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 Table of Contents  
Year : 2022  |  Volume : 9  |  Issue : 4  |  Page : 553-559

Sanitation and hand washing behavior of urban slum dwellers in Vellore Corporation of Tamil Nadu, India: during coronavirus disease

1 Department of Economics, Muthurangam Government Arts College, Vellore -632001, Tamil Nadu, India
2 Department of Economics, School of Management, Pondicherry University, Pondicherry-605 001, India

Date of Submission04-Jun-2022
Date of Acceptance23-Nov-2022
Date of Web Publication29-Dec-2022

Correspondence Address:
Mr. K Nirmalkumar
Department of Economics, Muthurangam Government Arts College, Vellore -632001, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mgmj.mgmj_235_22

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Objectives: This study examines the sanitation and hand-washing behavior of slum dwellers before coronavirus disease 2019 (pre-COVID-19) and during the COVID-19 period. The study also examines health-seeking behavior. Materials and Methods: Purposive sampling method was used to select the study area and household. Out of 49 registered slums in the Vellore municipality corporation, three slums were selected, which represent the highest number of slum households. The names of the urban slum settlement were Salavanpet, Old Town, and Makkan. After selecting the study areas, households were selected on snowball techniques through telephonic conversation with a structured interview schedule. The total samples were 75 households. The study period was from June 2021 to August 2021. Results: The study shows that Vellore has the 18th highest number of positive COVID-19 cases in Tamil Nadu. This study found that regular wage incomes in urban slum dwellers have been severely affected by COVID-19 lockdowns. The majority of households without a toilet in slums have used open defecation during COVID-19. Hand washing behaviors for people living in the urban slums have increased during the COVID-19 than the pre-COVID-19 pandemic. This study found that middle-aged (age 31–40 years) people’s habit of hand washing as a precautionary measure against coronavirus disease increased during COVID-19 compared with pre-COVID-19. Suggestion and Conclusion: The study suggests that improving hand-washing habits could aid in the prevention of the COVID-19 virus and other illnesses and suggests advancing hand washing habits after the pandemic as basic protective measures, which continues to remain essential in urban areas.

Keywords: COVID-19, hand washing, sanitation, slum, urban

How to cite this article:
Nirmalkumar K, Sivasankar V. Sanitation and hand washing behavior of urban slum dwellers in Vellore Corporation of Tamil Nadu, India: during coronavirus disease. MGM J Med Sci 2022;9:553-9

How to cite this URL:
Nirmalkumar K, Sivasankar V. Sanitation and hand washing behavior of urban slum dwellers in Vellore Corporation of Tamil Nadu, India: during coronavirus disease. MGM J Med Sci [serial online] 2022 [cited 2023 Feb 6];9:553-9. Available from: http://www.mgmjms.com/text.asp?2022/9/4/553/365995

  Background Top

The Coronavirus disease 2019 (COVID-19) pandemic has unleashed devastation in the existence of worldwideresidents. It has prompted stopping of the social and economic activities, as well as a negative impact on the health and livelihood of the urban poor (vulnerable communities).[1] The severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection has its starting point in the most noticeable metropolitan habitat of China, Wuhan[2] from where it has spread transversely throughout the world, infiltrating aimlessly throughout the urban communities of worldwide north and south.[3] The Asia Pacific area is perhaps the highest vulnerable because of its rapid urbanization and a higher proportion of urban poverty, with one-third of urban residents living in slums or slum-like environments.[3]

The continuous urbanization and industrialization processes have added to a quick expansion in the number of casual settlements around the world. The particular settings are described by huge population densities as well as poor ecological circumstances and are households of more than a billion people.[4] Inhabitants of high population density places are also more exposed to infection and disease flare-ups[5] in regions where overpopulation is the standard and across to outside places is restricted, attachment to key general health informing on social distancing and hand washing is a difficulty, while people sterilization offices are practically absent and access to clean purify water and cleanser is restricted. India has 542 million and Indonesia has 94 million individuals who do not have fundamental hand washing provisions with soap and water in the household.[6] It is difficult to apply policies from standard urban communities to high-density informal settlements.[7]

During the COVID-19 pandemic, the significance of water, sanitation, and hygiene is being reemphasized. Hand washing is an important method for turning away the spread of this virus, along with physical separation, according to universal recommendations to control the current outbreak.[8] In Bangalore's slums, inhabitants cannot maintain their social isolation under any circumstances. Slums are much high vulnerable because of their huge density of population and low level of well-beings. In pandemic periods, the density of the population and the necessity to move out for the cause of well-being and livelihood adversely impacts the biggest and most powerful preventative measure—social distancing.[9]

As indicated by WHO rules appropriate hand washing ought to contain soap, water, and scouring the two edges of the hands for a base time frame of 20 s, and was encouraged to pursue this throughout the day as often as possible.[10] The normal time of cleaning hands per individual each day was multiple times which drinks almost around 10–20 liters of water, regardless of whether calculating the two-fold time of hand washing during this COVID-19 episode will need almost around 20–40 liters of water every day per individual for hand washing only.[11] During the pandemic period, the quality of health care and water facilities is significant, and the fecal pollution in the water test of medical services setting is an alarming condition.[12],[13] Because socioeconomic disassociating indicators constrain movement, the provision of public or communal toilets could be restricted. As a result, it is essential to understand if such hurdles had also accelerated open defecation practices to prevent the risk perceptions by using shared toilet provisions.[14] Seventy-four million Indians living in slums or homeless, controlling COVID-19 requires specific policy measures to afford to access to water and sanitation facilities and soap, with social distancing.[15],[16] Government policies and efforts along with nongovernmental organizations (NGOs) have increased toilet coverage and toilet usage in India.[17],[18] UNICEF/WHO and Joint Monitoring Programme calculated that more than 60% of the Indian population had access to the basic sanitation and safely managed.[17] Numerous studies have emphasized the incidence of inconsistent toilet usage, as well as continuous open defecation practices, remains a challenge. Along with access to private toilets, some household people do not completely utilize them.[19],[20] In this context, the present study examines the sanitation and hand-washing behavior of slum dwellers in pre-COVID-19 and during the COVID-19 period, and this study also examines health-seeking behavior.

  Materials and methods Top

Study area

The study was conducted on urban slum dwellers in Vellore city, located in the northern part of Tamil Nadu, India. Vellore Corporation is divided into six zones, with 60 wards. According to Census 2011, Vellore Corporation has 1, 24, 380 households with a combined population of 5,04,078.

Study design

This study was based on both primary and secondary data. Primary data were collected by using a structured interview schedule. A purposive sampling method was used to select the study area and household. Vellore Corporation had 49 registered slums, out of these, three slums were purposely selected, representing the highest number of slum households. The names of the urban slum settlement were Salavanpet, Old Town, and Makkan. The three slum neighborhoods selected for this study had about 10,925 inhabitants in 1,986 households. After selecting the study areas, household respondents were selected on snowball techniques through telephonic conversation with a structured interview schedule. The primary purpose of snowballing techniques is to obtain the phone number of the household respondents. The researcher belongs to the residence of the slum. The phone number of respondents was collected based on the researcher’s social network through friends in the three study slum areas. In each slum, the researcher purposely selected 25 household respondents. The total samples were 75 household respondents.

Interview schedule design

The interview schedule was divided into socioeconomic conditions, household amenities, and sanitation and hand washing-related questions. The first part included respondent age, gender, education, occupation, and family income. The second part included house ownership status, roof materials, number of rooms, lighting source, kitchen facility, and cooking fuel. The third part included drinking water, toilet facility, defecation behavior, and hand washing behavior. During the COVID-19 lockdown period, personal interviews were not possible. Consequently, the researcher collected telephone numbers from the respondent households in the slum area. The snowball technique was used to collect telephone numbers (the respondent in a slum household refers to the telephone number of another respondent in the slum area). The interview was completed over the telephone. The study period was from June 2021 to August 2021.

Secondary data and statistical methods

Data on COVID-19-positive and fatal cases in the Vellore district and Tamil Nadu were collected from the Ministry of Health and Family Welfare, Government of Tamil Nadu. Microsoft Excel 2010 and IBM Statistical Package for Social Science (SPSS) 20 software were used for cross-tabulation and analysis of the data.


Respondents were informed of the subject matter of the study and obtained consent to participate.

  Results Top

COVID-19-positive cases and fatalities in Vellore district

By finding out COVID-19 prevalence and COVID-19 fatality, we were able to determine the COVID-19 status of the Vellore district in the first part of this study. In this study area (Vellore City Municipal corporation), no COVID-19 case statistics were available during the study period. The Vellore Municipal Corporation area of the Vellore District has a significant population, and the Vellore District COVID-19 cases were conceivably related to the Vellore Municipal Corporation. Therefore, this study has focused on the COVID-19 cases in the Vellore District. [Figure 1]. Sensitivity analysis found that COVID-19-positive case increases due to the election.[21]
Figure 1: COVID-19 positive cases in Vellore District. Source: Department of Health and Family Welfare, Government of Tamil Nadu

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The following situation also exists in the Vellore district as depicted in [Figure 1]. The COVID-19 positive case trend line demonstrates that there was only one case reported in Vellore during the COVID-19 beginning period of March 2020, but that number significantly increased in May 2021 (42,168) before declining in August and December 2021. As of the end of March 2022, 34,52,825 COVID-19-positive cases were reported in Tamil Nadu, and 57,303 cases were reported in the Vellore district. Despite the unexpected spread of COVID-19, the Vellore district retained the lowest positive cases due to the local governments’ successful execution of the lockdowns in several phases. As a result, Vellore had the 18th-highest overall COVID-19-positive case incidence in Tamil Nadu. [Figure 2].
Figure 2: COVID-19 fatalities in Vellore District. Source: Department of Health and Family Welfare, Government of Tamil Nadu

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[Figure 2] demonstrates that COVID-19 fatalities were not initially recorded in the Vellore district of Tamil Nadu until the first fatality case was reported on April 7, 2020. Because of the relaxation of COVID-19 restrictions, there were a significant number of fatality cases reported from April 2021 (383) to July 2021 (1095), with these months seeing the highest number of fatalities registered in the Vellore district. The horizontal straight-line curve demonstrates that there were fewer fatalities reported in Vellore from August 2021 to March 2022 than in the preceding months. As a result, the fatality rate decreased from August 2021 to March 2022. In March 2022, Tamil Nadu reported 38,025 COVID-19 fatalities, out of which 1,163 fatalities were reported in the Vellore district. In the Vellore district, 26,917 COVID-19-positive cases were recorded in April 2021, which resulted in 383 fatalities. In May 2021, there were a maximum of 42,168 COVID-19-positive cases, which resulted in 742 deaths. Additionally, 359 fatalities occurred in May 2021 alone. These data demonstrate a strong relationship between the increase in positive COVID-19 cases and COVID-19 fatalities in Vellore.

Socio-economic condition

Socio-economic status is the most important association between households’ quality of life, health, hand washing habit, and the toilet.[22],[23],[24] Human behavior during the COVID-19 pandemic is influenced by demographic parameters such as gender, income, education, and employment.[25],[26] Therefore, this study examines the socio-economic status in the second part.

According to [Table 1], 54.70% of respondents are female and 45.30% are male, concerning their socioeconomic status. Salavanpet, Makkan, and Old Town slum areas were found to have low levels of education, according to this study. The majority of respondents are lower middle-class educators, including 30.67% of primary educators, 29.33% of secondary educators, 20% of high schoolers, 16% of higher educators, and 1.33% of degree holders. Nearly 56 respondents worked for pay, 20% received a monthly salary, and 32% were employed in other types of work such as business. Construction workers made up the majority of respondents (27.67%) and drivers in the slum area, respectively, in terms of occupation. Street vendors made up 14.67% of respondents, followed by shop employees at 8%, business respondents at 12%, and others at 20%. (others include homemakers and students). According to the aforementioned socioeconomic finding, daily wage workers make up the majority of respondents in the study area. Daily wage workers’ income was negatively impacted by the COVID-19 lockdown and was severely affected by the lack of social security. The socioeconomic data demonstrates that the COVID-19 pandemic significantly impacted demographic factors such as employment and income in the study area.
Table 1: Socio-economic condition of the respondent

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Household amenities

[Table 2] shows house ownership (standard deviation [SD] = 0.452), roofing material (SD = 0.356), drinking water (SD = 0.963), kitchen facility (SD = 0.356), cooking fuel (SD = 0.567) and toilet facility (SD = 0.464), these variables have less SD which means variable are clustered around the mean. On the other hand number of rooms (SD = 1.115) is a high SD variable. Kurtosis found the household amenities such as household ownership status, roof material, number of rooms, and toilet facility negative kurtosis value. Skewness value found that drinking water, kitchen facility, cooking fuel, toilet facility, number of rooms, and household ownership have positive skewness, and roof marital have negative skewness.
Table 2: Household amenities

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The cross-tabulation of the sample respondents’ defecation locations and age-based classification is shown in [Table 3] for the respondents. In the pre-COVID-19 period, 57.33% (43) of respondents used individual toilets was increased in the COVID-19 period to 61.33% (46). The utilization of public/community toilets by respondents under the age of 30 years decreased during COVID-19; however, it increased between the ages of 31 and 50 years, rising from 4% (1.33 + 2.66) to 8% (4 + 4). Because of the COVID-19 prevention measures during the pandemic, no one used public toilets. During the COVID-19 period, open defecation was used by a majority of households without toilet facilities, up from 25.33% to 28%. Therefore, this study found that there was an increase in open defecation during the COVID-19 pandemic compared to the pre-COVID-19 period. These results demonstrate that there is a clear and significant relationship between age and defecation place.
Table 3: Age-wise classification and place of defecation

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Hand washing behavior

During the pre-COVID-19 period hand washing with soap was 38.7% it increased by 76% during the COVID-19 period. Hand washing without soap, only with water in the pre-COVID-19 period was done by 61.3% of respondents. This hand-washing behavior was reduced by 24% during the COVID-19 period. It had been observed that slum dwellers’ hand-washing practices increased during the COVID-19 period [Table 4].
Table 4: The behavior of hand washing after using the toilet

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[Table 5] shows the analysis of the hand washing behavior before food and how pre-COVID-19 and during the COVID-19 period present, it was found that 14.7% of respondents living in a slum did not have hand washing behavior before COVID-19, 8% of the respondent had hand washing behavior with soap and 58% of the respondent had the hand washing behavior with water. Hand washing with soap before food increased from 8% in the pre-COVID-19 period to 52% during the COVID-19 pandemic period, and the practice of hand washing during the COVID-19 period was present in all respondents. This analysis found that the practice of hand washing before food is more prevalent during the COVID-19 pandemic than pre-COVID-19.
Table 5: Hand washing behavior before food

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[Table 6] shows the before and after food age-wise hand-washing behavior. The cross-table [Table 6] found that before and after food hand washing behavior with soap during the COVID-19 period increased. Particularly in the age groups of 31–40 years from 2.67% to 18.67%, for the prevention of COVID-19 diseases. This study found that middle-aged (age 31–40 years) people’s habit of hand washing as a precautionary measure against coronavirus disease increased during COVID-19 compared to the pre-COVID-19. Most importantly, all age groups had hand-washing behavior during the COVID-19 period.
Table 6: COVID-19 age wise and hand washing behavior before food and after food

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The suggestion was to improve hand-washing practices to prevent the spread of the COVID-19 virus and other diseases.

  Conclusions Top

This study revealed that health behavior changed in the pre-COVID-19 than during the COVID-19 period. This study found that during the COVID-19 pandemic, the majority of respondents increased their regularity of handwashing practices for the prevention of disease. The COVID-19 virus outbreak has highlighted the importance of enhancing urban infrastructure and implementing contextualized public health policies. COVID-19 gives a chance to invest in sanitation associations for densely populated urban slums. This would facilitate urban slum settlements and lead to get better environmental and health conditions. Targeted sanitation, hygiene, and environmental development improve slum settlements’ ability to respond to pandemics and slum population health by reducing infection transmission pathways. Enhancing the advancement of hand washing behavior after the pandemic as basic precautionary measures also remains critical in urban settlements.

Ethical consideration

Clearance/approval received from the Ph.D. Doctoral Committee. The Ph.D. Doctoral Committee monitors the research work and gives suggestions and advice to the researcher. Ph.D. Doctoral Committee of Muthurangam Government Arts College (Autonomous) Vellore, Tamil Nadu Affiliated to Thiruvalluvar University, Vellore, Tamil Nadu, India. letter no: TVU/Exam/Ph.D.,/DC approval-19/2019 Regulation/2020 8547. Dated July 23, 2020.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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