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Hygiene-IntroductionENVR890MarkD.SobseySpring,2007卫浴网HygienePromotion:OneoftheBigFivetoReduceDiarrhealDiseaseHygiene:TheImportanceandImpactofHandwashingHandwashingwithsoapandwateraftercontactwithfecalmaterialcanreducediarrhealdiseasesby42%%ormoreCurtis,VandS.Cairncross(2003)Effectofwashinghandswithsoapondiarrhoeariskinthecommunity:asystematicreview.LancetInfectDis.2003May;3(5):275-81.WashingHandsOneofthemosteffectivebehaviorstopreventdiarrhoea,roundwormandwhipworm.Rarelydoneatthemostcrucialtimesandrarelydonemosteffectively(withsoap).(Issoapreallyneeded?)Handsgetmostdangerouslycontaminatedfronhumanfacesandsoil(possiblycontainingwormeggs).Crucialtimesforhandwashingtoreducetransmissionsare:afterdefecationandaftercontactwithchildren’sfaecesbeforehandlingfoodandafterhandlinghighriskfoodsuchasrawmeatbeforeeatingandbeforefeedingchildrenbeforehandlingwater.Effectivehandwashingrequiresthoroughrubbingofthehandswhileusingsoapandsufficientwatertorinseitoff.Ifsoapisnotavailable,ashorearthisnearlyaseffectiveWateraloneiseffective,especiallyofwateriscleanCleaningfingernailsCloselyrelatedtohandwashing.HandwashingdoesnotensurefingernailsgetcleanedCleanfingernailsareparticularlyimportantwhenfoodisconsumedorfedtoinfantsusingfingersCleanfingernailshaveanaestheticvalueHandwashingandcleaningfingernailsalsoplayaroleinthepreventionofeyeandskininfections,suchasscabies.

Whenwipinginfectedeyesorscratchingitchinginfectedskin,bacteriaormitescansettleonfingersandhencebetransmitted.

Keepingfingernailscleanrequiresthemtobekeptshortandbrushedregularly.Washingthebody(bathing)Importantforpreventingskininfectionslikescabies(causedbysmallmiteslivingundertheskin),andringworm(afungalinfection).Alsolouse-bornetyphusandlouse-bornerelapsingfeverarecontrolledwithregularwashingofthebodyandclothes.WashingisbestdoneusingrunningwaterandsoapSpecialattentionneedstogotofoldsoftheskinaswellastoskinbetweenfingersandtoes.WashingthefaceHasanimportantroleinthepreventionofeye-infectionsHygienerelatedeyeinfectionsareconjunctivitisandtrachomaMorefrequentwashingofthefaceandfewfliessittingoneyesreducestheincidenceoftrachomaWashingthefaceregularlyremovesinfectiousdischargefromtheeyes.Thispreventsfliesfrombeingattractedtotheinfectedeyes,thusbecomingtransmissionagents.Removingeyedischargeusingbarefingersoracloth,causesbacteriatobepickeduponthefingersorclothandtransmittedtoanythingelsethattheytouch.WashingclothesandbeddingMajorpreventivemeasurestoreducetransmissionofscabiesandlouse-bornetyphusandrelapsingfever.TouchingclothesorbedclothesofapersoninfectedwithscabiesorringwormcaneasilycausespreadandfurtherinfectionofothersLice,whichmayspreadtyphusorrelapsingfever,hideinseamsofclothesandbedclothesWashingremovesthemCommunaluseofclothesandbedclothesshouldbeavoidedIntroductionandIssuesThemostimportantlessonlearnedfromwaterandsanitationprogrammes:waterandsanitationfacilitiesontheirowndonotresultinimprovedhealth.Accesstoimprovedfacilitiesiscrucial,but…CorrectuseofwaterandsanitationfacilitiesiswhatleadstoareductionindiseaseCorrectuserequirespersonal,communityandinstitutionalactionsactionsdependonbehaviorsHygieneandBehaviorHygieneisakeyfactorinreducingriskofdiarrhealandothersanitation-relateddiseasesPeopleandcommunitiescanprotectthemselvesfromdiarrheaandotherinfectiousdiseasestheymakechangesinhygienebehaviorMakingbehaviorchangesrequiresactionsThesebehaviorchangeactionswilloccuronlyifpeopleareinformedTheyneedinformationabouthowandwhycertainpersonalandcommunitybehaviorswillreducediseasetransmissionrisksTheyneedencouragementtomakepositivechangesintheirhygienebehavior.Hygieneeducationisessentialtoachievehygienebehaviorchange.UNICEFHygieneImprovementFrameworkAccesstoFacilitiesImplementandpromoteapackageofappropriate,low-costsanitation,waterandhandwashingfacilitiesIntroducebasictechnologiesthatmaybeupgradedwhenfamiliesandcommunitiescanaffordtodosoHygieneAwarenessandPromotionFocusonbehaviorchangebycommunicatingkeyhygienepracticeslikehandwashing.Encouragechildren,youthandmotherstobeagentsofchangeintheirfamiliesandcommunitiesImplementthroughinitiativessuchaslifeskillstrainingprograms,curriculumdevelopmentandintegratedsanitationandhygieneeducationinschools,andmaternalandchildhealtheducationEnablingEnvironments

(andInstitutions)PromotehygienecontinuouslyatalllevelsVillagehouseholdVillageorcommunityDistrict,province,canton,etcNationallyRegionallyGloballyDevelopingnationalpoliciesiscriticalUNICEFfocusesonpromotingcommunity-managedsystemsthatareaffordableandeasytomaintain.EquipcommunitieswiththeknowledgeandskillstoeffectivelymanagetheirownfacilitiesEncouragecommunitiestodemandhigh-qualityservicefromduty-bearersingovernment,civilsocietyandtheprivatesectorEnablingConditionsThemostobviousenablingconditionforpersonalhygieneistheavailabilityofwater.However,forbehavioralchangetooccurandbesustainedthereisaneedtocontinuehygienepromotion

untilthenewbehaviorhasbecomeentrenchedHygienePromotionKeyPrinciplesTargetasmallnumberofriskpracticesTargetspecificaudiencesIdentifythemotivesforchangedbehaviorHygienemessagesneedtobepositiveIdentifyappropriatechannelsofcommunicationDecideonacost-effectivemixofchannelsHygienepromotionneedstobecarefullyplanned,executed,monitoredandevaluated.HygienePromotion:TargetPracticesHavingaPositiveHealthImpactTheBig3:Handwashingwithsoap(HWWS)Removalofstools(feces)fromthehouseholdenvironmentHometreatmentandsafestorageofdrinkingwaterOthers:Safedisposalofchildren'sstoolsSafehandlingofweaningfoodIdentifyingBehavioralDomainsforHygieneFiveBehavioralDomains

(BootandCairncross,1993)DisposalofhumanfaecesUseandprotectionofwatersourcesWaterandpersonalhygieneFoodhygieneDomesticandenvironmentalhygienePersonalHygieneBehaviors:Washingofhands/cleaningofnailsWashingoffaceBodywash/bathingHygieneafterdefecationWashinganduseofclothes,towelsandbeddingPersonalHygieneMeasures

(Benenson,1990)washinghandsinsoapandwaterimmediatelyafterfecacation/urinationandalwaysbeforehandlingfoodoreating

keepinghandsanduncleanarticles,orarticlesthathavebeenusedfortoiletpurposesbyothers,awayfromthemouth,noseeyes,ears,genitalia,andwoundsavoidingtheuseofcommonoruncleaneatingutensils,drinkingcups,towels,handkerchiefs,combs,hairbrushesandpipesavoidingexposureofotherpersonstosprayfromthenoseandmouthasincoughing,sneezing,laughingortalkingwashinghandsthoroughlyafterhandlingapatientorhis/herbelongingsand

keepingthebodycleanbysufficientlyfrequentsoapandwaterbaths.HygienePromotionforChildrenMosthygienepromotionisdevelopedforadultsYoungchildrendonotpossessthesameskills,knowledgeandabilitytolearncomplexconceptsasolderchildren(oradults),andtheylearndifferently

Childrenlearnthrough:Helping(e.g.,withchores)PlayingBeingcreativeDealingwithothers(interactionandcommunication)PlayingExercisingHygienepromotioninSchoolsSchoolsanitationandhygieneeducation(SSHE)Combinationofhardwareandsoftwarecomponentstoproduceahealthyschoolenvironmentandtodeveloporsupportsafehygienebehaviors.Thehardwarecomponents:drinkingwaterhandwashingexcretadisposalsolidwastedisposalfacilitiesinandaroundtheschoolcompound.Softwarecomponents:activitiesthatpromoteconditionsatschoolandpracticesofschoolstaffandchildrenthathelptopreventwaterandsanitation-relateddiseasesandparasitesBenefitsofSchoolHygieneandSanitationEffectivelearning:Childrenperformbetterwhentheyfunctioninahygienicandcleanenvironment.Increasesenrolmentofgirls:Thelackofprivatesanitaryfacilitiesforgirlscandiscourageparentsfromsendinggirlstoschoolandcontributestothedropoutofgirls,particularlyatpuberty.Reducesincidenceofdiseaseandworminfections:Ifschoolsanitationandhygienefacilitiesareabsent,orarebadlymaintainedandused,schoolsbecomehealthhazards.Environmentalcleanliness:Presenceandproperuseoffacilitiespreventspollutionoftheenvironmentandlimithealthhazardsforthecommunityatlarge.Implementingchildren’srights:Childrenhavetherighttobeashealthyandhappyaspossible.Beingclean,healthyandhavingcleanwaterandpropersanitationfacilitiescontributetoahappychildhood.IssuesinSchoolHygieneEducationDevelopingandproducingteachingmaterials:

hygieneeducationmaterialswhichcanbereproducedonalargescale,sothattheyarenottoocostlyandallowforeasyadaptationtolocalcircumstances.Basicinsightsintothemoretechnicalaspectsofsanitationfacilitiesattheschool:Teachertrainingonhowsanitaryfacilitiesworkinpracticewhichincludestheconstruction,operationalandmaintenanceaspects.Organizationalissuesofsanitaryfacilities:Includeswaystomonitorbehavioralchanges.Focusingofteachertraining:HowtousethematerialsofSSHE;howtoorganize/implementaSSHEprogrammeHowtoplanforthereplacementoffacilities.Outreachprogramstothecommunity:TogaincommunitysupportToensurethatthelearnedbehaviourcanalsobepracticedathome.Focusingonmonitoring:EvaluationanddocumentationofSSHEexperiencesforteachersinschoolsaroundtheworld.SchoolHygieneProgramStrategyStrivingforacommongoal,commonpurpose,commonpolicyandcommonplanning

Focusingonthechildasthekeyresource

Focusingonschoolsastheknowledgecentre

Focusingoneducationforbehaviorchange

Acknowledgingtheteacherasthefacilitator

Concentratingonresultoriented/effectivedeliverysystem

RecognizingthatthecommunityisanequalpartnerFiveFallaciesaboutHygienePromotionFallacyNo.1.Behaviourchangeiseasy.FallacyNo.2.Knowledgechange=behaviourchange.FallacyNo.3.Expertsknowhowtochangebehavior.FallacyNo.4.Awholevarietyofhygienepracticess