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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 251-257

Impact of swachh bharat summer internship by medical students at a village in Trichy, Tamil Nadu


Department of Community Medicine, Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India

Date of Submission23-Dec-2019
Date of Decision25-Jan-2020
Date of Acceptance16-Apr-2020
Date of Web Publication28-Jul-2020

Correspondence Address:
Dr. Prabha Thangaraj
Department of Community Medicine, Trichy SRM Medical College Hospital and Research Centre, Irungalur, Trichy - 621 105, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_124_19

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  Abstract 


BACKGROUND: Inadequate sanitation and hygiene is one of the important public health issues in rural communities of India. Swachh Bharat Gramin was initiated by the Government of India to accelerate sanitation services in rural areas. Recently, Swachh Bharat Summer Internship (SBSI) program was introduced to involve students of higher educational institution to contribute 100 h of service for cleanliness activities and mass awareness creation in villages. The objective of this study was to assess the impact of SBSI activities by medical students at a selected village in Trichy district.
MATERIALS AND METHODS: Under SBSI program, a community-based educational intervention study was done in a rural area of Trichy district from May to July 2018. The intervention was provided by a team of medical students to about 1600 individuals residing in the village. Among them, 100 individuals were included in pre- and posttest survey to assess the impact of intervention. The activities include Information, Education, and Communication, community mobilization, and participation to prevent open-air defecation (OAD), promote handwashing, and proper solid waste management. The Chi-square test was used to compare baseline and postintervention results.
RESULTS: In baseline survey, 45% have ever heard about Swachh Bharat Mission (SBM), 58% were practicing OAD, and 55% were unaware about waste segregation at household level. Awareness on SBM, waste segregation at household, and practice of handwashing improved in postinterventional survey (P < 0.05). Among the study population, 62% were motivated by our activities to change their behavior toward better sanitation.
CONCLUSION: The internship program improved the knowledge and behavior on sanitation at the rural community, and it also provided a learning opportunity for medical students.

Keywords: Health education, open-air defecation, rural, sanitation, Swachh Bharat Mission


How to cite this article:
Hemalatha K, Thangaraj P. Impact of swachh bharat summer internship by medical students at a village in Trichy, Tamil Nadu. Int J Health Allied Sci 2020;9:251-7

How to cite this URL:
Hemalatha K, Thangaraj P. Impact of swachh bharat summer internship by medical students at a village in Trichy, Tamil Nadu. Int J Health Allied Sci [serial online] 2020 [cited 2020 Aug 6];9:251-7. Available from: http://www.ijhas.in/text.asp?2020/9/3/251/290710




  Introduction Top


The Sustainable Development Goals (SGDs) was launched by the United Nations in 2016 with a universal call to all nations to end poverty worldwide and protect the planet.[1] Goal 6 of the SGDs aims to achieve universal access to safe drinking water and adequate sanitation and hygiene to all by 2030. The proportion of Indian households with access to improved water source increased from 68% in 1993 to about 90% in 2016. However, only 37% of rural households and 80% of urban households had improved sanitation facilities in 2015–2016.[2] World Bank statistics shows that 40% of India's population (520 million) practice open-air defecation which is the highest in the world.[3] Keeping this in view, the Government of India launched the swachh bharat mission (SBM) with the objectives of eliminating open-air defecation (OAD) and improving sanitation practices among the rural residents. The World Bank appreciated the efforts and provided the financial support in implementing the project.[4]

As a part of SBM, Swachh Bharat Summer Internship (SBSI) 2018 for students of higher education institutions was announced by the Ministry of Human Resource Development in association with the Ministry of Drinking Water and Sanitation for 100 h of Swachhata activities in villages. The objective of the internship was to involve youth across the country to improve rural sanitation. Internship activities under SBSI were classified under two categories: Information, Education, and Communication (IEC) and Solid Waste Management (SWM).[5] The present study has been done with the aim of assessing the impact of the internship activities done by medical students at a selected village in Trichy district.


  Materials and Methods Top


A team of 10 students (second-year MBBS) registered online for SBSI program under the guidance of Nodal Officer from the Department of Community Medicine, Trichy SRM Medical College Hospital and Research Centre. This was approved by the parent institution, and necessary logistic arrangement was made. [Figure 1] depicts the study methodology.
Figure 1: Flow diagram showing the study process

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Study design and setting

The study village Seedevimangalam was randomly selected from the available list of 30 villages under Manachanallur block, Trichy district, in the SBSI website. The village has about 450 households with a total population of 1625 and located at a distance of 23.4 km from Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamil Nadu.

Sample size and sampling method

For assessment of baseline details and impact of postinterventional activities, 20% of the households were included in the survey. The sample size was calculated to be 100 households including 10% of nonresponse rate. However, the interventional activities were done for the entire village. We divided the village into 5 sectors for sampling purpose, and 20 households from each sector were selected by nonprobability sampling method. We included adults aged more than 18 years available at the household during the time of visit. If more than one adult was present, the eldest person among them was surveyed.

Study period

Baseline survey was done in May 2018 before implementation of SBSI activities. Students planned various interventional activities and visited the village on several occasions during the months of May to July 2018. Postinterventional survey was conducted 2 weeks after the intervention activities.

Data collection tool

A semi-structured questionnaire was prepared for the baseline survey and pilot tested among five households, following which content validation was done by the guide. In a similar manner, postinterventional questionnaire was also prepared. The questionnaire contained questions to assess the individual's knowledge and source of information about SBM, handwashing practices, awareness on waste segregation and disposal methods, defecation practices, and major sanitation-related issues in their village to assess their felt need and plan the interventional activities.

Interventional activities

Following the baseline survey, students planned several activities to promote better sanitation practice in the village. Most of these activities were based on the suggested list of activities in the SBSI website.[5] Brief description of the activities conducted as part of SBSI:

1. Activities conducted at the community

  1. Door-to-Door visit: Students prepared booklet with pictures and information on dos and don'ts to maintain good sanitary practices. Key messages delivered were: avoid OAD, follow handwashing with soap before eating and after defecation, household-level waste segregation into dry and wet waste, avoid indiscriminate disposal of waste, and benefits of clean surrounding
  2. Rally: Two rallies were conducted on different days to cover the entire village. School students accompanied the medical students in conducting the rallies. Banners and placards were prepared for the purpose. Slogans were chanted in the local language (Tamil) giving key messages such as “Avoid plastics and save the fertility of soil,” “Do not litter on streets,” “Let's construct toilet in each and every house,” and “Having clean surrounding means leading hygienic life”
  3. Movie screening: Members from the household were gathered in the streets and short films of 10–15 min duration were screened in the local language (Tamil) to create awareness on sanitation and hygiene
  4. Street play: Three street plays were performed in different locations of the village to sensitize the community members on harmful effects of OAD and improper handwashing
  5. Wall painting: Walls from two main streets were chosen for wall paintings to increase visibility among the community members. The walls covered were that of primary school, middle school, and village administrator's office. A total of 8 walls were painted – 5 walls with pictures and 3 with slogans on themes relating to Swachhta
  6. Street cleaning: Three streets were cleaned by the medical students along with sanitary workers and community members. This activity was undertaken to motivate the villagers to keep their surroundings clean
  7. Drainage cleaning: Four drainages in the village were cleaned with the help of panchayat workers to prevent stagnant water that could promote mosquito breeding
  8. Waste segregation and transportation of solid waste: Charts were used to disseminate information on waste segregation as dry and wet waste. Demonstration of the same was done to promote waste segregation at household level. The students sensitized the sanitary workers on the importance of waste segregation, daily collection, transport, and appropriate disposal
  9. Construction of compost pit: Two compost pits of 3 × 3 × 3 feet were constructed near the waste disposal area of the village to encourage proper disposal of biodegradable waste and manure production
  10. Biogas installation plan: Model plan of biogas plant was prepared and explained by the students to the panchayat leader and village administrative officer.


2. Activities conducted at Government Primary and Secondary School

  1. Drawing competition and speech competition on the theme “Clean India” was conducted, and prizes were distributed to the winners
  2. Health education on better sanitation practices
  3. Handwashing technique was demonstrated to the school students, and we supervised them perform the same
  4. Skit was performed to enlighten students on the harmful effects of OAD.


3. Activity conducted at Integrated Child Development Services center.

  1. Health education on sanitation was given to the mothers along with their children available at the center using flipcharts.


Analysis

Data entry was done in MS excel and analysis in SPSS Version 21 (IBM Corp., Armonk, NY, USA). Descriptive data were expressed in frequency and percentage. The Chi-square test was used to compare the baseline and postintervention results, and P < 0.05 was considered to be statistically significant.


  Results Top


Majority of the households (85%) had their monthly income directly or indirectly from agriculture. About 45% had owned at least one domestic animal at home. The sociodemographic profile of the surveyed individuals is given in [Table 1].
Table 1: Sociodemographic details of study population (n=100)

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Only 45 individuals had ever heard about SBM during baseline survey, and the most common source of information was television (80%). The other sources were newspaper (13.3%), radio (8.8%), and posters (8.8%). Among these 45 individuals, only 14 (31.1%) correctly identified the two objectives of SBM. Among the households visited, 58% practiced OAD and 55% were unaware about waste segregation at household level. About 68 individuals perceived that their village is not clean mainly due poor drainage facility and practice of OAD [Table 2].
Table 2: Knowledge about Swachh Bharat Mission and sanitation practice among the surveyed population during baseline survey (n=100)

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During posttest survey, all the study participants said that they had heard about SBM and 65% were aware of both the objectives of SBM [Figure 2]. Among various SBSI activities that were conducted by the students in the village, the most known activity was rally (63%), followed by wall painting (47%), door-to-door campaign (43%), and street play (31%). Only 16% and 10% were aware about demonstration of waste segregation and street cleaning done by the students. Following our IEC activities, most of the villagers were motivated to adopt better sanitation practice [Figure 3], of which 51.6% were willing to construct latrine within their home premises [Table 3]. Postintervention survey showed a statistically significant improvement in awareness of SBM and waste segregation of solid waste at household level. There was also improvement in handwashing practices before eating and after defecation [Table 4].
Figure 2: Proportion of change in knowledge and practice regarding sanitation between baseline and postintervention surveys

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Figure 3: Proportion of individuals motivated toward change any of their behavior toward better sanitation due to Swachh Bharat Summer Internship activities

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Table 3: Aspects of sanitation measures that individuals are motivated to change following our Swachh Bharat Summer Internship activities in the village (n=62)

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Table 4: Statistical analysis of change in proportion of knowledge of Swachh Bharat Mission and sanitation practice between the baseline and postintervention surveys

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  Discussion Top


In our study, 45% of the individuals had ever heard about SBM, while few other studies done in rural areas found that 24%, 62.2%, and 93.62% were aware of SBM.[6],[7],[8] There is a wide difference in awareness on SBM among these studies. Among the study participants who were aware of SBM, 31.1% knew both the objectives of SBM, whereas in a study done in Telangana,[7] 82.84% knew both the objectives correctly.

The prevalence of OAD among the study participants was 58%. The practice of OAD reported by previous researches ranges from 23.2% to 90%.[7],[9],[10],[11],[12] Although 72% of the participants were aware about the harmful effects of OAD, only 42% were using sanitary latrines. Nonwillingness to use toilet is the most common reason for OAD practice. This indicates that changing their attitude toward toilet usage should be given priority among all other interventions. More than 50% of the participants belonged to Class IV and V socioeconomic status in the present study. However, only 13% of the total study participants stated financial issue as the reason for OAD practice. This could probably be due to the availability of government funds for toilet construction. In the present study, harmful effects of OAD were known to 72% of the study group. Panda et al.[9] and Anuradha et al.[10] had reported that 65.2% and 87.2% of the individuals, respectively, were not aware that OAD practice may lead to spread of various diseases in their studies.[9],[10] In our study, 75% had habit of washing their hands with soap after defecation, which was better compared to other studies where the practice was reported among 69.81% and 14.4% of the study participants in Telangana and Andhra Pradesh, respectively.[7],[11] About 68% of our study group were dissatisfied with the sanitary conditions of their village. Among various reasons stated by them, improper drainage system was the most common cause for poor sanitation. This reason was different from our perception during the transect walks in the village that OAD would have been the most important sanitation issue. This could be attributed to the fact that most of the individuals visit the outskirts of the village to defecate, thus not creating immediate nuisance, while open drainage causes water stagnation with unsightly appearance and smell in their immediate surrounding.

Concept of sanitation programs in India has changed over the years. The Central Rural Sanitation Programme implemented in 1986 focused mainly on providing subsidies for construction of sanitation facilities. A survey conducted in 1996–1997 to assess the impact of the program delineated that subsidies alone are not sufficient in improving the sanitation.[13] The revised programs implemented later including SBM focused on motivating and modifying the behavior of the community toward the use of sanitary latrines and also to improve liquid and SWM.[13],[14] Community-level studies are needed to evaluate the effectiveness of the initiatives taken under the program.

Most of the previous studies done in India [6],[7],[8],[9],[10],[11],[12] have focused on assessing the knowledge of SBM and sanitation practices except for a study done by Nikita et al.[15] among school students where intervention was provided to school students. To the best of our knowledge, the present study is first of its kind to provide educational intervention at community level and also to assess its impact on sanitation. The intervention was provided for all the residents of the village apart from study participants. Along with health education to the community, the study has included community mobilization activities as a means to sustain the efforts taken by the students for improving the sanitation in the village. The SBSI activities done by us in the community were found to be effective in improving the awareness on SBM, waste segregation at household level, and practice of handwashing before eating and after defecation. Since the duration of SBSI program was about 2 months, impact of the interventions on practice of solid waste segregation and usage of sanitary latrine could not be assessed.


  Conclusion Top


The SBSI activities had a statistically significant impact in improving knowledge regarding sanitation and hygiene. It provided an opportunity for medical students to understand the sanitation-related issues in rural area and also a learning experience to implement classroom teaching in the community. Since the present study was done in a village among a small sample, further large-scale studies are need to provide a conclusive evidence about the impact of SBSI. We suggest that implementing SBSI program as a part of curriculum for undergraduate medical students would be beneficial for both students and the community as well.

Financial support and sponsorship

Funds required to prepare the IEC activities and logistic arrangements were provided by the management of Trichy SRM Medical College Hospital and Research Centre.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
United Nations Development Programme. Sustainable Development Goals. Available from: http://www.undp.org/con tent/undp/en/home/sustainable-development-goals.html. [Last accessed on 2019 May 10].  Back to cited text no. 1
    
2.
United Nations in India. SGD 6: Clean Water and Sanitation. Available from: https://in.one.un.org/page/sustainable-development-goals/sdg-6/. [Last accessed on 2018 Nov 10].  Back to cited text no. 2
    
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The World Bank. Data: People Practicing Open Defecation (% of Population). Available from: https://data.worldbank.org/indic ator/SH.STA.ODFC.ZS. [Last accessed on 2019 May 10].  Back to cited text no. 3
    
4.
The World Bank. Press Release. World Bank Approves US$1.5 Billion to Support India's Universal Sanitation Initiatives; 2015. Available from: https://www.worldbank.org/en/ne ws/press-release/2015/12/15/world-ban k-approves-usd-1point5-billion-support-india-uni versal-sanitation-initiatives. [Last accessed on 2019 May 10].  Back to cited text no. 4
    
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Swachh Bharat Summer Internship 2018. Ministry of Human Resource Development. Department of Higher Education. Government of India. Available from: https://www.ugc.ac.in/pdfn ews/9072199_Swachhata-Summer-Inte rnships-2018.pdf. [Last accessed on 2019 May 10].  Back to cited text no. 5
    
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Swain P, Pathela S. Status of sanitation and hygiene practices in the context of “Swachh Bharat Abhiyan” in two districts of India. Int J Community Med Public Health 2016;3:3140-6.  Back to cited text no. 6
    
7.
Kishore YJ, Naidu NK, Sreeharshika D, Harikrishna B, Malhotra V. Study to assess knowledge, perception and practices regarding Swachh Bharat Abhiyan among rural people of Nalgonda district in Telangana state. Int J Community Med Public Health 2018;5:3399-405.  Back to cited text no. 7
    
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Karan RK. Report on Impact Assessment of Swachh Bharat Abhiyan Project Implemented by Aarogya Foundation India in Blocks of Jharkhand State. Ranchi: Asian Development Research Institute; 2015. p. 16-7.  Back to cited text no. 8
    
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Panda PS, Chandrakar A, Soni GP. Prevalence of open air defecation and awareness and practices of sanitary latrine usage in a rural village of Raipur district. Int J Community Med Public Health 2017;4:3279-82.  Back to cited text no. 9
    
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Anuradha R, Dutta R, Raja JD, Lawrence D, Timsi J, Sivaprakasam P. Role of community in Swachh Bharat mission. Their knowledge, attitude and practices of sanitary latrine usage in rural areas, Tamil Nadu. Indian J Community Med 2017;42:107-10.  Back to cited text no. 10
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Banerjee AB, Pasha MA, Fatima A, Isaac E. A study of open air defecation practice in rural Nandivargam village. Int J Bioassays 2013;2:1051-4.  Back to cited text no. 11
    
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Geetha J, Kumar S. Open defecation: Awareness and practices of rural districts of Tamil Nadu, India. Int J Sci Res 2014;3:537-9.  Back to cited text no. 12
    
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Guidelines Central Rural Sanitation Programme, Total Sanitation Campaign. Department of Drinking Water Supply. Ministry of Rural Development. Government of India; 2007. Available from: https://jalshakti-ddws.gov.in/sites/de fault/files/TSCGuideline2007_0.pdf. [Last accessed on 2020 Jan 28].  Back to cited text no. 13
    
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Restructuring of the Nirmal Bharat Abhiyan into Swachh Bharat Mission. Press Information Bureau. Cabinet. Government of India; 2014. Available from: https://pib.gov.in/newsite/print release.aspx?relid=109988. [Last accessed on 2020 Jan 28].  Back to cited text no. 14
    
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Utpat NJ, Bogam RR. Effect of 'SMART health education model' on knowledge and attitudes of school students in rural area about 'Swachh Bharat Abhiyan of India' and sanitation practices. Int J Community Med Public Health 2017;4:582-7.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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