Abstract
BackgroundDiarrhoea incidence has been increasing progressively over the past years in developed countries, including Singapore, despite the accessibility and availability to clean water, well-established sanitation infrastructures and regular hygiene promotion. The aim of this study is to determine the current knowledge, attitude and behaviour of hand and food hygiene, and the potential risk factors of diarrhoea in a residential community of Singapore.MethodsA cross-sectional study was conducted within a residential area in the west of Singapore from June to August 2013. A total of 1,156 household units were randomly sampled and invited to participate in an interviewer-assisted survey using standardised questionnaires. Descriptive, univariate and multivariate analyses were performed using descriptive statistics, Fisher’s Exact test and multivariate logistic regression modelling, respectively. R program was used for all statistical analysis. All tests were conducted at 5 % level of significance with 95 % confidence intervals (CI) reported where applicable.ResultsA total of 240 units (20.8 %) consented and responded to the survey invitation. About 77 % of the expected knowledge and attitude were observed in at least 80 % of the participants, compared to only about 31 % of the expected behaviours and practises. Being single [adjusted odds ratio (AOR) = 2.29; 95 % CI = 1.16-4.48], having flu in the past six month (AOR = 3.24; 95 % CI = 1.74-6.06), preferred self-medication (AOR = 2.07; 95 % CI = 1.06–4.12) were risk factors of diarrhoea. Washing hands with water before attending to children or sick persons (AOR = 0.30; 95 % CI = 0.11–0.82), washing hands with water (AOR = 0.16; 95 % CI = 0.05–0.45) and water with soap (AOR = 0.29; 95 % CI = 0.12–0.72) after attending to children or sick persons, and hand washing between 30 s to a minute (AOR = 0.44; 95 % CI = 0.20-0.90) were protective factors against diarrhoea.ConclusionsGood knowledge and attitude of the participants did not positively translate into high compliance and motivation to perform good hygiene practices. This observation may have resulted in a significant extent on the increasing diarrhoea incidences. Current interventions may be improved with more active community partnership among the residents, schools and the relevant social organizations, to raise awareness on the importance of compliance to good hygiene practices, and the risk factors of diarrhoea. A large case–control study would be required to validate these findings in future.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1910-3) contains supplementary material, which is available to authorized users.
Highlights
Diarrhoea incidence has been increasing progressively over the past years in developed countries, including Singapore, despite the accessibility and availability to clean water, well-established sanitation infrastructures and regular hygiene promotion
The questionnaire was designed to tackle the behaviour of the participants first before we questioned them on their knowledge and attitude towards handwashing
The median age of the participants was 41.5 years old [Interquartile range (IQR): 32–52], 50.8 % was female, 76.7 % was married, 66.3 % was Chinese, 75.8 % was Singaporean, and 55.4 % stayed in a four room flat (Table 1)
Summary
Diarrhoea incidence has been increasing progressively over the past years in developed countries, including Singapore, despite the accessibility and availability to clean water, well-established sanitation infrastructures and regular hygiene promotion. Diarrhoea episodes in children under the age of five, are estimated at about 1.7 billion of which 36 million were severe cases [1, 2]. The main cause of diarrhoea in a developed community is usually due to either foodborne or person to person transmission [8,9,10,11,12]. Diarrhoea can be significantly reduced through improvements in drinking water, sanitation facilities, hygiene knowledge and practices [11, 13, 14]. Well-structured campaigns to improve hygiene knowledge and practices have been shown to be effective in the prevention of diarrhoea disease transmission in clinical settings [15] as well as in the less developed communities [16, 17]
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