INTRODUCTION:

A robust and healthy nation is built on its children. Over 1.2 billion people globally, including roughly 21% of India's population, are children. This age group's morbidity and death are mostly caused by the spread of infectious diseases and poor health¹. The main obstacles to this are inadequate services from the healthcare delivery system in poor nations, parents' illiteracy, a lack of skills, inadequate guidance, and inaccurate information. Diseases that can be prevented and treated with basic measures afflict children. Infection is the process by which the disease-causing pathogen enters the human body and multiplies. A particular organism or its harmful by-products are the cause of a disease. Communicable diseases are spread by humans, animals, or environmental agents such as food waste, air, soil and dust, fluid, flies, excrement, and fomites.²

The five Fs food, fingers, fluids, flies, and faeces may spread these pathogens. Health promotion and illness prevention are becoming increasingly crucial due to the rising incidence of communicable diseases and the associated financial burden. Feco-oral infections, as the name implies, are illnesses that arise when the pathogenic organisms enter the human host through the mouth after being expelled in the stools of sick individuals [or, less frequently, animals].⁴ As a result, the organisms must travel through the environment from an infected person's excrement to a susceptible person's digestive tract. The Feco-oral transmission pathway is the name given to this.¹

Faecal contamination of food, water, and hands is the primary method of Feco-oral transmission of disease-causing organisms, which is completely undetectable. Faeces can contain enough microbes to cause an infection in very tiny amounts. It appears that infectious organisms are harboured by sparking clear. Even seemingly clean hands can harbour and transfer enough germs to cause illness.⁶ Pathogenic microorganisms like bacteria, viruses, parasites, or fungi are the source of infectious diseases, which can be transferred from person to person either directly or indirectly.²

These infectious diseases frequently spread from person to person through direct touch. Contacting bodily fluids, secretions, or even the infected person's fomites. The five Fs finger, food, fluid, and faeces can be used to summarise the Feco-oral pathway. The primary illnesses brought on by the Feco-oral pathway include cholera, hepatitis, polio, and diarrhoea.³

A sickness caused by a pathogen or its toxic by-product that spreads to a susceptible host from an infected individual, an infected animal, or a contaminated inanimate object is known as an infectious disease. Vulnerable communities are disproportionately affected by infectious diseases, which cause a massive global burden of disease that affects public health systems and the economy globally.⁴

NEED FOR THE STUDY:

Five thousand children die every day from infectious diarrhoea, which is mostly brought on by poor sanitation, according to research from the Water Supply and Sanitation Collaborative Council.⁵

Diarrheal illnesses are the second leading cause of death for children, after pneumonia, accounting for 17% of fatalities in children under five. Additionally, diarrhoea has a significant role in stunting and malnutrition.⁶

Diarrheal illnesses are frequently referred to as water-related; however, as the infections originate from faeces, it would be more accurate to refer to them as excreta-related. The main ways that infectious diarrheal illness spreads are described by the "Faecal-oral cycle." The "five F's" fluid (drinking contaminated water); fields (contaminated soil and crops with human Faecal matter); fingers (unwashed hands preparing food going into the mouth); food (eating contaminated food); and flies (transmitting disease from faces to food and water or directly to people particularly problematic where open-air defecation is the norm) are what drive this cycle.⁵

The Water Supply and Sanitation Collaborative Council stated on World Health Day 2011 that in nineteenth-century North America and Europe, typhoid, cholera, and diarrhoea spread by inadequate sanitation were the main causes of childhood illness and mortality; these deaths are now uncommon in these areas. However, they are all too common in underdeveloped nations, and new data indicate that over half of the 9.2 million child fatalities that occur each year are either the primary cause or the underlying cause due to poor sanitation and hygiene. Evidence-based, persuasive, and one of the most economical public health measures to lower childhood mortality. Just having access to a restroom can cut down on childhood diarrheal fatalities by more than 30% and hand washing by more than 40%.⁵

Children's lives can be saved by breaking the faecal-oral cycle, which is mostly dependent on hand washing and using toilets or latrines that contain and sterilize faecal matter.⁶

OBJECTIVES:

1. To assess the knowledge regarding the 5 Fs among high school students.

2. To find an association between the knowledge score among high school students with their selected demographic variables.

HYPOTHESIS:

H1: There will be a significant level of knowledge regarding the 5 Fs of disease transmission among high school students.

H2: There will be a significant association between the knowledge of the 5 Fs and selected demographic variables among high school students.

METHODOLOGY:

Source of data:

The data was collected from High School students of JSS Public School, Chamarajanagar

Research approach:

Quantitative approach was used for the present study

Research design:

The design adopted is a descriptive study

Settings:

The present study was conducted in JSS Public School, Chamarajanagar

Population:

The target population of the study was high school students who were all studying in JSS Public School, Chamarajanagar

METHOD OF DATA COLLECTION:

Sampling technique:

A simple random sampling technique was selected.

Sample:

In this study, the sample was high school students aged between 13-16 years from the JSS Public School, Chamarajanagar

Sampling size:

The sample size consists of 60 high school students in JSS Public School, Chamarajanagar

Inclusion criteria:

The study included:

· High school students who are willing to participate in the study.

· High school students from 8^th, 9^th and 10^th standard.

· High school students are present at the time of data collection.

Exclusion criteria:

The study excluded:

· High school students who are absent during the time of data collection.

· High school students who are not willing to participate in the study

Instrument used:

Tool I: Demographic data

Tool II: A Structured questionnaire consists of multiple-choice questions to assess the knowledge on the 5Fs

Description of the tools:

TOOL-I: Tool I consists of demographic data, which includes age in years, gender, educational status of students, religion, type of family, mothers educational status, fathers educational status, parents monthly income, type of diet, and prior information on 5Fs.

TOOL-II: Tool II consists of multiple-choice questions to assess the knowledge of the 5FS. Each multiple-choice question had four alternatives. For every correct response in each question score 1was given, and for a wrong answer score of 0. The total score of the structured questionnaires was 24.

Data collection method:

The data collected by using a structured questionnaire consists of multiple-choice questions to assess the knowledge of the 5fs.

RESULTS:

Table 1: Frequency and percentage distribution of students based on their demographic characteristics N=60

Demographic characteristics	Frequency	Percentage
1. Age in years
a. 13 years	12	20
b. 14 years	24	40
c. 15 years	24	40
2. Gender
a. Male	27	45
b. Female	33	55
3. Class Studying
a. 8th standard	18	30
b. 9th standard	26	43.3
c. 10^th standard	16	26.7
4. Religion
a. Hindu	54	90
b. Muslim	3	5
c. Christian	0	0
d. Any others	3	5
5. Types of Family
a. Nuclear	45	75
b. Joint	15	25
6. Mothers’ educational status
a. Uneducated	2	3.33
b. Primary school	0	0
c. High school	22	36.66
d. PUC and above	36	60
7. Fathers’ educational status
a. Uneducated	2	3.33
b. Primary school	3	5
c. High school	9	15
d. PUC and above	46	76.66
8. Parents monthly income
a. Below 10000	11	18.33
b. 10001-15000	6	10
c. 15001-20000	8	13.33
d. 20001 and above	35	58.33
9. Types of diet
a. Vegetarian	46	76.66
b. Non vegetarian	0	0
c. Mixed diet	14	23.33
10. Prior Information on 5Fs
a. Yes	23	38.33
b. No	37	61.66

The data presented in Table1 shows that majority of the school students are in the age group of 14 and 15 years (40% each), Majority of the school students are females (55%), Majority of students are studying 9^th standard (43.3%), Majority of students are Hindu religion (90%) and from nuclear family (75%). The majority of students' parents' educational level is PUC and above (Mothers 60% and Fathers 76.6%). The majority of parents monthly income is 20001 and above (58.3%). The majority of students type of diet is vegetarian (76.7%). The majority of students dont have prior information on the 5Fs (61.66%).

Table 2: Frequency and percentage distribution of students based on their level of knowledge N=60

Sl. No.	Level of knowledge	Frequency (f)	Percentage (%)
1	Good knowledge (0-7)	14	23.33
2	Average knowledge (8-15)	42	70
3	Poor knowledge (16-24)	04	6.66

The data presented in Table 2 shows that the majority, 70% of the school students, have average knowledge regarding 5fs, 23.33% of students have good knowledge, and 6.66% of students have poor knowledge regarding 5fs.

Table 3: Mean, median, range, and standard deviation of knowledge scores of students regarding 5fs

Mean	Median	Range	SD
13	13	6-23	±0.6403

The data presented in Table 3 shows that the mean is 13, the median is 13, with a standard deviation of ±0.6403, and it ranges from 6 to 23.

Table 4: Association between knowledge score among high school students and their selected demographic variables N=60

Variables	Below Median	Median and above	Chi square	P value (0.05)	Inference
Age in years
13 years	7	5	1.58	0.4489	NS
14 years	10	14
15 years	14	10
Sex
Male	13	14	0.51	0.4664	NS
Female	19	14	0.51	0.4664	NS
Class studying
8th standard	9	9	0.3493	0.8393	NS
9th standard	15	11
10thstandard	8	8
Religion
Hindu	28	26	0.4762	0.788	NS
Muslim	2	1
Others	2	1
Type of Family
Nuclear family	22	23	1.4286	0.231998	NS
Joint family	10	5	1.4286	0.231998	NS
Mothers’ education
Uneducated	1	1	5.3024	0.07056	NS
Primary school	16	6
High school	15	21
PUC above	5	6
Fathers’ education
Uneducated	1	1	5.2301	0.1557	NS
Primary school	1	2
High school	8	1
PUC and above	23	23
Parents monthly income
Below 10000	8	3	4.7414	0.1917	NS
10001-15000	3	3
15001-20000	6	2
20001 and above	15	20
Type of Diet
Vegetarian	25	21	0.0815	0.7752	NS
Mixed Diet	7	7	0.0815	0.7752	NS
Prior information about 5FS
Yes	8	15	6.1596	0.01307	S
No	25	12	6.1596	0.01307	S

The data presented in Table 4 shows that the association of the knowledge score among high school students with their demographic variables, and the result shows that prior information about the 5FS is significant.

RECOMMENDATIONS:

Based on the findings of the study, the recommendations for future studies follow

· A Similar study can be conducted for larger samples

· Comparative studies between rural and urban high school students may be undertaken to identify differences in knowledge levels regarding the 5 Fs

· An experimental or quasi-experimental study can be conducted to assess the effectiveness of a structured teaching programme on improving knowledge about the 5 Fs

· Studies may be extended to assess the knowledge of parents and teachers, as they play a crucial role in reinforcing hygienic practices among children

CONCLUSION:

The present study assessed the level of knowledge regarding the 5 Fs of disease transmission among high school students in Chamarajanagar District. The findings revealed that a considerable proportion of students had varying levels of knowledge about the 5 Fs. Statistical analysis demonstrated a significant association between students knowledge scores and selected demographic variables. This indicates that students who had previous exposure to information related to the 5 Fs through school teaching, health education programs, or other sources possessed better knowledge compared to those without prior information. The results emphasise the importance of early and continuous health education in improving awareness and understanding of disease transmission routes among school students.

Overall, the study highlights the need for strengthening school-based health education programs and active involvement of teachers and health professionals to enhance students knowledge, thereby contributing to the prevention of communicable diseases and promotion of healthy practices among adolescents.

REFRENCCE:

1. Park, K. Parks Textbook of Preventive and Social Medicine. 26th Edition. Jabalpur: M/s Banarsidas Bhanot Publishers; 2021.

2. World Health Organisation (WHO). Infectious Diseases. Geneva: WHO; Available from: https://www.who.int/health-topics/infectious-diseases

3. World Health Organisation (WHO). Diarrhoeal Disease: Fact Sheet. Geneva: WHO; 2020.

4. United Nations Childrens Fund (UNICEF). Water, Sanitation and Hygiene (WASH): Diarrhoea and Child Mortality. New York: UNICEF; 2019.

5. Water Supply and Sanitation Collaborative Council (WSSCC). WASH and Child Health: Ending the Cycle of Fecal Oral Disease Transmission. Geneva: WSSCC; 2011.

6. Black, R.E. et al. Global, Regional, and National Causes of Child Mortality. The Lancet. 2010; 375(9730): 19691987.

Received on 08.01.2026 Revised on 18.02.2026

Accepted on 26.03.2026 Published on 05.05.2026

Available online from May 09, 2026

A and V Pub J. of Nursing and Medical Res. 2026;5(2):55-59.

DOI: 10.52711/jnmr.2026.12

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