Effectiveness of Child To Child Approach on Knowledge and PracticeRegarding Importance of Hand Washing Among Primary School Children

INTRODUCTION

Hand washing is an integrated part of our culture and daily life. Hand washing and other hygienic practices are taught at every level of school, advocated in the work place, and emphasized during medical training. Proper hand washing is one of the best ways to prevent the spread of illness. It is especially important at school, where small children are in constant contact with each other, often spreading micro-organisms. While many children may wash their hands after using the toilets, they may not be washing their hands properly¹

Hand washing is significantly important in children as children are vulnerable to illness since they are very playful and more exposed to dirt, soil and other sources of infections. By teaching them proper hand washing techniques, schoolaged children can keep theirown hands clean and also teach other children how to stop the spread of germs.¹ 

The hands are one of the main medium for disease transmission. They vectorin fection from one person to another. Research shows that there is reduction indiarrhoeal diseases by nearly 50% by washing hands with soap and water. There areover million episodes of food-related infection in a year but most of these are probably related to lack of improper hand washing. Hand washing is highly habitual, aroutine behaviour that can be instilled at an early age.²

Diarrhoea and pneumonia are among the leading causes of child mortality worldwide. In fact, over two million children under five years die due to diarrhoea and pneumonia every year. In India, this translates to the loss of over six lakhs children under the age of five, every year. Many of these deaths are easily preventable through simple practices such as hand washing with soap. Evidence suggests that improved hand washing can have a major impact on public health inany country and significantly reduce the two leading causes of childhood mortality.

Since hand washing with soap can prevent the transmission of a variety of pathogens, it may be more effective than any single vaccine or hygiene behaviour. Promoted broadly enough, hand washing with soap can be viewed as an essentialmeans of preventing cross infection. Almost every household in the world, regardless of economic status, has soap. Hand washing with soap at key times, however, is not widely practiced.

The Child to child approach is an emerging concept for spreading awarenesson various health related concepts among family members and communities byeducating children. The aim of this approach is that children will be more responsible forthe health of themselves and their communities. The ideas of the child to child approach are: Children learn better by doing, they are active learners, they learn better from each other , children act as partners in promoting health and issues concerning their communities, children influence adults as well as other children e.g. sisters, brothers, siblings and playmates.³

OBJECTIVES

1. To assess the knowledge and practice of primary school children regarding importance of hand washing in terms of pre and post-test scores.

2. To evaluate the effectiveness of child to child approach by comparing pre and post-test knowledge and practice scores.

3. To find the association between knowledge and practice of primary school children with their selected demographic variables.

METHODOLOGY

An evaluative approach and Quasi-Experimental one group Pre-test Post-test design was adopted for the study. The setting was a selected school in Begur, Bangalore. Sample size for the study comprised of 60 children studying in 2nd and 3rd grade. Simple random sampling technique was adopted to select the children based on inclusion criteria. The tools for data collection were a structured knowledge questionnaire consisting of objective type questions and a practice checklist to assess the skills of hand washing.The structured knowledge questionnaire consisted of 15 multiple choice items regarding importance of hand washing. Score 1 was given to each correct response and score 0 for every wrong response.The resulting scores were categorised as high knowledge (more than 75%), average knowledge (51-75%) and low knowledge (Less than 50%)

The observation checklist had ten items on general hand washing techniques for assessment of skills of primary school children. A score of ‘1’ was awarded for ‘correct technique’ and ‘0’ for ‘incorrect’ The total score was classified as good (more than 70%), average (51-70 %) and poor (less than 50 %). A Structured Teaching Programme on importance of hand washing was developed on the basis of the objectives of the study. Validity of the tools were established by nine experts.The reliability of the knowledge questionnaire was 0.897 andpractice check list was 0.8536. Prior to data collection ethical clearance was taken. A formal permission was obtained from the Head of the school. Consent was taken from the parents of the participants and assent from the participants after explaining the purpose of the study. Data collection was done by administering pre-test on day one, followed by educational intervention of STP on importance of hand washing, using the child to child approach whereby the selected 2 students were given the teaching, who in turn taught the rest of the students on the knowledge and skills on handwashing. On day seven post-test was done. 

Selection of children for the training of child to child approach was done by selecting the 1st rank holders of the 2nd and 3rd grade students. Training of the 2 children involved teaching them importance of hand washing and skills of handwashing. Then they re-demonstrated the teaching using the Power Point Presentation, Audio Visual Aids like flashcards and posters. andthe hand washing technique.

RESULTS

I. Description of demographic variables of primary school children

The majority (41.7%) of primary school children were 8 years, 33.3% were 7 years and 25% were 9 year old. Majority (55%) of primary school children were male and 45% were female, 63.3% were studying in 3rd standard and 36.7% were studying in 2nd standard, 50% each were Hindu and Christians, 33.3% of primary school children’s fathers had primary education and 33.3% were graduates, a little less than 50% children’s mothers had primary education, 63.3% of fatherswere private employees, 48.3% of children’s mothers were housewives. Majority (63.3%) of primary school children had water from Government water supply at their homes. 

II. Overall knowledge scores of primary school children regarding hand washing.

The overall pre-test & post-test knowledge scores regarding importance of hand washing. revealed that 45% of the primary school children had average knowledge in the pre-test and 66.7 % of the subjects had high knowledge in the post-test. (Figure 1)

III. Overall practice scores of primary school children regarding hand washing.

The overall pre-test and post-test practice scores of the school children regarding the proper techniques of hand washing showed that majority (88.3%) have average skill in the pre-test and 91.7% had good skill in the post-test. (Figure 2)

IV. Effectiveness of child to child approach on knowledge and hand washing practice skills of primary school children.

There was a significant difference between the mean pre and post-test knowledge and practice scores of primary school children (t=6.41, p<0.001), (t=18.67, p< 0.001). Hence the child to child approach was effective in improving the knowledge and practice of hand washing among the primary school children. (Table 1)

V. Association between pre-test knowledge scores and practice scores with selected demographic variables of primary school children.

The chi square value was computed to find association between the level of Knowledge of primary school children and selected demographic variables like gender, class of study, education of father, occupation of father and mother and source of water at home. They were not found to be significant at 0.05 level except for age and education of mother. There was no association between level of practice scores and demographic variables.

DISCUSSION

The overall pre and post-test knowledge scores showed that majority 45% of the subjects had average knowledge in the pre-test whereas 66.7% children had high knowledge in the post-test on importance of hand washing. In a similar crosssectional study conducted by Vivas AP, Gelaye B, Aboset N, Kumie A, Berhane Y, Williams MA 4toevaluate the knowledge, attitudes, and practices (KAP) of hand washing hygiene among rural primary school children in Ethiopia results showed that approximately (52%) of students were classified as having adequate knowledge of proper hand hygiene.

The overall pre and post-test practice scores of the school children regarding the practice of hand washing showed that majority (88.3%) of the subjects had average practice in the pre-test and majority (91.7%) of the subjects had good practice in the post-test regarding hand washing. These findings were similar to findings of study by Annesi SM5 wherein the interventional program was found effective in increasing both the frequency and correct technique of hand washing among the children (73%).

In the present study there was a significant difference between the mean pre and post-test knowledge and practice scores of primary school children (t=6.41, p<0.001), (t=18.67, p< 0.001). Hence the child to child approach was effective in improving the knowledge and practice of hand washing among the primary school children. These findings were supported by an interventional study conducted by Kaewchana S et al ⁶

The findings of the study revealed that majority of primary school children had moderately adequate knowledge regarding the importance of hand washing. Therefore school children are in need for health education with regard to different aspects of hand hygiene. Although every child is aware of hand washing concept but may not be following the correct technique or ignoring its practice every time. Educating children regarding the prevention of these diseases by simple hand washing can prevent many potential health complications. Schools must ensure availability of water and provide soap for effective hand washing practice. Health visitors and community health nurses’ school teachers must conduct health camps creating awareness among children and general public. School health nurses can conduct school health programs importance of hand washing to help prevent school absenteeism. 

CONCLUSION

Hand washing is one of the most important disease prevention skills that can be taught to children who are especially exposed to microorganisms because they do somuch exploring with their hands and they have not built up immunity to many common organisms causing illnesses and diseases. This study was designed toexplore the importance of skills-based health education within the concept of health promotion and the contribution of Child-toChild approaches towards inculcating the proper practice of hand washing program. The present study concludes that child to child approach was effective in improving knowledge and practice of a simple personal hygiene measure such as hand washing among primary school children.