Knowledge, Attitudes, and Practices Regarding Menstrual Health among Female Pharmacy Students in Bangladesh: A Cross-Sectional Study

Technical Summary: Knowledge, Attitudes, and Practices Regarding Menstrual Health among Female Pharmacy Students in Bangladesh

Problem Statement
Menstrual health is a critical component of women's reproductive health, yet it remains obscured by misconceptions, cultural taboos, and stigma, particularly in low- and middle-income countries. While pharmacists are increasingly recognized as accessible healthcare professionals capable of providing evidence-based counseling on menstrual physiology and disorders, there is a paucity of data regarding the specific menstrual health literacy of future pharmacists in Bangladesh. Previous research has largely focused on schoolgirls or mixed-discipline university students, leaving a gap in understanding the Knowledge, Attitudes, and Practices (KAP) of female pharmacy students who will soon enter professional practice. This study addresses the need to evaluate whether these future healthcare providers possess adequate knowledge to effectively promote reproductive health and counsel patients, despite their academic training.

Methodology
The study employed a descriptive cross-sectional design conducted between January and March 2026. The target population consisted of 452 female undergraduate and postgraduate pharmacy students enrolled in accredited public and private universities across Bangladesh. A non-probability convenience sampling technique was utilized to recruit participants via academic networks, social media platforms (Facebook, WhatsApp), and university forums.

Data collection utilized a structured, self-administered online questionnaire (Google Forms) developed through a review of existing literature and validated by experts in pharmacy, gynecology, and public health. The instrument comprised four sections: socio-demographic characteristics, knowledge, attitudes, and practices. Reliability was confirmed via Cronbach's alpha (Knowledge: 0.85; Attitude: 0.80; Practice: 0.73).

Data analysis was performed using IBM SPSS Statistics version 27. Descriptive statistics summarized participant characteristics. Knowledge, attitude, and practice levels were categorized using predefined percentage-based cut-offs (e.g., Knowledge: Poor <50%, Moderate 50–74%, Good ≥75%). Associations between sociodemographic variables and KAP levels were assessed using Pearson's chi-square tests. Multivariable ordinal and binary logistic regression models were subsequently applied to identify independent predictors of knowledge, attitudes, and practices, reporting Adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI).

Key Results
The study revealed a significant discrepancy between the participants' attitudes/practices and their knowledge levels:

• Knowledge: Only 18.8% of participants demonstrated "good" knowledge, while 55.1% exhibited "poor" knowledge. Significant gaps were identified regarding the physiological causes of dysmenorrhea (46.5% correctly identified prostaglandins) and the utility of cycle tracking for ovulation prediction (45.4%).
• Attitudes: Attitudes were predominantly neutral (53.3%), with 36.3% positive and 10.4% negative. Most participants recognized menstrual health as vital to overall well-being and acknowledged the role of stigma in hindering care-seeking.
• Practices: Practices were generally favorable, with 77.7% classified as having "good" practices. However, health-seeking behaviors were largely reactive; 60.6% reported self-medicating for menstrual pain, and only 8.8% attended annual gynecological check-ups.
• Associated Factors:
  • Academic Progression: Higher academic years were strongly associated with better knowledge and attitudes. Third-year and fourth-year students had significantly higher odds of good knowledge (AOR = 3.03 and 15.8, respectively) and positive attitudes compared to first-year students.
  • Marital Status: Single students showed higher odds of good knowledge and positive attitudes compared to married students.
  • Training: Surprisingly, prior formal training in gynecological or reproductive health was not significantly associated with improved knowledge levels (p = 0.700), though it did influence attitudes in bivariate analysis.
  • University Type: Public university students demonstrated better knowledge and practices compared to private university students.

Significance and Claims
The authors claim that while female pharmacy students in Bangladesh generally hold favorable attitudes and adhere to appropriate hygiene practices, substantial knowledge gaps persist regarding menstrual physiology, disorders, and evidence-based management. The study posits that positive behaviors do not necessarily reflect a comprehensive scientific understanding, which is critical for future healthcare providers.

The paper asserts that the persistence of these knowledge gaps among senior pharmacy students suggests that current pharmacy curricula in Bangladesh may not adequately emphasize menstrual health education. Consequently, the authors conclude that integrating comprehensive, evidence-based menstrual health education into pharmacy undergraduate programs is essential. This integration is framed not merely as an academic improvement but as a necessary step to prepare future pharmacists to effectively counsel patients, reduce menstrual stigma, and promote reproductive health outcomes in the community. The study serves as a baseline for curriculum development and targeted educational interventions within the pharmacy sector in Bangladesh.