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      Sanitation behavior among schoolchildren in a multi-ethnic area of Northern rural Vietnam

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          Abstract

          Background

          In Vietnam, efforts are underway to improve latrine use in rural and remote areas with particular focus on increasing coverage of sanitation in schools. However, there is a lack of information on how the school program affects latrine use by schoolchildren and at community level. This paper analyzes sanitation use among schoolchildren in a multi-ethnic area to inform future school-based sanitation promotion programmes.

          Methods

          A combination of quantitative and qualitative methods was applied during a 5 months period in six primary and secondary schools and in the homes of schoolchildren in four different ethnic villages in Northern rural Vietnam. Using a structured questionnaire, 319 children were interviewed face-to-face to collect quantitative data. Qualitative methods included extensive observations at schools and in the homes of 20 children, a single day's diary writings of 234 children, in-depth interviews with children (20), their parents (20) and school staff (10), and focus group discussions with parents (4) and teachers (6), and picture drawing with children (12).

          Results

          All surveyed schools had student latrines. However, the observed schoolchildren most commonly urinated and defecated in the open. Main barriers for latrine use included inadequate number of latrines, limited accessibility to latrines, lack of constant water supply in latrines and lack of latrine maintenance by school management. Programs promoting latrine use for children were not conducted in either schools or communities and were not established as a preferred social norm in such settings. Children perceived existing school latrines as unappealing and expressed a wish to have basic, functional, clean, and colorful school latrines with privacy.

          Conclusions

          The paper shows that the current school based sanitation promotion is insufficient to change sanitation behavior of school children irrespective of their ethnicity. It is important that schools, households and communities work more closely together to increase use and uptake of latrine use among schoolchildren. Also, the contractors of latrine facilities must work more closely with local school management when constructing latrines, including identifying location, design and appropriate systems of water supply. A separate budget needs to be allocated to allow the school to maintain the sanitation infrastructure and keep it hygienic and appealing for users.

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          Most cited references9

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          Water handling, sanitation and defecation practices in rural southern India: a knowledge, attitudes and practices study.

          Diarrhoea and water-borne diseases are leading causes of mortality in developing countries. To understand the socio-cultural factors impacting on water safety, we documented knowledge, attitudes and practices of water handling and usage, sanitation and defecation in rural Tamilnadu, India, using questionnaires and focus group discussions, in a village divided into an upper caste Main village and a lower caste Harijan colony. Our survey showed that all households stored drinking water in wide-mouthed containers. The quantity of water supplied was less in the Harijan colony, than in the Main village (P<0.001). Residents did not associate unsafe water with diarrhoea, attributing it to 'heat', spicy food, ingesting hair, mud or mosquitoes. Among 97 households interviewed, 30 (30.9%) had toilets but only 25 (83.3%) used them. Seventy-two (74.2%) of respondents defecated in fields, and there was no stigma associated with this traditional practice. Hand washing with soap after defecation and before meals was common only in children under 15 years (86.4%). After adjusting for other factors, perception of quantity of water received (P<0.001), stated causation of diarrhoea (P=0.02) and low socio-economic status (P<0.001) were significantly different between the Main village and the Harijan colony. Traditional practices may pose a significant challenge to programmes aimed at toilet usage and better sanitation.
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            Hygiene and sanitation among ethnic minorities in Northern Vietnam: does government promotion match community priorities?

            Improving sanitation and hygiene to prevent infectious diseases is of high priority in developing countries. This study attempts to gain in-depth understanding of hygiene and sanitation perceptions and practices among four Ethnic Minority Groups (EMGs) in a rural area of northern Vietnam. It is based on extensive participatory observations in 4 villages and 20 case households over a period of six months (May-October 2008). In addition, 10 key informants and 60 household-members were interviewed and 4 focus group discussions conducted. The study found that among the four selected EMGs the cultural perceptions of hygiene and sanitation which inform everyday hygiene practices did not differ substantially and were similar to hygiene explanations found in the rural majority population elsewhere in Vietnam. However, the difficult living conditions, particularly in highland communities, reinforce a sense of marginalization among the EMGs, which had great impact on how they perceive and respond to government sanitation interventions. The enclosed latrines promoted by authorities are met with reluctance by the EMGs due to cultural perceptions of the body as permeable and therefore, vulnerable to 'dirty air' such as bad smells from human faeces. In addition, the prioritization of specific sanitation hardware solutions by the central government aimed at increasing coverage creates expectations and dependency among the EMGs that hygiene 'comes from the outside society', resulting in low levels of community initiated actions. Based on these findings, we suggest that future hygiene promotion strategies aim for a closer match between community priorities and government hygiene policies, e.g. by allowing for a larger diversity of low-cost sanitation solutions. Scaling up participatory community-based hygiene promotion is also recommended to curb dependency and spark initiatives in ethnic minority communities. Finally, interventions should focus on hygiene "software"--promoting hygiene behaviour changes known to effectively prevent hygiene related diseases. Copyright (c) 2010 Elsevier Ltd. All rights reserved.
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              Perceptions of school toilets as a cause for irregular toilet habits among schoolchildren aged 6 to 16 years.

              Irregular bladder and bowel habits can contribute to urinary and bowel problems. Schoolchildren undergoing treatment for these problems often do not follow the recommendation of regular toilet visits at school, claiming negative perceptions of school toilets. This study examined 6- to 16-year-old schoolchildren's perceptions of school toilets and whether the perceptions affect bladder and bowel habits at school Some 385 Swedish schoolchildren aged 6 to 16 years were surveyed using a semistructured questionnaire. Children aged 13 to 16 years had the most negative perceptions. Twenty-five percent (overall 16%) of older children reported never using the school toilet to urinate, and 80% (overall 63%) never used it to defecate. Perceptions of sight and smell and emotional constraints hindered children from using the school toilets. Children generally based their perceptions of school toilets on physical appearance, offensive smell, and feelings of insecurity. Children's perceptions affected their toilet habits and would rather endure physical discomfort than the psychological and social discomfort of using the school toilet. Children already suffering from urinary tract or intestinal problems face particular difficulties without regular toilet visits during the day.
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                Author and article information

                Journal
                BMC Public Health
                BMC Public Health
                BioMed Central
                1471-2458
                2012
                21 February 2012
                : 12
                : 140
                Affiliations
                [1 ]Department of Environmental Health, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
                [2 ]Department of Biostatistics and Medical Informatics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
                [3 ]Department of Veterinary Disease Biology, University of Copenhagen, Copenhagen, Denmark
                [4 ]Department of International health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
                Article
                1471-2458-12-140
                10.1186/1471-2458-12-140
                3305623
                22353490
                b7e212d9-6416-4b9f-a56d-604705e4659f
                Copyright ©2012 Xuan et al; BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 September 2011
                : 21 February 2012
                Categories
                Research Article

                Public health
                multi-ethnic,vietnam,schoolchildren,behavior change,sanitation use
                Public health
                multi-ethnic, vietnam, schoolchildren, behavior change, sanitation use

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