|Year : 2021 | Volume
| Issue : 2 | Page : 68-72
Assessment of personal hygiene and morbidity pattern among primary schoolchildren in a rural coal-field area of West Bengal, India
Baisakhi Maji1, Sumana Samanta2
1 Community Medicine, ID and BG Hospital, Kolkata, West Bengal, India
2 Department of Community Medicine, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
|Date of Submission||29-Oct-2020|
|Date of Acceptance||01-May-2021|
|Date of Web Publication||18-Aug-2021|
Department of Community Medicine, Heritage Institute of Medical Sciences, NTS Hostel, NH-2, Varanasi - 221 311, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Foundations of lifelong responsibility for maintenance of good health are laid down in childhood. School is the best place where information regarding hygiene, environment, and sanitation, as well as social customs, should be conveyed. Materials and Methods: Community-based cross-sectional study was conducted in August–September 2017 at the rural coal-field area of Raniganj in Paschim Burdwan district of West Bengal, India. One government undertaken Bengali medium primary school was selected by SRS among 45 primary schools in Raniganj block area. After complete enumeration, the sample size became 106. Data were collected by interview of parents and children as well as observation of personal hygiene among children. A predesigned, pretested, and structured interviewer-administered questionnaire was used. The questionnaire consisted of sociodemographic information, illness during last 15 days, assessment of nutritional status according to the WHO grades of malnutrition based on BMI, and different indicators of personal hygiene. Data were entered into Microsoft (MS) Excel spread-sheet and analysis was done with the help of statistical software SPSS 20.0 version. Results: About 29% of students suffered from common health morbidities in preceding 15 days. Children who suffered from morbidity had less hygiene score than who had no morbidity and this difference was statistically significant. Hygiene score was significantly associated with WHO grade of malnutrition. Binary logistic regression showed that mother's education, hygiene score, and class were significantly related to the presence of morbidity. Conclusion: Majority of the childhood illnesses are preventable by promotion of hygienic practices among schoolchildren through proper health education of their parents and teachers.
Keywords: Pattern of morbidity, personal hygiene, primary schoolchildren
|How to cite this article:|
Maji B, Samanta S. Assessment of personal hygiene and morbidity pattern among primary schoolchildren in a rural coal-field area of West Bengal, India. J Sci Soc 2021;48:68-72
|How to cite this URL:|
Maji B, Samanta S. Assessment of personal hygiene and morbidity pattern among primary schoolchildren in a rural coal-field area of West Bengal, India. J Sci Soc [serial online] 2021 [cited 2021 Nov 30];48:68-72. Available from: https://www.jscisociety.com/text.asp?2021/48/2/68/324070
| Introduction|| |
The foundations of lifelong responsibility for the maintenance of good health and personal hygiene are laid down in childhood. Good habits can be better inculcated during the formative years of life. The teachers and school play a pivotal role when the process of primordial prevention is concerned. Children in their primary schooling age can learn specific health-promoting behaviors, even if they do not fully understand the connections between illness and behavior. School is the best place where health education regarding important aspects of hygiene, environment, and sanitation, as well as social customs, is being imparted.
The increased burden of communicable diseases among schoolchildren due to poor personal hygiene practices and inadequate sanitary conditions remains a major public health concern in developing countries. Studies have shown that improved awareness and hand hygiene practices among children have effectively reduced gastrointestinal and respiratory tract infections by up to 50% of the leading causes of childhood morbidity and mortality, also help in fewer sick days and absenteeism in school and achieve higher grades.
Poor health among schoolchildren is resulted from the lack of awareness of the health benefits of personal hygiene. Diarrheal diseases, skin diseases, worm infestations, and dental diseases are most commonly associated with poor personal hygiene. Infection and malnutrition form a vicious circle and hamper children's physical development and cognitive performance, which compromise children's attendance and performance at school. Majority of the childhood diseases can be preventable by promotion of hygienic practices at school and home through proper health education.
UNICEF's Strategy for WASH aims to advance children's rights. They need WASH – water, sanitation, and hygiene – to survive and thrive. This is true in times of stability and crisis, in urban and rural communities, and in every country around the world. WASH is also necessary for health, nutrition, education, and other outcomes for children. Sustainable Development Goal 6 also targeted universal, sustainable, equitable access to safe drinking water, sanitation and hygiene, and the elimination of open defecation by 2030. Poor WASH is the main cause of fecally transmitted infections, including cholera and diarrheal disease, which remains the second leading cause of morbidity and mortality among under-five children. Poor WASH is also strongly associated with malaria, polio, and neglected tropical diseases such as guinea worm, schistosomiasis, helminths, and trachoma that have a debilitating effect on children and their families.
In 2004, the Government of India has started a Total Sanitation Campaign to ensure “School Sanitation and Hygiene Education” which emphasizes skill-based child-to-child hygiene education for behavior change among schoolgoing children.
In coal-field area, people's life is very hard as they work long hours for low wages. If both the parents are working, then it is very obvious that children are getting neglected in early life. Hence, maintenance of adequate personal hygiene is very difficult in those children. With this backdrop, the present study was conducted among primary schoolchildren in a rural coal-field area of Raniganj, West Bengal, with the aim to assess the practice of personal hygiene as well to find out the determinants of the presence of morbidity among them.
| Materials and Methods|| |
A community-based cross-sectional study was conducted at the rural coal-field area of Raniganj in Paschim Burdwan district of West Bengal. One government undertaken Bengali medium primary school was selected by SRS among the total of 45 primary schools in Raniganj block area. Data were collected from August 2015 to September 2015. All children in Grades I to IV from the selected primary school were the study population. The students from each grade who were absent on the specific day of the study were excluded. After complete enumeration, the sample size became 106. The students varied in age from 5 to 12 years old. Data were collected by interview of the parents and children as well as observation of personal hygiene among children. A predesigned, pretested, and structured interviewer-administered questionnaire was used. Hygiene practice was assessed by a Likert scale, which was based on Global School Health Survey Questionnaire and contained 14 questions. Each question had three options, i.e. never, sometimes, and always. During the analysis, scores were given such as never – 0, sometimes – 1, and always – 2. Hence, the minimum score of the scale could be 0 and maximum could be 28. Before starting the study, pretesting of the questionnaire was done in a different school situated in the same locality and accordingly necessary modifications were made.
Permission was obtained from the school authority after explaining the purpose of the study and the parents were informed beforehand to attend the interview. The selected school was visited on a pre-assigned day of each week and one grade was covered every week. The school was a co-education school. The students and parents were given a brief introduction about the survey and explained the method of giving responses. Verbal informed consent was obtained beforehand and anonymity was maintained. The questionnaire consisted of sociodemographic information, for example, age, grade, gender, religion, education and occupation of parents, practice of personal hygiene, any illness during last 15 days, and assessment of nutritional status according to the WHO grades of malnutrition based on BMI. The questionnaire covered different indicators of personal hygiene, i.e., brushing teeth, washing mouth after eating, washing hands before eating, washing hands after visiting toilet, taking bath daily, combing hair, trimming nails, wearing shoes, and wearing clean clothes, etc., Each student was observed thoroughly to assess their status of personal hygiene, i.e., cleanliness of clothes, cleanliness of teeth, condition (clean and trimmed) of fingernails and toenails, condition (clean and combed) of hair, presence of shoes, etc.
Data were entered into Microsoft (MS) Excel spreadsheet. Analysis was done with the help of MS Excel and statistical software SPSS 20.0 version (IBM SPSS 20.0 (Armonk, New York, United States)). Mean, standard deviation, (SD) and proportion were calculated for the description of hygienic practices and pattern of morbidity. Bivariate analysis like Chi-square, t-test, ANOVA test were used to find out the relationship of hygiene score with morbidity and WHO grades of malnutrition as well as the relation between morbidity and different baseline characteristics. In these statistical tests, P ≤ 0.05 with a 95% confidence interval was considered significant. Multivariate analysis was done using binary logistic regression to find out the inter-relationship of different variables as well as to assess the determinants of presence of morbidity, while adjustment was done for all the possible confounders. The baseline characteristics which were significantly associated with morbidity in bivariate analysis were taken into consideration for logistic regression.
| Results|| |
The average age of the study participants was 7.4 ± 1.74 years (mean ± SD). All of the students belonged to the Hindu religion. Almost half of the participants were female. Almost 74% of children belong to SC and ST category. Regarding the literacy status of the parents, we found that 64% of mothers and 9.4% of fathers were illiterate. About 68% of fathers and 36% of mothers of the children were laborer by occupation.
About 93% of students brushed their teeth once/day; for brushing, 71% used toothbrush and 88% used toothpaste. Half of the students reported of washing their mouth after eating [Table 1]. Chewable tobacco product was used by 6.6% of the students. Majority (87.7%) of the students had daily bathing habit, but 77.3% used soap only once in a week [Table 1]. Almost 59% of students had a habit of open-air defecation. About 29% of the students reportedly suffered from common health morbidities in the preceding 15 days [Table 2]. Children who suffered from any type of morbidity had less hygiene score than who had no morbidity in the last 15 days and this difference was statistically significant [Table 3]. Again, the hygiene score was significantly associated with the WHO grade of malnutrition [Table 3]. In post hoc test, it was found that mean hygiene score was significantly different between the children having normal and severe thinness grade but not so between thinness and severe thinness grade. Regarding the baseline characteristics, it was found that class, gender, caste, mother's education, and occupation were significantly associated with the presence of morbidity [Table 4]. Finally, binary logistic regression showed that the mother's education, hygiene score, and class were significantly related to the presence of morbidity while considering the effect of confounders. If the mother is illiterate, then the chance of presence of morbidity was 2.18 times more. If the hygiene score is ≤75%, then the chance of presence of morbidity was 4.06 times more. Class III and IV children had a 2.09 times more chance of presence of morbidity than the Class I and II children [Table 5].
|Table 1: Distribution of the study subjects according to practice of personal hygiene (n=106)|
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|Table 2: Distribution of children according to morbidities encountered in last 15 days (n=106)|
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|Table 3: Distribution of students according to various attributes and hygiene score (n=106)|
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|Table 4: Distribution of students according to various attributes and presence of morbidity in last 15 days (n=106)|
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|Table 5: Binary logistic regression showing association between different factors and presence of morbidity among the primary schoolchildren|
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| Discussion|| |
In the present study, we found that almost half of the participants were female. Mehta et al. also found similar results at Mumbai (48.5% were female). Overall, 93.4% of students brushed their teeth once per day; well in resonance to the present study, Ansari and Warbhe, Suresh and Kavitha (2013) Mohammed, and Seenivasan et al. reported daily brushing of teeth in 100%,,,, whereas Punita and Sivaprakasam (2011) reported 92.6% brushed once in a day. In our study, 70.8% of children used toothbrush for brushing their teeth; 87.7% used toothpaste. Mehta et al. found bit higher proportion, 94.7% of participants used a toothbrush and toothpaste, while 1.8% used “manjan” for brushing teeth, whereas the study of Punita and Sivaprakasam showed a lower proportion, 62.96% brushed their teeth with brushes; 55.6% used toothpaste, while the rest used twigs “datum” in combination with chalk powder, charcoal, or sand. In the present study, 95.3% of participants cleaned their tongue regularly, Mehta et al. found that proportion was 75%.
Washing hands was practiced before eating by 75.5% and after defecation by 50% of students in the present study, whereas Sarkar found that 84.6% of students washed hand before eating and 94.2% washed hands after defecation. Regarding handwashing after toilet, Priyanka et al. reported only 18.1%, but other authors such as Ansari and Warbhe, Suresh and Kavitha (2013), and Seenivasan et al., Pati et al. reported 98%, 81%, 66%, and 91.6%, respectively.
Majority (87.7%) of the students had daily bathing habit, but 77.3% used soap only once in a week. Similar observations were made by Ghose et al., Ansari and Warbhe, Mohammed, and Seenivasan et al. who reported 75.9%, 81%, 100%, and 100% every day bath, respectively.,,, However, Sarkar found that in a slum of Kolkata, less proportion of children (42.31%) had a daily bathing habit.
Overall, 29.2% of the students reportedly suffered from common health morbidities in the preceding 15 days. Among them, 2.8% suffered from diarrheal episodes, 2.8% fever with cough and cold, 12.3% from skin-related morbidities, 8.5% from dental carries, 1.9% from ear infection, and 0.9% from eye infection. This finding was quite different from the findings of Sarkar where 74.04% were suffering from one or more morbidities related to poor personal hygiene, most commonly diarrhea (56.73%), followed by fever with or without cough/cold (54.81%), passage of worms in stool (45.19%), head lice (40.38%), scabies (39.42%), dental caries (9.62%), and multiple boils (7.69%).
Morbidity pattern of the children was assessed by history only. No attempt was made to perform clinical examination or any invasive laboratory investigations. Due to resource constraints the study was conducted in one school only. Future studies involving a large number of schools are needed to generalize the findings in coal-field area of rural West Bengal.
| Conclusion|| |
Majority of the childhood illnesses are preventable by promotion of hygienic practices among schoolchildren through proper health education of their parents and teachers. Literacy status of the population should be increased by intensive efforts. The government of India has started “Sarbasiksha Abhijan,” but educational reforms still need to focus extensively on education and providing financial support for the children of lower socioeconomic strata. Literacy status of the adult population should be increased by adopting “National Adult Education Programme.” Special emphasis should be placed on the education of women, Scheduled Castes and Scheduled Tribes, and other weaker sections of society, who comprise the bulk of illiterate population in India. Finally, more research is needed for the development of new strategies and maintenance of personal hygiene, which is of great importance to decrease the burden of communicable diseases in developing countries like India.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]