INTRODUCTION:

The global burden of disease associated with poor water, sanitation and hygiene (WASH) is concentrated among children and thus promoting the practice of hand washing with soap (HWWS) among children presents an important public health measure.¹ Young children are particularly susceptible to respiratory tract (RT) and gastrointestinal (GI) infections.² Standard public health interventions to improve hand hygiene in communities with high levels of child mortality encourage community residents to wash their hands with soap at five separate key times, a recommendation that would require mothers living in impoverished households to typically wash hands with soap more than ten times per day.³

More than 3·5 million children aged less than 5 years die from diarrhoea and acute lower respiratory-tract infection every year.⁴Hand washing has been globally acknowledged and accepted as a low cost and effective technique in preventing communicable diseases by countries all over the world, including WASH programme by UNICEF (United Nations Children’s Emergency Fund, 2012).⁵

Hand washing before and after certain activities (e.g. before eating food and after going to the toilet) is considered as most effective in removing germs thus protecting one against infectious diseases like diarrhoea and pneumonia and also in preventing transmitting disease causing germs to others.⁶ Hand washing is predominantly important for children as the prevalence of diarrhoea and pneumonia is high among them. Nearly 90% of child deaths due to diarrhoea and pneumonia occur in the 5 most populous and poor countries: India, Nigeria, Democratic republic of Congo, Pakistan and Ethiopia.⁷

In a study to evaluate the effectiveness of structured teaching programme on hand washing practices among school going children in Ambala Haryana revealed The data depicts that in pretest; most of the students (81%) had good practice followed by (19%) fair, regarding hand washing techniques. but in posttest majority of the students (61%) had very good followed by (39%) good knowledge regarding hand washing techniques.⁸similarly a study done with an aim to assess the effectiveness of hand hygiene technique demonstration on hand hygiene practices of primary school going children. Data was collected from the Rotary Shikshan Santha Malkapur Karad, Maharashtra, India. The result showed that the mean pre-demonstration value was 5.383 and mean post-demonstration value was 9.033. The paired t' test value was 23.744, (p<0.0001) showing a significant gain in the improvement of hand hygiene practice of primary school going children.⁹

Report of National Health and Medicine Research (2015) states, infectious diseases affect the world unevenly. 31% of all deaths in Asia and 62% of all deaths in Africa are due to infection. For global community reducing this disparity is a big challenge. The public health fraternity is busy in combating malaria, tuberculosis and HIV/AIDS, but there is less importance is given to the two biggest killers of children such as diarrheal diseases and acute respiratory infections, as a result of a child’s daily interactions through the air, skin contact and through contamination of environment, fifty percent of the all child deaths each year due to diarrhea and acute respiratory infections, both of which are transmitted from person to person during every day.¹⁰

If we give information related to hand hygiene to the children. School children can tells their parents about hand hygiene techniques and also parents get awareness regarding hand washing; we can easily cure or prevent the diseases.

OBJECTIVES:

1. To assess the pretest knowledge regarding hand washing techniques to Prevent gastrointestinal infections among school going children in control and experimental group.

2. To assess the posttest knowledge regarding hand washing techniques to prevent gastrointestinal infections among school going children in control and experimental group.

3. To compare the pretest and posttest knowledge regarding hand washing techniques to prevent gastrointestinal infections among school going children in control and experimental group.

4. To find out the relationship between pretest and posttest knowledge regarding hand washing techniques to prevent gastrointestinal infections among school going children in control and experimental group with selected variables

MATERIALS AND METHOD:

In this research, under quantitative research approach, quasi experimental design was selected to study the effect of structured teaching programme on Hand washing techniques to prevent gastrointestinal infections among School going children. Study setting was schools in Ludhiana. Punjab. Samples were selected for the present study with convenience sampling technique. Sample size was 100. Each group consists of 50 samples. Date for data collection was 14/01.2020 to 13/02/20 before collecting data researcher had obtained formal permission from the selected school authorities. Data were collected through interview method. Informed consent was obtained from school children before data collection. Pre-test was carried out on day one from subjects in both groups. Experimental group subjects received structured teaching programme on hand washing techniques to prevent gastrointestinal problems. Post-test was done on the seventh day followed by the intervention.

ANALYSIS AND INTERPRETATION OF DATA:

Table I: Frequency and Percentage Distribution of Subjects in Experimental and Control Groups: (N = 100)

S. No.	Demographic Variables	Frequency (Percentage)
S. No.	Demographic Variables	Experimental Group	Control Group
1.	Age (Years):
	a. 9	16 (32%)	16 (32%)
	b. 10	23 (46%)	19 (48%)
	c. 11	11 (22%)	15 (30%)
2	Gender:
	a. Male	30 (60%)	26 (52%)
	b. Female	20 (40%)	24 (48%)
3	Class:
	a. 3rd standard	16 (32%)	16 (32%)
	b. 4th standard	23 (46%)	19 (48%)
	c. 5th standard	11 (22%)	15 (30%)
4	Education of Father
	a. Illiterate	3 (6%)	3 (6%)
	b. 1st to 10th standard	17 (34%)	26 (52%)
	c. 11th to 12th standard	6 (12%)	16 (32%)
	d. Graduate and above	24 (48%)	11 (22%)
5	Education of Mother
	a. Illiterate	10 (20%)	9 (18)
	b. 1st to 10th standard	27 (54%)	17 (34%)
	c. 11th to 12th standard	13 (26%)	9 (18%)
	d. Graduate and above	0 (0%)	15 (30%)
6	Occupation of Father
	a. Government employee	12 (24%)	7 (14%)
	b. Private employee	26 (42%)	24 (28%)
	c. Self employed	8 (16%)	11 (22%)
	d. Laborer	4 (8%)	8 (16%)
7	Occupation of Mother
	a. Government employee	4 (8%)	5 (10%)
	b. Private employee	19 (38%)	17 (34%)
	c. Self employed	7 (14%)	10 (20%)
	d. Home maker	20 (40%)	18 (36%)
8	Type of Family
	a. Nuclear	13 (26%)	15 (30%)
	b. Joint	22 (44%)	23 (46%)
	c. Extended	15 (30%)	12 (24%)
9	Family Monthly Income (Rupees)
	a. ≤5000
	b. 5001-10000	16 (32%)	16 (32%)
	c. 10001-15000	20 (40%)	23 (46%)
	d. ≥ 15001	14 (28%)	11 (22%)
		0 (0%)	0 (0%)
10	Hand washing facilities at home
	a. Tap water and soap
	b. Only water	21 (46%)	34 (68%)
		29 (58%)	16 (32%)
11	Hand washing facilities at school
	a. Tap water and soap
	b. Only water	35 (70%)	14 (28%)
		15 (30%)	36 (72%)
12	Source of Information
	a. Electronic media	15 (30%)	10 (20%)
	b. Printed media	8 (16%)	13 (26%)
	c. Family/friends	11(22%)	7 (14%)
	d. Teachers	16 (32%)	20 (40%)

Table II: Frequency and Percentage Distribution of Subjects According to Pre-test knowledge in Experimental and Control Group. (N = 100)

S. No	Pre-test Level of Knowledge	Experimental Group		Control Group
S. No	Pre-test Level of Knowledge	f	%	f	%
1.	Poor (1 – 10)	38	76	50	100
2.	Average (11 – 20)	12	24	0	0
3.	Good (21 – 30)	0	0	0	0

Table II shows the pre-test level of knowledge regarding hand washing technique with regard to prevention of gastrointestinal problems among subjects in experimental and control group.

In control group, all the 50 (100%) of the subjects were having poor level of knowledge.

Figure 1: Percentage Distribution of Subjects According to Post-test knowledge in Experimental and Control Group.

Table III: Mean, Mean Difference, Standard deviation and paired ‘t’ test value regarding pre-test and post-test knowledge among subjects in experimental group. (N = 50)

S. No.

Test

Mean

Mean Difference

Standard Deviation

‘t’ test

‘P’ Value

Pre-Test

9.78

2.234

40.415*

0.000

Post-Test

25.78

2.053

*-Significant at ‘P’ value less than 0.05

The mean pre-test score was 9.78 and the mean post-test score was 25.78. The mean difference score was 16. Standard deviation score of pre-test was 2.234 and for posttest was 2.053. Paired’ test score was 40.415. This was statistically significant at ‘P’ value 0.000.

Table IV: Mean, Mean Difference, Standard deviation and paired ‘t’ test value regarding pre-test and post-test knowledge among subjects in control group. (N = 50)

S. No

Test

Mean

Mean Difference

Standard Deviation

‘t’ test

‘P’ Value

Pre-Test

1.24

6.4

0.431

13.269

0.000

Post-Test

.64

3.367

*- Significant at ‘P’ value less than 0.05

The mean pre-test score was 1.24 and the mean post-test score was 7.64. The mean difference score was 6.4 Standard deviation score of pre-test was 0.431 and for posttest was 3.367 paired’ test score was 13.269. This was statistically significant at ‘P’ value 0.000.

Table V: Mean, Mean Difference, Standard deviation and independent ‘t’ test value regarding post-test knowledge among subjects in experimental group and control group. (N = 50)

S. No.	Post - Test	Mean	Mean Difference	Standard Deviation	‘t’ test	‘P’ Value
1	Experimental Group	25.72		2.17
2	Control Group	13.71	12.01	9.131	59.524	0

*- Significant at ‘P’ value less than 0.05

The above table shows the independent ‘t’ test value between post-test scores in experimental and control groups.

Mean post –test score in experimental and control group was 25.72 and 13.71 respectively. The mean difference score was 12.01. The standard deviation scores in experimental group was 2.170 and for control group 9.131. The ‘t’ value was 59.524 which was statistically significant at the ‘P’ value 0.000.

DISCUSSION:

Significant study results were discussed based on the study objectives.

First objective of the study was to assess the pretest knowledge regarding hand washing techniques to prevent gastrointestinal infections among school going children in control and experimental group.

In the present study Table II shows the pretest knowledge regarding hand washing techniques to prevent gastrointestinal infections:

In experimental group, majority of the subjects 38 (76%) were having poor level of knowledge and those subjects with average level of knowledge were 12 (24%). None of the subjects were with good level of knowledge. In control group, all the 50 (100%) of the subjects were having poor level of knowledge. This finding was similar to the study findings of Mamta et al (2018) study aimed to evaluate the effectiveness of structured teaching program in terms of Practice regarding hand washing techniques among school going children in selected school of Barara, in pretest; most of the students (81%) had good practice followed by (19%) fair, regarding hand washing techniques.⁸ The current study findings also supported by the research don eby Nivetha R (2016) pre-test and post-test disclosed that most of the 82( 82%) school children had inadequate knowledge in pre-test whereas 96(96%) had adequate knowledge in post-test.¹²

Second Objective of the study was to assess the post-test knowledge regarding hand washing techniques to prevent gastrointestinal infections among school going children in control and experimental group:

Table III in the present study shows the data regarding post-test knowledge among subjects in an experimental and control group. In experimental group, all the 50 (100%) of the subjects were having good level of knowledge In control group, majority of the subjects 41 (82%) had poor knowledge and those who were with average level of knowledge were 9 (18%).. these findings were supported by a study done to assess the Effectiveness of hand hygiene teaching on knowledge and compliance of hand washing among the students at a selected school in Mugalivakkam village, Kancheepuram District Rubanpremkumar S.A, Dr Aruna S, and Sasikala M (2014) In the posttest, 13 (65%) of the students had adequate knowledge and seven (35%) had moderately adequate knowledge on hand hygiene.¹³

Third objective of the study was to compare the pretest and posttest knowledge regarding hand washing techniques to prevent gastrointestinal infections among school going children in control and experimental group.

Table V shows the independent ‘t’ test value between post-test scores in experimental and control groups.

Mean post-test score in experimental and control group was 25.72 and 13.71 respectively. The mean difference score was 12.01. The standard deviation scores in experimental group was 2.170 and for control group 9.131. The ‘t’ value was 59.524 which was statistically significant at the ‘P’ value 0.000.

The above findings were supported by the following studies Shrestha A and Angolkar M (2013) which highlighted that mean practice score was increased from 41.42 to 60.87 after health education intervention on hand washing. From these findings it is proved that structured teaching programme improved the level of practice on hand washing among school children. The study done by Kennan also revealed similar findings that the hand hygiene intervention increased 40% of the knowledge level among target population.

Study done in Tamil Nadu by Rubanprem K.S.A, Aruna S and Sasikala M (2014) also supports the current study findings. The pre-test mean score was 6.15 (SD 1.95) and the mean post-test score was 16.25 (sd 1.83), the ‘t’–test value was 18.621. This shows after the structured teaching programme there was an increase in knowledge regarding hand washing technique.¹³

CONCLUSIONS AND RECOMMENDATIONS:

The study finding proved that the structured teaching program administered by the researcher was effective to increase the knowledge of school children’s in selected schools regarding prevention of gastrointestinal problems.

Based on the research findings the recommendations are as follows:

· A similar study can be conducted to assess the knowledge and practice among mother of school children regarding hand washing practice.

· A study can be conducted among different age group of children

· A comparative study can be conducted among the rural and urban area school children.

· A study can be conducted to find out the knowledge of parents and teachers on hand washing practice.

· Similar study can be conducted with large sample to generate the findings

REFERENCES:

1. Watson JA, Ensink JHJ, Ramos M, Benelli P, Holdsworth E, Dreibelbis R, et al. Does targeting children with hygiene promotion messages work? The effect of handwashing promotion targeted at children, on diarrhoea, soil-transmitted helminth infections and behaviour change, in low- and middle-income countries. Tropical Medicine and International Health. 2017; 22(5): 526–38.

2. Rodríguez L, Cervantes E, Ortiz R. Malnutrition and Gastrointestinal and Respiratory Infections in Children: A Public Health Problem. Int J Environ Res Public Health. 2011 Apr; 8(4): 1174–205.

3. Luby SP, Halder AK, Huda T, Unicomb L, Johnston RB. The Effect of Handwashing at Recommended Times with Water Alone and With Soap on Child Diarrhea in Rural Bangladesh: An Observational Study. PLoS Med [Internet]. 2011 Jun 28 [cited 2020 Oct 21];8(6). Available from: https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3125291/

4. Selvaraj K, Chinnakali P, Majumdar A, Krishnan IS. Acute respiratory infections among under-5 children in India: A situational analysis. J Nat Sci Biol Med. 2014; 5(1):15–20.

5. Gawai P, Taware S, Chatterjee A, Thakur H. A cross sectional descriptive study of hand washing knowledge and practices among primary school children in Mumbai, Maharashtra, India. International Journal of Community Medicine and Public Health. 2016 Oct 1;3: 2958–66.

6. Bloomfield SF, Aiello AE, Cookson B, O’Boyle C, Larson EL. The effectiveness of hand hygiene procedures in reducing the risks of infections in home and community settings including handwashing and alcohol-based hand sanitizers. Am J Infect Control. 2007 Dec; 35(10): S27–64.

7. Effect of handwashing on child health: A randomised controlled trial | Request PDF [Internet]. [cited 2020 Oct 21]. Available from: https://www.researchgate.net/publication/7720327_Effect_of_handwashing_on_child_health_A_randomised_controlled_trial

8. Kumari M, Thakur M, Sharma M, Sharma M, Machal M, Devi SS, et al. A study to evaluate the effectiveness of structured teaching program in terms of knowledge regarding hand washing techniques among school going children in selected school of Barara, Ambala.: 2.

9. Mane MA, Tata SH. A Study to Assess the Effectiveness of Hand Hygiene Technique among School Children in Maharashtra, India. Asian Journal of Pharmaceutical Research and Health Care. 2017 Dec 8;9(4): 174–9.

10. Fenollar F, Mediannikov O. Emerging infectious diseases in Africa in the 21st century. New Microbes New Infect. 2018 Sep 21;26: S10–8.

11. 3002378nivethar.pdf [Internet]. [cited 2020 Oct 21]. Available from: http://repository-tnmgrmu.ac.in/2759/1/3002378nivethar.pdf

12. [PDF] Effectiveness of hand hygiene teaching on knowledge and compliance of hand washing among the students at a selected school in Mugalivakkam village, Kancheepuram District | Semantic Scholar [Internet]. [cited 2020 Oct 21]. Available from: https://www.semanticscholar.org/paper/Effectiveness-of-hand-hygiene-teaching-on-knowledge-Aruna/32553db95195295572601c 6e7343ff63aa729728

13. Shrestha A, Angolkar M. Improving hand washing among school children: an educational intervention in South India. 2015;8:5.

Received on 21.10.2020 Modified on 19.11.2020

Int. J. Nur. Edu. and Research. 2021; 9(1):37-41.

DOI: 10.5958/2454-2660.2021.00009.0