INTRODUCTION

Hygiene refers to the set of practices perceived by a community to be associated with the preservation of health and healthy living. Hygiene is also the name of a branch of science that deals with the promotion and preservation of health, also called hygienics. Hygiene practices vary widely, and what is considered acceptable in one culture might not be acceptable in another. While in modern medical sciences there are a set of standards of hygiene recommended for different situations, what is considered hygienic or not can vary between different cultures, genders. Some regular hygienical practices may be considered good habits by a society while the neglect of hygiene can be considered disgusting, disrespectful or even threatening. (Source: Wikipedia) In general, hygiene mostly means practices that prevent spread of disease-causing organisms. Since cleaning processes (e.g., hand washing) remove infectious microbes as well as dirt and soil, they are often the means to achieve hygiene. Types of hygiene: Personal hygiene Occupational hygiene Food hygiene Respiratory hygiene Home hygiene

Hygiene ranges from personal hygiene in domestic realm to occupational hygiene and public health. Hygiene involves healthy diet, cleanliness, and mental health. One of the most effective ways to protect ourselves, from illness is good personal hygiene. This means not only washing your hands but also your body. Body hygiene also known as personal hygiene pertains to hygiene practices performed by an individual to care for one's bodily health and well being, through cleanliness. It is the basic concept of cleaning, grooming and caring for our bodies. It is the first step to good grooming and good health.
1

Maintaining personal hygiene is necessary for many reasons; these can be personal, social, for health reasons, psychological or simply as a way of life. Essentially keeping a good standard of hygiene helps to prevent the development and spread of infections, illnesses and bad odours. Hygiene behavior plays an important role in the prevention of diseases related to water and sanitation such as cholera, typhoid, dysentery, diarrhea and intestinal worms. (Park, 2007) Hygiene and Good Habits are commonly understood as prevention methods against infection. In broader call scientific terms, hygiene is the maintenance of health. It was found that the worldwide risk factor which accounted for 5.3% of all deaths is diarrohea.(Murray et al) Good personal hygiene improves the confidence of a person which helps in overall building up of personality.

The hygienic practices are given an important place in ancient Indian medicine. Archeological excavations at Mohenjodaro and Harrappa in the Indus valley uncovered city of over 2000 years old which yields rather advanced knowledge of water, hygiene and engineering. In 460- 136, B.C. goddess Hygeia was worshipped as the goddess of hygiene. Certain communities like Jews follow good personal hygiene practices to prevent diseases. From Indus valley civilization, the inhabitants follow good personal hygiene practices and they clean their teeth with natural wood, datun and ashes. To stay away from impurities and diseases, great bath is a good example. ( Park, 2009) Hygiene maintenance continues throughout life. Early in childhood our habits are formed which continues to govern our status of personal hygiene till death. So, early childhood is important for inculcating good personal hygiene habits. School is a place that plays an important role in a childs physical, mental and emotional life. It is the foundation stone of a childs future. In a school setting children learn, their
2

characters can be easily moulded and values can be inculcated. Schools can be dynamic settings for promoting health, for enabling child to grow and mature into healthy adults. Health and psychosocial well being of children and youth is fundamental value and a school setting can provide a strategic means of improving childrens health and hence their self esteem. The idea of comprehensive school health programme was conceived in 1940, also included the major components i.e. Medical care, Personal hygiene, nutrition and physical education. Personal hygiene can be easily taught to children through some basic packages of training. A primary school is an institution in which children receive the first stage of compulsory education known as primary or elementary education. Children generally attend primary school from around the age of four or five until the age of eleven or twelve. This is the place where a child develops basic habits and etiquettes School children are the most impressionable group. They can be easily used as resources for communication of ideas and values to family and friends. They are great learners and observers. Childhood is the most momentous period in an individuals life. They are characterized by creative bursts of energy and immense curiosity about the self and the world. Adequate guidance on good hygiene habits can create a healthy environment for the child. The health and development of future generations will depend on the health of young children. Public health has a specific role to play in ensuring good personal hygiene training of children. Various strategies of personal hygiene training need to be tried and before that it is important to study that currently prevailing status of personal hygiene in children. The training procedure also known as health education is defined as general education which is concerned with changes in knowledge, feelings and behavior of people. In its most usual forms it concentrates on developing about the best possible state of well being. Health education is an active process of learning and doing by ones self and it may encompass various aspects like personal hygiene, home and environmental sanitation or nutritional hygiene. Personal hygiene is most important aspect of health education. It means taking care of the cleanliness of the body parts. Until and unless measures are taken for making the body parts clean, the body is liable to catch infections and it may pose threat to the physical well-being of the individual.
3

Educational material for children should be designed to focus attention to provide knowledge to children regarding the importance of personal hygiene in their life without stressing them. Some basic aids for education are: Audiovisual aids These are the aids which can attract children as they reinforce learning by appealing to more than one sense and provide a dynamic way of avoiding monotony. For e.g. tape recorders, amplifiers, video etc. Visual aids Chalk boards, posters, charts, models etc. can be used easily to educate children and can be displayed where they can be repeatedly seen by the children. Demonstration A demonstration is a carefully prepared presentation to show how to perform a skill or procedure. (Park, 2009) e.g. tooth brushing demonstration, hand washing demonstration etc. Group discussion

It is an aggregation of people interacting in a face to face situation. It helps children to clear their doubts regarding the topic and also creates interest by their own participation. Role play

These training packages can be helpful only if the teachers and parents work together to create a learning atmosphere for the child. The onus lies on them. However, very few studies on these aspects have been conducted. (Dongre et al, Barlett). Particularly in north India, these are lacking. Hence, this study is conducted by the aim of assessing the status of personal hygiene in children and providing information and education to them in order to inculcate healthy hygiene habits which will further help them in keeping communicable diseases at bay.

AIMS AND OBJECTIVES

The aim of the study is Evaluation of Personal Hygiene status among Primary School children in Mohali village OBJECTIVES 1. 2. 3. To determine the status of personal hygiene in primary school children. To ascertain the behaviour pattern of primary school children regarding personal hygiene. To compare the impact of training on personal hygiene status/ behaviour on primary school children.

REVIEW OF LITERATURE
Hygiene is a branch of science that deals with the promotion and preservation of health, also called hygienics.The terms cleanliness (or cleaning) and hygiene are often used interchangeably, which can cause confusion. In general, hygiene mostly means practices that prevent spread of disease-causing organisms Hygiene practices vary widely, and what is considered acceptable in one culture might not be acceptable in another. Hygiene is an old concept related to medicine, as well as to personal and professional care practices related to most aspects of living. In medicine, in home (domestic) and everyday life settings, hygiene practices are employed as preventative measures to reduce the incidence and spreading of disease. Since cleaning processes (e.g., hand washing) remove infectious microbes as well as dirt and soil, they are often the means to achieve hygiene. Other uses of the term appear in phrases including: body hygiene, personal hygiene, sleep hygiene, dental hygiene and occupational hygiene, used in connection with public health Personal hygiene pertains to hygiene practices performed by an individual to care for one's bodily health and well being, through cleanliness. Motivations for personal hygiene practice include reduction of personal illness, healing from personal illness, optimal health and sense of well being, social acceptance and prevention of spread of illness to others. Brushing teeth, washing hands, and hot showers are a necessity in today's world where these hygienal rituals are performed daily. One would be gawked at if they were to come to work covered in grime, and grimaced at by co-workers if they left the bathroom without washing their hands. Though hygiene is an important "duty" to protect oneself and others from sickness, back in ancient times, till up to the early 1900's, the nature of our ancestor's hygiene could be seen as dubious.

HISTORY OF HYGIENE PRACTICES ANCIENT AGE Cleaning clothes during this time was never a truly essential chore. People were used to the smell, grime, and dirt. Though the cleaning that did occur would either be a quick rinse in a river, or hiring a fuller to soak and scrub their clothes in large vats of urine which acted as ammonia. The emergence of soap is credited to the Celts of Gaul. Made from animal fat, or sheep tallow, soap proved to be more effective than olive oil and coarse salt. Hair care during this time was strange, and painful. Men especially did not want hair on them. In public baths it was not unusual for other men to shave one another. Excess hair to them was "dirty" attracting lice, and hair removal was almost like a pastime. The hygienic practices are given important place in ancient Indian medicine. Archeological excavations of Mohenjodaro and Harrappa in the Indus valley uncovered city of over 2000 years old which yields rather advanced knowledge of sanitation, water supply and the inhabitants followed good personal hygiene practices. (Park, 2009) MIDDLE AGES Bathing evolved in the Middle Ages into a more thorough, and comfortable affair. It was not uncommon for a family to have a portable tub, which was padded and lined with cloth. Aristocrats were able to afford rudimentary models of the bathrooms we have today. It would be tiled, and surrounded by bath mats. Even though bathing was easier during this time, it was still not an everyday occurrence. Usually every few days, one would just shave, clean the face, hands, and feet. Soon etiquette books on hygiene were being published informing the public that it was rude to blow their nose on their hands and not wipe it on their clothes (obviously germs were not acknowledged during this time), that one should keep their nails clean, one should brush their teeth every morning, and that one should wash their face daily.

Aristocrats during this time considered hand washing mandatory before a meal and it was carried out ritualistically. There would be two bowls placed before the hand washer, one bowl with filled with scented water and another one that was empty. The aristocrat would extend his hands over the empty bowl and rubbed them together while a servant poured scented water over top of them, the water falling into the empty bowl. Then a second servant would dry the aristocrat's hands with a dry towel. Cleaning clothes had also improved in technique. To achieve a fresh scent and cleanliness, people would bundle their clothes with sweet smelling roots and boil it in a pot of water. When storing away the clothes, it was popular to sprinkle dried flower petals on them to help keep a sweet scent. MODERN ADVANCES IN HYGIENE It was in 1860 did a monumental breakthrough by French chemist Louis Pasteur ignite the eventual discovery of germs. During the 1800's to the early 1900's, surgeons were not aware of germs; they even used the same surgical instruments unclean with multiple patients (especially during the Civil War). It was due to Pasteur's belief in the germ theory that he found a way to immunize diseases, and find a cure to rabies. With the presence of germs confirmed, new steps were taken in hygiene to prevent these germs from proliferating, sickening, and spoiling. Milk after Pasteur's discovery was pasteurized (heated to destroy germs), and this process was named after him for his groundbreaking discovery. Personal hygiene entails bathing regularly, keeping our hair clean, trimming fingernails and toenails, brushing your teeth and using deodorant. Personal hygiene can enhance your selfconfidence and improve your chances of success in many areas of our life. A lack of it can have certain social and health ramifications. Psychological problems can often spur bad hygiene practices. Personal Hygiene is the first step in maintaining a healthy lifestyle. we are taught elementary cleanliness during childhood, and should be common knowledge among most everyone. But more often times than not, neglect of personal hygiene can be a risk to health. An

overall improvement of personal hygiene can improve health in more ways than one. (Source Wikipedia) COMPONENTS OF PERSONAL HYGIENE Oral hygiene It goes without saying that the teaching of good oral hygiene is essential for young. Along with brushing technique, the importance of mouth rinsing should also be explained in order to keep the dentition healthy. Hand Washing Hand washing is essential to avoid developing infections. When a child is ready to go to school parents should make sure that the child learns to wash his hands properly or infections and diseases can spread. Nails Nail beds are a perfect environment for germs to prosper. Face and feet Feet are most prone to dust which should be cleaned properly to avoid infections. SIGNIFICANCE OF PERSONAL HYGIENE: A lack of personal hygiene can cause many health problems. People who do not bathe regularly are more susceptible to fungus infections such as jock itch, athlete's feet or toenail fungus infections. A lack of oral hygiene can cause fungus infections such as oral thrush. Those who fail to wash their hands regularly are more prone to getting viruses or bacterial infections from others. Bed bugs are a common problem when good hygiene and regular cleaning are lacking. Hygiene and good habits are commonly understood as prevention methods against infection. In broader call scientific terms, hygiene is the maintenance of health.
9

and healthy living. Hygiene ranges from personal hygiene in domestic realm to occupational hygiene and public health. Hygiene involves healthy diet, cleanliness, and mental health. One of the most effective ways to protect ourselves, from illness is good personal hygiene. This means not only washing hands but also the body. Personal hygiene includes health practices such as bathing, washing your hair, brushing teeth, and cleaning clothes. Maintaining good personal hygiene helps to fight infection by removing essences that allow bacteria to grow from the surface of skin. Maintaining personal hygiene is necessary for many reasons; these can be personal, social, for health reasons, psychological or simply as a way of life. Essentially keeping a good standard of hygiene helps to prevent the development and spread of infections, illnesses and bad odors. An individual learns personal hygiene habits in the following ways: 1. From parents 2. From school 3. From peers and colleagues Parents, teachers and peers can influence the way in which children approach personal hygiene. It is also important to start early as it will have more time to settle in the childs mind. The home, the school and the community has to share the task of helping each child to realize optimal health and keep pace with his increasing maturity, train gradually to assume more and more responsibility for his own health. School children are the most impressionable group. They can be easily used as resources communication of ideas and values to family and friends. On an average a child spends 6-8 hours in school every day. Out of 16 hours spent in the house a child spends around 9 hours sleeping and rest 7 hours in playing, eating, watching TV and doing other things. So, a school is considered the valuable place where good habits can be taught and regulated. The main reason for emphasizing on school health is that the child is under strict supervision for 6 hours, so the habits are regulated easily.
10

for

Another reason is that the child learns easily when he sees something which his friend is also doing. So, it is easier for the child to learn good habits in school. Educating children on good hygiene is the best way to avoid the spread of infection and disorders and not just for childhood complaints; teaching the principles of correct hygiene at an early age can help keep individuals healthy in later life, and be taught to future generations.

Health education may be defined as general education which is concerned with changes in knowledge, feelings and behavior of people. In its most usual forms it concentrates on developing about the best possible state of well being. Moreover education concerning prevailing health problems and the method of preventing and controlling them is considered to be one of the first essential activities in primary health care. Health education is an active process of learning and doing by ones self and it may encompass various aspects like personal hygiene, home and environmental sanitation or nutritional hygiene. Personal hygiene is most important aspect of health education. It means taking care of the cleanliness of the body parts. Until and unless measures are taken for making the body parts clean, the body is liable to catch infections and it may pose threat to the physical well-being of the individual. Though a multitude of programmes are going on for the eradication and control of diseases yet a lot of intervention that needs to be done for giving first hand information about practices and prevention of spread of diseases Health education is defined as an effort to promote good health behavior or to prevent bad health behavior. For such education to be imparted to school children, the relevant intervention strategy for children should include the easy language& more colors. The content should be in such a way that the children are attracted towards it.

Some very easy and basic modes of such interventions are: 1. Education through charts, posters: colourful posters depicting cartoons taking bath etc influence the children the most. 2. Child to Child technique is evolved from child to child programme in 1979 launched in more than 70 countries. Through this technique emphasis is laid on idea of using primary

11

school children to reach out to their peers and younger siblings for teaching certain aspects of personal hygiene and personal security from accidents. 3. Puppet shows and role play methods can also be adopted to teach the children importance of good personal hygiene. 4. Demonstrations: hand washing technique, tooth brushing techniques can be demonstrated to children Good hand washing is the first line of defense against the spread of many illnesses, from the common cold to more serious illnesses such as meningitis, influenza, hepatitis A, and most types of infectious diarrhea. Hand washing with soap is among the most effective and inexpensive ways to prevent diarrheal diseases and pneumonia, which together are responsible for the majority of child deaths. The seven step hand washing technique is shown below in fig: 1

Fig 1: Hand Washing Technique

12

Interventional studies on personal hygiene training of school children: Biswas et al. (1990) reported that health knowledge of the student significantly improved after education. Attitude of the students towards personal hygiene also improved significantly after education. The practice of personal hygiene also revealed improvement.

Moreover, Dongre et al. (2006). also ascertained that after giving an intervention of school health programme there was significant improvement in the personal hygiene of the students. It was also found that with the implementation of the school health education programme with the emphasis on improvement of personal hygiene, the proportion of children with clean and cut nails, clean hairs and clean clothes increased significantly.

Barlett (1981) found that such programmes were found to be effective in modifying health knowledge and awareness less effective in modifying attitudes and slightly less in modifying behavior towards personal hygiene. The results have also been found to be concordant with the studies of Parcel et al. (1984), Peterson et al. (1984) and Hendricks et al. (1989). Another study by Zivkovic et al. (1998) elucidated that intervention contributed symbolically to personal hygiene practice which is important to health as before and after difference was found to be significant. It has been found that hygiene behavior plays a major role in the prevention of disease related to water and sanitation such as cholera, typhoid etc.with changing the behavior in order to reduce the risk practices that predisposes them to hygiene and sanitation related diseases. The simple act of hand washing with soap can reduce diarrhea by over 40%. (Park, 2009)

Findings of some of the studies are summarized in Table 1:

13

Table 1: Summary of Interventional Studies on Personal Hygiene

Name of author, year and place Dongre,et al Feb(2003), Wardha District

Study design n

Intervention type and duration

Results

Interventional study (n= 145)

Siwach, (2007-2008), Rural Panipat.

Experimental, Randomized Control Trial (n= 60)

Illika and Obionu, (2002), Nigeria Quintero & Freeman, (2004), Bogota, Columbia

Interventional study (n= 398) Cross sectional study (n= 2042)

Health education lectures- 1 hour/ week. Poster display on personal hygiene. Demonstration of hand washing, nail cutting. Intervention given for 8 weeks to experimental group of 30. Health education through lectures on personal hygiene. Three months of school based hygiene health education. Survey

Prevalence of clean hair in pre intervention 27.6% and cut nails- 29.7% In post intervention: Clean hair- 52.7% Cut nails- 48.2% Improvement from 3.30+_ 0.78 to 4.57+_ 1.27 with t- value 7.41 in experimental group.

In pre interventional results 45% were rated clean. In post intervention- 65% were rated clean. Only 33.6% of the sample reported always or very often washing hands with soap and clean water before eating and after using the toilet Practice of personal hygiene habits increased from 32% to 45%.

Biswas et al, interventional 1990, study( n= 113) Burdwan, West Bengal

Health education was imparted by a team of Medical Officer and Paramedical staff on personnel hygiene for 6 months

14

METHODOLOGY
STUDY AREA: This study was conducted in a primary school in village Mohali, located in Punjab near the Chandigarh, S.A.S. Nagar border, with a population of 3853: (Ministry of Rural Development Report, 2009). The map 1; shows the location of the study village:

Map 1: Rupnagar District map STUDY DESIGN: Single group (before, after) interventional study STUDY PERIOD: September 2010- March 2011

15

SAMPLE SIZE AND SAMPLING TECHNIQUE: 1. Selection procedure: purposive selection was done keeping feasibility in mind.

Study Area

S.A.S. Nagar

Study Village

Village Mohali

Study Population

Total schools-3

Study Sample

One selected randomly

Study Units

Total primary school children(150) Included all (nsampling done)

Baseline data collected

COMPARISON

Training session

Endline data collected

Figure 2: STUDY PLAN

16

TOOLS: An interview schedule containing 24 questions (Annexure1) and an observational checklist (Annexure 2) containing 33 sub parts regarding personal hygiene practices was developed and pretested. Pretest / pilot study: Pretest was done on 18 children. The questionnaire contained following sub divisions: 1. Socio demographic data: Information was taken about name, age, sex, address, fathers name, occupation, mothers name. 2. Personal data: It included various questions on bathing, hand washing, skincare, hair care and other hygiene related questions. 3. The observational checklist had sub divisions on hair, shoes, hands, eyes, ears, nose and face. Each individual was examined and scoring was done. The interview schedule was then discussed with experts in Public Health. It was then refined and revised. It was then used for main survey. SCORING CRITERIA: Scores were allotted to each question ranging from 3 to 0 depending on the answers. The overall comparison was made between the status of personal hygiene before and after the intervention was given. The baseline data scores of individuals were divided into four subgroups: poor, average, good and excellent. These subgroups were made on the collective scores of observational and scheduled questionnaire. The poor grade was awarded to the group of children who had a combination of certain factors like uncut and unclean nails, presence of caries and halitosis and untidy hair and did follow basic regimen of personal hygiene. The average grade was awarded to that group which had uncut and unclean nails but no halitosis along with not following some basic habits of personal hygiene. Good and excellent grades were awarded to the group which had nails cut, hair properly combed and caries free dentition and also followed good hygiene regimen. MAIN SURVEY: 1. Consent: the school chosen with random sampling was VIDYA NIKETAN HIGH SCHOOL. The whole concept and importance of the study was explained to the principal. 2. Written consent was taken. 3. With the support of the school authorities and staff, baseline data was collected. 4. Data was collected in school on every Saturday being it activity day. 5. Children were called class wise and interviewed individually and the schedule was filled accordingly by the interviewer. 6. Each question had four options out of which the closest answer was marked. 7. Then a thorough examination of the child was done for the observational checklist for personal hygiene aspect.

17

INTERVENTION: 1. After the completion of baseline data intervention was done in the month of March 2011. 2. Intervention package had three components: - A lecture on personal hygiene in Hindi containing details about bathing, hand washing and body care of 40 minutes was given by the personal interviewer. For this charts and posters were used depicting cartoons on personal hygiene.(Photo 1, 2, 3 page no. 39, 40) - For this children were divided into 7 groups (each group containing 18 children), and were called to a vacant classroom at 11 a.m. every Thursday and Saturday. (Photo 4 &5 page no. 40, 41) - They were asked to sit in a semi circle and interviewer sat in the centre. - A video containing a story of a lion of 15 minutes length was shown to encourage the children about importance of tooth brushing. The video was downloaded from utube.com - A seven step hand washing technique was also demonstrated by the personal interviewer. ENDLINE SURVEY: The data was collected again after a gap of 10 days on the same set of interview schedule. Then again observational checklist was used to grade the status of personal hygiene of each child. ANALYSIS: -The data hence collected was analyzed using SPSS and MS-Excel 2007. Paired t test and percentages were used for analysis. -Scoring was done based on the scoring criteria already developed. - Data analysis was done in the month of April 2011.

18

RESULTS
Overall 126 children were included in the study as against the determined sample size of 150. (Coverage 84%)

Figure 3: Age distribution of children

54
60 Percentage(%) 40 20 0 5-7 8-10 Age group 11-13 30.2

15.9

Out of total 126 children studied, 30.2% were aged 5-7 years of age, 54% were aged 8-10 years and 15.9% were aged 11-13 years. (Figure 3)

Figure 4: Gender distribution of children

64, 51%

62, 49%

Male Figure 4 shows Out of the total sample, 61.51% were females and 62.49% were males.
19

Figure 5: Occupational status of father

50 45 40 35 30 25 20 15 10 5 0
46.0

21.4

11.9

11.1 5.6 2.4 0.8 0.8

*NR- Not responding The occupation of 46% of childrens fathers was businessman, (11.1%) government employee, (2.4%) bank employee (figure 5)

Figure 6: Overall scores of baseline data

13.5% 23.8%

32.5%
poor average good

30.2%

excellent

20

Figure 7: Impact of training of healthy hygiene practices of children related to bathing

80
70.6

73
69

70

Pre test

Post test

60

53.2 44.1 42.1

50

40

30
19.8 16.7 15.1 14.3

20

10

0
Take bath today In morning 2 times Use Lifebuoy/dettol Lukewarm water

Figure7 shows that frequency of bathing increased in children after intervention but the time of taking bath has shifted from morning to different times of the day. Use of antiseptic soap was also increased by the children after health education programme.

21

Table 3: Impact of intervention on children in bathing habits

Parameter When did take bath Today Yesterday More than 3 days More than 7 days Who helps to take bath Mother Sister Father/brother Self At what time Morning Evening/afternoon Different times How many times 2 times Once Less than 1 Which soap do you use Lifebuoy/dettol Dove/baby soap Lux Other Water used for bath Lukewarm water Cold water Hot water 18 61 47 14.3 48.4 37.3 25 18 83 19.8 14.3 65.9 53 17 44 12 42.1 13.5 34.9 9.5 56 17 41 12 44.4 13.5 32.5 9.5 21 97 8 16.7 77.0 6.3 19 98 9 15.1 77.8 7.1 87 15 24 69.0 11.9 19.0 67 33 26 53.2 26.2 20.6 44 10 6 66 34.9 7.9 4.8 52.4 62 12 7 45 49.2 9.5 5.6 35.7 N 89 34 2 1 Pre-test % 70.6 27.0 1.6 0.8 N 92 30 4 0 Post test % 73.0 23.8 3.2 0.0

Table 3 indicates that children started taking bath every day after the intervention but the time of taking bath also shifted from morning to evening or afternoon.

22

Figure 8: Impact of training of healthy hygiene practices of children related to hair care

70

63.5

Pre test 60
56.3

Post test
43.7 37.3 41.3

50

40

31

30

20

10

0
Wash hair today Shampoo Oil Everyday

There was very less impact of health education on children regarding hair care. Use of shampoo decreased by 7%. (Figure 8)
23

Table 4: Impact of intervention on children on habits related to hair care

Parameter When did you wash hair last Today Yesterday Last week Other What do you use Shampoo Soap Water only How many times do you comb Twice Once in the morning More than twice Never Who combs your hair Mother/sister Father/brother Self None How many times do you oil Everyday After 2 days After more than 3 days More than a week Who puts oil in your hair Mother/sister Father/brother Self Other 85 3 37 1 67.5 2.4 29.4 0.8 90 8 27 1 71.4 6.3 21.4 0.8 55 25 24 22 43.7 19.8 19.0 17.5 52 20 41 13 41.3 15.9 32.5 10.3 69 3 53 1 54.8 2.4 42.1 0.8 80 9 36 1 63.5 7.1 28.6 0.8 59 59 8 0 46.8 46.8 6.3 0.0 52 63 9 2 41.3 50.0 7.1 1.6 80 44 2 63.5 34.9 1.6 71 49 6 56.3 38.9 4.8 N 39 46 39 2 Pre-test % 31.0 36.5 31.0 1.6 N 47 50 27 2 Post test % 37.3 39.7 21.4 1.6

Use of shampoo to wash hair was more evidently seen in children followed by soap. 60 -70%of the children took help of their mothers to wash their head or oiling their hair. (Table 4)

24

Figure 9: Impact of training of healthy hygiene practices on children related to dental care

83.3

88.1

Pre test 90 80 70 60 50 40 30 20 10 0
Brush Morning and evening 28.6 70.6

Post test

Use toothbrush and toothpaste

Figure 9 Indicates a significant improvement was seen in brushing habits of children with an increase up to 70% from 28.6% in frequency of tooth brushing and 5% increase in the use of toothbrush and toothpaste.

25

Table 5: Impact of intervention on children for habits related to face and dental care
Parameter When did you wash your face Morning and evening Morning, evening Only morning Other When do you brush your teeth Morning and evening Evening Morning Dont brush What do you use for cleaning Toothbrush and toothpaste Dantmanjan Datun Finger/other Rinse mouth Yes, regularly Yes, occasionally No Parents take you to dentist Every 6 Months Every year When have some problem Never 7 10 48 61 5.6 7.9 38.1 48.4 3 11 53 59 2.4 8.7 42.1 46.8 30 46 50 23.8 36.5 39.7 19 86 21 15.1 68.3 16.7 105 18 1 2 83.3 14.3 0.8 1.6 111 14 1 0 88.1 11.1 0.8 0.0 36 4 83 3 28.6 3.2 65.9 2.4 89 2 34 1 70.6 1.6 27.0 0.8 N 40 43 42 1 Pre-test % 31.7 34.1 33.3 0.8 N 47 65 13 1 Post test % 37.3 51.6 10.3 0.8

Face washing habit thrice a day showed a significant improvement after intervention. Mouth rinsing also showed improvement up to 68.3% post intervention. Toothbrush and toothpaste was preferred 8 times than dantmanjan and use of dantmanjan also decreased by 4% after intervention. Tooth brushing twice a day also reached to 70% whereas before intervention 65% children brushed their teeth only once in the morning. (Table 5)

26

Table 6: Impact of intervention on children for habits related to hand wash

Parameter Use to wash hands Soap and water Sand/ashes and water Only water Apply any cream Yes No Wash hand before meals Wash hands after meals Wash hands after using toilet Wash hands after playing 51 75 124 102 123 94 40.5 59.5 98.4 81.0 97.6 74.6 71 55 126 126 126 124 56.3 53.7 100.0 100.0 100.0 98.4 N 123 0 3 Pre-test % 97.6 0.0 2.4 Post test N 120 2 4 % 95.2 1.6 3.2

Table 6 shows a good improvement in hand hygiene practice of children after intervention.

Table 7: Impact of intervention on children related to other hygiene habits

Parameter N Cover face while sneezing Cover while sneezing with Handkerchief Hand Share water bottle with friends Wash feet before going to bed 60 66 44 74 47.6 52.4 34.9 58.7 101 25 55 95 80.2 19.8 43.7 75.4 111 Pre-test % 88.1 N 124 Post test % 98.4

Table 7 indicates the increase in percentage of children covering their face while sneezing post intervention i.e. from 88.1% to 98.4%. 80.2% used handkerchief while others still used hand to cover their face.
27

Table 8: Impact of intervention on total hygiene score

Pre-test Hygiene score N <39 (poor) 39-42 (average) 43+46 (good) >46 (excellent) 41 38 30 17 % 32.5 30.2 23.8 13.5 N 19 28 39 40 % 15.1 22.2 31.0 31.7 Post test

Mean 40.60, Std.Deviation 4.92

Mean 43.73 Std. Deviation 4.80 -6.266,df- 125 p- 0.000

Total hygiene score has shown a significant increase in the number of children falling in the excellent category from 13.5% to 31.7%. (Table 8)

Table 9: Impact of intervention on hygiene score in different domains

Pre-test Area Mean Bathing Hair care Hand wash Face and dental care Other hygiene habits Total score 10.18 13.37 6.87 7.89 2.29 40.60 SD 2.20 2.08 0.98 2.54 0.94 4.92 Mean 10.41 13.67 7.47 9.20 2.98 43.73 SD 2.49 2.05 0.68 1.68 0.76 4.80 -1.294, df-125, p-0.198 -1.753, df-125, p-0.082 -5.443, df-125, p-0.000 -6.543, df-125, p-0.000 -7.364, df-125, p-0.000 -6.266, df-125, p-0.000 Post test p-value of paired t test

Table 9 shows that there was a significant improvement post intervention in the mean scores of hand washing, face and dental care and other habits like covering face while sneezing, washing

28

feet before going to bed. The overall hygiene score has shown a significant improvement from a mean score of 40.60 to 43.73.

Table 10: Impact of intervention on observational hygiene score in different domains

Pre-test Area Mean Hair Teeth and tongue Hands Shoes and clothes Eyes Ears/nose Face Total score 4.38 3.47 3.53 3.49 4.78 4.41 4.29 28.00 SD 0.89 1.52 1.23 1.15 0.47 0.73 0.74 3.30 Mean 4.53 4.24 4.71 4.31 4.69 4.60 4.68 32.07 SD 0.73 1.00 0.52 0.75 0.50 0.55 0.50 1.80 -1.402, df-125, p-0.163 -6.422, df-125, p-0.000 -9.943, df-125, p-0.000 -6.427, df-125, p-0.000 -1.490, df-125, p-0.139 -2.285, df-125, p-0.024 -4.742, df-125, p-0.000 -8.486, df-125, p-0.000 Post test t

The observational scoring showed a significant increase in the hand hygiene score from a mean value of 3.53 to 4.71 post intervention. The dental hygiene also rose from 3.47 to 4.24. The mean scoring of hygiene of eyes and hair did not show any improvement. (Table 10)

29

DISCUSSION
A primary school is an institution in which children receive the first stage of compulsory education known as primary or elementary education. Children generally attend primary school from around the age of four or five until the age of eleven or twelve. This is the place where a child develops basic habits and etiquettes. These etiquettes have a bearing on their future life. Poor habits especially related to body can propagate illness and hence can affect their efficiency in life, for e.g. a child who is not in the habit of washing hands before meals will invite illness and along with that will face problems in social life. The incidence of illness relating to areas of personal hygiene is more apparent in children as they are learning to take care of themselves and are exposed to many germs whilst in the school environment or in a play area. Childhood habits translate to good habits during adolescence when hygiene becomes even more important. Thus imbibing good personal hygiene habits is the easiest way to keep communicable diseases at bay. Personal hygiene in children between the age group of 6 to 12 years of age is mainly determined by many factors like economic and social status of the family, educational status of the parents and the school environment. Parents, teachers and peers can influence the way in which children approach personal hygiene, which will stay with them for life. It is also important to start early, as it will have more time to settle in the child's mind, and they will learn earlier how to do it on their own without your prompting. A child who grows up learning proper hygiene at home can better fit in as he grows up. The home, the school and the community has to share the task of helping each child to realize optimal health and keep pace with his increasing maturity, train gradually to assume more and more responsibility for his own.

In the analysis of baseline data, it was significant to note that the personal hygiene scores of primary school children in the study were POOR. Maximum childrens scores fell into the poor category (32%) and only 13% were in excellent category. These results were similar to a study carried out by Illika and Obionu, (2002), Nigeria on 398 children out of which 45% were rated clean.

30

The findings were disappointing as the nails were found uncut and unclean in many children. They were not in the habit of washing hands before meal; oral hygiene was bad as they had carious teeth along with halitosis due to irregular brushing. The children were unaware of the concept of hand washing and brushing technique. This implies that neither their families nor their schools were playing their expected role in ensuring good personal hygiene in children. So, there was a definite gap in the training of primary school children for personal hygiene. This study helped to fill in the gap. Delivery of lecture which had dos and donts about good hygiene led to an increase up to 68.3% in mouth rinsing. Children were convinced to imbibe the knowledge about the importance of different hygiene measures like use of handkerchief while sneezing, washing feet before going to bed which showed significant improvement post intervention. Charts and posters which contained colorful pictures of cartoon characters shown brushing their teeth, washing hands and feet and bathing also made a noticeable improvement in the results. 75.4% started washing feet before going to bed as compared to an earlier figure of only 58.75% practicing this habit. Demonstration of hand washing, tooth brushing technique along with a video motivated the children in great manner. Post interventional data showed a significant improvement in children. 28% of them who earlier did not brush or brushed their teeth only once a day improved to 70.6%.

Our results indicate that the intervention package devised in the study played a significant role in improving the personal hygiene status of the children. There was a definite reversal of scores. The percentage of children who scored in poor category came down to only 15% from an earlier score of 32.5%, followed by good category and then the average category. (P value 0.000) these outcomes implied that a child can easily learn good habits if he is guided properly. Childhood is the most impressionable stage of life. A child is a very quick learner and obeys easily to what is told. Children look up to their teachers and parents as they try to enact and copy in every aspect. So they can be easily convinced to learn good habits by just doing those in front of them. Some other methods of teaching can also be included. The package in this study included demonstration; lecture and video which attract children but apart from these parents and teachers can device some other techniques to involve children into practicing good hygiene habits. e.g.
31

giving away a small prize to best and cleanest child as done in this study, may have encouraged other children towards good habits

It was found that 73% children started taking bath everyday in the morning after intervention as compared to earlier figures of 70%. A major factor in bath hygiene is the quality of soap, this decision is not in the hands of the children but still a little improvement was seen from 42% to 44.4% of those who started using lifebuoy/dettol or other antiseptic soap.

Another finding of the study shows that the percentage of children combing their hair in the morning rose from 46.8% to 50% due to the intervention. As far as observational hygiene scores are concerned, there was no significant improvement as mean increase was very less from 4.38 to 4.53. This finding is in contrast with a study by Dongre et al who found out a significant improvement in hair hygiene in children from 27.6% to 52.7%. This variation may be because of certain factors which include weather conditions as the baseline data was collected in between September and October and post interventional data was collected in the month of February which is comparatively colder. Being it a colder month, children mostly abstain from taking bath in the morning. This goes in terms of a study conducted by Barlett who found that intervention programmes were found to be effective in modifying health knowledge and awareness, less effective in modifying attitudes and slightly less in modifying behavior towards personal hygiene. A significant improvement was seen from 28.6% to 70.6% in tooth brushing. Use of toothbrush and toothpaste also showed an increase from 83.3% to 88.1%. The children were more convinced due to many factors like enjoyable technique of brushing and the fear of their teeth getting carious.

It was seen in the study that frequency of hand washing before and after meals and after using toilet increased significantly. Hand washing habit is greatly seen imbibed by the children post intervention which has risen to 100% and use of soap and water to wash hands is also very much practiced by the children. The observational scores also increased significantly from a mean score of 3.53 before intervention to 4.71 which is again in accordance with study by Dongre et al who accounted an increase from 29.7% to 48.2% post intervention in hand hygiene whereas
32

Another study by Quintero & Freeman showed that only 33.6% of the sample reported washing hands with soap and water after using the toilet.

Use of handkerchief to cover the face while sneezing also showed a significant increase from 47.6% to 80.2%, which clearly indicates that children can easily be adapted to good habits by little efforts. Other hygiene related habits like washing of feet before going to bed has showed a tremendous rise from 58.7% to 75.4% post intervention. Washing of feet before going to bed is important to avoid dust and other infectious substances enter your body through skin and children showed a significant improvement post intervention.

This finding goes well with that of a study conducted by Biswas et al where it was found that practice of personal hygiene habits increased from after health education was imparted. Total scores of all subgroups like bathing, hair care, hand washing, face and dental care and other habits when clubbed, mean score increased to 43.73 post intervention which is a significant improvement. This finding is in accordance with a study conducted by Zivkovic et al. (1998) who also elucidated that intervention contributed symbolically to personal hygiene practice which is important to health as before and after difference was found to be significant The overall change in the status of personal hygiene that occurred in children was significant. This implied that children can be easily made to learn and adapt good personal hygiene habits. Childhood is a time of immense creative energy, carefree and abundantly energetic. It is also a time of widening horizons at all levels. The need of the day is to address the concern of personal hygiene in a holistic manner. Education can play a supportive role by incorporating all aspects of good health in the curriculum of school education. A little effort is required by the parents and teachers to teach the children and regulate good habits in them. Children in primary age need intervention which can encourage them to modify their habits and intervention should be started at a younger age as children learn and grasp easily during that age and carry those habits for life. The schools must provide a setting where education and health come together to create a health promoting environment.

33

Thus, the ultimate goal of health education intervention i.e. to positively influence health status and bring about behavioral changes regarding health could be achieved in the present study.

CONCLUSION
The data collected during the study was analyzed and compiled to reach the following conclusions: Overall personal hygiene status among primary school children was poor. The intervention package comprising of demonstration, video and lectures used in this was successful in obtaining the desired results of improved personal hygiene in children. Primary school children can be easily be trained to acquire good personal hygiene habits by simple means of teaching.

RECOMMENDATIONS
Periodic retraining by the parents and teachers is required to sustain the change in long run.

34

 The personal hygiene training should be incorporated into the school curriculum to create a health promoting environment.
Further studies should be conducted to analyze the relative impact of different training

packages in improving personal hygiene status of children.

LIMITATIONS
There are a few limitations that need to be acknowledged regarding the present study. The time span of the study was only six months which was less due to which parents were not included in the study. The amounts of financial resources for the study were less. So, only a limited version of training package was implemented. All behavior was not directly observed. Many of the responses were self reports which could be socially desirable responses.

35