Knowledge, Attitudes, and Practices of Menstrual Hygiene Management Among Women of Reproductive Age in Nakuru City, Kenya

Abstract Background: Menstrual hygiene management (MHM) is a critical public health and dignity issue affecting women and girls worldwide. In low- and middle-income countries, inadequate MHM contributes to reproductive tract infections, school absenteeism, reduced economic participation, and poor psychosocial well-being. In Kenya, despite policy progress, empirical data on women's knowledge, attitudes, and practices regarding menstrual hygiene remain limited, particularly in urban settings. This study assessed the knowledge, attitudes, and practices of menstrual hygiene management among women of reproductive age in Nakuru City, Kenya. Objective: The primary objective of this study was to assess the knowledge, attitudes, and practices (KAP) of women of reproductive age (15–49 years) in Nakuru City, Kenya, concerning their menstrual hygiene product selection and the determinants of product choice; menstrual waste disposal methods; and the challenges encountered in maintaining hygienic menstruation. Methods: A community based cross-sectional study was conducted between July 2023 and March 2024 among 330 women aged 15–49 years in Nakuru City. A structured questionnaire adapted from the Menstrual Hygiene Matters toolkit was used to collect data on sociodemographic characteristics, menstrual product knowledge, product choice, hygiene practices, disposal methods, and challenges faced. The KAP framework guided analysis. Disposal methods were categorized by risk level (low, moderate, high) based on health and environmental consequences. Descriptive statistics (frequencies, percentages, means) were generated using SPSS version 26. Results: Disposable sanitary pads were the predominant product used (85.5%), driven by comfort (26.7%), affordability (14.5%), availability (13.9%), and hygiene (14.2%). Environmental considerations were virtually absent (0.3%). Knowledge of sustainable alternatives was low: 57.9% had knowledge gaps about tampons and 68.7% about menstrual cups. Attitudinal barriers against reusable products were strong, with 71.7% expressing negative or neutral views toward washable pads. The majority of respondents (87.9%) practiced ideal personal hygiene (frequent bathing and pad changing). However, disposal methods were predominantly high-risk: pit latrines (29.4%), disposal with general garbage (26.1%), and hybrid methods (23.1%). Only 2.7% used designated sanitary bins at home and work. The most cited reason for disposal choice was "this is what is available/most suitable in our area" (38.5%), highlighting infrastructural constraints rather than informed preference. Conclusion: Women in Nakuru City demonstrate adequate personal hygiene knowledge but lack environmental awareness regarding menstrual product choice and disposal. High-risk disposal practices dominate due to infrastructure deficits, not lack of willingness. Attitudes toward reusable products are predominantly negative, driven by cultural taboos, lack of information, and perceived inconvenience. Interventions must address systemic infrastructure gaps, provide accurate information on sustainable alternatives, and actively disrupt menstrual stigma through community-based education.