CHAPTER ONE

INTRODUCTION

1.0 Background to the Study

Diseases is a major threat to man’s existence overtime and Man continues to do all within his
reach to understand how disease can be prevented, treated/managed. Diseases majorly are
classified as Communicable and Non-communicable diseases. Disease burden of Communicable
diseases in recent times continues to be on the rise. The increased burden of communicable
diseases among students due to poor personal hygiene practices amounts to a concern on the
public health agenda in developing countries.

School-based hand washing practice is a condition that ensures good health of the students and
teachers. School-based hand washing practices refer to the health care delivery system that is
operational within a school or college (Ghanim, Dash, Abdullah, Issa, Albarazi & Al Saheli,
2016). These practice aim at promoting and maintaining the health of students so as to give them
a good standing in life. In addition, this practice seeks to enable students benefit optimally from
their school learning experience. The purpose of the school-based hand washing practice which
is a sub set of school health services is to help students at school to achieve the maximum health
possible for them to obtain full benefit from their education.

School health services in the form of hand washing practice deal with health appraisals, health
education, control of communicable diseases, record keeping and supervision of the health of
students and personnel (Kuponiyi, Amoran & Kuponiyi, 2016). Students are particularly
vulnerable to neglect of basic personal hygiene like regular hand washing due to lack of
knowledge and practice (Vivas, Gelaye, Aboset, Kumie, Berhane & Williams, 2010). Poor
knowledge, practice of and attitudes (health education) to personal hygiene such as hand
washing play major roles in the high incidence of communicable diseases and therefore has
negative consequences for a student’s long term overall development (Sarkar, 2013).

Improved awareness (health education) and hand hygiene practices especially among children
have effectively reduced gastrointestinal and respiratory tract infections by up to 50% the two
leading causes of students’ morbidity and mortality around the world (Rabie & Curtis, 2016). In

1
addition, studies have also shown that school children with better knowledge and practices of
personal hygiene have fewer sick days and absenteeism in school and achieve higher grades
(Vivas et al., 2010). School is the place where health education regarding important aspects of
hygiene, environment and sanitation, as well as social customs is being imparted (Dongre,
Deshmukh, Boratne, Thaware & Garg, 2017).

Health is a key factor in school entry, as well as continued participation and attainment in school.
The teacher is the guardian of the student in school and plays a pivotal role in the whole process
of primordial prevention (Deb, Dutta, Dasgupta & Misra, 2010). Bearing in mind that students
have been consistently implicated in the spread of communicable diseases and that the school has
been recognized as a vital setting for health promotion (Varu, 2008) there is need to target the
study area. A well organized and properly executed school health programme like school-based
hand washing practice can be used to create safe environment for schools. This is to prevent
infectious diseases. Prevention of infectious diseases has become one of the daunting challenges
facing developing countries all over the world in varying degrees. One area of special concern is
the control of diseases in a school population where students live in very close proximity with
each other. One of the most important vehicles of transmission of diseases in such environment
is the hand, spelling the need for appropriate hand hygiene (Galiani, Gertler & Orsola-Vidal,
2012)
Hand washing arguably is the act of washing hands with plain or antimicrobial soap and water
and it is the single most preventive measure for reducing the spread of contagious diseases. In
fact skin is the body’s first line of defense against bacteria, therefore careful attention to hand
care is an essential part of the hand hygiene program.. The presence of dermatitis, cracks, cuts or
abrasions can trap bacteria and compromise hand hygiene (Core, 2002). In the developed climes,
according to Centre for Disease Control report estimates each year, nearly 2 million patients in
the United States get an infection in hospitals, and about 90,000 of these patients die as a result
of their infection. More widespread use of hand hygiene products that improve adherence to
recommended hand hygiene practices will promote patient safety and prevent infections (Core,
2002). The two biggest killers of children in the developing world today are diarrhea disease and
respiratory tract infections (Jennifer and Param, 2014), while the simple act of washing hands
with soap and water can cut diarrhea risk by almost half, and respiratory tract infection by a third

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(Jennifer and Param, 2014). There is improvement on morbidity and mortality rates but still
diarrheal diseases are responsible for 21% of all deaths and 2.5 million deaths per year which has
either direct or indirect relation with poor hand washing. In developing countries, there were 3.2
episodes of diarrhoea per child per year in children with mortality rate of 4.9 children per 1000
per year (Kosek et al., 2016).
Considering the above findings on the practice of hand-washing in developing countries Nigeria
inclusive. Researcher’s individual perception portrays the possibility of increase in the practice
of hand-washing practice among Adults and Children, specifically among secondary school
students in the study area putting into the consideration the current global pandemic of COVID-
19 but what the practice will be after the pandemic might not be ascertained. There are seems to
be dearth in empirical data as to what the current situation as regards hand washing practice
Knowledge, Attitudes, and Practice of adolescents, specifically those in Junior Secondary
Schools in Isolo area of Oshodi-Isolo Local Government area Lagos State.

1.1 Statement of Problem

The re-emergence of Communicable diseases such as Corona Virus, Ebola Virus and more
closely in recent times to our environment Lassa-fever poses a public health concern to all ages
in the country. Lassa fever, E;bola and more recently COVID-19 and other diseases have been
found to be prevented by proper hand-washing. One of the most effective and least disruptive
hygiene-promoting practice is hand washing. Hand washing, especially with soap under running
water, is considered to be one of the most cost-effective practice which can enhance personal
health and ultimately public health (Jamieson, Breman, Measham, Alleyne, Claeson, Evans,
Jhaet, 2016). Different studies have shown that hand washing is key in hygiene management in a
bid to reduce Morbidity and Mortality as a result of Communicable disease occurrence but there
seems to be paucity of empirical data of studies been carried out among Junior Secondary School
Students in Isolo area of Lagos State on Knowledge Attitude and Practice of Hand washing.
Hence, this study intends to consider knowledge Attitude and Practice of Junior Secondary
School Students on hand washing in the Isolo area of Oshodi-Isolo Local Government of Lagos
State.

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1.2 Main Objective of the Study

The main Objective of the study is to determine Knowledge, Attitude and Practice of Hand
washing among Junior Secondary School Students in Isolo area of Lagos State.

Specific Objectives

1. To find out What Junior Secondary School Students in Isolo area of Oshodi- Isolo Lagos
know about hand washing
2. To identify available hand washing equipment available in Junior Secondary School in
Isolo area of Oshodi - Isolo Lagos State
3. To determine the attitude of Junior Secondary School Students in Isolo area of Lagos
State on Hand washing
4. To Examine the Practice of Hand washing among Junior Secondary School Students in
Isolo area of Lagos State.
5. To ascertain factors affecting the personal hygiene practice of Junior Secondary School
Students in Isolo area of Lagos State

1.3 Research Questions

1. What do Junior Secondary School Students in Isolo area of Oshodi-Isolo Lagos know
about hand washing?
2. Is there available hand washing equipment in Junior Secondary Schools in Isolo area of
Oshodi-Isolo Lagos State?
3. What is the attitude of Junior Secondary School Students in Isolo area of Lagos State on
Hand washing?
4. What is the pattern of Practice of Hand washing among Junior Secondary School
Students in Isolo area of Lagos State?
5. What are the factors affecting the personal hygiene of Junior Secondary School Students
in Isolo area of Lagos State?

1.4 Significance of the study

Findings from this study may be made significant through online publication of study
outcomes which can enable Junior Secondary School Students in Isolo area of Lagos
State know about the state of hand washing practice, thereby serving as positive enforcer
of such behavior (hand washing practice) or stimulus for change in behavior. Findings
from this study may also serve as a guide to researchers and other knowledge seekers
who want to determine the present information available on hand washing among Junior
Secondary School students

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 This study may be considered significant as it will contribute to the body of knowledge in
the area of public health and specifically hand washing and its importance to health care
delivery in Nigeria.
1.5 Delimitation of Study

This study was delimited to the following

- Independent variable of Knowledge, Attitude and Practice
- Dependent variable of Hand washing
- Multistage sampling technique as sampling technique
- Test statistic of frequency count and Percentages

1.6 Limitation of the Study

Envisaged limitation of this study might be the sudden occurrence of COVID-19 global

pandemic which will delay the collection of data as proposed study locations and population

were placed on locked down by the Federal and State government and restrictions were placed

on movement hence, little could be done as regards data collection.

The non-readiness of Secondary School Students to fill research instrument after resumption

when they will be bombarded with backlog of academic work missed during the schools short-

down might not make them interested in attending to non-academic matters such as

questionnaire filling, but researcher is ready to persuade them with incentives such as

distribution of free writing pen to all participants.

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1.7 Definition of Terms

Attitude: This is a relatively enduring organization of belief around an object, subject, or

concept, which predisposes one to respond in some preferential manner.

Hand washing: Hand washing is the sequential act of washing hands with plain or
antimicrobial soap and water in other to achieve hygiene and prevent infection

Knowledge: This is defined as the expertise and skills acquired by a person through experience
or education with the ability to use it for a particular purpose.

Secondary school: A school that is intermediate in level between elementary school and college
that usually offers general, technical, vocational, or college preparatory curricula (The Free
Dictionary, 2013).

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 CHAPTER TWO

2.0 LITERATURE REVIEW

Introduction: This study in this chapter reviewed literature of concepts pertinent to the study

under the following sub-headings:

2.1 Conceptual framework

2.2 Theoretical framework: (Theory of Planned Behavior)

2.3 Conceptual Review

Definition hand-washing/hygiene

History of hand-washing

Benefits of hand-washing

Step of Hand washing

Personal Hygiene practices

Personal hygiene practices inclusive of hand washing and health

Factors that can affect secondary school students’ personal hygiene

2.4 Empirical Review

Assessment of hand-washing habits among school students aged 6–18 years

in Jordan

Knowledge, attitude and practice on hand washing and associated factors among public primary
schools children in Hosanna town, Southern Ethiopia

School-based hand washing practice and students' health in secondary schools in Obudu Local
Government Area of Cross River State, Nigeria

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2.1 CONCEPTUAL FRAMEWOEK OF KNOELDEGE ATTITUDE AND PRACTICE OF
HANDWASHING

INDEPENDENT VARIABLES

KNOWLEDGE OF SCHOOL DEPENDENT VARIABLE

CHILDREN

HAND WASHING
PRACTICE

ATTITUDE OF SCHOOL
CHILDREN

Researcher opines that students’ knowledge and attitude will ultimately lead to their hand
washing/hygiene practice

Source: Researcher developed 2020

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2.2 Theoretical framework: (Theory of Planned behavior)

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Theory of Planned behavior

The theory of planned behavior (abbreviated TPB) is a theory that links one's beliefs

and behavior. The theory states that intention toward attitude, subject norms, and perceived
behavioural control, together shape an individual's behavioural intentions and behaviours. In the
context of this study students hand washing behavior will be shape their knowledge and attitude.

The concept was proposed by Icek Ajzen to improve on the predictive power of the theory of
reasoned action by including perceived behavioural control(Ajzen, 1991).  It has been applied to
studies of the relations among beliefs, attitudes, behavioural intentions and behaviours in various
fields such as health care, advertising, public relations,   sport management and sustainability.

The model

Human behavior in the context of this study the behavior under observation is hand washing
behavior and it proposed by proponents of this theory that such behavior will is guided by three
kinds of consideration: behavioral beliefs of students, normative beliefs of students, and control
beliefs. In their respective aggregates, behavioral beliefs produce a favorable or unfavorable
attitude toward the behavior, normative beliefs result in a subjective norm, and control beliefs
gives rise to perceived behavioral control.

In combination, the attitude toward the behavior, the subjective norm, and the perceived
behavioral control lead to the formation of a behavioral intention (Ajzen, 2002). In particular,
perceived behavioral control is presumed not only to affect actual behavior directly, but also to
affect it indirectly through behavioral intention (Noar, Zimmerman, 2005).

As a general rule, the more favorable the attitude toward behavior and the subjective norm, and
the greater the perceived behavioral control, the stronger the person's intention to perform the
behavior should be. Finally, given a sufficient degree of actual control over the behavior, people
are expected to carry out their intentions when the opportunity arises (Ajzen, 2002).

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2.3 Conceptual review

Definition of Hand-Washing/Hygiene

Hand washing also known as hand hygiene, is the act of cleaning one's hands for the purpose of
removing soil, grease, microorganisms, or other unwanted substances.

Hand washing with soap consistently at certain "critical moments" during the day prevents the
spread of many diseases, for example diarrhea and cholera, which are transmitted through fecal–
oral route. People can also become infected with respiratory diseases such as influenza or the
common cold, for example, if they do not wash their hands before touching their eyes, nose, or
mouth (i.e., mucous membranes). The five critical moments during the day where washing hands
with soap is important include: before and after defecation, after cleaning a child's bottom or
changing nappies, before feeding a child, before eating and before and after preparing food or
handling raw meat, fish, or poultry (United Nations International Children Emergency Fund,
2020). If water and soap are not available, hands can be cleaned with ash (Unites State Agency
for International Development, 2014)

Medical hand hygiene refers to hygiene practices related to medical procedures. Hand washing

before administering medicine or medical care can prevent or minimize the spread of disease.
The main medical purpose of washing hands is to cleanse the hands of pathogens (bacteria,
viruses, or other microorganisms that can cause disease.) and chemicals which can cause harm or
diseases. This is especially important for people who handle food or work in the medical field,
but also an important practice for the general public.

Historical Overview of Hand washing

Religious hand washing rituals have been around for thousands of years in Islamic, Jewish and
other cultures, but the notion of disease spreading by hand has been part of the medical belief
system for only about 130 years (Amy, 2020).However, the first recorded discovery of hand
washing’s life-saving power came 50 years earlier, in 1848, as a huge, unwelcome shock. “If
there had to be a father of hand washing it would be Ignaz Semmelweis,” says Miryam
Wahrman, a professor of biology at William Paterson University in New Jersey and author of
The Hand Book: Surviving in a Germ-Filled World(Amy, 2020). While working at Vienna

11
General Hospital, the Hungarian doctor was at the forefront of a more scientific approach to
medicine (Amy, 2020). Faced with a doctor-led maternity ward in which maternal deaths from
the dreaded childbed fever were significantly higher than in the midwife-run clinic there, he
racked his brain for clues as to why

Germs were yet to be discovered, and it was still believed in the 1840s that disease was spread
by miasma – bad smells in the air – emanating from rotting corpses, sewage or vegetation.
Victorians kept their windows firmly shut against such malevolent forces. So it didn’t seem a
problem that trainee doctors at Vienna General would hang out in the morgue dissecting corpses
to figure out what had rendered them dead and then pop up to the maternity ward to deliver a
baby without washing their hands (Amy, 2020). One of them then accidentally got cut by a
scalpel during a dissection and died, seemingly of the same childbed fever the mothers had been
getting. Semmelweis hypothesised that cadaverous particles from the morgue were to blame, and
that such particles on the hands of doctors were making their way into women’s bodies during
childbirth (Amy, 2020).

To test his theory, he ordered doctors to wash their hands and instruments in a chlorine solution,
a substance he hoped would dispatch the deadly smell of cadaverous particles. Before the
experiment, says Wahrman, “the mortality rate for new mothers was as high as 18%. After
Semmelweis implemented hand hygiene between the morgue and the delivery room, the rate of
mortality for new mothers dropped to about 1%(Amy, 2020).” Despite his success, his idea faced
great resistance, and met a tragic end. He lost his job, and is thought to have had a breakdown.
He died in a psychiatric institution, “a very despondent person at the untimely age of 47”, says
Wahrman. Part of the problem, says Tomes, was that people, “didn’t have that conception of
themselves as sort of walking petri dishes”. And doctors were offended by the suggestion that
they could be causing infections. “The majority of doctors in Vienna at this time were from
middle- or upper-class families, and they thought of themselves as very clean people compared
with the working-class poor. He was insulting them when he said their hands could be dirty
(Amy, 2020)”.

Over the next 40 years, an understanding of germs developed, and attitudes to hygiene gradually
shifted. In 1857, while Semmelweis’s mental health declined, Louis Pasteur, of pasteurization

12
fame, raised awareness of pathogens, and how to kill them with heat. In 1876, the German
scientist Robert Koch discovered the anthrax bacillus, kicking off the new research field of
medical bacteriology. Cholera, tuberculosis, diphtheria and typhoid bacilli were subsequently
identified (Amy, 2020).

Surgeons started hand washing in earnest. Tomes says: “If you’re cutting open someone’s skin –
that protective layer – you need to take extraordinary precautions.” The British surgeon Joseph
Lister pioneered antiseptic surgery, which included hand washing, “and by the 1890s and into the
early 1900s,” adds Tomes, “hand washing moved from being something doctors did to
something everybody had been told to do”.

Benefits of Hand washing

Hand washing has many health benefits, including minimizing the spread of influenza, flu virus,
and other infectious diseases (Cowling, 2009) preventing infectious causes of diarrhea(Luby,
Agboatwalla, John, Altaf, Billhimer, Keswick, Hoekstra, Robert, 2006), decreasing respiratory
infections and reducing infant mortality rate at home birth deliveries (Rhee, Mullany, Khatry,
Katz, Leclerq, Darmstadt, Tielsch, 2008). A 2013 study showed that improved hand washing
practices may lead to small improvements in the length growth in children under five years of
age. 

In developing countries, childhood mortality rates related to respiratory and diarrheal

diseases can be reduced by introducing simple behavioral changes, such as hand washing with
soap. This simple action can reduce the rate of mortality from these diseases by almost 50%
(Curtis, Cairncross, 2003).Interventions that promote hand washing can reduce diarrhoea
episodes by about a third, and this is comparable to providing clean water in low income areas.
48% of reductions in diarrhoea episodes can be associated with hand washing with soap
(Cairncross, Hunt, Boisson, Bostoen, Curtis, Fung, Schmidt, 2010). 

Hand washing with soap is the single most effective and inexpensive way to prevent diarrhea and
acute respiratory infections (ARI), as automatic behavior performed in homes, schools, and
communities worldwide. Pneumonia, a major ARI, is the number one cause of mortality among
children under five years old, taking the lives of an estimated 1.8 million children per year.
Diarrhea and pneumonia together account for almost 3.5 million child deaths annuall(UNICEF,

13
2012).  According to UNICEF, turning hand washing with soap before eating and after using the
toilet into an ingrained habit can save more lives than any single vaccine or medical intervention,
cutting deaths from diarrhea by almost half and deaths from acute respiratory infections by one-
quarter. Hand washing is usually integrated together with other sanitation interventions as part of
water, sanitation and hygiene (WASH) programmes. Hand washing also protects
against impetigo which is transmitted through direct physical contact(National Health Survey,
2020)

Types of Hand washing technique

Soap and Water Hand washing

Correct hand washing technique recommended by the US Centers for Disease Control for
prevention of transmission of disease includes the following steps (CDC, 2019).

1. Wet hands with warm or cold running water. Running water is recommended because
standing basins may be contaminated, while the temperature of the water does not seem
to make a difference
2. Lather hands by rubbing them with a generous amount of soap, including the backs of
hands, between fingers, and under nails.  Soap lifts germs from the skin, and studies
show that people tend to wash their hands more thoroughly when soap is used rather than
water alone.
3. Scrub for at least 20 seconds. Scrubbing creates friction, which helps remove germs from
skin, and scrubbing for longer periods removes more germs.
4. Rinse well under running water. Rinsing in a basin can re-contaminate hands.
5. Dry with a clean towel or allow to air dry. Wet and moist hands are more easily re-
contaminated.

The most commonly missed areas are the thumb, the wrist, the areas between the fingers, and
under fingernails. Artificial nails and chipped nail polish may harbor microorganisms.
Moisturizing lotion is often recommended to keep the hands from drying out; dry skin can lead
to skin damage which can increase the risk for the transmission of infection.

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Low-cost options when water is scarce

Various low-cost options can be made to facilitate hand washing where tap-water and/or soap is
not available e.g. pouring water from a hanging jerry can or gourd with suitable holes and/or
using ash if needed in developing countries (USAID, 2015).

In situations with limited water supply (such as schools or rural areas in developing countries),
there are water-conserving solutions, such as "tippy-taps" and other low-cost options (Morgan,
2011). A tippy-tap is a simple technology using a jug suspended by a rope, and a foot-operated
lever to pour a small amount of water over the hands and a bar of soap.

Drying with towels or hand driers

Effective drying of the hands is an essential part of the hand hygiene process, but there is some
debate over the most effective form of drying in public washrooms. A growing volume of
research suggests paper towels are much more hygienic than the electric hand dryers found in
many washrooms.

In 2008, a study was conducted by the University of Westminster, London, and sponsored by the
paper-towel industry the European Tissue Symposium, to compare the levels of hygiene offered
by paper towels, warm-air hand dryers and the more modern jet-air hand dryers. The key findings
were:

 After washing and drying hands with the warm-air dryer, the total number of bacteria was
found to increase on average on the finger pads by 194% and on the palms by 254%.
 Drying with the jet-air dryer resulted in an increase on average of the total number of
bacteria on the finger pads by 42% and on the palms by 15%.
 After washing and drying hands with a paper towel, the total number of bacteria was
reduced on average on the finger pads by up to 76% and on the palms by up to 77%.

The scientists also carried out tests to establish whether there was the potential for cross
contamination of other washroom users and the washroom environment as a result of each type
of drying method. They found that:

 The jet-air dryer, which blows air out of the unit at claimed speeds of 180 m/s (650 km/h;
400 mph), was capable of blowing micro-organisms from the hands and the unit and

15
 potentially contaminating other washroom users and the washroom environment up to 2
metres away.
 Use of a warm-air hand dryer spread micro-organisms up to 0.25 metres from the dryer.
 Paper towels showed no significant spread of micro-organisms.

Personal Hygiene Practices inclusive of Hand Hygiene

Personal Hygiene involves personal grooming that deals with maintenance of good personal and

public appearance (Nardo, 2015). In a study done by Purdue University in 1993, it was reported

that some children who followed a rigorous hand-washing plan greatly reduced their number of

colds (Begum, 2000). Hygiene behaviors that can prevent the transmission of water and

sanitation related diseases are numerous and varied and reflect a variety of mechanisms for

interrupting disease transmissions (Bateman, 2015). Among these are hand-washing, food

hygiene, not sharing personal effects with others, vector control, daily bathing and proper care of

the different parts of the body. Children and youth tend to respond better than do older people to

health education in the development of desirable attitudes and desirable health practices.

Therefore, the earlier that an individual learns the elements of healthful living, the more likely it

is that they will be applied (Leonard, 2014). Personal hygiene practices of the students in private

secondary schools will likely be better than those in the public secondary schools due to the fact

that the facilities in the public schools are not enough and adequate. This means that investment

in schooling should be improved and expanded (Nutbeam, 2015). A study of behavioural factors

can be carried out more quickly and much more cheaply than a health impact study, and its

results would offer power to diagnose problems in an existing programme (Datko, 2014). A

programme was organized by Glaxo Smithkline in 1998. It is a simple hand washing programme

that helps to save lives. It was initiated by GSK after identifying personal hygiene and sanitation

16
as a neglected health education priority. The aim of the programme was to reduce diarrhoea

related disease associated with poor hygiene, and to improve children overall health and well-

being – a goal that fits perfectly with that of save the children‘s School Health and Nutrition

Programme. (Save the children‘s lives, 2014). The promotion of hygiene is another integral

component of environmental health activities and is often included as the third part of any water

and sanitation programme. It is widely recognized that the promotion of hygiene practice must

be included alongside the provision of clean water and excreta disposal (Cairncross and Vijah,

2003). Various studies have shown that wealth, education and hygiene consciousness/practices

are associated with a 20 lower incidence of disease. Hence those having water and sanitation

facilities will tend to have less disease. Many studies tend to support the view that water and

sanitation can reduce the incidence of diarrhoea by about 25%. Water supply and sanitation can

almost eliminate guinea worm (White, Snow, and Kim, 2008).

Personal hygiene practices inclusive of hand washing and health

Each part of the body needs adequate care to ensure wholesome health. As defined by WHO in

1948, health is a state of physical, social, emotional and mental well-being, not merely the

absence of diseases. So many gastro intestinal diseases like diarrhoea, dysentery, typhoid and

cholera can be prevented through personal hygiene (Lucas and Gilles, 2012).Others are urinary

tract infections, pin worms, impetigo, boil, ringworm, allergic reactions, body louse, ticks, black

hairy tongue, trachoma, cystitis thrush, colds, helminthic infestations and athletes foot (Lucas

and Gilles, 2012). The hair requires great care. It is necessary to wash the hair daily or at least

once in a week with soap and water for those styling it. Care needs to be taken on type of hair

shampoo used to prevent allergic reactions. Brushing the hair with a soft bristled brush 3 or 4

times a day can be of help. The scalp should be oiled once a week to prevent it from getting dry.

17
Those involved with sports should endeavour to wash the hair after practice and games,

especially for those with oily hair. Chemical treatment on the hair can also harm the hair when

not used properly. As with the rest of the body, the hair is healthiest when the right type of food

is eaten (Better health channel, 2015) .

The human head has numerous hairs; each hair shaft has three layers, with cuticle or outside

layer protecting the two inner layers. Shining hair is a sign of good hair care because the layers

of the cuticle lie flat and reflect light. When the scales of the cuticle lie flat they overlap tightly,

the inner layers are well protected from the sun, heat, chlorine and all other hazards that come

from living in the environment. A number of health problems can arise due to poor hair hygiene.

Such diseases conditions include head lice, dandruff and seborrhoea (Victoria State, Department

of Health, 2015). The eyes also need to be taken perfect care of as it is a sensitive part of the

body despite its size. Protecting the eyes will prolong its usage.

The human eye is the organ which gives the sense of sight, allowing people to observe and learn

more about the surrounding world. As one gets older the ciliary muscles become weakened as

well as lessening of flexibility of the crystalline lens occurs causing presbyopia. It is also referred

to as the inability of the eye to adjust for near vision and properly fitted reading glasses will

solve the problem (Parks, 2011). Some students may find it difficult to cope when they are

suffering from myopia and they are placed far away from the chalkboard. It is therefore essential

for teachers to detect early students having such defects so that it can be corrected in time. Even

people with normal vision need eye examination to screen for diseases and infection and changes

in vision (Montgomery, 2008). The various ways of taking care of the eyes include

18
preventing foreign objects like chemicals and dust from entering the eyes, avoiding trauma to

the eyes and desisting from the use contaminated article in cleaning the eye (Parks, 2011).

Too much use of cosmetics may provoke allergic reactions in some cases. Taking food rich

in vitamin A and yeast promotes optical health (Health facts, 2014). Another part of the body

which requires routine personal hygiene practices is the ear. The ear is a delicate irreplaceable

organ which requires a high level of care. There are a number of ear related practices which

should be avoided and these include picking or fiddling with the ear with objects like hair grips,

matchsticks or nail files which can harm the otitis media (WHO, 2015).

The use of cotton buds to clean the ear is not necessary because the ear has naturally self-

cleansing potentials. Rather than doing this, it is better to have regular hearing tests under a

specialist examination to check for hearing loss or other disorders; this is a practice that should

be adopted. Cerumen or ear wax can accumulate in the ear canal, as the ear secretions come out

of the ear, daily wash with soap and water is enough to keep the outer ear clean (Web Health

Centre, 2015). It should be noted that children who lose their hearing faculty from infancy find it

difficult to speak properly, and could even become unable to speak.

It is therefore, necessary to keep the external organs of the ear clean and to protect the internal

ear from injury (UNICEF, 2013). The other ear-related health promoting practices that should be

adopted include visiting the medical personnel once an injury, pain or an abnormal change is

experienced in the ear. Cleaning the ear with care, and not putting anything smaller than an adult

finger in the ear and avoidance of loud noise is also of value (UNICEF, 2013). The nose

facilitates breathing; it is an organ for smelling (Olabisi, 2012). The nose is also used to detect

19
the odour of different things. In order to prevent air-borne infections, a clean tissue or

handkerchief should be used to cover the mouth and nostrils when sneezing or yawning. The

nose should be lubricated with Vaseline or olive oil to prevent dryness and breaking of the

mucosal lining (Olabisi, 2012). It is necessary to breathe through the nose; probing the nose with

fingers or any dirty object should be avoided. Clean handkerchief or tissue should be used to

clean the nose and this should not be too often. Overcrowding and exposure to smoke and

pollutants may affect the respiratory system (UNICEF, 2014).

Oral health care is an important component of general health care (BHC, 2015). If not cared for,

oral health problems arise, for instance the combination of bacteria in the mouth, sugar in the

diet, and susceptible teeth lead to decay/cavities, gum disease and sometimes loss of the teeth

(Loochtan, 2013). Dental caries, periodontal diseases, dental calculus and malocclusion are the

main diseases of the oral cavity (Moronkola and Okanlawon, 2003). Dental caries is caused by

progressive destruction of the teeth by the plaque acid. Bacteria on the teeth surface metabolising

dietary sugars generate this acid. The plaque holds the acid in direct contact with the tooth

surface (Loochtan, 2013). Gum disease can also be referred to as periodontal disease which is

common among people with poor oral health care practices (Loochtan, 2013).

Gum disease occurs when bacteria eat away at gum tissue, causing it to pull away from the teeth.

This space between the tooth and gum is called a periodontal pocket which traps even more

bacteria. Gingivitis, the first stage of gum disease is manifested by swollen gums, bleeding and

inflammation (National Institute of Health (NIH), 2012). The teeth and mouth must be brushed

correctly after every meal or at least twice in a day; that is first thing in the morning and the last

20
thing at night before going to bed since brushing removes plaque. When bacteria in plaque come

into contact with food, they produce acids. Those acids lead to cavities (UNICEF, 2013). In

order to promote good oral health, the tooth-brush should be replaced every 3-4 months and

tooth-brush should never be shared with others (Victoria State, Department of Health, 2013). The

skin is an important organ and should be well kept; it contains millions of sweat glands (Johnson,

2015). These glands produce three quarts to one pint of sweat each day. In tropical countries

more sweat is produced and the perspiration increases with an increase in physical exertion or

nervous tension.

An offensive smell is caused when bacteria that are present on the skin get to work on the sweat

and decompose it. This is especially so in the groin under arms, feet or in the clothing that has

absorbed sweat (WHO, 2015). Certain body creams and soaps can cause allergic reactions to the

users. Some deodorants and soaps too can cause allergy. This comes in form of rashes and

auticaria on the body. Acute allergic dermatitis is the most common dermatological disease in

the primary care clinic. Swelling and itching of the eyelids and genitals should suggest a

diagnosis of contact dermatitis (Derrick, 2008). It is necessary for students not to use any kind of

body cream or cosmetics that comes their way. Students are expected to take bath at least once or

twice a day using soap, sponge and plenty of water.

A mild soap can be used, not necessarily antiseptic soap; back brushes may be used. It is

necessary to always bath after any strenuous physical activity (Victoria State, Department of

Health, Australia, 2013). The different types of worms that can affect students with poor

personal hygiene practices include ascariasis, hookworm and tapeworm and this can occur when

eggs get ingested through eating of contaminated foods or drinking contaminated water with the

21
eggs of ascariasis lumbricoides. Hookworm affects people who work barefooted especially in the

farms having necanor americanus. This can pass into the soil due to indiscriminate passing of

faeces (WHO, 2008). Gastro intestinal diseases occur as a result of food contamination and

contamination of water. They can also occur through contaminated fingers when hygiene is poor

or indirectly through contaminated, food, milk, flies and articles of daily use. Poor personal

hygiene-related diseases include cholera, diarrhoea, hepatitis A, poliomyelitis, salmonellosis and

typhoid (Parks, 2011).

Hand washing with soap and water is pivotal to the prevention and control of several

communicable diseases. Hands should be washed before preparing meals and after every meal.

In order to prevent diseases contacted through feaco-oral routes, hands must be washed with

water and soap after visiting the toilet and urinals (Better Health Channel, 2015). Proper hand

washing include the following actions: Washing hands with warm running water and applying

liquid or clean bar soap, running one‘s hands vigorously together for at least 15-20 seconds,

scrubbing all surfaces including the back of one‘s hands, rinsing one‘s hands and drying hands

with a clean disposable towel (FDA, 2009).

Personal hygiene includes proper care of the feet. Good feet hygiene can prevent fungal

infections, warts, hammertoes and hookworms (WHO, 2008). Keeping the feet clean and dry can

help prevent foot odour and fungal infection. In addition, feet should be washed daily with water

and soap while wearing of tight socks and shoes should be avoided (WHO, 2008). According to

WHO (2008), long nails should be avoided as much as possible and teeth should not be used to

cut nails. Personal clippers or new blades are preferred for cutting nails. Good personal hygiene

22
among students includes proper care of one‘s clothes, uniforms, underwears, towels and

handkerchiefs (Nardo, 2013).

Factors that can affect secondary school students’ personal hygiene

Provision of personal hygiene facilities and materials is an important factor that can promote

students‘ Personal Hygiene and this is the responsibility of the parents, school and the

community. Students should have access to materials needed on personal hygiene. Students need

various materials in the school as well as in the home before they can effectively carry out

personal hygiene. In the school, these materials are needed - a good restroom, portable and

regular water supply for drinking and washing of hands and other items, personal plates, cups

and spoons, water bottles, towels or napkins and a neat and decent environment.

There should also be a recreational centre or playground that is safe and neat for the students

(BHC, 2015). The expert Committee established by WHO to work on school health programmes

gave a vision of the future of school health programmes. This is one in which the schools around

the globe place healthy human development at the core of their mission and use all their

resources to achieve this goal (WHO, 1990). Organizations can be identified that can support and

assist in provision of the personal hygiene materials for students. It is important to discover those

areas of focus that will bring greatest benefit in public health. In most of the health studies where

a significant impact was found, the provision of water supply or sanitation has been accompanied

by improvement in hygiene. Hygiene may be promoted by better access to water and sanitation

(WHO, 2015). A safe learning environment for students and a safe working environment for staff

are essential. This includes provision of safe water and sanitary facilities. Provision of school

23
clinics, safe and nutritious food and micronutrients to combat hunger and disease is also an

important factor in promoting personal hygiene of students (Nutbeam, 2015). In developing

countries, preventable water related diseases affect the lives of the poor. Diseases resulting from

poor personal hygiene rank among the leading causes of illhealth. Much of this suffering is

needless because health provides an effective gateway for development and poverty alleviation

(WHO 2015). So many diseases and deaths can be prevented through simple, inexpensive

measures.

For example, trachoma remains the leading cause of preventable blindness; accounting for 146

million acute cases around the world and can be prevented through personal hygiene. It is

essential that simple, safe and cost efficient and cost effective measures are integrated into

diseases‘ control globally thereby enabling the rural poor to live healthier lives. Where water is

always available it will promote personal hygiene and ability to have control over one‘s health.

But diseases are almost unheard of in places where basic water supply and adequate sanitation to

protect health are among basic human rights (WHO, 2015).

Studies have shown that school attendance by girls increases when separate latrines for boys and

girls are installed. In a school in Bangladesh where UNICEF began promoting separate facilities

in 1992 girls‘school attendance has risen by an average of 11.0% per year. Maintaining a high

level of hygiene will help to increase self-esteem and confidence while minimizing the chances

of developing imperfections (WHO, 2015). Lack of water and sanitation provides means for

feaco-oral diseases to thrive (Park, 2011). It has been noted that where a community improve its

water supply, hygiene, and / or sanitation then health improves (Ghose et al, 2012). Deaths as a

result of diarrhoea can be prevented through the adoption of personal hygiene and basic

24
sanitation ( Esrey, Potash, Roberts, & Sciff, 1990). The simple act of washing hands with soap

and water destroys different microbes causing diarrhoea diseases by 35.0% (Batram, 2015). The

use of soap and water for personal hygiene helps prevent trachoma and scabies. Washing fruits

and vegetables with good quality water is a recipe for good health (Lucas and Gilles, 2012). In

secondary schools, water supply will be an essential factor in the students’ forming good

personal hygiene habits which can last for a lifetime.

A study of water and sewage facilities conducted by Health Canada and the Department of

Indian Affairs examined 863 First Nations community water treatment systems and 425

community sewage-treatment systems. It found that vast improvements in health, leading to

economic development and poverty reduction, could be achieved by providing native

communities with a good water supply and sanitation (WHO, 2014). Parents can rise up to the

occasion to provide deep wells for schools that are not having good water supply. Good hygienic

habits are easy to adopt and maintain only if all the necessary materials are available.

Failure to protect water and food from contamination by faecal matter and ingesting such can

cause infections (WHO, 2015). Contamination of food and water can be prevented through good

personal hygiene. When the supply of water in homes and schools is adequate and of good

quality, students will be able to take their bath easily, clean their teeth, wash their hands and hair

as at when necessary. In controlling strong odour, students have to wash daily, when they have

carried out any dirty job they should remove the fluid that is emitted from the apocrine glands

with the aid of a mild or antiseptic soap. These fluids are located under the arms, around the

genitals. (Leonard, 2014) Large numbers of both urban and rural schools and health centres lack

25
access to facilities that can promote personal hygiene (Agbhaji, 2014). These days in Nigeria,

pipeborne water is not a common sight. However, several simple interventions had been made

available, such as improving the quality of water in the home as well as improving hygiene

education at the household level. Poor people can take charge of their own destinies and improve

their lives by applying some of these measures (Brundtland, 2015). But they need to know what

works and how such interventions can be exploited. Federal Ministry of Education, Nigeria

(2006) in National School Health Policy emphasises the prevention and control of communicable

and non-communicable diseases, through inspections, exclusions, educational measures,

immunization, sanitation and epidemic control.

Each school building should be in line with approved standards of sanitation. The major

conditions required for healthful school environment include: location of schools away from

potential environmental hazards, protection of the school community from excessive noise, heat,

cold and dampness, provision of adequate buildings, constructed in line with approved standards,

with particular emphasis on facilities for physically challenged learners and provision of an

appropriate and adequate amount of furniture for learners and staff. (FMOE, 2006). Part of the

School educational policies include but not limited to provision of an adequate number of

gender-sensitive toilet facilities, provision of adequate safe water supply and sanitation facilities

for the school community, provision of proper drainage and waste disposal facilities provision of

safe recreational and sport facilities, perimeter fencing of the school, observation of Annual

School Health Days, promotion of healthy human relationships in the school community,

promotion of health related-school policies, promotion of a maintenance culture ( National

Policy on Education (NPE), 2006). World Water Day, celebrated on 22nd March, became an

26
annual event after the 1992 Earth Summit in Rio de Janeiro, Brazil, and brought home to

millions of people the importance of cherishing a valuable resource which affects our very

existence. The theme for 2001, Water and Health, highlights the opportunities for promoting

health and development through safe water. People everywhere can use this day to raise

awareness of the high level of disease and misery that results from bad and inadequate water

sources. People can learn that they need not be victims, but can take matters into their own hands

to create good, clean water for better health (WHO, 2015). All external parts of the body need

attention, time and care and water plays a major role in ensuring this.

To achieve international development target of halving the proportion of people without access

to improved water and sanitation by 2015, 1.5 billion people will require access to water supply

and about 2.2 billion people will require access to sanitation facilities (WHO, 2015). Other basic

facilities needed in the schools include decent classrooms, water closet toilets, dustbins, water

bowls, soaps, disinfectants, deodorants, tissue papers, good play grounds, napkins, incinerators

(UNICEF, 2008). A variety of resources are needed in the home by students to enable them

practice personal hygiene. These include the following: uniforms, shoes, clothes, toothbrushes

and toothpastes, body cream, deodorant, disinfectants, hair cream, oil, restrooms soap

forwashing hands, underwears, towels, nails cutters, bathrooms, iron, personal plates, spoons and

cups. In addition to appropriate information provided by schools, parents should make all these

materials available to them. Despite the fact that a student has appropriate information from the

school, there is still the need to have all the materials and facilities needed to promote his

personal hygiene at home. Students need materials like toothbrushes, soap, toothpastes,

uniforms, shoes, socks and other items for good grooming (Beth and Jones, 2014). A child‘s first

27
contact is the parents. The life style of parents influences the lifestyle of the child therefore if

they value personal hygiene, the child will also grow up to do the same. The attention given to

the child as he/she grows up can affect his/her way of life. When the parents endeavour to

inculcate good health values into the child, as well as providing personal hygiene facilities, he/

she is bound to practice it.

There is the need for the community to contribute its quota in the promotion of the health of

students. Communities are at the centre and recipient of many of these changes. Their active

participation plays an essential role in promoting and protecting health as we move into the 21 st

century (Glaxosmithkline, 2007). For instance in Ghana, over 425 girls in about 20 communities

aged between 13 and 20 have each received a hygiene kit made available by the Christian

Children‘s Fund of Canada (CCFC), a Canadian based registered charity and child centred

international development organization. The aim of the hygiene kit is to increase personal

hygiene practice among teenage girls in primary school, junior and senior high schools and

increase awareness of proper hygiene behaviour among teenage girls within the CCFCs

operational areas (CCFC, 2007).

This action is encouraged, to be performed by communities especially in Africa. We can no

longer afford to ignore the concerns and needs of students, especially those specific health

problems which students face. Health is created by caring for oneself and others by being able to

take decisions and have control over one‘s life circumstances and by ensuring that the society

one lives in creates conditions that allow the attainment of health by all of its members. Health is

nurtured in the family, the school and in the community as a whole (Beth et al, 2014).

Communities can play an active role in supplying certain expendable materials for students like

28
toothbrushes, toothpastes, soaps, body creams, towels and socks especially where there is lack of

such things. Health education can advocate for the provision of toilets and urinals, classrooms,

decent play-ground and environment. They can also create awareness on different ways students

can improve their personal hygiene. (Glazosmithkleen, 2007)

2.4 Empirical Review

Considering past relative studies in the areas of hand washing among students, a study on

Assessment of hand-washing habits among school students aged 6–18 years which was carried

out in Jordan by (Mohamed, 2017). This study was conducted to investigate the hand-washing

habits among primary and secondary public school students aged 6–18 years in the north Jordan

governorate of Mafraq. It was the first in-depth study of this kind to shed light on this habit in

Jordan. In the current study, only 68.5% of the school students washed their hands with soap and

water and less than a fifth used disinfectant substances relatively, in a hand-washing survey in

Turkey in 2012, it was found that just over half the population washed their hands with soap

(General Directorate of Health Promotion, Ministry of Health of Turkey, 2012).

The findings show that different proportions of school students always washed their hands in

different situations: 86.7% after using the toilet, 84.4% after touching rubbish, 81.7% when their

hands were dirty, and 55.4% before eating. Worldwide, the figures differ. Halder et al (2010), in

their study in Bangladesh, found that nearly 70% of the students washed their hands after using

the toilet, 87.3% before eating and 83.2% when their hands became dirty. In other countries, the

frequency of hand-washing before meals ranged from 35% to 80% (Aunger et al, 2009; Ray et

al, 2006; Ray et al, 2009; Jeong et, 2007). In the current study, findings showed that systematic

hand-washing after using the toilet was higher among girls (91.6%) than boys (81.8%) with

29
statistically significant differences. Furthermore, these habits increased with age (78.3% among

the 6–8 age group, compared to 95.9% among those aged 16–18). These results compare

favourably to some other studies conducted in Africa (Sarkar, 2013; Ahmadu et al, 2013; Oyibo,

2012) and India (Vivas et al, 2010). One possible explanation for the higher proportion of girls

could be a greater concern for personal appearance and being seen as role models (ALBashtawy

et al, 2015). Several studies found that the score for hygiene among girls is higher than for boys

(ALBashtawy et al, 2016; ALBashtawy, 2014; Garbutt et al, 2007; Jeong et al, 2007; Luby et al,

2005). Improved hand-washing as they grow older may be explained by students becoming more

independent and better able to achieve personal hygiene by themselves, together with greater

awareness during their growth and development, and sharing new knowledge and practice from

the school, teachers, friends and their families (ALBashtawy et al, 2015; ALBashtawy et al,

2014; Ahmadu et al, 2013).

This current study also cited Ahmadu et al (2013) in Nigeria who revealed that general hygiene

among school children was 74.0%, and that personal hygiene in general improved as the children

became older. In the current study, the main sources of encouragement regarding basic hand-

washing are family and school teachers, followed by friends. This emphasises the essential role

of parents and schools in teaching children about basic personal hygiene, including hand-

washing. Lopez-Quintero et al (2009), in their study in Colombia, revealed that the most reported

sources of information regarding hand-washing were parents (88.5%), followed by teachers

(66.7%). Health-care providers, parents, school nurses and school staff can play a crucial part as

role models. Families, parents and teachers are likely to transmit their attitude towards hygiene

and their practices to their offspring and students (ALBashtawy, 2014; Vivas et al, 2010;

Ahmadu et al, 2013; Oyibo, 2012; Lopez-Quintero et al, 2009). In the current study, hand-

30
washing was found to improve with the increased level of parents’ education. This may be

explained by the fact that the level of education is one of the basic determinants of a family’s

socio-economic, income and professional levels (ALBashtawy, 2014; Al-ghzawi et al, 2014;

General Directorate of Health Promotion, Ministry of Health of Turkey, 2012; Luby, 2008;

Ocaktan et al, 2010 ). Several studies showed that there is a significant relationship between

parents’ level of education and their socioeconomic position, and hand-washing practice (Dongre

et al, 2006; Luby, 2008; Ocaktan et al, 2010; Moussa et al, 2015).

Sufficient hand-washing facilities should be easily available and accessible to all school students,

taking into account the number of students in each school. In the current study the students

reported many reasons for not washing their hands: 70.8% reported ‘no need’ to do so, 82.3%

said that the facilities were not clean, and nearly a third commented that soap and the washing

facilities were not easily accessible. Lopez- Quintero (2009) concluded that many developing

countries reported a lack of water and soap in their schools. However, Afroza (2007) stated that

water, soap and hand-washing facilities were found in the majority of schools.

The logistic regression analysis showed that the number of students ‘always washing hands after

using the toilet’ is higher among urban students (89.3%) than rural ones (84.1%). These results

are congruent with other studies carried out worldwide (General Directorate of Health

Promotion, Ministry of Health of Turkey, 2012; Ray, 2006; Paliwal et al, 2014). The findings of

this study suggest a need for easy and clear materials for teaching hand-washing to students’

mthrough many parts of the school curriculum. Moreover, health-promotion programmes by

school nurses and health providers to raise the knowledge, attitude and practices of the students

31
and their families regarding basic personal hygiene and effective hand-washing should be

developed and implemented (Assefa and Kumie, 2014; AlAzzam et al, 2016; ALBashtawy et al,

2016; LBashtawy, 2014; Dube and January, 2012; Khamaiseh and ALBashtawy, 2015;

Tawalbeh et al, 2015).

Another study in an African country on Knowledge, attitude and practice on hand washing and

associated factors among public primary schools children in Hosanna town, Southern Ethiopia

by (Besha, Guche, Chare , Amare, Kassahun , et al. 2016) . A total of 246 school children were

recruited from the school giving a response rate of 97%. From the total students who participated

(239) in this study 116 (48.5%) are males and 123 (51.5%) are females with mean age of11.66

years. Majority of the respondents’ families (160, 66.9%) were protestant religion followers

whereas 17.2, 12.6 and 3.3% were Orthodox, Muslim and other religion followers respectively.

The global hand washing day as a movement is a critical initiative; it is a source of information

and enhances knowledge of individuals on practice of hand washing.

Information on global hand washing day but only 3 reported the exact month in which global

hand washing day is celebrated. Benefit of washing their hands using clean water and soap was

reported by 108 (45.2%), 83 (34.7%), and 39 (16.3%) to promote health, prevent transmission of

disease and to be beautiful respectively (Table 2). Based on the specific responses by the

participant students, over all 167(69.8%) and 72 (30.1%) students had good and poor knowledge

respectively. Factors that affect level of knowledge primarily, variables that had p-value <0.2

at bivariate analysis were used to develop logistic model in order to identify factors which are

more strongly linked with the outcome knowledge. On multivariate logistic regression,

educational status of mother and grade of student were found to be significantly associated to

32
knowledge toward hand washing. The likelihood students in 2nd cycle are 8 times [AOR, 9.099;

95% CI (4.36 .17.36)] more likely to have good knowledge on hand washing than those students

in first cycle.

Attitude towards hand washing among the participant students, 222 (92.9%) and17 (7.1%) said

that it is their own and their parents’ responsibility to wash their hands respectively. Based on six

questions/scale to measure the attitude towards hand washing, 142 (59.4%) and 97 (40.6%) had

positive and negative attitude respectively. There is no statistically significant association with

different socio demographic variables and attitude towards hand washing.

Practice of hand washing; out of the total respondents, 237(99.2%) washed their hands in the

morning of the interview day and only two students failed to wash their hands because they were

aroused from their sleep. From those who have washed their hands in the morning of the

interview day, about 204 (85.4%) reported the use of soap and the remaining 33 (13.8%) used

water only to wash their hands. Water and soap (188, 78.7%) are more used in the families of

students to wash their hands followed by water only (50, 20.9%). The usage of soap is elaborated

in the following bar graph before and after some activities. Overall, 172 (71.97%) of the students

had good practice and 67 (28.03%) had poor practice toward hand Washing. From those factors

that affect practice of elementary school children area of sex and grade of students are among the

major ones. More Closely to the study location is another study carried out here in Nigeria on

School-based hand washing practice and students' health in secondary schools in Obudu Local

Government Area of Cross River State, Nigeria by Anam (2019). There is no statistically

significant relationship between school-based hand washing practice and students health in

secondary schools in Obudu Local Government Area. The result of the analysis reveals that the

calculated Chi-square (X2) value is 12.09 and the critical value of Chi-square at 95% confidence

33
interval (X2 95) is 7.815 at degree of freedom (df) of 3. Since the test statistic (X 2) is greater than

the critical value (X2 95), the researcher rejected the Null Hypothesis (Ho) in favour of the

Alternative Hypothesis (Ha). This implies that, there is a statistically significant relationship

between school-based hand washing practice and students’ health in secondary schools in Obudu

Local Government Area. based hand washing practice and students’ health in secondary schools

in Obudu Local Government Area. This is because a good number of communicable diseases are

transmitted by hand. When a school child is healthy, he or she can study and learn effectively

without been down as a result of ill-health. This finding is supported by Uneke et al (2014) who

asserted that hand hygiene has been identified as the simplest and the most cost effective method

of preventing most common infections that cause mortality and morbidity in human population

especially among school populations. Agberemi, Ofenu and Saidu (2009) also supported this

findings in that, they emphasized effective hand washing by stressing that the hands are readily

contaminated from so many activities like, using the toilet, after changing a baby’s diaper

(nappy), handling raw food, playing, shaking hands, cleaning, after handling pets and domestic

animals, after wiping or blowing the nose or sneezing into the hands and after caring for an

infected person. They added that in such critical moments, hand hygiene especially hand

washing with soap and with running water has been scientifically proven and recommended as a

cost effective and high impact intervention in reducing morbidity and mortality due to infectious

diseases. This has proven beyond reasonable doubt that school-based hand washing practice can

guarantee good health for students for better studying and learning. Similarly, the findings of

Azuogu et al (2016) supported this findings in that they asserted that diseases in a school

population is a major limiting factor in the educational progress of any student, as it leads to

absenteeism, poor classroom performance and early school dropout, and all these militate against

34
the achievement of quality universal basic education. Adams et al (2009) also supported this

study findings by asserting that targeting school children and young persons in hand washing

campaign plays a significant role in efforts to achieve the Millennium Development Goals

(MDGs) which is now Sustainable Development Goals (SDGs) connected to health

improvements, education band the diminution of poverty and child mortality. This according to

them obviously led to early internalization of hand washing principles and practice from the

primary and secondary levels of education and ensure adherence to these practices all through

life. In the same vein, Olukanni (2013) found a significant relationship difference between

school-based hand washing practice and students’ health.

35
 CHAPTER THREE

METHODOLOGY

3.0 Research Design

The study adopted a descriptive survey design method because it identified hand washing
knowledge, Attitude and Practice of Junior secondary students

3.1 Research setting

The study was carried out in the isolo area of Oshodi/Isolo local government area of Lagos state.
Oshodi-Isolo is a Local Government Area (LGA) within Lagos State. It was formed by the
second republic Governor of Lagos State, Alhaji Lateef Kayode Jakande, also known as 'Baba
Kekere' and the first Executive Chairman of the Local Government was late Sir Isaac Ademolu
Banjoko. The LGA is part of the Ikeja Division of Lagos State, Nigeria. At the 2006 Census it
had a population of 621,509 people, and an area of 45 square kilometers. Hon. Idris Bolaji Muse
Ariyoh, has been re-elected for a second term into office July 25, 2017, as the Executive
Chairman. The Local Government was constituted by eleven wards as listed: Oshodi/Bolade,
Orile Oshodi. Mafoluku, Sogunle, Sogunle/Alasia, Isolo, Ajao Estate, Ilasamaja, Okota,
Ishagatedo, Oke-Afa/Ejigbo. There are 15 public secondary schools in the Isolo area of
Oshodi/Isolo Local Government.

3.2 Population

The population of this study comprised of all Junior Secondary School Students in Isolo area of
Oshodi-Isolo Lagos State.

3.3 Sample size determination

Sample size determination is the act of choosing the number of observations or replicates to
include in a statistical sample. The sample size is an important feature of any empirical study in
which the goal is to make inferences about a population from a sample. In choosing a sample
size, the objectives and circumstances of the investigation has to be considered. The choosing of
sample size depends on non-statistical considerations and statistical considerations. The non-

36
statistical considerations may include availability of resources, manpower, budget, ethics and
sampling frame. (Explorable.com, 2009). For this study the non-statistical consideration of
capacity of the researcher and time on the hands of the researcher will make the researcher to
select only 200 respondents for this study
3.4 Sampling technique
Sampling design can be grouped into two categories: Non-probability and probability sampling.
The one used for this study is Probability sampling (Akinsola, 2005). The first stage was to
define the study population after which the units of the population were listed. A sample of the
units (subset) was chosen for the study which represents the study population (Explorable.com,
2009). The sampling was done in a way that made every student to have equal opportunity of
being selected. The sample used for this study was drawn using multi-stage sampling technique
which involved 3stages. The first stage was done through categorizing the public secondary
schools in Isolo area to senior and Junior School. At stage two 5 junior secondary schools were
selected. At stage three 40 students were picked in each of the schools to make a total of 200
students
3.5 Training of Research Assistants
In order to ensure validity of data collected, four Research Assistants (RAs) was recruited;
Community Health Extension Workers in training from the Isolo Primary Health Care Centre
are the ones that will be recruited as Research Assistants for this study. They were trained at the
Isolo Primary Health Care Centre for the purpose of thorough data collection. This was done few
days to data collection and they were trained by the researcher. The Research Assistants were
enlightened on the objectives of the study and made to go through each of the research
instruments, so as to enable them have good understanding of how to administer it on the
respondents with little or no mistake. They were allowed to ask questions on issues they were not
sure of. Methods employed in the training of the research assistants include role play, question
and answer, as well as discussion.
3.6 Instrument for Data Collection

A questionnaire titled Knowledge Attitude and Practice of Hand Washing (KAPHW) was
developed for data collection for this study. The instrument was divided into three sections.
Section A considered the demographic variables of respondents while the remaining 2 sections
focus on the research questions of the study.

37
3.7 Validity of instrument

The questionnaire for this study was designed by the researcher and submitted to the study
supervisor for validation with regard to content, structure and face validity of the instruments as
it relates to the study. The corrections were used in the reconstruction of the instrument as
appropriate.

3.8 Reliability of the Instrument

To ensure the reliability of the instrument, a test-re-test technique was employed. A pilot study
shall be carried out by administering the data collection instrument at intervals of two weeks on
20 non-participating students in another local government. The reliability index will be
calculated using the person product moment correlation. A correlation coefficient index of 0.75-
obtained was adjured reliable.

3.9 Data Collection

The researcher, with the assistance of 4 trained research assistants administered the
questionnaires to the all the selected Schools in Oshodi area, questionnaires were distributed on
contact basis (one on one basis) to the students of each schools selected. Researcher will and
Research assistants ensure that questionnaires are retrieved on the spot to ensure high retrieval
rate of questionnaires.

3.10 Data Analysis

Simple Frequency count and Percentages was used to provide answers to research questions and
Pie charts and Bar charts will be used to present the socio demographic data of respondents in
this study.

3.12 Ethical Consideration

To ensure confidentiality of respondents in this study, researcher ensured that non-inclusion of

names or any form of identification number was maintained for data collection purpose, a signed
letter of introduction and request for data collection permission will be obtained from the
Primary Health Care Tutors’ Course University College Hospital Ibadan.

38
 CHAPTER FOUR

4.0 DATA ANALYSIS AND PRESENTATION

4.1 Introduction

This chapter presents analysis of data which is divided into two sections, section A for
Demographic data, while section B is for Research questions.

4.2 Analysed Demographic Data of respondents

Age of Respondents

53
11

136

< 10 years old 10 - 15 years > 16 years

Figure 4.0: Pie chart showing age of respondents in years

From the figure above 53 (26.50%) out of the total number of respondents were below 10 years
old, 136 (68%) were between ages 10 – 15 while 11 (5.50%) were above the age of 16 years

39
 Level of Education

80

70

60

50
79
40 66
55
30

20

10

0
JSS1 JSS2 JSS3

Figure 4.1: Bar chart showing the level of Education

From the figure above 55 (27.50%) out of the total number of respondents in JSS1, 79 (39.50%)
were in JSS2 while 66 (33.00%) were in class JSS3.

40
Tale 4.1: Family set up of parent

Family Set Up Frequency/Percentage

Monogamous 108
(54.00%)
Polygamous 45
(22.50%)
Separated 23
(11.50%)
Divorced 9
(4.50%)
Widowed 15
(7.50%)

Table 4.1 above 108 (54.00%) out of the total number of respondents were from a Monogamous
family set up, 45 (22.50%) were from polygamous homes, 23 (11.50%) have parents that are
separated, 9 (4.50%) have parents that are divorced and 15 (7.50%) have widowed parents.

41
Religion

Traditional 29

Islam 84

Christianity 87

0 10 20 30 40 50 60 70 80 90

Figure 4.2 A bar chart showing the religion of the respondents

From the figure above 87 (43.50%) are Christians, 84 (42.00%) are Muslims and 29 (14.50%)
are traditional worshippers.

42
 Sex

77

Male
Female

123

Figure 4.3: A pie chart of the sex of the respondents

From the figure above females make up 123 (61.50%) of the total number of respondents while
the males are 77 (38.5%)

43
1.3 Research Questions

Research question one sought to find what Junior Secondary School Students in Isolo area of
Oshodi-Isolo Lagos knew about hand washing?

Table 4.2: Showing Knowledge of Hand Washing

Knowledge of hand washing Yes No

Hand washing is able to prevent diseases 200 -

(100.00%)
Hands should be washed with soap and water before, during and 123 67
after student is done with class (61.50%) (33.5%)
Washing the hands with soap can be done any how 53 147
(26.50%) (73.50%)
Washing the hands with soap and water requires a technique 165 35
(82.50%) (17.50%)
I know the technique to wash my hands with soap and water 153 47
(76.50%) (23.50%)

The table above shows that 200 (100.00%) of the respondents knew that hand washing could
prevent diseases. 123 (61.50%) of the respondents said hands should be washed with soap and
water before, during and after student is done with class while 7 (33.50%) of the respondents
said No. 53 (26.50%) of the respondents said that washing the hands with soap can be done
anyhow, while the remaining 147 respondents (73.50%). When asked whether washing the hands
with water required a technique, 165 (82.50%) said yes, while 35 (17.50%) said no. 153
(76.50%) said they knew the technique to wash their hands with soap and water, while 47
(23.5%) of the total respondents said they did not.

44
Research question two sought to find if there were available hand washing equipments in Junior
Secondary Schools in Isolo area of Oshodi-Isolo Lagos State?

Table 4.3: Availability of hand washing equipment in Junior Secondary Schools

Availability of hand washing equipment in Junior Secondary Yes No

Schools
There is a wash hand station in front of my class 152 48
(76.00% (24.00%)
)
There is always soap at the hand washing station to wash my hands 128 72
(64.00% (36.00%)
)
Water is always available to wash my hands 153 47
(76.50% (23.50%)
)
We have a water reservoir for storage in case of water shortage 68 132
(34.00% (66.00%)
)

From the above table 152 (76.00%) of the respondents have a wash hand station in front of their
class while 48 (24.00%) do not. 128 (64.00%) said there was always soap at the hand washing
station to wash their hands while 72 (36.00%) said there was not. 153 (76.50%) of the students in
this study affirmed that water was always available to wash their hands while 47 (23.50%) said
there was not. When asked if a water reservoir was available in case of water shortage, 68
(34.00%) said there was, while 132 (66.00%) said there was not.

45
Research question three sought to know the attitude of Junior Secondary School Students in
Isolo area of Lagos State on Hand washing

Table 4.4: Showing Attitude of Junior Secondary School Students to Hand Washing

Attitude of Junior Secondary School SA A D SD

Students to Hand Washing
I consider hand washing to be very important 98 63 26 13
(49.00%) (31.50%) (13.00%) (6.50%)
Hand-washing is needed by both students and 156 44 - -
teachers (78.00%) (22.00%)
I feel Hand-washing can prevent diseases 174 26 - -
(87.00%) (13.00%)
Hand-washing is beneficial and effective is 152 48 - -
done properly (76.00%) (24.00)

From the table above 98 (49.00%) strongly agreed that hand washing was very important,
63(31.50%) agreed, 26 (13.00%) disagreed while 13 (6.50%) strongly disagreed. 156 of the
respondents (78.00%) strongly agreed and 44 (22.00%) agreed that handwashing was needed by
both students and teachers.

174 (87.00%) strongly agreed that they felt hand washing could prevent diseases, while 26
(13.00%) agreed. 152 (76.00%) strongly agreed that hand washing is beneficial and effective if
done properly, while 48 (24.00%) agreed.

46
Research question four sought to find out the pattern of Practice of Hand washing among Junior
Secondary School Students in Isolo area of Lagos State?

Table 4.5: Showing Knowledge of Hand Washing

Pattern Of Practice Of Hand Washing Always Sometimes Never

I wash my hands in school 56 112 32
(28.00%) (56.00%) (16.00%)
Hand washing is enforced by our teachers in school 53 101 46
(26.5%) (50.5%) (23.00%)
Hand-washing is encouraged by our school teachers 59 113 28
(29.50%) (56.50%) (14.00%)
Hand washing practice is recorded in our school 13 28 159
(6.50%) (14.00%) (79.50%)

From the table above 56 (28.00%) said they always washed their hands in school, 112 (56.00%)
said they do it sometimes, while 21 (16%) said they never washed their hands in school.

53 (26.50%) said hand washing was enforced by teachers in school always, 101 (50.5%) said it
was enforced sometimes, 46 (23.00%) said it was never enforced by teachers in their school.

59 (29.50%) of the students in this study indicated that hand washing was always encouraged by
their teachers, 113 (56.50%) said it was encouraged sometimes and 28 (14.00%) said their school
teachers never encouraged the practice of hand washing. When asked if hand washing practice
was recorded in their school, 13 (6.50%) said it was always recorded, 28 (14.00%) said it was
recorded sometimes and 159 (79.50%) said it was never recorded.

CHAPTER FIVE

47
2.0 DISCUSSION OF FINDINGS, SUMMARY CONCLUSION AND

RECOMMENDATION

5.1 Discussion of findings

The Demographic data obtained from the field work of this study revealed that 26.50% out of the
total number of respondents were below 10 years old, 68% were between ages 10 – 15 while
5.50% were above the age of 16 years. 27.50% of respondents were in JSS1, while 39.50% were
in JSS2 and 33.00% were in class JSS3. The study showed that majority of the respondents,
54.00%s were from a Monogamous family set up, 22.50% were from polygamous homes,
11.50% have parents that are separated, 4.50% have parents that are divorced and 15 7.50% have
widowed parents. 43.50% are Christians, 42.00% are Muslims and 14.50% are traditional
worshippers. The study revealed that females make up 61.50% of the total number of
respondents while the males are 38.5%.

Research Questions

Research question one sought to find what Junior Secondary School Students in Isolo area of
Oshodi-Isolo Lagos knew about hand washing?
The table above shows that 100.00% of the respondents knew that hand washing could prevent
diseases. 61.50% of the respondents said hands should be washed with soap and water before,
during and after student is done with class while 33.50% of the respondents said No. 26.50% of
the respondents said that washing the hands with soap can be done anyhow, while the remaining
73.50% indicated the opposite. When asked whether washing the hands with water required a
technique, 82.50% said yes, while 17.50% said no. 76.50% said they knew the technique to wash
their hands with soap and water, while 23.5% of the total respondents said they did not. Majority
of respondents know what hand washing is

Research question two sought to find if there were available hand washing equipments in
Junior Secondary Schools in Isolo area of Oshodi-Isolo Lagos State?

From the above table 76.00% of the respondents have a wash hand station in front of their class
while 24.00% do not. 64.00% said there was always soap at the hand washing station to wash
their hands while 36.00% said there was not. 76.50% of the students in this study affirmed that

48
water was always available to wash their hands while 23.50% said there was not. When asked if
a water reservoir was available in case of water shortage, 34.00% said there was, while 66.00%
said there was not. Majority of respondents indicated that hand washing equipment’s are
available.

Research question three sought to know the attitude of Junior Secondary School Students in
Isolo area of Lagos State on Hand washing

From the table above 49.00% strongly agreed that hand washing was very important, 31.50%
agreed, 13.00% disagreed while 6.50% strongly disagreed. 78.00% of the respondents strongly
agreed and 22.00% agreed that hand-washing was needed by both students and teachers. 87.00%
strongly agreed that they felt hand washing could prevent diseases, while 13.00% agreed.
76.00% strongly agreed that hand washing is beneficial and effective if done properly, while
24.00% agreed. Majority of respondent have positive attitude towards hand- washing

Research question four sought to find out the pattern of Practice of Hand washing among
Junior Secondary School Students in Isolo area of Lagos State?

From the table above 28.00% said they always washed their hands in school, 56.00% said they
do it sometimes, while 16.00% said they never washed their hands in school. 26.50% said hand
washing was enforced by teachers in school always, 50.50% said it was enforced sometimes,
23.00% said it was never enforced by teachers in their school. 29.50% of the students in this
study indicated that handwashing was always encouraged by their teachers, 56.50% said it was
encouraged sometimes and 14.00% said their school teachers never encouraged the practice of
hand washing. When asked if hand washing practice was recorded in their school, 6.50% said it
was always recorded, 14.00% said it was recorded sometimes and 159 79.50% said it was never
recorded. Majority of respondent practice hand-washing in this study.

5.2 Summary

49
 In summary, this study was carried out to Attitude and Practice of Hand washing among Junior
Secondary School Students in Isolo area of Oshodi-Isolo Local Government Lagos State
Multistage sampling techniques were used in this study. The sample used for this study was
drawn using multi-stage sampling technique which involved 3stages. The first stage was done
through categorizing the public secondary schools in Isolo area to senior and Junior School. At
stage two 5 junior secondary schools were selected. At stage three 40 students were picked in
each of the schools to make a total of 200 students

5.3 Conclusion

This study concludes on the findings beneath

- Majority of respondents know what hand washing is

- Majority of respondents indicated that hand washing equipment’s are available.
- Majority of respondent have positive attitude towards hand- washing
- Majority of respondent practice hand-washing in this study

5.4 Recommendations

Based on the findings from this study the following recommendations were made:

- Continuous campaign in support of hand washing in schools should be encouraged by

governmental and non-governmental organizations.

- Inclusion of discussion about hand washing and personal hygiene the responsibilities of

Community Health Workers school health service.

- There should be enlightenment programs and public awareness at the Local Government

level by the government and non- governmental organizations to inform people,

especially parents on the dangers of lack of personal hygiene.

50
 - Training and Retraining of health workers specifically community health workers on the

need to improve their skills as regards school health services should also be employed

Suggestion for further studies

This same study can be replicated among the same study population in another local government

in Lagos state in a bid to compare outcomes

51
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 Appendix I

Primary Health Care Tutors Course

Federal Training Centre for Teachers of Health Sciences
University College Hospital, Ibadan

Questionnaire on Knowledge, Attitude and Practice of Hand washing among Junior

Secondary School Students in Isolo area of Lagos State.

Dear Respondent

I am a Primary Health Care Tutor in training at the University College Hospital Ibadan
conducting a study on Knowledge, Attitude and Practice of Hand washing among Junior
Secondary School Students in Isolo area of Lagos State. I humbly solicit for your honest
response in this questionnaire which is strictly for academic purpose; all information supplied
will be treated with utmost confidentiality.
Thank you

Adewunmi Eunice
SECTION A: DEMOGRAPHIC DATA

Instruction: Kindly tick (√) or fill in the space with best represent your response(s) to the
questions

1. Age (a) Less that 10 yrs. old ( ) (b) 10-15yrs old ( ) (c) 16 yrs. and above ( )
2. Level of education (a) JSS1 ( ) (b) JSS2 ( ) (C) JSS3( )
3. Family set up of parent: (a) Monogamous( ) (b) Polygamous ( ) (c) Separated ( ) (d)
Widow ( )
4. Religion: (a.) Christianity { } (b.) Islam { } (c.) Traditional { }
5. Sex: Male ( ) Female ( )

Section B

knowledge of hand washing Yes No

6. Hand washing is able to prevent diseases

7. Hands should be washed with soap and water before, during and after
student is done with class
8. Washing the hands with soap can be done any how

55
9. Washing the hands with soap and water requires a technique

10. I know the technique to wash my hands with soap and water

Available hand washing equipment in Junior Secondary Schools Yes No

11. There is a wash hand station in front of my class

12. There is always soap at the hand washing station to wash my hands
13. Water is always available to wash my hands
14. We have a water reservoir for storage in case of water shortage

Attitude of Junior Secondary School Students to Hand SA A D SD

Washing
15. I consider hand washing to be very important

16. Hand-washing is needed by both students and teachers

17. I feel Hand-washing can prevent diseases
18. Hand-washing is beneficial and effective is done properly

Pattern Of Practice Of Hand Washing Always Sometimes Never

19. I wash my hands in school

20. Hand washing is enforced by our teachers in school

21. Hand-washing is encouraged by our school teachers
22. Hand washing practice is recorded in our school

56