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

1

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

2

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

4

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].

5

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]

6

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

7

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

8

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

9

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

10

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].

11

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

12

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

13

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

15

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.

17

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]

18

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] .

19

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

20

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

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