Handwashing with Soap Counseling (CTPS) on Children's Knowledge and Attitudes in the Era of the Covid-19 Pandemic

Knowledge about handwashing is important as an effort to prevent Covid-19 in children. The purpose of this study is to determine the effect of handwashing with soap (CTPS) counseling on children's knowledge and attitudes in the era of the Covid-19 pandemic. This research was designed as a quasi-experimental approach with a pre-test, post test group design approach. The sampling technique used was purposive sampling. The sample for the study consisted of children aged 12 to 14 years, for a total of 30 people. The instrument used was a questionnaire with a meter using the Guttman scale. The data were analyzed using a statistical test (Wilcoxon test). The results of this study showed that based on the statistical test results of the ranking test signed by Wilcoxon, a p-value = 0,000 was obtained, which means that the p value is less than 0,05. There was an effect of counseling on handwashing with soap (CTPS) on the knowledge and attitudes of MTS class VII students. Based on the discussion, it can be concluded that there was an effect of hand washing counseling on the hand washing attitude and knowledge. Therefore, students should apply hand washing with soap (CTPS) in preventing the transmission of Covid-19.


INTRODUCTION
Infection caused by the novel coronavirus  was first detected in December 2019 in Wuhan in Hubei Province, China. The World Health Organization (WHO) declared the outbreak a Public Health Emergency of International Concern in January 2020. After SARS and MERS, Covid-19 has become the third pandemic caused by the coronavirus to cause worldwide panic. Considering it as a disease with a high risk of transmission, the WHO has issued the necessary guidelines to deal with the transmission of Covid 19. Because Covid-19 is a new virus, there is no population that has antibodies to it worldwide. Therefore, everyone has the opportunity to get infected, including the children (Syarif, 2021).
Washing hands with soap according to WHO is the right way according to health, because soap can kill germs or viruses that stick to the hands. So the simplest effort to uphold the pillars of a healthy life is to like to wash your hands. This effort, which is considered trivial by the community, can actually make an important contribution to efforts to prevent Covid-19 (Ibrahim et al., 2020).
Apart from functioning as a place for teaching and learning, schools are also a threat of disease transmission if the school environment is not managed properly. More than that, school age children are an age that is prone to various diseases. Diseases that often appear in school-age children include diarrhea, intestinal worms, anemia, and dental caries which are related to Clean and Healthy Living Behavior (PHBS) (Maryunani, 2018).
The habit of washing hands is important to be taught from an early age because children are potential agents of change for the surrounding environment. One of the factors that influence the formation of hand washing behavior is knowledge. In Indonesia, hand washing has not become a culture carried out by the wider community. Idris 1 et al. Vol. 4, No. 2, Agustus 2022 254 In everyday life, many wash their hands only with water before eating. Washing hands with soap is actually done after eating (Nugroho, 2014). Problems that are so complex in the midst of the Covid-19 outbreak require immediate action, so family support is needed, for example through adequate daily care such as personal hygiene care (Ministry of Health RI, 2014) Families in providing knowledge about good and correct hand washing because it will have an impact on children's attitudes in carrying out their daily activities.
Based on the initial data obtained through interviews with one of the staff, it said that children in the Medina Islamic Boarding School in Makassar City were still not able to apply the 6 steps of washing hands properly. This is what makes the researchers interested in conducting research on the description of hand washing habits in children (MTS) in the Covid-19 Pandemic Era at Medina Islamic Boarding Schools, Makassar City. Based on the description of the theory and phenomena above, there is an interest in researching the effect of handwashing with soap counseling on children's knowledge and attitudes in the Covid-19 Pandemic era at Pondok Pesantren Medina Makassar City.

METHODS
This study was designed with a quasi-experimental approach with a pre-test, post-test group design approach. The sampling technique used is purposive sampling. The side technique used is purposive sampling. The research was carried out in August-December 2021. The number of samples was 30 subjects of class VII MTS at Pondok Pesantren Madina Makassar City. The instrument used is a questionnaire with a measuring instrument using the Guttman scale. guttman scale is a measurement for a definite answer, the data obtained can be found at. As dichotomous range or ratio data (two alternatives). Data were analyzed using statistical tests (Wilcoxon test) (Sugiyono, 2013). Table 1 shows the results of the pre-test on handwashing knowledge. It was found that most of the class VII MTS children had sufficient knowledge of 16 subjects (53,3%). This table also shows pre results The test on hand washing attitude showed that most of the class VII MTS children had a poor attitude as many as 28 subjects (93,3%).  Table 2 shows the results of the post test on hand washing knowledge, it was found that most of the VII grade MTS children had sufficient knowledge as many as 25 subjects (83,3%). This table also shows the post results The test on hand washing attitude showed that most of the class VII MTS children had a sufficient attitude as many as 24 subjects (80%). The effect of washing counseling hands with soap on knowledge and attitudes in children in the era of the Covid 19 pandemic In Table 5 shows the results of the Wilcoxon statistical test, the value of p = 0,000, and r = 0,998. Because the p value (0,000) <0,05, meaning that there is an effect of counseling on hand washing with soap on children's knowledge and attitudes in the era of the covid 19 pandemic. Based on the results of the post-test study of children's knowledge about hand washing, it showed that from 30 (100%) there were 25 subjects (83,3%) in the sufficient category and 5 subjects (16,7%) in the poor category. This is because knowledge about hand washing with previous counseling methods has been given so that students understand properly and correctly because at the time of counseling the children listen and pay close attention.

Distribution of children's knowledge and attitude about hand washing
While the results of the post-test research on children's attitudes about hand washing showed that of the 30 subjects who were included in the sufficient category, 24 subjects (80,0%) were included in the less category and 6 subjects (20,0%). This is because knowledge about hand washing with the extension method has been given previously so that students understand properly and correctly because at the time of counseling students pay close attention.
The journey of the Covid-19 virus into the human body begins with the entry of the virus through the mucous membranes, especially the nasal and laryngeal mucosa, then enters the lungs through the respiratory tract. Corona virus infection is the same as other viruses, which can be transmitted by splashing saliva, touching the hands or face of an infected person, and touching the eyes, nose or mouth after handling items that have been splashed by someone's saliva. with the SARS-CoV2 virus. If exposed to a large number of viruses at the same time, it can cause illness, even if the immune system is functioning normally. People with low immune systems such as the elderly, pregnant women, and other conditions, this disease can progress more quickly and be more serious (Burhan, 2020).
It was explained in detail that maintaining personal hygiene during the Covid-19 pandemic, such as washing hands, was one of the steps that students needed to take. The World Health Organization (WHO) has also explained that maintaining hand hygiene has been able to save human lives from Corona virus infection (WHO, 2020). After students know and realize this, then interest arises, namely students are interested in washing their hands before and after the activity. This study is in line with research conducted by Dewi and Wawan (2011) that the relationship between Knowledge and Attitude towards Handwashing Behavior in Pegiran Communities. Which says that good behavior can be an effort to prevent Covid-19 this research is also in line with the Sulaiman and Supriadi (2020) which says that a good attitude can affect the implementation of health protocols in preventing Covid-19. The results of research conducted by Koesmawardani (2020) that health promotion interventions carried out are proven to increase knowledge and attitudes in washing hands. This is not in accordance with the research of Nismawati and Marhtyni (2020) The results of statistical tests for the knowledge variable show no significant relationship. There is a significant relationship between knowledge about the application of health protocol behavior because the p-value is more. Above 0,05 (p = 0,056).
Counseling involves listening, speaking and seeing activities which makes this method effective. From this counseling there is a learning process for children. Learning is an effort process carried out by individuals to obtain a new behavior change as a whole, as a result of the individual's own experience in the individual's interaction with his environment (Koesmawardani, 2020).
The opinion expressed by Rahmawati and Dimas (2015) that hand health and hygiene significantly reduces the number of disease-causing microorganisms on both hands thereby minimizing cross-contamination, for example from health workers to patients. From the point of view of infection prevention and health practice, sanitation activities are intended to prevent hand-borne infections, by removing dirt and dust and Jurnal Ilmiah Kesehatan (JIKA) Vol. 4, No. 2, Agustus 2022 257 inhibiting or killing microorganisms on the skin. Hand sanitation can eliminate not only most of the organisms that are transmitted through contact with the patient and the environment, but also some organisms that live in the deeper layers of the skin. The results of this study are different from those obtained by Norfai (2018), there are differences in the knowledge of PHBS counseling subjects about CTPS before counseling and subjects' knowledge about PHBS counseling about CTPS after counseling, there are differences in knowledge before and after counseling. CTPS counseling intervention with the Emo method demo for school-age children at MI Al-Badri Kalisat Jember (Lipinwati et al., 2018). There are factors that experienced a significant increase before and after health promotion interventions related to hand washing with soap (CTPS), namely the knowledge variable (Ashari, 2020). The same thing was found (Wati et al., 2017) that there was an increase in knowledge, after an intervention video shows about washing hands with soap. Therefore Knowledge is the key to behavior change, and individuals can build knowledge and skills through the learning process (Liu et al., 2016).

CONCLUSION
Based on the results and discussion, it can be concluded that students' knowledge about hand washing with soap (CTPS) using soap and running water has an important effect on students' knowledge after the intervention. So that children can apply or be able to cultivate the 6 steps of hand washing in everyday life.