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Indian Journal of Community Medicine

The Impact of School Health Education Programme on Personal Hygiene and Related Morbidities in Tribal School Children of Wardha District

Author(s): A R Dongre, P R Deshmukh, B S Garg

Vol. 31, No. 2 (2006-04 - 2006-06)


India has one of the largest groups of school going children, especially in rural areas. There are about 6.3 lakh rural schools both primary and upper primary with 80 millions school going children. But it is also a fact that only 8 percent of schools have the sanitation facilities in school premise. Out of 6.3 lakh primary and upper primary rural schools, only 44 percent have water supply facilities, 19 percent have urinals and 8 percent have lavatory facilities. Only 19 percent have separate urinals and 4 percent lavatory facility for girls. Under these conditions, schools and community environment become unsafe places where diseases are transmitted.1

In the present study, an attempt has been made to find out impact of the "school health education program" on personal hygiene and related morbidities in a tribal school of Wardha district.

Material and Methods

The present study was undertaken in a state government funded residential Adivasi Ashram School, of village Mandwa. In February 2003 Kasturba Rural Health Training Center (KRHTC), Anji which is the peripheral rural center of Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram started "School Health Education Program" with emphasis on improvement in personal hygiene of school children.

The request by the village Sarpanch and school teachers prompted us to undertake the study. In February 2003, the baseline health check-up of all 145 children in the school was carried out with the help of pre-tested and structured questionnaire to find out the status of personal hygiene and related morbidities. The check-up was carried out by the team of medical officer, social workers and school teachers through a scheduled visit. Similarly, end line assessment was carried out after one year in March 2004.

The appropriate, need based, low cost health education materials (flip books) on water supply, environmental sanitation and personal hygiene were developed according to PATH guide lines2.

Health education among school children was undertaken with the use of flip books. The demonstration activities were used for imparting health education on hand washing, nail cutting, and cleaning teeth. The planned health education sessions were conducted once a week in the school for one hour for the period of six month. It was carried out by the team of social worker and medical officer. Posters on personal hygiene were also displayed in the classrooms. The teachers were motivated to monitor and facilitate behavior change of school children for the period of next six-months.

The data thus collected was entered and analyzed in epi_info 2000. The proportions were expressed in percentages. Nutritional status was assessed by using CDC 2000 reference and using nutrition program of epi_info 2000.


We started with 145 students (6-14 years) in February 2003 which came down to 112 in March 2004 leading to 33 students lost (22.7%) during follow up.

Table I: Status of personal hygiene among school children in February 2003 and March 2004

of personal
Year 2003
Year 2004
OR (95% CI) P- value
1 Clean and combed hair 40 (27.6%) 59 (52.7%) 1.91 (1.16-3.14) <0.05
2 Clean and cut nails 43 (29.7%) 54 (48.2%) 1.63 (0.99-2.67) <0.05
3 Clean clothes 62 (42.80%) 72 (64.3%) 1.50 (0.97-2.34) >0.05
4 Clean teeth 49 (33.8%) 56 (50%) 1.48 (0.91-2.39) >0.05
5 Wax in Ear 15 10.3% 1 (0.9%) 0.09 (0.00-0.64) <0.05
(Figures in parenthesis indicate percentages.)

Table II: Morbidities related to poor personal hygiene among school children in February 2003 and March 2004

Sr. No. Morbidities
related to
2003 n=145
2004 n=112
(95% CI)
P- value
1 Diarrhea, fever, Upper RTI 82 (56.6%) 50 (44.6%) 0.79 (0.50-1.24) > 0.05
2 Head lice 62 (42.8%) 21 (18.8%) 0.44 (0.24-0.79) <0.05
3 Scabies 53 36.6% 20 (17.9%) 0.49 (0.27-0.89) <0.05
4 Multiple boils 13 (8.9%) 9 (8.0%) 0.90 (0.34-2.34) >0.05
5 Dental caries 12 (8.3%) 6 (5.4%) 0.65 (0.21-1.93) >0.05
6 History of worm infestation 42 (28.9%) 19 (16.9%) 0.59 (0.31-1.10) >0.05
(Figures in parenthesis indicate percentages.)

As seen in the Table I, the point prevalence of clean combed hair and cut nails were 27.6% and 29.7% respectively in February 2003, which increased to 52.7% (OR = 1.91, CI = 1.16-3.14) and 48.2% (OR = 1.63, CI = 0.99-2.67) respectively in March 2004. The difference was statistically significant (p<0.05). Similarly the proportion of the children with wax in ears decreased from 10.3% to 0.9% (OR = 0.09, CI = 0.00-0.64).

The minor ailments reduced from 56.6% in year 2003 to 44.6% in year 2004 (OR = 0.79, CI =0.50-1.24), as may be seen in Table II. The morbidities related to poor personal hygiene like lice infestation and scabies also reduced significantly (p<0.05).

Most of the children (56.6%) were thin (BMI less than 5th percentile) in 2003 and did not change significantly later (56.3%).


"Total Sanitation Campaign" (TSC) was launched by Government of India in 1999 with emphasis on personal hygiene, home sanitation, safe water, garbage disposal and wastewater disposal. It emphasized more on health education, human resource development, and capacity development activities to increase awareness and sanitation demand1. Government of India is committed to scale up TSC throughout the country by the end of 10th plan with the special focus on schools by covering all the government rural schools by 2005-20063.

In the present study, there was significant improvement in personal hygiene of the students. The monthly school health education program had in built role for the teachers who acted as agents for behavior change who implemented the program for six months through facilitation and monitoring. Nayar S. et al4 (1990) had already reported the teachers' superior role over community health volunteer in imparting health education to school children. The activities planned in the present intervention are also recommended in Technical Note Series on School water supply, sanitation and Hygiene education1 (SSHE) by Ministry of Rural Development, Government of India. After the implementation of school health education program with emphasis on improvement of personal hygiene, the proportion of children with clean and cut nails, clean hairs and clean clothes increased significantly.

The proportion of the children with clean teeth increased from 33.8% to 50% (p>0.05). The point prevalence of dental caries reduced from 8.3% to 5% (p>0.05). As reported by Rao et al5 (1993), dental caries were found more prevalent among urban children than rural and tribal children (22.8% vs. 15.5% and 15%, respectively). Thus, the tribal children showed a better oral health status than urban counterparts. This finding was comparable with Jalili et al6 (1993).

The improvement in personal hygiene had significant impact on reducing related morbidities like lice infestation, worm infestation and scabies. But there was no significant impact on conditions like fever, diarrhea and aches and pains (p>0.05). These findings were comparable with the that reported by Biswas et al.7

The study concludes that the school health education program with the active involvement of school teachers leads to improvement in personal hygiene in school children and reduction in related morbidities.


  1. School water supply, Sanitation and Hygiene Education: India Technical Note Series, Ministry of Human Resource Development, Government of India, 2004.
  2. Program for Appropriate Technology for Health (PATH). Developing health and family planning materials for Low literate audiences - A guide; 1996.
  3. Towards Total Sanitation and Hygiene: A challenge for India, Country paper series, New Delhi, 2003.
  4. Nayar S, Singh D, Rao NP, Choudhury DR: Primary school teacher as a primary health a care worker. Indian J Pediatr. 1990; 57(1):77-80.
  5. Rao SP, Bharambe MS: Dental caries and periodontal diseases among urban, rural and tribal school children. Indian Pediatr. 1993; 30(6):759-64.
  6. Jalili VP, Sidhu SS, Kharbanda OP: Status of dental caries and treatment needs in tribal children of Mandu (Central India). J Pierre Fauchard Acad. 1993; 7(1):7-15.
  7. Biswas AB, Roy AK, Das KK, Sen AK, Biswas R: A study of the impact of health, education imparted to school children on their knowledge, attitude and practice in regard to personal hygiene. Indian J Public Health. 1990; 34(2):87-92.

Deptt. of Community Medicine
Mahatma Gandhi Institute of Medical Sciences,
Sewagram, Wardha (Maharashtra)-442 102.
e-mail: [email protected]
Received: 25.11.2004

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