RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DESSERTATION

1. Name of the candidate and address

Ms. RAMA DEVI PAHARI

1 year M.Sc.(N)

Faran College of Nursing

Bangalore

2. Name of the institution Faran College of Nursing

3. Course of study and subject M.Sc.Nursing

Community Health Nursing

4. Date of admission to course 29 June 2012

5. Title of the topic“A descriptive study to assess the

knowledge and attitude of unmarried young

women in age group of (18-20)years

regarding dysmenorrhoea, residing in a

selected urban community at Bangalore”

6. BRIEF RESUME OF THE INTENDED WORK1

INTRODUCTION

Unmarried young women is in a transition period from childhood to adulthood

and is characterized by a spurt in physical, endocrinal, emotional, and mental growth,

with a change from complete dependence to relative independence. The period of

adolescence for unmarried young women is a period of physical and psychological

preparation for safe motherhood. As the direct reproducers of future generations, the

health of an adolescent unmarried young woman influences not only their own health,

but also the health of the future population. Almost a quarter of India's population

comprises of unmarried young women below 20 years. One of the major physiological

changes that take place in adolescent unmarried young women is the onset of

menarche, which is often associated with problems of irregular menstruation,

excessive bleeding, and dysmenorrhea. Of these, dysmenorrhea is one of the common

problems experienced by many adolescent unmarried young women.1

Dysmenorrhoea is a gynecological medical condition of pain during menstruation

that interferes with daily activities. Dysmenorrhoea can be classified as either primary

or secondary based on the absence or presence of an underlying cause. Secondary

dysmenorrhoea is dysmenorrhoea which is associated with an existing condition. The

most common cause of secondary dysmenorrhoea is endometriosis. Other causes

include leiomyoma, adenomyosis, ovarian cysts, and pelvic congestions.

Dysmenorrhoea is a common health problem, having negative effects on the health

related quality of life which translates to poor academic performance of majority of

the female university students. Dysmenorrhoea is the leading cause of recurrent short-

term school absence in adolescent girls and a common problem in women of

reproductive age. About 15 percent of adolescent girls report severe dysmenorrhoea,

2

and it is the leading cause of recurrent short-term school absenteeism in adolescent

girls.2

The global library of women’s medicine dedicated to the enhancement of women’s

healthcare reported that more than 50% of post pubescent menstruating women are

affected by dysmenorrhea, with 10–12% of them having severe dysmenorrhea with

incapacitation for 1–3 days each month. Women who continue to work or to attend

classes have been shown to have lower work output or scores during their

dysmenorrhea. Dysmenorrhea is most common in women between the ages of 18 and

2o years, with most of the severe episodes occurring before 21 years of age. Primary

dysmenorrhea occurs more frequently in unmarried women than in married women

(61% vs. 51%), decreases with age, and does not appear to be related to the type of

occupation or physical condition of the woman. Exercise does not appear to have any

significant effect on the incidence of dysmenorrhea. Associated factors that increase

the risk duration and severity of dysmenorrhea include early menarche, long

menstrual periods, overweight Dysmenorrhea can feature different kinds of pain,

including sharp, throbbing, dull, nauseating, burning, or shooting pain.3

6.1 NEED FOR THE STUDY

Adolescent girls, almost always, silently suffer the pain by dysmenorrhea and the

discomfort associated with it due to lack of knowledge about reproductive health. It is

probable that this also affects their academic performance. Due to some cultural and

religious restrictions, many unmarried young women in this country lack appropriate

and sufficient information regarding dysmenorrhoea causing incorrect and unhealthy

behaviors during their menstrual period. This burden, unfortunately, has not been

taken seriously in terms of its social or hygienic aspects.

3

Dysmenorrhea is the most common gynecologic complaint and the leading cause

of recurrent short-term school or work absenteeism among unmarried young women.

Despite the high prevalence of dysmenorrhea in unmarried young women, they do not

seek medical advice or are under-treated. In one study, a majority (98%) of unmarried

young women used non pharmacologic methods such as heat, rest, or distraction to

treat dysmenorrhea, with perceived effectiveness of 40% or less. In other studies from

different populations, 30-70% of unmarried young women reported at least

occasionally self-medicating with over-the-counter (OTC) pain medications.7-9

However, 57% of those who self-medicated with OTC preparations used sub-

therapeutic. Only 54% of adolescents knew that certain medications could relieve

menstrual cramps, and 27% of girls are unable to recognize any of three non-steroidal

anti-inflammatory drugs (NSAID) listed as possible treatments for dysmenorrhea.4

A descriptive cross-sectional study was conducted to evaluate adolescents self-

reported knowledge of dysmenorrhea types, and symptoms, and to identify its

severity, factors that make pain worse and its negative academic impacts. The study

sample consisted of 289 participants selected by non-probability, convenience

sampling. The results revealed that majority (59.9%) of the participants were within the

age group of 18 – 22 years with Mean ± SD of 19.5 ± 3.1 years. Most (50.9%) of the

participants reported that they were suffering from primary dysmenorrhea while slightly

below one-half (45%) of the participants did not know the type of dysmenorrhea they

were suffering from, 129 participants experienced poor academic performance. The most

common reason for poor academic performance was inability to concentrate in class

(46.5%). The researchers concluded that, outstanding high number of female students did

not know the type of dysmenorrhea they were suffering from and dysmenorrhea impacts

4

negatively on their academic performance, which may be as a result of inadequate

management among the studied participants.5

An explorative survey study with correlation approach was conducted on the

prevalence of dysmenorrhea and associated symptoms among adolescent girls in

Gwalior. The study sample consisted of 970 adolescent girls in the age group of 15-20

years. The results revealed that, the prevalence of dysmenorrhea in adolescent girls is

79.67%. Most of them, 37.96%, suffered regularly from dysmenorrhea severity. The

three most common symptoms present on both days, that is, day before and first day

of menstruation were lethargy and tiredness (first), depression (second) and inability

to concentrate in work (third), whereas the ranking of these symptoms on the day after

the stoppage of menstruation showed depression as the first common symptoms.

Negative correlation was found between dysmenorrhea and the General Health Status

as measured by the Body surface area1

A cross-sectional study was conducted to assess the knowledge and attitude of

urban adolescents. The study sample consisted of 169 subjects in age group of 15-20

years. The results revealed that, majority (84.3%) of the adolescents reported

menstrual disorder followed by dysmenorrhea (65%), abnormal cycle lengths

(13.2%), and excessive uterine bleeding (8.6%). Only 2% of teens reported about

receiving information about menstruation from their health care provider. Negative

expectations regarding menstruation were associated with higher rates of school

absenteeism and missed activities. The researchers concluded that, it is imperative

that health care provider’s should increase their anticipatory guidance to adolescence

regarding normal mesturation.6

5

From the available literature reviewed, it is evident that burden of dysmenorrhoea

is greater than any other gynecological complaint, and is associated with significant

impact. Social disadvantage, co-morbidity with other somatic syndromes and

reproductive factors are determinants of these complaints. Dysmenorrhea is a very

common problem among adolescent girls, and they experience a number of physical

and emotional symptoms associated with dysmenorrhea, and with the increased

intensity of pain in occurrence of dysmenorrhea the probability of experiencing these

symptoms. Since the available studies are few in the Indian scenario the researcher

found it relevant to assess the knowledge and attitude of unmarried young women in

the age group of 18 to 20 years regarding dysmenorrhoea residing in the selected

urban community at Bangalore.

6.2 REVIEW OF LITERATUR

Review of literature is a key step in research process. Review of literature refers to

an extensive, exhaustive and systematic examination of publication relevant to the

research project. Nursing research may be considered as a continuous process in

which knowledge gained from earlier studies are an integral part of research in

general. Literature review is concerned with review of related literature which

includes research and non-research reports, articles, documents, journals, books and

internet search. The aims of literature review are extension of knowledge and finding

out evidence, which support data, information and provide the basis from which

conclusions will be drawn in the study.

A cross-sectional study was conducted to determine patterns of menstrual cycles

among young girls and its related problems, discomfort and also to infer the extent of

awareness and sources of information regarding menstruation possessed by Indian

6

girls before attaining puberty. The study sample consisted of 194 unmarried

adolescents studying in various institutions in Mysore city. The results revealed that,

the mean age of the subjects at menarche was 13.36 ± 1.25 years with the range being

10 to 17 years. Mean duration of menstrual flow was 4.77 ± 1.06 days. The most

prevalent menstrual symptoms were tiredness (47.9%), backache (38.3%), and anger

(34.5%). Prevalence of menstrual irregularity and dysmenorrhea was 11.9 and 78.2%.

About 6.7% of the participants had severe dysmenorrhea and 76.6% of the subjects

reported that their working ability was affected. About 60.4% of the girls were aware

of menstruation prior to menarche. Mothers and friends were the main sources of

information (47.8%).The researchers concluded that the prevalence of dysmenorrhea

and menstrual irregularity among young females are high. They suggested of

awareness programme to improve menstruation discomfort management.7

A descriptive, cross sectional study was conducted to assess the incidence of

dysmenorrhea and menstrual hygiene practices among adolescent girls from selected

nursing institutions. The study sample consisted of 160 students. The results revealed

a high prevalence (94.4%) and was categorized as (49.0%) for 1st degree of pain,

(34.4%) for second-degree and (16.6%) for third-degree. Measures taken to relieve

dysmenorrhea were found to be: intake of certain types of domestic hot drinks

(43.0%), taking analgesics (22.5%), and (66.2%) performed physical activities during

menstrual period to relieve pain. All students (100.0%) took complete hot baths

during menstruation. About one-fourth (26.9 %) of students just took rest and stayed

at home, who believed that physical activities will increase the menstrual pain and

increase feelings of exhaustion. On conclusion high prevalence of dysmenorrhea was

observed. However the necessity to adopt a healthy behavior, which includes:

7

appropriate nutrition and appropriate use of medications based on a physician's

prescription was a very important issue.8

A cross sectional study was conducted to assess the perception regarding

menstruation and practices during menstrual cycles among selected high school

adolescent girls in resource limited settings around Bangalore city. The study sample

consisted of 506 adolescents. The results revealed that, the average age was 14.08

with Standard deviation of 1.06 and range between 12-16yrs. About 99.6% of the

students had heard of menstruation and 57.9% had acquired this knowledge even

before attaining menarche and 73.7% knew that menstruation was a normal

phenomenon, but only 28.7% had adeuate knowledge regarding menstruation. About

48.1% did not know that menstruation was related to pregnancy. Only 44.1% used

sanitary pads during the menstrual cycles. Among those who used cloth, only 31.3%

used soap and water to clean them, 56.8% used soap and water to clean their genital

organs and 88.8% of the girls took bath daily during menstruation. Regarding

perception about the word menstruation, many of the girls mentioned that they

experienced fear (44.1%) on attaining menarche, while some of them (26.1%) were

anxious. About 74.2% felt that menstrual cycle is a natural phenomenon while 17%

felt that menstruation occurred due to the curse of God. Majority of them (56.8%) felt

that menstruation poses a huge physical and psychological burden on them. On the

whole among the girls who had attained menarche only 43 (14.07%) showed a

positive attitude (scores=4) towards the process of menstruation.9

A cross sectional study was conducted to describe the prevalence and

determinants of dysmenorrhea among adolescents in Goa. The study sample

consisted of 2494 subjects. The results revealed that more than half of the samples

8

reported dysmenorrhea. Moderate to severe dysmenorrhea was reported by 755

participants (33.4%, 95% CI 31.4–35.4). There was a linear association between

severity of pain and impact (medication and taking rest) and the onset of pain

(premenstrual onset associated with more severe pain). On multivariate analyses, the

risk of moderate–severe dysmenorrhoea was associated with the experience of

violence (OR 2.23, 95% CI 1.5–34); other somatic complaints (OR 3.67, 95% CI 2.7–

4.9 for highest somatoform symptom score category compared with the lowest);

gynecological complaints (non-menstrual lower abdominal pain: OR 1.78, 95% CI

1.3–2.3; dysuria: OR 1.98, 1.4–2.7. The researchers conducted that the burden of

dysmenorrhea is greater than any other gynecological complaints and is associated

with significant impact.10

A descriptive cross sectional study was conducted to assess knowledge, attitudes

and health-taking behaviors of adolescents in the age group of 15-18 years with

regard to dysmenorrhea and menstrual hygiene. The study sample consisted of 250

students. The results revealed that, about 77% of the subjects reported that they have

enough knowledge about dysmenorrhea from which only 32% follow appropriate

practices, such as taking a bath and using hygienic materials. About 33% of the

students avoided any physical activity or even mild exercise during menstrual period.

Over 67% of the girls reported to take palliative medicine for their menstrual pain

without prescription by a doctor. The prevalence of dysmenorrhea in this study was

71%. The main point achieved in this study was the necessity of educating female

students about the menstrual period health-taking behaviors, including: appropriate

nutrition, exercise and physical activity, personal hygiene, and appropriate use of

medication based on physician’s prescription.11

9

A comparative cross sectional study was conducted to identify different

epidemiological problems, perception socio economic loses of life and management

of dysmenorrhea in different setting. The study sample consisted of 101 girls from

urban area and 79 girls from rural area. The results revealed that, the prevalence of

dysmenorrhoea is 54% (53% in girls in urban areas and 56% in girls in rural areas)

(X2 df = 0.1, P = 0.05). Sickness absenteeism (28–48%), socio economic losses, and

perceived quality of life losses are more prevalent among girls in urban areas than in

girls in rural areas. Girls in rural areas resort to physical labour and other natural

methods to obtain relief while the girls in urban areas are mainly depending on

medications.12

A study was conducted on menstrual discomfort and its influence on daily academic

activity, and psychosocial relationship among female undergraduate students. The sample

consisted of 415 female adolescents. Results showed a high prevalence of dysmenorrhoea

(64%) among respondents within 3 months prior to this study. Dysmenorrhoea was significant

among female students who reported dizziness, headache, depression and irritation; and those

whose menstrual disorder ever called for medical attention (P<0.05). Similarly, menorrhagia

was less frequent (21%) than dysmenorrhoea (64%), but occurred more significantly with

dizziness, headache and depression. Menstrual disorder was experienced as an objective and

subjective reality among those interviewed. Both dysmenorrhoea and menorrhagia were

significant predictors of psychosocial relationship of the female students (P<0.05). 13

A cross-sectional study was conducted to determine the prevalence of

dysmenorrhea and to determine the health related quality of life among a group of

adolescents. The study sample consisted of 623 participants. The results revealed that,

prevalence of dysmenorrhea was found to be 72.7% and was significantly higher in

coffee consumer females with menstrual bleeding duration of >_ 7 days and those

10

who had a positive family history of dysmenorrhea when compared to others (P<0.05,

for each one). By multivariate analysis, coffee consummation (OR-2.084) menstrual

bleeding duration >_ 7days (OR 1.590), and positive family history of dysmenorrhea,

(OR 3.043) were important risk factors for dysmenorrhea. Except for social

functioning role emotional and mental health domains the SF-36 points received from

other domains were higher in family with dysmenorrhea (for each on P>_0.05).14

A cross sectional study was carried out to determined the prevalence of

dysmenorrhea among adolescent girls. The study sample consisted of 404 adolescent

girls. Data were collected by self administered questionnaire including information on

demographic variables, prevalence of dysmenorrhea severity, its impact and treatment

used. The study results revealed that 94% (n = 380) of the participants had

dysmenorrhea. It was mild in 27% (n = 104), moderate in 41% (n = 155) and severe in

32% (n = 121). Dysmenorrhea was the cause of limited sports activities in 81%,

decreased class room concentration in 75%, restricted home work in 50%, school

absenteeism in 45%, limited social activities in 25% and decreased academic

performance in 8% of the affected student. Only 3% (n = 10) had consulted a

physician, 21% (n = 80) self medicated and 55% (n= 210) took no action. The

commonest drug used were paracetamol (n = 60, 16%) ibuprofen (n= 9, 8%) and

mefenemic acid (n =12, 3%). There was no statistically significant correlation

between dysmenorrhea and demographic and menstrual characteristics.15

A study was conducted to determine the prevalence of dysmenorrhea among

female adolescents and its impact on academic performance, school attendance and

social activities and its management. The study sample consisted of 706 female

adolescents. The results revealed that among participants who had a period in the

11

previous 3 month 85% reported dysmenorrhea, of these 38% reported missing classes

due to dysmenorrhea, during 3 months prior to the study and 33% reported missing

individual classes. Activities affected by dysmenorrhea included class concentration

(59%), sports (51%), class participation (50%), socialization (46%), homework

(35%), test-taking skills (36%), and grades (29%). Treatment taken for dysmenorrhea

included rest (58%), medications (52%), heating pads (26%), tea (20%), exercise

(15%), and herbs (7%). About 14% consulted a physician and 49% saw a school nurse

for seeking help with the symptom management. Menstrual pain was significantly

associated with school absenteeism, decreased accademic performance, sport

participation and socialization with peers (P<01).16

6.3 STATEMENT OF THE PROBLEM:

“A descriptive study to assess the knowledge and attitude of unmarried young

women in the age group of (18- 20) years regarding dysmenorrhoea residing in a

selected urban community at Bangalore.”

6.4 OBJECTIVES OF THE STUDY:

The objectives of the study are to:

assess the knowledge of unmarried young women in the age group of 18 to 20

years regarding dysmenorrhoea.

assess the attitude of unmarried young women in the age group of 18 to 20

years regarding dysmenorrhoea.

find out correlation between knowledge and attitude of the unmarried young

women in the age group of 18-20 years regarding dysmenorrhoea.

12

determine an association between the knowledge of unmarried young women

in the age group of 18- 20years regarding dysmenorrhoea and their selected

socio demographic variables.

determine an association between attitude of unmarried young women in the

age group of 18-20 years regarding dysmenorrhoea and their selected socio

demographic variables.

6.5 HYPOTHESIS

The following hypothesis will be tested at 0.05 level of significance:

H1: There is a significant relationship between the knowledge and attitude of

unmarried young women in age group of 18-20 years regarding

dysmenorrhoea.

H2: There is a significant association between the knowledge of unmarried young

women in age group of 18-20 years regarding dysmenorrhoea and their

selected socio demographic variables.

H3: There is a significant association between the attitude of unmarried young

women in the age group of 18- 20 years regarding dysmenorrhoea and their

selected socio demographic variables.

6.6 OPERATIONAL DEFENITION OF TERMS:

13

Assess

In this study, it refers to identifying the knowledge and attitude by the

organized and continuous process of data collection regarding

dysmenorrhoea among unmarried young women in age group of (18-20)

years.

Knowledge

It denotes the awareness or information that the unmarried young women

in age group of (18-20) years possess regarding dysmenorrhea which will

be collected through the interview schedule.

Attitude

In this study, it refers to an expressed opinion regarding the way in which

the unmarried young women look at dysmenorrhoea.

Young women

It refers to the unmarried young females in age group of (18-20) years who

are residing in the selected urban community.

Dysmenorrhea

It refers to the pain or discomfort associated with menstruation experienced

by women, who have attained menarche.

Urban Community

14

It refers to a group of people who inhabit in a particular geographic area, who

are sharing some common traditions, customs, beliefs and practices.

6.7 ASSUMPTIONS

The study is based on the following assumptions:

Most measurable attitudes are held strongly enough to direct the behaviour .

The tool prepared for study will be sufficient to assess the knowledge and

attitude of unmarried young women regarding dysmenorrhoea.

Unmarried young women operate on the basis of the cognitive information

they posses regarding dysmenorrhoea.

6.8 DELIMITATIONS:

The study is delimited to:

assessment of knowledge and attitude only as correct responses made to the

items in the tool.

unmarried young women in the age group of 18 to 20 years from the selected

urban community at Bangalore.

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

The data will be collected from unmarried young women age group of (18-20)

years residing in the selected urban community at Bangalore.

7.2 METHODS OF DATA COLLECTION:

15

Research method : Non experimental Survey method

Research design : Descriptive survey design

Sampling technique : Purposive sampling

Sample size : 100 unmarried young women age group of

(18-20) years.

Setting of the study : Selected urban community at Bangalore,

namely K Narayanapura

7.2.1 CRITERIA FOR SELECTION OF SAMPLE

INCLUSION CRITERIA

The study includes “unmarried young women”;

residing in the selected urban community at Bangalore.

who attained menarche.

who are willing to participate.

who can understand Kannada and English.

who are in the age group of 18 to 20 years.

Exclusion criteria

The study excludes “unmarried young women”;

who are not available at the time of data collection.

who are below 18 years of age.

16

who are above 21 years of age.

7.2.2 DATA COLLLECTION TOOL

A structured interview schedule will be prepared by the investigator to assess the

knowledge of unmarried young women regarding dysmenorrhoea. Attitude scale

which is a likert type of scale will also be prepared to assess the attitude of unmarried

young women regarding dysmenorrhoea.

Content validity of the tool will be ascertained in consultation with the guide and

experts in the field of community medicine, psychiatric nursing and community health

nursing. Reliability of the tool will be established by split half method.

Prior to the study, written permission will be obtained from the concerned

administrative authority of the setting to conduct the study. Further an informed

consent will be obtained from the participants regarding their willingness to

participate in the study. The proposed period of data collection will be in October

2013.

7.2.3. DATA ANALYSIS METHOD

Data analysis will be done by using descriptive and inferential statistics.

Frequency and percentage distribution will be done to analyze demographic variables.

The demographic variables will also be described descriptively by using column, bar

pie and cone diagrams.

Mean and standard deviation will be used to assess the level of knowledge and

attitude of unmarried young women in the age group of (18 – 20) years regarding

dysmenorrhea.

17

A coefficient of correlation ‘r’ wills the used to determine correlation between

knowledge and attitude of unmarried young women regarding dysmenorrhoea.

7.3: DOES THE STUDY REQUIRES ANY INVESTIGATIONS

OR INTERVENTIONS TO BE CONDUCTED ON THE PATIENT

OR HUMAN BEING OR ANIMAL?

YES,

Only a structured interview schedule and an attitude scale regarding

dysmenorrhoea will be used. No other interventions which cause any physical harm

will not be used in the study.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED?

YES

Confidentiality and anonymity of the subjects will be maintained.

Consent will be obtained from the participants before conducting the study.

A written permission from the concerned administrative authority will be

obtained prior to the study.

8. LIST OF REFERENCES

18

1. Agarwal A. K, Agarwal A., A Study of Dysmenorrhea during Menstruation in

Adolescent Girls, Indian Journal Community Medicine. 2010 January; 35(1):

159–164.

2. Wikipedia, the free encyclopedia, Dysmenorrhea.

3. Dawood, Y,Dysmenorrhea The Global Library of Women’s Medicine

Dedicine to the nhancement women’s healthcare.

4. Zeep Harel,Dysmenorrhea in adolescent and young adults: Etiology and

Management, Journal Pediatric adolescent gynecology (2006)19:363-371.

5. Okoro R. N, Malgwi H., 3Okoro G. O. Self- reported knowledge of

Dysmenorrhoea and its Negative Academic impacts among a group of female

students of University of Maiduguri, North Eastern Nigeria.Novel Science

International Journal of Medical Science (2012), 1(7): 220-225

6. Shanbhag D, Shilpa R, D.Souza N, Josephine P, Singh J, Goud BR,

Perceptions regarding menstruation and Practices during menstrual cycles

among high school going adolescent girls in resource limited settings around

Bangalore city, Karnataka,India.International Journal of Collaborative

Research on Internal Medicine & Public Health, (2012).Vol.4 No.7

7. Chiou MH, Wang HH, Yang YH. Menstrual pattern among unmarried women

from south India”, Journal of Natural Science Bio- Medical.2011 Dec; 2(2):

174–179

8. Neamat A., Mohamed M. S, Ahmed N H, Ahmed E R. Assessment of

Dysmenorrhea and Menstrual Hygiene Practices among Adolescent Girls in

Some Nursing Schools at EL-Minia Governorate, Egyp, Journal of American

Science, 2011;7(9)

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9. Houston A. M, Abraham A., Huang Z, Knowledge, Attitudes, and

Consequences of Menstrual Health in Urban Adolescent Female. Journal of

Pediatric Adolescence Gynecology (2006) 19:271-275

10. Patel V, Tanksale V, Sahasrabhojanee M, Gupte S, Nevrekar P, The burden

and determinants of dysmenorrhea. A population-based survey of 2262

women in Goa, India. February 2006.

11. Poureslamii M, Ashtiani F O, Assessing Knowledge, Attitudes, and Behavior

of Adolescent Girls in Suburban Districts of Tehran About Dysmenorrhea and

Menstrual Hygiene,

12. S. Dysmenorrhoea in Different Settings: Are the Rural and Urban Adolescent

Girls Perceiving and Managing the Dysmenorrhoea Problem Differently,

Indian Journal of Community Medicine. 2008 October; 33(4): 246–249.

13. Titilayo A. Agunbiade O.M,. Banj O, Lawani A. Menstrual discomfort and its

influence on daily academic activities and psychosocial relationship among

undergraduate female students in Nigeria, Tanzania Journal of Health

Research, October 2009:Vol. 11, No. 4.

14. Unsal A., Ayraanel U., Tozun M.,Prevalance of dysmenorrheal and its effect

on quality of life among a group of female university students, Journal sutan

caboose university medical, April 2010:

15. Rahana, A., Anbarin B. Prevalence and impact of dysmenorrhea among

Omani high school student. Published online. 2011-october: 11, 485-491.

16. Banikarlmc C, Kedar SH. Prevalence and impact of dysmenorrhea on

Hispanic female adolescents, Arch – Pediatric adolescence Medicine;

2000:154 (2); 1226-1229.

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9 SIGNATURE OF THE

CANDIDATE:Ms. RAMA DEVI PAHARI

10. REMARKS OF THE GUIDE : This is a feasible study

11. NAME & DESIGNATION OF:

11.1 GUIDE

11.2 SIGNATURE

Mrs. SHEELIA WHITE N

Associate Professor

Community Health Nursing

11.3 HEAD OF THE

DEPARTMENT:

11.4 SIGNATURE:

MRS. SHEELIA WHITE N

Associate Professor

12. 12.1 REMARKS OF THE

CHAIRMAN & PRINCIPAL

12.2 SIGNATURE:

This is a relevant study

Mrs. ASHA ANDREWS

PRINCIPAL

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