Hygiene Practices Among Young Adolescents Aged 12-15 Years in Low- and Middle-Income Countries: A Population-Based Study

Abstract

Background: Poor personal hygiene increases disease risk, however, the extent and prevalence of hygiene practices among adolescents is poorly described in low- and middle-income countries (LMICs). We aimed to assess the hygiene practices among young adolescents in LMICs using data from the Global School-based Student Health Surveys (GSHS). Methods: This population-based study analysed the GSHS data for adolescents aged 12-15 years from 75 LMICs. Data were collected between 2003 and 2015 using standardised, anonymous, self-reported questionnaires. This report focuses on hygiene related behaviours such as tooth brushing, washing hands after using the toilet, washing hands before eating and washing hands with soap. The weighted prevalence and 95% confidential intervals (CIs) for the hygiene practices, and overall and regional estimates were calculated with random-effects meta-analysis. Findings: A total of 181,848 young adolescents from 75 LIMCs with available hygiene data were analysed. The overall prevalence for never washing hands were 7·4% (95% CI: 4·4-10·3) for before eating, 5·9% (95% CI: 3·8-7·9) for after using the toilet, and 9·0% (95% CI: 6·2-11·8) for with soap. For tooth brushing, the overall prevalence estimates were 8·6% (95% CI: 5·5-11·7) for never brushing teeth, 80·9% (95% CI: 74·7-87·1) for 1-3 times per day, and 9·7% (95% CI: 5·8-13·6) for >3 times per day. However, the prevalence of different hygiene practices varied significantly among countries and regions (all P values 20%, was still observed in several LMICs (e.g., 12 countries for never washing hands and 4 for never brushing tooth). Interpretation: The hygiene practices of young adolescents aged 12-15 years were generally frequent, but poor status was still observed in several LMICs. These findings emphases the need for hygiene and health education targeting young adolescents in LMICs. Funding: This study received funding from the National Natural Science Foundation of China (81602853, 81872721), National Key R&D Program of China (2017YFC1310902), Natural Science Foundation of Zhejiang Province (LY17H260002), Sanming Project of Medicine in Shenzhen (SZSM201803080), K.C. Wong Magna Fund in Ningbo University, and Ningbo Scientific Innovation Team for Environmental Hazardous Factor Control and Prevention (2016C51001). Declaration of Interest: The authors confirm that this article content has no conflict of interest. Ethical Approval: In each participating country, the GSHS survey has been approved by both a national government administration (most often the Ministry of Health or Education) and an institutional review board or ethics committee. Verbal or written consent is obtained from the participants and their parents.