Prevalence and factors associated with poor hand hygiene practices among adult cares of children under five years in Mbale district: A cross-sectional study

Abstract

Abstract Background: While proper hand hygiene practices can reduce the risk of contracting hygiene-related diseases among children under five, incidences of poor hand hygiene practices continue to exist in the community. The reasons for this behavior are not well documented. We determined the prevalence and factors associated with poor hand hygiene practices among adult carers of children under five to inform the design of tailor-made interventions to improve hand hygiene practices among adult carers of children under five years. Methods: This was a cross-sectional study in which both quantitative and qualitative data were collected. Data collection took place in March 2023. Quantitative data were collected from 320 adult carers of children under five. Structured questionnaires were utilized to capture data on socio-demographic characteristics, household characteristics, knowledge of hand hygiene, and COVID-19 prevention practices. A carer was considered to have engaged in poor hand hygiene practice if he/she washed hands at five or less out of ten listed critical junctures. We conducted multivariable logistic regression to identify independent factors associated with poor hand hygiene practices. Factors with a p-value less than 0.05 were considered to be statistically significant to the primary outcome. Qualitative data were collected from 51 purposively selected carers identified at the end of each quantitative interview. Data were collected using focus group discussions (FGDs) and in-depth interviews to explore the barriers to and facilitators for good hand hygiene practices among the carers. Qualitative data were analyzed following a thematic framework approach, supported by the use of Atlas. ti software. Results: Of the 320 carers, 275 (85%) were females. Slightly more than one-third (38.4%, n=123) of the carers were aged 25-34 years while 55.6% (n=178) had primary education. Twenty-eight percent (n=88) of the carers had engaged in poor hand hygiene. In the multivariable analysis, significant factors were; carers who attained above primary education level (adjusted odds ratio [AOR] = 0.5; 95% Confidence Interval [95%CI]: 0.2, 0.9), carers who heard information that hand hygiene protects against COVID-19 (AOR=0.2; 95% CI: 0.04,0.8), those that had received information on hand hygiene from village health teams [VHTs] (AOR=3.0; 95% CI: 1.6, 9.8), and those who sometimes have soap or sanitizer at the place reserved for hand washing (AOR=8.8; 95% CI: 1.7, 45.5). From the qualitative findings, the facilitators of good hand hygiene were remaining free from hygiene-related disease, fear of contracting COVID-19, influence of COVID-19 lockdown and society, while the barriers were shortage of hand hygiene facilities and personal decision to engage in hand hygiene (negligence, laziness, and tiresomeness). Conclusion: Poor hand hygiene practices were prevalent among a considerable proportion of adult carers of children under five years, largely driven by receipt of hand hygiene information from VHTs, lack of time to wash hands, fatigue, and lack of hand-washing materials. These findings suggest a need for target-specific hygiene-related interventions to increase the proportion of carers who engage in proper hand hygiene practices in Mbale district.