Since 1990, the Joint Monitoring Programme (JMP) for Water Supply, Sanitation and Hygiene by WHO and UNICEF  has regularly produced estimates of global WASH progress. In September 2015, world leaders in a meeting of United Nations pledged to achieve 17 Sustainable Development Goals by 2030. The Goal No. 6 aims on the availability and livable management of water and sanitation for all [1]. The JMP is now responsible for tracking progress towards those SDG 6 Targets [2].

Hygiene has two aspects Personal& environmental. PersonalHygiene includes clothing, washing, bathing, washing hands &care of nails, feet & teeth. Training forPersonalHygiene should begin at early age [3].

Hygiene is the simplest &most important measure in preventing many communicable diseases.Perception of Hygiene varies from individual to individual. Hygienebehaviors and practices among a given population will thus provide a great deal of insight towards the preventive medicine process. 

Keeping a good standard of Hygiene helps to prevent the development and spread of infections and disease.According to a World Health Organization (WHO) estimate, 1.5 million children die from diarrheal diseases each year worldwide, with 88% of these deaths occurring due to inadequate sanitation, Hygiene, and drinking water [4]. Access to sanitation facilities alone does not indicate their hygienic use or adoption of other hygienic practices[5].

Despite a large base of evidence showing that adequate Hygiene Practices are associated with better health outcomes, results from several studies show that complex factors stillremainthat influence individual, household, and community motivations to change behavior. There is not enough literature available for assessing the progress of WASH strategy at household levels in Himachal Pradesh.

Thereforean extensive survey was undertaken by the Department of Community Medicine, Indira Gandhi Medical College Shimla along with Department of Environment, Science & Technology, Himachal Pradesh from July through October 2020 to establish a baseline of the current knowledge, attitudes and behavior of population in Shimla city in relation to water, sanitation, Hygieneand other health-related practices. This article is a part of that survey and presents the Hygiene promotion practices in the Shimla city, the capital ofHimachal Pradesh.

Objective of the study

To Assess The Knowledge And Practices Of Population In Shimla City In Relation To PersonalHygienePromotion Practices.

Study Design: 

Cross sectional survey.

Study Area: 

Shimla city of Himachal Pradesh.

Study Period: 

Four months; July 2020 through October 2020.

Study Population:

Population residing in all 34 wards under Municipal corporation area of Shimla City.

Sample Size:

Sampling unit was households in the Municipal corporation area of Shimla city. Sample size was estimated to be 640 expecting 50% of households having adequate knowledge about hygiene promotion practices, with 95% level of confidence, design effect 1.5, 5% absolute error and non-response rate of 5%.

Sampling Design:

Stratified Random Sampling was done for the selection of Households for survey. We equally divided the households in all the 34 wards of Shimla city and average 15-30 households per municipal ward were selected. First household of the ward was selected randomly and then every 10^th household was selected to complete the sample size in the respective ward. An effort was made to have a balance of males and females, as well as to involve some younger persons as respondents. The Principal Investigator & Co- Principal Investigator in collaboration with the Local community leaders conducted the sampling process.

Data collection:

Before doing the data collection, the survey teams consisting of medical social workers and residents of Department of Community Medicine were given training regarding the administration of the questionnaire. The data collectors obtained consent from the head of Family and Pretested Standardized Questionnaire administered in every selected household, and the respondents (who willing to participate) were asked questions regardingPersonal Hygiene PromotionPractices. Only one adult member per household was selected for data collection. 

The data was collected to obtain information on following parameters:

• Socio demographic profile 

• Knowledge, Attitude and Practices about Personal Hygiene Promotion Practices

Inclusion Criteria

Any adult person (only One per household) in selected household who was willing to participate in the study and had given consent.

Exclusion Criteria

Not available at the time of survey or refused due to unavoidable issues after consenting.

In the study maximum (71.7%) respondents were females, 97% were Hindus, 93.1% were literate and 37.7% were employed or working. (Table 1)

37.8% of the study participants consider cleaning house & household items, 50.2% consider mopping & dusting, 41.7% consider daily bathing, brushing teeth, trimming nails, and 12.1% participants consider other things that they do to maintain good Hygiene. (Table 2).

On the question about signs of lack of Hygiene in the household, 61.3% answered Presence of Flies and Mosquitos, 30.8% answered unclean home, 25.6% answered bad smell, 17.1% answered presence of rodents and insects and 18.6% of the study participants answered presence of more diseases in the household members.68.1% participants consider that maintenance of good Hygiene is important to prevent diseases.

On the question about how to prevent Head Lice, 49.8% answered maintaining Personal Hygiene, 43.8% consider applying Anti-Lice lotions, 19.7% answered Daily Hair-washing, and 6% answered avoiding crowded areas.

In our study group, 95.3% respondents bath daily, 95.5% brush daily, 51.7% clean their ears weekly,91.4% cut their nails weekly,97.2% wash their clothes regularly,98.8% use shoes while going to the toilet,99.4% wash their hands when coming from market,99.8%wash their hands before eating, 99.8% wash their hands before preparation of food,99.8% wash fruits and vegetable before eating, 70.8% clean the seat of public toilet before use, 82.5% wear trouser for 2 days or more, 15.55 wear shirt for 2 days in a row,6.09 % use inner wear for more than 2 days and 5.8%  skip their bath for more than 2 days. 13.6% of the study participants were not washing their hands at workplace. (Table 3)

Table 1: Distribution of the Participants According to Socio-demographic characteristics 

Table 2: Perception about Hygiene

Table 2: Perception about Hygiene

In our study respondents (459 were females out of total 640 households) , 86% females were using Sanitary pad while 6% still use disposable clothes, 6% reusable cloth & 2% use cotton during menstruation. (Figure 1)

Figure 1: Type of material used during menstruation(N=459)

Figure 2: What do you use for Handwashing (N=640)

When asked about the handwashing, 62study participants i.e. 9.6% were still not using soap. (Figure 2)

In the present study, 95.3% respondents bath daily. In a study done by Farah Set al [6] in Bangladesh in 2015 it came out to be 81% &98% in a study done by Shekhawat R et al [7] in Bikaner Rajasthan in 2019 which were in concordance with our study. In our study 95.5% of the participants brush their teeth daily. This is in concordance with the study done by Shekhawat R et al (93%) and in contrast to in study done by Farah S et al (60%). 91.4% cut their nails weekly which is in contrast with study done by ShekhawatR et al (68%). 97.2% wash their clothes regularly. This is in contrast to the study done by Farah S et al (22%) and in concordance with study done by Shekhawat R et al (95.7%).Majority of our study participants i.e. 98.8% use shoes while goingto the toilet which is in contrast to the study done by Farah S et al which reported it to be 60.6%. 99.4% wash their hands when coming from market, 99.8%wash their hands before eating, 99.8% wash their hands before preparation of food which is in concordance with the study done byVivas A et al [8] in Ethiopia in (99.8%) 2010, Rajbhandari KA et al [9] in Nepal in 2018 (81.2%)&Hothur R et al [10] in Andhra Pradesh in 2019 (81.8%).  99.8% wash fruits and vegetable before eating which is in concordance with Rajbhandari KA et al. 70.8% of the households responded that they clean the seat of public toilet before use. 82.5% wear trouser for 2 days or more which is in contrast to the study done by Vivas A et al (18.5%), 15.55 wear shirt for 2 days in a row,6.09 % use inner wear for more than 2 days and 5.8% skip their bath for more than 2 days.These findings are in contrast with the findings of the study done by Sarkar M et al in Kolkata in 2013(87.5%) [11].

Regarding perception about hygiene, most of the participants in this study (50.2%) perceive Mopping & Dusting while 37.8% cleaning house and household items, 41.7% daily bathing, brushing & trimming nails to maintain good hygiene. 61.3% study participants identify lack of hygiene by presence of flies & mosquitos in the house, 30.8% by unclean home, 25.6% by bad smell, 18.6% by presence of more diseases. These Personal Hygiene practices were found to be satisfactory among the households in the Shimla city.

In the currentstudy respondents, 86% females were using Sanitary pad for menstruation but there are still many women who were using other materials for menstrual Hygiene which needs to be discouraged.

When asked about the handwashing, 9.6% of the study participants were still not using soap which is worrisome as many hand washing programs are being run by various departments for promoting handwashing with soap and water.

Most PersonalHygiene practices were found to be satisfactory in the present study. The study shows good perception about hygiene promotion practices among residents of Shimla city.  Handwashing at Workplace was still not being followed especially during COVID times also.Women were using materials other than sanitary pads during menstruation.There were plenty who do not use both soap and water for handwashing.

Recommendations

People were aware of the uses of handwashing, but were not practicing it regularly at workplace, which needs to be re-emphasized especially during COVID times to achieve SDGs by 2030. Use of Sanitary pads needs to be encouraged for each and every woman and they need to be sensitized about the harmful effects of other items used during menstruation. Intensive IEC activities about Hygiene Promotion Practices should be carried out. 

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11. About Water, Sanitation and Hygiene. UNICEF, https://www.unicef.org/wash/3942_3952.html. Accessed November 2020.