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Health and sanitation conditions of school washrooms as

associated with students’ self concept, anxiety and disruptive behaviour

(Rawnak Jahan Jui, Master’s in School psychology, Department of Psychology

University of Dhaka, Dhaka 1000 Phone: 01677916465 Email: rawnak.jui@gmail.com)

Introduction

Toilets and sanitation systems cater for one of the most basic human functions. Inadequate

facilities, poor access and poor knowledge of urinary or bowel health can have wide ranging

implications for physical, emotional and psychological health.

Poor sanitation is linked to transmission of diseases such as cholera, diarrhoea, dysen-

tery, hepatitis A, typhoid and polio and exacerbates stunting. Avoiding toilets can have a big

impact on health. A survey of schools and school nurses conducted by ERIC in 2010 found

79% of respondents recognised the link between poor toilets and poor health, and 84% felt

toilet-related health issues have a negative effect on children’s learning. Humphrey (2009)

hypothesized that infants and young children living in conditions of poor sanitation and

hygiene have chronic exposure to large quantities of fecal bacteria, which results in a subclin-

ical disorder of the small intestine known as tropical/environmental enteropathy. A study by

the World Health Organization in 2010 reported the improvement of water, sanitation and hy-

giene can prevent 9.1% of the WASH-related disease burden or 6.3% of deaths. A very large

share of the disease burden falls on children under the age of five.

Lack of access to sanitation has an impact not only on public health but also on human dig-

nity and personal safety. Providing sanitation to people requires attention to the entire system,

not just focusing on technical aspects such as the toilet , fecal sludge management or the

wastewater treatment plant.

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An assessment of School Sanitation and Hygiene Education (SSHE) strategy was

done by UNICEF (1998). The data collected from 4,388 primary schools, show the following

key statistics: average of 246 students and 4 teachers per school, 19% schools have no water

source, 28% have nonfunctional water source, 53% have functional water source, 6% have no

latrine, 13% have a nonfunctional latrine, 25% have one latrine, 44% have two latrines, 12%

have three or more latrines, 46% have separate latrines for girls, on average there is one lat-

rine for 152 pupils (Nahar and Ahmed, 2006).

Poor sanitation reduces human well-being, social and economic development due to

impacts such anxiety, risk of sexual assault, and lost educational opportunities. 385 Swedish

schoolchildren aged 6 to 16 years were surveyed using a semistructured questionnaire. Chil-

dren 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 (Anna-Lena Hellström Barbro Lundblad).

Anxiety UK a charity foundation after an analysis of the case studies received the main

conditions which appear to relate to difficulties in using the toilet.These were: Social

phobia – commonly involving worries that people are aware of you using the toilet, people

noticing you using the toilet or that people may hear you using the toilet,OCD (Obsessive

Compulsive Disorder) – involves factors such as worrying that the toilet is contaminated or

being unable to use facilities that are deemed “unclean”. Agoraphobia – worrying about leav-

ing the house unless there is a “safe” toilet that can be used combined with fears around soil-

ing or urinating ones self if leaving a deemed “safe” locality. Parcopresis – fear of defecating

in public places, Paruresis – fear of urinating in public places, Panic attacks/Panic disorder –

fear of being unable to use a toilet in a public place. Specific phobia – specific fear of a toi-

let or toilet related situation.

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Another study in France, 62% of students reported that they did not feel safe and 54% repor-

ted a lack of privacy. This lack of privacy affects girls more, which can entail reduced parti-

cipation in school or even reduced consumption of water whilst girls are in school to avoid

using the toilet. With regard to water, distress can manifest from stressful experiences that

arise from individuals' everyday roles and experiences.

The goal of the study is to characterise how sanitation condition in the school

environment have the potential to make an impact on students mental health related issues

like ( Self concept, Anxiety, Disruptive behaviour).

Therefore regarding the prediction of health and sanitation conditions of school washrooms

as associated with student’s mental health, the following research questions are formed:

1. Is there any correlation between poor sanitation and self concept?

2. Is there any correlation between poor sanitation and anxiety?

3. Is there any correlation between poor sanitation and disruptive behaviour?

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Methods

Inclusion criteria

The present study would include on an average 240 secondary school going children

of class six, seven and eight from Dhaka district evenly distributed by gender, grade,

government and private school. All data will be collected in school settings. They will

be selected applying purposive sampling technique.

Study instrument

A questionnaire package comprising the following three questionnaires will be used in

the present study. Each measure is described more fully below.

The Personal Information Form (PIF)

The PIF would include demographic, personal, and social information about

respondent’s gender, age, grade in school, parental occupation etc.

Beck Youth Inventory

The BYI is a 100-item self-report measure comprising five self-report inventories that

can be used separately or in combination to assess symptoms of depression, anxiety,

anger, disruptive behaviour, and self-concept. We will need the three BYI are:

1) The Beck Self-Concept Inventory for Youth (BSCI-Y)

2) The Beck Anxiety Inventory for Youth (BAI-Y)


3) The Beck Disruptive Behaviour Inventory for Youth (BDBI-Y)


Each inventory contains 20 questions about thoughts, feelings and behaviours associ-

ated with emotional and social impairment. Children and young people describe how

frequently a statement has been true for them over the past two weeks.
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We will prepare a questionnaire through interview process which would include the

perception of students, parents, teachers and staffs regarding sanitation condition of

the schools.

Procedure

A written permission to collect data will be sought from principals of all the schools

included in the sample. Having received permission, all measures will be admin-

istered on students. Respondents will be asked to complete the questionnaires at their

own paces. It might take one hour on average to complete the task. Members of the

research staff will assist if any student faces difficulty in reading, understanding, and

filling the questionnaire(s).

Data Analysis

Mean, standard deviation, t-tests, correlations, and regression analyses will be per-

formed.
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References

1.Bradley Corporation, Students Say Unclean Restrooms Impact Their Perception of School,

August 2019.

2.Ebikabowei Lucky Kotingo, Evaluation of the Toilet Facilities in Primary Schools in the

Niger Delta: WASH Education Series 2, Federal Medical Centre, Yenagoa, Bayelsa State, Ni-

geria, September 2014.

3.Elijah Bisung and Susan J. Elliot, Psychosocial impacts of the lack of access to water and

sanitation in low and middle-income countries: a scoping review Journal of water and health

15.1, 2017.

4. Krithi Ravi, Mental health impact of lack of access to sanitation during menstruation, Wat-

erAid Nepal, July 2016.

5.Human Rights Council resolution 15/9, Human rights and access to safe drinking water and

sanitation, October 2010.

6.Project Toilet phobia, Anxiety UK, 2018.

7. Sabrina Shahidullah, Yes, hygiene and school enrolment are directly proportional, sanita-

tion: schools in Bangladesh, Brac, January 2015.

8.Sjaak van der Geest, MA PhD, Professor Emeritus of Medical Anthropology,Hygiene and

sanitation: medical, social and psychological concerns.

9.Tilley, E., Ulrich, L., Lüthi, C., Reymond, Ph. and Zurbrügg, C. (2014). Compendium of

Sanitation Systems and Technologies. 2nd Revised Edition. Swiss Federal Institute of Aquat-

ic Science and Technology (Eawag), Duebendorf, Switzerland.

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