FACTORS INFLUENCING IMPLEMENTATION OF HYGIENE PRACTICES IN PUBLIC SECONDARY SCHOOLS IN NIGERIA

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Factors influencing poor hygiene among secondary students In Nigeria

CHAPTER ONE

1.1 Background of the Study

Hygiene is the practice of keeping oneself and one’s surroundings clean so as to prevent illness or the spread of preventable diseases (Ministry of Public Health and Sanitation and Ministry of Education, 2009).It is often referred to as the behaviors and measures which are adopted so as to break the chain of transmission of infections both at home and in school. While lack of safe water, sanitation and prevalence of poor hygiene behaviors is the major cause of death among students in developing countries, a contaminated environment and poor hygiene practices account for over 60% of the total burden of disease among students in these countries. (UNICEF and WHO, 2009).

Eradication of open defecation, improved hand washing practices and ensuring that all liquid and solid waste are properly managed will help in ensuring proper hygiene practices and also save an estimated 1.9 billion school days that are lost due to diarrhea illness and other water and sanitation-related diseases (Hutton, Guy and Laurence, 2004).It is important to note that apart from the family, schools are important and stimulating learning environments for children and have the potential to significantly alter the behavior patterns of students leading to improved hygiene practices (UNICEF,2009). According to Water Supply and Sanitation Collaborative Council (2010), these hygiene behaviors include proper hand washing, regular bathing and laundering, safe disposal of waste, and proper use of toilets which will help in enhancing effective learning, attracting large student enrollment in schools and ensuring a reduced burden  on diseases.

While water and sanitation infrastructure provide the physical facilities needed for hygiene, they cannot independently prevent the transmission of diseases in a school set up. They need to be used in a hygienic manner by all the people so as to prevent environmental pollution and disease

(WHO, 2010).Too often, schools are some of the places where children become ill and although health education can bring about the intention to change poor hygiene practices, availability of appropriate hygiene facilities is essential in transforming students’ intention to change into actual change both today and even in future. This will further be facilitated by mutual sharing of information and ensuring that these facilities are well designed, well located and that they are used and maintained appropriately thus enabling students to practice good hygiene and stay healthy (UNICEF, 1998b).

Poor hygiene practices have not only serious health consequences but also represent large economic losses and a bad image for countries and governments. The cholera epidemic in schools in Latin American cities for example, which was caused by deteriorated water supply and poor hygiene conditions, spurred politicians and administrators into action although they had thought that the disease had long been overcome. Schools in Peru were hit by a similar cholera epidemic which caused the country an estimated 200 billion US dollars in lost lives, decreased production, exports and tourism (Hutton, Guy and Laurence, 2004). There is therefore  little doubt that access to clean water and sanitation should become a priority in schools and this will trigger implementation of proper hygiene practices. According to Cairncross and Kocher (1994), proper hygiene practices is a critical input in the overall development of a child and is significantly influenced by factors namely availability of water, soap, toilets and sanitary towel disposal bins. However, many schools experience unsanitary conditions that force them to practice poor hygiene.

According to studies done by UNICEF and WHO (2008), 1.1 billion people worldwide have already gained access to improved sanitation facilities since 1999 but the global community is still unlikely to achieve the Millennium Development Goal target-to halve by 2015, the proportion of people living without sustainable access to safe drinking water and basic sanitation facilities (Howard and Bartram, 2003). This is because the number of people (including students) who continue to suffer from lack of access to improved water and sanitation is still high (UNICEF, 1998).

During the world summit on sustainable development in 2002, the UNICEF executive director emphasized that every school should be equipped with separate sanitation facilities for boys and girls and should have a source of safe water. However, UNICEF estimates that half of the

schools in the world today still lack safe water and sanitation and experience unhygienic conditions that vary from inappropriate and inadequate sanitary facilities such as unavailability of water to the outright lack of toilets. Based on this, one can conclude that more than three hundred million children go to schools which lack safe water or clean toilets. This situation makes the students practice poor hygiene and yet very few studies have been done concerning factors influencing implementation of these poor hygiene practices. This problem has partly been aggravated by the implementation of the Free Primary Education (FPE) which has witnessed a drastic increase in the number of secondary school students.

In Tanzania for example, there was an increase in school enrolment from 5.4 million in 2001 to

7.6 million in 2005 (MOE strategic plan,2002-2005).This has led to constraining of the available sanitation and school infrastructure. In Nigeria the enrolment of pupils in both primary and secondary schools increased from 5.9 million in 2002 to 8.6 million in 2010, overstretching the already existing inadequate water and sanitation facilities (MOE strategic plan, 2006-2010). As a way of trying to address this issue, most governments have come up with guidelines for providing sanitation infrastructure in schools which range from a simple latrine to student ratio to detailed designs that must be used in the construction of toilets and hand washing stations. According to The Ministry of Public Health and Sanitation and Ministry of Education (2009), the recommended ratio is 1:25 and 1:30 for girls and boys respectively. However, studies show that these standards have not been met. In reality, standards are almost never met and most school sanitation infrastructure is woefully inadequate.

In most schools, latrine to student ratio is a main concern with hundreds of students sharing one toilet thus affording no privacy especially for the girls and forcing most of the students to practice poor hygiene. This is in contrast to recommendation by The Ministry of Public Health and Sanitation and Ministry of Education (2009) which emphasize that these sanitation facilities should provide privacy to all students. A study conducted in Zimbabwe by The Small Projects Foundation (SPF) for example showed that 400 girls out of 700 students were subjected to use four toilets for all their ablution needs. The study further observed that the toilets had broken doors and passersby could see into the toilet (Sommer, 2009). Girls reported that absence of privacy, which was contributed by doors that could not lock, caused them embarrassment and fear while accessing such toilets (Freeman et al., 2009).

According to Maria (2010) a study which was conducted in 6500 schools in South Africa reported that majority of the schools in the Eastern Cape had pit latrines which were poorly maintained with most of them full and therefore no longer in use. This forced the students to  look for alternative places where they could relieve themselves when answering to calls of nature.

In Tanzania, national data shows that on average there is only one pit latrine for every 56 children in schools (UNICEF, 2009). A research which was carried out in public schools in Tanzania by UNICEF and Water Aid (2009) reported that in one of the schools one latrine was being used by 187 pupils. This makes students in most of the schools in Tanzania not to be in a position to practice proper hygiene.

In Nigeria, the situation is not any better. A research carried out by The Schools Sanitation and Hygiene Education Group in public schools in Nigeria found out that an average of 64 students were sharing a single toilet (WHO, 2009). Learners’ toilets in a school reflect the school’s image and may have an influence on the learners’ morale, behavior and health and as the children’s commissioner for Wales stated in one of his reports, lack of priority given to these basic amenities is seen by many children as an indication of lack of priority and respect given to them by the society (Gould, 2012).

Disposal of solid waste is a very big challenge which was recognized by all nations in the 1992 conference on Environment and Development and regarded as a major barrier in the path towards sustainability (UNICEF, 1992). Parker,(2004) underscored this in his report which showed that globally, school girls use over 12 billion sanitary towels which are disposed off annually, filling up pit latrines or ending up in city dumps and landfills. He further observed that currently, sanitary towels form an estimated 6.3% of the sewerage related debris along rivers and beaches. Crofts and Fisher (2011) reported that these sanitary towels may lead to clogging of sewerage systems and consequent difficulties of unblocking such systems. A study conducted in Libode district in Zimbabwe by Maria (2010) found out that most primary school girls were dumping used sanitary towels in pit latrines claiming that the sanitary towel disposal bins were always full and never emptied. Crofts (2011) pointed out that such latrines would fill up very quickly since most of the sanitary towels used were not very bio-degradable.

Pilliteri (2011) reported that in Malawi, one school had an open pit full of used sanitary towels which were being removed by birds and dogs. He was supported by Crofts (2011) when he recorded similar observations in Uganda. This behavior can easily lead to land pollution and force the governments of the affected countries to spend huge amounts of money in rehabilitating such a land.

The Schools Sanitation and Hygiene Education Group that carried out a study in Nigeria observed that in one of the schools, girls threw used sanitary towels behind the dormitories (WHO, 2009). These observations, most of which were carried out in primary schools, reveal very poor hygiene practices. Very few studies have been carried out particularly in public secondary schools to investigate whether similar practices are carried in these schools.

As part of hygiene, The Global Hand Washing Day has been calling for improved hygiene practices since its inception in 2008 with its guiding vision being a local and global culture of washing hands with soap. This practice has not been adopted by many schools as Parker (1993) reported that globally the rates at which hands are washed with soap range from 0–34%. Cairncross (1998) observed that the use of soap is an uncommon practice both in schools and at home.

Kay et al. (2005) and Curtis (2002), conducting a study among school adolescents from nine African countries found out that hand washing after visiting the toilet was poorly practiced. Cairncross (1998) expressed concern over the situation in rural schools in Nigeria which he said lack the simplest hand washing facilities let alone a source of safe water. This situation makes it difficult for students in such schools to practice proper hygiene. A survey conducted in seven districts in Nigeria including Machakos reported that washing hands with soap is almost non- existent in many Nigerian schools as only 1% use soap while washing hands. The study also reported that there were higher levels of hand washing at home than in school. In addition, it asserted that 17% of the participants involved in the study practiced proper hygiene (WHO, 1999).

The above researches revealed that there were very poor hygiene practices in public schools and yet there was very limited literature in regard to factors influencing implementation of hygiene practices in public secondary schools in Lagos State .

In relation to this, this study sought to establish factors influencing implementation of hygiene practices particularly in public secondary schools in Lagos State and possibly establish the extent to which these factors had been addressed in the schools under study.

Statement of the Problem

Hygiene is very important to healthy living and survival of humanity. Despite the realization of the importance of observing good hygiene practices and the risk of poor hygiene practices, many public secondary schools in Nigeria had not implemented good hygiene practices. Even though  the rapid growth of student intake in public schools since 2003 as a result of free primary and secondary education was deemed to be the immediate cause, the situation could have been attributed to culmination of many years of neglect and mismanagement of sanitation systems in many public secondary schools. The state of sanitation and hygiene practices in public secondary schools of Lagos state was wanting despite the fact that the government of Nigeria, through the Constitutional Development Fund (CDF), had endeavored to provide water and sanitation facilities to schools so as to enable students in such institutions to practice proper hygiene. This fact was backed by a number of studies conducted in this region to gauge the level of hygiene practices in the schools. A survey conducted in Enugu among other districts by World Health Organization reported that hand washing with soap was almost non-existent as only 1% of the students used soap in washing hands after visiting the toilets (WHO, 2009).

The student toilet ratio in many public secondary schools was another core concern with hundreds of students sharing a single toilet. This was in contrast with the recommendation by The Ministry of Public Health and Sanitation and Ministry of Education (2009) which recommended a ratio of 1 toilet for every 25 girls and 1 toilet for every 30 boys in order for the sanitation facilities to provide adequate privacy to all students and to be used hygienically. The condition of the existing toilets was pathetic with broken doors, foul smell and alarming grubbiness.

Unhygienic disposal of used sanitary towels by girls in most public secondary schools was another alarming hygienic practice with most of the girls hipping used sanitary towels behind their dormitories or in dark corners of the school compound. This practice led not only to clogging of sewerage systems and consequent difficulties in unblocking of the sewerage systems but also posed a great threat to the environment as was observed by some researchers. It had  been revealed that there was a dire lack of empirical researches on the factors influencing implementation of hygiene practices particularly in public secondary schools in Lagos State . There was therefore a dire need for learning and research institutions to instigate research in order to find out the factors which led to the dominance of these poor hygiene practices in most public secondary schools in this region. This would enable the concerned stakeholders and policy makers to initiate strategies so as to enhance the sanitation situation and hygiene practices in public secondary schools in this area.

It is against this background that this research sought to fill this gap by providing comprehensive information on factors influencing implementation of hygiene practices in public secondary schools in Lagos State.

 The Purpose of the Study

The purpose of this study was to establish the factors influencing implementation of hygiene practices in public secondary schools in Lagos State with a view of coming up with a practical solution that would enhance sanitation situation and ensure reduction of poor hygiene practices in public secondary schools in the district. The study was based in Lagos State.

Objectives of the Study

The study was guided by the following objectives

  1. To establish whether availability of safe water influences implementation of hygiene practices in public secondary schools in Lagos State.
  2. To establish whether availability of soap influences implementation of hygiene practices in public secondary schools in Lagos State.
  3. To establish the relationship between availability of toilets and the implementation of hygiene practices in public secondary schools in Lagos State.
  4. To investigate the relationship between availability of sanitary towel disposal bins and implementation of hygiene practices in public secondary schools in Lagos State.

 Research Questions

The study addressed the following research questions

  1. To what extent does the availability of water influence implementation of hygiene practices in public secondary schools in Lagos State?
  2. To what extent does the availability soap influence implementation of hygiene practices in public secondary schools in Lagos State?
  3. To what extent does the availability of toilets influence implementation of hygiene practices in public secondary schools in Lagos State?
  4. To what extent does the availability of sanitary towel disposal bins influence implementation of hygiene practices in public secondary schools in Lagos State?

Hypotheses of the Study

  1. There is no significant relationship between availability of water and implementation of hygiene practices in secondary schools in Lagos State.
  2. There is no significant relationship between availability of soap and implementation of hygiene practices in secondary schools in Lagos State.
  3. There is no significant relationship between availability of toilets and implementation of hygiene practices in secondary schools in Lagos State.
  4. There is no significant relationship between availability of sanitary disposal bins and implementation of hygiene practices in secondary schools in Lagos State.

 Limitations of the Study

The researcher was faced by the following limitation when carrying out the study. It was not possible to study all public secondary schools Lagos state  due to financial constraints and therefore the researcher sampled only 28 schools in Lagos State to represent all public secondary schools under study. Time was also limited. However the researcher recruited data collection experts to assist in data collection. This enabled the researcher to cover all the 28 public secondary schools adequately and in time.

 Assumptions of the Study

For the purpose of this study the following assumptions were made;

Students in public secondary schools understand the importance of hygiene practices.

The principals of secondary schools are conversant with hygiene practices and the proper use of hygiene facilities.

The respondents would be co-operative and provide reliable information for this study.

The Scope of the Study

The research study confined itself to the factors influencing implementation of hygiene practices in public secondary schools in Lagos State namely availability of soap, safe water, toilets and sanitary towel disposal bins. The study may not have been generalized to cover tertiary institutions and universities since factors influencing implementation of hygiene practices in these institutions may be significantly different.

Data was collected from form two and three students only but not from form one and four students. This is because the form two and three students had stayed in the school long enough and had familiarized themselves with the school environment and therefore knew where most of sanitation facilities were unlike the form one students who were still be in the process of being oriented in the school. The form four students were revising for their mock examination and therefore seemed too busy to fill the questionnaires.

There are moderating variables that may influence implementation of hygiene practices. These include students’ attitudes, background, beliefs, knowledge and perception towards hygiene but due to limited time and other resources, this study did not collect data on them.

Significance of the Study

The findings of this study may be of help to several groups of people: Firstly, it may provide the curriculum planners and developers and all the stakeholders in the education sector with a better understanding of factors influencing implementation of hygiene practices in schools. The curriculum planners may then use the study findings to develop appropriate national standards of toilets and other hygiene facilities that are relevant to secondary schools in Nigeria.

Secondly, the ministry of education may use the study findings to develop a school program with guidelines for hygiene practices. These guidelines may be approved by the ministry and send to teacher training colleges where they may be used to prepare teachers and help them develop

curricular materials related to hygiene. The trained teachers may then use the materials and the guidelines to incorporate the theme into their subjects and encourage students to practice the knowledge gained both in school and at home.

Thirdly, the community health workers may use the research findings to educate the general public on good hygiene practices and factors that influence their implementation. They may as well use the findings to persuade individuals, families and social groups to adopt new, healthier and better hygiene practices.

Fourthly, the research findings may also provide a foundation for policy makers and project managers to make rational decisions on improving adolescent reproductive health both in school and in the communities.

Finally, heads of learning institutions and the teaching and non-teaching staff may use the research findings to re-assess hygiene facilities in their institutions and perhaps apply recommendations made by the researcher to better these facilities and also emphasize on improving hygiene practices in their own schools.

Definitions of Significant Terms

Hygiene: This word has been used in this study to mean the practice of maintaining clean hands, toilets and making proper use of the sanitary towel disposal bins in schools.

Hygiene practices: This word has been used in this document to include hand washing using soap, proper disposal of used sanitary towels, regular bathing and avoiding open defecation.

Implementation: It refers to the process of putting in place resources and strategies towards achieving the desired level of hygiene.

Sanitary towel disposal bins: Sanitary towel disposal bins has been used to refer to containers in which adolescent girls dispose of their used sanitary towels.

Sanitary towels: This word has been used in this study to refer to the materials which adolescent girls use to absorb blood during their menstruation.

Sanitation: This word has been used in this study to refer to any system that promotes proper disposal of sanitary towels, human waste, proper use of toilets and avoiding open space defecation

School principal: Refers to the administrator of a school appointed by the Teachers Service Commission in accordance with Education Act Cap 211

Secondary school: Post primary institutions where pupils progressively receive formal education from form one to form four.

Soap: The word soap in this document is used to refer to cleaning agent used with water for hand washing.

Toilet: This word has been used to refer to a room used by students in case they want to go for a long or short call.

Water: The word water has been used in this document to refer to water that has been treated and made safe for drinking and washing hands.