personal hygiene , knowledge attitude and practice of secondary school students in ikeja
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CHAPTER ONE
INTRODUCTION
Hygiene is the science of preserving and promoting the health of both the individual and the
community. It has many aspects: personal hygiene (proper living habits, cleanliness of body
and clothing, healthful diet, a balanced regimen of rest and exercise); domestic hygiene
(sanitary preparation of food, cleanliness, and ventilation of the home); public hygiene
(supervision of water and food supply, containment of communicable disease, disposal of
garbage and sewage, control of air and water pollution); industrial hygiene (measures that
minimize occupational disease and accident); and mental hygiene (recognition of mental
and emotional factors in healthful living). The World Health Organization promotes hygienic
practices on an international level [1].
As stated in the above definition, it will be observed that personal hygiene is a composite
subject, consisting of important sub units. Of these sub units ,hand hygiene which
constitutes a part of cleanliness of body forms a major part due to the fact that most of the
diseases which result in diarrhoea are spread by pathogens found in human excreta . The
faecal-oral mechanism, in which some of the faeces of an infected individual are transmitted
to the mouth of a new host through one of a variety of routes, is by far the most significant
transmission mechanism: it accounts for most diarrhoea and a large proportion of intestinal
worm infections. This mechanism works through a variety of routes, vis fingers, fluids,
surfaces, hand held objects e.t.c[2].
Hygiene in the earliest sense was not connected to cleanliness [3]. Indeed popular attitudes
in Western Europe and the US held that frequent bathing was dangerous to individual
health. It upset the physical system, robbed the body of precious natural oils, and led to
debilitating illness. Though individuals such as Benjamin Franklin urged cleanliness as a
necessary component of healthful living, the plumbing technology required to make this
easy was underdeveloped and expensive. Travellers in Europe and the US during the early
nineteenth century frequently commented on the filthy conditions both of persons and
households. One historian has suggested that, in a largely agricultural community, the dirt
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of honest labour was associated with both economic and physical well-being, an outlook
that applied to both peasant cultures in Europe and yeoman farm life in the US.
Beginning in the early nineteenth century, the repeated onslaught of diseases such as
cholera began to alter people's understanding of personal hygiene. Since orthodox medicine
seemed powerless in response to these pandemics, a variety of alternative medicines gained
popularity. Many of these alternatives emphasized disease prevention through healthful
living, which included diet and clothing reform, daily cold water bathing, exercise, regulation
of bowel movements, and abstinence from coffee, tea, alcohol, and sex. In their attack on
heroic medicine, reformers emphasized personal and domestic responses to health crises.
For these reformers, living hygienically was essential both because it led to physical well-
being, and because it revealed proper moral character. Florence Nightingale, in her efforts
to reform English hospital care, provided the most cogent arguments linking personal and
public hygiene with good health and morals. Like many of her contemporaries, Nightingale
believed that unhealthy living made individuals susceptible to contagion [3].
1.1 JUSTIFICTION OF THE STUDY
WHO data on the burden of disease shows that “approximately3.1% of deaths (1.7 million)
and 3.7% of disability-adjusted-life-years (DALYs) (54.2 million) worldwide are attributable
to unsafe water, sanitation and hygiene.” In Africa and developing countries in South East
Asia 4 –8% of all disease burdens is attributable to these factors. Over 99.8% of all the
deaths attributable to these factors occur in developing countries and 90% are deaths of
children [4].
Therefore, this study is justifiable by the fact that personal hygiene is indeed a pressing
problem and requires a lot of input as regards studies research and finances towards
reducing the effects of improper hygiene and raising the standard of living especially in sub-
Saharan Africa. Also, special attention being payed to secondary school students is due to
the fact that majority of the ill consequence do affect this age group as cited in the
preceding paragraph.
1.2 AIM OF THE STUDY
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The aim of this study is to contribute to the information already gathered on the subject
matter with the view to help in solving the menace and indeed improving the health
standard especially in sub-Saharan Africa.
1.3 OBJECTIVES OF THE STUDY
The objectives of the study will be to:
(1).To determine the level of knowledge of secondary school students to personal hygiene
especially hand washing.
(2).To assess the attitude of secondary school students to personal hygiene especially hand
washing.
(3).To assess the practice of secondary school students towards personal hygiene especially
hand washing.
`
CHAPTER 2
3
LITERATURE REVIEW
2.1. DEFINITION OF HYGIENE
Hygiene is the science of preserving and promoting the health of both the individual and the
community. In medicine, hygiene practices are employed to reduce the incidence and
spreading of disease. Other uses of the term appear in phrases including: body hygiene,
domestic hygiene, dental hygiene, and occupational hygiene, used in connection with public
health.
Body 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.
Personal hygiene practices include: seeing a doctor, seeing a dentist, regular washing
(bathing or showering) of the body, regular hand washing, brushing and flossing of the
teeth, basic manicure and pedicure, feminine hygiene and healthy eating[1].
2.2. A BRIEF HISTORY OF HYGIENE
The word hygiene derives from the name of the ancient Greek goddess of healthful living,
cleanliness and sanitation Hygeia. Initially worshipped in her own right, by the fifth century
B.C.E in Athens Hygeia was instead depicted as a demi-god, the daughter or wife of the god
of healing, Asclepius. While worship of Asclepius aimed at curing disease through divine
intercession, worship of Hygeia emphasized obtaining health by living wisely in accordance
with her laws. In contemporary Western society the concept of hygiene has become
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associated with standards of personal grooming which often have little effect on individual
health [7].
Elaborate codes of hygiene can be found in several Hindu texts, such as the Manusmriti and
the Vishnu Purana. [8] Bathing is one of the five Nitya karmas (daily duties) in Sikhism, not
performing which leads to sin, according to some scriptures. These codes were based on the
notion of ritual purity and were not informed by an understanding of the causes of diseases
and their means of transmission. However, some of the ritual-purity codes did improve
hygiene, from an epidemiological point of view, more or less by accident.
Regular bathing was a hallmark of Roman civilization.[9] Elaborate baths were constructed in
urban areas to serve the public, who typically demanded the infrastructure to maintain
personal cleanliness. The complexes usually consisted of large, swimming pool-like baths,
smaller cold and hot pools, saunas, and spa-like facilities where individuals could be
depilated, oiled, and massaged. Water was constantly changed by an aqueduct-fed flow.
Bathing outside of urban centres involved smaller, less elaborate bathing facilities, or simply
the use of clean bodies of water. Roman cities also had large sewers, such as Rome's Cloaca
Maxima, into which public and private latrines drained [10].
Since the 7th century, Islam has always placed a strong emphasis on hygiene. Other than the
need to be ritually clean in time for the daily prayer (Arabic: Salat) through Wudu and Ghusl,
there are a large number of other hygiene-related rules governing the lives of Muslims.
Other issues include the Islamic dietary laws. In general, the Qur'an advises Muslims to
uphold high standards of physical hygiene and to be ritually clean whenever possible [11].
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Contrary to popular belief[12] and although the Early Christian leaders condemned bathing as
unspiritual,[13] bathing and sanitation were not lost in Europe with the collapse of the Roman
Empire.[14]15] Soap making first became an established trade during the so-called "Dark
Ages". The Romans used scented oils (mostly from Egypt), among other alternatives.
Bathing did not fall out of fashion in Europe until shortly after the Renaissance, replaced by
the heavy use of sweat-bathing and perfume, as it was thought in Europe that water could
carry disease into the body through the skin. (Water, in fact, does carry disease, but more
often if it is drunk than if one bathes in it; and water only carries disease if it is
contaminated by pathogens.) Medieval church authorities believed that public bathing
created an environment open to immorality and disease. Roman Catholic Church officials
even banned public bathing in an unsuccessful effort to halt syphilis epidemics from
sweeping Europe.[16] Modern sanitation was not widely adopted until the 19th and 20th
centuries. According to medieval historian Lynn Thorndike, people in Medieval Europe
probably bathed more than people did in the 19th century.[17]
Until the late 19th Century, only the elite in Western cities typically possessed indoor
facilities for relieving bodily functions. The poorer majority used communal facilities built
above cesspools in backyards and courtyards. This changed after Dr. John Snow discovered
that cholera was transmitted by the faecal contamination of water. Though it took decades
for his findings to gain wide acceptance, governments and sanitary reformers were
eventually convinced of the health benefits of using sewers to keep human waste from
contaminating water. This encouraged the widespread adoption of both the flush toilet and
the moral imperative that bathrooms should be indoors and as private as possible.[18]
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Throughout the times, there has been a strong connection between hygiene and religion as
most religions viewed sin as “uncleanliness“, thus the development of maxims such as:
cleanliness is next to Godliness e.t.c[19]. It was widely held that to be a good Christian one
needed to be cleanly in both body and habits, for ‘all the teaching of the Bible is in favour of
cleanliness and purity’. One pamphlet even went as far as to claim that ‘attention to
cleanliness is a duty of the very highest obligation, the neglect of which is attended with the
most pernicious consequences; and therefore, a strict regard to it is urged most strenuously
upon all’ [20]. The inference here was that the ‘pernicious consequences’ of neglecting their
‘very highest obligation’[21] may not only have been illness but even possibly eternal
damnation, for only the most foolish would dare to ‘neglect and degrade the temple of the
Holy Spirit’[22].
2.3. COMPONENTS OF PERSONAL HYGIENE
Body Hygiene
Oral Hygiene
Hand Hygiene
Personal Hygiene for adolescent male
Personal Hygiene for adolescent female
Personal Grooming
Travelling Hygiene
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2.3.1. BODY HYGIENE
Body 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 [23].
Body hygiene is achieved by using personal body hygiene products including: soap, hair
shampoo, hair conditioner, cotton swabs, deodorant, chap stick, cream, lotion, facial tissue,
hair clippers, nail clippers, nail files, skin cleansers, razors, shaving cream, skin cream and
toilet paper. Other personal body hygiene and grooming products can be used to improve
health and well being.
2.3.1.1. CARE OF THE BODY
Care of the body as practised varies from one area to another depending on various factors
such as culture, climate, availability of water and/or other personal hygiene products
moreover, care of the body is a wide term which encompasses the following :
Care of the skin
Care of the hair
2.3.1.2 CARE OF THE SKIN
A brief mention of the structure and physiology of the skin is imperative to fully understand
the subject matter. The skin is the largest organ in the body and usually the first barrier to
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foreign bodies trying to gain entrance to the human system [24] , hence it’s care cannot be
overemphasised.
The primary function of the skin is to reduce water loss, provide protection against abrasive
action and microorganisms, and act as a permeability barrier to the environment. The basic
structure of skin includes, from outer- to innermost layer, the superficial region (i.e., the
stratum corneum or horny layer, which is 10- to 20-μm thick), the viable epidermis (50- to
100-μm thick), the dermis (1- to 2-mm thick), and the hypodermis (1- to 2-mm thick). The
barrier to percutaneous absorption lies within the stratum corneum, the thinnest and
smallest compartment of the skin[25]. The intercellular region of the stratum corneum is
composed of lipid . The intercellular lipid is required for a competent skin barrier and forms
the only continuous domain. Directly under the stratum corneum is a stratified epidermis,
which is composed primarily of 10–20 layers of keratinizing epithelial cells that are
responsible for the synthesis of the stratum corneum. This layer also contains melanocytes
involved in skin pigmentation; Langerhans cells, which are important for antigen
presentation and immune responses; and Merkel cells, whose precise role in sensory
reception has yet to be fully delineated.
The skin is a dynamic structure. Barrier function does not simply arise from the dying,
degeneration, and compaction of the underlying epidermis. Rather, the processes of
cornification and desquamation are intimately linked; synthesis of the stratum corneum
occurs at the same rate as loss. Substantial evidence now confirms that the formation of the
skin barrier is under homeostatic control, which is illustrated by the epidermal response to
barrier perturbation by skin stripping or solvent extraction [25]. Circumstantial evidence
indicates that the rate of keratinocyte proliferation directly influences the integrity of the
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skin barrier. A general increase in the rate of proliferation results in a decrease in the time
available for uptake of nutrients (e.g., essential fatty acids), protein and lipid synthesis, and
processing of the precursor molecules required for skin-barrier function. Whether chronic
but quantitatively smaller increases in rate of epidermal proliferation also lead to changes in
skin-barrier function remains unclear. Thus, the extent to which the decreased barrier
function caused by irritants is caused by an increased epidermal proliferation also is
unknown.
The current understanding of the formation of the stratum corneum has come from studies
of the epidermal responses to perturbation of the skin barrier. Experimental manipulations
that disrupt the skin barrier include extraction of skin lipids with apolar solvents, physical
stripping of the stratum corneum using adhesive tape, and chemically induced irritation. All
of these experimental manipulations lead to a decreased skin barrier as determined by
transepidermal water loss (TEWL). The most studied experimental system is the treatment
of mouse skin with acetone. This experiment results in a marked and immediate increase in
TEWL, and therefore a decrease in skin-barrier function. Acetone treatment selectively
removes glycerolipids and sterols from the skin, which indicates that these lipids are
necessary, though perhaps not sufficient in themselves, for barrier function. Detergents act
like acetone on the intercellular lipid domain. The return to normal barrier function is
biphasic: 50%–60% of barrier recovery typically occurs within 6 hours, but complete
normalization of barrier function requires 5–6 days [26].
The importance of the above information is most illuminating when considering the care of
the skin. It is no lame fact therefore that the most important factor in ensuring the health of
the skin is adequate nutrition, as this provides the skin with the necessary amino acids
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essential for the build up of the constituent cells which make up the skin as a whole. It also
provides the skin with the necessary lipids essential for maintaining the intercellular matrix
which bestows the skin with a good proportion of its protective function.
Also, adequate action as regards the desquamation of the skin and aiding the sloughing off
of dead cells is necessary. This can be achieved by taking a bath or shower once daily is very
important to ensuring your body stays clean. Cleaning your body is also important to ensure
your skin rejuvenates itself, as the scrubbing of your arms, legs, and torso will slough off
dead, dry skin and help your skin stay healthy and refreshed[27] . Dermatologists recommend
that a person wash the face two times a day with a mild soap or gentle cleanser. It is best to
avoid washing too often, as the skin will become irritated and dry out. If too much of the
skin's natural oil is washed away, the skin may become very dry and begin to itch and flake.
Because the skin's natural process is interrupted, the skin may begin to produce more oil
than usual, which can cause more breakouts [27]. Dermatologists also recommend the
following for clean, healthy skin:
Use lotions only if needed, and use ones that are oil-free and water-based.
Try to identify what irritates the skin; if it's stress, try to reduce stress levels.
Leave pimples alone; picking, popping, or squeezing them will only make them
worse.
Have only a dermatologist remove or extract pimples.
Try to avoid touching the face [28].
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In washing the body, special attention needs to be paid to certain parts of the body because
they are prone to bacterial infections due to increased sweat production in those regions
because of a high concentration of apocrine sweat glands for example the armpit regions or
the face and back regions due to the incidence of acne common in adolescents [28].
2.3.1.3 CARE OF THE HAIR
Just like skin, hair covers and protects the body. Hair is made up of tubes of keratin. Keratin
is a tough protein produced by the body. Hair grows from roots in the skin, which are called
follicles. Unlike the skin, which is a living organism, by the time a hair grows out of the
follicle, it is already "dead." At the bottom of the follicle is the sebaceous gland. There,
sebum, an oily substance that lubricates the hair shaft, is made.
Scalp Hair: The Hair on Your Head
Hair comes in a variety of types. Whether hair is curly, wavy, or straight depends upon the
shape of the hair follicle. A flat follicle yields wavy hair while a round follicle produces
straight hair. Very curly hair comes from oval-shaped follicles. As there are different types of
hair, there are also different colours and different textures—thick or thin. Whatever kind of
hair a person has, it is important that it be kept clean. This will help it look and smell good
and prevent the development of scalp problems.
The hair on the head (and the scalp, for that matter) can be dry, oily, or normal, which is a
combination of the two. These categories refer to the amount of sebum that accumulates
on the scalp. Sebum gets distributed through the hair by combing, brushing, or touching the
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hair. When sebum accumulates at a normal level, it acts as a built-in conditioning system for
the hair, keeping it soft and shiny.
The amount of sebum a person produces varies throughout his or her life. With puberty,
there is a marked increase in sebum production between the ages of eleven and fifteen.
From eighteen to twenty-four years of age, there isn't as much sebum being produced, and
by age fifty, there is a dramatic drop-off in sebum production, which causes hair to look
duller and rougher.
Most people have normal hair, which means it's neither too dry nor too oily. Those with dry
hair often have chemically treated (coloured, permed, or straightened) or coarse hair. While
people of all ages can have oily hair, teens often have oily hair because of the increase in
sebum that puberty causes. Washing of Hair is important to keep the hair clean and
conditioned to ensure it stays healthy and strong. Washing of the hair at least every other
day is important to keeping the hair healthy and in good shape. If the hair is washed too
frequently, it becomes brittle and dry, making it difficult to grow and keep strong. If it is
washed too infrequently, it will become greasy and will also stunt its growth. Washing of the
hair too frequently also strips it of necessary nutrients required to keep it strong and
healthy.
Cutting of Hair: Getting a hair cut frequently is critical to healthy hair. The longer one waits
to get hair cut, the frailer and brittle the hair can become, especially if it is longer. The
length of your hair will determine how often you get your hair cut. Grooming hair often
using a brush, comb, or pick is important as it helps distribute sebum through the hair. This
will help hair look shinier and smoother. It will also prevent knots and tangles, both of which
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can lead to hair breaking or splitting [29]. There are shampoos available for all hair types. How
often a person shampoos varies and depends upon that individual's hair type. A person with
dry or extremely curly hair may shampoo less often than an individual with oily or straight
hair. The key to good hair hygiene is shampooing often enough to keep hair looking and
smelling clean.
Conditioners can help keep hair shiny and smooth. They also offer protection against the
drying effects of styling hair with heat or using styling products that contain alcohol, which
can be drying too. Just as with shampooing, how often and how much conditioner a person
uses will depend on hair type and styling habits. An individual with coarse, curly hair that
must be straightened with a blow-dryer each day should protect hair with a good amount of
conditioner; someone with limp, oily hair may opt not to use conditioner at all [29].
2.3.2 ORAL HYGIENE
Oral hygiene simply refers to care of the mouth and teeth. It is important not only because it
improves social acceptability but more importantly as a safe guard to health. This can be
achieved by the following.
Going to the Dentist: The mouth is the area of the body most prone to collecting harmful
bacteria and generating infections. In order to have and maintain good oral hygiene, it is
critical to visit a dentist at least every six months. In some cases, dentist may recommend
every four months, depending on how much plaque builds up on your teeth and how often
you need to have it removed. To keep teeth free from tartar build-up and tooth decay,
constant visits to a dentist as frequently as he or she recommends is extremely important.
14
Brushing Your Teeth: For best results, it is compulsory to brush ones teeth at least two
times per day, if not after every meal. This will help minimize the amount of bacteria in your
mouth which leads to tooth decay [30].
Flossing Your Teeth: In addition to regular brushing, it is critical to floss your teeth at least
once a day, usually before you go to bed. This will enable you to reduce plaque in the more
difficult to reach places—between teeth and at the back of your molars. Flossing also keeps
gums healthy and strong, and will help protect your mouth from a variety of diseases [30].
2.3.3 HAND HYGIENE
The hand is important in adolescents especially secondary school students because when
not properly taken care of, can serve as a medium of transfer of harmful micro organisms
not just to the individual, but also from one individual to another.
A number of infectious diseases can be spread from one person to another by contaminated
hands, particularly gastro-intestinal infections and hepatitis A. Proper hand hygiene can help
prevent the spread of these organisms. Some forms of gastro-enteritis can cause serious
complications, especially for young children, the elderly or those with a weakened immune
system. Drying of hands properly is as important as washing them [31].
Many diseases/conditions can be prevented and/or controlled through proper personal
hygiene by:
Washing hands with soap and clean, running water (if available):
o Before and after preparing food
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o Before and after eating food
o After using the toilet
o After changing diapers and cleaning children
o During times of illness
o After handling an animal or animal waste
o After handling garbage [31]
To wash hands properly:
Wet your hands with warm water (hot water can dry out your skin).
Apply one dose of liquid soap and lather well for 15-20 seconds (or longer if the dirt
is ingrained).
Rub hands together rapidly across all surfaces of your hands and wrists to help
remove dirt and germs.
Don’t forget the backs of your hands, your wrists, between your fingers and under
your fingernails.
Wash your hands for at least 10 seconds.
Rinse well under running water and make sure all traces of soap are removed, as
residues may cause irritation.
16
Pat your hands dry using paper towels (or single use cloth towels). Make sure your
hands are thoroughly dry.
Dry under any rings you wear, as they can be a source of future contamination if
they remain moist. If possible, remove rings and watches before you wash your
hands.
Hot air driers can be used but, again, you should ensure your hands are thoroughly
dry.
At home, give each family member their own towel and wash them often [32].
Proper care of the hands also entail cutting of the nails. Cutting of the nails regularly reduces
risk of ingesting harmful bacteria which may be hidden under the nails, reduces risk of
injuries to self or individuals in close contact and also improves the general outlook of the
individual. The cuticle protects the integrity of the nail by "guarding" the cells that
manufacture keratin, which forms the nail. If a cuticle is trimmed and becomes infected or if
a cuticle is trimmed to expose a sensitive area of the nail, future growth of that nail could be
compromised. Many doctors and manicurists now advise their clients not to cut their
cuticles at all [33].
2.3.4 PERSONAL HYGIENE FOR THE ADOLESCENT MALE
The pubertal male will experience some changes as a result of the flux of hormones which
occur at that time of development. Some of these changes, if not taken into proper
consideration could pose a threat to the health or comfort of the adolescent.
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Sweating is a vital and normal process. When people sweat or perspire, the moisture
combines with bacteria to create an odour. The apocrine glands, located primarily under the
arms and in the genital area become active at the onset of puberty. When these glands are
stimulated, they produce perspiration. When the sweat comes in contact with bacteria on
the skin the result is body odour. This odour is often unpleasant and increases with physical
activity, stress, excitement, nervousness and warmth. More perspiration means a different
type of body odour, one that is stronger and similar to an adult's. Daily bathing and
showering are enough to control body odour, but many people go above and beyond just
washing and use different types of hygiene products that will keep the body smelling and
feeling fresh[27] .
Acne affects about 80% of adolescents. It is not caused by uncleanliness and food probably
only plays a minor role. Increased hormone levels stimulate the oil glands in the skin. These
glands produce a substance that can block the pores and the result is blackheads and
pimples. Blackheads and pimples should never be picked at or squeezed as this can result in
permanent scarring. Almost all cases of acne can be treated successfully. The treatment for
acne is:
• Gently wash involved areas with a non-oiled soap and a face cloth, twice a day;
• avoid moisturizers;
• Over-the-counter medications that contain benzoyl peroxide can be used in mild cases;
• See a dermatologist if acne is severe and does not respond to normal treatment. [27][30]
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Hair: especially facial hair , depending on factors such as culture or religion may be expected
to be cut clean or kept, but irrespective, facial hair and indeed scalp and body hair is
expected to be washed and kept neat[29] .
Genitals: It is necessary for boys to pay attention to the health of their genital area.
However, like girls, boys contend with societal pressures to not talk about their genitals.
They are often embarrassed to speak to anyone about any problems or questions they may
have about their genitals. It is important for both boys and girls to learn about their genitals,
ask questions, and practice good hygiene in order to maintain health. Boys should wash
their genitals every day. This includes washing the penis, the scrotum which holds the
testicles, the anus, and pubic hair (if puberty has been reached) with water and mild soap.
For cleanliness after urinating, the penis should be shaken gently until the few remaining
drops of urine are expelled. It may be wiped as well. Following a bowel movement, the anus
should be wiped. Covering public toilet seats with toilet paper is also recommended since
bacteria grows easily on toilet seats. Washing hands after urinating is a must, otherwise,
bacteria will be spread via the hands.
As well as washing and wiping the genitals, boys should be concerned with the kind of
underwear and pants they wear. Underwear or pants should not be too tight, and they
should be well ventilated to help stem bacteria growth. If underwear gets wet or soiled, it
should be changed. Also, towels should not be shared since they can pass bacteria. If a boy
is uncircumcised, the foreskin should be pulled down daily to expose the tip of the penis,
which should then be washed with mild soap and water. However, do not force the foreskin
down at any time. If it is painful to pull the foreskin down (and the foreskin has already
detached itself from the glans), contact a physician for advice and possible treatment [33] .
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Pulling down the foreskin and washing the area daily is important because the area under
the foreskin is not well ventilated. Dead skin and an oil-like substance (called sebum, which
usually doesn't appear until puberty) can accumulate under the foreskin forming a
substance called smegma. This substance is a natural lubricant between the foreskin and the
glans. If smegma is not washed from underneath the foreskin, it can build up and harden.
This collection can lead to infections and disease. Soft smegma that is washed away on a
regular basis poses no health risks [33].
2.3.5 PERSONAL HYGIENE FOR THE ADOLESCENT FEMALE
Females within the puberty age range also experience rapid changes that have far reaching
consequences on their health and personal well being. Issues such as body odour, acne are
common to both male and female sexes in this age range. Some of them have already been
discussed in the previous segment and hence will not be discussed again to avoid repetition.
However, females do have peculiar challenges some of which are:
Genitals: Many females have received the false message from society that their genitals are
"dirty" and that they shouldn't talk about them. Because of these messages, which can
come from media as well as parents, girls are under the impression that any smell or
discharge from their vagina is abnormal. It is perfectly natural to have a slight sweet smell
that is non offensive. A strong, foul odour indicates a possible infection. With treatment, the
infection will go away and so will the strong odour. Vaginal discharge is a necessary part of
the body's regular functioning. Normal discharge, usually clear to white, is part of the body's
self-cleaning process. As discharge leaves the body, it takes bacteria with it, which helps
keep vaginal infections at bay. An infected or abnormal vaginal discharge has the following
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characteristics: bad odour , itching or irritation, thick, like soft cheese , creamy or frothy ,
strange colour, such as green, gray, or yellow , bloody (not during menstruation)[34] .
It is important to regularly wash the genital area, including the anus, to help ward off
infections and bad odour. Since the genital area is moist and warm, bacteria can grow easily.
Excretions from the vagina, perspiration, and urine can build up making it even easier for
the bacteria to grow. These bacteria can cause urinary tract infections (UTI's) or vaginal
infections. Cleaning the genital area with a mild soap and water on a regular basis will help
control the bacteria growth and limit infections. The area that a girl should be concerned
with washing is the external genital area. The internal genitals have their own self-cleaning
processes. The external female genital area, or vulva, has large lips called labia majora that
protect the genital area. These lips have sweat glands that produce perspiration and glands
that secrete oil. If a girl has reached puberty, these lips will also have hair on them.
Beneath the labia majora are smaller lips called labia minora. In some people, the labia
minora are large enough that they poke through the labia majora. This is a normal
occurrence. The labia minora also contain oil and scent glands. Inside the labia minora are
the openings of the urethra and vagina. Urine is expelled from the urethra. The clitoris, a
small, pea-like organ that is sensitive to the touch, lies in front of the labia minora. The anus,
which is not considered part of the vulva, should be washed as well. It lies in back past the
lip region.
The external genitalia and the anus can be washed using a wash cloth or fingers. This can be
done daily in a shower or bath or standing near a sink. Special care should be taken to open
the labias and wash between them. Then rinse the area with water and towel dry. Besides
21
washing the external genital area, it is important to wipe it with toilet paper after urinating
or having a bowel movement. Solid body waste expelled by the anus contains bacteria that
can cause vaginal and urinary tract infections. Therefore, the proper wiping method is from
the front to back. This is so the bacteria from the anal area do not make their way to the
vaginal and urethral area. A person should always wash her hands after going to the
bathroom [34].
Extra Care During Menstruation
During menstruation, the lining of the uterus is shedding and menstrual blood comes out of
the vagina. While menstruation can be messy, it is easily controlled with a tampon or pad.
However, once the blood is exposed to the air, it can produce an odour. A strong odor
should not occur unless the person does not bathe often enough. To minimize odor and
staining of clothes, washing the genital area at least once a day is recommended. It is also
recommended to change a tampon every four to six hours (a pad every two to four hours),
which will help control the odor and the collection of blood. Tampons are worn inside the
vagina. Both nonvirgins and virgins can use them. Tampons cannot get lost inside the body
or be pushed up into the uterus (the canal—called the cervical canal—to the uterus is too
small for a tampon to fit through). They are made of absorbent cotton that is either scented
or unscented and have a string attached for easy removal. (The deodorant tampons may
cause irritation in some women.) Tampons are meant to be used only for menstrual flow,
not vaginal discharge. They can come with or without applicators. For greater protection,
some women wear pantiliners when they use tampons. Tampons should be changed every
four to six hours, and not worn more than eight hours. Otherwise, bacteria can build up in
the vagina, which can cause toxic shock syndrome (TSS)[35] .
22
Toxic Shock Syndrome is a rare, non-contiguous disease that can be fatal. It is caused by the
Staphylococcus aureus bacterium, which produces a toxin resulting in symptoms that
include a sudden high fever, vomiting, diarrhoea, headache, rash that looks and peels like a
sunburn, achiness, and dizziness. If a person using a tampon experiences any of these
symptoms, she should remove her tampon right away and contact her doctor [36].
Researchers have found that the risk of contracting TSS is linked to the absorbency of the
tampon. The higher the absorbency, the higher the risk for contracting TSS. To judge the
right absorbency, a woman should monitor the amount of blood found in her tampon after
she removes it. If the tampon is completely red, a person should use a tampon with a higher
absorbency; if the tampon has white areas, a person should use a tampon with a lower
absorbency. A way to lower the risk of contracting TSS is to switch between using a tampon
and using a pad. An easy way to do this is to wear tampons during the day and pads at night
[37].
2.4 INADEQUATE PERSONAL HYGIENE: DISEASES AND CONDITIONS THAT
ARISE FROM UNDER-HYGIENE
Having outlined what personal hygiene is and some of the perspective from which it might
be viewed, paying special attention to adolescents, it is now imperative to briefly outline the
consequences of improper hygiene. Schools are more than places of knowledge sharing:
they often become centres of disease transmission. Several studies highlight the potential
for inadequate hand washing and sanitation facilities in schools to contribute to the spread
of gastrointestinal infections among children. From diarrhoeal diseases, Hepatitis A to
intestinal worms, all these diseases have detrimental effects on children's cognitive and
23
educational achievement. The subsequent paragraphs will outline various conditions
according to the region in which they occur in the body.
2.4.1 HEAD AND MOUTH
HEAD LICE: Head lice are tiny insects, or skin parasites, that burrow into the scalp. They
cause itching of the scalp, which can lead to a bacterial infection because of repeated
scratching. In children, however, head lice are often barely noticeable. Head lice are spread
through personal contact and through sharing things such as combs, brushes, and hats.
Often, the lice can make their way into a person's eyebrows, eyelashes, or facial hair. Head
lice can easily turn into an epidemic (the rapid spreading of a disease to many people at the
same time) at a school because children often share personal items. The problem is
treatable by using a cream, lotion, or shampoo, all of which are available at pharmacies [38] .
DANDRUFF: Dandruff, also known as seborrheic dermatitis, is a swelling of the upper layers
of skin on the scalp. The first signs are a drying or a greasy scaling of the scalp. Often this is
accompanied by itching. Dandruff is a condition that may be inherited, and cold weather can
often make dandruff worse. Unlike head lice, dandruff is not contagious. Similarly, though, it
is treatable with shampoos or solutions that are available at pharmacies [38].
TRACHOMA: Has been associated with infrequent washing of the face
TOOTH DECAY AND CAVITIES: Plaque is the main cause of tooth decay, or cavities, and gum
disease. When people eat, especially foods containing starches and sugars, and they don't
brush their teeth right away, the plaque bacteria in their mouths make acids. These acids
24
then attack the enamel on the teeth. When this happens repeatedly, teeth will begin
decaying. Cavities accompanied by painful toothaches can develop [30].
GUM DISEASE: Another problem that plaque causes is gum disease. Gum disease, which is
also called periodontal disease, occurs when gums get infected. The first stage of gum
disease is known as gingivitis. Gingivitis is the inflammation of the gums. Over time, the
gums and the bone around the teeth can become weakened. This can cause teeth to fall
out. When this happens, it means a condition known as periodontitis is present.
Unlike tooth decay, gum disease is not as obvious as tooth decay because it is painless.
Some signs of gum disease include red, swollen, or sensitive gums, chronic bad breath, and
gums that bleed while brushing the teeth. Even though gum disease usually affects adults,
good oral hygiene as a young adult will help prevent this disease and protect the teeth [30].
BAD BREATH: Bad breath, or halitosis, can be caused by gum disease, eating certain foods
(such as garlic), or a medical disorder. Often, though, bad breath is the result of poor oral
hygiene. When bacteria build up in the mouth, it can lead to a bad taste in one's mouth and
a bad odour too. Regularly brushing the teeth as well as the tongue often helps eliminate
bad breath [30].
2.4.2 GASTROINTESTINAL SYTEM (VIA HANDS)
INFECTIOUS DIARRHOEA: (acute gastroenteritis, amoebiasis)1.8 million people die every
year from diarrhoeal diseases (including cholera); 90% are children under 5, mostly in
developing countries.88% of diarrhoeal disease is attributed to unsafe water supply,
inadequate sanitation and hygiene. Improved sanitation reduces diarrhoea morbidity by
25
37.5%. Improved water supply reduces diarrhoea morbidity by 21%. The simple act of
washing hands at critical times can reduce the number of diarrhoeal cases [39].
INTESTINAL HELMINTHS (ASCARIASIS, TRICHURIASIS, HOOKWORM DISEASE): 133 million
people suffer from high intensity intestinal helminth infections, which often leads to severe
consequences such as cognitive impairment, massive dysentery, or anaemia. These diseases
cause around 9400 deaths every year. Access to safe water and sanitation facilities and
better hygiene practice can reduce morbidity from ascariasis by 29% and hookworm by
4%.by up to 35%. Additional improvement of drinking-water quality, such as point of use
disinfection, would lead to a reduction of diarrhoea episodes of 45% [40].
Others include Hepatitis A, Typhoid fever and other forms of intestinal parasitism [40].
2.4.3 SKIN
A variety of conditions could arise or be worsened by poor personal hygiene and include
Scabies
Eczema
Acne
Fungal infections
26
Athletes foot
Body odour [28].
2.4.4. URINOGENITAL TRACT
Infections which are associated with the urinary and genital tracts could occur due to
inadequate or bad personal hygiene practices, some of them include.
Schistosomiasis
Jock itch, or groin ringworm, is a fungal infection (caused by certain fungi and yeasts)
that usually occurs in warm weather. It is caused by wearing tight clothes that are
not well ventilated. The symptoms include redness, blisters, itchiness, and pain of
the groin and upper, inner thigh area.
Yeast Infection
Body odour
Toxic shock syndrome [33][34][37]
2.4.5 RESPIRATORY TRACT
Sore throat
Influenza [41]
2.5 EFFECTS OF EXCESSIVE HYGIENE
27
Just as inadequate hygiene can cause effects detrimental to the health of the individual, so
also can excessive hygiene. Below are outlined some conditions which can arise as a result
of excessive hygiene.
Excessive body hygiene can cause allergies. The hygiene hypothesis states that a marked
lack of early childhood exposure to infectious agents, and later a lack of exposure to
helminths as adults, increases susceptibility to allergic diseases [42] .The lack of exposure to
these agents prevent the body from developing appropriate allergens and auto-immune
responses.
Excessive body hygiene of external ear canals
Excessive body hygiene of the ear canals can result in infection or irritation. The ear canals
require less body hygiene care than other parts of the body, because they are sensitive, and
the body system adequately cares for these parts. Attempts to clean the ear canals through
the removal of earwax can actually reduce ear canal cleanliness by pushing debris and other
foreign material into the ear that would otherwise have been removed by the natural
movement of ear wax from the interior to exterior of the ear [42].
Excessive hygiene of skin
Excessive hygiene of the skin can result in skin irritation. The skin has a natural layer of oil,
which protects the skin from drought. When washing, unless using aqueous creams, etc.,
with compensatory mechanisms, this layer is removed, leaving the skin unprotected. By this
mechanism, excessive washing may eventually trigger eczema [42].
28
Excessive application of soaps, creams, and ointments can also adversely affect certain of
the body's natural processes. For examples, soaps and ointments can deplete the skin of
natural protective oils, and some substances can be absorbed and, even in trace amounts,
disturb natural hormonal balances [42].
2.6. FACTORS WHICH MILITATE AGAINST ADEQUATE PERSONAL HYGIENE IN
SECONDARY SCHOOLS
1. Inadequate /poor facilities: School toilets across the world are among the least
popular places. School toilets are often dirty, highly inappropriate, and unfriendly;
they often lack essential items such as soap, anal cleansing materials and sometimes
water.
2. Inadequate water supply
3. Inadequate finances
4. Poor accessibility to hygiene promoting materials
5. Cultural influences
6. Indiscipline
7. Misplaced priorities
8. Lack of awareness and education.
CHAPTER THREE
METHODOLOGY
29
3.1 DESCRIPTION OF THE STUDY AREA
Command Day secondary School Ikeja, is co-educational secondary school established in August 1981 by the Nigerian Army Education Corps And Schools N.A.E.C.S , under the Nigerian Ministry of Defence. It is presently located close to the main entrance of the Ikeja Military Cantonment, off Mobolaji Bank Anthony road Ikeja , Lagos, haven relocated after her former site, still within the cantonment was accidentally destroyed. It is surrounded by the cantonment in which it is contained which is in turn bound on the North by Oshodi , on the South by Mobolaji Bank Anthony road, on the east by Ikeja G.R.A and on the West by Maryland .
The school was established by the Nigerian Ministry of Defence with the aim of making high standard and affordable education available to the wards of personnel of the army whilst inculcating in them the impeccable standards of discipline the army is noted for. As such, the school has the status of a unity school being administered by a federal parastatal.
All personnel employed by the school are staff of the Nigerian Ministry of Defence and includes both Military and Civilian personnel working side by side. The school is headed by a Commandant who is a military officer usually of the rank of a Lieutenant Colonel and assisted by an Administrative officer who is usually an army Captain and four Vice principals. Other important officials include the Bursar, Heads of departments and Regimental Sergeant Major.
The school consisting of classes JSS 1-3 and SSS 1-3, awards the senior school certificate on completion of the training course and conducts the National Examinations Council (N.E.C.O) junior and senior secondary certification examination and the West African Examinations Council (W.A.E.C) senior certificate examination. Admission into the school is conducted via entrance examinations carried out by the Nigerian Army Education Corps and Schools at specific times of the year. The departments within the school include: Mathematics and Sciences, Languages, Humanities, Art, and Social sciences. There exist about 7 arms in each class with an average of about 70 pupils per class, bringing the total student population to about 3000.
Facilities available in the school include classrooms, a library, workshops and laboratories, a sick bay, toilet facilities, staffrooms, offices, and stores.
The target population of the study includes the students in JSS 1-3 and SSS 1-3.
3.2 STUDY TYPE
The study is a descriptive cross-sectional study in which a subset of the population will be observed for the desired trait and the findings are generalised as typical of that population.
30
The desired trait here being the Knowledge Attitude and Practice of Secondary School Students Towards Personal Hygiene Especially Hand washing.
3.3 STUDY POPULATION
The population includes of male and female students of Command Day Secondary School
Ikeja i.e. From JSS 1-3 and SSS 1-3. The total number amounts to the figure of 3000.
3.4 SAMPLE SIZE
The sample size was calculated using the following formulae
n = Z2pq/d2 and ns = n ÷ (1 + n/N)
Where,
ns = sample size for population less than 10, 000
n= sample size
N= study population = 3000
Z= Confidence level set at 1.96 for 95 % confidence level
p= prevalence (proportion of population estimated to have the particular trait of
interest)= 0.8 (80 %)
q= 1-p =0.2
d= precision value set at 0.05
Therefore,
n = 1.962 x 0.8 x 0.2/ 0.05 2
n= 245.86
Also,
ns = n ÷ (1 + n/N)
31
ns =245.86 ÷ (1 + 245.86/3000)
ns = 227.24
The sample size was thus rounded up to 230 participants
3.5 SAMPLING METHOD
The sampling method used is the stratified sampling method where the sample population
is divided into 6 homogenous groups or strata based on current class of study, with each
class i.e. JSS 1-3 and SSS 1-3 representing a stratum. In each level, a simple random sampling
which is an equal probability sampling method is used to select 40 students.
3.6 COLLECTION OF DATA
Data will be collected via anonymous, structured and self administered questionnaires from
each stratum of the population. Collection would last for a school week (Monday to Friday)
from the hours of 8:00am to 2:00pm. Distribution would be done and supervised by myself
and so would the collection of the questionnaires. A few of the questionnaires would be
distributed (presampled) to a few students to check their understanding of the
questionnaire.
The questionnaire would be structured into 4 sections vis:
1. Section on Sociodemographic data
2. Section on questions assessing the Knowledge of students on personal hygiene
3. Section on questions assessing the attitude of students towards personal hygiene
4. Section on questions eliciting the practice of students on personal hygiene
3.7 DATA ANALYSIS
Data will be analysed using the appropriate version of EPI software. Presentation of the
data would be done using aids of data presentation such as tables, graphs and charts.
3.8 ETHICAL CONSIDERATION
32
All participants/respondents will be assured of utmost confidentiality , they will also be duly
informed of the reasons for the study and will be left with the final decision as to whether to
participate or not.
CHAPTER FOUR
33
RESULTS
A total of 240 structured self administered questionnaires were issued out of which 222 were returned and analysed.
TABLE 1: TABLE OF SOCIO- DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS
Variable Frequency PercentageAge
12 and below years13-16 years
17 and above yearsTotal
6813915
222
30.662.66.8
100.0Sex
MaleFemale
Total
104118222
46.853.2
100.0Class
J.S.S ClassS.S.S Class
Non responseTotal
1165155
222
52.323.024.8
100.0Religion
ChristianityIslam
Total
20814
222
93.76.3
100.0Ethnic group
HausaIgbo
YorubaOthers
Non responseTotal
1966
107282
222
8.629.748.212.60.9
100.0
Table 1 shows that majority of the respondents were in the 13-16 years age group constituting 62.6%. There was an almost equal sex distribution with 104 (46.8 %) male respondents and 118 (53.2 %) female respondents. Majority of the respondents belonged to J.S.S. 3 and below (52.3 %). More than 90% of the respondents were of the Christian religion. About half of the respondents belonged to the Yoruba tribe (48.2%) while about a third were of Igbo roots (29.7%)
FIGURE 1: HISTOGRAM SHOWING AGE DISTRIBUTTION OF RESPONDENTS
34
Age at last birthday20.0018.0016.0014.0012.0010.008.00
Fre
qu
ency
60
40
20
0
Histogram
Mean =13.58Std. Dev. =2.192
N =222
Mean age of respondents was 13.58 years
Majority of the respondents fell in the 13-16 age group with the modal age group being 14yrs.
35
FIGURE 2: PIE CHART SHOWING SEX DISTRIBUTION OF RESPONDENTS.
FemaleMale
Sex
The female respondents were slightly more than the males with a 1: 1.14 male to female sex distribution.
36
FIGURE 3: HISTOGRAM SHOWING RELIGIOUS DISTRIBUTION OF THE RESPONDENTS.
ReligionIslamChristian
Fre
qu
ency
250
200
150
100
50
0
Religion
Majority of the respondents were of the Christian faith with 208 out of the 222 analysed questionnaires.
37
TABLE 2: TABLE SHOWING DISTRIBUTION OF KNOWLEDGE AMONGST RESPONDENTS
Variable frequency percentageHave you ever heard about the term “Personal Hygiene”?
YesNo
Total
2220
222
100.00.0
100.0Where did you find out about it?
SchoolMediaBooks
Church/MosqueParents
Total
14412266
34222
64.95.4
11.72.7
15.3100.0
Personal hygiene includes practices performed by individual to care for ones bodily health and well being through cleanliness?
TrueFalse
Total222
0222
100.00.0
100.0Personal hygiene includes regular brushing and flossing of teeth?
TrueFalse
Non responseTotal
21642
222
97.31.80.9
100.0Personal hygiene includes balanced rest and exercise?
TrueFalse
Non responseTotal
184344
222
82.915.31.8
100.0Personal hygiene includes seeing a Doctor?
TrueFalse
Non responseTotal
152664
222
68.529.71.8
100.0Personal hygiene includes seeing a Dentist?
TrueFalse
Non responseTotal
144744
222
64.933.31.8
100.0
38
Have you heard of excessive hygiene?
YesNo
Non responseTotal
1226040
222
55.027.018.0
100.0Excessive hygiene could lead to
AllergiesSkin irritation
EczemaHormonal imbalance due to misuse
Non responseTotal
4566132
96222
20.329.75.90.9
43.2100.0
The table shows that all the respondents had heard of the term ‘personal hygiene’. School constituted the largest source of information about personal hygiene accounting for 64.9% of responses. Parents accounted for 15.3% followed by books 11.7%. Churches and mosques constituted the least accounting for a mere 2.7%.More than 95% of respondents responded true to personal hygiene as practises performed by individual to care for ones bodily health and well being through cleanliness. 97% of respondents responded true to Personal hygiene including regular brushing and flossing of teeth. 82% of respondents agreed that personal hygiene includes balanced rest and exercise. About 69% and 65% responded true to seeing a doctor and dentist respectively as part of personal hygiene. Only slightly more than half (55%) of respondents had heard of the term excessive hygiene. About 20.3% of respondents believed that excessive hygiene could lead to allergies, 29.7% believed that it could cause skin allergies whilst less than 1% and 5.9% respectively believed that excessive hygiene caused hormonal imbalance due to product misuse and eczema respectively.
39
TABLE 3: TABLE ASSESSING ATTITUDE OF RESPONDENTS
Variable Frequency PercentageWhat is your attitude toward personal hygiene?
Very importantImportant
Non responseTotal
1748
40222
78.43.6
18.0100.0
How far do you think proper personal hygiene would go toward solving health problems?
Very farNot far
Non responseTotal
1754
43222
78.81.8
19.4100.0
What is your attitude toward hand washing?
Very importantImportant
Non responseTotal
1444038
222
64.918.017.1
100.0How far do you think hand washing is to the maintenance and improvement of health?
Very farNot far
Barely importantNon response
Total
131444
44222
59.019.81.4
19.8100.0
Just less than 80% of the respondents viewed personal hygiene as very important with less than 5% seeing it as just important. Most of the respondents (78.8%) felt that proper personal hygiene would go very far in solving health problems. 1.8% responded that it would not go far towards solving health problems. About 65% of respondents saw hand washing as very important.6 out of every 10 respondents responded that hand washing would go very far in maintenance and improvement of health. About a fifth of respondents (19.8%) did not think hand washing would go very far in maintaining and improving health.
40
TABLE 4: TABLE ASSESING THE PRACTICES OF THE RESPONDENTS
Variable Frequency PercentageDo you take a bath every day?
YesNo
Non responseTotal
1782
42222
80.20.9
18.9100.0
how many time in a day1-2 times3-4 times
Above 4 timesNon response
Total
122542
44222
55.024.30.9
19.8100.0
Do you brush your teeth every day?
yesno
non responseTotal
1762
44222
79.30.9
19.8100.0
How many times daily?1-2 times3-4 times
Non responseTotal
1715
46222
77.12.3
20.7100.0
80.2% of the respondents said they took a bath every day, 55% took a bath 1-2 times daily whilst 24% had their baths 3-4 times daily. 79.3% of respondents brushed their teeth daily, 77.1% brushed their teeth 1-2 times daily while 2.3% brushed their teeth more than two times in a day.
41
CHAPTER FIVE
5.1 DISCUSSION
The purpose of the study was to determine the knowledge and asses the attitude and practice of secondary school students towards personal hygiene especially hand washing. A total of 222 secondary school students were involved in the study.
The largest percentage of participants came from the 13-16 (62.6%) years age group followed by the 12 years and below age group which constituted 30.6% of the total respondents. Only 6.8% of the students were aged 17 years and above. The modal age was 14 years. This is not surprising as most primary schools turn out most of their students by Primary 5 when they age an average of about 10 years. Thus is not unexpected to have most of the secondary school students being 13-16 years of age. There was an almost equal sex distribution with 104 (46.8 %) male respondents and 118 (53.2 %) female respondents. This is not unexpected also as the school is a coeducational school. About half of the participants were in J.S.S. 3 and below (52.3%).208 students, accounting for 93.7% of the total participants claimed Christianity as religion.
About half of the respondents were of the Yoruba tribe (48.2%), 66 participants (29.7%) belonged to the Igbo tribe. 8.6% belonged to the Hausa tribe. This is in keeping with expected results as the Yoruba tribe is the dominant tribe in the south western part of Nigeria and this is also reflected in the pattern of tribe distribution in the school.
All the participants responded to have heard about the term ‘personal hygiene’. This can be explained by the fact that the subject is taught as ancillary topics especially in primary school and junior secondary school in subjects like social studies and home economics. This is further more bolstered by the fact that majority of the respondents (64.9%) found out about it from school followed by parents (15.3%), books (11.7%) and the media (5.4%) respectively. Only a mere 2.7% claimed churches and mosques as the source of their information. This simply shows that the concept of personal hygiene is not taken too seriously outside the confines of the academic environment and this is especially true in the religious houses.
All the respondents agreed that personal hygiene includes all practices performed by an individual to care for ones bodily health and well being through cleanliness. Almost all the participants (97.3%) viewed regular brushing and bathing and proper and regular hand washing as part of personal hygiene. Also, most of the respondents (82.9%) responded true to personal hygiene including eating balanced diets, rest and exercise. This shows a good degree of knowledge amongst participants. This can be explained by the fact that most of these issues are covered in part of their curriculum at some point in time or the other during
42
their course of study. However, the level of knowledge dropped to about 68.5% and 64.9% when asked if personal hygiene involved seeing a doctor and a dentist respectively. Only about half of the respondents (55%) had heard of excessive hygiene and still fewer respondents could identify some of the sequelae of excessive hygiene as shown by the following results: only about one fifth (20.3%) associated outbreak of allergies to excessive hygiene, only less than a third of all the participants felt excessive hygiene could result in skin irritations, less than 10% of respondents felt that excessive hygiene could lead to hormonal imbalance due to product misuse or eczema. This can probably be attributed to focusing of the curriculum on hygiene practices and consequences of insufficient hygiene without stressing much importance on the effects of excessive hygiene. The not too impressive degree of knowledge shown by respondents on the issue of visiting a dentist or doctor as part of personal hygiene can be explained by the fact that hospitals and clinics are viewed as places to be visited by the sick and hence most individuals would not visit one except there is a pressing health issue.
Regarding the attitude of the respondents, 78.4% of the respondents viewed personal hygiene as very important and about the same number (78.8%) felt that proper personal hygiene as a whole would go very far towards solving health problems. However, when assed specifically on the role of hand washing, only about 65% thought that it was important and only 59% believed that hand washing would go very far in the maintenance and improvement of health. 44 of the 222 candidates amounting to almost 20% felt that hand washing would not go far in maintaining and improving health. This simply shows that though most of them view hand washing to be a component of proper personal hygiene, most of them have relegated the function of hand washing to a mere formality with as much as one in every five respondent viewing it as inconsequential to the state of health.
Regarding the practices of respondents to personal hygiene, 4 out of every 5 respondents (80.2%) claimed to have their baths every day with as many as a quarter of total respondents having their baths 3-4 times in a day. A similar result was obtained about oral hygiene with 79.3% brushing their teeth every day. This can be attributed to the fact that most of the respondents are teenagers and are likely to carry out these activities as they foster peer acceptance upon which outward appearance is based and which is also highly valued at this stage of their lives.
Almost all respondents claimed to wash their hands regularly. However, this should be taken with a pinch of salt because as earlier stated, though most of the respondents agree that hand washing is a part of proper personal hygiene, their attitude towards it was not commensurate to the degree of knowledge demonstrated hence the likelihood that this high rate of hand washing is done only ceremoniously without paying heed to its real importance thereby making it ineffective.
43
5.2 CONCLUSION
This study was carried out to determine the knowledge and asses the attitude and practice of secondary school students towards personal hygiene especially hand washing. At the end of the survey, some findings were arrived at which are summarised below.
The participants had a good knowledge of personal hygiene as most of them had heard of the term before, could accurately identify its components and some of the harmful consequences of not engaging in sufficient personal hygiene practices. Most of them received this information from school. The degree of knowledge displayed by participants on excessive personal hygiene and its consequences was however not satisfactory.
The results obtained on assessment of the attitude of the participants towards the subject matter revealed that most of them believed that good personal hygiene was important to preservation and improvement of health. This attitude was however downplayed when it came to hand washing specifically.
The participants also showed good hygienic practices including hand washing although the effectiveness of the hand washing might be put to question due to the not too satisfactory attitude shown towards it.
5.3 RECOMMENDATIONS
Based on the findings from this study, the following are recommended:
There should be more efforts to increase knowledge on the gray areas concerning personal hygiene in the school by revising the school curriculum to cover more areas of personal hygiene especially hand washing and excessive hygiene.
Religious institutions should be encouraged to teach the values of not just good hygiene but also other important health issues.
Secondary schools should employ policies and embark on projects that encourage better hygiene amongst students such as providing facilities for hand washing in laboratories.
Private organisations and corporate bodies should assist schools in improving knowledge attitude and practice towards personal hygiene by either directly supplying or subsidising hygiene related products or sponsoring projects aimed at increasing awareness or improving the practice of personal hygiene.
The Government could improve the attitude towards hand washing by increasing awareness of its benefits and consequences of its avoidance through regular, short and simple but detailed broadcast via national and state television and radio stations or other means available to it.
44
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48
QUESTIONNAIRE
I am a 500 Level student of The College of Medicine, University of Lagos and I am carrying
out a study on the Knowledge, Attitude, and Practice of Secondary School Students
Towards Personal Hygiene Especially Handwashing in partial fulfilment of the requirements
of my Principles and Practice of Primary Healthcare course. Any information supplied by way
of this questionnaire would be of help in conducting this study and would be treated as
confidential. Thank you.
BASTOS T.S.
SECTION A: DEMOGRAPHIC DATA
1. Age at last birthday: .
2. Sex: Male Female
3. Class: J.S.S S.S.S
4. Religion: Christianity Islam Others . (Please specify)
5. Tribe: Hausa Igbo Yoruba Others . (Please specify)
SECTION B: KNOWLEDGE
1. Have you heard about the term “Personal Hygiene”? Yes No
2. Where did you find out about it: School Media Books
Church/Mosque Friends Parents
Others .(Please specify).
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3. Please tick the following questions True OR False as appropriate
Personal Hygiene includes
Practices performed by an individual to care for one's bodily health and well
being, through cleanliness. TRUE FALSE
Cleanliness of the body and clothing: TRUE FALSE
Regular brushing and flossing of teeth: TRUE FALSE
Regular and proper hand washing: TRUE FALSE
Balanced rest and exercise: TRUE FALSE
Seeing a Doctor: TRUE FALSE
Seeing a Dentist: TRUE FALSE
4. Personal hygiene products include: (tick as appropriate, you can tick more than one)
Water
Soap
Deodorants
Chapsticks
Cream
Lotion
Facial tissues
Toilet paper
Nail clippers
Sanitary pads/tampons
5. Which of the following diseases or conditions could be caused or worsened by poor
personal hygiene ? (you can tick more than one answer)
Acne Body odour Head Lice Dandruff
Trachoma Tooth decay Gum disease Mouth Odour
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Diarrhoea Intestinal Worms Scabies Eczema
Fungal Infections Schistosomiaisis Jock itch/ Groin Ringworm
Yeast Infection Toxic Shock Syndrome Sore throat
Influenza
6. Have you heard of the term : “excessive hygiene” ? Yes No
Excessive hygiene could lead to: (you can tick more than one)
Allergies Skin irritations Eczema
Hormone Imbalance due to product misuse
SECTION C: ATTITUDE
1. What is your attitude towards personal hygiene?
Very important Important Barely important Not important
2. How far do you think proper personal hygiene would go toward solving health
problems ?
Very far Not far Makes no difference Worsens Health
3. What is your attitude towards hand washing ?
Very important Important Barely important Not important
4. How important do you think hand washing is to the maintenance and improvement
of health ?
Very important Important Barely important Not important
5. Why do you think personal hygiene should be practiced(you can tick more than one)
Good health
Social Acceptance
Reduction of illnesses
Sense of well being
Prevention of spread of disease to others
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Others .(Please specify)
6. Do you think personal hygiene is practised optimally in your environment?
Yes No
Please state
reason(s) .
7. What factors do you think might be responsible for inadequate practise of personal
hygiene? (you can tick more than one)
Inadequate or poor facilities
Inadequate water supply
Inadequate finances
Indiscipline
Misplaced priorities
Lack of awareness and education
Others .(Please specify)
SECTION D: PRACTICE
1. Do you take a bath every day? Yes No
How many times ? .
2. Do you brush your teeth everyday? Yes No
How many times? .
3. When do you wash your hands ? (you can tick more than one)
Before meals
After meals
Before cooking
After cooking
After using the toilet
After cleaning up children
After handling garbage
After laboratory or workshop sessions
After handling animals
Others .(Please specify)
4. How often do you cut your nails .(Please specify)
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5. How often do you wash your hair .(Please specify)
6. Which of these hygiene promoting products do you use?
Soap
Cream
Facial Tissue
Cotton Swabs
Hair clippers
Nail clippers
Sanitary pads
Tampons
Deodorants
Others .(Please specify)
7. How often do you see your Doctor in a year in the absence of illness .
8. How often do you see your Dentist in a year in the absence of illness .
9. Do you eat a balanced diet, exercise and rest well? Yes No
53
54
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