
TOTALS 100 100
Less than half of respondent (44%) heard the information from their mothers, 30% heard
information from media and 26% heard from their teachers.

Figure 4.6: Distance to the nearest shop

50

45

40

35

30
500
25 1000
1500
20

15

10

0
500 1000 1500

Slightly less than a half of the respondents (49%) walk for a distance of less than 1000 meters,
39% walks distance of 500 meters whereas 12% walks at a distance of 1500 meters.

Table 4.3: Hours of change of sanitary (n=100)

Hours Frequency Percentage frequency
3hrs 52 52
4hrs 16 16
1 day 32 32
TOTALS 100 100
More than half of the respondents (52%) change sanitary towels after 3 hours, 32% change
sanitary towels after 1 day and 16% change after sanitary pads 4 hours.

23
Table 4.3: Use of sanitary towels(n=100)

Use of sanitary towels frequency Percentage frequency

Yes 100 100
No 0 0
Totals 100 100
All respondents (100%) use sanitary towels.

Table 4.4: feeling of respondent while menstruating (n=100)

Respondent Frequency Percentage Frequency
Strongly agree 15 15
Disagree 59 59
Strongly disagree 26 26
Totals 100 100
More than a half of respondent (59%) disagreed that they feel shy, 26% of the respondent
strongly disagree they feel shy and 15% of the respondent strongly agree that they feel shy.

Figure 4.7: Sanitary towels per day (n=100)

four

thre
four
three
two
two one

one

0 10 20 30 40 50 60 70 80

24
Less than three quarter of the respondent (72%) uses three sanitary towels, 14% respondent uses
four sanitary towels, 12% of the respondent uses two sanitary towels and 2% uses one sanitary
per day.

Table 4.5: attitude of boys when girls are menstruating (n=100)

Respondents Frequency Percentage frequency
Strongly agree 18 18
Disagree 37 37
Strongly disagree 45 45
Totals 100 100
Less than a half of the respondent (45%) strongly disagrees that boys are mocking them, 37%
disagree that they isolate while 18% strongly agrees that are friendly.

Figure 4.8: Cost of sanitary (n=100)

36
expensive
cheap
I don’t know

60

More than half of the respondent (60%) said that sanitary towels are expensive, 36% opposed
that they were cheap where 4% had no idea about the cost of the sanitary towel.

Table 4.6: privacy during changing of sanitary pads

privacy Frequency Percentage frequency
Yes 22 22
No 78 78

25
Totals 100 100
More than two thirds (78%) said there is no privacy while 22% said there was privacy.

CHAPTER FIVE: DISCUSSION OF THE STUDY FINDINGS

This chapter discusses the study findings on the factors influencing menstrual hygiene
management.

The study results showed that majority of the respondents (82%) used latrine to dispose used
sanitary pads while 18% used dustbin to dispose sanitary pads. This agree with the study carried
by Mahon and Fernandez (2010), which showed that in some schools, girls throw their pads in
the toilets.

According to the results finding less than a half of the respondent (40%) their parents are
unemployed, 33% their parents are employed and 27%are unemployed. This agree with the study
carried by Dalton, et.al (2014), which showed that the cost of sanitary towels is beyond the
reach of youngest girls who they are or their parents are unemployed and those who are living in
poverty index can’t afford.

The study results shows that less than a half of the respondent (44%) heard information from
their mothers, 30% heard from the media and 26% heard from their teachers. This agree with the
study carried by Puri, et.al (2010), which showed teachers report that they do not always feel
it’s their role, nor that they have skills to educate girls on topic and girls report that male teachers
at times tease them.

The study results showed that more than half of the respondent(60%) said that sanitary towels
are expensive , 36% said they were cheap and 4% others said they don’t know this agrees with
the study carried by Crowset, et.al (2010), which showed sanitary products are easily available
at many stores, chemist and online platforms. They are expensive compared to cloths, pads and
re-usable pads.

According to the study showed that more than three quarter (78%) said they do not have privacy
during changing of pads while 22% said that they had privacy. This agrees with the study carried

26
out by Mahon and Fernandez (2010), which showed many reported being absent from school
due to lack of disposal system broke locks and doors of toilets.

More than a half of respondent (59%) disagreed that they feel shy, 26% of the respondent
strongly disagree they feel shy and 15% of the respondent strongly agree that they feel shy. This
agrees with the study carried out by Sommer, et.al (2013) which showed that girls feel shy when
menstruating and when they stain they feel embarrassed and they are laughed by others.

Less than a half of the respondent (45%) strongly disagrees that boys are mocking them, 37%
disagree that they isolate while 18% strongly agrees that are friendly. This agrees the study
carried out by Girod et.al (2017) which showed that boys were prompted to tease by perception
that periods are embarrassing and incidences where girls reveal bad odor and blood stain.

27
5.1 CONCLUSION
From the study the researcher concluded that:

1. All the respondents had knowledge about menstruation on how they can manage their
menstrual.
2. Majority lacked of support and peer education on menstrual hygiene from teachers
especially male teachers.
3. Majority of the respondents their parents / guardians are unemployed.
4. Most of the respondents have heard about menstruation and menstrual hygiene
management from their mothers.

28
5.2 RECOMMENDATION
1. Teachers should be educated and trained to impart knowledge about menstruation and
menstrual hygiene management.
2. The ministry in charge of road works should be in position to improve the accessibility of
sanitary towels by making sure that roads are passable.
3. Also recommend that mothers should continue being close to their daughters.
4. Teachers together with public health officers should make sure that they give out health
education about sanitary towels.
5. Dustin bin with proper lids should be placed in toilets; if possible incinerators should be
installed at homes, schools and community levels.

29
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C., and Vaval, L., 2011. Evaluation of UNFPA'S provision of dignity kits in humanitarian and
post crisis setting, US school of international and public affairs.

Bagger.C, and Kulkarni.R, (2011) “age at menarche and collar trends in Maharashtrian (Indian)
girls “Acta Biological szegediensias volume 44 no1-4 page 53,57.

Bello fatusi, A, Adepojo, B, Kabiru C, Sommer. M and K, 2017.adolecent and parental reaction
in Nigerian and Kenya: Across cultural and intergeneration comparison. A journal of adolescent
health vol 6 no 4 pg35-44.

Bhagwan, N and Still, D. (2010) “Challenges up scaling dry sanitation technology “water science
and technology vol. 58 no 1. Pg. 21.

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Bott S. Jeejeebhoy and Puri.C, (2013) towards adulthood exploring the sexual and reproductive
health education of adolescent in south Asia.

Chandra, V., Patel, S., 2017. Mapping knowledge and understanding menarche menstrual
hygiene, menstrual health among adolescent girls in low and middle income countries.
Reproductive health vol.14(1) pg30.

Chandra, V. Plesons, M., Hadi, S., Baig, Q. And Lang, L. Building support for adolescent.
Sexuality and reproductive health education and responding to resistance: case from Pakistan.

Chiton, S., Dipesh, P., and Maitri, P, 2017. Use of flow care menstrual cups over conventional
menstrual products in India. International journal of advance research and development.

Colombia University and international rescue committee, 2017. A tool kit for integrity menstrual
hygiene management into humanitarian response.

Crofts. T. 2010. An investigation into school girls use low cost sanitary pads in Uganda:
Loughborough University.

Diaz, Laufer and L. Breech (2010) menstruation in girls and adolescent pediatrics vol118, no 5
pg2245,2250.

Goldman. D, (2012) Responding to parental objection to school sexuality education sex

education: sexuality and learning vol8. No4 pg. 415 – 438.

House, S, Mahon, T., Calvin.T, (2012) Mensuration hygiene matter. A resource for improving
menstrual hygiene around the world water aid, pg3478.

Hytel, M., Rajanthan, J., Tieller.M, and Talemwa. W, (2017). driver and challenges to use
menstrual caps among school girls in rural Uganda: a qualitative study waterline, vol36 no 2
pg109-2.

Joint monitoring program Editor, meeting report of joint monitoring program post 2015. Global
monitoring working group on hygiene Washington DC,2012.

Khanna. A, Goyal, S.and Bhawsar, R. (2015) menstrual practices and reproductive problems
journal of management; vol no 1 pp91-107.

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Kirby, D. Loris, A. and Rolleri, L (2011) sex and HIV education program: journal of adolescent
health vol.40 no.3 pg. 206 – 217.

Krosesa, R. Canada (2010) the creep peace guide to paper Vancouver.

Mahon, T. Tripathy, A. Singh, N. (2015) “putting men into menstruation”: journal of role of men
and boys in community menstrual hygiene management waterline vol.34 pg. 7-14.

Medsar.L, Imma.C, Rwanda, (2015). An assessment of barriers for teachers to carry out sexual
education in Rwanda schools.

Montgomery, P. Hennegan, J., Dolan, C, Wu, M. (2016). Menstruation and the cycle of poverty:
a cluster quasi-randomized control trial of sanitary pads and puberty education provision in
Uganda.

Nsakala, G. Coppietes, Y.and Lapika, B. (2012) perception of adolescent girls in matter of

health: sexual reproductive health in DRC public health volume 24. No.5 pg.403 – 415.

Pokharel, S. Shakya, S. (2013) school-based sex education in western Nepal: Reproductive

health matter, vol14, n 28 pg. 156- 161.

Pedezert, L., Crow, H., Arthur, S. (2010). Understanding blockage in sewer system A case-by-
case approach, Herrot University, Edinburgh Scotland.

Philip, P. Nyothach, E., Omato, J. and onyango, C. (2014) menstrual needs cups and sanitary
pads to reduce school attrition and sexual transmitted and reproductive tract infection: a duster
randomized control feasibility in rural western, Kenya vol.6 no 11.

SNV,2014. Menstrual hygiene management and wash in school baseline survey report. Eastern
in Equatorial state in South Sudan.UNESCO - 2014. Good policy and practice in health
education booklet: Puberty education and menstrual hygiene management.

32
APPENDIX I: STRUCTURED QUESTIONNAIRES.

INTRODUCTION.

I’m diploma student undertaking health records and information at KMTC Kitui campus carrying
out a study factors affecting menstrual hygiene management among primary school girls (class 5,
6, 7, and 8) in Thika primary school

TOPIC: MENSTRUAL HYGIENE MANAGEMENT AMONG PRIMARY SCHOOL

GIRLS (CLASS5,6,7,8) AT THIKA PRIMARY SCHOOL

Instructions

1. Confidentiality is maintained to the information given

2. Tick the right choice in the brackets provided.

3. Do not write your name.

33
4. The questionnaire is meant for future supports for other girls.

5. Kindly try to be honest in what you answer.

SOCIO DEMOGHRAPHIC INFORMATION.

1. Age group of the respondents

10-12years ()

13-15years ()

16-18 years ()

2. Level of education in primary school of respondent.

Class 5 ()

Class 6 ()

Class 7 ()

Class 8 ()

3. Occupation of your parents.

Salaried ()

Farmers ()

Un-wage ()

Others (specify)……………………..

4. How many girls are you in the family?

1-3 ()

4-6 ()

7-9 ()

34
5. Religious affiliation of the respondents.

Protestant ( )

Catholic ()

Others (specify)………………….

Menstrual waste disposal practices.

6.What type of sanitary towels do you use during your menstrual?

()

Old cloth ()

Sanitary pad ( )

Tissue paper ( )

Others (specify)……………………………………...

7. How do you dispose your menstrual absorbents

A. incinerators

B. In latrines

C. By burying them

D. Throwing them in an open space.

LEVEL OF KNOWLEDGE AND AWARENESS

8. Have you ever heard of the term menstruation?

35
Yes ()

No ()

9. If yes from which source.

Mother ()

Teacher ()

Media ()

Church ()

Other (specify)……………………………………………

10. What is menstruation?...........................................................

ACCESSIBILITY OF SANITARY PRODUCTS

11. Does your parent buy you sanitary towels?

Yes ()

No ()

If (no) why doesn’t he/she buy?

Expensive ()

Not available ()

Not necessary ()

Others (specify)

12. Can you access one of the disposable methods in your school?

Yes ()

No ()

36
If yes which one?

Dust bin ()

Latrine ()

Others (specify) ……………………………………………

13. How far is your home from the nearest shop?

Below 500m ()

1000 m ()

1500m or more ()

14. What means of transport do you use to your nearest shop?

Vehicle ()

Foot ()

Others (specify)………

15. Do you use your menstrual towel?

Yes ()

No ()

16. After how long do you change your towels?

3Hrs ()

4Hrs ()

1 day ()

17. How many sanitary towels do you use in a day?

One ()

37
Two ()

Three ()

Four ()

18. What is the cost of sanitary towel?

Cheap ()

Expensive ()

No idea

APPENDIX II: BUDGET

ITEMS QUALITY AMOUNT TOTALS

PEN IDOZEN 150 150
PENCIL 1DOZEN 120 120
RUBBER IRUBBER 50 50
RULER 1RULER 40 40
LOOSELEAFPAD 4ROLLS 400 40
SPRINGFILE 2FILES 40 80
FLASHDISK 8GB 1200 1200
PRINTING 30 300 300
BINDING 4COPIES 100 400
INTERNET 180DAYS 50 9000
SERVIES
TRANSPORT 30DAYS 50 1500

38
ACCOMODATION 30DAYS 100 3000
MISCELLENOUS 5000 5000 5000
TOTAL 20880

APPENDIX III: WORKPLAN

ACTIIVITY SEEP OCT NOV’20 DEC’20 JAN’2 FEB’21

20 20 1
TOPIC
IDENTIFICATIO
N
LITERATURE
REVIEW
PROPOSAL
WRITING AND
SUBMISSION
MATERIAL
IDENTIFICATIO
N
DATA
COLLECTION
DATA ANALYSIS

39
REPORT
WRITING
DISSEMINATION

APPENDIX IV: NACOSTI LETTER

40
41
42
APPENDIX III: LETTER OF APPROVAL

43
 APPENDIX VI: LIST OF STUDENTS TOPICS
KENYA MEDICAL TRAINING COLLEGE –KITUI CAMPUS

DEPARTMENT OF HEALTH RECORDS AND INFOERMATION TECHNOLOGY

SEPTEMBER 2018 DIPLOMA RESEARCH TOPICS

S.NO STUDENTS COLLEGE NUMBER RESEARCH TOPIC COUNTY

NAME
1. EUNICE D/UPHRIFT/19028/135 CHALLENGES FACING HEALTH NYERI
MUTHONI WORKERS IN UTILIZATION OF
GIKONYO ELECTRONIC MEDICAL RECORDS
IN NYERI COUNTY REFFERAL
HOSPITAL
2 EUNICE D/UPHRIFT/19028/041 FACTORS AFFECTING HEALTH KIAMBU
KWAMBOKA DATA QUALITY IN KIHARA SUB
COUNTY HOSPITAL
3 IRENE MBEKE D/UPHRIFT/19028/149 FACTORS CONTRIBUTING TO NAIROBI
UNDERUTILIZATION OF VCT
SERVICES AMONG YOUTH AGED
15-35 YEARS IN KIAMBIU SLUM
4 IRENE MBARI D/UPHRIFT/19028/136 FACTORS INFLUENCING KIAMBU
PATIENT WAITING TIME IN
OUTPATIENT DEPARTMENT IN
RUIRU SUB COUNTY HOSPITAL
5 SALOME D/UPHRIFT/19028/253 FACTORS CONTRIBUTING TO KAKAMEGA
CHILANDE HOME DELIVERY AMONG
MOTHERS IN MANYONYI
VILLAGE IN LUGARI SUB
COUNTY
6 FAITH D/UPHRIFT/19028/258 KNOWLEDGE, ATTITUDE AND KERICHO
CHEPKORIR PRACTICES ON MALE
INVOLVEMENT IN ANTENATAL
SERVICES IN KAPKATET TOWN
7 LINDAH BARASA D/UPHRIFT/19028/145 FACTORS INFLUENCING BUNGOMA
INFECTION CONTROL
PRACTICES AMONG HEALTH
WORKERS IN SURGICAL WARDS
AT WEBUYE SUB COUNTY
REFFERAL HOSPITAL
8 JUDY KEBUT D/UPHRIFT/19028/140 FACTORS INFLUENCING KIAMBU
UTILIZATION OF FAMILY
PLANNING SERVICES AMONG
SEXUALLY ACTIVE PEOPLE

44
 LIVING WITH HIV AIDS
ATTENDING THIKA LEVEL V
HOSPITAL
9 BENJAMIN D/UPHRIFT/19028/081 FACTORS INFLUENCING THE KITUI
MALOMBE QUALITY OF MEDICAL RECORDS
DOCUMENTATION AMONG
HEALTH WORERS AT KITUI
COUNTY REFFERAL HOSPITAL
10 MORINE D/UPHRIFT/19028/146 FACTORS INFLUENCING KAKAMEGA
MANYALI ADHERENCE TO TUBERCULOSIS
TREATMENT AMONG PATIENTS
ATTENDING TB CLINIC IN
MALAVA SUB COUNTY
HOSPITAL
11 CAROLINE D/UPHRIFT/19028/1049 FACTORS INFLUENCING MACHAKOS
NZOKA UTILIZATION OF ANTE NATAL
CARE SERVICES AMONG
WOMEN OF REPRODUCTIVE
AGE AT KARIOBAGI VILLAGE
12 RISPER D/UPHRIFT/19028/1054 FACTORS CONTRIBUTING TO MACHAKOS
MUSEMBI LOW UPTAKE OF SKILLED
DELIVERY SERVICES AT
MASINGA VILLAGE
13 LYDIA NGEI D/UPHRIFT/19028/019 KNOWLEDE, ATTITUDE AND KITUI
PRACTICES ON EXCLUSIVE
BREASTFEEDING AMONG
LACTATING MOTHERS IN
MATINYANI LOCATION
14 MERCY D/UPHRIFT/19028/021 FACTORS AFFECTING KITUI
MWENDWA UTILIZATION OF INTRAUTERINE
DEVICE METHOD OF FAMILY
PLANNING AMONG WOMEN
OF REPRODUCTIVE AGE IN
KYUSO SUB COUNTY HOSPITAL
15 EMMACULATE D/UPHRIFT/19028/1057 FACTORS INFLUENCING KITUI
MUEMA UPTAKE OF LINDA MAMA
MATERNAL HEALTH CARE
DELIVERY PROGRAMMME
AMONG WOMEN IN KITUI
COUNTY REFFERAL HOSPITAL
16 BEATRICE D/UPHRIFT/19028/537 FACTORS CONTRIBUTING TO KITUI
MALONZA NON ADHERANCE OF
APPOINTMENTS AMONG

45
 PATIENTS IN MEDICAL
OUTPATIENT CLINIC AT
MWINGI LEVEL IV HOSPITAL
17 FIDELIS MBITHI D/UPHRIFT/19028/1058 FACTORS AFFECTING DELIVERY MAKUENI
OF QUALITY HEALTH RECORDS
AND INFORMATION SERVICES
IN MAKUENI COUNTY
REFFERAL HOSPITAL
18 MALCOLM D/UPHRIFT/19028/148 FACTORS HINDERING THE NAIROBI
GOGO PERFORMANCE OF
COMMUNITY HEALTH
ASSISTANTS IN LANGATA SUB
COUNTY
19 MERCY D/UPHRIFT/19028/202 FACTORS INFLUENCING KITUI
WAMBUA ACCESS AND UTILIZATION OF
COMPUTERIZED PATIENT
INFORMATION AT JORDAN
HOSPITAL
20 VIOLET D/UPHRIFT/19028/408 KNOWLEDGE ON KITUI
MUNYWOKI MANAGEMENT OF TYPE 2
DIABETES MELLITUS AMONG
PATIENTS ATTENDING
DIABETIC CLINIC IN MWINGI
SUB COUNTY REFFERAL
HOSPITAL
21 NICHOLAS D/UPHRIFT/19028/548 FACTORS INFLUENCING KITUI
CHARO PATIENTS COMPLIANCE TO
ISONIZED PREVENTIVE
THERAPY AMONG PATIENTS
ATTENDING COMPREHENSIVE
CARE CENTRE CLINIC AT
MUTITO SUB COUNTY
HOSPITAL
22 IRENE MUSYOKI D/UPHRIFT/19028/020 FACTORS INFLUENCING KITUI
UTILIZATION OF MATERNITY
SERVICES AMONG PREGNANT
WOMEN IN TIVA VILLAGE
23 REBECCA D/UPHRIFT/19028/747 KNOWLEDGE ATTITUDE ANS KAJIADO
NAFULA PRACTICES ON EXCLUSIVE
BREAST FEEDING AMONG
LACTATING MOTHERS IN
KITENGELA SUB COUNTY
HOSPITAL

46
24 SYLVIA D/UPHRIFT/19028/144 FACTORS INFLUENCING DROP KAKAMEGA
MUSIOMI OUT OF LEARNERS WITH
SPECIAL NEEDS IN REGULAR
PRIMARY SCHOOLS IN
KAKAMEGA EAST SUB COUNTY
25 KENNEDY D/UPHRIFT/19028/064 FACTORS CONTRIBUTING TO KITUI
NYONGESA TEENAGE PREGNANCY AMONG
YOUNG GIRLS ATTENDING
ANTENATAL CLINIC IN KITUI
COUNTY REFFERAL HOSPITAL
26 CHEBON D/UPHRIFT/19028/063 FACTORS CONTRIBUTING TO ELGEYO
DORCAS FEMALE GENITAL MUTILATION MARAKWET
IN KAPYEGO VILLAGE
27 DENNIS D/UPHRIFT/19028/526 FACTORS CONTRIBUTING TO KITUI
MAKUTHU NON ADHERANCE TO
ANTIRETROVIRAL THERAPHY
AMONG ADULTS LIVING WITH
HIV/AIDS AT NUU SUB COUNTY
HOSPITAL
28 NGAMI MUMBI D/UPHRIFT/19028/1046 FACTORS HINDERING MACHAKOS
ANALYSIS OF HEALTH DATA
AMONG HEALTH WORKERS AT
MACHAKOS LEVEL V HOPSITAL
29 CAROLYNE D/UPHRIFT/19028/541 FACTORS AFFECTING KITUI
MUSANGI ADHERENCE TO
IMMUNIZATION AMONG
CHILDREN AGED 0-5 YEARS
ATTENDING MATERNAL CHILD
HEALTH CLINIC IN KITUI
COUNTY REFFERAL HOSPITAL
30 SELLAR SIMIYU D/UPHRIFT/19028/534 FACTORS AFFECTING HAND KITALE
HYGIENE PRACTICES AMONG
HEALTH CARE WORKERS AT
KITALE COUNTY REFFERAL
HOSPITAL
31 EDDY IMEMBI D/UPHRIFT/19028/550 FACTORS CONTRIBUTING TO KITUI
PRE MARITAL SEX AMONG
STUDENT AGED 18-25 IN
KENYA MEDICAL TRAINING
COLLEGE KITUI CAMPUS
32 DANIEL K. D/UPHRIFT/19028/521 FACTORS HINDERING KISII
SOPHIA UTILIZATION OF FEMALE
CONDOMS AMONG WOMEN

47
 OF REPRODUCTIVE AGE IN
MATERNAL CHIRLD HEALTH
CLINIC AT NYAMACHE SUB
COUNTY HOSPITAL
33 ROSE WAMBUA D/UPHRIFT/19028/680 FACTORS INFLUENCING MACHAKOS
UTILIZATION OF HEALTH CARE
SERVICES AMONG RESIDENTS
OF KITULU VILLAGE
34 RUTH MUSYOKI D/UPHRIFT/19028/324 FACTORS HINDERING MAKUENI
ADOPTION OF ELECTRONIC
MEDICAL RECORDS AMONG
HEALTH CARE WORKERS AT
MAKUENI COUNTY REFFERAL
HOSPITAL
35 JACINTA D/UPHRIFT/19028/542 FACTORS INFLUENCING MAKUENI
KINGOO UTILIZATION OF ANTENATAL
CARE SERVICES AMONG
PREGNANT MOTHERS IN
MATERNAL CHILD HEALTH IN
MAKINDU SUB COUNTY
HOSPITAL
36 WINFRED D/UPHRIFT/19028/133 AWARENESS OF UNIVERSAL MAKUENI
MUTUI HEALTH CARE PROGRAM
AMONG PATIENTS AT OUT
PATIENT DEPARTMENT IN
MAKINDU SUB COUNTY
HOSPITAL
37 ROBERT NDIOO D/UPHRIFT/19028/319 KNOWLEDGE, ATTITUDE AND MAKUENI
PRACTICES ON FEMALE
CONDOMS AMONG YOUTH
AGED 18-35 YEARS IN UNOA
VILLAGE
38 JUDY GACHOKI D/UPHRIFT/19028/1048 FACTORS CONTRIBUTING TO KIRINYAGA
DOMESTIC VIOLENCE AMONG
WOMEN IN KIARUKUNGU
VILLAGE
39 PHANICE D/UPHRIFT/19028/529 KNOWLEDGE, ATTITUDE AND BUNGOMA
CHENANE PRACTICES ON INFECTION
CONTROL AMONG HEALTH
WORKERS AT WEBUYE SUB
COUNTY HOSPITAL
40 ALEX NALIANYA D/UPHRIFT/19028/317 FACTORS CONTRIBUTING TO BUNGOMA
IMPROPER SANITATION AND

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 HYGIENE AMONG PUPILS AT
CHEBUKAKA PRIMARY
SCHOOL
41 JACINTA D/UPHRIFT/19028/539 FACTORS HINDERING KIRINYAGA
WANGUI UTILIZATION OF MODERN
FAMILY PLANNING AMONG
WOMEN OF REPRODUCTIVE
AGE IN KIARUKUNGU
LOCATION
42 AGNES MUITHI D/UPHRIFT/19028/536 KNOWLEDGE, ATTITUDE AND MACHAKOS
PRACTICES ON NEONATAL
CARE AMONG MOTHERS IN
MATERNITY WARD IN MATUU
SUB COUNTY HOSPITAL
43 JACKLINE D/UPHRIFT/19028/530 AWARENESS OF HUMAN MAKUENI
MUTUNGI PAPILOMA VIRUS VACCINE
AMONG PATIENTS ATTENDING
OUT PATIENT
DEPARTMEMENT AT
MAKINDU SUB COUNTY
HOSPITAL
44 PAULINE WERE D/UPHRIFT/19028/532 FACTORS CONTRIBUTING TO KITUI
UNDERWEIGHT AMONG
CHILDREN AGED 6-59
ATTENDING CHILD WELFARE
CLINIC IN KITUI COUNTY
REFFERAL HOSPITAL
45 ABIGAEL JULIUS D/UPHRIFT/19028/535 FACTORS CONTRIBUTING TO KITUI
UTILIZATION OF EMERGENCY
PILLS AMONG FEMALE
STUDENTS IN KENYA MEDICAL
TRAINING COLLEGE, KITUI
CAMPUS
46 VICTORIA D/UPHRIFT/19028/533 FACTORS CONTRIBUTING TO KITUI
MUVEA MALNUTRITION AMONG
CHILDREN UNDER 5 YEARS
ATTENDING MATERNAL CHILD
HEALTH CLINIC IN MIGWANI
SUB COUNTY HOSPITAL
47 KIRUI D/UPHRIFT/19028/1051 FACTORS INFLUENCING CHILD KERICHO
VERONICAH SPACING AMONG WOMEN OF
REPRODUCTIVE AGE AT
KAPKATET SUB COUNTY

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 HOSPITAL
48 JACKLINE D/UPHRIFT/19028/1052 FACTORS CONTRIBUTING TO MACHAKOS
MUTISO DRUG ABUSE AMONG YOUTHS
AGED 18-25 ATTENDING
REHABILITATION UNIT IN
MACHAKOS LEVEL V HOSPITAL
49 CAROLINE D/UPHRIFT/19028/549 FACTORS CONTRIBUTING TO LAIKIPIA
WANJIKU UTILIZATION OF BREAST
CANCER SCREENING SERVICES
AMONG WOMEN ATTENDING
MATERNAL CHILD HEALTH
CLINIC IN NANYUKI COUNTY
REFFERAL HOSPITAL
50 DELMONTI D/UPHRIFT/19028/527 KNOWLEDGE AND ATTITUDE KITUI
ONDIEK ON MENOPAUSE AMONG
WOMEN AGED 40 TO 45
YEARS ATTENDING
OUTPATIENT DEPARTMENT IN
KITUI COUNTY REFFERAL
HOSPITAL
51 NAIBEI RODGERS D/UPHRIFT/19028/522 FACTORS CONTRIBUTING TO NAIROBI
PREVALENCE OF
TUBERCULOSIS AMONG
PATIENTS ATTENDING CHEST
CLINIC AT MBAGATHI SUB
COUNTY REFFERAL HOSPITAL
52 OBED CHOI D/UPHRIFT/19028/400 FACTORS INFLUENCING KISII
TURNOUT OF MOTHERS WITH
CHILDREN UNDER FIVE YEARS
DURING POLYMYELITIS
CAMPAIGNS IN IKORO SUB
LOCATION
53 DANIEL RUTO D/UPHRIFT/19028/525 KNOWLEDGE, ATTITUDE AND NAIROBI
PRACTICES ON ELIMINATION
OF MOTHER TO CHILD
TRANSMISSION AMONG
PREGNANT WOMEN
ATTENDING ANTENATAL
CLINIC IN MBAGATHI SUB
COUNTY REFFERAL HOSPITAL
54 CHRISTINE D/UPHRIFT/19028/1055 KNOWLEDGE AND ATTITUDE KITUI
WAMBUA ON USE OF IUCD AMONG
WOMEN OF REPRODUCTIVE

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 AGE AT MCH IN KATULANI SUB
COUNTY REFFERAL HOSPITAL
55 RACHEL KISAVI D/UPHRIFT/19028/543 FACTORS CONTRIBUTING TO MAKUENI
PREVALENCE OF UPPER
RESPIRATORY TRACT
INFECTION AMONG CHILDREN
UNDER FIVE YEARS AT KISAU
SUB COUNTY HOSPITAL
56 EMMA KINYUA D/UPHRIFT/19028/524 FACTORS CONTRIBUTING TO NYERI
CHRONIC PULMONARY
DISEASE AMONG PATIENTS
ATTENDING CHEST CLINIC IN
KARATINA SUB COUNTY
REFFERAL HOSPITAL
57 LORNA CHEBOI D/UPHRIFT/19028/1045 FACTORS CONTRIBUTING TO UASIN GISHU
WOMEN PREFFERENCE OF
CAESAREAN SECTION AT MOI
TEACHING AND REFFERAL
HOSPITAL
58 ELIZABETH D/UPHRIFT/19028/1044 FACTORS CONTRIBUTING TO MACHAKOS
KYALO MOTOR CYCLE ACCIDENTS
AMONG RESIDENTS OF
MUMBUNI ESTATE
59 WINNY KOSGEI D/UPHRIFT/19028/1047 FACTORS INFLUENCING ITEN
INFANT FEEDING PRACTICES
AMONG WOMEN ATTENDING
MCH CLINIC AT ITEN COUNTY
REFFERAL HOSPITAL
60 SHALLEEN D/UPHRIFT/19028/547 KNOWLEDGE, ATTITUDE AND MAKUENI
KIOKO PRACTICES ON MEDICAL
WASTE MANAGEMENT
AMONG HEALTH WORKERS AT
MAKINDU SUB COUNTY
HOSPITAL
61 KENNEDY D/UPHRIFT/18028/141 KNOWLEDGE, ATTITUDE AND MACHAKOS
MUTISYA PRACTICES ON IMMUNIZATON
AMONG MOTHERS WITH
CHILDREN AGED UNDER FIVE
YEARS IN MACHAKOS COUNTY
REFFERAL HOSPITAL
62 ESTHER D/UPHRIFT/19028/251 FACTORS AFFECTING WASTE MURANGA
WANJIKU DISPOSAL IN MARAGUA
TOWN

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63 CAROLINE D/UPHRIFT/19028/318 FACTORS CONTRIBUTING TO KIAMBU
MAITHYA UNINTENDED PREGNANCIES
AMONG TEENAGERS AGED 13-
18 YEARS IN KIHARA
LOCATION
64 JEMIMAH D/UPHRIFT/19028/321 FACTORS CONTRIBUTING TO TAITA
WAMBUGHA CONSUMPTION OF KHAT TAVETA
AMONG YOUTH IN
MWAKINGALI VILLAGE, VOI
SUB COUNTY
65 FAITH MBEKE D/UPHRIFT/19028/466 CHALLENGES FACED BY KITUI
HEALTH CARE PROVIDERS IN
DELIVERING HEALTH CARE
SERVICES TO THE DEAF
PATIENTS AT MWINGI SUB
COUNTY REFFERAL HOSPITAL
66 VALENTINE D/UPHRIFT/19028/320 FACTORS INFLUENCING MOMBASA
KALELI CHOICE OF CONTACEPTIVES
AMONG HIV POSITIVE
WOMEN ATTENDING
COMPHREHENSIVE CARE
CLINIC AT COAST PROVINCIAL
GENERAL HOSPITAL
67 ANN WAWERU D/UPHRIFT/19028/254 FACTORS AFFECTING KIAMBU
MESTRUAL HYGIENE
MANAGEMENT AMONG
PRIMARY SCHOOLS GIRLS IN
THIKA PRIMARY SCHOOL
68 ISENE ISACKO D/UPHRIFT/19028/758 FACTORS CONTRIBUTING TO MARSABIT
EARLY MARRIAGES AMONG
GABRA COMMUNITY IN
MAIKONA VILLAGE
69 CHARITY NZUKI D/UPHRIFT/19028/540 FACTORS AFFECTING THE KITUI
UPTAKE OF IRON AND FOLIC
ACID SUPPLEMENTATION
AMONG PREGNANT WOMEN
IN ZOMBE SUB COUNTY
HOSPITAL
70 HAMIDA D/UPHRIFT/19028/692 FACTORS CONTRIBUTING TOP MARSABIT
ABDULRAHMAN ABORTION AMONG WOMEN
OF REPRODUCTIVE AGE IN
MARSABIT COUNTY REFFERAL
HOSPITAL

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71 NYABUTO D/UPHRIFT/19028/545 FACTORS CONTRIBUTING TO KISII
SAMUEL EARLY WEANING OF INFANTS
AMONG LACTATING MOTHERS
ATTENDING MCH CLINIC IN
GUCHA SUB COUNTY
HOSPITAL
72 PURITY D/UPHRIFT/19028/046 FACTORS INFLUENCING HOME KIRINYAGA
MUCHIRI DELIVERIES AMONG WOMEN
OF REPRODUCTIVE AGE IN
GICHUGU SUB COUNTY
73 SYLVIA SOILA D/UPHRIFT/19028/1053 FACTORS AFFECTING THE KAJIADO
UPTAKE OF NATIONAL
HOSPITAL INSURANCE FUND
AMONG RESIDENTS OF
MAJENGO VILLAGE
74 MERCY D/UPHRIFT/19028/528 PREVALENCE OF ANAEMIA MACHAKOS
MAITHYA AMONG PREGNANT WOMEN
ATTENDING ANTENATAL
CLINIC AT MATUU SUB
COUNTY HOSPITAL
75 MICHAEL D/UPHRIFT/19028/315 FACTORS INFLUENCING NON MAKUENI
MWOLOI UTULIZATION OF LATRINES
AMONG RESIDENTS OF
MATUNDANI VILLAGE
76 LINET OWINO D/UPHRIFT/19028/546 FACTORS UNFLUENCING NAIROBI
HEALTH SEEKING BEHAVIOUR
AMONG RESIDENTS OF
UMOJA ESTATE
77 JUSTINE KIIO D/UPHRIFT/19028/1050 KNOWLEDGE AND PRACTICES MACHAKOS
ON IMPLANTS AS A FAMLY
PLANNING METHOD AMONG
WOMEN OF REPRODUCTIVE
AGE IN MASINGA SUB COUNTY
HOSPITAL
78 FLORENCE D/UPHRIFT/19028/135 FACTORS INFLUENCING KITUI
KAMUTHA HEALTH SEEKING BEHAVIOUR
AMONG HYPERTENSIVE
PATIENTS ATTENDING
MEDICAL OUTPATIENT CLINIC
IN KITUI COUNTY REFFERAL
HOSPITAL
79 DORIS D/UPHRIFT/19028/523 KNOWLEDGE, ATTITUDE AND KERICHO
CHELAGAT PRACTICES ON VASECTOMY

53
 AMONG MEN AT TIMO
ESTATE, KAPKATET TOWN
80 NANCY MUTUA D/UPHRIFT/19028/128 FACTORS AFFECTING DATA MACHAKOS
QUALITY AMONG HEALTH
WORKERS IN KANGUNDO SUB
COUNTY HOSPITAL
81 ERASTUS D/UPHRIFT/19028/065 EFFECTS OF IMPLEMENTATION KAJIADO
SHITADI OF HEALTH INFORMATION
TECHNOLOGY ON HEALTH
SERVICE DELIVERY AT
KITENGELA SUB COUNTY
HOSPITAL
PREPARED BY
THOMAS MUANGE
HOD-HEALTH RECORDS AND INFORMATION

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