Hygiene behaviours among school children in rural VN: the role of a school based hygiene promotion Le thi Thanh Xuan, Hanoi Medical University PhD research protocol, SANIVAT project Presented at TWG meeting, 22 Aug 08

BACKGROUND Better water and sanitation infrastructure does not necessarily improve health Hygiene behaviour, rather than service levels, was found to be more closely related with improvements in health Schools are most important places of learning and behaviour change for children Childhood is the best time for children to learn hygiene behaviours

Children and We…. Basic facilities are created Children enjoy learning and learn better Take back to their families Investing in children-> positive change

Percent Reduction in Diarrhoea by SSHE interventions

VIETNAM? 1 national WS in 1986-> HE was developed (curricula and textbooks) for PSC National target: 100% school hygienic sanitation coverage from 12% in rural areas by 2010 Many efforts but still poor personal hygiene of rural population and school children (11.5% students who WHWS after defecation). School sanitation and hygiene is still limited (77.4% of schools had latrines but only 37.7% that met the MOH hygienic standards, 52.5% of schools did not supply drinking water for pupils) Hygiene seems to be influenced by ethnicity, educational level and socio-economic status

GENERAL OBJECTIVE Generate in-depth information on how school children perceive hygiene, how they practice hygiene (including sanitation at school setting), what motivates their hygiene behaviour and how they respond to participatory school-based hygiene promotion activities

SPECIFIC OBJECTIVES 1.Describe and analyse activities and institutions involve in hygiene promotion as understood by communities and government authorities, especially at school setting. 2.Analyse how school children perceive hygiene and hygiene practices to be related to human health. 3.Analyse how school children practice hygienic behaviours and what motivates these behaviours 4.Assess how school children respond to participatory school-based hygiene promotion pilot activities (based on WASH approach)

KEY STUDY QUESTIONS 1.What are formal and informal school-based hygiene promotion activities as perceived by communities and government authorities? 2.What are the formal and informal hygiene promotional activities that school children have been exposed to? 3.Who are actors involve in performing these activities? 4.Who are the actors influencing or motivating hygiene behaviour at community level and among school children in particularly? 5.How do school children perceive hygiene? 6.How do school children perceive hygiene practices to be related to human health?

KEY STUDY QUESTIONS 7.How do school children practice hygienic (especially hand washing)? What motivates such behaviour? 8.Why do school children fail to adopt specific hygiene practices promoted by schools or outside agencies? 9.What are important factors in determining hygienic behaviour of school children? 10.How do school hygiene promotional activities influence to hygiene perception and practices of school children? Is there any difference between boys and girls? Any difference among different ethnic group students? Between different age groups?

KEY HYGIENE BEHAVIORS Handwashing (after defecation and/or before eating, cooking) Drinking water Using latrines (both at school and at home)

STUDY POPULATION The primary: school children (grade 1, 4, 7) The secondary: teachers, administrators, cleaners and parents of primary pupils and parent-pupil associations The tertiary: related persons in the commune (VHWs, CHWs, CPC and local residence) and local authorities at district and provincial levels (DOET, PMC, WU, IEC…)

SELECTION CRITERIA 1)The children able to communicate; 2)Diversity of ethnic groups 3)Diversity of age groups (both primary and secondary school) 4)Diversity of genders (boys and girls) 5)Diversity of geography (both main and branches) 6)Able to participate in the study (with informed consent) 7)Diversity of sanitary system at school (schools with and without latrine and drinking water supply)

STUDY DESIGN ObjectiveDesign 1 st objectiveStakeholder interviews (qualitative study) 2 nd objectiveHygiene perception study of school children (school survey) 3 rd objectiveHygiene practice study (home and school surveys) 4 th objectiveResponse-to-hygiene study

SCHOOL STUDY Areas Tools Opportuni ty AbilityPerceptionPracticeMotivationResponseSchool-home transfer School staff I.XXxx Cleaner I.xxxxx Hygiene facilities ob. x Face-to-face child I. x Motivator picture x Daily diaryxxxX Family structure x Beliefs inte.xxxxxxX Behavior trials Xxxx Role modelsxx Observationxxxx

HOME STUDY Areas Tools Opportuni ty AbilityPerceptionPracticeMotivationResponseSchool-home transfer Open Observation XXXXXX Structured observation XX Caretaker interview XXxx Child interview xxXXXXX

STUDY LOCATION Hop Thanh and Ta Phoi communes, Lao Cai city, Lao Cai province Home study: two-three villages (represents for highland and lowland, most and least popular ethnic groups, having schools) School study: all 4 main primary school and secondary school and two satellites (located in two villages of home study)

TIMELINE StudyTime Stakeholder interviewsApril-July 08 Home studyJune-Aug 08 and 09 School study (1-2 weeks per school) Sept-Nov 08 and April- May09