Pubertal Communication Between the School Nurses and Adolescent Girls in Nigeria

Purpose:

School nurses play a significant role in communicating reproductive health information to adolescent girls especially during pubertal period which could help make the period less confusing. The role of school nurses in such capacity in Nigeria has received limited attention hence, the need to investigate how school nurses were able to provide information on pubertal changes in a view to improve the knowledge of adolescent girls on pubertal changes and thus promote their sexual and reproductive health by provision of school health services. 

Methods:

A descriptive sequential mixed method was adopted for the study. A multistage sampling technique was employed to select 420 adolescent girls from five purposively selected private secondary schools in three local government areas of Osun State, Nigeria. All ten (10) school nurses working in the selected private secondary schools were selected for the qualitative aspect of the study. Inclusion criteria include adolescent girls aged 10-18 years schooling in the selected schools with school clinics and school nurses. A self-developed and validated questionnaire and interview guide was used for data collection. Quantitative data was analyzed using percentages, mean, standard deviation, Spearman rho correlation and chi square, while qualitative data was subjected to content and thematic analysis.

Results:

There were 10 school nurses and 420 school adolescent girls, with a mean age of 31.4±6.0 and 13.6±1.7 years respectively while 88.3% of the school girls observed their first pubertal change below age 9. The result showed that communication on pubertal changes is not regular and frequent as 40.2% and 46.4% of the school adolescent girls were educated about physical body changes and menstruation once in a session by the school nurses respectively, while 16.2% of the school girls were informed about menstruation once in a month by the school nurses. Close to half of the respondents 47.6%, 42.6%, 44.3% never informed about sexual abstinence and contraception, sexually transmitted diseases and teenage pregnancy respectively. Group teaching and classroom teaching were the major methods of communication employed by the school nurses while individual method and demonstration were the least methods used. Verbal discussion was the most used medium of communication, while audio visual aids, phone messages and email least used media. The results further indicated that dsymenorrrhea, body odour, vaginal itching, and concern about weight gain accounted for 65.9%, 84.8%, 81.7% and 74.5% of the adolescent girls’ health challenges and reasons for visiting the school clinics respectively while 77.9% of the adolescent girls visited the school clinics for emotional counseling. The results further showed the challenges encountered by the school nurses to include time constraints, topic censorship by school authorities, non-availability of teaching visual aids and non inclusion of pubertal education in the school curriculum. The results also showed that majority of the adolescent girls 80.7% had good knowledge of pubertal changes, 13.8% had fair knowledge while 5.5% had poor knowledge of pubertal changes. Significant association was found between the adolescent girls’ knowledge of pubertal changes and maternal educational level (p-val=0.008), paternal educational level (p-val=0.001) and grade level (p-val=0.00) while no association was found between their knowledge and age of the adolescent girls (p-val=0.385). Frequency of school nurses’ communication was found to significantly influence the school adolescent girls’ knowledge of pubertal changes (p-val=0.043).

Conclusion:

School nurses can play a strategic role in the education of adolescents on issues relating to their reproductive and sexual health. The study concluded efforts should be made to promote school nurses involvement in pubertal education in the schools by the full implementation of the national policy on school health in the country vis a vis provision of standard school clinics well equipped with both the needed medical staff and materials in order to promote the sexual and reproductive health of school adolescents.