INTRODUCTION:

Health of people is affected by the quality of place where they live and work, air which they breathe, the water which they drink and food which they consume. Environment have many predisposing factors or various agents such as various bacteria, viruses and fungi which may cause various diseases or health problems. As environment is determinant of health which consist of three component that is physical component, biological and social component. Physical environment includes all non-living things which is present surrounding us for e.g. air, water and soil. Biological environment includes all animals, plants including microorganism, so many animals can directly transmits zoonotic diseases and also spread different vector born diseases.¹

Sanitation is “the means of collecting and disposing of excreta and community liquid wastes in a hygienic way so as not to endanger the health of individual and the community as a whole”. It consists of both public and private elements, and the individual’s hygiene can affect the whole community. Good or adequate sanitation, together with good hygienic practices and safe water, are fundamental to good health and ultimately result in social economic development. That why in 2008, the Prime minister of India quoted Mahatma Gandhi who said in 1923, “sanitation is more important than independence”.²

Sanitation is the component of public health conditions which is related to clean or safe drinking water and adequate treatment and disposal of solid waste, human excreta and sewage or adequate disposal system.³

According to the World Health organization (WHO) definition of environmental sanitation is as “the control of all those factors in man′s physical environment, which exercise or may exercise a deleterious effect on his physical development, health and survival." Sanitation can include two important things i.e. personal sanitation and public hygiene. Personal sanitation is work which can include handling or management of waste, maintaining cleanliness of household, toilet and managing household garbage. Public sanitation work which can involve garbage collection, transfer and treatment, cleaning drains, streets, school, train, public spaces, community toilet and public toilet, operating sewage plant etc.⁴

The importance of environmental sanitation includes two major objectives, first is to protect and promote health through some measures as keeping diseases carrying waste and insects away from people and home, breaks the spread of diseases, prevent spreading of waterborne diseases and improves health and quality of life and also decreasing economic burden of illness. The second objective is to protect the environment against pollution through some measures as keeping disease carrying waste and insects away from environment, prevent environmental pollution (air, soil and emission) and prevent contamination of water resources (surface and ground water).⁵

Most of health problems or diseases transmits through fecal oral route, so preventing human contact with faces is part of sanitation, as a hand washing with soap and water. The aim of sanitation system is to protect human health by providing a clean environment that will stop transmission of diseases, especially through the fecal oral route. E.g. Diarrhoea, a main cause of malnutrition and stunted growth in children can be reduced through sanitation, such as intestinal worm infection or helminthiasis, cholera, hepatitis, polio, trachoma.⁶

As per studies globally 829000 people are at risk or estimated to die every year because of diarrhoea as result of unsafe drinking water, poor sanitation and lack of hand hygiene. Diseases with the highest number of reported outbreaks are viral gastroenteritis, hepatitis A, E. coli diarrhoea and legionellosis. Poor sanitation is linked with the transmission of diseases such as cholera, diarrhoea, dysentery, hepatitis A, typhoid and polio and exacerbates stunting. Poor sanitation results in bad effects on human well-being, social and economic development due to impacts such as anxiety, risk of sexual assault, and lost educational opportunities. Inadequate sanitation is estimated to cause 432 000 death due to diarrhoeal diseases annually and is a major factor in several neglected tropical diseases, including intestinal worms, schistosomiasis, and trachoma. Poor sanitation also contributes to malnutrition.¹²

MATERIAL AND METHODS:

The present descriptive cross sectional study was conducted with an aim to assess the environmental sanitation practices and its effect on health. An ethical approval was obtained from Institutional Ethics Committee of Pravara Institute of Medical Sciences (Deemed University), Loni (Bk). The purpose of study was explained to the patients, and a written informed consent was sought before enrolling them A sample comprising 100 people in the age group of 18 and above was taken. Those peoples satisfying the inclusion criteria and residing at urban and rural area of Rahata taluka, (Maharashtra, India) were selected by using a systemic random sampling. The expert validated tool to collect the data.

After seeking informed consent, structured interview schedule was prepared in the form of structured questionnaires to assess environmental sanitation practices and physical examination carried out to assess health status or illness. The study was conducted in Rahata and Astagaon village. Structured interview schedule was used to gather data. The socio demographic data was elicited from peoples and data about environmental sanitation practices was also obtained. Further, the tool comprised of three sections as:

Section 1: Performa for collecting selected socio demographic data such as age, gender, marital status, education, religion, occupation, monthly family income, place of residence, type of family and number of family members. There are total 10 items in the socio demographic data.

Section 2: It consist of questionnaire to assess practices regarding environmental sanitation which contains about 28 items such as type of house, number of rooms, ventilation facility, source of drinking water supply, water storage, methods of water purification, type of drainage system, latrine facility, methods of waste disposal, electricity facility, presence of vectors and rodents, method of controlling vectors and rodents, farming practices, cooking and hygienic practice. Section 3: It consist of Performa for assessing physical health status which includes the presence of illness which includes 7 items and systemic physical examination which includes any abnormalities in Central nervous system, respiratory system, cardiovascular system, GI system, ENT system, Urinary system, reproductive system and orthopaedic system.

RESULTS:

A total of 100 people were participated in the study. Findings related to sociodemographic data:

Highest percentage (40%) people were in the age group of 18-28 years in urban area than rural area (26%)

Highest percentage (74%) were female in rural area than where (54%) were male in urban area

Highest percentage (72%) people were married in rural area than urban area (68%)

Highest percentage (34%) people were had higher secondary education in urban area where (30%) had secondary education in rural area.

Highest percentage (50%) were had family monthly income in rupees 3001-6000 in rural area while (34%) were had family monthly income 6001-9000 in urban area

Findings related to environment sanitation practices:

Housing qualities were shows highest percentage (82%) were had pakka house in urban area while (76%) in rural area. Highest percentage (68%) had adequate ventilation in urban area while (68%) had adequate ventilation in sssrural area.

Water facilities were shows highest percentage (52%) were had nagarpachayat tap water supply in urban area while (52%) were had grampanchayat tap water supply in rural area and Highest percentage (94%) were purifying water drinking by various methods in urban area than rural area (84%).

Toilet facility were shows highest percentage (100%) of availability of toilet facility in urban area than rural area (90%).

Waste management shows that highest percentage (78%) were had closed drainage system in urban area than rural area (64%). Highest percentage (64%) people were using community dustbin in urban area where (48%) people were burning waste in open in rural area.

Total availability (100%) electricity facility in urban and rural area. Highest percentage (90%) people were had presence of presence of vectors and rodent in around home in rural area than urban area (80%) and Highest percentage (40%) using lotion in urban area while (42%) not using any method for control vectors in rural area

Farming practices shows highest percentage (82%) were doing farming in rural area than urban area (50%) and (42%) were not using protective measures pest control in farm in rural area than urban area (18%).

Hygienic practices were highest percentage (94%) peoples practicing hand washing after defecation in urban area than rural area (90%)

Cooking practices shows highest percentage (92%) people were washing hands before cooking in urban area than rural area (68%). Highest percentage (84%) people were washing vegetables before cooking in urban area than rural area (74%). Highest percentage (86%) people were using LPG gas for cooking food in urban area than rural area (68%)

Findings related to assessment of physical health status

Highest percentage of presence of illness in urban area were (20%) had other illness such as dengue, typhoid, malaria, rickettsia fever and skin infections etc. The 4.25 were average/mean of presence of illness in urban area.

In line with rural area highest percentage of presence of illness were (18%) had hypertension and also (18%) were case of anaemia, (16%) were any other illness such as dengue, malaria, typhoid, rickettsia fever, skin infections etc. The 4.71 were average/mean of presence of illness in rural area.

Table No. 1: Distribution of socio demographic data among urban and rural area

S. N	Socio demographic data	Urban		Rural
S. N	Socio demographic data	Frequency	%	Frequency	%
1.	Age
	18- 28 years	20	40%	13	26%
	29- 38years	11	22%	12	24%
	39 – 48 years	08	16%	10	20%
	49 – 58 years	05	10%	04	8%
	Above 58 years	06	12%	11	22%
2.	Gender
	Female	13	26%	37	74%
	Male	27	54%	23	46%
3.	Marital status
	Married	34	68%	36	72%
	Single	14	28%	12	24%
	Divorced	2	4%	2	4%
4.	Education
	No formal education	0	0%	6	12%
	Primary	11	22%	11	22%
	Secondary	13	26%	15	30%
	Higher secondary	17	34%	9	18%
	Graduate and above	9	18%	9	18%
5.	Monthly family income
	>3000	2	6%	3	6%
	3001-6000	15	30%	25	50%
	6001-9000	17	34%	9	18%
	More than 9000	15	30%		26%
6.	Religion
	Hindu	24	48%	39	78%
	Muslim	1	2%	0	0%
	Christian	8	16%	3	6%
	Other	17	34%	8	16%
7.	Occupation
	Student	8	16%	6	12%
	Home maker	13	26%	5	10%
	Daily wages	5	10%	7	14%
	Farmer	11	22%	21	42%
	Business	11	22%	9	18%
	Private employee	2	4%	2	4%
	Govt. employee	0	0%	0	0%
8.	Types of family
	Nuclear family	34	68%	27	54%
	Joint family	16	32%	20	40%
	Extended family	0	0%	3	6%

Table 2: Housing qualities among urban and rural area

S. N	Housing Qualities	Urban		Rural
S. N	Housing Qualities	Frequency	%	Frequency	%
1.	Types of house
	Kaccha	0	0%	3	6%
	Pakka	41	82%	38	76%
	Semipakka	09	18%	9	8%
2.	Number of rooms
	Two	13	26%	9	18%
	Three	22	44%	26	52%
	More than three	15	30%	15	30%
3.	Adequate Ventilation
	Yes	32	64%	39	78%
	No	18	36%	11	22%

Table No 3: Water facilities among urban and rural area

S. N	Water Facilities	Urban		Rural
S. N	Water Facilities	Frequency	%	Frequency	%
1	Source of drinking water
	Well	8	16%	14	28%
	Tub well	2	4%	1	2%
	Tanks	1	2%	1	2%
	Nagarpalika / grampanchayat tap water	26	52%	26	52%
	Packed (Ro) water	13	26%	8	16%
2	Water storage facility
	Yes	31	62%	36	72%
	No	19	38%	14	28%
3	Source of water used for sanitation purpose
	Hand pump	0	0%	1	2%
	Piped water	2	4%	2	4%
	Tanks	14	28%	5	10%
	Well	14	28%	24	48%
	Tube well	20	40%	18	36%
4.	Purification of water
	Yes	47	94%	42	84%
	No	03	6%	8	16%
	Methods of water purification
	Boiling	4	8%	3	6%
	Straining by cloth	10	20%	16	32%
	Water filter	17	34%	10	20%
	Chlorine drops	14	28%	12	24%
	Iodine solution, Crystal/tablet	2	4%	1	2%
5.	Frequency of cleaning water container
	Daily	22	44%	18	36%
	More than 1day	5	10%	2	4%
	Before fetching water	13	26%	14	28%
	When dirty	8	16%	11	22%
	Sometimes	2	4%	5	10%
6.	Rain water storage facility
	Yes	22	44%	13	26%
	No	28	56%	37	74%

Table No 4: Toilet facility among urban and rural area

S. N	Toilet Facility	Urban		Rural
S. N	Toilet Facility	Frequency	%	Frequency	%
1.	Availability of toilet facility
	Yes	50	100%	45	90%
	No	0	0%	5	10%

Table No 5: Waste management practices among urban and rural area

S. N	Waste Management	Urban		Rural
S. N	Waste Management	Frequency	%	Frequency	%
1.	Type of drainage
	Open	11	22%	18	36%
	Closed	39	78%	32	64%
2.	Disposal of solid waste
	Community dustbin	32	64%	20	40%
	Throw in Open	4	8%	6	12%
	Burn in opening	14	28%	24	48%

Table No: 6 Vectors and rodent control practices among urban and rural area

Sr. No	Vectors and rodents	Urban		Rural
Sr. No	Vectors and rodents	Frequency	%	Frequency	%
1.	Presence of vectors and rodents in and around home
	Yes	40	80%	45	90%
	No	10	20%	5	10%
	Method used for controlling rodents and vectors
	Insecticide	8	16%	8	16%
	Mosquito/ protective net	6	12%	6	12%
	Lotion / Liquid	20	40%	10	20%
	No	6	12%	21	42%

Table No 7: Presence of illness among urban and rural area (n=100)

S. N	Presence of illness	Urban		Rural
S. N	Presence of illness	Frequency	%	Frequency	%
1	Diabetes mellitus	07	14%	6	12%
2	Hypertension	06	12%	9	18%
3	Congestive cardiac failure	02	4%	1	2%
4	Anaemia	09	18%	9	18%
5	Any other	10	20%	8	16%

Table No 8: Mean, SD wise distribution of manifestation/problems in various health system (n=100)

SN	System	Urban		Rural
		Mean	SD	Mean	SD
1.	Central nervous system	0.87	0.47	1.37	0.9
2.	Respiratory system	2.28	1.24	3.57	1.49
3.	Cardiovascular system	5.87	2.45	7.12	2.67
4.	Gastroinstinal system	2.81	1.25	2.63	0.86
5.	Ear, Nose, Throat	3.15	1.99	3.07	1.68
6.	Urinary system	3.6	1.11	4.83	1.18
7.	Reproductive system	1.4	1.08	0.77	0.55
8.	Orthopedic System	07	2.49	5.25	2.26

DISCUSSION:

a) Description of demographic data:

· Highest percentage of sample in urban area among (40%) were in the age group of 18-28 years. (54%) of them were male, (68%) of them were currently married, (34%) of person had higher secondary education, (34%) of them had monthly family income Rs.6001-9000, (48%) of them were Hindu, (26%) of them were home maker and (68%) were living in nuclear family.

· In line with rural area highest percentage of samples (26%) were in the age group of 18-28 years, (74%) of them were female, (72%) of them were currently married, (30%) of person had secondary education, (50%) of them had monthly family income Rs.3001-6000, (78%) of them were Hindu, (42%) of them were farmer and (54%) were living in nuclear family.

b) Assessment of environmental sanitation practices

i) Environmental sanitation practices in urban area:

Housing qualities were highest percentage (82%) of pakka houses, (44%) were house with three rooms, (64%) were had adequate ventilation in their house. Water facilities were shows highest percentage (52%) of them had nagarpanchayat tap water as a source of drinking water, (62%) of them had water storage facilities, (40%) of them using tube well water for sanitation purpose, (94%) of them were purifying water for drinking, mostly (34%) of them using water filter for purification of water, (44%) of them were cleaning water container daily and (44%) of them were had rain water storage facility. This study is supported by 54^th national sample survey which had an estimated 70% of urban household being served by tap water and 21% by tube well and 96% reported storing their water.⁷

Toilet facility were (100%) availability of toilet facility, higher percentage (66%) of them were had Indian type of toilet. Waste management facilities shows higher percentage (78%) were closed drainage system, (64%) of them were using community dustbin for solid waste disposal.

All (100%) were had availability of electricity facility. This study is supported by India Residential Energy Consumption Survey (IRES 2020) which states that 89.7% of Indian households are now connected to the grid with another 0.33% relying on off-grid electricity source. Only 2.4% of Indian households still remains unelectrified.⁸

Domestic animal rearing practices shows 30% of them were rearing animals among which 26% were had cow shield and among this 18% of cow shield were attach with home and 18% of dung manure/fertilizer location were near to home.

Vectors and rodent presence were 80% and higher percentage (40%) were using lotion/ liquid for controlling vectors and rodents. Farming practices shows higher percentage (50%) of families doing farming and (50%) were using pesticides in farm, (32%) were using protective measures during pest control in farm, (42%) were using mixed fertilizer for farming. Cooking and hygienic practices shows that higher percentage (94%) were practicing hand washing after defecation, (92%) were practicing hand washing before cooking and (86%) of them were using LPG gas for cooking food and (30%) of them were cleaning of all surfaces, refrigerator, stove/ oven/ other appliances twice in a week.

ii) Environmental sanitation practices in rural area:

Housing qualities were highest percentage (76%) of pakka houses, (52%) were house with three rooms, (78%) were had adequate ventilation in their house.

Water facilities were shows highest percentage (52%) of them had nagarpanchayat tap water as a source of drinking water, (72%) of them had water storage facilities, (48%) of them using well water for sanitation purpose, (84%) of them were purifying water for drinking, mostly (32%) of them straining water by cloth for purifying water, (36%) of them were cleaning water container daily and (26%) of them were had rain water storage facility. Tis study is supported by survey conducted by NSSO 65^th survey round report (2008-09) 88.3% of household in rural Maharashtra were uses improved drinking water.⁹

Toilet facility were 90% of availability of toilet facility, higher percentage (78%) of them were had Indian type of toilet. According to TSC report 78.7% household in

Maharashtra had toilet as in June 2011.4.¹⁰

Waste management facilities shows higher percentage (64%) were closed drainage system, (48%) of them were burns waste in open. This study is supported with previous study conducted by Harshal T. Pandve, Kevin Feranandez on assessment of environmental sanitation in rural area of Pune, show that open disposal of waste material was done by 68.89%.¹¹

All (100%) were had availability of electricity facility. Domestic animal rearing practices shows 74% of them were rearing animals among which 48% were had cow shield and among this 40% of cow shield were attach with home and 56% of dung manure/fertilizer location were near to home. Vectors and rodent presence were 90% and higher percentage (42%) were not using any method of controlling vectors and rodents. Farming practices shows higher percentage (82%) of families doing farming and (78%) were using pesticides in farm, (36%) were using and 42% were not using protective measures during pest control in farm, (66%) were using mixed fertilizer for farming.

Cooking and hygienic practices shows that higher percentage (90%) were practicing hand washing after defecation, (68%) were practicing hand washing before cooking and (68%) of them were using LPG gas, 16% were using biogas for cooking food and (36%) of them were cleaning of all surfaces, refrigerator, stove/ oven/ other appliances weekly. This is supported by study which were conducted by Beulah sarah james, Ranjitha S. Shetty, on household cooking fuel and its effect on health among rural area that shows 92.7% of families using biogas fuel and LPG simultaneously.¹²

c) Assessment of physical health status:

Highest percentage of presence of illness in urban area were 20% of them had other illness such as dengue, typhoid, malaria, rickettsia fever and skin infections etc. 18% of them case of anemia, 14% were DM, 12% were HTN and 4% were CCF. The 4.25 were average/mean of presence of illness in urban area.

In line with rural area highest percentage of presence of illness were 18% of them had hypertension and also 18% were case of anemia, 16% were any other illness such as dengue, malaria, typhoid, rickettsia fever, skin infections etc.12% were DM cases and 2% were CCF . The 4.71 were average/mean of presence of illness in rural area.

d) Co-relationship between environmental sanitation practices effects on health with selected socio demographic variables:

There was positive relationship between environmental sanitation practices and its effect on health in both urban and rural area.

There was positive relationship between physical health statuses of peoples with their socio-demographic background

CONCLUSION:

The major conclusion drawn from study is that community people are vulnerable to develop physical health problem due to poor environmental sanitation and hygienic practices. Thus it should be emphasized having awareness session with community people regarding importance of maintaining good environmental sanitation and hygienic practices and its effect on health. The finding help the nursing profession to have more emphasis on assessment phase of nursing process.

ACKNOWLEDGEMENT:

I would like to take this opportunity to express my profound gratitude and deep regard to Dr T Shivabalan, Principal, PIMS, College of Nursing, Loni for his exemplary guidance, valuable feedback and constant encouragement throughout the duration of the research. His valuable suggestions were of immense help throughout my research work. His perceptive criticism kept me working to make this project in a much better way.

My special words of thanks should go to My parents, for their continuous support, cooperation, encouragement and for facilitating all the requirements, going out of her way. Their constant cooperation, motivation and support have always kept me going ahead.

I owe my deepest gratitude towards my husband Pravin Dange for his eternal support and understanding of my goals and aspirations. Without his help, I would not have been able to complete much of what I have done.

REFERENCES:

1. K. Park's Textbook of preventive and social medicine. 19th ed. Jabalpur: Bhanot Publication; Environment and Health, 2007; page 566-570

2. M. Singh opening address to the third south Asian conference on sanitation, New Delhi,18 November 2008, Available on URL: http://pib.nic.in/release/release.asp

3. SuSanA, Towards more sustainable sanitation solutions . Sustainable Sanitation Alliance (SuSanA);2008, Available on

http://www.susana.org/en/resources/library/details/267

4. K. Park's Textbook of preventive and social medicine. 19th ed. Jabalpur: Bhanot Publication; Environment and Health, 2007, page 566-570

5. The types and importance of sanitation- public health, Available on URL https://www.publichealth.com.ng/the-7-types-of-sanitation/

6. "Diarrhoeal disease". World Health Organization Report, 2 May 2017, Available on https://www.who.int/en/news-room/fact-sheets/detail/diarrhoeal-disease

7. 54th national sample survey, common property resources, sanitation and hygiene services Available on URL https://catalog.ihsn.org/index.php/catalog/2623

8. Residential Energy Consumption Survey (IRES 2020), Available on URL

https://www.ceew.in/publications/state-electricity-access-india

9. NSSO 65th survey round report (2008-09), Available on URL

https://mahades.maharashtra.gov.in/files/publication/unicef_rpt/chap7.pdf

10. Water and sanitation, TSC report of Maharashtra government, June 2011.4 https://mahades.maharashtra.gov.in/files/publication/unicef_rpt/chap7.pdf

11. Harshal T. Pandve, Kevin Feranandez, Assessment of environmental sanitation in rural area of Pune Maharastra, Indian Journal of Occupation and Environmental Medicine 2012; 16:90, Available on URLhttps://www.ijoem.com/text.asp?2012/16/2/90/107091

12. Beulah sarah james, Ranjitha S. Shetty, Assessment of household cooking fuel and its effect on health among rural area Available on URL

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231757

Received on 09.05.2022 Modified on 24.05.2022

Int. J. of Advances in Nur. Management. 2022; 10(3):182-188.

DOI: 10.52711/2454-2652.2022.00046

SN	Age in years	Presence of illness % (Urban)					Presence of illness % (Rural)
SN	Age in years	DM	HTN	CCF	Anemia	other	DM	HTN	CCF	Anemia	Other
1.	18-28 years	-	-	-	16%	4%	-	2%	-	10%	2%
2	29-38 years	4%	-	-	-	4%	-	-	-	2%	2%
3.	39-48 years	6%	4%	-	2%	6%	8%	2%	-	6%	-
4.	49-58 years	-	-	4%	-	2%	2%	2%	2%	-	4%
5.	>58 years	4%	8%	-	-	4%	2%	12%	-	-	8%

SN	Monthly family income in rupees	Presence of illness % (Urban)					Presence of illness % (Rural)
SN	Monthly family income in rupees	DM	HTN	CCF	Anemia	other	DM	HTN	CCF	Anemia	Other
1.	>3000	-	-	-	10%	-	-	-	-	-	-
2	3001-6000	8%	10%	-	6%	10%	8%	10%	-	8%	10%
3.	6001-9000	2%	2%	4%	4%	6%	4%	4%	2%	2%	4%
4.	>9000	4%	-	-	8%	4%	-	4%	-	8%	2%

Arati P. Dange1, Kale Kalpana2