Nope

1. Personal Hygiene Practices among Secondary School
Students in Darchula district, Nepal: A cross sectional study
尼泊尔达楚拉地区中学生的个人卫生习惯：一项横断面研究
By: Bishweshwar Prasad Bhatt
Student ID: 2021YM04
School of Public Health
Southern Medical University
Supervisor: Dr. Zheqing Zhang

2. INTRODUCTION (介绍)
1

3. What is Personal Hygiene ?
Personal hygiene refers to maintaining the body’s
cleanliness. It comprises personal habits like having a bath
frequently, washing hands, brushing teeth, trimming
fingernails ,using toilet for defecation and more.
Personal hygiene practices play a crucial role in
promoting health and preventing the spread of infectious
diseases, especially among school-level students.
Inadequate personal hygiene practices can contribute to
the transmission of diseases, absenteeism from schools,
and overall negative impacts on the well-being of students.
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION
2

4. Importance of Personal Hygiene
Conditions that can develop if there is poor personal
hygiene include:
Diarrhea, especially gastroenteritis
 Respiratory infections, including colds and flu
 Staph infections
Worm-related conditions, such as threadworms
 Scabies
Trachoma, an eye infection which can lead to
blindness
Tinea or athlete’s foot
 Tooth decay
https://www.healthdirect.gov.au
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION
3

5. INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION
Global and Nepal’s Scenario:
Every 20 seconds, a child around the world
dies as a result of poor sanitation3. Moreover,
about 80% of all diseases in the developing
world are related to unsafe water and inadequate
sanitation(Shidiki A, 2017). This alarming situation
highlights the urgency of addressing the
sanitation crisis on a global scale.
In Nepal, the lack of access to sanitation is
striking, with approximately 45% of the
population without proper sanitation facilities,
one of the highest proportions in Asia. The
disparity between urban and rural areas is also
significant, with 75% of urban areas having
sanitation coverage compared to only 20% in
rural areas. (Webb. P. 2005) 4

6. Continued...
5
• Despite the ODF declared
country in South Asia, open
defecation is still a stubborn
challenge for Nepal.
https://kathmandupost.com/natio
nal/2019/10/01/nepal
• 20% have no supplies of water,
soap or any other available hand
cleaning agents [Gerwel-Jensen,
L., Rautanen, S. L., & White, P.
(2015)].
• As per the study conducted in
Nepal, Proper handwashing
technique seems to be reported
by 59.5% of the students from
the urban areas and 48.5% from
rural areas. The majority of the
students used toothpaste for
brushing teeth in urban (79%)
and rural areas (76%)
respectively. For hand washing,
52% used soap in the urban areas
whereas only 26% used soap in
the rural area.[Koirala N, Kafle
S.2021]
• Infectious diseases, such as
influenza, malaria, pneumonia
and diarrhea, are the top leading
causes of death in Nepal [MoHP,
Nepal)
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION

7. Continued.....
Percentage of children under age 5 with symptoms of
ARI, fever, and diarrhea 2 weeks before the surveys.
Source: NDHS 1996- 2022
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION
6

8. Statement of Problem
Worldwide, infectious diseases continue to affect school-age children, and their exposure
to a range of pathogens that can lead to preventable diseases is unavoidable. The root causes
of this issue are primarily linked to lack of personal hygiene and insufficient sanitation
practices.
Lack of adherence to personal hygiene practices among students is a burning issue
especially in rural and remote areas.
This knowledge gap hampers targeted interventions to improve personal hygiene habits,
potentially impacting the health and well-being of students.
Without investigating prevalent personal hygiene practices, exploring sociodemographic
associations, and assessing the link between hygiene practices and health outcomes, it is not
practical and rationale to enforce policy and intervention strategies.
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION
7

9. INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION
Though there is existing evidence showing association between personal hygiene practices
and health outcomes, findings are not uniform.
Most of the available evidences are from developed parts of the world where personal
hygiene is least of their problems and sanitation facilities are easily accessible.
Yet, there hasn’t been conducted any research regarding hygiene and sanitation in
Darchula.
Continued......
8

10. By understanding the existing hygiene practices among students, we can identify areas
that need improvement and develop targeted interventions to promote better hygiene
habits.
District having socioeconomically and educationally heterogenic society, feasible to
analyze association of sociodemographic attributes to hygiene practices.
 Looking at the recent data, communicable disease outbreaks and malnutrition in under-
5 children seem relatively high in this district, lack of hygiene and sanitation has been
thought to be one of the probable reasons behind this public health issue (Bhusal CK,
2020)
It can serve as a reference for policymakers, educators, and health professionals to
design effective hygiene education programs and policies especially for rural and remote
areas. 9
Significance of Study:
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION

11. 10
Limitations of the Study:
 Firstly, the use of self-reported data through a questionnaire may introduce
response bias, as participants might provide socially desirable answers or
inaccurately recall their hygiene practices.
 Reliance on cross-sectional data restricts the ability to establish causal
relationships, preventing us from determining whether personal hygiene
practices directly cause changes in health outcomes.
 The research focuses on a specific district and school environment, potentially
limiting the generalizability of findings to broader contexts.
 The use of qualitative data from focused group discussions, while insightful,
may be subject to interpretation bias during analysis.
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION

12. 11
Ethical Consideration:
 Informed written consent will be obtained first from each "School management
committee" and later from all participants, including students, teachers, school
staff, and guardians orally prior to conducting survey.
 This consent process will involve transparently explaining the research purpose,
procedures, potential risks, and benefits, allowing participants to make an
informed decision regarding their involvement.
 Moreover, all collected data will be treated with strict confidentiality, ensuring
that participants' personal information is anonymized and stored securely.
Participants' privacy and dignity will be safeguarded,
 and their willingness to participate will be entirely voluntary, with the option to
withdraw at any point without consequences.
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION

13. OBJECTIVES(目标）
12

14. Research Questions:
1. What are the prevalent personal hygiene practices among secondary school students in
Darchula district?
2. How do sociodemographic variables, such as age, gender, and socioeconomic status,
relate to personal hygiene practices among students in Darchula district?
3. What is the association between personal hygiene practices and health outcomes among
secondary school students in this district?
4. How do teachers, school staff, and parents perceive the personal hygiene practices of
students in Darchula district, and what insights can be gained from their perspectives.
13
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION

15. General Objective: To investigate and analyze the personal hygiene practices among
secondary school students in the Darchula district of Nepal.
Specific Objectives:
a. To determine the prevalence of various personal hygiene practices among school-
level students.
b. To explore the association of personal hygiene practices with sociodemographic
factors and health outcomes.
c. To analyze the insights and recommendations provided by teachers, school staff, and
parents for improving student personal hygiene practices.
Research Hypothesis:
Null Hypothesis (H0): There is no relationship between personal hygiene practices and
health outcomes among school-level students in Darchula District, Nepal.
Alternative Hypothesis (HA): There is a relationship between personal hygiene practices and
health outcomes among school-level students in Darchula District, Nepal. 14
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION
Objectives:

16. LITERATURE REVIEW (文献综述）
Main Findings.............
15

17. 16
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION
 Search Strategy:
First
Step
• PubMed and Web of Science were searched using the search term
• A total of 108 articles were obtained (PubMed 35, web of science = 73).
Second
Step
• Articles screened against title (71)
Third
Step
• Irrelevant articles excluded (57)
Fourth
Step
• Finally selected 38 articles for review based on inclusion/exclusion criteria.

18. 17
 What does Personal Hygiene mean:
It includes regular washing of hands, body, and hair, maintaining oral hygiene, and keeping
one's living environment clean to prevent the transmission of infections and promote
overall health.
Research indicates that around 88 percent of global diarrhea cases result from drinking
contaminated water, inadequate sanitation, or poor hygiene practices.
It has been estimated that 10,500 Nepali children below the age of 5 die due to water-borne
diseases.
Acute respiratory tract infections, skin infections, gastroenteritis , intestinal worms,
malnutrition and hepatitis are most prevalent diseases due to lack of personal hygiene.
Poor dental hygiene practices have been associated with a higher prevalence of dental
caries and gum diseases among school children.
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION

19. 18
Repeated attacks of infections have revealed that it may compound the existing poor
health of children leading to negative consequence in children's attendance and
performance at school.
Nepal’s education system is affected by the inadequate supply of safe drinking water
and safely managed sanitation services. Nepal has 34,782 schools, of which 79% report
they have a toilet. Over half of these schools (56.7%) report they have a separate toilet
for girls (World Bank, WHO & UN Water 2015)
In a majority of developing nations including Nepal, approximately 80% of diseases
are attributed to suboptimal domestic and personal hygiene.
Geographical variation in hygiene practices.
High infectious disease burden and malnutrition due to poor hygiene.
Prevalent diseases: water-borne, respiratory infections.
Inadequate sanitation conditions, open defecation.
Continued.......
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION

20. METHODOLOGY (方法)
19

21. Study design
Design: Cross-Sectional Study (Among Secondary Level Students)
Method: Mix(Quantitative and Qualitative)
Sample Size:
For quantitative data using
Taro Yamane Formula (Yamane, 1973) 𝑛 = N/ 1 + N(𝑒)2 which is used for
finite population from where sample is drawn.
Where n = sample size N = population size , 𝑒 = margin of error (0.05)
Based on this formula, total required sample size will be calculated; hence
equal number of students will be randomly selected from each male and
female strata of each grade corresponding to the schools of each
geographical region to constitute the appropriate sample frame.
20
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION

22. Continued...
For qualitative data :
Purposive sampling technique
Group of 6 participants will be randomly selected from each school
including teachers, school staffs and parents of students for focus group
discussion. As per DL Morgan(1996) there is no fixed rule to determine the
size of group; in practice focus groups usually consist of 6 to 12 participants
and this range is often recommended to facilitate meaningful interactions
allowing each participant to contribute. (Morgan DL. Focus Groups. Annu Rev Sociol.
1996).
 Braun et al., (2016) argued that the appropriateness of the sample size in a
qualitative study is defined by the depth of the data collected and not the
frequency of the responses.
21
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION

23. Inclusion and Exclusion Criteria
• Inclusion criteria For Quantitative Sample
 Secondary school students in grade 8, 9, and 10 in
Darchula district, Nepal.
 Students from both selected public and private
schools.
• Exclusion criteria For Quantitative Data
 Students beyond the age range of typical
secondary school students i.e. 12 to 15 years ( as per
National Curriculum Structure 2076,Nepal)
 Those students who are out of school at the time
of data collection and are reluctant to participate in
research and hesitating to respond the survey
questions as per their real practices.
22
• Inclusion criteria For Qualitative Sample
 Teachers, School Staffs and Parents of the
corresponding students.
 Eager to participate in research and convinced to
respond the survey questions as per their real
practices.
Exclusion criteria For Qualitative Sample
 Not Familiar with personal hygiene and
sanitation awareness.
 Who can not communicate in Nepali or English
language
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION

24. Sampling Method
23
Purposive Stratified sampling
based on geography
Purposive
sampling
Random
sampling
Purposively
classes will be
selected
Stratification based
on gender
Simple
Random
Sampling
Study
population
Darchula
District,
Nepal
Duhun region
All secondary
schools (6)
2 Schools
8
Male
Female
9
Male
Female
10
Male
Female
Lekam region
All secondary
schools (7)
2 Schools
8
Male
Female
9
Male
Female
10
Male
Female
Marma region
All secondary
schools (5)
2 Schools
8
Male
Female
9
Male
Female
10
Male
Female
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION

25. 25
Data Collection
Questionnaires
Socio-demographic data
Health Outcomes
Personal Hygiene
Practices
Barriers and
responsibilities
towards practicing
personal hygiene
24
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION

26. Continued.................
25
A standardized pre-structured questionnaire will be designed as a survey
instrument
A set of required questionnaires will be developed and used for all the
students to be involved in research.
The questionnaire will be pretested among a small group of students
before using it for real research intent to ensure its clarity and consistency.
It is estimated that it will take approximately 15–20 minutes to collect the
quantitative data from each student.
For the last part of the questionnaire i.e. "Recommendations for Improving
Personal Hygiene Practices" focused group discussion will be organized
including teachers, school staffs and available guardians/parents of students at
the last of the survey with students at each school.
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION

27. Continued.....Anthropometric measurements
• Weight (nearest 0.1 kg)
• Height (nearest (0.1 cm)
Table 1: WHO classification of weight status
Weight status Body mass index(BMI)
Underweight < 18.5
Normal range 18.5-24.9
Overweight 25.0-29.9
Obese ≥ 30
Obese I 30.0-34.9
Obese II 35.0-39.9
Obese III ≥ 40
BMI= weight in kg/ height in m2
26
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION

28. Data analysis
Data Input and Analysis
Statistical method
Confounders
IBM SPSS 25.0
Univariate analysis, logistic regression, Chi-Square test,
Manual interpretation of qualitative data.
Family income, Parents' occupations, and Education levels,
Age, Grades, Type of school (Public/Private), Ethnicity and
Religion, Gender, Geographic Location, Access to Hygiene
Materials, Seasonal Variations.
27
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION

29. Variables in the research
28
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION
Age
Height
Weight
Gender
Religion
Family education
(Father)
Family education
(Mother)
Family occupation
(Father)
Family occupation
(Mother)
Family income
Grade
Type of School
Ethnicity
Family Occupation
(Father)
Family Occupation
(Mother) Personal hygiene status (categorized
as "Good Hygiene" or "Poor Hygiene"
based on the threshold.
Personal hygiene status (categorized as "Good
Hygiene" or "Poor Hygiene")
Health outcomes (presence or absence of various
health issues listed in Section 4)
Frequency/episode of health issues (for each
health issue listed in Section 4)
Hospitalization or medication for health issues
(for each health issue listed in Section 4)
Dependent Variables
Independent Variables

30. Data analysis
29
Univariate analysis will be used in obtaining the frequency of sociodemographic characteristics
and other discrete variables of the study population.
For the second section of questionnaire; score shall be assigned to each response option based on
the provided weights in brackets (0-3) and summed up the scores for each participant across all
questions to calculate their total hygiene score.
Later on, by setting up the dependent variable (hygiene category) and independent variables (encoded
sociodemographic attributes); the binary logistic regression will be calculated for each independent
variable, reflecting the change in log odds of the dependent variable for each unit change in the
independent variable while holding other variables constant.
For the analysis of health outcomes, Chi-Square test will be done to explore the association of personal
hygiene status (poor or good) with health outcomes and compare the calculated Chi-Square value with
the critical value or the p-value
Regarding qualitative data analysis, after transcribing discussions and responses, key points will be
highlighted and grouped based on similar themes and the analysis will consider patterns and
differences. Findings will be presented with themes, summaries, and illustrative quotes.
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION

31. 30
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION
Type of
Data
Mean of data
collection
Anticipated Indicators Remarks
Quantitative
Structured self-
administered
questionnaire
(section-1)
Comprehensive description of sociodemographic characteristics.
Descriptive
statistical
tool
Structured self-
administered
questionnaire
(section-2)
Clear categorization of participants into "Good Hygiene" and "Poor
Hygiene" groups based on Threshold Score.
Quantification of the impact of sociodemographic attributes on
hygiene status and identification of statistically significant
sociodemographic factors influencing hygiene practices.
Binary
Logistic
regression
Structured self-
administered
questionnaire
(section-3)
The percentage of respondents who select each option (a, b, c, d, e) to
identify the primary stakeholders perceived as crucial in promoting
personal hygiene and the most commonly perceived barriers.
Descriptive
statistical
tool
Structured self-
administered
questionnaire
(section-4)
Determination of significant associations between personal hygiene
status and health outcomes.
Chi square
test
Anticipated Indicators

32. 31
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION
Type of
Data
Mean of data
collection
Anticipated Indicators Remarks
Qualitative
Focused Group
Discussion
Identification of key themes and patterns within qualitative
data.
Insightful interpretation of qualitative findings, enhancing
the overall depth of the research.
Manual manipulation of
data and findings will be
presented with themes,
summaries, and
illustrative quotes.
Anticipated Indicators
Continued...
Potential Biases:
Response Bias:
Social Desirability Bias: Students may provide answers they believe are socially acceptable, leading to over
reporting of positive personal hygiene practices and underreporting of negative ones.
Recall Bias: Students may not accurately recall or report their personal hygiene practices, leading to
inaccuracies in the data.

33. CONCLUSION (结论)
32

34. 研究结论
Conclusions
33
INTRODUCTION OBJECTIVES LITERATURE REVIEW METHODOLOGY CONCLUSION
Research will comprehensively investigate personal hygiene practices among secondary school students in
Darchula district, Nepal addressing unique socio-cultural factors in the region.
Regarding methodology, utilize a mixed-methods approach with quantitative and qualitative data collection
methods, employ multistage and purposive sampling techniques and validated the questionnaire for
reliability.
Key findings will be prevalence of personal hygiene practices among students, sociodemographic
factors influencing hygiene practices, associations between personal hygiene and health outcomes and
other qualitative insights.
The research will provide insights for policymakers, educators, and health professionals and recommendations for
improving personal hygiene practices among students.

35. Acknowledgements
Professor and Supervisor: Dr. Zhang Zheqing
Data collection enumerators: Mr. Ramesh, Mrs. Bimala
The Government of People’s republic of China
Southern Medical University
School of International education
School of Public Health
34

36. References
•Shidiki A, Bhargava D, Gupta RS, Ansari AA, Pandit BR. Bacteriological and Physicochemical Analysis of Drinking
Water in Tokha, Kathmandu, Nepal.
•Webb. P. Water and Food Insecurity in Developing Countries: Major Challenges for the 21st Century.; 2005.
http://www.nutrition.tufts.edu
•https://kathmandupost.com/national/2019/10/01/nepal
•Gerwel-Jensen, L., Rautanen, S. L., & White, P. (2015)].
•Koirala N, Kafle S. Personal Hygiene Among School-Going Children in Morang District , Eastern Nepal. 2021;4(2):1-9.
•WHO. environment-climate-change-and-health/housing-and-health/health-impact-assessment-guidance/good-practice-
guidance-on-assessing-environmental-impact-on-health/personal-hygiene-steps-for-good-health. WHO website. Published
2009. www.who.int
•CDC. Hygiene Fast Facts. Web Page. Published 2021. www.cdc.gov
•NDHS 1996- 2022
•MOHP, Nepal 35

37. THANK YOU