A MODULE ON
BASIC HEALTH EDUCATION AND
HYGIENE PROMOTION
Dr. Wassaf Syed
Rural Water Supply & Sanitation Project
H. No. 6, Street No. 12, Sector E-1, Phase I Hayatabad, Peshawar
DFID
CONTENTS
Page
iii
iv
Executive Summary
Acronyms
PART - 1
 Introduction
 Why RWSSP in NWFP
 Purpose of the Module
 Target Group
 List of Teaching Aids
 Methodology
 Sessions on Health and Hygiene
 Objectives of the Training
 Situation Analysis
 Need for Health Education and Hygiene Promotion
 How to use this Module
PART - 2
Session No 1
Health and Hygiene
 What is Health and Hygiene
 Importance of Health and Hygiene in Islam
Session No 2
1-6
1
1
3
3
3
4
5
5
5
6
6
7-43
7-10
7
7
11-22
Water
 Potable Water (Clean or Safe)
 Importance of Water
 Sources of Water
 Water Contamination
 Effect of Unsafe Water on our Health
 Methods of Keeping Water Clean and Safe
11
12
13
14
15
15
Session No 3
Sanitation
 What is Sanitation
 Components of Sanitation
 Disposal of Human Excreta (Types of Latrines)
 Waste Water Disposal
 Solid Waste Disposal
 Personal Hygiene
 Environmental Hygiene
23-36
Session No 4
Food Safety
 Principles of Keeping Food Clean
37-39
i
23
24
26
28
28
29
31
37
CONTENTS
Session No 5
40
Video session on water, sanitation and hygienic practices
40
Session No 6
41-60
Waterborne and Sanitation-Related Diseases
Transmission Routes and Control Measures
 Diarrhoea and Dysentery
 Hepatitis
 Worms and other Intestinal Parasites
 Round worm
 Thread worm (pin worm)
 Hook worm
 Typhoid Fever
 Poliomyelitis
 Malaria
 Skin and Eye Infections
ii
41
45
48
49
49
50
51
52
53
54
55
EXECUTIVE SUMMARY
This Module comprises two parts. The Part-1 contains introduction, situation
analysis, rationale for this Module, target group, methodologies, list of teaching
aids and guidelines for use of the Module.
The Part-II describes central theme of the Module, detailing all essential
information on the topics that should be on the finger tips of a hygiene promoter
involved in the training of community activist and members for advocacy building
on hygiene education.
According to the definition used by RWSSP, health and hygiene education
means a system which envisages principles for preservation of health and
prevention of diseases, in line with Islamic practices.
Water is life and its source is limited hence we must preserve it, use it judiciously
and ensure its cleanliness. Its sources are to be kept clean to provide potable
water and to ensure that the source never gets contaminate. Natural and artificial
techniques are shared for its safe preservation.
In the sanitation sessions, participants are informed that disease prevention and
hygiene promotion is nothing but a collective effort of the community members.
Hazards of open air defecation, solid and liquid waste disposal were shared.
Participants are educated how to combat those menace through promotion of
low-cost options.
Under the food section participants are informed about the fall out of
contaminated food and the simple and affordable techniques to keep the food
clean. Session five is devoted to video display to acquaint participants with
pictorial presentation of the ground situation on water and hygiene practices for
better understanding and deeper impression in lighter tune.
Finally an exhaustive list of water-related diseases, caused by contaminated
water and lack of sanitary facilities. Participants are equipped how water-related
diseases spread vis-à-vis its control mechanism to avoid any untoward situation.
iii
ACRONYMS
ADB
CCB
CIIP
CO
DFID
HP
HPTL
LGE&RDD
LGO
MCO
NGO
NWFP
O&M
OHP
ORS
PBUH
P&D
PHED
RWE
RWSSP
SM
SO
SRSP
TMA
TV
VCR
VIP
WatSan
WHO
Asian Development Bank
Citizen Community Board
Community Infrastructure Initiative Project
Community Organisation
Department for International Development
Hygiene Promoters
Hygiene Promotion Team Leader
Local Government Election and Rural Development
Department
Local Government Ordinance
Men Community Organisation
Non Government Organisation
North West Frontier Province
Operation and Maintenance
Overhead Projector
Oral Rehydration Solution
Peace Be Upon Him
Planning and Development
Public Health Engineering Department
Regional WatSan Engineer
Rural Water Supply and Sanitation Project
Social Mobiliser
Social Organiser
Sarhad Rural Support Programme
Tehsil Municipal Administration
Television
Video Cassette Recorder
Ventilated Improved Pit
Water and Sanitation
World Health Organisation
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A Module on Basic Health Education and Hygiene Promotion
HEALTH EDUCATION AND HYGIENE PROMOTION
IN RURAL WATER SUPPLY AND SANITATION PROJECT
NWFP – Rural Water Supply and Sanitation Project (RWSSP)
The Local Government Election and Rural Development Department (LGE&RDD)
launched the Rural Water Supply and Sanitation Project (RWSSP) in collaboration
with the UK Department of International Development (DFID) in all the 61 Tehsils
and Towns of NWFP on 1 July 2003. The main objective of the project is to build the
capacity of LGE&RDD in general and Tehsil/Town Municipal Administrations (TMAs)
in particular for improved service delivery under WatSan sector in addition to
provision of potable water, improved sanitation, hygiene practices to one million
people. Technical assistance is provided by SEED Team engaged through SRSP.
Why Rural Water Supply Sanitation Project (RWSSP) in NWFP
The Government of NWFP has embarked upon RWSSP keeping in view the lessons
learnt from the following projects.
RWSSP Punjab
Background
PHED Government of Punjab with the assistance of ADB started a RWSS Project in
335 rural villages at a cost of $46 million for provision of Water Supply Sanitation
and drainage system. It was the first ADB project in Punjab to employ a communitybased, demand-driven approach in which local people were involved in planning and
overseeing the construction of the systems, and were responsible for over all
operation and maintenance costs.
The project, was from May 1995 until May 2002, and constructed 305 pumping and
30 gravity systems to benefit about 800,000 rural dwellers whose average monthly
income is less than $63.
Good Practices
The Department was recognized for
successfully
promoting
stake-holder
participation, hygiene education and local
community ownership. Access to clean
water has led to significant benefits.
• The
incidence
of
waterborne
diseases has decreased by 90%
• Children are no longer required to
fetch water and are instead sent to
school. This has resulted in an 80%
increase in enrolment
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A Module on Basic Health Education and Hygiene Promotion
•
•
Household income has increased by more than 20% because women have
more time to generate income
With a clean water supply in homes, more time is spent on productive
activities. Life-styles have changed.
Efforts are now focused on promoting livelihood activities such as embroidery,
poultry raising, milk production, and marketing products in urban centres. “Women
feel good that they are helping the men generate revenue.”
At times, monthly tariff collections from households have exceeded requirements.
The money was used to provide scholarships, books, and street lighting; finance
small industries; and help orphans. Savings were also recently used to buy 12
sewing machines for women.
Improved living conditions in Punjab have attracted migrants to return to their
villages. The project has, in effect, contributed to “de-urbanization.”
Lesson Learnt
It is evident from the above facts and figures that it is high time for WatSan sector to
gradually switch over to low-cost affordable technology resulting in sizable saving in
capital cost, O&M and above all availability of portable water, better sanitary
conditions and excellent hygienic environment setting a stage for overall prosperity.
Low cost options and community active involvement have made possible easy
provision of basic facilities and also popularizing the concept of wide spread
replication. Hence the Government of NWFP has embarked upon the RWSSP.
Community Infrastructure Initiative Project (CIIP)
Background
Community Infrastructure initiative project CIIP was a DFID UK funded project
implemented by SRSP in eleven districts of NWFP in collaboration with the newly
established District Governments.
Total cost of the project was around Rs. 70.18 Million, with community share of
Rs.14.08 Million and project share as Rs. 56.10 Million. The project constructed 254
infrastructure schemes with active involvement of the community to benefit 263,917
numbers of beneficiaries. Men community organizations (MCOs) formed by the
project were 426 while Women community organizations formed were 139 in
number.
The Capacity building component of the project included trainings on social
mobilization and health hygiene education to the district government staff (Nazims
and Local councillors) and activists (School teachers and Lady Health workers) at
community level.
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A Module on Basic Health Education and Hygiene Promotion
Lesson Learnt
Lessons learnt from CIIP suggest that sustainability can only be achieved when
communities have a genuine feeling of project ownership. This denotes their stake in
the form of community contribution and active participation in scheme identification,
planning, design and construction. The ownership concept motivates the
communities to take full O&M responsibility. Transparency and good governance are
the outcomes of community ownership and self-monitoring.
Purpose of the Module on Health Education and Hygiene Promotion
Main objective of Rural Water Supply and Sanitation Project (RWSSP) is to improve
institutional capacity of Local Government in general and Tehsil Municipal
Administration (TMA’s) in particular for improved service delivery in providing safe
drinking water and sanitation services and to promote hygiene practices among the
poor communities of the NWFP. This Module is designed for the training of Hygiene
Promotion Team (at Regional and TMA levels). This can also be utilised by various
Government Organisations and Non Government Organisation (NGOs) working for
the strengthening of different women groups/Citizen Community Board (CCB) in the
implementation of drinking Water supply and Sanitation (WatSan) projects. Once
their knowledge regarding WatSan and health hygiene promotion is enhanced, they
can transfer this knowledge to the community women who are of prime importance
because of their vital role in caring for and protecting the family.
Target Group
Hygiene Promotion Team




Hygiene Promotion Team Leader (HPTL)
Hygiene Promoters/Social Mobilisers (HP/SM)
Social Organisers (SO)
Regional Water and Sanitation Engineers (RWE)
Number of participants
20
Duration
Two Days
List of Teaching Aids









White Board
Markers
Flip Charts
Multimedia/Over Head Projector (OHP)
Transparencies
Handouts
TV and VCR
Video cassette “PAANI”
Teaching material for utilisation in the community
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A Module on Basic Health Education and Hygiene Promotion
Methodology
1. Group Discussions
2. Brain Storming
3.
Bridging the Gap Exercises
4.
Ice Breaking Exercises
5.
Group Works
6.
Role Plays
7. Lecture
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A Module on Basic Health Education and Hygiene Promotion
8. Practical demonstration
Sessions on Health and Hygiene
1.
2.
3.
4.
5.
6.
Health and hygiene
Water
Sanitation
Food hygiene and Safety
Video Session
Water and sanitation related diseases
Objectives of the training
 To enhance the knowledge of Hygiene Promotion team regarding water
supply, sanitation and health hygiene education
 Explain and teach others, the causes of water and sanitation related diseases
and their methods of prevention/control
Background and Situation Analysis
Water supply and sanitation services in Pakistan have been a neglected sector with
extremely low levels of coverage of population, especially in rural areas of NWFP,
which accounts for about 70% of the total population. Water and sanitation coverage
according to the Bureau of Statistics, Planning and Development (P&D) Department
are as follows:
Existing overall estimated population coverage
•
•
Drinking water supply
Sanitation
63%
39%
Existing estimated rural population coverage
•
•
Drinking water supply
Sanitation
•
•
Water- related diseases account for 80% of all deaths in developing countries
Infectious and parasitic disease is the major cause of morbidity in the
developing countries and cause important outbreak worldwide
Many water-related diseases lead to epidemics, which may have high
mortality and morbidity ratio
Each year 264,000 children under five years of age die due to diarrhoea and
other waterborne diseases
•
•
59%
33%
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A Module on Basic Health Education and Hygiene Promotion
•
30% of total burden of diseases is due to poor hygiene practices and unsafe
sanitation conditions
There is little knowledge among people about health and socioeconomic benefits of
these services. Only a small proportion of population is aware of the fact that water
and sanitation related diseases (the major cause of high infant/child mortality) is
mainly associated with unclean drinking water, unhygienic conditions of the
household and that investment in water supply and sanitation facilities can
substantially reduce the incidence of those diseases.
Need for Health Education and Hygiene Promotion
The provision of clean water supply and sanitation infrastructure alone cannot
secure freedom from water and sanitation related diseases. People must recognize
safe water and sanitation as a “felt” health need and give up their generally
unhygienic habits.
In these circumstances health education emerges as an important tool in creating
among the people a desire for higher standards of life. Once the community
becomes aware of the hazards of unhygienic practices and unsafe (contaminated)
water and starts practicing safe hygiene in everyday life, the overall health standards
will be improved and child mortality and morbidity rates will be significantly reduced.
How to use this Module?
This Module comprises of two parts
Part-1: It contains introductory chapters of situation analysis, the rationale for this
Module, target group, methodologies, list of teaching aids and guidelines for the use
of this Module.
Part- 2: It contains Agenda for the training of 5 Sessions
Each session consist of different steps. A session is organized as follows:





Name or Title of the session
Duration
Objectives of the session
Training material required
Contents/Methodologies
Teaching materials have been designed according to the session’s methodology (see
list of teaching aids)
The training duration is of 2-days. All the sessions have been divided according to the
daily time table.
Trainer should read/prepare himself/herself for each day’s session in advance.
During feedback sessions trainer can judge the understanding and learning of the
participants from the training sessions.
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A Module on Basic Health Education and Hygiene Promotion
SESSION NO 1
HEALTH AND HYGIENE
Duration
30 minutes
Objectives
 To develop understanding of the participants regarding health and hygiene
and its importance in Islam
Training material
Flip chart, Markers (board and permanent), White Board, Zopp cards, Multimedia,
Computer and Handouts.
Methodology
Step - 1
Brain storm the participants by asking
What is health and hygiene?
•
•
Note down the responses of the participants on the board
Read out the responses and add more information with the help of slides (see
page 7 - 8)
Health and hygiene means a system which envisage principles for
preservation of health and prevention of diseases
Development of a society depends upon healthy individuals. One sick person not
only affects other individuals of the household but also has an impact on the rest of
the society. Therefore if we talk about health and hygiene collectively then the basic
principles of health and hygiene should not be limited to few individuals but the
messages should be propagated or disseminated to all the individuals of the
community.
Step - 2
Discuss with the participants about the importance of health and hygiene in
Islam
Health and hygiene have a high place in Islam. Islam clearly stresses upon every
Muslim to maintain cleanliness both at personal and community levels. Cleanliness
cannot be maintained if people defecate in the open.
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A Module on Basic Health Education and Hygiene Promotion
In the absence of cleanliness, Muslims cannot offer prayers or perform most other
religious activities.
As such personal and environmental hygiene is obligatory for every Muslim. The
Holy Prophet (PBUH) not only used to take care of his personal hygiene but also
advised others to maintain cleanliness.
According to a saying of the Holy Prophet (PBUH),
“Cleanliness is half of the faith”
In another saying Holy Prophet (PBUH) said,
“Almighty Allah likes purity and cleanliness”
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SESSION NO 1: HEALTH AND HYGIENE
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A Module on Basic Health Education and Hygiene Promotion
SESSION NO 2
WATER
Duration
2 hours
Objectives
 To develop understanding of the participants regarding contaminated and safe water
 To develop understanding of the participants regarding sources of water, contributing
factors for water contamination and how to keep water clean
Training material
Flip chart, Markers (board and permanent), White Board, Zopp cards, Masking tape,
Multimedia, Computer, Handouts, Water bucket, Soap, Towel and Litre size bottle
full of water.
Methodology
Brainstorming, group discussion, group work, presentations, practical demonstration and
lectures.
Step – 1
Potable Water (Clean/Safe)
Ask the participants to spend 5-7 minutes thinking about
What is Clean/Safe water?
•
•
•
•
•
Divide the participants into groups of three (just as they are seated) and ask
them to discuss
Give them zopp cards and markers
Ask them to write three characteristics of clean water after having group
discussion
Collect the cards from each group and paste them on the board with the help
of a masking tape
Read out the responses of the participants and add more information by using
slides (see page 17)
Potable water should have the following qualities, with references to World Health
Organisation (WHO) guidelines:
1. Physical properties: It should be odourless and colourless and pleasant to
taste
2. Biological properties: It should be free from pathogenic agents (worms,
germs and bacteria)
3. Chemical properties: It should be free from any toxic substances, e.g.
arsenic, mercury, lead and nitrates
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A Module on Basic Health Education and Hygiene Promotion
4. Have essential chemicals: It should contain calcium, iodine, magnesium,
iron and zinc in proper ratio
5. Radioactivity: It should not contain any radioactive elements, e.g. uranium
and radium
Step – 2
Importance of Water
Brainstorm the participants by asking
Why do we need water?


Note the responses of the participants on the board
Read out the responses of the participants and add more information about
the topic
There is a saying in the Holy Quran regarding importance of water.
“And we have kept alive everything from water”
Another saying in Surah Anaam (the cattle) ayyat 99,
“And it is He who sends down water from the sky. Then We (Allah) bring forth
everything to growth and out of it We (Allah) bring forth the green (foliage) from
which We (Allah) bring forth clustered grains and out of the date-palms the
bunches thereof, close to one another and gardens of grapes, olive and
pomegranates”










Water is essential for health, approximately 2/3rd of the body weight is made
up of water
Without enough drinking water we will die
Greater portion of the globe is occupied by water
It is found in every tissue of living beings. i.e. Humans, animals and plants
Science reveals that life started from water
Water is a necessity of life, an article of food and also essentially needed for
cleanliness (Bathing, washing clothes, cleaning streets, houses and for many
other things)
Water is an essential element of diet
Need of the body for water is second to its need for air
One can live without food for 70 days while without water for 72 hours
It regulates the body temperature
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A Module on Basic Health Education and Hygiene Promotion
Practical Demonstration


Share the process to acquaint the participants for better use of water
Show them a litre size bottle containing water with a pin size hole at the bottom
through which water oozes out for washing
 Now ask them to come in pairs and wash their hands turn by turn
 After the activity is over, ask the participants that what message they got from
this
Share the situation on ground of water scarcity due to which we are near to become a
water scarce country. The increasing pressure of the population and industrialization
has disturbed demand and supply position of water (sub-surface and surface level).
Prolonged drought during the past years has further exacerbated the problem. It is
therefore important to adopt water conservative measures and avoid wastage of water
in daily life.
Step – 3
Sources of water
Ask the participants individually about their existing source of water used for their
domestic purposes.
Then discuss in detail different types of water sources with the help of slides and
pictures (see Figure 2.1 and slide on page 18)
1. Natural
2. Artificial
Natural sources: Rain, Ice, rivers, lakes, spring and streams.
Artificial sources: Canals, wells, hand pump, tube well, pools and tapes.
Figure 2.1
Streams
Rivers
Sea
Wells
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A Module on Basic Health Education and Hygiene Promotion
Ditches
Rain
Canals
Ponds
Step – 4
Water contamination
Brainstorm the participants by asking
How water can get contaminated?
Note the responses on the flipchart. Discuss it in detail with the help of pictures and
relate it with the different sources mentioned above.
•
•
•
•
•
•
•
•
Human and animal excreta
Dust
Solid waste
Animal bathing / drinking from the water source
Dirty buckets or containers used for collection
and storage of water
Industrial or other wastes
Sewage lines
Washing clothes and utensils
Step - 5
Effect of unsafe water on our health
Ask the participants
What is the effect of unsafe water on our health?
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Note down the responses and discuss it further by adding more information.
Using dirty and contaminated water:
•
•
•
•
Causes of water-related diseases like, diarrhoea, dysentery, hepatitis,
different types of worms and typhoid
It can also cause skin and eye infections
May not be acceptable due to bad taste or smell
If turbid water is mixed with sand can lead to kidney stones with prolong use
Step – 6
Methods of keeping water clean and safe
Group work
 Duration: 40 minutes (20 minutes for group work and 20 minutes for
presentation)
 Divide the participants into four equal groups
 Assign one topic each for group discussion and presentation
Group No 1
Group No 2
Group No 3
Group No 4
Safe water handling
Protection of wells
Protection of hand pumps
Household purification of water
After presentation/role play add more information regarding the concerned topic with
the help of slides and pictures (see page 19 - 20)
1) Safe water handling
•
•
•
•
Always cover the water utensils and containers
While pouring out water always make sure that it
is not touched by hands and that a clean
container is used
Keep the water containers at higher places so
that children may not put their hands in them
Keep the water containers properly covered so
that insects, reptiles or other harmful objects
may not fall in them
2) Protection of wells
•
•
•
Keep the surroundings clean
Always keep them well covered
Never put the water drawing bucket on the
ground or floor; there should always be a higher
hygienically safe place to put the bucket for
pouring water into the pitchers and other
containers
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A Module on Basic Health Education and Hygiene Promotion
•
•
A good well should have a lined wall and a concrete apron with proper slope
and drainage around it, so that pooling of water can be avoided
Distance between the well and latrine pit should be about 10 meters
depending upon the texture of the soil
3) Hand Pumps
•
•
•
•
Keep the surroundings of the hand pump clean
Make proper arrangements for the wastewater
disposal through drains
Do not allow the children to take bath near the
hand pump
Do not wash utensils or clothes near the hand
pump
4) Household purification of water
The following methods are commonly applied for purifying water on an individual or
domestic scale. These methods can be used separately or in combination.
(a) Boiling
Ideally all water that does not come from
a safe water system should be boiled
before drinking. This is especially
important for small children and at times
when there are known cases of diarrhoea,
typhoid, hepatitis, or cholera in the area.
Water from ponds or rivers, even when it
looks clean, may spread disease if it is
not boiled before use.
•
•
•
•
To be effective, the water must be boiled for 5 to 10 minutes
It kills all bacteria, spores, cysts and ova and yields sterilised water
Water should be boiled preferably in the same container in which it is to be
stored to avoid contamination during transfer from one container to another
Boiled water usually becomes tasteless, but it is perfectly safe for drinking
(b) Chemical Disinfection
Bleaching Powder
•
•
•
Bleaching powder or chlorinated lime is white in colour with a pungent smell
Add 2.5 gms of bleaching powder in 1000 litre of water and keep it for one
hour
The principle in chlorination is to ensure “free” residual chlorine of 0.5 mg/litre
at the end of one hour contact
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A Module on Basic Health Education and Hygiene Promotion
Chlorine Solution
•
•
•
•
Ready-made chlorine solutions in different
strengths are available in the market to suit the
dosage requirements for different levels of
bacteriological contamination
For making chlorine solution, weigh 35gm of
bleaching powder, mix it with a little water and
beat to form a suspension
Allow the sediments to settle and mix the clear
solution with one litre of water. This gives 1%
chlorine solution for chlorinating water supplies
The amount of 1%chlorine solution required to treat different quantities of raw
water is given in the following table:
Required Dose
0.5mg/lit
1.0mg/lit
2.0mg/lit
3.0mg/lit
450 litres of water
22.5mls
45.0mls
90.0mls
135.0mls
Chlorine Tablets
•
•
•
Chlorine tablets are available under various trade names in the market
These tablets are quite good for disinfecting small quantities of water and
easy to use, but generally expensive for poor household
Normally a single tablet (e.g. aqua pura tablet) of 0.5 g is sufficient to disinfect
20 litres of water
Activated Silver

One star of activated silver is added to 20 litres of water. After one hour it will
be coli form free
Alum

Alum is used to reduce the turbidity of water
Potassium permanganate
•
•
•
Add 1 gm of potassium permanganate in 100 litre of water
It may kill cholera vibrio, but is of little use against other disease organisms
It has other drawbacks too, such as altering the colour, smell and taste of
water
Iodine
•
Iodine may be used for emergency disinfection of water. Two drops of 2%
ethanol solution of iodine will suffice for one litre of clear water
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A Module on Basic Health Education and Hygiene Promotion
•
Iodine is unlikely to become a municipal water supply disinfectant in a broad
sense because of its two major disadvantages (High cost and the fact that it
may cause thyroid activity)
(c) Filtration




It is a cheap method in which water is filtered
through three containers to render it clean as
shown in the figure. The upper two containers is
having a hole which allow the water to pass to the
next container
Water is first filtered through a fine piece of cloth
applied to the upper container
It is then passed to the second container having
special graded sand and stones
Finally it reaches the third container in which
water is stored for 24 hours. This water is said to
be bacteria free as they cannot survive due to lack
of nourishment
(d) Natural Treatment (Ultraviolet rays)
•
•
Aeration and exposure of water to ultraviolet rays also help in improving water
quality
Water filtered at home filled in bottles and left at roof tops or other safe places
for exposure to sun and ultraviolet rays can be quite safe for domestic use in
rural communities
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SESSION NO 2: WATER
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A Module on Basic Health Education and Hygiene Promotion
SESSION NO 3
SANITATION
Duration
2 hours
Objectives
 To develop understanding of the participants regarding sanitation and its
components
 To sensitize the participants about the hazards of open defecation
 To develop understanding of the participants about latrine usage and
cleanliness
 To sensitize the participants about the hazards of garbage heaps
 To motivate the participants to dispose garbage in a proper place
 To develop understanding of the participants about personal hygiene
 To sensitize the participants about hazards of lack of personal hygiene
 To motivate the participants to keep personal hygiene properly
Training material
Flip chart, Markers (board and permanent), White Board, Zopp cards, Multimedia,
Handouts.
Methodology
Brainstorming, group discussion, group exercise, presentation, lectures and role play.
Step – 1
Brainstorm the participants by asking.
What is Sanitation?
•
•
Note down the responses of the participants on the board
Read out the responses and add more information with the help of slides (see
page 31)
In the past, sanitation was centred on the sanitary disposal of human excreta. Even
now, to many people sanitation still means the construction of latrines. In actual fact,
the term sanitation covers the whole field of controlling the environment with a view
to prevent disease and promote health
In simple words it can be defined as public cleanliness involving community
efforts in disease prevention, promoting hygiene and keeping public places
free of waste
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A Module on Basic Health Education and Hygiene Promotion
WHO defines environmental sanitation as the control of all those factors in a
person physical environment, which exercise a deleterious effect on that
person’s physical development, health and survival.
Step – 2
Components of Sanitation
Brainstorm the participants and note down the responses.
Sanitation is the combination of the following components:
1. Disposal of human excreta
2. Waste water disposal
3. Solid waste disposal (including household waste, animal waste)
4. Personal hygiene
5. Environmental hygiene (including domestic hygiene)
1. Disposal of
human excreta
2. Waste water
disposal
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A Module on Basic Health Education and Hygiene Promotion
4. Personal
hygiene
3. Solid Waste
Disposal
Step – 3
Group work



Duration: 40 minutes ( 20 minutes for group work and 20 minutes for
presentation)
Divide participants into four equal groups through energiser
Assign all the groups different tasks i.e.
Group No 1: Disposal of human excreta
Group No 2: Waste water disposal
Group No 3: Solid waste disposal (including household and animal waste)
Group No 4: Personal hygiene and household hygiene
After group work ask each group for presentation.
For further information discuss and explain each topic with the help of slides (see
page 32 - 34)
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A Module on Basic Health Education and Hygiene Promotion
Step – 4
1) Disposal of Human excreta
Discuss with the participants hazards of human excreta.
Human excreta is the largest source of infection. It is an important cause of
environmental pollution. Figure below shows how the faecal-borne diseases are
transmitted to a new host. The human excreta of a sick person or a carrier of a
disease is the main cause of infection. It contains the disease agent, which is
transmitted to a new host through various channels, such as.
(1) Water (fluids)
(2) Fingers (mainly nails)
(3) Flies
(4) Soil (Fields used for open defecation)
(5) Fomites (instruments, utensils and other things of daily use)
(6) Food
Explain the F Diagram in detail.
Fluids
Flies
Faeces
Food
Fingers
Fields
Routes of transmission of faecal-borne diseases
How we can break this transmission chain?
The disease cycle may be broken at various levels by
• Segregation of faeces
• Protection of water supplies
• Protection of food
• Personal hygiene
• Control of flies
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New
Host
A Module on Basic Health Education and Hygiene Promotion
Fluids
Flies
Safe stool
Disposal
Faeces
Fingers
Hand
Washing
Healthy
Person
Fields
Food
Of these, the most effective measure is to segregate the faeces and arrange for safe
excreta disposal so that the disease agent cannot reach the new host, directly or
indirectly. Safe disposal of human excreta (whether adult or children excreta)
through sanitary latrine is a major step in breaking this transmission chain.
Type of Latrines
There are two major types of latrines


The dry latrines: which do not use water for human waste disposal. These
latrines are meant for areas with known water shortage, such as deserts and
arid areas
The flush latrines: are meant for areas where water availability is not a
serious problem
1. Dry Latrines are usually of two types
a) Pit Latrine
b) Ventilated Improved Pit Latrine (VIP)
2. Flush Latrines can be of many types, but the following three are most
commonly used
a) Direct Pour-flush
b) Twin-pit Pour-flush
c) Pour-flush with a septic tank
Latrine building being a household as well as a community activity, its design should
be carefully discussed with the community representatives both women and men.
The affordability and cultural acceptability of latrine designs is very important
because there is no hardware subsidy involved in it. The role of the TMAs and any
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A Module on Basic Health Education and Hygiene Promotion
government funded and donor-supported organisation is to motivate the people in
building and using hygienically safe latrines. The communities and activists should
be encouraged to come up with locally acceptable, cheaper but sustainable options.
2) Waste water disposal
A proper drainage system for the environmentally safe disposal of sullage and other
liquid wastes, excluding the waste from the latrine is also necessary for good health
and an overall healthy environment.
3) Solid waste disposal (including household waste, animal waste)
Systematic collection, disposal and utilisation of solid waste, which includes
household garbage (stable manure, street sweepings, leaves, garden refuse, waste
fruits and vegetables, old glass, tins, ashes, paper, plastic bags) and animal waste
(dead animals and animals excreta etc) is another important component of
sanitation.
What are the principles of Solid Waste Disposal?
•
Make a boundary wall around the garbage dump
• Garbage (e.g. paper, cloth etc) should
be separated for recycling. If this facility is not
available then it should be burnt
•
The material, which cannot be burnt, should
be dumped beneath the surface, which
becomes a good fertilizer after some time
• Plastic bags and things made of
plastic and rubber, which cannot be used as
fertilizer or as a fuel, should also be
separated for recycling, otherwise should be
dumped separately under the surface as it
takes years for decomposition
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A Module on Basic Health Education and Hygiene Promotion
•
At home a dustbin should always be used for
garbage disposal
4) Personal hygiene
Safe hygiene practices by all men, women and children is vital for their health.
What are the components of Personal Hygiene?
Hand washing
Always wash your hands with soap:
 After using latrine or defecation (preferably two
times)
 Before handling or cooking or serving or eating
food
 Before feeding the child
 After cleaning the child
(Note: if soap is not available use fuel wood or
charcoal ash for hands washing)
Bathing
•
•
•
•
Bath every day, or even more frequently when the
weather is hot
Bath after working hard or sweating
Frequent bathing helps prevent skin infections,
dandruff, pimples, itching, and rashes
Sick persons, including babies, should be bathed
daily
Teeth cleaning
Brush your teeth at least once a day or thrice a
day each after breakfast, lunch and dinner.
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A Module on Basic Health Education and Hygiene Promotion
Nail cutting
Always keep your nails clean and cut. Dirty
nails are major source of transfer and spread of
germs to mouth and stomach.
Wearing shoes
Do not walk barefooted. Germs and worms from
human, animal and other hazardous waste can
easily be transmitted to the human body through
barefoot walking.
Wearing clean clothes
Keep your clothes neat and tidy. This habit is not
only good to improve personality, but more
importantly it keeps any harmful germs and
parasites away and the person healthy.
Hair combing
Washing and combing of hair regularly keeps the
hair clean and devoid of germs and parasites.
5) Environmental hygiene
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A Module on Basic Health Education and Hygiene Promotion
Environmental hygiene is not restricted to domestic hygiene only, but it also covers
cleanliness of the streets and village as a whole.
What are the components of environmental hygiene?
Following are the components of environmental hygiene:
1. Domestic or household hygiene, which involve hygiene practices in kitchen,
handling and eating of food
2. Drain cleaning, inside and outside the house to maintain an efficient drainage
and sullage water disposal system
3. Garbage disposal involve safe disposal of solid wastes, including animal
excreta and recycling items, such as bottles, tins, plastic bags etc
What are the principles of keeping the household and nearby environment
clean?
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Clean the house often, sweep and wash the floors, walls, and beneath furniture.
Fill in cracks and holes in the floor or walls where cockroaches, bedbugs,
scorpion and mice can hide
Build and use latrines
The children should be trained not to defecate or urinate in the open and to use
latrines
Open urination by men is a common practice in urban and rural areas. The
hygiene message should be clear in this regard, as open urination is not only
equally harmful to human health but is also against Islam
Dispose garbage in a proper place. Burn all garbage that can be burned.
Garbage that cannot be burned should be buried in a special pit or place far
away from houses and the places where people get drinking water
Recyclable items, such as glass, bottles, plastic, tins, paper and cloth should be
disposed off separately. These items plus the organic which can be composted
to be used as a fertilizer can be used as sources for income generation
Stagnant water should be drained out and kept clean
Take care of drainage system, within and out of the household
Clean the household and communal drains daily
Never allow children to defecate or urinate in the drains
Never throw the solid waste in the drains
Avoid throwing plastic bags in the drains as they block the sewerage system
Keep wells and public waterholes clean. Do not defecate or throw garbage near
the water hole
Do not let any animals go near where people get drinking water. If necessary, put
a fence around the place to keep animals out
There should be a separate container for watering animals
Take special care in keeping rivers and streams clean upstream from any place
where drinking water is taken
Do not let the pet animals come into the house or places where children play
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A Module on Basic Health Education and Hygiene Promotion
•
•
•
•
•
•
Do not let dogs or cats lick children or climb up on beds. These pet animals can
spread diseases
If the pet animals have a bowl movement near the house, clean it up at once and
teach them to ease themselves away from the house
Hang or spread sheets and blankets in the sun often. If there are bedbugs, pour
boiling water on the cots and wash the sheets and blankets all on the same day
Plastic bags are very dangerous for environment. It has the capacity to survive
for a longer time and thus cannot be disposed off easily. It contains cancerous
chemicals, which are released when burnt (or when temperature rises). It
damages the fertility of the field also. It should be separated for recycling,
otherwise should be dumped separately under the surface as it takes years for
decomposition
Tie knots to the plastic bags before disposing off so that they do not fly
everywhere. Avoid using plastic bags and instead use baskets and cloth bag for
shopping
Activists should inform communities about the problem and hazards of plastic
bags and how these can be safely disposed off
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A Module on Basic Health Education and Hygiene Promotion
SESSION NO 3: SANITATION
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A Module on Basic Health Education and Hygiene Promotion
SESSION NO 4
Food Safety
Duration
30 minutes
Objectives
 To sensitize the participants about the hazards of contaminated food
 To develop understanding of the participants about the principles of keeping
food clean
Training material
Flip chart, Markers (board and permanent), White Board, Zopp cards, Multimedia
and Handouts.
Methodology
Step – 1
Principles of keeping food clean
Brain storms the participants by asking
What are the principles of keeping food clean?
•
•
Note down the responses of the participants on the board
Discuss it further with the help of slides (see page 37)
Keep the food covered
•
•
Do not let flies and other insects land or crawl on food. These insects carry
germs and spread diseases
Do not leave food scraps or dirty dishes lying around, as these attract flies and
breed germs. Protect food by keeping it covered or in boxes or cabinets with wire
screens
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A Module on Basic Health Education and Hygiene Promotion
Wash vegetables and fruits
•
•
Wash fruits and vegetables properly before usage
Any fruit fallen on to the ground should be washed
well before eating. Do not let children pick up and
eat food that is dropped from tree. Train them to
wash it first
Cook the food well
•
•
Cook the food well
Only eat meat that is well cooked. Be careful that roasted meat, especially
beef, does not have raw parts properly cooked inside
Avoid the use of rotten food
•
•
Do not eat food that is old or smells bad. It may be poisonous
Do not eat canned food if it is outdated. Be especially careful with canned
fish which deteriorates fast
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A Module on Basic Health Education and Hygiene Promotion
SESSION NO 4: FOOD SAFETY
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A Module on Basic Health Education and Hygiene Promotion
SESSION NO 5
Video Session on water, sanitation and hygienic practices
Duration
30 minutes
Objectives
 To show the participants a ground picture of the previous activities
related to water, sanitation and hygienic practices
Training material
TV, VCR and Video Cassette “Paani”
Methodology
Video display followed by discussion with the participants.
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A Module on Basic Health Education and Hygiene Promotion
SESSION NO 6
Water and Sanitation-related diseases
Duration
6 hours
Objectives
 To develop understanding of the participants regarding diseases caused by
contaminated water and lack of sanitation
 To enable the participants to understand the transmission route and control
measures of different water and sanitation related infections
Training material
Flip chart, Markers (board and permanent), White Board, Zopp cards, OHP,
Transparencies, Handouts and Pictures showing different diseases.
Methodology
Lecture and group work
Step – 1
Transmission routes and control measures of different water-related diseases
Brain storms the participants by asking
Name the common water and sanitation- related diseases?
•
•
Note down the names of diseases given by the participants on the board
Add more names to the list if any
Discuss with the participants the transmission routes and control measures of
different water-related diseases with the help of transparencies (see page 55-58).
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A Module on Basic Health Education and Hygiene Promotion
Transmission routes and control measures of different water related infections
S.
No.
Diseases
1.
Water-borne
(Faecal-oral)
Transmission
Control Measures
•
Faeces of infected
person
•
Diarrhoeas
Dysenteries
Typhoid
Cholera
Poliomyelitis
Hepatitis-A
Round worms
Thread (pin) worms
•
•
Food
Water
•
•
Safe disposal of human
excreta
Improved drinking water
quality
Improved personal
hygiene
Improved domestic and
food hygiene
Polio vaccination
Hepatitis-A gamma
globulin
Mouth of susceptible
person
2.
Worm Infection
a. Faecal oral
Round worms
Thread (pin) worms
(as above)
b.Direct infection
(penetrating skin
infection or worm
infection with no
intermediate host)
Hook worms
(as above)
Faeces of infected
person
(as above)
•
•
Eggs in the soil
•
Skin (feet
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Latrine use (prevent eggs
from depositing on soil)
Ensure before using in the
agriculture fields
decomposition and safety of
human waste
Always wear shoes
A Module on Basic Health Education and Hygiene Promotion
S.
No.
Diseases
Transmission
Control Measures
c. Water based
worm infection
(worm infection with
aquatic host)
Ginea worms
Female guinea worms
come to the skin
surface (foot)
Prevent eggs from entering the
drinking water source
(this is the only worm which is
purely water-related)
eggs released in the
water source
Water used for drinking
(small insects in the
water)
d. Worm infection
with animals as
intermediate host.
Tape worms
Feaces of infected
person (soil-grass)
•
•
Latrine use to which cattle
and pet birds and animals
do not have access
Ensure excreta safe to
handle before applying to
the fields
Ensure no open defecation
•
•
•
Improve water availability
Practice personal hygiene
Impart hygiene education
•
Livestock consume
with grass and fooder
Meat
Susceptible person
3.
Water-washed
infection (due to
less water usage)
Skin, eye and ear
infection
Caused by poor
personal hygiene
Also children taking
bath in dirty water
ponds
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A Module on Basic Health Education and Hygiene Promotion
S.
No.
4.
Diseases
Transmission
Water-related insect
borne diseases
Stagnant waterbreeding of
mosquitoes
Control Measures
•
•
Malaria
Bite infected person
•
•
Get the germs
•
•
Prevent water stagnation in
the drains by frequent
cleaning
Seal and repair covers of
septic tanks and soakage’s
pits, where needed
Fill stagnant water ponds
Take regular preventive
doses of suppressive drugs,
such as chloroquine
Use insecticides, oils and
mosquito nets
Spray insecticides
Bite a susceptible
person and inject the
germs in him
Step – 2
Group work and role play
 Duration: 45 minutes (20 minutes for group work and 25 minutes for
presentation)
 Divide the participants into four equal groups through energiser
 Assign all the groups different tasks by giving names of diseases (given
below)
 Ask them to explain each diseases with symptoms, transmission routes and
control measures
Group No 1: Diarrhoea
Group No 2: Hepatitis - A
Group No 3: Typhoid Fever
Group No 4: Poliomyelitis
Group No 5: Malaria
After group work ask each group for presentation as a role play in the community.
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A Module on Basic Health Education and Hygiene Promotion
For further information discuss and explain each topic with the help of
transparencies.
Diarrhoea and Dysentery
Show a picture of a dehydrated child with diarrhoea.
Ask their opinion about the picture.
Brain storms the participants by asking
Define Diarrhoea and Dysentery?
When children and adults pass loose, watery stools, 3 or more times a day or one
big watery stool, they are said to have diarrhoea. If mucus and blood is seen in the
stools, a person is said to be suffering from dysentery.
Why diarrhoea is dangerous?
Diarrhoea can lead to:
Immediate Effects
1. Dehydration -------- Death
2. Spread of infection to other parts of the body
3. Loss of appetite
Later Effects
1. Malnutrition
2. Susceptibility to other infections
3. Vicious cycle ------- chronic stage
How dehydration occurs?
Excessive loss of water and salts from the body without proper replacement of fluids
results in dehydration.
What are the dangerous signs and symptoms of diarrhoea?











Vomiting with repeated loose motions
Irritated behaviour of the affected child
Loss of appetite
Little dark yellow urine or no urine at all
Sudden weight loss
Sagging in of the “soft spot” on the heads of infants
Sunken, tearless eyes
Dry mouth
Loss of elasticity of the skin
Very severe dehydration may cause rapid and weak pulse
Fast deep breathing, fever or fits
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A Module on Basic Health Education and Hygiene Promotion
How to prevent diarrhoea?
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Breast-feed the baby rather than bottle-feed a basic and
natural medicare. Breast milk helps babies resist the
infections. If it is not possible to breast-feed, feed the baby
with a cup and spoon. Avoid using a baby bottle because it
is difficult to keep clean and likely to cause infection
When you begin to give the baby a new or solid food, start
by giving just a little, and mash it well. (too much food at
one time, may give diarrhoea)
Always use clean or potable water for preparing baby’s
food and even for washing the baby’s cup, spoon and
bottle
Always wash your hands with soap and water after going to latrine or cleaning
and dusting the house
Hand washing should also be done after cooking and handling food in any form
Ensure safe disposal of human excreta, including that of children and infants
Always wash hands after cleaning children’s stool
Cut your and the children’s nails regularly and keep them clean
Cover the food and water properly
Do not bath or wash clothes near the source of drinking
water
Do not water livestock or other animals direct from the
source of water
Vaccinate your children against Measles
Clean utensils properly
Eat raw vegetables only after properly washing them with
clean water
What is the treatment of diarrhoea at home?
Prevent or control dehydration
•
A person suffering from diarrhoea should be given
large amounts of fluids including water such as green
tea, rice water, beans meat or chicken broth and
juices
•
If diarrhoea is sever or there are signs of dehydration,
give the patient oral rehydration drink, i.e. ORS and
other juices that help regain nutrition as well
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A Module on Basic Health Education and Hygiene Promotion
Meet nutritional needs of the dehydrated child
•
Give the patient soft food after small intervals
•
Do not discontinue breast-feeding to children with diarrhoea
•
Under nourished or underweight child, should get plenty of body building foods
(proteins) and energy providing foods as an extra supplement immediately
after recovery from diarrhoea. Add one tea spoon oil to any food given to the
patient
Body building foods include proteins such as milk, egg, beans, peas and meat (well
cooked and mashed), while energy providing foods include rice, potatoes, banana
fresh maize (well cooked and mashed)
How to prepare ORS?
Most of the deaths in diarrhoea cases result from loss of fluids and salts from the
body. It is therefore important to know how to prepare Oral Rehydration Solution.
The following items are required for ORS preparation




A packet of ORS
A jug with a measuring scale
One big spoon
Container for boiling water
Procedure for making ORS Solution









Wash the hands and utensils properly using soap
Take one litre of boiled water in a jug or container. Four glasses (quarter size)
can also be used for measuring a litre of water
Make sure that the water is cold before adding a packet of ORS
Add full packet and stir it properly
Keep the jug or container well covered in a cool place
Solution should be used within 24 hours
Use a cup and a spoon to give ORS solution to a child under 2 years (a
teaspoonful every 1-2 minutes)
Give frequent sips from a cup for an older child
If the child vomits, wait for 10 minutes. Then give the solution more slowly (a
spoonful every 2-3 minutes)
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A Module on Basic Health Education and Hygiene Promotion
Hepatitis
Show the picture of a child having jaundice and take the participants view about the
picture.
Brainstorm the participants by asking different
questions related to the disease and add further
information with the help of transparencies.
Define Hepatitis?
Hepatitis is a viral infection that harms the liver and
has four different types A, E, B, and C.
What are the symptoms of Hepatitis?
•
•
•
•
•
•
The patient may have a fever, easy fatigability,
loss of appetite and distaste for normal food
Sometimes there could be pain on the right side near the liver
The colour of eyes and skin complexion turns yellowish after a few days
The patient does not want to eat or smoke and often goes for days without eating
anything
Even the sight or smell of food may cause vomiting
The urine turns deep yellow, and the stools become whitish
What is the mode of transmission?
•
•
The Hepatitis virus passes from the stool of one person to the mouth of another
by the way of contaminated water or food (Type A and E)
Hepatitis can also be transmitted by giving injections with unsterilized needles,
surgical instruments, sharing razors, transfusion of blood of an infected person
and sexual contact (Type B and C)
What precautions would you take during Hepatitis?
•
•
•
•
•
Do not use medicines because antibiotics do not work against hepatitis. In fact
some medicines will cause added damage to the sick liver
It is important to bury or burn the sick persons stool, and to keep him very clean
The person providing care should wash his hands well after each time he goes
near the sick person
All family members of the sick person should follow the guidelines of cleanliness
with great care
Always use disposable syringes
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A Module on Basic Health Education and Hygiene Promotion
Worms and other Intestinal Parasites
Brainstorm the participants by asking
What are the different kinds of worms?
There are many types of worms and other tiny
organisms (parasites) that live in people’s
intestines and cause diseases. Those, which
are larger, can sometimes be seen in the
stool.
The only worms commonly seen in the stool
are round worms, thread worms and tape
worms. Hookworms and Whipworms may be
present in the intestine in large numbers,
without ever being seen in the stool.
Discuss the commonest types of worms through participatory method by asking
questions related to the specific worm.
Round worm
Structure
•
•
Average length
Colour
20 to 30 cm
pink or white
What is the mode of transmission?
Mode of transmission is oro-faecal. The roundworm eggs pass from one person’s
stools or vomitus to another person’s mouth because of lack of cleanliness and
hygienic practices.
•
•
•
•
•
•
Ingestion of infected eggs with food or drink
Foods that are eaten raw such as salad and vegetables
Drinking polluted water
Fingers contaminated with soil
Ingestion of contaminated soil (pica) which usually happens in the case of
children playing with soil
Dust may play an important role in the dissemination of roundworm eggs in
arid area
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A Module on Basic Health Education and Hygiene Promotion
What is the effect on health?
•
•
Round worms in the intestines may cause discomfort, indigestion, and
weakness. Those children with many round worms often have very large,
swollen bellies
In some cases round worms may cause asthma, fits, or a dangerous
obstruction or blockage in the gut
What preventive measures can we take?
•
•
•
•
Use sanitary latrines
Wash hands with soap and water before eating or handling food
Protect food and drinking water from flies
Follow the guidelines of cleanliness
Thread worm (Pin worm)
Structure
•
•
•
Average length
1 c.m.
Colour
White
Physical appearance Very thin and thread-like
What is the mode of transmission?
•
•
•
These worms lay thousands of eggs just outside the anus
This causes itching, especially at night. When a child scratches, the eggs
stick under his nails, and are carried to food and other objects
In this way they reaches his own mouth or the mouths of others, resulting in
new carriers of threadworm infection
What is the effect on health?
These worms are not dangerous for general health although itching may disturb the
child’s sleep and general temperament.
What preventive measures can we take?
•
•
•
•
•
•
A child who has pinworms should wear tight diapers or pants while sleeping to
keep the child from scratching his/her anus
Wash the child’s hands and buttocks (anal area) on the child’s waking up and
after the bowel movement. Always wash the child’s hands before giving any food
for eating
Cut the child’s fingernails very short
Change the child’s clothes and bathe him/her frequently, washing the buttocks
and nails especially well
Put petroleum jelly in and around the child’s anal area at bedtime to help stop
itching
Give the child as well as the whole family worm repellent medicines
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A Module on Basic Health Education and Hygiene Promotion
•
•
Cleanliness is the best prevention for threadworms as most other sanitation
related diseases. Even if medicines get rid of the worms, they will be picked up
again if care is not taken with personal hygiene
Pinworms live for only about 6 weeks but in this short period it may cause
enough itching and suffering to a child and therefore measures to eradicate it
should be taken as early as possible
Hook worm
Structure
•
•
Average length
Colour
1 cm
Red
What is the mode of transmission?
•
•
•
The worm penetrates directly through skin or a wound and is carried by the blood
stream to the intestine
These worms lay eggs in the intestine, which are then passed in the human
faeces
Lack of hygiene practices and open defecation results in the transfer of hook
worms from one person to another and this health hazard quickly multiplies for
children walking bare footed
What is the effect on health?
•
•
Hookworm infection can be one of the most damaging diseases of childhood
Most of the children having hook worm infection are anaemic as they nourish
themselves on the blood, which they suck from the intestinal wall
What preventive measures can we take?
The following five weapons are available for use in the control and prevention of
hookworm
• Protection of feet: never move around without wearing shoes
• Disinfection of faeces or soil: use sanitary latrines and abandon open
defecation
• Prevention of soil pollution: do not use human or animal excreta as a fertilizer
until it is safe
• Treatment: use antiworm medication to eradicate all types of worm infection
• Dietary supplements: use balanced diet and always properly wash vegetables
and fruit before use. Never eat meat which is not properly cooked or suspect of
being healthy
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A Module on Basic Health Education and Hygiene Promotion
Typhoid fever
Define Typhoid fever?
Typhoid fever is the result of systemic infection mainly by Salmonella typhi found
only in man. The term enteric fever includes both typhoid and paratyphoid fevers.
What are the symptoms of Typhoid fever?
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Patients have continuous fever for 3-4 weeks
Patient does not want to eat or smoke. Often goes for days without eating
anything
What is the mode of transmission?
Typhoid fever is transmitted through faecal-oral route or urine-oral route
•
•
This may take place directly through soiled hands contaminated with faeces or
urine
Or indirectly by the ingestion of contaminated water, milk and food or through
flies
What preventive measures can we take?
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•
•
•
•
•
•
•
•
•
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Early diagnosis, isolation and treatment of typhoid cases are important step in
control of typhoid fever
It is important to bury or burn the sick persons stool and urine, as it is the sole
source of infection
All soiled clothes and linen should be soaked in a solution of 2% chlorine
Keep the patient clean
The person providing care should wash his/her hands well after each time
he/she goes near the sick person
All the family members of the sick person should follow the guidelines of
cleanliness with great care
It is important to identify and treat carrier cases and give them health
education regarding washing hands with soap and water after defecation or
urination and before preparing and eating food
Protect food and drinking water from flies and other sources of contamination
Use sanitary latrines
Wash hands with soap and water before eating or handling food
Immunization (anti typhoid vaccine) gives 70% protection
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A Module on Basic Health Education and Hygiene Promotion
Poliomyelitis
Show the picture of a child who developed paralysis of the lower limb due to polio.
Take the participants view about it and start the discussion regarding polio.
Define Poliomyelitis?
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
Poliomyelitis is a viral infection caused by poliovirus, which has three
serotypes 1, 2 & 3
It is primarily an infection of the intestine but the virus may infect the central
nervous system in a very small percentage (about 1%) of cases resulting in
paralysis and possibly death
What are the symptoms of Poliomyelitis?
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•
•
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95% of cases may have no presenting symptoms
There may be stiffness and pain in the neck and back
In less than 1% of cases virus invades the central nervous system and
causes varying degree of paralysis
A history of fever at the time of onset of paralysis is suggestive of polio
What is the mode of transmission?
•
•
The poliovirus passes from the stool of one person to the mouth of another by
the way of contaminated water or food or fingers
It can also be transmitted by droplet infection in the acute phase of disease when
virus occurs in the throat. Close contact with an infected person facilitates droplet
spread
What preventive measures can we take?
•
Polio vaccination: Immunization is the sole effective means of preventing
poliomyelitis
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A Module on Basic Health Education and Hygiene Promotion
•
•
•
Proper disposal of human excreta: It is important to bury or burn the sick
persons stool, and to keep him very clean. All the family members should use
sanitary latrines
Improved drinking water: Protect drinking water from flies and other sources of
contamination
Improved personal hygiene: The person providing care should wash his hands
well after each time he goes near the sick person. All the family members of the
sick person should follow the guidelines of cleanliness with great care
Malaria
Define Malaria?
Malaria is a disease caused by infection with parasites of
genus plasmodium and transmitted to man by certain
species of infected female Anopheline mosquito.
What are the symptoms of Malaria?
•
•
•
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Patients have fever with shivering and sensation of
extreme cold
Fever usually comes down with profuse sweating
Patient complains of nausea and headache
Sight or smell of food may cause vomiting
What is the mode of transmission?
•
•
Malaria is transmitted by the bite of certain species of infected female, mosquito
A single infected vector may infect several persons
What preventive measures can we take?
•
•
•
Prevent water stagnation in the drains by frequent cleaning
Seal and repair covers of septic tanks and soakage’s pits, where needed
Fill stagnant water ponds
•
Take regular preventive doses of suppressive drugs, such as chloroquine
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A Module on Basic Health Education and Hygiene Promotion
•
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Use insecticides and oils
Use of mosquito nets
Spray insecticides
Impart hygiene education
Skin and Eye Infection (Surface infections)
This group includes skin infections like scabies and louse borne infection. Eye
infections like trachoma.
What is the mode of transmission?
These infections results from poor personal hygiene due to less water usage.
Children taking bath in dirty water ponds is another source of transferring the
disease
• Infections may take place directly through skin contact or hand-to-eye contact
• Or indirect contact with an infected person or fomites e.g. infected fingers,
towels, kajal or surma. Eye-seeking flies play some role in spreading the infection
by mechanical transmission
What preventive measures can we take?
•
•
•
Improve water availability
Practice personal hygiene
Impart hygiene education
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A Module on Basic Health Education and Hygiene Promotion
SESSION NO 6: WATER AND SANITATION RELATED DISEASES
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Training Module on Health and Hygiene
The Local Government, Elections and Rural Development Department (LGE&RDD) launched the Rural Water Supply and
Sanitation Project (RWSSP) in collaboration with the UK Department of International Development (DFID) in all the sixtyone Tehsils and Towns of NWFP on 1 July 2003. Technical support is provided by the SEED Team engaged through
SRSP.
Capacity building of the Tehsil/Town Municipal Administration (TMA) is a major objective as the TMAs are responsible for
delivery of WatSan services since the introduction of Local Government Ordinance (LGO) 2001.
This Module is designed by RWSSP for the training of TMA staff. This can also be utilised by various Government
Organisations and Non Government Organisation (NGOs) working for the strengthening of different women
groups/Citizen Community Board (CCB) in the implementation of drinking Water supply and Sanitation (WatSan) projects.
Once their knowledge regarding WatSan and health hygiene promotion is enhanced, they can transfer this knowledge to
the community women who are of prime importance because of their vital role in caring for and protecting the family.
Main objectives of the Module are:
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To develop understanding regarding the basic knowledge related to water, sanitation and health hygiene education
Explain and teach others, the causes of water and sanitation related diseases and their methods of
prevention/control
Pakistan, NWFP – Rural Water Supply and Sanitation Project (RWSSP)
The DFID-assisted RWSSP is part of the Government of NWFP’s water and sanitation development programme in the
province, for which Sarhad Rural Support Programme (SRSP) provides technical assistance.
Main Objectives
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Institutional capacity building to provide simple, integrated and sustainable drinking water and sanitation
(WatSan) services in NWFP
Implementation of over 5,000 WatSan schemes to provide integrated WatSan services to at least one million
people during 2003-2008
Support to the devolved government system in NWFP
Salient Features
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Sustainable drinking water and sanitation (WatSan) services to over one million people under an integrated and
holistic approach, in which hygiene promotion, water quality, income generation and environmental protection
are essential considerations
Beneficiary communities’ capital cost-sharing and taking full responsibility for the operation and maintenance
(O&M) of schemes
Priority given to poorer communities with lower development indicators
Promotion of public sector, NGO and community partnership
Advocacy to support the devolved government system, particularly with respect to capacity building of the
Town/Tehsil Municipal Administrations (TMAs) in the delivery of safe and sustainable WatSan services
Government of North West Frontier Province, Local Government, Elections and Rural Development Department
DFID UK Department for International Development
Social Efforts for Education & Development