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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 17  |  Issue : 3  |  Page : 650-656

Association of wash practices with diarrheal diseases among residential and nonresidential school children at Wardha District: A comparative study


1 Department of Community Medicine, Datta Meghe Institute of Medical Sciences Sawangi (M), Wardha, Maharashtra, India
2 Department of Community Medicine, Pillai Institute of Management Studies and Research, New Mumbai, Maharashtra, India

Date of Submission08-Jan-2021
Date of Decision18-Dec-2021
Date of Acceptance17-Jan-2022
Date of Web Publication2-Nov-2022

Correspondence Address:
Dr. Shobha K Joshi
Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_10_21

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  Abstract 


Introduction: Sustainable development goals, adopted at the 2015 UN general assembly, aim to significantly boost water and sanitation globally and include two concrete targets for drinking water, sanitation, and hygiene (WASH) as set out in objective 6. Improved water supply and sanitation results in a reduction of 23% and 36% respectively in morbidity due to diarrhea and an increase of around 2 billion school days. The present study was conducted to assess and to compare the WASH practices and its association with diarrheal diseases in residential and nonresidential schools at Wardha district. Methodology: A cross-sectional school-based study conducted using a prestructured and predesigned questionnaire carried out among residential and nonresidential schools in Wardha district. The study participants were the students of 8–13 years of age group or 3rd–7th standard. Data collection tools were prepared using the World Health Organization standards for WASH in Schools in Low-cost Settings and Monitoring Package developed by UNICEF for WASH in Schools which is adaptable in developing countries. Results: In residential school, out of 240 boys 96 (40%) and out of 231 girl students 30 (12.98%) were suffered from diarrheal disease in the past 3 months of interview. While in nonresidential school out of 178 male students 10 and 12 female students gives a history of diarrheal disease in the past 3 months; this association was statistically nonsignificant. When compared by Binomial Logistic Regression found that in residential school variables like Gender, Not Using “Urinals” provided in the school, Not using soap for washing hands found to be statistically significant, with an odds ratio of 0.433, 1.65, and 4.43, respectively. Conclusion: This study shows that male participants from residential schools have a high incidence of diarrheal disease compared with females from the schools, whereas in nonresidential schools females suffered from diarrheal comparatively more than males; improper water handling practices seem to be more in residential schools than that of nonresidential schools this may be the main reason of getting more incidence of diarrheal diseases in residential school.

Keywords: Diarrheal diseases, nonresidential school, residential school, water, sanitation, and hygiene practices


How to cite this article:
Waghmare RN, Dakhode S, Choudhari S, Joshi SK, Gaidhane A, Waghmare V. Association of wash practices with diarrheal diseases among residential and nonresidential school children at Wardha District: A comparative study. J Datta Meghe Inst Med Sci Univ 2022;17:650-6

How to cite this URL:
Waghmare RN, Dakhode S, Choudhari S, Joshi SK, Gaidhane A, Waghmare V. Association of wash practices with diarrheal diseases among residential and nonresidential school children at Wardha District: A comparative study. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Feb 4];17:650-6. Available from: http://www.journaldmims.com/text.asp?2022/17/3/650/328439




  Introduction Top


Health for all is a mission of the World Health Organization (WHO). Universal declaration (1998), acknowledges the equal and inalienable rights of all members of the human family.[1] Sustainable development goals, adopted at the 2015 UN general assembly aim to significantly boost water and sanitation globally and include two concrete targets for drinking water, sanitation, and hygiene (WASH) as set out in Objective 6. Approximately 2.65 billion people worldwide live without proper toilet facilities and 883 million have no access to clean water. Schools with adequate WASH facilities have a reliable water network which provides safe and adequate water, especially for hand washing and drinking, sufficient number of private, clean, cultural, and gender-appropriate toilets for students and teachers; water use and hand-washing facilities, including some near toilets; and continuous hygiene promotion.[2],[3],[4] In developing countries, diarrhea is one of the leading causes of morbidity and mortality among children. Bad water quality, hygiene, and sanitation are significant contributors to the spread of diarrheal disease.[5],[6] The WHO has ranked diarrheal diseases in the fifth position on the list of global diseases with leading causes of death worldwide.[6] 90% of death in children under the age of 5 are due to diarrheal diseases, poor water quality, sanitation, and hygienic conditions; of all those 2000 deaths, 240 children die every day in India itself.[8] Improved water supply and sanitation results in a reduction of 23% and 36% respectively in morbidity due to diarrhea and increase of around 2 billion school days. Review of literature shows that there are very few studies done on Residential Schools (Ashram schools) for the assessment of WASH practices; hence, the study conducted to assess the association of WASH practices with diarrheal diseases among residential and nonresidential school children at Wardha district.[7],[8]

[TAG:2]Methodology[/TAG:2]

A cross-sectional school-based study was conducted using a prestructured and predesigned questionnaire carried out among residential and nonresidential schools in Wardha district (Maharashtra state, India). There were a total of 8 Residential schools (Ashram Schools) in Wardha district and 8 nonresidential schools were selected based on screening camp conducted under the Rashtriya Bal Suraksha Karyakram scheme. The study participants were the students of 8–13 years of age group or 3rd–7th standard studying among residential and nonresidential schools and sampling was done by complete enumeration method. A total of 820 students, i.e., 471 students from residential and 349 students from nonresidential schools were included in the study. The study conducted from July 2019 to February 2020. Data collection tools were prepared using the WHO standards for WASH in Schools in Low-cost Settings and Monitoring Package developed by UNICEF for WASH in Schools which is adaptable in developing countries.[10]

This UNICEF monitoring package consists of three modules:

  1. Module 1: Education Monitoring and Information System (EMIS Module: WASH in Schools Questions for National EMIS Questionnaires
  2. Module 2: Survey Module: WASH in Schools Questions, Observation Checklists and Focus Group Discussion Tools for National Surveys
  3. Module 3: Children's Monitoring Module: Teacher's Guide and Tools for Monitoring of WASH in Schools by Children.


With the help of the above modules, following data collection tools was prepared–

Basic information sheet for school and students: Socio-demographic information of children, age of entry in school, years residing in school, practices related to WASH, and past 3-month history of diarrheal diseases.

IEC approval was obtained from the Ethics Committee of the DMIMS University (DMIMS [DU] IEC/Sept-2019/8316) and Statistical analysis done using SPSS v 21 statistical tool. Chi-square test was used to compare the WASH practices of students from both the types of schools and Binomial Logistic Regression analysis was done.[9],[10],[11],[12]

Operational definition

Hygienic water drinking practices

The practice of drinking water in which a person uses their reusable or disposable or shared and properly washed drinking vessel for drinking water.

Unhygienic water drinking practices

Person who directly drinks water from the faucet or hand pump spout by dirty or unwashed hands of directly by touching mouth.

Sanitary practices

Participants who give a response to “Always” and “Most of the time” for health promotion practice or respective variable.

Unsanitary practices

Participants who give a response of “Sometimes,”Rarely” or “Never” for health promotion practice or respective variable.

Diarrheal diseases

A student reported diarrhea, defined as three or more loose or watery stools over any 24-h period in the (recent three month) [Table 2] and [Table 3] and [Figure 1].
Table 2: Association between water drinking practices with episodes of diarrheal disease

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Table 3: Gender wise distribution and association between episodes of diarrhoea at residential and nonresidential school

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Figure 1: Assessment of utensils that students use to drink water at residential and nonresidential schools

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  Results Top


[Table 1] shows that a total of 471 in residential and 349 nonresidential school students almost with the same percentages of 51% males and 49% females both in residential and nonresidential schools. Most of the study participants from residential schools were from 3rd standard (37.6%) followed by 4th (21.7%), in the case of nonresidential schools, most of the study participants were from 3rd standard (26.1%) followed by 4th standard (24.2%).
Table 1: Gender and standard wise distribution of study participants

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In residential schools, more than half of the students, i.e., 255 (54.1%) were observed to drink water directly from the faucet by mouth or by hand, which are unhygienic practices. Whereas, less than half of the students, i.e., 45.9%, were following hygienic practices for drinking water drinking water by shared, own reusable and disposable drinking vessel by 136 (28.9%), 42 (8.9%) and 38 (8.1%) students, respectively. In nonresidential school, most of the students were drinking water hygienically, i.e., using their reusable, disposable, and shared drinking vessel by 205 (58.7%), 30 (8.6%), and 25 (7.2%), respectively. However, only one-fourth students, i.e., 89 (25.5%) used to drink water unhygienic ally, i.e., directly from the faucet or hand pump spout disposable.

It was observed that, in residential schools, out of 216 students who were following hygienic drinking water practices, only 24 (11.11%) students were suffered from diarrheal episodes. A total of 255 students were following unhygienic drinking water practices, out of these 102 (40%) students were suffered from diarrhea in recent 3 months of interview. This difference of episodes of diarrhea is found to be significant (χ2 = 48.81, P < 0.0001).

In nonresidential schools, out of 260 students who were following hygienic water drinking practices, very few, i.e., 15 (5.76%) students suffered from diarrhea. Whereas episodes of diarrhea observed among 7 (7.86%) out of 89 students who were drinking water unhygienic manner. This difference is observed to be statistically insignificant in contrast to residential school (χ2 = 0.49, P = 0.48).

In residential school, out of 240 boys 96 (40%), and out of 231 girl students, 30 (12.98%) were suffered from diarrheal disease in past 3 months of interview. While in nonresidential school out of 178 male students 10 and 12 female students gives a history of diarrheal disease in past 3 months; this association was statistically nonsignificant. This gender-wise difference for association with diarrhea was found to be statistically significant in residential school (χ2 = 43.83, P < 0.0001) and nonsignificant in nonresidential school (χ2 = 0.28, P = 0.59).

[Figure 2] and [Table 4] show, out of the 471 participants in residential schools, only 196 (41.61%) of students were using urinals always or most of the time for micturition provided in the school. However, majority of the students 275 (58.38%) did not use school urinals. The most common place for micturition other than proper urinals was responded as an open ground for 213 (73.8%) students. Other places for micturition were adjacent farm and nearby area of urinals for 20 (7.3%) and 52 (18.9%) students, respectively. In nonresidential school, maximum students, i.e., 310 (90%), followed sanitary practice for micturition by using urinals. Only 39 (10%) students were avoiding urinals and other places for micturition were noted as open ground and nearby area of urinals. When we tried to find out the reason for not using urinals constructed in school premises, responses from students were smelly, unclean, or partially functioning, i.e., improper water supply or blocked.
Figure 2: Association between use of urinal in residential and nonresidential school with episodes of diarrhoeal diseas

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Table 4: Association between use of urinal in residential and nonresidential school with episodes of diarrhoeal disease

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[Figure 3] and [Table 5] shows that when we also assessed the hand hygiene practices by taking history regarding frequency of hand wash using soap or other material. In residential school, 383 (81.31%) students did not wash their hands regularly and; out of these 112 (29.24%) students gave the history of diarrheal episodes in the past 3 months of interview. Whereas 88 (18.68%) students maintained their hand hygiene sincerely and only 14 (15.9%) students experienced the diarrheal in respective duration.
Figure 3: Comparison of student's hand wash practices by using soap/other material

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Table 5: Comparison of student's hand wash practices by using soap/other material

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Contrast findings were observed in nonresidential school. Totally 315 (90.25%) students maintained hand hygiene on a regular basis and out of these 17 (5.39%) students narrated the history of gastrointestinal disturbances. 34 (9.74%) students observed to be habitual of unsafe hand washing and few of them, i.e., 5 (14.7%) were suffered from diarrhea in the past 3 months of assessment. When we studied the association between hand wash practices and diarrheal diseases, it is revealed that unsafe hand washing practices is significantly associated with diarrheal diseases in both the school (χ2 = 6.493, P = 0.01 in residential and χ2 = 4.5, P = 0.03 in nonresidential school).

The common reason for unable to maintain hand hygiene by 125 (32.6%) and 25 (7.5%) students of residential and nonresidential school was not availability of soap at hand washing station. Even though soap is available, 79 (20.6) and 9 (26.5%) students of residential and nonresidential school responded that due to hurriedness they did not use it every time. Some of the students 52 (13.6%) of residential school did not habitual at all to use the soap for washing hands.

[Table 6] shows when compared by A Binomial Logistic Regression found that in residential school variables like Gender, Not Using “Urinals” provided in the school, Not using soap for washing hands fond to be statistically significant, with an odds ratio of 0.433, 1.65, and 4.43 respectively while in nonresidential schools all the predicted WASH variables found to be nonsignificant.
Table 6: Binomial logistic regression analysis of diarrhoeal disease with predicted water, sanitation, and hygiene variables

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  Discussion Top


It was a school-based cross-sectional study and a total of 471 in residential and 349 nonresidential school students were included in this study, almost the same with the percentages of 51% males and 49% females, respectively. Most of the study participants from residential and nonresidential schools were from 3rd standard followed by 4th standard students. The same results were found in the study done with title sanitation behavior among schoolchildren in a multi-ethnic area of Northern rural Vietnam on 319 children who responded have 51.7% of males and 48.3% of females. Most of the study participants were from the 4th standard.[10] In other studies conducted on a total of 155 children were interviewed of which 90 were male (58.1%) and 65 were female (41.9);[13] A cross-sectional descriptive studies conducted between May 2014 and April 2015 on 839 subjects, out of which 408 (48.63%) were boys and 431 were (51.37%) girls.[14] In the residential school, more than half of the students, were following an unhygienic practice that is drinking water directly from the faucet or hand pump spout by the hand. If hands are washed with soap and water and then drink by hand, then it can be acceptable as hygienic behavior for drinking water. However, children usually reach the tap while playing or teaching hours hurriedly and ignore the proper manner of water drinking. They used to drink water by dirty or unwashed hands. This practice may be acting as a predominant step in chain of transmission of gastrointestinal diseases. In residential school, out of 240 male students 96 and out of 231 female students 30 gives a history of diarrheal disease in the past 3 months; this association was found to be statistically significant. While in nonresidential school-out of 178 male students 10 and out of 171 female students 12 gives a history of diarrheal disease in the past 3 months; this association was found to be statistically nonsignificant. Another study shows the prevalence of diarrhea was marginally higher among girls than boys (53% vs. 49%, odds ratio 1.18).[15] A significant high frequency of diarrheal episodes was observed among the students who were following unhygienic than hygienic drinking water practices in residential school. This shows that only provision of safe drinking water by the school is not sufficient to prevent or decrease the diarrheal cases, but students' manner of drinking water plays an important role in causing the gastrointestinal disturbances. Another study shows the same results and suggests that improper water drinking and handling practices are the most common factor for occurs of diarrheal disease.[16],[17],[18] In both residential and nonresidential schools, a higher number of the past history of diarrheal diseases was noted among those students who were habitual of unsafe than safe hand washing practices. This association of hand hygiene and diarrheal episodes was found to be statistically significant in both the schools. A study found that Children's answers to where “usually” urinate, “last” defecated, and “last” urinated at school (all pairwise correlations P < 0.001).[19] In residential school, 383 (81.31%) students did not wash their hands regularly. Common reason for unable to maintain hand hygiene by 125 (32.6%) and 25 (7.5%) students of residential and nonresidential school was not availability of soap at handwashing station. Even though soap is available, 79 (20.6) and 9 (26.5%) students of residential and nonresidential school responded that due to hurriedness, they did ot use it every time. Some of the students 52 (13.6%) of residential school did not habitual at all to use the soap for washing hands. A study done among Kenyan schoolchildren found that Pupil recorded the existence of hand-washing stations in the classroom, the availability of soap, the availability of hand-washing stations in the classroom, the availability of soap, and the availability handwashing water were all well correlated (all pairwise correlations P < 0.001), but finding at school level on drinking water and handwashing water have not been statistically associated.[19]

[TAG:2]Conclusion[/TAG:2]

This study shows that male participants from residential schools have a high incidence of diarrheal disease compared with females from the schools, whereas in nonresidential schools females suffered from diarrheal comparatively more than males; improper water handling practices seem to be more in residential schools than that of nonresidential schools this may be the main reason of getting more incidence of diarrheal diseases in residential school. The overall practices of nonresidential schools were found to be significantly better than the students of residential schools, this because of the good facilities available in nonresidential schools.

Limitations

It was a school-based cross-sectional study, and it was difficult to recall the episodes of diarrhea since the last 3 months, so recall bias is the main limitation of this study.

Recommendations

  1. The school management will concentrate on keeping clean drinking water available for the students
  2. Besides, all students should be advised and trained on the safe and hygienic water to avoid diarrhea, and the school management bodies should work to increase awareness about how students can use and manage handwashing products at crucial periods
  3. School students and teachers thought to be trained on the different successful forms of purification used before drinking water and made aware of good hand hygiene procedures, good usage of toilets, and urinal supply in micturition and deification classrooms.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Sanitation Behavior among Schoolchildren in a Multi-Ethnic Area of Northern Rural Vietnam. ResearchGate. Available from: https://www.researchgate.net/publication/221850390_Sanitation_behavior_among_schoolchildren_in_a_multi-ethnic_area_of_Northern_rural_Vietnam. [Last accessed on 2020 May 15].  Back to cited text no. 12
    
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Hossain S, Ahmed F, Hossain S, Sikder T. Nutritional status and basic hygiene practices of rural school age children of Savar Region, Dhaka, Bangladesh. Cent Asian J Glob Health 2018;7:282.  Back to cited text no. 13
    
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Prevalence of Undernutrition and Associated Factors: A Cross-Sectional Study among Rural Adolescents in West Bengal, India. Available from: https://catalog.ihsn.org/index.php/citations/65885. [Last accessed on 2020 Mar 10].  Back to cited text no. 14
    
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Shah SM, Yousafzai M, Lakhani NB, Chotani RA, Nowshad G. Prevalence and correlates of diarrhea. Indian J Pediatr 2003;70:207-11.  Back to cited text no. 15
    
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Keusch GT, Fontaine O, Bhargava A, Boschi-Pinto C, Bhutta ZA, Gotuzzo E, et al. Diarrheal diseases. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al., editors. Disease Control Priorities in Developing Countries. 2nd ed. Washington (DC): World Bank; 2006. Available from: http://www.ncbi.nlm.nih.gov/books/NBK11764/. [Last accessed on 2020 Jun 08].  Back to cited text no. 16
    
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Freeman MC, Chard AN, Nikolay B, Garn JV, Okoyo C, Kihara J, et al. Associations between school- and household-level water, sanitation and hygiene conditions and soil-transmitted helminth infection among Kenyan school children. Parasit Vectors 2015;8:412.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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