UNIVERSITI TEKNOLOGI MARA

HYGIENE EDUCATION:
UNDERDEVELOPED COUNTRIES STRATEGY

NAME OF STUDENTS STUDENT ID

AHMAD FIRDAUS BIN MAT ZAINI 2021214872

AIDA HUMAIRA BINTI RAHIMI 2021469754

ALIAA BINTI OTHMAN 2021841588

FARAH ILLIANA SOFEA BINTI ROSZALI 2021204364

Foundation of Science (PI080)

Centre of Foundation Studies

November 2021
TABLE OF CONTENT

TABLE OF CONTENTS ii
ABSTRACT iv

1.0 INTRODUCTION 1
1.1 Background of the Study 1
1.2 Problem Statement 2
1.3 Objectives 2

2.0 LITERATURE REVIEW 3

2.1 Hygiene Education 3
2.1.1 Water Supply 3
2.1.2 Sanitation 5
2.1.3 Food Handling 6
2.2 Importance of Hygiene Education 7
2.2.1 Reduce the Transmission of Illness 7
2.2.2 Increase Self-Confidence When Facing Society 8
2.2.3 Taught on How to Maintain Hygiene 8

3.0 METHODOLOGY 10
3.1 Delegation of Work 10
3.2 Information Retrieval 10
3.2.1 Hygiene Education in School and Public 10
3.2.2 Training for Food Handlers 11
3.2.3 Sanitation Campaign and Government Action 12

4.0 DATA ANALYSIS AND DISCUSSION 14

4.1 Main Findings 14
4.1.1 Hygiene Education in School and Public in Ethiopia 14
4.1.2 Food Handling Training in Montenegro 17
4.1.3 Long-term Impact of Sanitation Campaign in India 20
4.2 Strength and Weaknesses of Findings 22

5.0 CONCLUSION AND RECOMMENDATION 23

5.1 Conclusion 23

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5.2 Recommendation 24

REFERENCES 25

iv
 ABSTRACT

Concerns have been raised about the lack of hygiene education among communities in
underdeveloped countries. In underdeveloped countries such as Ethiopia, Africa, and India, the
community's exposure to hygiene education is indeed very limited since they were unable to
access the information they required. Hygiene education involves lessons on how to keep our
bodies, homes, and environments clean. Proper hygiene practice education shall be carried out
in effective ways to give a clear description about cleanliness to the community, especially
people in rural areas. We have reviewed several research in undeveloped countries regarding
hygiene education that was provided to the community and has found a few ways to improve
hygiene aspects to the respected population. Firstly, hygiene lessons need to be included in
schools with syllabus that cover the importance of hygiene and sanitation, guides to improve
hygienic behaviour, impacts on hygiene poverty and clean water source. All of these aspects
are known as basic knowledge in keeping a good personal hygiene and a healthy lifestyle. Thus,
food handlers need to undergo training in food handling from preparation, storing to serving.
This is because food handlers make the most contact with food and poor hygiene in food
handling is the main cause of foodborne diseases. Finally, sanitation campaign is one of the
best ways to improve the awareness in the community, for example, changing the behaviour of
open defecation to using latrines in daily life. All research showed positive impacts on
community after the intervention, and we can see that the populations in underdeveloped
countries are always ready for changes. By promoting hygiene to the community, it can help
them to improve hygiene behaviour and lead to a better health. Therefore, it is important to
promote health or hygiene groups among community from underdeveloped countries.

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 1.0 INTRODUCTION

1.1 Background of Study

Health is essential to a person to live longer. People in good health have a positive
mind and lifestyle. This fact can be ensured by practicing hygiene in his/her daily life.
According to the World Health Organization (WHO) “ Hygiene refers to conditions and
practices that help to maintain health and prevent the spread of diseases.” “Medical hygiene
therefore includes a specific set of practices associated with this preservation of health, for
example environmental cleaning, sterilization of equipment, hand hygiene, water and
sanitation and safe disposal of medical waste” (WHO,2020). Hygiene is significant to human
health and well-being as it keeps us from diseases—caused by an unhealthy environment and
lifestyle.

Hygiene education involves lessons on how to keep our bodies, homes, and
environments clean. Proper hygiene practice education shall be carried out in effective ways
to give a clear description about cleanliness to the community, especially people in rural areas
(in underdeveloped countries). The PPW used several effective approaches including
interactive group discussions, games, posters, and demonstrations to promote healthy habits
(Let's talk about hygiene education,2019). This effort has the potential to expose the attention
of community members to the need of maintaining a clean environment free from disease.

Besides, targeted audiences are encouraged to practise hygiene due to demonstrating

the advantages of developing hygiene that are being held by the teachers (health authorities or
volunteers). Effective hygiene education allows for dialogue and discussion (two-way
communication) between the teachers and learners so that learners can engage and receive
feedback on their successful implementation.

Health education is one of the strategies to achieve the goal of any programme to
promote hygiene to the public community. By promoting hygiene to the community, it can
help them to improve hygiene behaviour and lead to better health. Besides, hygiene education
also aims at providing a safe water supply and increasing sanitation standards. This is due to

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the fact that decent facilities and good hygiene habits are intertwined in order to improve
one's health.

Many diseases are transmitted totally or partially by a lack of clean water, sanitation,
and hygiene (WASH) (WHO | World Health Organization,2019). Good hygiene practices can
help to diminish the burden of common illnesses like diarrhoea, especially in young children.
Diarrhoea is due to infection caused by germs and bacteria from person-to-person because of
poor hygiene. According to WHO, diarrheal illness is the second largest cause of mortality in
children under the age of five years old, accounting for 525,000 deaths every year (WHO,
2017). In fact, every year, about 1.7 billion cases of childhood diarrhoea are reported
worldwide. (WHO,2017). As a safety measure, the WHO recommended hygiene education
about how the infection spreads in order to prevent diarrhoea spreading in the community
(WHO,2017). Hence, we know that hygiene education is significant in order to have a better
quality of health and well-being.

1.2 Problem Statement

Poor hygiene practices in the community are caused by the lack of hygiene education
especially in rural areas. As we know, rural areas in certain underdeveloped countries like
India are facing difficulty to access others (besides their own people in the community) as
they are not as advanced as we are. Even though many children learn some of the hygiene
skills at school, as they come home, they will follow what their parents and others in the
community do. Besides, people in remote areas are also facing problems to access clean water
and ideal sanitation facilities. According to WHO (2009), “Good hygiene behaviour and the
effectiveness of hygiene promotion in schools are severely limited where water supply and
sanitation facilities are inadequate or non-existent” (p. 24). It is important to have a balanced
situation between good hygiene education and sanitation facilities provided in the community.

1.3 Objectives of Study

● To encourage the community to be aware about health and practise good hygiene.
● To investigate the hygiene education provided in underdeveloped countries.

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 2.0 LITERATURE REVIEW

2.1 Hygiene Education

2.1.1 Water Sources

Water is known as one of the basic needs for all living things. Approximately, about 71
percent of earth’s surface is covered by water and 97 percent of is found as salt water or ocean.
Scientific report has stated that our body contains up to 60 percent of water. It is function as a
medium to carry nutrients, oxygen, and wastes from human’s cells to the organs in our body. It
is also important to maintain our body temperature from excessive heat. Water is also a home
for aquatic animals which is one of the food sources for human. Furthermore, water is a great
solvent for a diverse range of mineral and organic substances, and it is broadly utilized in
industrial processes, as well as in cooking and washing.

Water supply is the provision of water by essential services, commercial organisations,

infrastructure, or individuals, commonly through a system of pumps or pipes. The continuity of
water supply, the quality, and the pressure of water determined the water service quality. The
management of water sources are different in every country and region. It usually deals with
legislation and regulation, as well as service delivery and standardisation. As well as that, there
are numbers of sources of water for water supply such as groundwater, surface water, and the
sea. These water sources went through many treatments to make sure the water quality is good
enough for public use.

Water plays a huge role in maintaining living things’ health especially human. The body
requires about 8 cups of water every day to function effectively and avoid dehydration. The
approximate quantity depends on the daily activity, temperature, and humidity. Therefore, to
assure one’s health consistency, water supply must be taken seriously as it is the root of most
of health problems. It is important to assure the water supply is clean enough especially in the
era of pandemic. Moreover, according to the World Health Organization (WHO), access to safe
drinking water is critical to one's health, a fundamental human right, and a component of
excellent health policy (WHO/UNICEF, 2019).

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 Water management issues could result in a variety of health problems such as diarrhoea,
cholera, and typhoid. These deadly disease cause estimated 458 000 deaths yearly. This become
crucial issue and cause concerns for the public organisation. People spend less time and effort
physically collecting water when it comes from enhanced and more accessible sources, enabling
them to be more efficient in their daily activities. Thus, this can also promote social safety by
reducing the need to travel vast distances or take risks to acquire water. Likewise people are
less likely to fall ill and undergo medical bills when they have better water supplies, and they
are better able to remain economically productive.

Water supply systems are being impacted by climate change, developing droughts,
increased population, demographic trends, and urbanism. Water-stressed areas will be home to
half of the world's population by 2025. Wastewater re-use for the recovery of water, minerals,
or energy is becoming a popular strategy. Wastewater is increasingly being used for irrigation
in undeveloped countries, accounting for 7 percent of all agricultural area. While improper
wastewater management poses health dangers, proper wastewater management can result in a
variety of benefits, including enhanced food production.

Water is also one of way for human to maintain hygienic problems. We use water for
bath, and washing hands and clothes. In this crucial era of pandemic, it is important for one’s
to ensure the cleanliness in our surrounding as the virus can be spread through air and touch.
We should wash our hands with water and soap to remove the bacteria as we use our hands the
most to do daily activities. Despite of the needs to take care of hand hygiene to prevent virus,
there are lots of community who did not get a good quality of water sources. According to
WHO, three billion people worldwide, including hundreds of millions of school-going children
do not have access to hand washing facilities with soap (WHO/UNICEF, 2019). This affect the
rural areas community as they hold the most probability to get infected by the virus.

In conclusion, water management should be taken crucially by all the organizations

related to water supply all around the world. In this case, no one should be leave behind when
it comes to safe water sources as it is part of human rights. All people deserve to get a better
life and healthcare. Underdeveloped countries are most likely to face this kind of problems that
will affect their next generations. Thus, as someone from developing country, it is our
responsibility to make sure they get their hygiene education so that they can be independent
countries. This has to be in the spotlight in order for the world to have a better society and

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human equality. We could avoid the discriminations among population of the world and become
a healthier community and surrounding.

2.1.2 Sanitation

Sanitation defined as provision of facilities and infrastructure for the final disposal of
human faeces and urine. It is also refers to the management of hygiene practices through rubbish
collection and sewage disposal services. Sanitation is next in line after water supply in the
aspect of hygiene education. It is necessary for everyone, since it benefits in the maintaining
health and the increase of life spans. Effective sanitation systems create obstacles between
excreta and humans, preventing the disease transmission cycle (for example in the case of
faecal-borne diseases) (Stenström, 2005). In 2017, 45% of the global population (3.4 billion
people) used a safely managed sanitation service (WHO/UNICEF, 2019).

Many people consider hygiene promotion to be an important aspect of sanitation. "The

collection, transport, treatment, disposal or reuse of human excreta, residential wastewater, and
solid waste, as well as associated hygiene promotion," according to the Water Supply and
Sanitation Collaborative Council (Evans, 2009). Self-hygiene and environmental hygiene are
forms of sanitation. Handling menstrual waste, cleaning domestic toilets, and managing
household garbage are all some of sanitation tasks. Garbage collection, cleaning drains, streets,
schools, community toilets and public toilets, sewers, and operating wastewater treatment
plants are all types of environmental sanitation operations.

The presence of sanitation infrastructure by itself does not secure the population's health
in many contexts. According to studies, the impact of hygiene behaviours on lack of sanitation
diseases is just as significant as the provision of sanitation services. As a result, hygienic
education is an important aspect of sanitation and is usually essential in sustaining good health
(Reed & Bevan, 2014). In low- and middle-income nations, discrimination in access to
sanitation and hygiene services is common. Access to sanitation facilities is incredibly
challenging for certain groups or individuals. When a citizen is discriminated against on two or
more of these grounds, the cumulative effect is likely to be bigger than the amounts of the two
or even more racial grounds.

Sanitation may also be required to keep the workplace clean in order to avoid slips, trips,
and falls, as well as to preventing excessive dust from gathering and growing into combustible
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 dust scenarios. In these cases, the frequency of cleaning is critical. It is vital to give
careful thought and consideration to how and how frequently these chores are carried out. To
avoid accidents and injuries, all staff performing sanitation activities must get training and
education.

2.1.3 Food Handling

Food Hygiene, also referred as Food Safety, is described as the process of managing,
processing, and preserving foods in such a way that the chance of consumers experiencing the
illness from a food-borne disease is minimised. Food safety guidelines attempt to keep food
from getting spoiled and resulting in severe food poisoning. Food poisoning and other food
borne might arise via poor hygienic, especially in an area where foods are prepared. The
marketing of complete meals on the streets is a common source of income in most cities around
the globe.

Any food handler should practise high level of personal hygiene to reduce the possibility
of contaminated food. The majority of humans carry hazardous bacteria upon our bodies, which
they can unknowingly spread to food. Bacterial can be transferred and contamination caused
by touching your mouth, nose, hair, or even your garments. Nevertheless immune systems are
not invincible, thus excellent personal cleanliness is necessary to reduce the risk. Hands can
carry hazardous germs and bacteria even if they appear clean, therefore proper hand washing is
essential when handling with food.

Unfortunately, the growth of casual food manufacturers might lead to several health
concerns if foods are not cooked and managed in a hygienic manner. As a result, it's important
to examine food vendors' procedures whether they're following basic sanitation procedures. It
is vital to understand how it spreads so that we can avoid it from contaminated. For food
manufacturers to make and sell food that is safe to eat, good food hygiene is required. The first
step is for administration and employees to comprehend and know what food hygiene and food
safety are.

To ensure that the working environment is clean, the workspace must be before, during,
and after cooking. For example, between chopping raw chicken and veggies, a separate
chopping board must be used or it must be completely cleaned. If this isn't done, microbes from
the raw meat will move to the veggies, resulting in contamination of food. Food hygiene and

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cleanliness are vital because they guarantee the safety of the food you touch and manufacture.
Consumers could become gravely ill from food poisoning and other foodborne illnesses if food
safety and cleanliness are not maintained. As a consequence, food safety and hygiene are critical
for protecting consumers' health.

2.2 Importance of Hygiene Education

2.2.1 Reduce the Transmission of Illness

Hygiene education is essential in today's day and age for both social and health reasons.
As humans, we are obligated to take care of ourselves and society to be in the best condition of
health.

First and foremost, hygiene practises help to reduce the spread of illness among the
community. The community is provided with information about how the infection spread makes
them more aware about their health and encourages them to always be in a good environment.
When the community is full of information about hygiene, they will practise good hygiene
behaviours such as practising good personal and food hygiene in their daily life. In a clean
environment, infectious disorders like diarrhoea are less likely to spread. A significant
proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate
sanitation and hygiene (WHO,2017). This simple practise not only benefits your health, but it
may also safeguard people who are close to you.

An example that can be highlighted now is the spread of COVID-19 pandemic all over
the world. This pandemic teaches us to maintain our health by practising good hygiene habits
in our daily life. To reduce risk of catching the virus, the WHO recommends that individuals
clean their hands regularly with alcohol-based hand rub (hand sanitizer) or soap and water
(WHO,2020).

In fact, it is estimated that proper hygiene might save the lives of 8 million people all
over the world. Infections in the gastrointestinal and respiratory system, such as influenza and
salmonella, can be avoided by following good hygiene habits. This proves that exposure to
hygiene education not only reduces the spread of infectious diseases but also reduces the
number of deaths recorded worldwide.

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2.2.2 Increase Self-Confidence When Facing Society

The second importance of hygiene education is to help individuals to increase self-

confidence when facing society. Deborah Weatherspoon, a medical advisor once said “Looking
and feeling presentable can give you a confidence boost and a sense of pride in your
appearance” (Healthline, written by Kimberly Holland,2018). When we are well-grooming,
people around us will feel happy to communicate with us. For instance, it will be far more
pleasant to greet someone with clean clothes and a good odor than to meet someone with filthy
clothes and has a foul stench.

It can be proven by a program, organised by Lifewater in Ethiopia. "I feel confident and
attractive because I retain my personal hygiene," a female student from Lifewater's Ethiopia
programmes stated. "You only have courage to sit and chat with others if you are clean,"she
continued (Lifewater,2020).

It is obvious that maintaining personal hygiene may make a person happier in social
situations since he or she does not have to worry about other people's opinions of him or her.
As a result, humans are inclined to communicate with others and are no longer limited in their
ability to progress themselves and their country. Thus, good hygiene practises make people
appear more positive and attractive to others in the public community.

2.2.3 Taught on How to Maintain Hygiene

Last but not least, hygiene education taught the community with the knowledge on how
to maintain hygiene in their entire lives. This hygiene program is conducted in one or two
months to ensure that the community members manage to practice hygiene continuously even
if the organiser (health authorities, non-governmental organisation, or the health minister) are
no longer at their place.

In the health promotion program, the community is being taught on how to practice
hygiene in their daily lives. The community will be educated how to maintain a clean
environment as well as their own bodies. They will be taught how to wash their hands with soap
and water, take a bath twice per day, brush their teeth, sweep the floor, and throw the rubbish

8
 at the right place. Because of the positive impacts of what they learned during the
hygiene programme; the community will gradually become accustomed to living in a clean
environment.

Hence, hygiene promotion helps to maintain hygiene practices among the community
members.

In order to preserve one's health, it is essential to adopt good hygiene habits. All responsible
parties (non-governmental organisation, health authorities, and the health minister) must play
their respective roles and duties in the dissemination of hygiene education.

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 3.0 METHODOLOGY

3.1 Delegation of Work

In succeeding this research, we have delegated our work fairly to suit our cramped
schedule within the given time, which is for 11 weeks long. We have divided this assignment
into early part and ending part, where early part consists of abstract, introduction and literature
review and the ending part consists of methodology, data analysis and discussion and
conclusion. The early part of work was handed to two of our groupmates, Aida Humaira and
Farah Illiana Sofea. Aida worked on introduction of the research and the importance of hygiene
education while Farah did abstract of the study and the topline of each hygiene education that
includes water, sanitation, and food hygiene. Other two members of this group, Aliaa and
Ahmad Firdaus have the full responsibility on the assignment’s ending part. Both did research
on previous study regarding hygiene education in underdeveloped country and analyzed the
result. Aliaa worked on methodology used and data obtained from previous investigation and
reviewed together with Firdaus in the discussion part. Finally, Firdaus worked on the conclusion
and recommendation to improve future hygiene education.

3.2 Information of Retrieval

3.2.1 Hygiene Education in School & Public

As everyone knows, school are the place for students to learn, and hygiene education
should be one of the important lessons in school. Syllabus of hygiene lessons will need to
include the importance of hygiene and sanitation, guide to improve hygienic behaviour, effects
on hygiene neglection, clean water source and the list goes on. They can use various alternative
to expose them in hygiene education, as for example, we can convey the message through action
song, games, and demonstration for children in primary school and below. For teenagers, we
can include the lessons in their syllabus by group projects. Secondary school students may need
to do a case study in certain places regarding on hygiene education and they need to find out
the solutions of the problem. Students also can carry out research projects on the impact and

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importance of sanitation, transmittable diseases, effects of contaminated water source and so
much more.

In new research of Gizaw and Addisu, (2020) of exposing hygiene education to

underdeveloped countries community, they chose to implement WASH education in rural
Dembiya, Northwest Ethiopia to reduce the prevalence of intestinal parasitic infections. This
study used 2 methodologies from previous published books where the first study was a baseline
survey with the aim to know the prevalence of childhood intestinal parasitic infections and the
second study was an uncontrolled before-and-after intervention study to test the impacts of
WASH promotion on the disease. About 225 to 300 households have been chosen in the rural
kebeles using systematic random sampling technique. Data were collected using subjective
interview questionnaires and observational checklists.

After the first survey, they delivered health education to school children and rural
communities in the five selected rural kebeles on WASH and the effects on health due to poor
hygiene. They have used physical approaches to children such as role-playing, demonstration,
song, and games. They have also built hand washing spot in all schools using recyclable items
with a maximum capacity 400L of clean water to train hand washing after using toilet. To
increase the outcome of interventions, they have given out leaflets to the community convey
health message and created WASH committee in each kebele to facilitate the program. Data on
second survey were collected by different collectors from the baseline to avoid bias outcomes.

3.2.2 Training for Food Handlers

On the other hand, WASH had included food hygiene as one of the aspects in the
program because contamination of food has contributed huge amount of case diseases and
fatality. To ensure the cleanliness of food, authorities need to concentrate on food handlers
especially on unauthorized hawkers. It is crucial for food handlers to undergo training in food
preparation, serving and storing. Government also needs to strengthen the rule of law for food
services to compulsorily use disposable plastic glove when handling food especially for cooks
and helpers. It is much better if authority checks up on food services regularly to examine for
the restaurant letter grading.

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 In research by Barjaktarović-Labović et al. (2018), they had organized a two phases
survey, the first one was held for 32 randomly selected food services from Ulcinj, Bar, Budva,
Tivat, Kotor, Herceg Novi that located in Montenegro coast. A total of 128 food handlers
participated in this study, which data was collected by questionnaire and direct interview. Food
handlers that were included in this survey was from 18 to above 54 years old with different
education background and experience in handling food. But all the workers share the same
working system that had direct contact with food. The questionnaire was a set of 29 close-ended
questions that consists of the importance of hygiene, knowledge about contamination and
temperature control in food, and cleaning and sanitizing practices. In second phase of study, a
training was organized by MD hygiene specialist that involving work in small groups and
workshops. They have used interactive teaching materials such as video, animated films,
presentations, and flyers according to the three modules they referred. The training was held
for two days explaining and teaching the workers on transmittable diseases from module 1, raw
materials & food preparation and storing from module 2, and temperature control from the last
module. After the training, all workers were asked to answer the same questionnaire. Data was
collected.

3.2.3 Sanitation Campaign & Government Action

Finally, sanitation has been one of the critical issues in underdeveloped countries and
has been unfamiliar with improper sanitation such as correct disposal of excreta, personal
hygiene routine and treated sewage system. One of the ways to improve sanitation within
communities are with the introduction of sanitation campaign, for instance, ‘Swacch Bharat
Mission’ with the purpose to eliminate open defecation and improve solid waste management.
Sanitation campaign must include personal hygiene care like oral hygiene and hand washing
routine that can be followed by public in order to achieve great health. Furthermore, government
must act on sewage treatment system by increasing the number of it. Poor country can use
cheaper alternative on sewage treatment by stabilization ponds as it uses lower cost to build,
easier to operate and maintain, but only require more land space that located minimum a
kilometre away from neighbourhood according to World Health Organization (WHO) (Water
Sanitation and Health (WASH), 2021)

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 From the study by Orgill-Meyer et al. (2019), they had tested the impacts of a
community-led total sanitation campaign in Odisha, India in 2005 to 2006. It included in total
of 40 villages from Bhadrak district that received minimal sanitation promotion. In 2005,
random twenty villages from 40 villages were picked to receive a village-level intensive
promotion campaign while the rest act as controls. To obtain baseline data, around 28
households per village were surveyed on the rural conditions in the region which includes the
poverty and sanitation status. In 2006, a specialized field team worked with community-based
organizations to implement the campaign in those 20 villages by community education
activities. For example, they conveyed the importance of latrines and health, including dignity
and privacy for women that cannot be achieved in open defecation. They also had provided
local support in building pit latrines and raised awareness regarding the government subsidies
for latrine building. A post-intervention survey was organized after 6 months of the intervention
to see the short-term changes. Then, they study the sustainability of changes in the usage of
latrines, functionality and open defecation and sanitation with the surveys conducted to the
same households after four to ten years later. Additional questions were added in the new survey
to better understanding of latrine use and abandonment. They also did a re-survey on most of
the original households in 2016 but replaced with neighbouring household on ones they could
not relocate.

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 4.0 DATA ANALYSIS AND DISCUSSION

4.1 Main Findings

4.1.1 Hygiene Education in School & Public in Ethiopia

Basic personal hygiene of children shown an improvement at the endline compared to

the baseline. The percentage of children who cleaned their body once in three days was
increased from 70.2% to 99.3%. On the other hand, around 61.6% of the children kept short
fingernail and this resulted an increase of total 35.4%. The rest of the results are shown in
Table 1 and graph percentage in Figure 1.

Table 1

Hygiene Variables Baseline Endline Percent Point

(%) (%) Change (%)
Percentage of children who washed 70.2 99.3 29.1
their body once in 3 days with soap
Percentage of children who kept 26.2 61.6 35.4
their fingernails short
Percentage of children frequently 45.3 77.2 31.9
wash their hands after playing,
defecation, and before eating
Percentage of children whose 1.3 34.4 33.1
personal hygiene condition is
generally considered as clean

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 Figure 1

Percentage of Children Personal Hygiene

120
99.3
100

77.2
80 70.2
61.6
60
45.3
40 34.4
26.2
20
1.3
0
Wash Body Once Every 3 Keep Fingernail Short Frequently Wash Hand Generally Considered
Days Clean

Baseline Endline

On the other hand, households’ sanitation practice also shown a better result after the
intervention. The percent of households that keep their living compound free from human
excreta at the baseline and endline is 32% and 49% respectively. 10.7% and 37.7% of rural
households at the baseline and endline respectively, practiced proper dispose solid wastes and
the number of households who kept their living compound clean regularly was significantly
increased. The results are shown in Table 2 & Figure 2.

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 Table 2

Variables Baseline (%) Endline (%) Percent Point

Change (%)
Percentage of households whose 44.9 66.2 21.3
living compound is free from human
excreta
Percentage of households who 10.7 37.7 27
practice safe disposal of solid wastes
Percentage of households who 5.8 49.7 43.9
cleaned their living compound
regularly
Percentage of households who had 43.1 50.7 7.6
access to adequate sanitation

Figure 2

Percentage of Households' Sanitation Practice

70

60

50

40

30

20

10

0
Living Compound Free of Practice Safe Disposal of Clean Living Compound Have Access to Adequate
Human Excreta Solid Waste Regularly Sanitation

Baseline Endline

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 The study of uncontrolled before-and-after intervention was carried out to evaluate the
effectiveness of school and community regarding WASH education program on households in
rural Dembiya, northwest Ethiopia. It is found that households in studied region had positive
impact due to the WASH education program. The number of households that practiced basic
sanitation and good personal hygiene increased at the end of the study compared to the
baseline. In their intervention, they have promoted hand washing practice through training
and demonstration, and it has played roles in improving hand washing practice among
children.

The increase of percentage in children personal hygiene and households’ sanitation

practice marks the successfulness of hygiene education that was held in Ethiopia. Due to the
hard works that have been applied, researchers’ team effort on approaching Ethiopian’s
children regarding hygiene education must be followed. It is clear that the methods used are
effective against children, whereas they taught children through songs, demonstration, and
games, rather than learning it from book. Children tend to observe and learn from physical
action, and it is easier to memorize action compared to words. After learning the
consequences of unhygienic behaviour, children aware the bad outcomes from their daily
routine and know that it needs to be fixed. Therefore, they start to improve their personal
hygiene routine, for example, from a habitual act of not washing hand after using bathroom,
they will start to wash their hands with soap before proceeding to do other things. On the
other hand, the households also shown positive impact in improving their hygiene behaviour.
It is possibly because the community do not know the method and purpose of keeping a clean
environment. After being exposed to new knowledge, the community seem to be able to
accept better daily routine compared to the old ones.

4.1.2 Food Handling Training in Montenegro

The study of providing a food handling training in Montenegro involved a total of 128
food handlers where most of them (around 85.2%) graduated from primary and secondary
school and 14.8% participants had college or university degree. About half of the food
handlers have participated in food safety trainings and have some knowledge about Hazard
Analysis Critical Control Point (HACCP) principles.

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 The questionnaire consists of four aspects that are crucial in food handling, which is
contamination, storage condition, temperature control and maintaining hygiene. Twelve
questions were being asked regarding to the knowledge on the possible contamination of
food. Majority of the participants knew that meat and vegetables need separate equipment to
avoid cross contamination, or the same equipment need to be cleaned with water and
detergent first before use. However, there are quite amount of them still using the same
equipment without disinfecting for cutting meat and vegetables despite knowing the
consequences. Moreover, the rest of the participants do not have the knowledge about it and
makes the education need to be improved.

Other three aspects, storage conditions, temperature control and maintaining hygiene
were asked to the participants regarding to each issue. The percentage of correct answers
before and after the training is shown in Table 3 and Figure 3.

Table 3

Aspect of Question Average Pre- Average Post- Percent Point

Test (%) Test (%) Change (%)
Contamination 55.39 91.5 36.11
Storage Condition 34.6 89.8 55.2
Temperature Control 63.68 91.14 27.46
Maintaining Hygiene 78.28 95.76 17.48

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 Figure 3

Percentage of Correct Answers

120

100 95.76
91.5 89.8 91.1375
% of Correct Answer

78.28
80
63.68
60 55.392

40 34.6

20

0
Contamination Storage Condition Temperature Control Maintaining Hygiene
Aspect of Question

Pre-test Post-test

The level of food safety knowledge among food handlers was determined by
calculating the average of pre-test and post-test knowledge level. From the pre-test
questionnaire, it is clear that there was a lack of knowledge regarding safe temperature for
cooking or food storing. The most important factors for microbial growth are represented by
temperature and time, and inadequate temperature control will lead to major foodbourne
diseases. Furthermore, poor hygiene practices known as the main factor for cross
contamination. The study that was conducted in Italy (Angelillo et al.,2000) has also
mentioned the need for educational programs to improve knowledge and ability to control
foodbourne diseases. This is indirectly directed to food handlers as they have the most contact
with foods other than the consumer. In relation of storing detergents and food, respondents
stated lower level of knowledge as almost half of them do not know the method of storing
detergents and food. However, they also have noticed a big gaps in hygiene knowledge level.
Results shown that there is a lack of appropriate knowledge of cleaning and disinfection
procedures among respondents. In most cases, food-borne pathogens can possibly transfer
from raw food to food handlers, kitchen surfaces and utensils and even other food in worse
cases. Pathogens can survive for a long period of time on cloths and hands, and this will
increase the risk of getting infected. Cross contamination can be avoided by following a good
hygiene practice.

19
 From this study, it is clear that food workers need to be provided with education in
maintain food hygiene as well as a step of foodborne diseases prevention. Many people came
from a different family education background, where some of them might have learn the
importance of hygienic action in handling food, but some of them might not. Providing a
training for food handlers is an effective way to improve hygiene education.

4.1.3 Long-term Impact of Sanitation Campaign in India

In intervention villages, the number of households that own a latrine was higher in
2006 and 2010 surveys compared to 2005. In 2010, around half of in community-led total
sanitation villages built a latrine, while control villages only built a quarter amount. The
increase amount marked 29.3% higher than in control villages. Furthermore, the increase
shown higher results among below-the-poverty-line households as they could request for
subsidies to reduce the costs of constructing latrines. Figure 4 and Table 4 shows the
percentage of households owning a latrine.

Table 4

Percent of Household Owning a Latrine Percent Point

Year (%) Change (%)

Control Villages Intervention

Villages
2005 12 7 5
2006 15 30 15
2010 22 52 30
2016 32 57 25

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 Figure 4

Percent of Household Owning A Latrine

Control Villages Intervention Villages

60 57
52
50
% OF HOUSEHOLD

40
32
30
30
22
20 15
12
10 7

0
2005 2006 2010 2016
YEAR

The research team returned to the studied region of an intensive behaviour change
campaign and found that the usage of latrines constantly higher in intervention villages even
after 4 years. The success of the intervention was due to several factors. First, the campaign
focused on the importance of sanitation that consists of health, privacy, and dignity and it
helped in motivating community to use latrines. Second, local builders were recruited to
create an infrastructure for continuation of latrine sales even after the end of intervention.
Third factor is because the campaign aimed the communities to build the possibility of
spillovers across peers by time. This would help to connect the households with government
subsidies to build cheaper latrines. From the results, we can see that many new latrines have
been built it 2010 compared to 2006, but those facilities could have been built before 2010 as
many households reported in 2006 of their intention in building a latrine. However, the
increasing number of latrines in 2010 showed that the promotion campaign had effects on the
community for at least 4 years.

21
4.2 Strength and Weaknesses of Findings

From the findings, we can conclude that most of the ways to spread awareness and
information about hygiene among the society showed some positive impacts for them like the
percentage of children that clean their body increase significantly and we can see the food
handling also improve into a better way in avoiding any food poisoning. By this, we see that
educating the undeveloped countries’ community leads them to improve their daily water
management and healthy lifestyle. The findings of the current study are in line with the
outcomes of other studies. Studies reported that hygiene education is of paramount importance
in the promotion of safe water-handling and storage practices with little investment from
households. Unfortunately, this finding did not cover the ways that possible can be done from
various parties in society.

22
 5.0 CONCLUSION AND RECOMMENDATION

5.2 Conclusion

According to the World Health Organization " Hygiene refers to conditions and
practices that help to maintain health and prevent the spread of diseases". "Medical hygiene
therefore includes a specific set of practices associated with this preservation of health, for
example environmental cleaning, sterilization of equipment, hand hygiene, water and sanitation
and safe disposal of medical waste". This effort has the potential to expose the attention of
community members to the need of maintaining a clean environment free from disease. Health
education is one of the strategies to achieve the goal of any programme to promote hygiene to
the public community. By promoting hygiene to the community, it can help them to improve
hygiene behaviour and lead to better health. This is due to the fact that decent facilities and
good hygiene habits are intertwined in order to improve one's health. As a safety measure, the
WHO recommended hygiene education about how the infection spreads in order to prevent
diarrhoea spreading in the community.

Poor hygiene practices in the community are caused by the lack of hygiene education,
especially in rural areas. It is important to have a balanced situation between good hygiene
education and sanitation facilities provided in the community. As humans, we are obligated to
take care of ourselves and society to be in the best condition of health. In the health promotion
program, the community is being taught how to practice hygiene in their daily lives. Because
of the positive impacts of what they learned during the hygiene program, the community will
gradually become accustomed to living in a clean environment. Hygiene education in school &
public as everyone knows is a place for students to learn, and hygiene education should be one
of the important school lessons to be taught. This would give them an earlier exposure in
practicing hygiene lifestyle in their life.

The ultimate goal of this study is to introduce the people in underdeveloped nations to
hygiene education so that they may implement it in their daily lives. As we all know, these
nations' populations make up a significant portion of the global population; thus, it is our
obligation to improve their lives by promoting good health and preventing illnesses like
diarrhoea from spreading fast over the world. A single step toward providing them with
knowledge may alter the world for the better in the future, allowing people to live blissfully
without diseases caused by a lack of sanitary habits and information.

23
5.2 Recommendation

Based on our discussion and conclusions, several recommendations for improving the
research outcomes for this issue may be made. To begin, non-governmental organisations
should conduct campaigns in developing countries to raise awareness and provide information
on the need of water cleanliness. Following that, social media influencers or well-known
youtubers must promote and educate their followers about the need of water hygiene in their
daily lives. Finally, developing country governments should take personal efforts to teach
public about the benefits of keeping cleanliness through banners and commercials.

24
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