HL 367 - Course Project Fall 2014

Carlee Wasik - cwasik@nmu.edu

Hayley Keur - hkeur@nmu.edu
Target population:
Ethiopian communities
Dependent Variable:
Increase awareness of personal hygiene
Independent Variable:
Self-Care Strategies
Mission Statement:
Our mission is to increase awareness of personal hygiene in Ethiopian communities
by teaching basic self-care strategies.
Goals and Objectives:
1. Better global quality of life.
2. Increase knowledge in personal hygiene, health and wellness.
3. Increase accessibility to clean water
4. To give opportunity to prospective students and volunteers in international health.
5. To create partnerships with Northern Michigan University and Marquette community.

HL 367 Major Project Fall 2014

Our mission is to increase awareness of personal hygiene in Ethiopian
communities by teaching basic self-care strategies.
Carlee Wasik & Hayley Keur

Table of Contents
Table of Contents.....3
Introduction....4
Section 1: Mission....5
Section 2: Review of the Related Literature...6-15
Section 3: Synthesis of the Literature...16-23
Section 4: Programming...23-28
Section 5: Evaluation Design/Mission Fit..28-29
Section 6: Marketing and Communication....30-31
Section 7: Granting Agency....32-33
Section 8 Webliography...33-35
Section 9: Reflection....35-36

Introductions
Carlee Wasik
I am a senior at Northern Michigan University and will be graduating with a Bachelor degree
as a Community Health Educator with a passion in International Health. After spending 20
years growing up in Marquette, Michigan I had a great interest in what this beautiful world
had to offer. I decided to spend one year overseas spending time in Australia, Japan and
South-East Asia. In South-East Asia I found there was a need for health and hygiene
education and eventually volunteered at a permaculture farm in Thailand working with a
rural community. With lack of time and support I couldn't give back as much as I would have
liked, that is why I would love to raise the awareness and educate to help these countries in
need.
Hayley Keur
I am a senior at Northern Michigan University working towards my Bachelor degree in
Community Health Education with a focus on international health. I grew up in Grand
Haven, MI on the dunes of Lake Michigan and am now living in Marquette, MI's rocky coast
along Lake Superior. I have always had a passion for helping people in need and paired
with my desire to travel, I hope to use my degree around the world as an International
Health Educator. In 2012 I traveled to India for a service trip where I was able to go into
communities in the northern city of Palampur and educate children about personal dental
hygiene and first aid, and families about the importance of education in girls. That trip is
what started my love for international health education and I hope to further it as I find a
career in this field.

Section 1: Mission
1. What's Our Mission?
Our mission is to increase awareness of personal hygiene in Ethiopian communities
by teaching basic self-care strategies.
2. What are variables in our mission?
The variables are:
Dependent Variable = increase awareness of personal hygiene
Target Population = Ethiopian communities
Independent Variable = Basic Self-Care strategies
3. In what agency could we realize our mission?

The Water Trust (TWT) is a 501(c)(3) non-profit working to improve water, sanitation and
hygiene (WASH) in East Africa. Our mission is to combat disease and poverty in the
developing world through sustainable investments in WASH. We learn alongside local
communities, Ugandan district officials, WASH NGOs, while utilizing innovation and best
practices to provide the highest impact in the regions most in need.
http://watertrust.org/

4. What job could we have in this agency and what is the job description for that job?
Job Position: Project Area Manager
To execute on a program of water, sanitation and hygiene (WASH) communitydriven implementation, education and monitoring projects in target areas

 To ensure that the program is done in accordance with an agreed work plan and
budget
Manage a team of 14 full-time employees and 5 contracted employees in two
different locations (Masindi and Kiryondongo Districts of western Uganda)
4b. What is our job for this particular project?
Our job is to develop a program plan and evaluation plan to meet our mission of
increasing awareness of personal hygiene in Ethiopian communities through basic selfcare. As such, we shall:
Assess the need to educate Ethiopian communities.
Identify measurable objectives designed to increase personal hygiene.
Plan an evidence-based program that has shown to promote personal hygiene and
self care.
Implement the program
Evaluate to see if we have met our objectives/need and promoted personal hygiene
and self care in Ethiopian communities and therefore met our mission.

Section 2: Review of the Related Literature

5. What is our mission and the four questions for analyzing the literature in order to
develop our program plan and evaluation plan in order to do our job as listed above
in 4b?
Our Mission is: Our mission is to increase awareness of personal hygiene in
Ethiopian communities by teaching basic self-care education.

Mission Variables:
Dependent Variable = Increase awareness of personal hygiene
Target Population = Ethiopian communities
Independent Variable = Basic self-care education

The four questions:

1. Does the piece identify need to promote basic self-care strategies for personal
hygiene in Ethiopia?
2. Does the piece theoretically define effective self-care strategies for personal
hygiene?
3. Does the piece tell us how to measure effective self-care strategies for personal
hygiene?
4. Does the piece give us a model program or education that has shown to promote
effective self-care strategies for personal hygiene?
6. Which pieces shall we use to analyze the literature to develop our program plan
and evaluation plan designed to meet our mission?
We shall use the following pieces and ask/answer the 4 questions under each:

1. Health promotion through self-care and community participation:

Elements of a proposed programme in the developing countries

Abstract

The concepts of health promotion, self-care and community participation emerged during
1970s, primarily out of concerns about the limitation of professional health system. Since
then there have been rapid growth in these areas in the developed world, and there is
evidence of effectiveness of such interventions. These areas are still in infancy in the
developing countries. There is a window of opportunity for promoting self care and
community participation for health promotion.
Discussion
A broad outline is proposed for designing a health promotion programme in developing
countries, following key strategies of the Ottawa Charter for health promotion and principles
of self care and community participation. Supportive policies may be framed. Self care
clearinghouses may be set up at provincial level to co-ordinate the programme activities in
consultation with district and national teams. Self care may be promoted in the schools and
workplaces. For developing personal skills of individuals, self care information, generated
through a participatory process, may be disseminated using a wide range of print and
audio-visual tools and information technology based tools. One such potential tool may be a
personally held self care manual and health record, to be designed jointly by the community
and professionals. Its first part may contain basic self care information and the second part
may contain outlines of different personally-held health records to be used to record
important health and disease related events of an individual. Periodic monitoring and
evaluation of the programme may be done.
Studies from different parts of the world indicate the effectiveness and cost-effectiveness of
self care interventions. The proposed outline has potential for health promotion and cost
reduction of health services in the developing countries, and may be adapted in different
situations.
Summary
Self care, community participation and health promotion are emerging but dominant areas
in the developed countries. Elements of a programme for health promotion in the
developing countries following key principles of self care and community participation are
proposed. Demonstration programmes may be initiated to assess the feasibility and
effectiveness of this programme before large scale implementation.
Kumar Bhuyan, K. (2004). Health promotion through self-care and community participation:
Elements of a proposed programme in the developing countries (Vol. 4). London: BioMed
Central. http://www.biomedcentral.com/1471-2458/4/11
1. Does the piece identify need to promote basic self-care strategies for hygiene in
Ethiopia?
a. This piece specifically does not target Ethiopia but still targets
underdeveloped countries with a need for promoting self care and community
participation for health promotion.
2. Does the piece theoretically define effective self-care strategies for hygiene?
.
Yes, the piece defines self care as as a process whereby a lay person functions on
his/her behalf in health promotion and prevention and in disease detection and treatment at
the level of primary health resource in the health care system and has evidence of
effectiveness in their interventions. (Kumar, 2004)
3. Does the piece tell us how to measure effective self-care strategies for hygiene?

.
Yes, they evaluate the program periodically and for monitoring, process level
indicators may track the progress of the activities accomplished under each strategy against
the targets that are set at the beginning of the intervention. (Kumar)
4. Does the piece give us a model program or education that has shown to promote
effective self-care strategies for hygiene?
.
Yes and no, it provides us a program model for self care and health promotion but
does not provide information on hygiene. This strategy may be implemented through the
different stages of community organisation model as follows: 1) Community analysis, 2)
Design and initiation, 3) Implementation, 4) Maintenance-consolidation and 5)
Dissemination and reassessment. (Kumar)

2.

Implementing the SAFE Strategy for Trachoma Control: A Toolbox of

Interventions for Promoting Facial Cleanliness and Environmental
Improvement
World Health Organization has endorsed an integrated strategy known as SAFE (see Box
1.1 for more detailed information):
Surgery for people at immediate risk of blindness
Antibiotic therapy to treat individual active cases and reduce the community reservoir
of infection
Facial cleanliness and improved hygiene to reduce transmission
Environmental improvements to make living conditions better so that the
environment no longer facilitates the maintenance and transmission of trachoma
http://trachoma.org/sites/default/files/guidesandmanuals/TrachomaToolboxFinalEnglish.pdf
Emerson, P., Frost, L., Bailey, R., & Mabey, D. (2006). Implementing the SAFE strategy for
trachoma control: a toolbox of interventions for promoting facial cleanliness and
environmental improvement. Atlanta, GA: Carter Center ;.
1. Does the piece identify need to promote basic self-care strategies for hygiene in
Ethiopia?
a.
Yes, hygiene and sanitation promotion should be conducted in the targeted
countries, such as Ethiopia, to reduce the risk of trachoma.
2. Does the piece theoretically define effective self-care strategies for hygiene?
.
Yes, the hygiene promotion strategy includes an intervention toolkit of facial
cleanliness or face washing, promotion of individual towels and washcloths, rainwater
harvesting, pit latrines, provision of village cleaning equipment, etc. which are individually
defined and how to effectively use each program.
3. Does the piece tell us how to measure effective self-care strategies for hygiene?
.
Yes, .
4. Does the piece give us a model program or education that has shown to promote
effective self-care strategies for hygiene?
.
Yes, The Hygiene Improvement Framework, developed by the Environmental
Health Project for hygiene improvement programs, is a useful model for planning and
implementing F and E interventions for reducing trachoma transmission. The model has
three components: accessing hardware,promoting hygiene, and enabling environments. (M
Emerson)

3.

Center for Disease Control and Prevention: Hygiene Challenges and

Resources in Less Developed Countries
A number of challenges and barriers to good hygiene exist in less developed countries.
The greatest of these challenges is the lack of clean water. Hundreds of millions of people
do not have access to improved sources of drinking water (1); worldwide, there are 1.6
million deaths per year attributed to diseases spread through unsafe water, poor sanitation,
and lack of hygiene (2).
However, even under circumstances where clean water is not available, evidence indicates
that hygiene practices (for example, washing hands) using unsafe water are beneficial to
reducing the spread of disease and are better than not washing at all. When access to safe
water is poor, Centers for Disease Control and Prevention (CDC) recommends using
unsafe water in the same manner as safe water for hygiene practices, to clean hands
before eating, after using the toilet, and at other key times.
http://www.cdc.gov/healthywater/hygiene/ldc/hygiene_challenges.html
Water-related Hygiene: Hygiene Challenges and Resources in Less Developed Countries.
(2012, March 22).Centers for Disease Control and Prevention. Retrieved September 24,
2014, from http://www.cdc.gov/healthywater/hygiene/ldc/hygiene_challenges.html

4.

Human Development Report Office: Children and Water, Sanitation

and Hygiene: The Evidence
UNICEF supports the consolidation and use of knowledge about best practice in providing
the poor with sustainable WASH services. Where it has the means and a comparative
advantage it will seek to support sector learning platforms in the identification of priority
national knowledge needs, and in filling these needs through activities funded both by
UNICEF and other external support agencies. In addition it will use its global network of
country offices as a means of channelling and sharing relevant information and knowledge
globally.
http://hdr.undp.org/sites/default/files/unicef.pdf

5.

Global Health Observatory (GHO): Water and Sanitation

Highlight on access to safe drinking water: The MDG drinking water target, which calls for
halving the proportion of the population without sustainable access to safe drinking water
between 1990 and 2015, was met in 2010, five years ahead of schedule. While this is a
tremendous achievement, continued efforts are needed. In 2012, 748 million people still
relied on unimproved drinking water sources.
Proportion of population using improved drinking-water sources. (2014). WHO | World
Health Organization. Retrieved September 24, 2014, from
http://gamapserver.who.int/gho/interactive_charts/mdg7/atlas.html?indicator=i0

6.

Human Development Report 2006: Overview of the Global Sanitation

Problem

Today, more than one in three people worldwide lack sanitation and rather more lack good
quality sanitation.ii The numbers lacking sanitation have grown considerably over the last
four decades despite universal provision for water and sanitation being a key goal in
development discussions since the early 1970s.iii Almost all of those lacking sanitation live
in low- and middle-income nations; most have low-incomes; most live in Asia (80 percent)
and Africa (13 percent).iv Without a rapid increase in the scale and effectiveness of
sanitation programmes, the MDG sanitation target for 2015 will be missed by at least half a
billion people and it is in the regions with the worst provision that progress is most
lacking.v As a result, hundreds of millions of people will suffer the indignity of having no safe
and convenient place to defecate. Tens of millions of people, most of them children, will
become ill, and many will die. This is a problem that will not be addressed without working
with the women, men, and children who lack provision, and supporting a range of choices
for provision for toilets and personal and household hygiene from which they find ones that
work for them. To stress the obvious - improved sanitation requires (often large numbers of)
women, men and children to voluntarily change their defecation habits. Improving sanitation
cannot work if what is provided is too inconvenient or too costly for them to use. The perfect
design for a pit latrine has limited value if women cannot use it safely 24 hours a day or
children are frightened to use it (because it is dark or because they are frightened of falling
into the pit). Well maintained communal or public toilets have limited value if they are not
open all the time or if they charge too much for low-income groups to afford to use them.
Flush toilets dont work if water supplies to flush them are intermittent. Ecological sanitation
will not return nutrients to the soil unless it is easy, convenient and cheap to get the
nutrients to crop-growers that want them.
Any improvement in provision for sanitation also has to compete successfully with
unimproved sanitation which is very cheap. Defecating in the open or into a plastic bag or
waste paper (wrap and throw) may seem very inappropriate forms of sanitation but they
are free of monetary cost and often involve little extra time. For most people, wrap and
throw can also be done within the privacy of the home, 24 hours a day. Sanitation provision
must also meet everyones needs, if open defecation or wrap and throw and their
contamination of the environment (and of food, water, clothes and hands) are to be avoided.
So this means having enough provision for sanitation to avoid queues for toilets at peak
periods which discourage people from using them.
http://hdr.undp.org/sites/default/files/satterthwaite_mcgranahan.pdf

7.

Comparative Quantification of Health Risks: Chapter 16: Unsafe

Water, Sanitation and Hygiene
Summary: The disease burden from unsafe water, sanitation and hygiene (WSH) is
estimated at the global level taking into account various disease outcomes, principally
diarrhoeal diseases. The risk factor is defined as including multiple factors, namely the
ingestion of unsafe water, lack of water linked to inadequate hygiene, poor personal and
domestic hygiene and agricultural practices, contact with unsafe water, and inadequate
development and management of water resources or water systems.
For estimating disease burden of infectious diarrhoea, exposure scenarios are established
according to water supply and sanitation infrastructure,the level of faecaloral pathogens in

the environment and populations assigned to these scenarios. The total burdens from
schistosomiasis, trachoma, ascariasis, trichuriasis and hookworm disease are all
wholly attributable to unsafe WSH and have been quantified at global level as an additional
exercise.
Unsafe WSH is an important determinant in a number of additional diseases, such as
malaria, yellow fever, filariasis, dengue, hepatitis A and hepatitis E, typhoid fever,
arsenicosis, fluorosis and legionellosis, some of which present a high disease burden at
global level.
For infectious diarrhoea, six exposure levels were defined, with the lowest risk level
corresponding to an ideal situation where WSH plays no role in disease transmission.
Exposure prevalence, in terms of infrastructure, was determined from the Global Water
Supply and Sanitation Assessment 2000. This assessment is a synthesis of major
international surveys and national census reports covering 89% of the global population.
The parameters considered included access to improved water sources and improved
sanitation facilities.
http://www.who.int/publications/cra/chapters/volume2/1321-1352.pdf

8.
25

Africa Public Health.info: Combined

Global and African Ranking Country Populations with the Least Sustainable Access to Improved/
Clean Water
Sources

Lack of clean water, sanitation & hygiene costs Sub-Saharan African countries more in lost
GDP than the entire continent gets in development aid.
Depending on the country & region, economic benefits
have been estimated to
range from US $3 to US $34 for each dollar invested in clean water and sanitation.
The 25 countries globally with least access to safe water (19 of them African) dominate
the top 50 countries with highest child mortality. Between 23% & 59% of children in these
countries suffer stunted growth; & between 43% & 91% of their populations have no access
to improved sanitation. Between 18% & 68% of their populations live below the poverty line.
1.6 million people die every year from just diarrhoeal diseases (including cholera)
attributable to lack of access to safe drinking water & basic sanitation. 90% of these are
children under 5, mostly in developing countries.
An estimated 160 million people are infected with schistosomiasis/ bilharzia (parasitic
disease from flatworms) causing tens of thousands of deaths annually; About 500 million
people are at risk of trachoma from which 146 million are threatened by blindness, & 6
million are visually impaired.
Where water is not available on premises & has to be fetched, women/girls are about two
and a half times more likely than men/boys to be main water carriers for families.
It is estimated that women in low-income countries spend 40 billion hours annually
fetching and carrying water from sources that may not even provide clean water.
In the UK, massive investment in water & sanitation infrastructure in the 1880s
contributed to a 15 year increase in life expectancy within four decades.
Hygiene promotion is the most cost effective health intervention, but the 2015 goal to
halve the proportion of people living without sanitation is about 150 years behind schedule.

http://www.who.int/pmnch/media/news/2012/201205_africa_scorecard.pdf

9.

WASH: Water, Sanitation, and Hygiene: Sanitation and Hygiene

Promotion
This document is about setting in place a process whereby people (women, children and
men) effect and sustain a hygienic and healthy environment for themselves. It talks about
developing a programme for more effective investment in sanitation and hygiene promotion.
It is not about developing projects and it does not give blue-print solutions for project-level
interventions. Rather it lays out a process for long-term change which may encompass
institutional transformation of the policy and organizational arrangements for provision of
goods and services. This publication was produced jointly by WSSCC, WHO, LSHTM,
PAHO, UNICEF, USAID, WEDC and WSP.
http://www.who.int/water_sanitation_health/hygiene/sanhygpromo.pdf?ua=1

10.

The Joy of Learning: Participatory lesson plans on hygiene, sanitation,

water,health and the environment
The Joy of Learning: Participatory lesson plans on hygiene, sanitation, water, health and
the
environment is a guide for teachers and others who want to design participatory learning
activities on hygiene and sanitation as part of, or in addition to, their school curriculum or in
work with other children aged 2 to 14. The document is divided into two parts: theory and
lesson plans. The lesson plans are organised into three sections: hygiene (including
personal and food hygiene), sanitation and water. Each section contains a series of
information sheets for planning, implementing and evaluating participatory learning activities
on a specific subject. Examples include personal hygiene, the safe transport and handling
of water, protecting local water sources, and locally prevailing disease transmission routes.
The guide is characterised by its participatory methodology, the possibility of adjusting each
activity to local conditions and cultures, a combination of hygiene and health education with
more formal education goals, a focus on socio-psychological life skills such as cooperation
and mutual understanding, and the linking of learning activities in schools, homes and
communities. Activities require the exclusive use of no and low-cost materials which are
easily available and affordable.
http://www.clean-water-for-laymen.com/support-files/ircwashmaterials.pdf

11.

Knowledge, Attitudes, and Practices (KAP) of Hygiene among School

Children in Angolela, Ethiopia
Introduction
Poor hygiene practices and inadequate sanitary conditions play major roles in the increased
burden of communicable diseases within developing countries. This study evaluated the
knowledge, attitudes, and practices (KAP) of hygiene among rural school children in

Ethiopia and assessed the extent to which proper knowledge of hygiene was associated
with personal hygiene characteristics.

Methods
This cross-sectional study was comprised of 669 students who were interviewed by trained
staff. Participants were in grades 1-6 at Angolela Primary School, located in rural Ethiopia.
Data consisted of hygiene and hand washing practices, knowledge about sanitation,
personal hygiene characteristics, and presence of gastrointestinal parasitic infection.
Results
Approximately 52% of students were classified as having adequate knowledge of proper
hygiene. Most students reported hand washing before meals (99.0%), but only 36.2%
reported using soap. Although 76.7% of students reported that washing hands after
defecation was important, only 14.8% reported actually following this practice. Students with
adequate knowledge of proper hygiene were more likely to have clean clothes (AOR 1.62,
CI 1.14-2.29) and to have a lower risk of parasitic infection (AOR 0.78, CI 0.56-1.09)
although statistical significance was not achieved for the latter.
Discussion and conclusion
Study findings underscore the need for more hand washing and hygiene education in
schools; and provide objective evidence that may guide the development of comprehensive
health and hygiene intervention programs in rural Ethiopian schools. Successful
implementation of these programs is likely to substantially attenuate the transmissible
disease burden borne by school children in rural settings.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075961/

12.

WHO takes urgent action to address health situation in Kulle SouthSoudanese Refugee Camp, Gambella in Ethiopia
Kulle Refugee Camp in Gambella Region, western Ethiopia, currently hosts about 35,000
of the 97,000 refugees from South Sudan taking shelter in three camps in the region.
Almost 66 per cent of the refugees in Kulle are women and children. The WHO assessment
team led by the WHO Representative comprising technical experts in emergency and
outbreak response, malaria, water and sanitation, immunization, and communication,
witnessed the concerning health conditions at the camp on 22 April 2014 whilst assessing
the situation to urgently intensify WHO technical support.
http://www.afro.who.int/en/media-centre/pressreleases/item/6490-who-takes-urgent-actionto-address-health-situation-in-kulle-south-soudanese-refugee-camp-gambella-inethiopia.html
WHO takes urgent action to address health situation in Kulle South-Soudanese Refugee
Camp, Gambella in Ethiopia. (n.d.). Retrieved October 23, 2014, from
http://www.afro.who.int/en/media-centre/pressreleases/item/6490-who-takes-urgent-actionto-address-health-situation-in-kulle-south-soudanese-refugee-camp-gambella-inethiopia.html

13.

Trainees Participatory Hygiene and Sanitation Promotion Manual

Lack of adequate knowledge and awareness on the effect of poor sanitation and hygiene is
contributing to high mortality and morbidity rates due to faeco-oral diseases especially
amongst
children. This could be attributed to lack of quality training materials and inappropriate
approaches being adopted by sector professionals. The low level of awareness on hygiene
is a
major area of concern highlighted in various evaluations that were conducted between 2004
and
2007 including the Output to Purpose Review (OPR) of DFID. Part of the OPR
recommendations was the need to harmonize all the existing Hygiene and Sanitation
promotion
manuals to develop a quality manual that would facilitate improved hygiene and sanitation
behaviour change and ensure achievements of programme objectives in a sustained
manner.
http://www.washinschoolsmapping.com/projects/pdf/Nigeria4BTraineesHygiene.pdf

14.

The Violet Jabara Charitable Trust

The Trust makes grants to organizations which work in developing countries in the Middle
EastLebanon, Jordan, Syria, Iraq, Iran, Palestine (Occupied Territories), Yemen, Egypt
and North Africa.
Within this geographic focus, the Trust welcomes innovative ideas in the fields of
international economic development (including, but not limited to, health, environmental
issues, peace initiatives, microfinance, social entrepreneurship, education), as well as all
aspects of reproductive health and womens welfare.
http://foundationcenter.org/grantmaker/jabara/grants.html

15.

Complete travel health information, updated daily, for physicians and

travelers: Ethiopia
Summary of recommendations
http://www.mdtravelhealth.com/destinations/africa/ethiopia.php

Section 3: Synthesis of the Literature

7. What is the need for our mission?

The need is to increase personal hygiene in Ethiopia.

According to the highlight on access to safe drinking water: The MDG drinking water target,
which calls for halving the proportion of the population without sustainable access to safe
drinking water between 1990 and 2015, was met in 2010, five years ahead of schedule.
Ethiopia is the lowest ranked and a tremendous achievement, continued efforts are
needed. (WHO, 2014)
A number of challenges and barriers to good hygiene exist in less developed countries.
The greatest of these challenges is the lack of clean water. (CDC, 2012)
UNICEF supports the consolidation and use of knowledge about best practice in providing
the poor with sustainable WASH services. Where it has the means and a comparative
advantage it will seek to support sector learning platforms in the identification of priority
national knowledge needs, and in filling these needs through activities funded both by
UNICEF and other external support agencies. (HDR)
Today, more than one in three people worldwide lack sanitation and rather more lack good
quality sanitation. (Satterthwaite, D., & McGranahan, G., 2006)
The disease burden from unsafe water, sanitation and hygiene (WSH) is
estimated at the global level taking into account various disease outcomes, principally
diarrhoeal diseases. The risk factor is defined as including multiple factors, namely the
ingestion of unsafe water, lack of water linked to inadequate hygiene, poor personal and
domestic hygiene and agricultural practices, contact with unsafe water, and inadequate
development and management of water resources or water systems. (Prss-stn,
A., Kay, D., Fewtrell, L., & Bartram, J. (2004))
1.6 million people die every year from just diarrhoeal diseases (including cholera)
attributable to lack of access to safe drinking water & basic sanitation. 90% of these are
children under 5, mostly in developing countries. (Africa Public Health Info., n.d.)
Study findings underscore the need for more hand washing and hygiene education in
schools; and provide objective evidence that may guide the development of comprehensive
health and hygiene intervention programs in rural Ethiopian schools. (Vivas, A., Gelaye, B.,
Aboset, N., Kumie, A., Berhane, Y., & Williams, M. A. (2011).
8. What is the way we will theoretically define personal hygiene?
According to CDC personal hygiene refers to acts that can lead to good health and
cleanliness, such as frequent hand washing, face washing, and bathing with soap and water
through the process of self-care (CDC, 2012).
Self-care is defined as a process whereby someone functions on his/her behalf in Health
Promotion and prevention and in disease detection and treatment at the level of primary
health resource in the healthcare system. Health Promotion is the process of enabling
people to increase control over, and to improve, their health. Five key strategies for health
promotion action in the charter are building healthy public policy, creating supportive
environments, strengthening community action, developing personal skills and reorienting
health services (Kumar).

8a. How can we model the theoretical definition for personal hygiene.
Taken from Implementing the SAFE Strategy for Trachoma Control, this image
shows how the Behavior Change model can be used to show the progression of
personal hygiene promotion and awareness. (Emerson, 2006)
(Emerson)

9. A test is valid if it measures what it says it will measure.

We will test the personal hygiene of Ethiopia through a survey of the following
measurements:
Hygiene Practices: Taking baths, brushing teeth, feet washing, wash or change
clothes, and washing hair.
Knowledge, attitudes and practices of sanitation: Washing hands kills germs, boiling
water kills germs, boiled drinking water yesterday, water container needs cleaning
and covering, human feces contains germs, materials used for anal cleaning,
materials used for bathing, and materials used for cleaning teeth.
Hand washing practices: Washed hands day prior to interview, reasons for washing
hands (after defecation, before or after meals), materials used for hand washing,
usually wash hands before meals?, usually wash hands after meals?, when do you
prefer to wash hands? (before or after meals), and which do you think is important?
(washing after defecation, washing before eating meals, washing after eating meals).
Observe personal hygiene characteristics: Clean clothes, fingernails clean,
fingernails trimmed, clean face, eye discharge present, and clean hair.

Knowledge of Menstruation: Understanding concepts of menstruation. (KAP)

Table 1. Personal and Hygiene Practices

Characteristics

Total

Percentage (%)

Hygiene Practices
Taking baths
1-7 days
7-14 days
>14 days
Brushing teeth
1-7 days
7-14 days
>14 days
Feet washing
1-7 days
7-14 days
>14 days
Washing/changing clothes
1-7 days
7-14 days
>14 days
Washing and Brushing Hair
1-7 days
7-14 days
>14 days
Table 2. Knowledge, Attitude and Practices
Characteristics
Washing hands prevents illnesses/disease
No

Total

Percentage (%)

Yes
Dont Know
Boiling water kills germs
No
Yes
Dont know
Boiled drinking water yesterday
No
Yes
Water container needs cleaning and covering
No
Yes
Dont know
Human feces contains germs
No
Yes
Dont know
Materials used for anal cleaning
Paper
Leaf
Stone
Grass
Water
Nothing
Other
Proper latrine use
No
Yes
Dont know

Materials used for bathing

Soap
Water only without soap
Other
Materials used for cleaning teeth
Twigs
Water only
Other
Table 3. Hand washing practices
Characteristics
Washed hands day prior to interview
No
Yes
Reasons for washing hands
After defecation
Before meals
After meals
Materials used for hand washing
Soap and water
Water only
Usually wash hand before meals?
No
Yes
Usually wash hands after meal?
No
Yes
When do you prefer to wash hands?
Before eating meals
After eating meals

Total

Percentage (%)

Dont know
Which do you think is important?
Washing after defecation
Washing before eating meals
Washing after eating meals
Table 4. Observed personal hygiene characteristics
Characteristics

Total

Percentage (%)

Clean Clothes
No
Yes
Fingernails clean
No
Yes
Fingernails trimmed
No
Yes
Clean face
No
Yes
Eye discharge present
No
Yes
Clean Hair
No
Yes
Table 5. Knowledge and sanitation of Menstrual Cycle
Characteristics

Knowledge of Menstruation
No
Yes

Total

Percentage (%)

(KAP)
Evaluation of Data:
Table 1. Evaluation will be determined by the scale of:
1-7 days = Good
7-14 days = Adequate
>14 days = Poor (KAP)
Table 2, 3, and 4. We will be comparing with a neighboring Ethiopian community not
undergoing the program as a control group.
9a. Test Validity: Our test has content validity, that is, it actually measures
personal hygiene per the theoretical definition of personal hygiene.
We will perform tests on health and cleanliness by evaluating each attribute such as
hygiene practices, including hand washing, face washing, and bathing which is part
of the theoretical definition of personal hygiene. We will evaluate the attributes of
self-care by observing personal hygiene characteristics, the knowledge and
practices of sanitation and prevention and disease detection. To test the validity of
health promotion we will perform this test when we first arrive, and after two weeks
raising awareness and educational strategies, and then compare. We will compare
these test results with a comparable Ethiopian community to evaluate the test
accuracy.
9b. Test reliability is test consistency.
A test is reliable when the validity of a test is consistent. To have overall consistency
of a measurement we will perform the pre-test when we arrive to assess the
awareness of personal hygiene in the Ethiopian community. After the personal
hygiene program we will provide the community we will then assess the same
participants with the same test and compare the results. If the overall percentage
has risen a significant amount, <10%, then our testing was effective. We will then
continue the same methods in another Ethiopian community.
9c. Measurable objectives for personal hygiene.
1. The Ethiopian community will gain at least <10% overall knowledge in hygiene and
sanitation and perform self-care strategies within a two week intervention.
2. The Ethiopian community to be at 100% in performing proper hand washing
practices within the two week intervention.
3. The Ethiopian community to be at 80-90% educated of Knowledge, Attitude and
Practices of personal hygiene within the two week intervention.
4. 80-90% of the Ethiopian community to be at the advocacy behavior to continue to
proper self-care strategies of personal hygiene within a two week intervention.
5. Everyone in the Ethiopian community has access to a sanitized latrine by the end of
the two week intervention.

Section 4: Programming Planning an Evidence Based Program

and Implementation Plan
10. Based on the literature review, which program model from will you use? Identify
the model and then identify the steps in the model. Then, right next to it, show how

you will adapt the model for your content or time needs. Please go into very specific
detail about what your program is, WHAT YOU WILL COVER, and how you will
implement it. THIS IS THE PROGRAM YOU WILL USE TO TRY TO CHANGE YOUR
DV IT IS IMPORTANT THAT YOU FLESH IT OUT IN DETAIL. MAKE SURE YOU
FOLLOW THE MODEL COMPLETELY.

We will be implementing our own program called Self Care in Africa For Immunity
(SAFI). Safi is a native Swahili word for clean. We organized our model with the Logic
model and based our program material off of WASH program model and The Joy of
Learning lesson plans. Additional material came from SAFE Strategy for Trachoma
Control: A Toolbox of Interventions for Promoting Facial Cleanliness and Environmental
Improvement.
The SAFI program will be a two week long program in which we will go into a
selected Ethiopian community to educate the locals on self-care strategies to increase
awareness of personal hygiene.
1. Two weeks will be broken up into three steps:
1. Pre-test (Days 1-2) - Observation of program group community
and control group community, pretest both communities on
Hygiene Practices, Knowledge, attitudes and practices of
sanitation, Hand washing practices, and Observe personal hygiene
characteristics test, and Social Cognitive Theory survey.
2. Intervention (Days 3-12) - On these days we will be using some of
the WASH Materials lesson plans. For personal hygiene - Clean is
beautiful, hand washing - I am a well washer, related diseases The WASH song and Showtime, menstruation sanitation - My
Changing Body, safe water consumption/collection - Whats in your
water?, I drink...safe water!, and Filtering the Flow, defecation - The
six Fs. As well as the lesson plans, we will also be building latrines
and training teachers in the community to continue to educate the
community after the program is through. (Trainees)
3. Post-test (Days 13-14) - Observation of program group community
and control group community, post-test both communities on
Hygiene Practices, Knowledge, attitudes and practices of
sanitation, Hand washing practices, and Observe personal hygiene
characteristics test, and Social Cognitive Theory survey. Then
compare the pretest to the post-test to both communities to see if
there was an increase in knowledge on the taught subject and if

self care strategies are increased.

Sanitation and Hygiene promotion Guide by WASH

11. What apps are out there that would help us with our programming?

Water Supply, Sanitation and Hygiene Promotion (WASH): Water Supply

Mobile App:
Water is essential for life, health and human dignity. In extreme situations, there may not be
sufficient water available to meet basic needs and in these cases supplying a survival level
of safe drinking water is of critical importance. In most cases, the main health problems are
caused by poor hygiene due to insufficient water and by the consumption of contaminated
water. The Water Supply, Sanitation and Hygiene Promotion (WASH): Water Supply mobile
app covers key actions, key indicators and guidance notes for Access and water quantity,
Water quality and Water facilities. A Canvas template is a copy of a Canvas mobile app that
does not transmit down to a mobile device, but can act as a starting point for a new Canvas
mobile app.
http://www.gocanvas.com/mobile-forms-apps/11736-Water-Supply-Sanitation-and-HygienePromotion-WASH-Water-Supply

GOAL Syria Hygiene Promotion Assessment by Max

Izenberg:Survey used by the GOAL Syria hygiene promotion unit
as a baseline to understand hygiene practices prior to the
hygiene promotion activities.
The Hygiene Assessment will be conducted by the Hygiene Promotion branch of GOAL
Syria WASH Program team. GOAL Syria, as part of their WASH programming, is
rehabilitating and refurbishing two major water mains in Idleb Governorate, Northern Syria,
in coordination with the local Syrian water units.
https://www.commcarehq.org/exchange/e2bd73a7448214e2ae84d1c72c670e2d/info/
12. First do NO harm and then do good. What safety considerations for your program
are there? Explain. Include forms, liability waiver, PARQ, etc. if appropriate.
For students involved in going to Ethiopia they will have to complete the Faculty-Led Study
Abroad Application. This includes liability waivers, emergency contact information, health
and emergency agreements, the students statement of rights and responsibilities, and dean
of students release form. Then they will complete NMU Health Center Travel Information
Form and undergo a travel visit appointment at the Health Center to speak with physician in
event you need vaccines and medical issues.

Malaria: Prophylaxis with Lariam (mefloquine), Malarone

(atovaquone/proguanil), or doxycycline is recommended for all areas except
Addis Ababa and altitudes above 2000 m (6561 ft).
Vaccinations:

Hepatitis A

Recommended for all travelers

Typhoid

Recommended for all travelers

Yellow fever

Recommended for all travelers, except that travelers whose itinerary is

limited to the Afar and Somali Provinces need the vaccine only if at risk
for a large number of mosquito bites

Polio

One-time booster recommended for any adult traveler who completed

the childhood series but never had polio vaccine as an adult

Hepatitis B

Recommended for all travelers

Rabies

For travelers spending a lot of time outdoors, or at high risk for animal
bites, or involved in any activities that might bring them into direct
contact with bats

Measles, mumps, Two doses recommended for all travelers born after 1956, if not
rubella (MMR)
previously given
Tetanusdiphtheria

Revaccination recommended every 10 years

(http://www.mdtravelhealth.com/destinations/africa/ethiopia.php)
During classroom time we will conduct a training involving risk reduction. This will involve
food and water precautions, insect and tick protection, swimming and bathing precautions,
and general advice regarding embassy/consulate location and safety information.
13. Social Cognitive Theory Light says people are more likely to engage the
prescribed program behaviors if they know what to do (change the dv), know how to
do it (enact your program), want to do it (are motivated), believe they can do it (have
good self-efficacy), and have a supportive environment. How would you determine
that:
Your tp knows what to do?
Your tp knows how to do it?
Your tp wants to do it (is motivated)?
Your tp believes it can do it (is self-efficacious)?
Your tp has a supportive environment?

Questions

Strongly

Agree Undecided Disagree Strongly

Agree

Disagree

There is no personal hygiene

problem.
I am aware of personal hygiene
techniques and understand them.
I approve of personal hygiene
techniques but I am not sure Im
ready to try them.
I have motivation to practice
personal hygiene techniques.
I believe in myself to practice
personal hygiene techniques.
I see the benefits of these
personal hygiene techniques and
have the supportive environment
to show them to others.

HL 367 Sections 5-9: Please place section in middle of page and then add questions
and bold them and then answer them.
Section 5: EVALUATION Design/Mission Fit
12. What evaluation design will you use? Please show it in Os and Xs and label
each group if you use a control group (e.g., program group or control group) and
label what each O and X is. Document whose program model you are following.
We are using the Pretest-Posttest Control Group Design. We are using this so we know that
our program is the reason for the Ethiopian community to have an increase in their
knowledge of self-care strategies through our SAFI Program.

Program
Group

Pretest
Hygiene Practices,
Knowledge, attitudes and
practices of sanitation,
Hand washing
practices, and Observe
personal hygiene
characteristics test.

Intervention
Two week SAFI
Program meeting
daily
(WASH Guide)

Social Cognitive Theory

survey.
O
Control
Group

Hygiene Practices,
Knowledge, attitudes and
practices of sanitation,
Hand washing practices,
and Observe personal
hygiene characteristics test.
Social Cognitive Theory
survey.
O

Post-test
Hygiene Practices,
Knowledge, attitudes and
practices of sanitation,
Hand washing
practices, and Observe
personal hygiene
characteristics test.
Social Cognitive Theory
survey.
O

X
Hygiene Practices,
Knowledge, attitudes and
practices of sanitation,
Hand washing
practices, and Observe
personal hygiene
characteristics test.
Social Cognitive Theory
survey.
O

13. Internal validity has to do with your ability to say that your
iv/intervention/program caused the change in the dv, and not something else. What
threats to internal validity accompany the evaluation design you selected in #10?
Identify and briefly explain please.
Specific threats that could affect the internal validity of our program would be:

Cultural differences or previous thoughts - If the Ethiopian communities have not

previously used the self care strategies
Education - The participants could not understand the information given to them by
the SAFI program.
Availability of products - If certain self care products are not available to the
communities they may be less apt to use the strategies taught.
Lack of clean water - if there is not enough clean water to practice these strategies
then the program will not be successful.
A disaster - This could be disease outbreak, war, or a climate phenomenon.

14. Evaluation in program planning is about mission fit. What is your mission fit
question and what is the evidence that you met your mission?

Did we increase awareness of personal hygiene in Ethiopian communities through

our SAFI self-care strategies?
Evidence to support that we met our mission fit question will be analyzed through our
testing and social cognitive theory light survey. We will make sure to compare in our
Pretest-Posttest Control Group Design, making sure that our program group improved their
self-care strategies and the control group did not.
Section 6: Marketing and Communication
15. How can you use social media or traditional media to market your program (make
your target population aware that it exists and make them want to come to the
program)? Develop at least one marketing tool related to your program and show it
and link to it. Please place your agency logo on the material.
To market our SAFI Program we will use different means of social and traditional
media. Such as, phone apps to connect our partnerships, staff and volunteers with
opportunities available. To fund our program we will use a funding site online and will be
able to share throughout NMU websites, Facebook, Twitter, and Emailing. Its important to
contact influential people in the Ethiopian community to guide us in the right direction in
need most so we will target them through email. In Ethiopian schools we can market our
program to other schools through posters and word of mouth.
16. How can you use social media or traditional media to communicate with the
members in your program about the program? Develop at least one communication
tool related to your program and show it/link to it. Please place your agency logo on
the material.
To communicate with our members about the program we will highly rely on emailing
and phone. The email will have a direct link to our website. We will also highly rely on
Facebook and Twitter to spread news, information, and opportunities. We can use
universities websites to connect prospective staff and volunteers.
https://www.facebook.com/pages/SAFI-Self-Care-in-Africa-ForImmunity/1554862581394251?fref=nf

Section 7: Granting Agency

17. Identify a granting agency to help you fund your program. It should have a similar
mission to yours and give its mission. Indicate the agency and the mission and tell
what the grant is and how it is compatible with your mission. Put in the granting
agency logo and link to the granting agency.

The Violet Jabara Charitable Trust makes grants to organizations

which work in developing countries in the Middle EastLebanon, Jordan, Syria, Iraq, Iran,
Palestine (Occupied Territories), Yemen, Egypt and North Africa. The mission of the Trust is
two-fold: to help improve the lives of the people in developing countries of the Middle East
and to foster greater understanding of Middle Eastern culture in the United States. Within
this geographic focus, the Trust welcomes innovative ideas in the fields of international
economic development (including, but not limited to, health, environmental issues, peace
initiatives, microfinance, social entrepreneurship, education), as well as all aspects of
reproductive health and womens welfare.(LINK)
Our program will need a grant to fund our materials which will cost us $5,000. The following
provides more details regarding the materials:
Latrines = $900 for 30 latrines
Soap, toothbrushes, etc. = ~$4,100 affecting ~10,000 people

Section 8: Webliography
Africa Public Health Info. (n.d.). Health & Social development - Research, Policy, Analysis,
& Info - from Africa & on Africa. Retrieved October 29, 2014, from
http://www.who.int/pmnch/media/news/2012/201205_africa_scorecard.pdf
Emerson, P., Frost, L., Bailey, R., & Mabey, D. (2006). Implementing the SAFE strategy for
trachoma control: a toolbox of interventions for promoting facial cleanliness and
environmental improvement. Atlanta, GA: Carter Center ; Retrieved September 24, 2014,
from
http://trachoma.org/sites/default/files/guidesandmanuals/TrachomaToolboxFinalEnglish.pdf
Human Development Report. (n.d.). Children and Water, Sanitation and Hygiene: The
Evidence. Retrieved October 29, 2014, from
http://hdr.undp.org/sites/default/files/unicef.pdf
Khanal, S., Mendoza, R., Phiri, C., Rop, R., Snel, M., & Wijk, C. V. (2005). The Joy of
Learning. Delft: IRC International Water and Sanitation Centre. Retrieved from
http://www.clean-water-for-laymen.com/support-files/ircwashmaterials.pdf
Kumar Bhuyan, K. (2004). Health promotion through self-care and community participation:
Elements of a proposed programme in the developing countries (Vol. 4). London: BioMed
Central. Retrieved September 24, 2014, from http://www.biomedcentral.com/14712458/4/11
MD Travel Health - Ethiopia - vaccinations, malaria, safety, and other medical advice. (n.d.).
MD Travel Health - Ethiopia - vaccinations, malaria, safety, and other medical
advice. Retrieved October 29, 2014, from
http://www.mdtravelhealth.com/destinations/africa/ethiopia.php
Prss-stn, A., Kay, D., Fewtrell, L., & Bartram, J. (2004). Unsafe water,
sanitation and hygiene. Comparative Quantification of Health Risks (pp. 13211334). Geneva: WHO. Retrieved October 29, 2014, from
http://www.who.int/publications/cra/chapters/volume2/1321-1352.pdf
Proportion of population using improved drinking-water sources. (2014). WHO | World
Health Organization. Retrieved September 24, 2014, from
http://gamapserver.who.int/gho/interactive_charts/mdg7/atlas.html?indicator=i0
Sanitation and hygiene promotion: Programming guidance. (2005). Geneva: Water Supply
and Sanitation Collaborative Council, International Environment House.
Retrieved October 29, 2014, from
http://www.who.int/water_sanitation_health/hygiene/sanhygpromo.pdf?ua=1

Satterthwaite, D., & McGranahan, G. (2006). Human Development Report: Overview of

the Global and Sanitation Problem. n.a.: United Nations Development Programme.
http://hdr.undp.org/sites/default/files/satterthwaite_mcgranahan.pdf
The Violet Jabara Charitable Trust :: Recent Grants. (n.d.). The Violet Jabara Charitable
Trust :: Recent Grants. Retrieved October 29, 2014, from
http://foundationcenter.org/grantmaker/jabara/grants.html
Trainees Participatory Hygiene and Sanitation Promotion Manual. (2008). Nairobi:
UNICEF. Retrieved October 29, 2014, from
http://www.washinschoolsmapping.com/projects/pdf/Nigeria4BTraineesHygiene.pdf
Vivas, A., Gelaye, B., Aboset, N., Kumie, A., Berhane, Y., & Williams, M. A. (2011).
Knowledge, Attitudes, and Practices (KAP) of Hygiene among School Children in
Angolela, Ethiopia. PMC, 1. Retrieved October 29, 2014, from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075961/?report=classic
Water-related Hygiene: Hygiene Challenges and Resources in Less Developed Countries.
(2012, March 22).Centers for Disease Control and Prevention. Retrieved September 24,
2014, from http://www.cdc.gov/healthywater/hygiene/ldc/hygiene_challenges.html
WHO takes urgent action to address health situation in Kulle South-Soudanese Refugee
Camp, Gambella in Ethiopia. (n.d.). Retrieved October 23, 2014, from
http://www.afro.who.int/en/media-centre/pressreleases/item/6490-who-takes-urgent-actionto-address-health-situation-in-kulle-south-soudanese-refugee-camp-gambella-inethiopia.html

Section 9: Reflection: Please write a combined 1 - 2 page reflection piece on how this
project helped:
1) your professional growth relative to the program plan/eval process (do you think you can
assess a general need to have a warrant for proceeding, a specific need to identify
measurable objectives, find an evidence-based program, implement it, and then evaluate?);
After completing this project we now can assess a general need in a specific target
population with an evidence based approach. We now understand the importance of a wide
variety of credible literature when supporting our need. Based off the general need we
became knowledgeable of creating goals and measurable objectives and how they differ
from each other. Our analytical skills improved through the planning process to identify
measurable objectives to allow us to have a valid implementation and evaluation in regard
to our program. We learned the importance of the control group is key to understanding
internal and external threats that could affect implementation. Using a control and program
group we can evaluate the validity of our program.
Starting this project we had minimal experience with program planning. This project has
given us the proficiency to make a change in our passionate field, as well as the awareness
of key concepts and important steps to complete a successful implementation. In our future

careers as health educators this project has given us an in depth experience that allow us to
work at a more professional level.
2) how has this project helped your independent/self-directed learning,
With minimal direction in program planning it forced us to realize the importance of
independent/self-directed learning. Managing our time we found many credible sources that
werent commonly used in the classroom that enable a paradigm shift to our current learning
approach. We relied on evidence-based programs and research to guide us in the right
direction.
3) how has this project helped your critical thinking (determining what research is valid, and
finding/using valid materials); and
During this project our critical thinking was a very important factor while developing a
program plan. Our critical thinking skills improved when synthesizing our research to use
appropriate material for an effective program. Using valid research we were able to make
clear, concise decisions about what would be best for our individualized approach.
4) how has this project helped collaborative learning working with others to achieve
common goals..
This project has brought together two passionate individuals regarding global health to
initiate a change in the world. It is very important when working with others to have mutual
values and goals. Sharing experiences, skills, and ideas we were able to gain knowledge
from each other to reach our goal. As a team we improved our problem solving skills
through realizing threats/barriers that could affect our project, and overcome those hurdles
them through alternative solutions. It would have been very difficult to complete this project
individually because of what each of us were able to contribute to the task as a whole.