FACULTY OF MEDICINE

UNIVERSITY OF MALAYA

ELECTIVE REPORT
MBBS PHASE III B
2006/2011
SESSION 2009/2010

KNOWLEDGE, AWARENESS AND

PRACTICE OF PERSONAL HYGIENE
AMONG POPULATION IN RURAL
AREA (PONTIAN KECHIL)

NOR ASHIKA BINTI AHMAD

MEM 060115
870408-01-5548
SUPERVISOR
PROF JAMAIAH BT IBRAHIM
DEPARTMENT OF PARASITOLOGY
FACULTY OF MEDICINE, UNIVERSITY OF MALAYA
Abstract
Study of the knowledge, awareness and practice of personal hygiene
among population in rural area (Pontian Kechil).

Aim of study: To perform knowledge, awareness, and practice study on personal

hygiene among the adult in rural area (pontian kecil) in year 2009.

Methodology : The study area is in Pontian Kechil, Johor Darul Tak`zim. The total area
are about 907 km² and the population estimated about 54922. Pontian is a district in
southwest Johor. It is located 62km from Johor Bahru, the state capital of Johor. The
population included in the study is all-resident in Pontian Kecil within range age of 15 to 65
years old. The inclusion criteria are female aged between 15-65 years old, male aged
between 15-65 years old, agree to participate in the study, and Malaysia citizen. The
exclusion criteria are female aged below 14 and above 65, male aged below 14 and above
65, foreigner, not agree to participate in the study. The study design applied onto this study is
cross-sectional, also known as prevalence study. In this type of study, a population is
surveyed at a single point of time using a self-administered questionnaire. The questionnaire
consists of two variables which are dependent and independent variables. In the
independent variables, it composed of demographic aspect. For the socio-demographic part,
the respondents’ details such as age, gender, ethnic group, education stream,
socioeconomic status and environment were assessed. The dependent variables are to
assess three main criteria of the respondent. First is their level of knowledge on personal
hygiene. Secondly is whether or not they practice personal hygiene in their daily life and
thirdly whether or not they knew about H1N1, a disease that correlate with poor personal
hygiene. The data were analyzed by using Statistical Package for the Social Sciences
(SPSS) version 16.0 software. Appropriates statistical analyses were conducted and
presented by proportions. For the stratified analysis Chii Square Test was used. The result
will be presented in frequency table, bar chart and proportionate pie chart. To estimate
significant level, value of α was pre-set at 0.05.

Results: From the finding, the difference of mean knowledge score was not significantly
related to the ethnic, educational stream, environment, and salary with the p value being
greater than 0.05. On the other hand, the p-value is less than 0.05 (0.003) for the age group
indicate that the total knowledge score was significantly related to the age group. The total
score mean for age group from 15 to 25 are 3.04, from 26 to 35 are 2.61, from 36 to 45 are
2.42, from 46 to 55 are 3.08 which the highest, from 56 to 65 are 1.00 which is the lowest.
The total knowledge score was also significantly related to gender where the p value is less
than 0.05 (0.038). The total score mean for male and female were 2.66 and 3.04
respectively. In addition, the total knowledge score was also significantly related to
occupation (whether respondents have occupation or not) where the p value is less than 0.05
(0.022). The total score mean for have and not have occupation were 2.66 and 3.08
respectively. 38% of respondent get their information on personal hygiene from mass media.
In addition 22%, 17%, 12% of respondents receive information on personal hygiene from
health care workers, teachers and friends respectively. While 11% of respondents which is
the lower percentage get the information of personal hygiene from their parents. 100% of
respondent agree that personal hygiene is very important in their daily life and their practice
of personal hygiene in daily life. 88.2% of respondent washed their hair everyday, while
11.3% of respondent washed their hair more than once in a week and 0.5% of respondent
admit that they never washed their hair. 70.4% of respondent cut their hair when hair is long
enough, while 1.6% of respondent cut their hair until had been ask by family
member/friends.15.1% of respondent cut their hair until the hair make their appearance
worse. And 12.9% of respondent cut their hair in undetermined of time. 67.2% of respondent
brush their teeth more than 2 times a day. While 31.7% of respondent brush their teeth once
a day and finally 1.1% of respondents brush their teeth once a week. 46.8% of respondent
see dentist for medical check up when they had toothache or undetermined, 34.4% of
respondents see dentist once every 6 months, 15.6% of respondents see dentist once a
year while 3.2% of respondents never met dentist. 76.3% of respondent take a bath 2 times
or more per day, 17.7% of respondents take a bath anytime when they feel uncomfortable
while 5.9% of respondents take a bath once a day. 76.3% of respondent take a bath 2 times
or more per day, 17.7% of respondents take a bath anytime when they feel uncomfortable
while 5.9% of respondents take a bath once a day. 74.7% of respondent clean up their face
2 times or more per day which is recommended, 17.2% of respondents clean up their face
anytime when they feel uncomfortable. In addition, 5.9% of respondents clean up their face
once a day, 1.6% of respondents clean up their face once a week and lastly, 0.5% of
respondents admit that they never clean up their face. 65.6% of respondent cut their nails
once a week, 33.3% of respondents cut their nail when they feel uncomfortable and 1.1 of
respondents cut their nail once a month which is very bad habits. 86% of respondents wash
the dirty area by water and soap after urinate or pass motion, 11.8% of respondents wash
dirty area by water only, and 2.2% of respondents clean the dirty area by clean tissue. 49.5%
of respondents use communal septic tank to discharge the sludge, 40.3% of respondents
are use individual septic tank, 8.6% of respondents use man-made hole. In addition 0.5% of
respondents use open river and 1.1% of respondents use other methods to discharge the
sludge. For the type of disposal of kitchen waste where 59.7% of respondents use municipal
waste, 20.4% of respondents buried their disposal kitchen waste. Apart from that, 12.9% of
respondents use open hole, 4.3% of respondents use other methods and 2.7% of
respondents disposed their kitchen waste into the drain or river. For the type of drinking and
cooking water. 98.9% of respondents used pipe water and 0.5% of respondents used well
water and other 0.5% of respondents use rain water. For the type of treated water. 63.4% of
respondents filtered their water to treat them. While 29 % of respondents use chlorination
process to treat the source of water, 4.3% of respondents choose to not treated them, 2.2%
of respondents use reverse osmosis process and 1.1% of respondents use others method.
97.3% of respondents which is the majority admit that they will boil the pure water before
they drink it while 2.7% admit that they never boil the water. The majority of respondents
which is 98.9% know that the mosquitoes can transmit infectious diseases and this is true
while minority of respondents which is 1.1% that does not know that mosquitoes can transmit
diseases. 75.3% of respondents do not use mosquitoe net during sleep, and the minority of
respondents which is 24.7% admits that they use mosquitoes nets. 100% of respondents
which means that all the respondents knew the existence of H1N1.
CHAPTER 1- INTRODUCTION
1.1 PROBLEM STATEMENT

Hygiene refers to the set of practices associated with the preservation of health and
healthy living. It is a concept related to medicine, as well as to personal and professional
care practices related to most aspects of living, although it is most often associated with
cleanliness and preventative measures. The term "hygiene" is derived from Hygeia, the
Greek goddess of health, cleanliness and sanitation. Hygiene is also the name of the science
that deals with the promotion and preservation of health, also called hygienic. In medicine,
hygiene practices are employed to reduce the incidence and spreading of disease. Apart
from that, personal hygiene can be described as the principle of maintaining cleanliness and
grooming of the external body. It is in general looking after people themselves. Personal
hygiene can be controlled by sustaining high standards of personal care and humans have
been aware of the importance of hygiene for thousands of years. In fact, hygiene is actually a
scientific study.
Personal hygiene deal with proper caring from the top to below of the body. Start
from hair, face, eyes, teeth, ear, hand, nail, feet, external genitalia as well as anal area.
Usually for normal people who care about their hygiene, they will take a bath, brush the
teeth, wash their hair everyday, cut the nail every week, wash their genital area properly after
excretion, hand wash in proper way and for the women, and keep changing their pad during
menstrual period.
Recently, there was an outbreak of H1NI in the whole world and Malaysia is
one of the country that was severely affected that involved mostly co-morbidity group such as
younger age group, older age group, obese people, diabetic people and other else. As of 11
August 2009, the country has over 2,253 cases, beginning with "imported" cases from
affected countries, including the United States and Australia from May 15, 2009 onwards,
and the first local transmission on June 17, 2009. From August 12, the Malaysian Health
Ministry said that it had discontinued officially updating the total number of H1N1 cases
within Malaysia in line with guidelines issued by the World Health Organization. As of August
21, 2009 the unofficial number of cases reported in the media is 5,876 so far. The first death
related to the A (H1N1) virus was reported on 23 July 2009 and so far there have been 77
deaths reported. On July 6, 2009 Malaysia announced that it was shifting from containment
to mitigation to tackle the spread of the virus. Other than that, Malaysian government also
had spent billion of dollar to overcome this health problem.
One of the primary prevention of this situation is a good care of personal hygiene.
This is very important since this virus can easily be transmitted through contaminated hand.
Therefore, each individual must have awareness in personal hygiene to reduce the
incidence of H1N1.
1.2 RATIONALE OF STUDY

The main objective of this study is to assess the awareness of personal

hygiene and knowledge about H1NI among the adult population in the rural area (Pontian
Kecil). Adult Population in the rural area was specifically choosen as they are considered
having lack of knowledge and facilities compare to the population in urban area. This is
because they mostly depend on just television, radio, as well as newspaper to get the recent
information about something compares to urban population that more educated and can
have more extra facilities like internet and this makes them more aware compare to rural
area. So, it would be appropriate to choose them as the study targets. Recently there is an
outbreak of H1N1 that severely affect of all over Malaysia, therefore this is a good time to
assess the knowledge about personal hygiene and H1N1 to know the level of awareness as
well as to know how they take this thing seriously. To this date, there are not much studies
addressing and stressing about the awareness of personal hygiene especially in the rural
area. This will surely be a loss whenever the government or non-government body in the
future would want to make referral to justifying their new health programs related to personal
hygiene.
It is hope that this study can introduce and make the public, especially the
population in the rural area to understand more about personal hygiene since bad personal
hygiene can lead to many infectious disease. This could be achieved by determining and
enhancing their knowledge and attitude towards personal hygiene, and practice of personal
hygiene in daily living. The results of this study could be used as reference to other upcoming
studies on awareness of personal hygiene. During the performing of this study the person
would be indirectly aware of personal hygiene and the important of practices it in daily living.
In addition, the findings could provide important information for the development of a
comprehensive education campaign to prepare and educate the public to increase their level
of awareness of personal hygiene.
This study was performed in conjunction to project conducted for phase 3B MBBS
elective program. The exercise is to expose and familiarize undergraduate students to
conduct a scientific research.

1.3 LITERATURE REVIEW

1.3.1 History
Elaborate codes of hygiene can be found in several Hindu texts, such as the
Manusmriti and the Vishnu Purana. Bathing is one of the five Nitya karmas (daily duties) in
Sikhism, not performing which leads to sin, according to some scriptures. These codes were
based on the notion of ritual purity and were not informed by an understanding of the causes
of diseases and their means of transmission. However, some of the ritual-purity codes did
improve hygiene, from an epidemiological point of view, more or less by accident.
Regular bathing was a hallmark of Roman civilization . Elaborate baths were
constructed in urban areas to serve the public, who typically demanded the infrastructure to
maintain personal cleanliness. The complexes usually consisted of large, swimming pool-like
baths, smaller cold and hot pools, saunas, and spa-like facilities where individuals could be
depilated, oiled, and massaged. Water was constantly changed by an aqueduct-fed flow.
Bathing outside of urban centers involved smaller, less elaborate bathing facilities, or simply
the use of clean bodies of water. Roman cities also had large sewers, such as Rome's
Cloaca Maxima, into which public and private latrines drained. Romans didn't have demand-
flush toilets but did have some toilets with a continuous flow of water under them. Until the
late 19th Century, only the elite in Western cities typically possessed indoor facilities for
relieving bodily functions. The poorer majority used communal facilities built above cesspools
in backyards and courtyards. This changed after Dr. John Snow discovered that cholera was
transmitted by the fecal contamination of water. Though it took decades for his findings to
gain wide acceptance, governments and sanitary reformers were eventually convinced of the
health benefits of using sewers to keep human waste from contaminating water. This
encouraged the widespread adoption of both the flush toilet and the moral imperative that
bathrooms should be indoors and as private as possible.
Since the 7th century, Islam has always placed a strong emphasis on hygiene.
Other than the need to be ritually clean in time for the daily prayer through Wuduk and Ghusl,
there are a large number of other hygiene-related rules governing the lives of Muslims. Other
issues include the Islamic dietary laws. In general, the Qur'an advises Muslims to uphold
high standards of physical hygiene and to be ritually clean whenever possible.
Contrary to popular belief and although the Early Christian leaders condemned
bathing as unspiritual, bathing and sanitation were not lost in Europe with the collapse of the
Roman Empire. Soapmaking first became an established trade during the so-called "Dark
Ages". The Romans used scented oils (mostly from Egypt), among other alternatives.
Bathing did not fall out of fashion in Europe until shortly after the Renaissance,
replaced by the heavy use of sweat-bathing and perfume, as it was thought in Europe that
water could carry disease into the body through the skin. (Water, in fact, does carry disease,
but more often if it is drunk than if one bathes in it; and water only carries disease if it is
contaminated by pathogens.)

1.3.2 IMPORTANT
Maintaining personal hygiene is necessary for many reasons; these can be
personal, social, for health reasons, psychological or simply as a way of life. Essentially
keeping a good standard of hygiene helps to prevent the development and spread of
infections, illnesses and bad odours.

Personal Reasons
Many people, women in particular, are very conscious of their hygiene needs and practices.
This can be a result of being taught of the importance from an early age, from being picked-
on at school for head lice or similar, or as a way of making themselves more attractive to the
opposite sex. Self-esteem, confidence and motivation can all be altered by our body image,
often reflected on our ability to care for ourselves and keep good hygiene practices. A bright
white smile with clean and healthy teeth can endear people to us, whereas brown, unhealthy
teeth can cause embarrassment and can alter our sense of well-being. Healthy hair, skin and
nails are signs of a good well-balanced diet and can give us confidence in everyday life.

Social Reasons
Most people hate to be talked about, especially in a negative manner. By ensuring that our
body is clean and well presented, we are more assured of projecting a positive body image
that reflects our personalities. Children should be taught the importance of hygiene and how
to achieve good hygiene very early to keep themselves and others healthy and to reduce the
risk of being bullied at school.

Health Reasons
If a person is due to go into hospital, sometimes that person becomes very aware of their
hygiene. The thought of being vulnerable and exposed to strangers can cause the person to
become very strict on their hygiene needs. If you have cut yourself, the wound should be
cleaned and dressed suitably, this can help reduced the risk of infection and pain. Conditions
such as head lice, athlete’s foot should be treated immediately to prevent further infections
and spread to others. Hand washing cannot be emphasized enough as this simple action can
prevent a plethora of illnesses and disorders developing. Many people ‘forget’ to wash their
hands after using the toilet or before handling foods; this deed can cause a great deal of
illness and even death.

Psychological Issues
By being well presented, clean and tidy, people can feel more confident, especially in social
situations. Many job interviews and such like are highly dependent of hygiene as many
decisions are made by first impressions within the first few minutes of meeting; these
decisions are often made in the sub-conscious. Our chances of succeeding either in work or
social settings, or even with the opposite sex can be altered by our maintenance of hygiene.
Maintaining hygiene practices helps to reduce the risks of ill health, but equally important
affects how we and others perceive ourselves and can influence our levels of confidence and
self-esteem which can affect many aspects of our lives.

1.3.3 WAY TO BE CLEAN

Personal hygiene is the first step to good grooming and good health. Elementary
cleanliness is common knowledge. Neglect causes problems that may not even be aware of.
Many people with bad breath are blissfully unaware of it. Some problems may not be our
fault at all, but improving standards of hygiene will control these conditions..

Hair

It is a crowning glory. Wash hair at least once a week using soap or mild
shampoo. Avoid shampoos with borax or alkalis. Rinse well. This is more important than
working up a head load of lather. Dry hair after a wash. Brush your hair three to four times a
day with a soft bristled brush or a wide toothed comb. Wash your brush and comb every time
you wash your hair. Oil the scalp, once a week, preferably an hour before hair wash. There
are no completely safe or permanent hair dyes as of now. Apart from causing scalp allergies,
dyes can also cause allergic colds and throat conditions. Perform a sensitivity test every time
you use hair colour.
Skin

Soap and water are essential for keeping the skin clean. A good bath once or twice a day is
recommended, especially in tropical countries like India. Those who are involved in active
sports or work out to a sweat would do well to take a bath after the activity. A mild soap will
do the job adequately. Germicidal or antiseptic soaps are not essential for the daily bath. We
can use a bath sponge for scrubbing. Back brushes and heel scrubbers are available. But do
not use abrasive material. The genitals and the anus need to be cleaned well because of the
natural secretions of these areas, in unhygienic conditions, can cause irritation and infection.
Wash off well after soaping. Drying with a clean towel is important. Avoid sharing soaps and
towels. Change into clean underwear after bath. Around middle age the skin tends to go dry
a bit. A moisturising oil or cream can be used. It is better to use this at night, because if go
out in the sun or commute on dusty roads when the skin is wet, dust sticks to it and oils may
also give a tan.

Teeth

Brush teeth twice a day and rinse well after every meal. Brushing before going to bed is
important. (Especially recommended for people with a sweet tooth). For normal teeth this is
adequate. While brushing, pay attention to the fact that we are getting rid of the food particles
stuck in between the teeth and in the crevices of the flatter teeth at the back, the molars and
pre molars. Brush down on the upper teeth and brush up on the lower teeth. Use a circular
motion.

Hands

The world around us swarms with micro-organisms. Some bacteria are found on our
bodies. In countries where food is eaten and prepared with bare hands extra attention has to
be paid to the cleanliness of hands. Besides, a permanent layer of dust or grime reduces the
sensitivity of the hands. Wash hands thoroughly with soap and water before and after every
meal and after visiting the toilet. Soaping and rinsing should cover the areas between fingers,
nails and back of the hand. Hands should be dried with a clean towel after wash. The towel
at the wash stand has to be washed and changed everyday.

Nails

Grow nails only if can keep them clean. Short nails make less trouble. Clip nails short, along
their shape. Don't cut them so close that it pinches the skin. A healthy body ensures healthy
nails. Brittle or discoloured nails show up deficiencies or disease conditions. Do not keep
nails painted continuously. It causes the keratin, of which nails are made, to split. Pamper the
hands and nails once every three weeks with a manicure. This requires soaking hands in
warm water for ten minutes, massaging of hands, thorough cleaning and shaping of nails.

Feet

Give your feet a good scrub with a sponge, pumice stone or foot scrubber that is
not made of very abrasive material when having a bath. Dry after bath between toes. Keep
toenails clipped. In many Indian households it is mandatory to wash feet as you enter the
house. This is fine, but make sure that your skin does not become dry due to washing too
often. Those who use shoes constantly need to slip them off now and then. This airs the
socks a bit and makes them less smelly. Wear cotton socks. Wear a clean pair everyday.
Powder your feet before wearing socks. Many people have sweaty feet, and socks and
shoes can get quite smelly. If possible do not wear the same pair of shoes every day. Keep
atleast one more pair and use it alternatively. Go for a pedicure once in three weeks. Give
importance to wearing comfort in the choice of footwear. For those who go barefoot indoors,
door mats must be cleaned or changed frequently. Extra foot care is required for diabetics.

Menstrual Hygiene

Technology offers sanitary pads, tampons or menstrual cups or caps to deal with
the flow. The user has to decide what suits her best. Absorbent pads may be noticeable in
form fitting clothes. They cause some soreness on the inner thighs. Some women prefer
tampon to external pads. A plug of absorbent cotton or gauze is inserted inside. But these
should not be left unchanged beyond six hours. Some brands state that tampons left
unchanged for more than 12-18 hours increases the possibility of toxic shock. It is not clear
what causes toxic shock. But there seems to be a link between tampons and Toxic Shock
Syndrome (TSS). Approximately 1% of all menstruating women carry the bacteria in question
(Staphylococcus aureus) in their vagina. Absorbent tampons provide the medium for them to
grow and spread infection. TSS cases were first reported in 1978. It is marked by high fever,
severe vomiting and diarrhoea. The cases can be mild to fatal..

Head Lice

Lice are tiny insects that live on the human scalp and suck blood to nourish
themselves. Lice make a pinprick like puncture on the scalp, emit an anti clotting substance
and feed on the blood Lice thrive on unclean hair. Children are especially prone to lice
infestation. Lice spread from one head to another when there is close contact as in school
environments. Lice eggs are wrapped in a shiny white sheath and these show up on the
upper layers of hair as the infestation increases. They make the scalp itchy and are a cause
of annoyance and embarrassment. In infants they may cause disturbed sleep and bouts of
crying. Unchecked, they can produce scalp infection. Anti lice lotions are available in the
market, but in persistent cases a doctor's advice can be sought. Nit picking is painstaking
and requires patience. A fine toothed comb and regular monitoring can get rid of the
problem. Usually when a child in given an anti lice shampoo, all members of the family are
advised to use it too.

Dandruff

Dead skin on the scalp comes off in tiny flakes. This is associated with some
disturbance in the tiny glands of the skin called the sebaceous glands. They excrete oil, or
sebum. When there is too little oil the skin becomes flaky and dry. When there is too much oil
also dandruff is possible. It may have a slight yellow colour. Hair wash twice or thrice a week
might be necessary. Combs and brushes must be washed as well. Hair should be brushed
regularly. Awholesome diet and overall cleanliness will help. Massage the scalp everyday to
improve circulation. A shampoo with selenium sulfide or salicylic acid helps.

Body odour

The body has nearly two million sweat glands. These glands produce three quarts to
one pint of sweat in a day. In tropical countries, naturally, more sweat is produced. The
perspiration level increases with an increase in physical exertion or nervous tension. Fresh
perspiration, when allowed to evaporate does not cause body odour. An offensive smell is
caused when bacteria that are present on the skin get to work on the sweat and decompose
it. This is specially so in the groin, underarms, feet or in clothing that has absorbed sweat.
Diet influences the odour too. Two baths a day, with liberal lathering and change of clothes in
close contact with the body should take care of the problem. Talcum powders, of the non
medicated kind, can be used under the armpits. Deodorants or antiperspirants can be used.
Most commercial skin deodorants contain an antiperspirant, such as aluminum chloride,
which reduces sweating by forming a hydroxide gel in the sweat ducts. But sweat
suppressed in one area, comes out in another.

Urinary infection

Women are especially prone to this infection. This happens when bacteria travel up the
urethra and start breeding thereThis infection causes pain or a burning sensation during
urination. Sometimes the urine is discoloured. Itching, frequent urination, fever and chills can
also result from urinary infection. Though not a serious problem it can be rather an irritating
and an awkward one. It is easy to catch this infection when toilets are not clean or when too
many people share toilet facilities. To avoid this infection improve overall standards of
hygiene: both, regarding toilets and personal parts. Wash or wipe front to back after urinating
or defecating. Remember this when wiping or washing babies too, as a general rule. Do not
wear tight fitting synthetic underwear. Drink plenty of water. Do not hold back when you have
the tendency to urinate.

Pinworms

Pinworms are about a quarter of an inch long. And they can cause plenty of discomfort. The
worms come out of the anal opening to lay eggs at night. This leads to intense itching in the
area. Disturbed sleep, mild pain and diarrhoea are possible consequences. Children are
especially prone to this complaint. The urge is to scratch this area. When scratching, eggs
stick to the hand, and under the nails and infect anything the person touches. The eggs can
pass through air, or by contact with infected food or bed linen to others who share the
premises. The eggs are not affected by disinfectants and remain active in the dust for a long
period. A doctor has to be consulted to rid the worm infestation. Bed clothes, undergarments
and nightwear of the infected person must be washed thoroughly, if possible in hot water.
Sometimes all member of the family are advised to take deworming medication when one
member is affected. Scrubbing hands well with soap before eating should check the problem.
1.3.4 POOR HYGIENE-RELATED DISEASE

Acanthamoeba keratitis (AK)

Acanthamoeba is a commonly occurring, free-living microscopic ameba that occurs

naturally in the environment. It can live in treated and untreated water, soil, air (for example,
cooling towers), sewage systems, and drinking water systems (for example, shower heads
and taps). Although persons are regularly exposed to Acanthamoeba, contact with the
ameba rarely results in illness. However, under some circumstances, Acanthamoeba is
capable of causing infection. Acanthamoeba keratitis (AK) is a rare infection of the eye that
occurs when amebae invade the outer covering of the eye, called the cornea. AK can pose
serious complications, such as severe pain, permanent visual impairment, and blindness.
Although anyone can acquire AK, it is most commonly found in contact lens wearers. Early
symptoms of AK infection may include eye pain, redness, blurred vision, light sensitivity,
sensation that something is in the eye, or excessive tearing. Persons who suspect they may
have AK should consult a physician.AK may be prevented through appropriate contact lens
hygiene.

Athlete’s Foot (tinea pedis)

Athlete’s foot, or tinea pedis, is an infection of the skin and feet that can be caused by a
variety of different fungi. Although tinea pedis can affect any portion of the foot, the infection
most often affects the space between the toes. Athlete’s foot is typically characterized by
skin fissures or scales that can be red and itchy. Tinea pedis is spread through contact with
infected skin scales or contact with fungi in damp areas (for example, showers, locker rooms,
swimming pools). Tinea pedis can be a chronic infection that recurs frequently. Treatment
may include topical creams (applied to the surface of the skin) or oral
medications.Appropriate hygiene techniques may help to prevent or control tinea pedis. The
following hygiene techniques should be followed:

Prevention of athlete’s foot:

 Nails should be clipped short and kept clean. Nails can house and spread the
infection.
 Avoid walking barefoot in locker rooms or public showers (wear sandals).

Body Lice

Body lice, or Pediculus humanus corporis, are parasitic insects that can live and lay
eggs on clothing and only move to the skin to feed on human blood. Lice are spread most
commonly by close person-to-person contact. Body lice infestation is found worldwide.Good
hygiene can help prevent and control the spread of body lice:

 Bathe regularly and change into properly laundered clothes at least once a week;
launder infested clothing at least once a week.
 Machine wash and dry infested clothing and bedding using the hot water (at least
130°F) laundry cycle and the high heat drying cycle. Clothing and items that are not
washable can be dry-cleaned OR sealed in a plastic bag and stored for 2 weeks.
 Do not share clothing, beds, bedding, and towels used by an infested person.
 Fumigation or dusting with chemical insecticides sometimes is necessary to control
and prevent the spread by body lice of certain diseases (epidemic typhus).

Dental Caries (Tooth Decay)

Dental caries or cavities, more commonly known as tooth decay, are caused by a
breakdown of the tooth enamel. This breakdown is the result of bacteria on teeth that
breakdown foods and produce acid that destroys tooth enamel and results in tooth decay.
Although dental caries are largely preventable, they remain the most common chronic
disease of children aged 6 to 11 years and adolescents aged 12 to 19 years. Tooth decay is
four times more common than asthma among adolescents aged 14 to 17 years. Dental
caries also affects adults, with 9 out of 10 over the age of 20 having some degree of tooth-
root decay. Water fluoridation, named by CDC as one of the ten great public health
achievements of the 20th century, has been a major contributor to the decline of the rate of
tooth decay. Studies have shown that water fluoridation can reduce the amount of decay in
children’s teeth by 18-40%.In addition to fluoridated water, good oral hygiene can help
prevent tooth decay:

Chronic diarrhea

Diarrhea that lasts for more than 2 weeks is considered persistent or chronic. In
an otherwise healthy person, chronic diarrhea can be a nuisance. However, for someone
who has a weak immune system, chronic diarrhea may represent a life-threatening illness.
Chronic diarrhea has many different causes; these causes can be different for children and
adults. Chronic diarrhea sometimes is classified on whether or not it is caused by an
infection. The cause of chronic diarrhea somtimes remains unknown.

Diarrhea caused by an infection may result from:

 Parasites (e.g., Cryptosporidium, Cyclospora, Entamoeba, Giardia, Cystoisospora,

microsporidia)
 Bacteria toxins (e.g., Campylobacter, Clostridium difficile, E. coli, Salmonella,
Shigella, cholera)
 Viruses (e.g., norovirus, rotavirus)

The risk of serious complications from chronic diarrhea depends on the cause of the diarrhea
and the age and general health of the patient. Chronic diarrhea from some causes can result
in serious nutritional disorders and malnutrition. Severely immunocompromised persons,
including those with HIV/AIDS and those receiving chemotherapy for cancer or organ
transplantation can be at risk for serious chronic diarrhea. Determining the correct cause of
chronic diarrhea is necessary in order to select proper treatment and reduce the risk of
serious complications. The treatment of chronic diarrhea is determined by its cause.

Head Lice

Head lice, or Pediculus humanus capitis, are parasitic insects that can be found on the
head and neck and survive by feeding on human blood. Lice are spread most commonly by
close person-to-person contact. Getting head lice is not related to cleanliness of the person
or his environment; however, good hygiene is still important to help prevent and control the
spread of head lice:

 Avoid head-to-head (hair-to-hair) contact during play and other activities at home,
school, and elsewhere (sports activities, playground, slumber parties, camp).
 Never share clothing such as hats, scarves, coats, sports uniforms, hair ribbons, or
barrettes.
 Never share combs, brushes, or towels. Disinfest combs and brushes used by an
infested person by soaking them in hot water (at least 130°F) for 5-10 minutes.
 Never lie on beds, couches, pillows, carpets, or stuffed animals that have recently
been in contact with an infested person.
 Machine wash and dry clothing, bed linens, and other items that an infested person
wore or used during the 2 days before treatment using the hot water (130°F) laundry
cycle and the high heat drying cycle. Clothing and items that are not washable can be
dry-cleaned OR sealed in a plastic bag and stored for 2 weeks.
 Vacuum the floor and furniture, particularly where the infested person sat or lay.
However, spending much time and money on housecleaning activities is not
necessary to avoid reinfestation by lice or nits that may have fallen off the head or
crawled onto furniture or clothing.
 Do not use fumigant sprays or fogs; they are not necessary to control head lice and
can be toxic if inhaled or absorbed through the skin.

Lymphatic Filariasis

Lymphatic filariasis (LF) is a mosquito-borne parasitic disease caused by

microscopic, thread-like worms. Globally, 120 million people in 80 countries are affected by
LF, and the disease is the second leading cause of permanent and long-term disability
worldwide. Adult worms cause permanent damage to the human lymphatic system that
results in swelling of the limbs and breasts (lymphedema) and scrotum (hydrocele), or
swollen limbs with severely thickened, hard, rough and fissured skin (elephantiasis). Affected
people frequently are unable to work because of their disability, and this harms their families
and their communities. Lymphatic filariasis can be eliminated. To achieve that goal, the
Global Alliance to Eliminate Lymphatic Filariasis was established and set a target elimination
date of 2020. Elimination will be achieved primarily through regular mass drug administration
in affected communities. In most countries, a single dose of two drugs (albendazole and
diethyl-carbamazine or albendazole and ivermectin) is administered annually to the entire
population in an at-risk area. In order to interrupt the spread of LF and eliminate the disease,
coverage must reach a minimum of 80% of the population for an estimated duration of 6-7
years. Symptoms of lymphatic filariasis such as lymphedema (swelling) and accompanying
secondary infections, occurring when germs enter the body through entry lesions (such as
cracks in the skin and between the toes), can be managed by practicing basic principles of
care such as simple hygiene, exercise, and treatment of wounds. Patients can be taught
simple hygiene techniques for washing the affected body parts daily with soap and room
temperature water, and keeping the nails and spaces between toes clean. When practiced
regularly in conjunction with daily exercise of the affected limb and treatment of wounds,
these hygiene measures have been shown to reduce the frequency of acute attacks.

Pinworms

Pinworms, or Enterobius vermicularis, are small, thin, white roundworms (about the
length of a staple) that sometimes live in the colon and rectum of humans. While an infected
person sleeps, female pinworms leave the intestine through the anus and deposit their eggs
on the surrounding skin. Pinworm infection is the most common worm infection in the United
States.Good hygiene is important to prevent and control pinworms:

 Because itching and scratching of the anal area is common in pinworm infection,
strict observance of good hand hygiene is the most effective means of preventing
pinworm infection. This includes:
o Appropriate handwashing (particularly before eating or handling food, after
using the toilet, and after changing a diaper)
o Keeping fingernails clean and short
o Avoiding fingernail-biting
o Avoiding scratching the skin in the perianal area
 Daily morning bathing removes a large proportion of eggs; showering may be
preferred to avoid possible contamination of bath water. Careful handling and
frequent changing of underclothing, night clothes, towels, and bedding can help
reduce infection, reinfection, and environmental contamination with pinworm eggs.
These items should be laundered in hot water, especially after each treatment of the
infected person.
 Control can be difficult in child care centers and schools because the rate of
reinfection is high. In institutions, effective prevention and control methods include:
o Appropriate hand hygiene (the most effective method of prevention)
o Mass and simultaneous treatment, repeated in 2 weeks
o Trimming and scrubbing the fingernails and bathing after treatment to help
prevent reinfection and spread of pinworms.

Pubic Lice ("Crabs")

Pubic lice, or Pthirus pubis, are parasitic insects that can be found attached to hair in
the pubic area but sometimes are found on coarse hair elsewhere on the body (for example,
eyebrows, eyelashes, beard, mustache, chest, armpits, etc.). Pubic lice survive by feeding on
human blood and are usually spread through sexual contact. Good hygiene and other
behaviors can help prevent and control the spread of pubic lice.

Scabies

Human scabies is caused by an infestation of the skin by the human itch mite
(Sarcoptes scabiei var. hominis). The microscopic scabies mite burrows into the upper layer
of the skin where it lives and lays its eggs. The most common symptoms of scabies are
intense itching and a pimple-like skin rash. The scabies mite usually is spread by direct,
prolonged, skin-to-skin contact with a person who has scabies. Good hygiene is important to
prevent and control scabies:

 Bedding, clothing, and towels used by infested persons or their close contacts
anytime during the three days before treatment should be decontaminated by
washing in hot water and drying in a hot dryer, by dry-cleaning, or by sealing in a
plastic bag for at least 72 hours

Trachoma

Trachoma is the world’s leading cause of preventable blindness of infectious origin.

Caused by the bacterium Chlamydia trachomatis, trachoma is easily spread through direct
personal contact, shared towels and cloths, and flies that have come in contact with the eyes
or nose of an infected person. If left untreated, repeated trachoma infections can cause
severe scarring of the inside of the eyelid and can cause the eyelashes to scratch the cornea
(trichiasis). In addition to causing pain, trichiasis permanently damages the cornea and can
lead to irreversible blindness. Trachoma, which spreads in areas that lack adequate access
to water and sanitation, affects the most marginalized communities in the world. Globally,
almost 8 million people are visually impaired by trachoma; 500 million are at risk of blindness
from the disease throughout 57 endemic countries. The World Health Organization has
targeted trachoma for elimination by 2020 through an innovative, multi-faceted public health
strategy known as S.A.F.E.:

 Surgery to correct the advanced, blinding stage of the disease (trichiasis),

 Antibiotics to treat active infection,
 Facial cleanliness and,
 Environmental improvements in the areas of water and sanitation to reduce disease
transmission

1.3.5 STUDIES ON POOR HYGIENE

In a research article titled “Food hygiene education in UK primary schools: a nation-

wide survey of teachers' views” by Gill Bielby, Bernadette Egan, Anita Eves, Margaret
Lumbers, Monique Raats, Martin Adams published on 2006 in British Food Journal indicated
that food hygiene is taught in a number of subject areas, with handwashing and personal
hygiene being the principal topics. Teachers use a combination of methods to teach food
hygiene and to reinforce food safety messages. Primary school teachers responding to this
survey felt most children enjoy working with food, and deemed practical activities as the most
effective method of teaching food hygiene. Handwashing routines were also crucial in
developing good food hygiene related behaviours. Food hygiene is taught in many school
subjects but predominately in science, health-related subjects and D&T (or equivalents in
Scotland and Northern Ireland). Extra-curricular activities and whole school events also
provide opportunities to promote food hygiene messages. Indeed “Healthy Schools” and
other initiatives such as the “Fruit and Vegetable Scheme” appear to have increased the
scope for teaching and reinforcing food hygiene messages.This show that hygiene, in this
research specifically about food hygiene is very important until it have been stressed in
primary school which is the community that within a good process of learner.

OA Idowu and SA Rowland published an article titled Oral fecal parasites and
personal hygiene of food handlers in Abeokuta, Nigeria. This article was published in African
Health Science. 2006 September; 6(3): 160–164. The research focused on assessing the
prevalence of parasites with direct transmission and the level of hygiene among food
vendors. It showed that high prevalence of faecel orally transmissible parasite recorded in
this study (97%) is indicative of a high level of faecal contamination of the environment and
low level of sanitation since these parasites are acquired via accidental consumption of
parasite eggs and cysts and it signals high possibility of transmission of these parasites
through these infected food vendors to their customers especially in cases where such food
vendors are unhygienic in food handling. The facts that these food handlers are
asymptomatic make them cysts and/ or egg passers and are unaware that they are possible
transmitters of parasitic infections/diseases. Author suggest that poverty may be responsible
for the prevalence and or re-infection with these parasites since the use of soap in cleaning
of hands after defaecetion is considered an additional cost even by the school food vendors
that are aware of the need for hygienic practices in food handling. None of the food vendors
met the W.H.O requirement for effective hand wash which include washing of hands in hot
soapy water before preparing food and after using the bathroom, changing diapers and
handling pets. Majority of the food vendors (75%) use pit latrine and other related structures
and/or dung hills for defecation, these structures may however, facilitate contact with stools
from which they can either acquire infection or carry eggs and cysts of parasites with which
contamination of their wares may be inevitable thereby leading to widespread contamination
of food and drinks. In addition, lack of public toilet may be one of the factors of epidemiology
since food hawkers make use of dung hill for defaecetion while hawking their wares. And the
authors suggest that the routine inspection and enlightenment by health officers from the
ministry of health may have enhanced the level of awareness among the school vendors.
This study has revealed the need to improve personal hygiene of food vendors in
Abeokuta in order to reduce the prevalence of faecal-orally transmissible parasites. Based on
this, there is the need for adequate enlightenment programmes for food handlers especially
street food handlers. There is also the need to enact necessary food handling policies and
appropriate implementation of such policies should be ensured. Thirdly, more public toilets
should be provided in Abeokuta in order to reduce faecal contamination of the environment.

Proper Hand-Washing Techniques in Public Restrooms: Differences in Gender, Race,

Signage, and Time of Day is the report from a research conducted by Andrea Kinnison,
Randal R Cottrell, and Keith A King that was publish at American Journal of Health
Education on Apr 2004. It basically to evaluate hand washing behaviors in public restrooms
with and without reminder signs. Study used "undercover" observers to watch hand washing
behaviors in public restrooms. Observations were made at New York City's Penn Station, an
Atlanta Braves game, San Francisco's Golden Gate Park, a New Orleans casino, and
Chicago's Navy Pier. Results indicated hand washing rates of 60%, 64% 69%, 71%, and
78%, respectively. The results of this study clearly indicate the need for adult programming
on the importance of hand washing. Less than one-third (31.7%) of participants washed their
hands in a way that would effectively reduce fecal contamination. Author suggest that health
educators in all settings including worksites, community agencies, schools, public health
departments, and health care facilities need to developed programs that encourage proper
hand washing practices.
In a research article titled “ hygiene knowledge in small food businesses”
conducted by Elizabeth Walker,Catherine Pritchard, and Stephen Forsythe published on 27
January 2002 in Elsevier Science Ltd. demonstrates that although food handlers may be
aware of the need for personal hygiene, they do not comprehend crucial aspects of hygiene
such as cleaning of work-surfaces and cannot link temperature values with the role cooking
and low temperature storage for the control of microbiological hazards. Sixty percent of food
handlers did not know that food poisoning was caused by food that looked, smelt and tasted
normal .These results clearly revealed that the majority of food handlers did not understand
that organoleptic assessment of food was insufficient to identify food contaminated by
pathogenic bacteria. Therefore, they were relying on incorrect physical attributes for food
safety control. The majority (94–97%) of food handlers identified the need to wash their
hands after going to the toilet, wearing protective clothing, covering cuts with easily
detectable plasters and that jewellery should not be worn in the kitchen as it can carry dirt
and bacteria. However knowledge of hygienic practice was poor. Although the majority (97%)
knew that reason for separating cooked and raw foods, their knowledge of keeping work-
surfaces hygienically clean to avoid cross-contamination was poor. Author suggested that
food handlers need to be able to identify high-risk foods that support the survival and
multiplication of pathogens and are intended for consumption without further treatment and
since temperature treatment is frequently the critical control point a production process, the
issue of poor temperature understanding could be a major hindrance to effective HACCP
implementation.

1.4 OBJECTIVES

General
1. To perform knowledge, awareness, and practice study on personal hygiene among
the adult in rural area (pontian kecil) in year 2009.

Specific
1. To describe the demographic characteristics of population under study.

2. To measure the knowledge on personal hygiene among adult

 3. To show the association between the level of knowledge on personal hygiene
with age, gender, ethnic group, education stream, socioeconomic status and
environment.

4. To determine relationship between level of knowledge on personal hygiene

and its practice among adult in rural area (pontian kecil)

1.5 HYPOTHESES

1. The level of knowledge on personal hygiene among adult population in Pontian Kecil
is low.

2. There is association between level of knowledge on personal hygiene and age,

gender, ethnic group, education stream, socioeconomic status and
environment.
CHAPTER 2- METHODOLOGY
2.1 STUDY AREA

The study area is in Pontian Kechil, Johor Darul Tak`zim. The total area are about
907 km² and the population estimated about 54922. Pontian is a district in southwest Johor.
It is located 62km from Johor Bahru, the state capital of Johor. It is also located at Miles 37
(Batu 37) from Johor Bahru. The name Pontian is also used in the names of two towns in the
district, Pontian Besar and Pontian Kechil, of which the latter serves as its district capital. The
capital was formerly a fishing village which has developed into a small town. Pontian is noted
for its variety of seafood which is sold at a reasonable price. Visitors from neighbouring
towns and Singapore regularly visit Kukup, a fishing village about 20km from Pontian Kechil.
Notable national parks in Pontian include Tanjung Piai. Pontian Kechil is situated 1.5 hours
(via bus) from Johor Bahru (Capital of Johor State) via Jalan Johor. Other notable towns in
Pontian include Ayer Baloi and Benut, north of Pontian Kechil. To the south and east of
Pontian Kechil respectively are the towns of Teluk Kerang and Pekan Nanas. Especially
along coastal areas, Pontian is populated by Malays of Bugis descent.

History of Pontian

Actually, the name has to do with the pirates in the Straits of Malacca, who hijacked
vessels near Kukup at the south-westernmost tip of the peninsula. One of their hiding
grounds was called Perhentian Besar (Big Stopover) while another was Perhentian Kecil
(Small Stopover), both located at the estuary of two different rivers. The pirates shortened
the names to Pontian Besar and Pontian Kecil, and the rivers to Sungai Pontian Besar and
Sungai Pontian Kecil. Ironically, Pontian Besar is merely a small fishing village today while
Pontian Kecil has evolved into the district’s capital and commercial centre.
Some, however, say Pontian does not have its roots in either Pontian Besar or Pontian Kecil
but in Kukup. Yet others say the name came from Pulau Pisang. According to historical
records, an Arab merchant from Singapore, Syed Muhamed Alsogoff, appealed to the Sultan
of Johor, Sultan Abu Bakar, to let him develop a piece of agricultural land in Johor in 1878.
Not only was his request granted, he was also allowed to choose his site. The merchant left
Teluk Belangah in Singapore in a boat and toured along the southwestern coast of Johor to
find this ideal land. He earmarket Kukup, a fishing village populated by Malays from Malacca.
During the area, Kukup was the capital of Kukup District. The Sultan of Johor granted the
land at Sungai Pontian Besar, Sungai Pontian Kecil, Sungai Permas and Sungai Jeram Batu
to Syed Muhamad, who later brought in the Javanese to plant rubber, sago, coconut, coffee,
pineapple and spices. He named his farms Constantinople Estate, and printed his own
currency in demominations of two, one, 25 and 50 cents for use in his farm. All produce were
sent to Singapore by sea through Kukup. Syed Muhamad also leased out part of the land to
his workers and other merchants. His ambitious plan for the land prompted more and more
Javanese to migrate to Kukup, and the port grew in size. When Syed Muhamad died in 1906,
his son Syed Omar Alsagoff took control of the land until the British came in 1914. For
administrative purposes, the state government eventually bought back the land at RM1
million in 1926.
To further develop Kukup, the state government built a road linking Kukup and
Pontian Kecil. In 1929, another road was built to link Pontian Kecil and Johor Baru. The
Kukup folk were happy with the two projects, but what they did not realize was that the roads
would eventually lead them to their economis demise. The Pontian Kecil-Johor Baru road
helped Pontian Kecil to boom due to its proximity to Johor Baru and Batu Pahat. With more
businesses and government offices set up in Pontian Kecil, Kukup’s days of glory were
numbered. Eventually, Pontian Kecil replaced Kukup as the district capital while the district
was later renamed Pontian. Another version says Pontian was first established in Pulau
Pisang, a small island with a lighthouse off Pontian Kecil.
Hundreds of years ago, the island and Pontian Kecil were so close to each another that if a
cock were to crow in Pulau Pisang, it could be heard in Pontian Kecil. Because of earth
movement,the two places are now 12 nautical miles apart. Based on records, it was
Penghulu Merdang who established Pulau Pisang, with villagers planting padi and fruits,
especially mangoes. After his death, his son Basok migrated with some villagers to Pontian
Besar to develop the place. Another story has it that it was Hassan Koris who turned Pontian
Besar into an agricultural land and sold its produce to Singapore. For the older generation,
Pulau Pisang is a legendary island formed from a shipwreck. Legend has it that the only son
of a couple from Tanjung Piai ventured into the world and became a big merchant with many
vessels years later. When his vessel stopped at the existing Pulau Pisang one day, his
parents were so happy that they prepared much delicious food and travelled in a boat to see
their long lost son. However their son refused to acknowledge them and chased them away.
While travelling back to Tanjung Piai, the mother cursed her son. Suddenly, the sky changed
colour and a storm came, sinking the vessel, which became Pulau Pisang. It was named
Pulau Pisang as many banana trees were found there. But whichever version is right,
Pontian is inarguably an important agricultural district in Johor today, offering many
resources for agro and eco-tourism. Kukup has the world’s biggest mangrove forest, and
Tanjung Piai is a landmark due to its location on the southern-most tip of continental Asia.
Pulau Pisang remains as remote as it was, although the lighthouse there remains a
contentious issue as it is run by Singaporeans although the island belongs to Malaysia.

2.2 STUDY DESIGN

The study design applied onto this study is cross-sectional, also known as prevalence
study. In this type of study, a population is surveyed at a single point of time using a self-
administered questionnaire. All the information on exposure, outcome and other variable of
interest are collected simultaneously. Thus, it provides a snapshot picture of a population at
one time.

2.3 SAMPLING

2.3.1 Sample Population

The population included in the study is all-resident in Pontian Kecil within range age of 15 to
65 years old.
2.3.2 Study Sample

Inclusion criteria
1. Female aged between 15-65 years old.
2. Male aged between 15-65 years old
3. Agree to participate in the study
4. Malaysia citizen

Exclusion criteria
1. Female aged below 14 and above 65
2. Male aged below 14 and above 65
3. Foreigner
4. Not agree to participate in the study.

2.3.3 Data Collection

Variable collected

The questionnaire consists of two variables which are dependent and independent variables.
In the independent variables, it composed of demographic aspect. For the socio-
demographic part, the respondents’ details such as age, gender, ethnic group, education
stream, socioeconomic status and environment were assessed. The dependent variables are
to assess three main criteria of the respondent. First is their level of knowledge on personal
hygiene. Secondly is whether or not they practice personal hygiene in their daily life and
thirdly whether or not they knew about H1N1, a disease that correlate with poor personal
hygiene.

Methods of data collection

Data is collected using self administered questionnaire.

Tools
The questionnaire consist of three components, which are socio-demographic,
level of knowledge on personal hygiene and good practice of hygiene in daily life.
The socio-demographic component is to gain the information about the respondent age,
gender, ethnic group, education stream, socioeconomic status and environment. The level of
knowledge was assessed based on their answers to the questions about the personal
hygiene definition and how they practice in daily life.

2.3.5 Data Analysis

The data were analyzed by using Statistical Package for the Social Sciences (SPSS)
version 16.0 software. Appropriates statistical analyses were conducted and presented by
proportions. For the stratified analysis Chii Square Test was used. The result will be
presented in frequency table, bar chart and proportionate pie chart. To estimate significant
level, value of α was pre-set at 0.05.
CHAPTER 3 – RESULT
Table 1: Distribution of Study Sample According To Age Group, Faculty, Race, and Level Of
Parents Education.
Socio-demographic Frequenc % P
y value
Age group
15-25 118 63.4 P
26-35 33 17.7 >0.05
36-45 19 10.2
46-55 12 6.5
56-65 4 2.2

Gender
Male 88 47.3 P>
Female 98 52.7 0.05

Ethnic
Malay 148 79.6 P>0.05
Chinese 22 11.8
Indian 16 8.6

Education Stream
None 8 4.3 P>0.05
Primary school 15 8.1
Lower secondary school 51 27.4
Upper secondary school 62 33.3
University/college 50 26.9
Environment
Villlage area 82 44.1
Close to town 104 55.9 P>0.05

Occupation
Have 97 52.2
 Not have 89 47.8 P>0.05

Salary
<1000 58 31.2 P>0.05
1000-10000 35 18.8
>10000 5 2.7

Table 2: Mean knowledge score according to socio-demographic characteristic.

Socio-demographic Mean Knowledge SD P value

score
Age group
15-25 3.04 1.165 P <0.05
26-35 2.61 1.435 (0.003)
36-45 2.42 1.216
46-55 3.08 1.165
56-65 1.00 0.000

Gender
Male 2.66 1.268 P< 0.05
Female 3.04 1.218 (0.038)

Ethnic
Malay 2.93 1.251 P>0.05
Chinese 2.59 1.260
Indian 2.62 1.258

Education Stream
None 2.75 1.488 P>0.05
Primary school 2.47 1.302
Lower secondary school 2.84 1.173
Upper secondary school 2.89 1.332
University/college 2.98 1.204

Environment
Village area 2.91 1.209
Close to town 2.82 1.290 P>0.05

Occupation
Have 2.66 1.314
Not have 3.08 1.150 P<0.05
(0.022)
 Salary
<1000 2.76 1.288 P>0.05
1000-10000 2.43 1.378
>10000 2.80 1.304

Table 1 shows the distribution of study sample according to age group, gender, ethnic,
educational stream, environment, occupation and salary. The total score mean of study
sample is showed in Table 2 with regards to the socio-demographic characteristics.
From the finding, the difference of mean knowledge score was not significantly related to the
ethnic, educational stream, environment, and salary with the p value being greater than 0.05.
On the other hand, the p-value is less than 0.05 (0.003) for the age group indicate that the
total knowledge score was significantly related to the age group. The total score mean for
age group from 15 to 25 are 3.04, from 26 to 35 are 2.61, from 36 to 45 are 2.42, from 46 to
55 are 3.08 which the highest, from 56 to 65 are 1.00 which is the lowest.
The total knowledge score was also significantly related to gender where the p value is less
than 0.05 (0.038). The total score mean for male and female were 2.66 and 3.04
respectively. In addition, the total knowledge score was also significantly related to
occupation (whether respondents have occupation or not) where the p value is less than 0.05
(0.022). The total score mean for have and not have occupation were 2.66 and 3.08
respectively.

Mean Knowledge Score According to Age Group

 3.5
3.04 3.08

3 2.61
2.42
2.5

2
Mean knowledge score
1.5
1
1

0.5

0
15-25 26-35 36-45 46-55 56-65
Age group

Figure 1

Mean Knowledge Score According to Gender

3.04
3.1

2.9

Mean Knowledge Score 2.8

2.66
2.7

2.6

2.5

2.4
male female
Gender
 Figure 2

Mean Knowledge Score According Occupation

3.08
3.1

2.9

Mean Knowledge score 2.8

2.66
2.7

2.6

2.5

2.4
Have Not Have
Occupation

Percentage of Respondents According

Figure 3 to the Source of Information.

11%
38%
17%

Media Massa
Health Care Workers
Teachers
Friends
Parents

12% 22%

Figure 4

The figure above shows that 38% of respondent get their information on personal hygiene
from mass media. This indicated that in concert, media massa play a major role in conveying
information. In addition 22%, 17%, 12% of respondents receive information on personal
hygiene from health care workers, teachers and friends respectively. While 11% of
respondents which is the lower percentage get the information of personal hygiene from their
parents. This revealed that most people received information about personal hygiene outside
their own house.

Percentage of respondents according to the important of personal hygiene

and practice of personal hygiene in daily life.
 yes
no

100

Figure 5

The pie chart above shows that 100% of respondent agree that personal hygiene is very
important in their daily life and their practice of personal hygiene in daily life . While none of
respondent disagree about that. This proved that, the people in rural area like Pontian still
aware and take seriously about personal hygiene in their routine life.

Percentage of respondents according to practice of personal hygiene in their life.

Washed Hair

88.2
90
80
70
60
50
Percentage
40
30
20 11.3

10 0.5
0
Everyday More than once in a none
week
frequency of washed hair

Figure 6

The figure above shows that 88.2% of respondent washed their hair everyday, while 11.3%
of respondent washed their hair more than once in a week and 0.5% of respondent admit
that they never washed their hair. This indicated that majority of respondent still washed their
hair everyday which is important in such a way that this can keep away the head lice.

Cut Hair

80 70.4
70
60
50
40
Percentage
30
15.1 12.9
20
10 1.6

0
when hair long until had been until the hair make undetermined
enough askby family appearance worse
member/friends

Cut Hair

Figure 7

The figure above shows that 70.4% of respondent cut their hair when hair is long enough,
while 1.6% of respondent cut their hair until had been ask by family member/friends.15.1%
of respondent cut their hair until the hair make their appearance worse. And 12.9% of
respondent cut their hair in undetermined of time. This indicated that majority of respondents
still care of their appearance and personality.

Brush Teeth

67.2
70

60

50

40 31.7
Percentage
30

20

10 1.1

0
more than 2 times a day once a day once a week
brush teeth

Figure 8

The figure above shows that 67.2% of respondent brush their teeth more than 2 times a day.
While 31.7% of respondent brush their teeth once a day and finally 1.1% of respondents
brush their teeth once a week. This shows that majority of respondents still take care of their
hygiene even there still have respondents who just brush their teeth once a week.

See Dentist for Medical Check Up

46.8
50
34.4
40
30
15.6
20
3.2
10

percentage 0

see dentist for medical check up

Figure 9

The figure above shows that 46.8% of respondent see dentist for medical check up when
they had toothache or undetermined, 34.4% of respondents see dentist once every 6
months, 15.6% of respondents see dentist once a year while 3.2% of respondents never met
dentist. Our teeth have very important job. Therefore it`s our responsibility to care about
them and suppose we must meet a dentist at least once for 6 months. The graph above
shows that, majority of respondents just see a dentist when they had a toothache or
undetermined which is inconsistent way to keep a healthy teeth. In addition, there still have a
respondent who never meet a dentist which indicated that they never take seriously about
their teeth at all.

Take a Bath

76.3
80

70

60

50
percentage 40

30
17.7
20
5.9
10

0
2 times/more perday once a day anytime when I feel
uncomfortable
take a bath

Figure 10

The figure above shows that 76.3% of respondent take a bath 2 times or more per day,
17.7% of respondents take a bath anytime when they feel uncomfortable while 5.9% of
respondents take a bath once a day. This shows that majority of respondents still keep their
hygiene by take a bath 2 times or more per day

Clean Up Face

74.7
80

70
60

50

40
percentage
30
17.2
20
5.9
10 1.6 0.5
0
2 times/more once a day once week anytime when none
perday feel
uncomfortable
clean up face

Figure 11

The figure above shows that 74.7% of respondent clean up their face 2 times or more per
day which is recommended, 17.2% of respondents clean up their face anytime when they
feel uncomfortable. In addition, 5.9% of respondents clean up their face once a day, 1.6% of
respondents clean up their face once a week and lastly, 0.5% of respondents admit that they
never clean up their face. This shows that majority of respondents still care about their face
with clean it 2 times or more per day but still have respondents who never clean up their face
which shows very bad habit.

Cut Nails

65.6

60 33.3
40
20 1.1

0
Percentage

Cut a nail
 Figure 12

The figure above shows that 65.6% of respondent cut their nails once a week, 33.3% of
respondents cut their nail when they feel uncomfortable and 1.1 of respondents cut their nail
once a month which is very bad habits. Graph above shows that majority of respondents still
keep their nail short and clean.

Thing Done After Urinate or Pass Motion

2.2
11.8

wash dirty area by water and soap

wash dirty area by water only
clean the dirty area by clean tissue

86

Figure 13

Pie chart above shows 86% of respondents wash the dirty area by water and soap after
urinate or pass motion, 11.8% of respondents wash dirty area by water only, and 2.2% of
respondents clean the dirty area by clean tissue. It actually depend to the individual whether
they want to use water or tissue to clean up their private part. But it more appropriate to use
water and soap because it will get rid all the bacteria, virus or parasite easily compare to
other method. Graph above indicate that majority of respondents more prefer to use water
and soap compare to other method.

Type of Toilet

67.2
70

60

50
32.8
percentage 40

30

20

10

0
cistern-flush and clean pour-flush and clean

type of toilet in the house

Figure 14
Graph above shows 67.2% of respondents use cistern-flush and it is clean. While 32.8% of
respondents use pour-flush and it is clean. Nowdays cistern-flush is more recommended and
appropriate compare to pour-flush due to it`s condition which is more comfortable and clean.
The majority of respondents as shows above choose to use cistern-flush compare to pour-
flush

Discharge of Sludge

49.5
50
45 40.3
40
35
30

percentage 25
20
15
8.6
10
5 0.5 1.1

0
communal individual man-made hole open/river others
septic tank septic tank
discharge of sludge

Figure 15
This figure shows 49.5% of respondents use communal septic tank to discharge the sludge,
40.3% of respondents are use individual septic tank, 8.6% of respondents use man-made
hole. In addition 0.5% of respondents use open river and 1.1% of respondents use other
methods to discharge the sludge. Many people nowdays prefer to use communal septic
tank and individual septic tank to discharge the sludge and it is more systematic and reliable.
Moreover, both methods will keep better hygiene compare to other method. Man-made
whole, Open River is an old fashioned method which is not systematic and not suitable with
environment nowdays. Majority of respondents above prefer to use communal septic tank
and individual septic tank.

Disposal of Kitchen Waste

59.7
60

50

40

percentage 30
20.4
20 12.9

10 2.7 4.3

0
municipal open hole buried into the others
waste drain/river
disposal of kitchen waste

Figure 16
Figure 16 above showed the type of disposal of kitchen waste where 59.7% of respondents
use municipal waste, 20.4% of respondents buried their disposal kitchen waste. Apart from
that, 12.9% of respondents use open hole, 4.3% of respondents use other methods and
2.7% of respondents disposed their kitchen waste into the drain or river. Municipal waste is a
method used by many people because this method is cleaner and easier to handle
compared to other method that can lead to air, water, smell pollution.
As shown above, majority of respondents prefer to choose municipal waste to keep better
hygiene.

Source of Drinking and Cooking Water

98.9
100
90
80
70
60
percentage
50
40
30
20
10 0.5 0.5
0
pipe water well water rain water
source of drinking and cooking water

Figure 17
Graph shown above showed the type of drinking and cooking water. 98.9% of respondents
used pipe water and 0.5% of respondents used well water and other 0.5% of respondents
use rain water. As we all know, majority of people nowdays are use pipe water and this can
be prove by evidence that shown in the graph. While well water and rain water was seldom
use by people nowdays due to its quality and its cleanliness.

Treated of Source Water

 70 63.4

60

50

40
29
percentage
30

20

10 4.3
2.2 1.1
0
filtered reverse chlorination not treated others
osmosis
type of treated water

Figure 18

Graph above show type of treated water. 63.4% of respondents filtered their water to treat
them. While 29 % of respondents use chlorination process to treat the source of water, 4.3%
of respondents choose to not treated them, 2.2% of respondents use reverse osmosis
process and 1.1% of respondents use others method. This indicates majority of respondents
choose or prefer to use filtration process to treat the source water.

Boil of Drinking Water

2.7

yes
no

97.3

Figure 19
Pie chart above show percentage of respondents according to whether they boil drinking
water or not. 97.3% of respondents which is the majority admit that they will boil the pure
water before they drink it. This is important since pure water is full with bacteria, virus and
even parasite that can interfere with our immune system and affect our gastrointestinal
system. And the rest of respondents which is 2.7% admit that they never boil the water
before they drink it which is inappropriate habit to practices.

Does Mosquitoes Transmit Infectious Diseases

 1.1

yes
no

98.9

Figure 20
The pie chart above showed percentage of answer from respondents whether mosquitoes
transmit infectious diseases or not. The majority of respondents which is 98.9% know that
the mosquitoes can transmit infectious diseases and this is true. Mosquitoes can lead to
infectious diseases like malaria, dengue, chikungunya and filariasis. Minority of respondents
which is 1.1% that does not know that mosquitoes can transmit diseases. Therefore
education about infectious disease among community is important in order to prevent the
outbreak as well as the spreading of infectious diseases.

Uses of Mosquitoes Net

24.7

yes
no

75.3

Figure 21
Pie chart above showed the percentage of respondents wearing mosquitoe net during sleep.
As shown above, 75.3% of respondents do not use mosquitoe net during sleep, and the
minority of respondents which is 24.7% admits that they use mosquitoes nets during sleep to
prevent mosquitoes bite.

Knowledge About H1N1.

 yes
no

100

Figure 22
The pie chart above showed percentage of respondents knowledge about H1N1. As shown
above 100% of respondents which means that all the respondents knew the existence of
H1N1. This indicates that all campaign that had been done by government via media massa
is fully effective. As we all well known, H1NI is newly infectious diseases that massively
spread to all over the world and indirectly related to poor hygiene.
CHAPTER 4-DISCUSSION
Personal hygiene refers to the set of practices associated with the preservation of
health and healthy living. Nevertheless it will give a big impact not only to our health but also
socially, psychologically and personally. Of course, the main things that can lead to
problems are poor hygiene that can impact our health it can also lead to death. For example
recently, there was outbreak of H1NI that lead to many cases of death. And the main cause
was from bad personal hygiene. Since it can easily transmit from person to person easily
which is by airborne, now all people over the world have a higher risk to be infected.
Other examples of diseases that can be cause by poor personal hygiene are food
poisoning cause by vibrio cholera, E.coli, Salmonella, Shigella, dysentery that caused by
Entaemoeba Histolytica, bloody diarrhea that cause by Coccidiosis, and other like
Cryptosporidiosis, Giardial enteritis, Toxoplasmosis, Candidiasis, Ascariasis, Hookworm,
Tapeworm, Trichinosis. Therefore, it is necessary for each individual to have awareness an
importance personal hygiene and practiced it in the correct way in their daily life.
Pontian is a district in southwest Johor. It is located 62km from Johor Bahru, the state
capital of Johor. The total area is about 907 km² and the population estimated about 54922.
It is also located at Miles 37 (Batu 37) from Johor Bahru. The name Pontian is also used in
the names of two towns in the district, Pontian Besar and Pontian Kechil, of which the latter
serves as its district capital.
The finding shows the difference of total knowledge score was not significantly
related to ethnic group. Malaysia’s education systems are thoroughly integrated. Even
though each ethnic has their own prefered school, they definitely have the same syllabus.
Association between the total knowledge score with age was significant. The most
likely reason being that the range group from 15 to 25 is the age group that majority of them
still in a learning stage whether in school, college or university. Age group 46 to 55 is a range
group that is mature enough to make a difference between bad or good. There also
association between the total knowledge scores with gender which is significant. Female
group is usually the group that is more aware and practical compare to male. Nowdays
female group is more educated compared to male and this is prove by the difference
between ratio of female and male in university.
Apart from that, association between the total knowledge score with occupation which is
whether respondents working or not is also significant. As shown in Table 2 respondents who
do not have any occupation posses high mean score knowledge compared with respondents
who have job. This is most probably because of jobless respondents is consisting of group
that still study or group of people that just stay at home such as housewife or pensioner
people. Usually this kind of people have a lot of time to spent where they can care much
about their personal hygiene compared to the person who are busy with work and some of
them have no time to themselves.
There is no significant association between the total knowledge score mean and the
educational stream. The respondent’s education level did not markedly affect the total
knowledge score. This most probably because even the respondents did not have high
education level, but they still can keep personal hygiene because hygiene teaching is to
being taught in children since kindergarden and primary school.
There is also no significant association between the total knowledge scores mean
and the environment. Whether the respondents stay close to town or at the village, there is
no factor that can influence the individuals from caring about their hygiene because nowdays
both people who stay in rural area or urban area had received equal education.
 Related to H1N1, 100% of respondents knew about this lethal infectious disease. This is a
good sign and must be take seriously especially the way to prevent it from spreading
massively. This also indicates that all the campaigns that had been done by government was
a great success. The government should take similar procedures or steps if there is any
outbreak in future.
Limitations. There were some limitations that arise during this project related to the
questionnaire, respondent and others that causes the result to deviates from what was
expected earlier. Firstly, while answering the questionnaire, respondents are required to
recall their activity about personal hygiene daily. The limitation is due to human error,
whenever the respondents unable to recalled correctly about their personal hygiene daily.
Thus, it will affect the study result.This study has limited sample from the population as only
adult age group which is from 15 to 65 years old were considered eligible to take part in the
survey. As the consequence, this study’s finding is not entirely represent the whole
population in Pontian Kechil since population in Pontian Kechil consist of people from various
age groups and both female and male. Since this study is specifically choosing only adult
age group, most of the respondents aged between 15 to 25.
The number of questionnaires distributed to the eligible students during the study is
were 250 sheets. However, the respond rate was low as only 186 questionnaire sheets were
returned and valid for data analysis. The low response rate is mainly attributed due to do not
want to contribute and not well known the importance of survey. And some of the returned
questionnaire sheets were incompletely fill and had to be excluded.
Because of no previous exposure on how to develop a comprehensive questionnaire, I
ended up having questions that were not relevant enough for the study. Moreover, some of
very important questions that might help us assessing the level of knowledge were not
included in questionnaire.

CHAPTER 6- CONCLUSION
 The level of knowledge on personal hygiene among adult population in Pontian Kechil
is satisfactory with 44.62% had high scores. The mean total score on personal hygiene was
associated with age group with age between 46 to 55 had better score, gender with female
had better score compare to male, and occupation( whether respondents have a job or not)
where respondents who do not have a job had high score compares to respondents who
have a job. Ethnic group, education stream, environment and salary bearing had no
significant contribution to knowledge level.

ACKNOWLEDGEMENT
Firstly, I would like to acknowledge of my supervisor, Prof. Dr. Jamaiah from Department of
Parasitolgy. We highly appreciate the assistant of the people below for their contribution
through out the process of completing the project from the very beginning till the end.
1. Ahmad Bin C Moideen
2. Lamisah Binti Ronoh
3. My family
4. My relative and friends

REFERENCES:

1. http://en.wikipedia.org/wiki/Personal_hygiene
2. http://www.cdc.gov/ncidod/EID/vol12no03/05-0625.htm
3. http://www.webhealthcentre.com/HealthyLiving/personal_hygiene_index.aspx
4. http://www.cdc.gov/healthywater/hygiene/disease/index.html
5. http://en.wikipedia.org/wiki/Pontian_Kechil
6. http://31august1957.blogspot.com/2009/03/legend-of-pontian.html