International Journal of Medicine and Health Development

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 27  |  Issue : 3  |  Page : 214--219

Prevalence and pattern of dysmenorrhea among secondary school girls in Enugu Metropolis: A cross-sectional study


Edith C Ikpeama1, Emmanuel O Izuka2, Joseph T Enebe3, Uchenna A Umeh1, Chinelo E Obiora-Izuka4, Uchenna I Nwagha1,  
1 Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
2 Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Nigeria
3 Department of Obstetrics and Gynaecology, College of Medicine, Enugu State University of Science and Technology, ESUTH-Parklane, Enugu, Nigeria
4 Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria

Correspondence Address:
Emmanuel O Izuka
Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Ituku-Ozalla
Nigeria

Abstract

Background: Globally, dysmenorrhea is a common menstrual condition among adolescent girls. It interferes with the emotions and physical activities and adversely affects school attendance and performance. However, the prevalence and pattern of presentation are underexplored in Nigeria. Objective: The objective of this study is to determine the prevalence and patterns of dysmenorrhea and its effect on school attendance in adolescent girls in Enugu, South-East, Nigeria. Materials and Methods: This study is a population-based cross-sectional survey of the prevalence and pattern of dysmenorrhea among 326 secondary school girls in Enugu Metropolis between October and December 2019. A structured questionnaire was used to collect relevant information. Data were analyzed using Statistical Package for Social Sciences (SPSS) IBM version 23.0. Chi square was used to test for association between categorical variables, and a P-value of less than 0.05 was considered statistically significant. Results: Prevalence of dysmenorrhea was 75%. Majority of the students (60.7%) had 1–2 days of menstrual pain, with 39.3% presenting with severe pain. The length of menstrual cycle (P < 0.011) and duration of flow (P < 0.009) were significantly higher among subjects with dysmenorrhea than those without dysmenorrhea. Forty-six students (14.1%) were absent from school due to dysmenorrhea; however, there was no significant association between dysmenorrhea and school absenteeism (P > 0.05). Also, there was no significant association between degree of pain and school absenteeism (P > 0.05). Conclusion: The prevalence of dysmenorrhea was high among secondary school girls in Enugu, Nigeria. It was associated with the length of menstrual cycle and duration of flow. There was no association between degree of dymenorrhean and school absenteeism.



How to cite this article:
Ikpeama EC, Izuka EO, Enebe JT, Umeh UA, Obiora-Izuka CE, Nwagha UI. Prevalence and pattern of dysmenorrhea among secondary school girls in Enugu Metropolis: A cross-sectional study.Int J Med Health Dev 2022;27:214-219


How to cite this URL:
Ikpeama EC, Izuka EO, Enebe JT, Umeh UA, Obiora-Izuka CE, Nwagha UI. Prevalence and pattern of dysmenorrhea among secondary school girls in Enugu Metropolis: A cross-sectional study. Int J Med Health Dev [serial online] 2022 [cited 2022 Jun 26 ];27:214-219
Available from: https://www.ijmhdev.com/text.asp?2022/27/3/214/346431


Full Text



 Introduction



Menstruation is an important indicator of women’s reproductive and endocrine health.[1] Although it is a natural physiological phenomenon, many girls face problems of menstruation such as irregular bleeding, excessive bleeding, and painful menstruation.[1] Dysmenorrhea is a common problem among young girls. It is often underdiagnosed and undertreated due to underreporting on the part of the individuals experiencing it and the relative lack of physician awareness of the prevalence rates and associated morbidity.[2]

Dysmenorrhea or painful menstruation is defined as a severe, painful, cramping sensation in the lower abdomen that is often accompanied by other symptoms such as sweating, headaches, nausea, vomiting, diarrhea, and tremulousness, all occurring just before or during the menses.[3]

It is considered primary in the absence of underlying pathology. Onset is typically 6–12 months after menarche, with peak prevalence occurring in the late teens or early twenties.[4] The cause of primary dysmenorrhea is not well established.[5],[6]

Dysmenorrhea is a cause of frequent short-term work and school absenteeism in women of reproductive age. Approximately 10–15% of females experience monthly menstrual pain severe enough to stop normal daily functions at work, home, or school.[7]

As the pain results from uterine vasoconstriction and contraction mediated by prostaglandins, the most reliable way and effective treatment of dysmenorrhea is to inhibit prostaglandin synthesis using non-steroidal anti-inflammatory drugs (NSAIDs). If symptoms do not respond to three menstrual periods, combined oral contraceptive pills for three menstrual cycles can be tried.[8]

Most young girls do not seek medical help as they seem to accept the discomfort as part of the physiological process of the transition between adolescent and adulthood and as something that cannot be ameliorated.[9]

In a study done by Nwankwo et al.[10] to determine the prevalence, pattern of menstrual disorders, treatment practices, and the effect of menstrual disorders on school attendance in 500 adolescent school girls in Enugu, Nigeria, the prevalence of menstrual disorders was 69.4% and dysmenorrhea, premenstrual dysphoric disorder, and short menstrual cycles were the commonest disorders. Being older, later age of menarche, and being domiciled in the boarding house were significantly associated with menstrual disorders. Dysmenorrhea was responsible for the greatest number of school absences. In 80% of the cases, paracetamol, aspirin, or piroxicam were the drugs used for symptom relief.[10]

Another study was done by Chigbu et al. on factors influencing the prevalence rate of dysmenorrhea in Abia State University medical students. A total of 132 students were studied, and the prevalence rate of dysmenorrhea in students was approximately 70%. Dysmenorrhea was significantly associated with heavy menstrual blood loss and positive family history of dysmenorrhea. There was no significant association between dysmenorrhea and age at menarche, regularity of the cycle, length and duration of the cycle, and parity of the students. Severe dysmenorrhea was reported by 57 (62%) students. Forty-one (45%) reported absenteeism from classes, whereas 27 (30%) reported decreased concentration in classes.[2]

A similar study done by Okoro et al. on evaluation of factors that increase the severity of dysmenorrhea among university female students in Maiduguri, North Eastern Nigeria showed that dysmenorrhea was increased by heavy menstrual flow, nulliparity, and low body mass index (BMI), whereas it was decreased by multiparity and high BMI. It also had a negative impact on academic performance.[5]

A study was done by Bello et al.[11] among 360 female students at a teaching hospital in south western Nigeria to assess the prevalence and factors associated with dysmenorrhea in a population of young females and to explore the impact on routine activity and proven relief measures experienced. All respondents had attained menarche at 12.4 ± 1.2 years; 299 (83.1%) reported dysmenorrhea. Primary dysmenorrhea constituted 63.6%; secondary was 19.4%. Younger respondents (teenagers) and married females were significantly less likely to suffer dysmenorrhea, whereas non-users of oral contraceptives were more likely to have dysmenorrhea. Period pain precluded usual activity in 48.8% of the sufferers, and 39.5% had missed classes on account of it; however, only 10% had sought medical care. The most effective treatment used was piroxicam (an anti-prostaglandin drug). Increasing age was significantly associated with dysmenorrhea.

Dysmenorrhea is one of the main causes of absenteeism from school among secondary school girls. It also leads to loss of man hours in offices among working class ladies with associated social and psychological consequences. Though it is a well-known medical condition affecting teenage population, there is paucity of information on the severity of dysmenorrhea and its negative impact on academic performance in our environment. The objective of this study was to determine the prevalence of dysmenorrhea, the pattern and effect of menstrual disorders, and the treatment practices, among secondary school girls in Enugu Metropolis. This study, therefore, will provide us with baseline information on this topic and may impact on the quality of care given to this special group of people with dysmenorrhea.

 Materials and Methods



Study design

This was a cross-sectional study.

Study setting

This study was conducted within Enugu Metropolis in Enugu State. The study centres were three Government Girls Secondary Schools: one conveniently selected from each of the three local government areas in Enugu Metropolis: Trans-Ekulu Girls Secondary School from Enugu-East, Queens Secondary School at Independence Layout from Enugu-South, and Government Secondary School, GRA from Enugu-North. The study was conducted between July and December 2019.

Study population

The study was conducted among secondary school girls in SS1–SS3 classes in the selected secondary schools.

Sample size determination

Using the formula for prevalence by Daniel[12]: n = Z2P (1−P)/d2 with a prevalence rate of 69.4% from a previous study[10] at a confidence level of 95% and a precision of 5%, the calculated minimum sample size was 326.

Sampling technique

The stratified single-stage cluster sampling technique was used to select subjects for the study. The three local government areas in Enugu Metropolis form the strata. A secondary school was selected from each of the three local government areas; this was the first stage. Thereafter, the sample size of 326 was allocated proportionately to each of the schools. The distribution was as follows:

[INLINE:1]

Inclusion criteria

Consecutive students of SS1–SS111 of three secondary schools from three local governments of Enugu Metropolis were included, until the desired sample size was attained.

Exclusion criteria

The exclusion criteria were JS1–JS111 students and students who presented after the desired sample size was attained.

Data collection

A pretested structured interviewer administered questionnaires with Cronbach’s alpha value of 0.872, indicating that the questionnaire reliable for the study was administered individually to each consenting participant by trained assistants. Data sought included the socio-demographic characteristics of the respondents, the pattern of menstrual disturbances, degree of pain assessed using a numerical (0–10) pain scale, treatment practices, and number of days absent from school due to dysmenorrhea.

Data analysis

The data collected were analyzed descriptively and inferentially using IBM SPSS version 23. Descriptive statistical tools which included frequencies and percentages were used to summarize categorical variables. Inferential tools such as χ2 were used to test for association between categorical variables. A P-value of less than 0.05 was considered statistically significant. Results were presented in tables and charts.

Outcome measures

The primary outcome measure was the prevalence of dysmenorrhea among the respondents.

Ethical considerations

Ethical clearance for the study was obtained from the Health Research Ethics Committee of the UNTH, Ituku-Ozalla, Enugu with number NHREC/05/01/2008-B-FWA00002458-1RB00002323. Students’ assent and school principal’s consent were also obtained before the commencement of data collection from the participants.

 Result



Basic characteristics of the participants

A total of 326 female students were recruited in this study. The mean age of the participants was 15.51 ± 1.24 years, the mean age at menarche was 12.87 ± 1.29 years, and the mean BMI was 23.09 ± 4.66 kg/m2. The length of their menstrual cycle ranged from 16 to 44 days. Details are shown in [Table 1].{Table 1}

The prevalence and pattern of pain among the participants

The prevalence of dysmenorrhea among the participants was 75%, as 244 out of the 326 participants had pains during their menstruation. Most (60.7%) of the participants had pain that lasted between 1 and 2 days. About half (45.9%) of the study population had pain that was graded as moderate degree of pain. Other details were shown in [Table 2].{Table 2}

Treatment practices of dysmenorrhea among the participants

[Table 3] shows that 66% of the girls took medications for the pain of menstruation and out of them, 47% took medications regularly. The medications were effective in 75.9% of the school girls. The major medications include paracetamol (48.5%) and proxicam capsule (19.6%); whereas 21.6% were unknown as medications were bought by their caregivers.{Table 3}

Relationship between some basic characteristics of the participants and dysmenorrhea

The length of menstrual cycle and duration of flow were significantly higher among subjects with dysmenorrhea than those without dysmenorrhea (P < 0.05). There was no significant relationship between the age at menarche and presence of dysmenorrhea among the participants (P > 0.05). Details are shown in [Table 4].{Table 4}

Association between dysmenorrhea and school absence

There was a high level of school attendance among the participants, despite the presence of dysmenorrhea in 75% of the participants. Majority (85.9%) of the participants had 100% attendance within the previous school session. In contrast, 10.7% (35) missed school for only one day, whereas 3.1% (10) and 0.3% (1) missed school for 2 days and a day, respectively, in their last school session. There was no significant association between dysmenorrhea and number of days of school absence (χ2 =2.291, P = 0.514). This implies that number of days of school absence among the girls is not dependent on the occurrence of dysmenorrhea. Details are shown in [Table 5].{Table 5}

Association between degree of pain and school absence

[Table 6] shows that there was no significant association between degree of pain and number of days of school absence (χ2 =3.924, P = 0.687).{Table 6}

Other symptoms experienced during menses and effect on the behaviors of participants

[Table 7] shows that 29.8% of the students experienced headache during menses, 64.4% preferred lying down when menstruating, and 52.1 were moody. About 39.6% had dietary restriction while menstruating, and 47.2% had lack of concentration while in class during menses.{Table 7}

 Discussion



Dysmenorrhea is a common problem among young females.[2] This study found a prevalence rate of 75%, which was closely related to what was reported by Nwankwo et al.[10] (69.4%) in a similar study in Enugu, Nigeria, in 2010. In another study, Chigbu et al.[2] found that severe dysmenorrhea was experienced by 62% of the students. This was higher than 39.3% obtained in this study. This difference in the severity could be due to different categories of females studied. The length of the menstrual cycle and the duration of flow were significantly higher among students with dysmenorrhea than those without dysmenorrhea.

Some of the students who had dysmenorrhea did not take medications while menstruating; this could be as a result of the acceptance by these sets of females that dysmenorrhea is a physiological process of the transition between adolescent and adulthood and cannot be ameliorated.[9] Among those who subscribed to medications, paracetamol (48.5%) and piroxicam (21.6%) were the most preferred analgesics. The possible reason could be that it is the most available and affordable. These findings were similar to those made by Nwankwo et al.[10] in a similar study in Enugu, Nigeria. About 21.6% of the students could not remember the names of the drugs because they were purchased by their caregivers. Some of the students used home remedies such as hot water and salt as medication for dysmenorrhea. Interestingly, one student admitted to using “gbogbonise” (Yoruba herbs for the treatment of pains and some other ailments). This might have resulted from variation in baseline knowledge, attitude, and management practice of dysmenorrhea among the pupils.

The percentage of students who preferred lying down during menses was 64.4%. This can be responsible for their school absence (which was reported in this study) during their menses. A study done by Bello et al.[11] showed that 39.5% of students missed classes. In this current study, 13.1% missed school and this difference may be attributed to the fact that Bello’s study was carried out in a higher institution in which students have lesser consequences when they miss classes, whereas our study was done in a secondary school in which school attendance counts.

Another study done by Aziato et al.[13] showed that dysmenorrhea was associated with symptoms such as diarrhea, headache, and vomiting. These findings were similar to the findings of our study. In addition, some students admitted to having bloating. The effect of dysmenorrhea included activity intolerance, altered emotion and interaction, altered sleep pattern, absenteeism, and inattentiveness[13]; similar experiences were found in this study. Some of the pupils had different mood swings. Being irritable and crying as a result of severe pain during menses definitely causes poor attention in class and affects academic performance.

 Conclusion



The prevalence of dysmenorrhea is high among secondary school girls in Enugu. About half of the participants had moderate pains that lasted for about 2 days, and an appreciable number of the pupils responded well to analgesics. However, some students still stayed away from school during menses and while in class, attention is impaired which may result in poor academic performances.

Recommendation

Considering the negative impact of dysmenorrhea viz-à-viz school absenteeism and impaired attentiveness while in class, effort should be geared toward providing adolescent school girls with medications (analgesics), especially during menstruation so as to avert these negative impacts of dysmenorrhea.

Acknowledgments

We want to acknowledge the school principals and teachers of the three girls secondary schools we used for this study for the cooperation and enabling environment provided for us to conduct this study. We also want to extend our appreciation to a few residents of the Obstetrics and Gynaecology Department of UNTH whom we used as research assistants during the study, we are indeed grateful.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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