Subject for Dissertation

SYNOPSIS FOR REGISTRATION OF

SUBJECT FOR DISSERTATION

SUBMITTED BY:

Mrs. VIJAYA KUMARI.K.B

I M.Sc. NURSING

PEADIATRIC NURSING

(2012-2014 BATCH)

SHARABHESWARA COLLEGE OF NURSING

6TH WARD, GUGGARAHATTI, BANGALORE ROAD,

BELLARY – 583 102

SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

INTRODUCTION

The word hygiene is derived from the name of the ancient Greek goddess of healthful living-Hygeia. Hygiene refers to the set of practices associated with the preservation of health and healthy living1. Cleanliness gives us healthy and sound living. Personal hygiene is important for keeping kids healthy and clean. It includes hygiene of the skin, mouth, hand, hair, nails, feet etc2.

Hygiene is the science of health and its maintenance. It is highly personal determined by individual values and practices. Hygiene status of children is an index of national investment in the development of its man power. It is influenced by social, familial and individual factors as well as the children’s knowledge of health on personal hygiene, comfort and basic needs, characteristic associated with child such as their natural and lack of knowledge are aggregating factors3.

Hygiene has two aspects that are personal and environmental. The main aim of personal hygiene is to promote standards of personal cleanliness within the settings of the condition where people live. Good hygiene is an aid to health, beauty, comfort and social interactions. Good personal hygiene, directly aids in disease prevention and health promotion4.

According to the Government of India, the total population of children in the age group seven to fourteen years is 19,97,91,198, that is, 19.4% of the total Indian population. India has largest group of school going children in rural areas. In India, there are 6.3 lakh rural schools with 80 million school going children. Out of this, 44% have water facilities, 19% have urinals, and less than eight percent have lavatory facilities for girls. Thus, schools are unsafe places where diseases are spread. A total of sixty percent of the population living in developing countries, amounting to some 2.4 billion people, has no access to hygienic means of sanitation5.

For growing children, personal hygiene is a very important factor. Personal hygiene not only makes them comfortable, but it teaches them to do what is right and what is wrong6. Early hygiene enhancement gives the child a healthy and comfortable life, and will teach them to be hygienic up to the time they grow old. Children touch, reach and grasp to learn about environment and are at a high risk of infection7.

Some infectious diseases which spread through poor hygiene are common cold, flue and gastrointestinal diseases. However, good hygiene teaches them to understand the importance of personal hygiene and to take care of their body from health hazards such as diarrhoea, dysentery, intestinal worm infestation, infestation of lice, and skin diseases8.

Primary school children constitute about 5 percent of the total population and are vulnerable for various infections. As there is more prevalence of ignorance and illiteracy among the public, there is a great need to educate them, especially the children about good hygienic practices and to promote healthy life style9.

The children are the most important segment of our population and intend to receive attention from family, school, society and government Children are truly the foundation of a society because healthy children grow to become healthy and strong adults who can actively participate in the developmental activities of a nation10.

6.0 BRIEF RESUME OF THE INTENDED WORK

6.1NEED FOR THE STUDY

Personal hygiene refers to the cleaning and grooming of the body. In addition to improving appearance, personal hygiene is an important form of protection against disease and infections of all kinds. Understanding the importance of personal hygiene allows child to make informed decisions about how to care for their healthand appearance. The main purpose of personal hygiene is to prevent illness and improve appearance, but hygiene also plays an important role in social acceptance and can either improve or hinder a person's reputation in social situations. Bad breath, body odor and an unkempt appearance, for example, are often considered undesirable and can give a bad first impression to peers, acquaintances and potential mates11.

Personal hygiene is important in every stage of life, but good cleanliness habits start in childhood. Kids who learn what it is and how to follow proper hygiene practices will usually carry that into adulthood12.

Hygiene education starts with the family, and eventually youngsters can learn what to do and follow cleanliness rules on their own when a baby makes the transition into childhood, it may be more of a challenge to keep her fresh. As a child grows, so do his opportunities for the face, hands and feet to become messy and dirty12.

Learning proper cleanliness skills in childhood can help prevent the spread of germs and illness. As a child grows, good hygiene becomes increasingly important because hormonal changes during puberty lead to stronger body odor and oilier hair and skin12.

Australian psychologist Marion Kostanski study suggested that a child who does not practice good personal hygiene is placed at risk for injurious teasing by peers and advised to take the time to teach child at a young age the basics of good hygiene to avoid unnecessary teasing and taunting by peers13.So it is the responsibility of either the teacher or nurse to educate child in personal hygiene. Because hygiene practices can stave off childhood illness and infections. So training in personal hygiene could also save child from embarrassing moments and teasing by peers. Nurse should set a standard for other family members to follow. Overall better health will be family's reward if you stress the importance of personal hygiene. According to World Health Organization study, every rupee spent on improving hygiene generates an average economic benefit of Rupee nine14.

Practicing good hygiene means looking, feeling and smelling good. A child may appear unclean for a variety of reasons, ranging from illness to parental neglect.A child with poor hygiene can feel bad about himself and become the target of bullies. Teaching good hygiene can prevent illness and helps a child learn how to take care of himself15.

India has one of the largest groups of school going children, especially in rural areas. There are about 6.3 lakhs rural schools both primary and upper primary with 80 million school going children. But it is also a fact that only 8 percent of schools have the sanitation facilities in school premise. Out of 6.3 lakhs primary and upper primary rural schools, only 44 percent have water supply facilities, 19 percent have urinals and eight percent have lavatory facilities16.

Only 19 percent have separate urinals and four percent lavatory facility for girls. Under these conditions, schools and community environment become unsafe places where diseases are transmitted16.

A descriptive study was conducted to compare the health education activities of different government and private school of Delhi. Data was collected by observation of health education activities, interview of the health care providers and focus group discussion with the parents and teachers of the schools. The study revealed that in government organizations health education is one of the ongoing activities and this activity poorly managed. There is a need of imparting health education on important health matters such as personal hygiene and prevention of communicable disease and it should be carried out with the help of different AV aids17.

A study conducted revealed the concepts in personal hygiene; the first concept in personal hygiene is the positive and negative emotions that affect physical health, such as feeling pride in being neat and clean or feeling frustration in using hygiene tools. The second concept is personal hygiene practices such as hand washing, oral hygiene etc. The third concept is the fact that germs that can lead to common diseases such as the flu or a cold. Nurses can use various techniques to help kids remember these lessons18.

Children are eager to learn and schools are important places of learning for children. Promotion of personal hygiene and sanitation in schools therefore help the students to adopt good hygiene and habits during their childhood. Children learn in school they can and often do pass on in their families and communities19.

World Health Organization stated that the prevalence of personal hygiene has increased in schools, due to the worse situation of health status. Diseases are lead by unhygienic and the families almost unbearable. It has been estimated that 0.02% of child has proper hygienic practice among 180 children.8

National health policy appealed that promotion of child health in voluntary basis, found that the children access to hygienic practices widely differ between regions. Overall 60% of children in developing countries had changed to good hygienic practices and self care measures by best health education by teachers and health care professional21.

Schools are sacred because they provide an environment for learning skills, and for development of intelligence that can be utilized by students to achieve their goals in life. It is also observed that “to learn effectively children need good health22.”

Health is a key factor in school entry, as well as continued participation and attainment in school.School is the place where health education regarding important aspects of environment sanitation and hygiene need to be given to children to disease the infections22, hence the investigator in the present study aim to assess to assess the knowledge and practice of primary school children regarding personal hygiene and to conduct structured teaching programme to improve the knowledge and practice on personal hygiene.

6.2REVIEW OF LITERATURE

A cross-sectional survey was conducted in six rural areas of Bangladesh to explore knowledge and practices of the school children regarding personal hygiene. Thirty cluster sampling technique was applied coving 180 schools and 1800 students. Data collection took place between March to April, 2011. Data reveals that about 75% children were aware about wearing shoes during latrine use and washing hands with soap after defecation. More than 80% children mentioned about washing hands with soap before meal intake. Though the children possessed good knowledge on few indicators of personal hygiene but their practice was inadequate. It was found that more than 50% of the children did not wash hands with soap before meal intake and after defecation. Moreover, taking open food, open place defecation and use latrine without shoes were quite prevalent among them. Type of school, socio-economic status of households and geographical characteristics were reported as potential determinants for knowledge and practices of hygiene among children. A holistic approach addressing social, economical and geographical characteristics of the children should be introduced aimed at improving the hygiene practices among school children23.

A descriptive, observational, cross-sectional study was conducted in a primary school situated in the largest slum of Kolkata to find out the status of nutrition and personal hygiene among primary school children and their association with their varied morbidity profiles. The participants included 103 boys and 81 girls, with a mean age of 6.2 years. The mean personal hygiene score of the girls (4.15 ± 0.98) was significantly higher than that of boys (3.2 ± 1.4) [P<0.05]. Most of the boys (54.37%) and girls (74.07%) were normally nourished as per the CDC growth chart. Over 70% of the children were suffering from one or more morbidities, the most common morbidity in both the sexes being pallor, followed by worm infestation. Personal hygiene scores were significantly higher (P<0.05) among those children who were normally nourished as well as those who did not suffer from any morbidity in the last 15 days and concluded that care should be taken to improve the pitiable state of personal hygiene and poor sanitary practices of these school children through coordinated and concerted health education measures by teachers as well as parents24.

A cross-sectional study was conducted for 669 students to study evaluated the KAP of hygiene among rural school children in Ethiopia and assessed the extent to which proper knowledge of hygiene was associated with personal hygiene characteristics, who were interviewed by trained staff Participants were in grades 1-6 at Angolela Primary School, located in rural Ethiopia. Data consisted of hygiene and hand washing practices, knowledge about sanitation, personal hygiene characteristics, and presence of gastrointestinal parasitic infection; results showed approximately 52% of students were classified as having adequate knowledge of proper hygiene. Most students reported hand washing before meals (99.0%), but only 36.2% reported using soap. Although 76.7% of students reported that washing hands after defecation was important, only 14.8% reported actually following this practice. Students with adequate knowledge of proper hygiene were more likely to have clean clothes (AOR 1.62, CI 1.14-2.29) and to have a lower risk of parasitic infection (AOR 0.78, CI 0.56-1.09) although statistical significance was not achieved for the latter and concluded that the need for more hand washing and hygiene education in schools; and provide objective evidence that may guide the development of comprehensive health and hygiene intervention programs in rural Ethiopian schools. Successful implementation of these programs is likely to substantially attenuate the transmissible disease burden borne by school children in rural settings25.

A descriptive, cross-sectional study was conducted in a primary school in the largest slum of Kolkata on the status of nutrition and personal hygiene and their association with varied morbidity profiles. The participants included 103 boys and 81 girls with a mean age of six years. The mean personal hygiene score of the girls (4.15±0.98) was significantly higher than boys (3.2 ±1.4). Most of the boys (54.37%) and girls (74.07%) were normally nourished as shown by the growth chart. It was found that 76% of the boys and 74% of the girls were suffering from one or more morbidities. The researcher concluded that care should be taken to improve personal hygiene26.

A cross-sectional study was undertaken in rural Peshawar to determine the frequency of intestinal infestation in primary school children. The study population included 200 primary schoolchildren aged five to ten years. Data was collected by stool examination. The results showed 45.5% (91 cases) prevalence of Ascaris lumbricoides, less than eight percent (16 cases) of Hymenolepis nana, less than four percent (16 cases) of Enterobious vermicularis, less than three percent (7 cases) of hookworm, less than four percent (7 cases) of whipworm, and less than seven percent (3 cases) prevalence of tapeworm. The researcher concluded that there was a high percent of primary school children in need of health education on promotion of personal hygiene and possibly mass treatment27.

A longitudinal study was conducted in Vishakapattanam on dermatophytes and other fungi associated with hair-scalp of primary school children and hygiene. A total of 2804 primary section pupils aged six to fifteen years of 12 schools were screened. A questionnaire was administered along with physical examination of volunteers for scalp, body and nail ringworms. The results showed that the occurrence of hair-scalp infection was more in boys (61.60%) in comparison to girls (38.39%) and a number of pupils of age group five to eight years were suffering with infection (34.82%). The researcher concluded that there was a need for greater awareness on personal hygiene to reduce skin infection28.

An experimental study was conducted on the impact of school health education programme on personal hygiene and related morbidities in tribal school children of Wardha district. The sample of the study was 145 primary school children from six to eight years. Data was collected using a structured knowledge questionnaire and health check-up. Health education was done with flip books, demonstration activities, and planned health education programme sessions. Results showed that proportion of children with clean teeth increased from 33.8% to 50% and prevalence of dental caries reduced from eight to five percent. The researcher concluded that the school education programme improved personal hygiene and reduced related morbidities29.

An experimental study was conducted to assess the effectiveness of school based health education on the practice of personal hygiene by children in primary schools in Nigeria. 395 and 398 preschool children were selected randomly as intervention group and control group. Less than 45 percent were rated clean before health education in both groups. After health education 65 percent were rated clean. There was no change in the control group. The study concluded that school based health education improved the personal hygienic practices of the preschool children. There is need for regular reinforcement to sustain the gains30.

A pre-test – post-test study was conducted in Mangalore on effectiveness of planned teaching programme on personal hygiene among school children of six to twelve years. The sample comprised 50 school children. Data was collected using a closed-ended questionnaire on various areas such as care of skin, teeth hair, hands, and feet. The mean percent of total knowledge score of pre-test was 49.45% with meanSD (19.74±2.877) and mean post-test score was 79.9% with meanSD (31.96±2.303). The researcher concluded that health education would definitely improve the health status of school children31.

A descriptive study was conducted to assess the awareness of hygienic practices among children in Government School in Hyderabad. 30 preschool children were selected non randomly. The data was collected by structured interview. Findings revealed that majority of children had moderately adequate awareness (70%). According to age wise analysis of data 62.5% of 5 year old children and 12.5% of 4 year old children had moderately adequate awareness. 47.7% of 3 year old children had inadequate awareness. The study concluded that regular education has to be given to preschool children regarding hygienic practices32.