Assessment of Knowledge, Attitude, and Practice Regarding Menstruation and Menstrual Hygiene among School Going Girls in Rural Areas of Lahore, Punjab

Background: Menstrual hygiene management (MHM) is fundamental to adolescent health and school participation, yet in rural settings it is frequently constrained by incomplete knowledge, sociocultural stigma, and suboptimal school WASH resources. Objective: To assess knowledge, attitudes, and practices regarding menstruation and MHM among school-going girls in rural areas of Lahore, Punjab, Pakistan. Methods: A descriptive cross-sectional observational survey was conducted among 385 school-going adolescent girls aged 10–19 years in rural Lahore. Participants completed a structured, close-ended questionnaire adapted for context, assessing socio-demographics, menstrual knowledge, attitudes (Likert-scale), hygiene practices, disposal behaviours, school-based pad changing, dysmenorrhea, and reported access to washing soap at school. Data were analyzed using descriptive statistics (frequencies, percentages). Results: Knowledge was mixed: 44.2% (n=170) identified menstruation as a normal physiological process, 36.6% (n=141) attributed it to hormones, and 41.8% (n=161) did not know the cause; 22.6% (n=87) incorrectly reported the bladder as the origin of menstrual blood. Only 23.6% (n=91) were aware of menstruation at menarche, and mothers were the predominant information source (84.2%, n=324). Attitudes largely supported hygienic practices (e.g., 88.6% agreed that handwashing after genital cleaning prevents reproductive tract infections). Practices were comparatively favourable: 68.6% (n=264) used sanitary pads, 44.2% (n=170) changed absorbents ≥3 times/day, and 93.8% (n=361) reported genital cleansing; however, only 14.8% (n=57) changed pads at school. Soap access at school was reported by 63.4% (n=244). Dysmenorrhea was common (83.1%, n=320). Conclusion: Rural schoolgirls in Lahore reported generally positive menstrual hygiene practices and supportive attitudes, but substantial knowledge gaps and low preparedness at menarche persist alongside incomplete school enabling conditions, underscoring the need for school-based MHM education integrated with reliable WASH and disposal supports.