Handwashing with soap after potential faecal contact: global, regional and country estimates.

Jennyfer Wolf,Eric Laurenz,Pavani K Ram,Richard Johnston,Annette Prüss-Ustün,Matthew C Freeman,Tom Slaymaker

doi:10.1093/ije/dyy253

Abstract

BackgroundLimited data have been available on the global practice of handwashing with soap (HWWS). To better appreciate global HWWS frequency, which plays a role in disease transmission, our objectives were to: (i) quantify the presence of designated handwashing facilities; (ii) assess the association between handwashing facility presence and observed HWWS; and (iii) derive country, regional and global HWWS estimates after potential faecal contact.MethodsFirst, using data from national surveys, we applied multilevel linear modelling to estimate national handwashing facility presence. Second, using multilevel Poisson modelling on datasets including both handwashing facility presence and observed HWWS after potential faecal contact, we estimated HWWS prevalence conditional on handwashing facility presence by region. For high-income countries, we used meta-analysis to pool handwashing prevalence of studies identified through a systematic review. Third, from the modelled handwashing facility presence and estimated HWWS prevalence conditional on the presence of a handwashing facility, we estimated handwashing practice at country, regional and global levels.ResultsFirst, approximately one in four persons did not have a designated handwashing facility in 2015, based on 115 data points for 77 countries. Second the prevalence ratio between HWWS when a designated facility was present compared with when it was absent was 1.99 (1.66, 2.39) P <0.001 for low- and middle-income countries, based on nine datasets. Third, we estimate that in 2015, 26.2% (23.1%, 29.6%) of potential faecal contacts were followed by HWWS.ConclusionsMany people lack a designated handwashing facility, but even among those with access, HWWS is poorly practised. People with access to designated handwashing facilities are about twice as likely to wash their hands with soap after potential faecal contact as people who lack a facility. Estimates are based on limited data.

Highlights

Handwashing with soap (HWWS) is an important public health behaviour as it reduces exposure to faecal pathogens and other infectious agents, thereby reducing gastrointestinal[1,2] and respiratory infections.[3]
Handwashing behaviour when handwashing facility presence is adjusted by the association with actual observed handwashing. This could be highly valuable for aggregated handwashing with soap (HWWS) estimates because data on handwashing facility presence are reliable and efficient and—whereas structured observations can estimate handwashing behaviour directly—structured observations are too time consuming to be integrated in national data collection.[6,14]. This analysis suggests that using handwashing facility presence for estimating handwashing behaviour, without further adjustment, would grossly overestimate actual handwashing prevalence, as we show that in low- and middle-income countries only 25% of potential faecal contacts in households with access to a designated handwashing facility are followed by HWWS
To effectively promote HWWS, there is a need to increase handwashing facilities equipped with soap and water in or around the home

Summary

Introduction

Handwashing with soap (HWWS) is an important public health behaviour as it reduces exposure to faecal pathogens and other infectious agents, thereby reducing gastrointestinal[1,2] and respiratory infections.[3]. To better appreciate global HWWS frequency, which plays a role in disease transmission, our objectives were to: (i) quantify the presence of designated handwashing facilities; (ii) assess the association between handwashing facility presence and observed HWWS; and (iii) derive country, regional and global HWWS estimates after potential faecal contact. Using multilevel Poisson modelling on datasets including both handwashing facility presence and observed HWWS after potential faecal contact, we estimated HWWS prevalence conditional on handwashing facility presence by region. From the modelled handwashing facility presence and estimated HWWS prevalence conditional on the presence of a handwashing facility, we estimated handwashing practice at country, regional and global levels. Second the prevalence ratio between HWWS when a designated facility was present compared with when it was absent was 1.99 (1.66, 2.39) P

Methods

Results

Discussion

Conclusion