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Active Learning Item 2:
Diarrhea and hygiene checklist

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Short description:

Pupils will learn how diarrhea spreads when hygiene is not optimally practiced. They will then prepare a list of possible diarrhea spreading pathways in their own area. After consolidating the list on the school, they will take use the list to register pathways at home. When summarizing the results the class will discuss how disease spreading pathways can be broken in practice.


You can find all the text parts of the Active Learning Item on the homepage below this section. In this box you can download it as a zip-package of pdf descriptions and summary answer sheets. 

Machine translation:

School subject

Mathematics, Biology


12-16 years

Work time

7 hours

Sustainable Development Goals

Results from other classes:

  • None available yet

Invitation for communication

Read more explanation about the communication here.

Diarrhea and hygiene checklist

(Full description without summary sheet. Download as pdf with summary sheet above)

Short description

In this assignment, the pupils will get an insight into the spreading/epidemiology of diarrhea, which is related to poor water supply and sanitation installations and hygiene practices. Diarrhea is painful, and sometimes deadly for small children, and it also means that people miss out on a lot of work and school.

The teacher will first introduce the subject to the class, then the class will discuss what the main risk factors are in their area and create a common checklist. After trying out the list on the school premises in groups, all pupils will then collect data on the risk factors in their own home and surrounding areas. They will then meet in class again and summarize the data in percentage.

Generic learning outcomes


  • The pupil can apply different strategies for mathematical problem solving.
  • The pupil can apply percentage calculation.
  • The pupil can complete and present their own statistical surveys.


  • The pupil can explain how microorganisms spread in epidemiological terms.
  • The pupil can explain how Earth biological factors affect human living conditions.


  • Pupils can plan and implement survey data collection, data verification and data presentation.

SDG related outcomes

Goal 6: Ensure availability and sustainable management of water and sanitation for all.

  • Target 6.2: By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations
  • Target 6.b: Support and strengthen the participation of local communities in improving water and sanitation management

Notes for the teacher

Before giving pupils the full assignment:

  • Introduce the diarrhea and hygiene issue
    • Tell the pupils what diarrhea is and how it spreads from one person to the other. The main messages are:
      • Diarrheal disease means that a person has at least three loose, liquid, or watery stools (bowel movements) each day. It can result in dehydration due to fluid loss.
      • Discuss with the pupils whether they have had diarrhea (once? Often?), for which people it is most common and serious (infants? Children?) and whether this is considered a serious disease in their society.
      • It is caused by different disease causing microorganisms (bacteria, viruses, parasites) that are in the stomach in large quantities.
      • The microorganisms are excreted with faeces (not urine). If someone else gets just a tiny bit of this faeces into the mouth somehow, that person may also get diarrhea.
      • There are many ways a microorganism from diarrheal faces may come into the mouth, via fingers, foods, flies and contaminated water. Show the pupils the F-diagram (see appendix); fx draw on the blackboard while you let the children give their ideas of how microorganisms could move from faeces through some carrier, to another person’s mouth.
    • When you discuss the practical ways diarrhea is spreading in the local area (see under “Activity description for pupils”) you should let the pupils suggest ways of spreading, acknowledge their suggestions and discuss with them how to formulate it precisely, so everyone understands.
    • When a pupil has a question about anything, try as much as possible to let the class discuss the matter and agree (with your moderation), rather that you give all the answers
    • Also try to make sure that all pupils end up having the same checklist before they go out looking for epidemiological pathways in the school or at home. During the first exercise on the school premises, the discussion in the groups and in the class afterwards will clear things in the pupils’ heads, so they are ready to do the exercise at home.
    • While the class discusses which could be done to prevent the epidemiology pathways, it may be a good idea to look at the F-diagram, and see which arrows can be blocked see in attachment).
    • After the exercise and final discussions are done, note down the collected summary results from the class on the attached excel summary sheet. Note also some main conclusions from the discussion of the three topics and upload the summary sheet to the platform.


Reading links:

Aids for the assignment

  • Excel sheet for summarizing results
  • Feedback sheet to the international DIAL# network

Time needed

Intro, questions and verification at school: 4  hours

Fieldwork: 1 hour

Finishing: 2 hours

Materials needed

  • Pen and paper

Activity description for pupils

Preparation of checklist

Let the class discuss:

  • How could diarrhea spread in practice in the pupils’ environment, at home and in the school? Note down and formulate their good suggestions together with the pupils, so you end up creating a list of at least 5-10 typical ways it spreads. Do not show the pupils this list, they are only examples you may use for your own inspiration:
    • Are there people in the village/area who defecate in the open, not using a latrine/toilet?
    • Are latrines/toilets dirty, with touchable faeces on the side?
    • Do people eat food that is uncooked from fields where people defecate nearby?
    • Do animals (chicken, goats) have access to step in faeces and thereby take it to foodstuff or drinking water?
    • Are latrines unprotected to flies, so flies can take faeces to foodstuff, drinking water or the lips? (Protection can be a water seal in flush toilets or a cover or a chimney on a latrine)
    • Are food items stored unprotected, so flies have easy access to it? (protection can be in boxes, bags or under nets)
    • Is drinking water stored in open containers (bucket, jar), not covered by a lid?
    • Do fingers touch the water in the storage container when pouring the water?
    • Is someone eating without washing hands with soap before the meal?
    • Is someone preparing the food/cooking without washing hands with soap before?
    • Is someone not washing hands with soap after visiting the toilet/latrine?

Let everyone note down the list that you agree with the class on and let the pupils solve this first exercise in groups in the school premises:

School investigation

  • Divide the class in groups of 4-6 pupils. Preferably send all groups out (for example 30 minutes) with the checklist to agree on which of the items on the checklist may be causing spread of diarrhea in the school. Alternatively, they can solve the task in the class in groups.
  • Back in class, let some of the groups present and discuss their results and agree on a final result.
  • Perhaps some groups may have found other relevant epidemiological pathways during their discussion. Let everyone note it down on their lists if you agree on it.

Home investigation

  • Give everyone a home exercise, to fill the checklist based on the situation at home. The pupils can be encouraged to discuss the answers with their parents, to gain more understanding.
  • When they come back to class all results should be summarized on the blackboard or similar – that is for each of the pathways write how many households had that problem. If the class is large, they can start to summarize the numbers in the groups and then group representatives may give the total numbers for the class overview.
  • If someone has found out some extra relevant epidemiology pathways note it down, though it cannot be used for the statistics.
  • Let the whole class look at the congregated numbers together. Discuss with the class (perhaps they can discuss in groups first):
    • Which epidemiology pathway for the spreading of diarrhea in the area is most commonly observed? Second most? Third most?
    • It is not necessarily the most common pathway that is the most important or influential for the spreading of diarrhea. Which epidemiological pathways do you think are the most important / influential in your area? Why?
    • Which technical improvements (for example more/better toilets? Protection of water?) or human behavioral changes (for example people should wash hands more often? Always use the toilet?) could be done to prevent the epidemiology pathways?
    • What could and will the pupils do to implement some of these changes?