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Original Article

Association of personal hygiene with common

morbidities among upper primary school children in rural
Odisha
Kalyan Kumar Paul1, Sandeep Kumar Panigrahi1, Arun Kiran Soodi Reddy1,
Trilochan Sahu1
1
Department of Community Medicine, IMS and SUM Hospital, Siksha ‘O’ Anusandhan University, Bhubaneswar,
Odisha, India

A bstract
Context: In India, children of upper primary school receive less attention from health‑care providers. The majority of their health
problems are preventable through hygienic practices. Aims: The aim of this study was to find out the association of personal
hygiene with common morbidities among upper primary school children. Settings and Design: A cross‑sectional study conducted
in a rural upper primary school of Odisha. Subjects and Methods: A semi‑structured schedule based on the Global School Health
Survey Questionnaire and necessary instruments for clinical examination were used. Statistical Analysis Used: Data were entered
in Microsoft Excel 2007 and analyzed by SPSS version 20 software. Results: Of 90 participants, 58 (64.4%) were girls. The mean age
was 11.8 (±1.01) years. The mean body mass index of females was significantly higher than males (16.95 vs. 14.72; P = 0.001). More
than 90% of children maintained good personal hygiene such as clean tongue, clean hair, handwashing, and using footwear. The most
common morbidities found were dental caries (38.9%), history of worms in stool and lethargy (20%). A mean score of 6.14 ± 0.11 (out
of 8) was seen for personal hygiene and not associated with any particular morbidity or gender. Brushing daily was significantly
associated with reduced dental caries (χ2 = 8.7; P < 0.005) and foul‑smelling breath (χ2 = 4.93; P < 0.05). Fungal infections were
significantly less in children who bathed daily (χ2 = 28.7; <0.005) and wore clean clothes (χ2 = 5.06; P < 0.05). Conclusion: Dental
caries, foul‑smelling breath, and fungal infections were significantly associated with poor personal hygiene. School health services
should also focus on upper primary school children for improvement of personal hygiene.

Keywords: Morbidity, personal hygiene, school children

Introduction childhood will enable to lead a healthy life in adulthood. Teachers

Children spend a considerable time in schools where they are in
close contact with each other facilitating transmission of diseases.
Most of the health problems among school children are due to
lack of personal hygiene and thus can be prevented by following
hygienic practices. The hygienic practices developed during
Address for correspondence: Dr. Sandeep Kumar Panigrahi,
Department of Community Medicine, IMS and SUM Hospital, K‑8,
Kalinga Nagar, Ghatikia, Bhubaneswar ‑ 751 003, Odisha, India.
E‑mail: dr.sandeepvss@gmail.com
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play a leading role in imparting education on personal hygiene as
they are the first contacts. School health services have been an
important program to provide nutritional support and medical
assistance to lower middle‑class school‑going children, especially
in developing countries. In India, children of upper primary school
receive less attention from health‑care providers as most health
programs focus on infants and under‑five children. Assessment
of the state of personal hygiene of school‑going children will give
necessary inputs in improving their overall health.
This is an open access article distributed under the terms of the Creative Commons
Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak,
and build upon the work non‑commercially, as long as the author is credited and the new
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How to cite this article: Paul KK, Panigrahi SK, Soodi Reddy AK,
DOI: Sahu T. Association of personal hygiene with common morbidities among
10.4103/2249-4863.222039 upper primary school children in rural Odisha. J Family Med Prim Care
2017;6:509-12.

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Paul, et al.: Personal hygiene and common morbidities in primary school children

The present study was conducted among children of upper primary

school situated in the rural field practice area of IMS and SUM
hospital, Bhubaneswar, Odisha, with the following objectives:
• To assess the personal hygiene and morbidity pattern of rural 26.70%

upper primary school children

40%
• To find out the association between personal hygiene and
morbidity profile.
33.00%

Subjects and Methods

A cross‑sectional study was done in an upper primary school
situated in the rural field practice area of the Hospital in Odisha,
by conducting a health checkup program for 2 weeks in August
2014. All children studying in class VI, VII, and VIII were 6th Std 7th Std 8th Std

included. Necessary permission from the headmaster of the

school was obtained before conducting the study and parents Figure 1: Class‑wise distribution of children participating in the study
were duly informed by the school authority.

The study tools included pretested and predesigned

semi‑structured questionnaire based on the Global School
Health Survey Questionnaire and instruments such as weighing
machine, measuring tape, blood pressure instrument, tuning
35.60%
fork, Snellen chart and Ishihara chart. Students were interviewed
using the questionnaire followed by clinical examinations. Clinical
examinations were conducted by the interns, and wherever
morbidity was found, confirmed by the medical officer of the
rural health and training center to avoid observer bias. 64.40%

Personal hygiene was assessed using a hygiene score by assigning

one point to each of the correct hygiene practices. The maximum
possible score was 8. Content validity of the tool was assessed by Girls Boys
experts in the field. The significance of association of personal
hygiene score with any particular morbidity or gender was Figure 2: Gender distribution of participating children
determined using t‑test (P < 0.05 was considered significant).
Chi‑square tests were applied to estimate significance between
a particular hygiene practice and any morbidity. Data collected 100.0% 97.8% 93.3% 92.2%
91.1%
were entered in Microsoft Excel 2007 and analyzed by IBM 90.0% 81.1% 80.0% 78.9%
80.0%
SPSS Statistics Version 20 (© Copyright IBM Corporation & 70.0%
60.0%
its licensors 1989, 2011) licensed to the institute. 60.0%
50.0%
40.0%
Results 30.0%
20.0%
Of a total 116 students enrolled for the study, 90 students 10.0%
0.0%
participated. Figure 1 shows the distribution of students in the
Clean Tongue

Handwashing

Bathing Daily

Brushing Daily

Clean Clothes

Clean Nails
Use Footwear
Clean Hair

classes and Figure 2 shows the gender distribution among all

the participants.

The mean age of the study population was 11.8 (±1.01) years. The
mean body mass index of females was significantly higher than
males (16.95 vs. 14.72; P = 0.001). More than 90% of children
maintained good personal hygiene such as clean tongue, clean
hair, handwashing, and using footwear. However, the practice of
daily bathing and brushing was about 80% [Figure 3].
Figure 3: Personal hygiene practices among children in percentage
statistically significant (χ2 = 3.2; P = 0.07). The most common
morbidities found in the children were dental caries followed by
history of worms in stool and lethargy (20%) [Figure 4].

Only 23% of children did not have any morbidity. Boys had Boys and girls did not differ regarding maintenance of personal
more morbidities than girls (87.5% vs. 70.6%) though it was not hygiene [Table 1]. Of an 8‑point score of personal hygiene, the

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Paul, et al.: Personal hygiene and common morbidities in primary school children

45.0% Table 1: Hygiene practice among study

40.0%
40.0% participants (gender wise)
35.0%
Hygiene practice Number of Number of χ2 df P
30.0%
25.0%
boys n=32 (%) girls, n=58 (%)
20.0% 20.0%
20.0% 17.8%
15.6% Clean nails 20 (62.5) 34 (58.6) 0.129 1 0.72
15.0% 11.0% 11.0% Clean hair 28 (87.5) 56 (96.6) 2.716 1 0.09
10.0% 9.0%
Clean clothes 24 (75) 47 (81) 0.451 1 0.50
5.0%
0.0%
Wear footwear 28 (87.5) 54 (93) 0.8 1 0.37
Handwashing 31 (96.9) 52 (89.7) 1.29 1 0.22
Dental Caries

Lethargy

Red Conjunctive

Fungal Infection

Refractive Error

Foul smell in breath

Worm in stool

Ear Wax
Daily bathing 27 (84.4) 46 (79.3) 0.345 1 0.56
Brushing daily 25 (78.1) 47 (81) 0.109 1 0.74
Clean tongue 32 (100) 56 (96.6) 1.12 1 0.29

Figure 4: Types of morbidities found in the school children (in %)

Table 2: Morbidity pattern in study participants
(gender wise)
overall mean score was 6.14 ± 0.11, but it was not significantly Morbidity pattern Number of Number of χ2 df P
boys, n=32 (%) girls, n=58 (%)
associated with any particular morbidity or even gender. The
Foul smell in breath 2 (6.2) 6 (10.3) 0.427 1 0.51
mean score of boys and girls was 6.15 and 6.13, respectively.
History of worms in 5 (15.6) 12 (20.7) 0.345 1 0.56
stool
Morbidity pattern was also similar among boys and girls except Dysuria 0 (0) 4 (6.9) 2.31 1 0.29
impaired visual acuity, which was found to be significantly higher Impaired visual acuity 0 (0) 10 (17.2) 6.2 1 0.01
in the girls (χ2 = 6.2; P < 0.05) [Table 2]. Impaired color vision 2 (6.2) 2 (3.4) 0.381 1 0.54
Ear wax 4 (12.5) 10 (17.2) 0.353 1 0.55
In our study, we also tried to find the association between morbidity Conjunctival redness 8 (25) 8 (13.8) 1.77 1 0.18
and status of personal hygiene. It was found that brushing daily Lethargy 6 (18.8) 12 (20.7) 0.48 1 0.83
significantly reduced dental caries  (χ2 = 8.7; P < 0.005) and Fungal Infection 3 (9.4) 14 (24.1 2.93 1 0.08
foul‑smelling breath (χ2 = 4.93; P < 0.05). Fungal infections were Skin Infection 3 (9.4) 11 (19) 1.44 1 0.23
significantly less in children who bathed daily (χ2 = 28.7; <0.005)
and wore clean clothes (χ2 = 5.06; P < 0.05). Deb et  al. conducted a study in South Kolkata and found
that the common morbidities in boys were pallor (55.34%),
Discussion undernutrition (40.78%), and worm infestation (39.81%),
and in the girls, it was pallor (51.85%), followed by dental
The present study was conducted to assess the status of
caries (33.34%) and worm infestation (29.63%).[1]
personal hygiene and morbidity pattern of children in a rural
upper primary school of Bhubaneswar, Odisha. It was based
In the study done by Ananthakrishnan et al., it was found that
on interview using predesigned pretested questionnaire,
worm infestation (46.4%) is more than dental caries (27.9%)
anthropometric measurements, and clinical examinations.
among school children in Kedar village in Tamil Nadu.[3]
We found that 77% of children were suffering from one or more
morbidities. Boys were having more morbidities than girls, but it In our study, the mean personal hygiene score of boys and girls
was statistically insignificant. A similar result was found by Deb et al. was 6.15 and 6.13, respectively. In a study by Motakpalli et al.
in a study done at Kolkata where boys had more morbidities done in Karnataka, 65.9% of girls had good personal hygiene
than girls (76% vs. 74%).[1] However, a study done in Assam compared to boys (i.e., 60.5%).[5]
showed that girls suffered more than boys (57.4% vs. 56.7%).[2]
Ananthakrishnan et al. also found that the prevalence of morbidity In our study, girls maintained better personal hygiene than boys
in girls is more (97.5% vs. 96.7%) than that in boys.[3] regarding clean hair (81% vs. 75%), wearing footwear (93% vs.
87.5%), and daily brushing of teeth (81% vs. 78.1%), though
In our study, the major morbidities found were dental caries (40%), the difference was not statistically significant. Boys showed
worms in stool and lethargy (20%), conjunctival redness (17.8%), better hygienic practices related to clean nails (62.5% vs. 58.5%),
and ear wax (15.6%). It is similar to the findings of studies done handwashing (96.9 vs. 89.9%), daily bathing (84.1% vs. 79.3%),
by Syed et al. in Hyderabad and Motakpalli et al. in Karnataka.[4,5] and clean tongue (100% vs. 96.6%).

A study conducted in Hyderabad by Syed et al. showed that the The study by Deb et al. in Kolkata showed that the status of
most common morbidities were dental caries (56%), worms in personal hygiene among girls was better than boys regarding
stool (48%), and anemia (33%).[4] clean and trimmed nails (77.8% vs. 50.5%, P < 0.05) and clean

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Paul, et al.: Personal hygiene and common morbidities in primary school children
hands and skin (92.6% vs. 68.9%, P < 0.05), but the result for
clean clothes and cleanliness of tooth and tongue was more or
less same for both the sexes. Clean hair was found more in boys
than girls (92.23% vs. 85.19%).[1]
In a study by Okemwa et al. in Kenya, only 48% of the school‑age
children were found to brush their teeth daily, which is much
lower than that of our study (80%).[6]
In another study among primary school students in Turkey
by Arikan et al., it was reported that 94.2% were washing their
hands with soap after using the toilet and 75.1% before taking
meals.[7]
Conclusion and Recommendation
Dental caries, foul‑smelling breath, and fungal infections were
significantly associated with poor personal hygiene. Although
worms in stool, refractive errors, ear wax, and redness of
conjunctiva were higher in children practicing low personal
hygiene, a significant association was not found.
Since most of the morbidities were higher in children lacking
proper personal hygiene, it is important to focus on programs for
developing the personal hygienic practices. Care should be taken
to improve the level of personal hygiene in children with a low
socioeconomic and parental education level through coordinated
and concerted health education measures by teachers as well as
health workers.
A well‑planned school health program can provide a proper
health education with the active involvement of the parents and
teachers. It would help parents to create a healthy environment
in their homes so that their children can lead a healthy life. More
focus on upper primary school children to be given in health
programs of the country.
Limitations of the study
The study sampling was purposive and may not be generalizable.
However, considering the findings being similar to other studies
Journal of Family Medicine and Primary Care 512 Volume 6 : Issue 3 : July-September 2017
elsewhere in the country, as discussed, the study findings can be
accepted in the Indian situation.
Acknowledgment
We acknowledge the role of interns posted at Rural Health
and Training Centre during the study period, who helped us in
conducting the study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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