Abstract
While appropriate hand hygiene practices (HHP) are protective against infections, the paucity of evidence on global estimates and determinants of HHP in adolescents limits effective design and planning of intervention to improve HHP in young people. We examined the prevalence and correlates of HHP in adolescents. We used nationally representative data from the Global School-based Student Health Survey (2003–2017) from 92 countries. HHP were categorized as “appropriate”, “inappropriate” and “lacking” based on the information about “hand washing before eating”, “hand washing after using the toilet”, and “hand washing with soap”. Multinomial logistic regression analyses were used to assess the role of socio-demographic, health, lifestyle, school, and family-related variables in HHP. Among 354,422 adolescents (13–17 years), only 30.3% were found to practice appropriate hand hygiene. Multivariable models suggest that sedentary behavior (adjusted relative risk ratio (ARRR) 1.41, 95% CI 1.31–1.51)), and bullying victimization (ARRR 1.20, 95% CI 1.10–1.30) promoted inappropriate HHP. In contrast, parental supervision (ARRR 0.55, 95% CI 0.50–0.59) and parental bonding (ARRR 0.81, 95% CI 0.75–0.87) were protective against inappropriate HHP. From a policy perspective, hand hygiene promotion policies and programs should focus on both school (bullying, exercise) and family-level factors (parental supervision and parental bonding) factors.
Highlights
Over 150 years ago, Ignaz Semmelweiss first demonstrated the effectiveness of a seemingly simple intervention, hand washing, in preventing obstetrical nosocomial infections [1,2]
The results from pooled multivariable multinomial logistic regression model for global data (Table 3) showed that sedentary behavior was associated with an increased odds of inappropriate hand hygiene practices (adjusted relative risk ratio (RRR) (ARRR) 1.41, 95% confidence interval (CI) 1.31–1.51, p-value < 0.001)
Adolescents who were bullied at school had higher odds of inappropriate hand hygiene practices than their counterparts (ARRR 1.20, 95% CI 1.10–1.30, p-value < 0.001)
Summary
Over 150 years ago, Ignaz Semmelweiss first demonstrated the effectiveness of a seemingly simple intervention, hand washing, in preventing obstetrical nosocomial infections [1,2]. Hand washing with soap and water at key times is heralded as one of the most cost-effective measures to reduce the global burden of gastrointestinal and respiratory diseases [3]. Post the emergence of COVID-19 there is a renewed emphasis on good hygiene practices, hand washing with soap, for protecting against coronavirus disease (COVID-19) infection and breaking the chain of transmission [4,5]. Hand washing with soap was listed as one of three key behaviors in the global Water Supply and Sanitation Assessment 2000 report by WHO that are of greatest likely benefit to health, in developing countries [6]. A systematic review reported good evidence that hand washing with soap has a similar impact on diarrhea in both industrialized and developing countries, where water supply and sanitation differ greatly [3]. This study provided good evidence to justify the promotion of hand washing with soap
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