By: Melari Shisha Nongrum
The Global Handwashing Day is celebrated every year on October 15thsince 2008 as a global advocacy day dedicated to increasing awareness and understanding about the importance of handwashing with soap as an easy, effective and affordable way to prevent diseases and save lives. The current COVID19 pandemic has reminded us about the effectiveness of one of the simplest preventive measures to stop the spread of the corona virus and other viruses through handwashing with soap. Hand washing might have been taken seriously during the pandemic since we are reminded time and again through various media and because of the fear of the virus.
However, we have to realise that hand hygiene is not limited only to this pandemic but ensures better health outcomes beyond the pandemic. Research studies have revealed the effectiveness of handwashing with soap. As diarrhoea and pneumonia are leading causes of death for children under the age of five, handwashing with soap can save lives, cutting diarrhoea by almost one-half and acute respiratory infections by nearly one-quarter. The World Health Organization (WHO) estimates that 50% of cases of child undernutrition are due to repeated diarrhoea and intestinal infections caused by poor sanitation and hygiene conditions or lack of safe water. When children get diarrhoea, they often eat less food, and have a reduced ability to absorb and benefit from nutrients in the food they do eat. As a result, this can contribute to undernutrition. When children are undernourished, they become far more susceptible to developing diarrhoea when they come into contact with the bacteria and viruses in faecal matter. And so, the cycle repeats itself. Handwashing with soap is therefore a critical determinant for achieving and maintaining good nutrition and it can break this viscous cycle.
We are very well aware that the two primary times to wash hands with soap are after contact with faeces (such as using the toilet or cleaning a child) and before contact with food (preparing food, eating, feeding a child, and so on). The other times are after blowing your nose, coughing, or sneezing; after contact with an animal, animal feed, or animal waste; after handling pet food or pet treats and after touching garbage. When hands are contaminated with disease-causing bacteria and viruses, these pathogens can enter the body or pass from one person to another to cause diseases such as diarrhoea and pneumonia.
In view of the facts indicated above, given the context in our own state, we have many children who are undernourished. According to the National Family Health Survey (2015-16), a large proportion of the children under five years of age are stunted (43.8%), underweight (28.9%), wasted (15.3%) and severely wasted (6.5%). The health indices reflect poorly of the health of our children. There could be many other factors that can make a child undernourished but we have one simple and easy solution that could help curb this condition among children and contribute to healthier children.
Home is where we can wash our hands regularly; adults and children are to take hand hygiene seriously. Though doable, this is not done. The National Sample Survey (NSS) 76th round report, 2019, revealed that only 35.8% of households in the country practice hand-washing with soap or detergent before a meal, while 60% households wash hands only with water. More surprisingly, about 24% population don’t wash their hands with soap or detergent even after defecation. Besides, there is a gap between the rich and the poor where only 2 out of 10 poor households use soap compared to 9 out of ten rich households. The reasons are multifaceted; knowledge, attitudes and access to water facilities and soaps are the main problems. It is important to note that several studies including a study conducted in Bangladesh found that while the use of water alone does help reduce the risk of diarrhoea, use of soap is substantially more effective. Given this context, there needs to be more awareness on the benefits of handwashing. During this pandemic and during community placements, Social Work students from the Public Health specialization have always conducted sessions in their villages to remind people including children of the importance of handwashing with soap and the steps for effective handwash. Such efforts will hopefully bring about an increase in knowledge, change attitudes and mothers and children alike would practise handwashing with soap.
Besides the home, there are other institutions that are important to consider at the community level namely schools and Anganwadi centres. These are places where children spend a lot of time and also eat their mid-day meals and supplementary nutrition respectively. The Centre for Disease Control and Prevention (CDC) has stated that handwashing with soap reduces absenteeism due to gastro-intestinal illness in school children by 29-57%. One important issue is for teachers to teach children to wash their hands after using the toilet and before eating food. But the larger question is, “where do they wash their hands?”. According to a report by the National University of Educational Planning and Administration, New Delhi, it was found that only 57% private schools and 66% private unaided schools in Meghalaya do not have water facility in schools. However, it is not surprising to note that the report did not mention the availability of handwashing facilities in the schools which shows that ‘handwashing’ has not been considered important enough when planning and assessing infrastructure in schools.
Furthermore, in Aganwadi Centres, under Section 5(2) of the National Food Security Act, 2013, every school and Anganwadi Centre shall have facilities for cooking meals, drinking water and sanitation. In Meghalaya, according to the Meghalaya State Food Commission, out of 5890 AWC’s, only 1799 or just 30% have potable water supply and 1537 have toilet facilities. The Department is said to be dependent on Public Health Engineering (PHE) to provide these facilities. When the lack of convergence and funds are given reasons, the children continue to bear the brunt of these lacunae.
My experience in working with communities and schools is the issue of ‘soap’. Who will provide the soap? We had promoted community contribution for the soaps with a collection of Re 1 per child per month to buy soap for the purpose. Of course, this was done only after parents and teachers understood the importance of hand hygiene.
With the New Education Policy, reforms would be implemented to bring about positive change, which we are hopeful that the quality of education would be enhanced at all levels. But I urge the government that while ICT and smart classrooms are essential for learning, it must be equally mindful that learning environment includes good sanitation and handwashing facilities for children. If children are not attending school because of preventable diseases, we have failed our children in putting into practice the subject of Health Education. Let’s make handwashing with soap a habit that adults and children can practise at home, in schools and workplaces. Handwashing with soap must be a priority now and in the future for better health outcomes.
The writer is from Department of Public Health, School of Social Work, Martin Luther Christian University
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