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ORIGINAL ARTICLE
Year : 2019  |  Volume : 12  |  Issue : 3  |  Page : 233-238  

Handwashing practices among caregivers of children


1 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
2 Department of Pediatrics, Institute of Human Virology, Kano, Nigeria
3 Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
4 Department of Paediatrics, Federal Medical Centre, Birnin Kudu, Nigeria

Date of Submission19-Sep-2018
Date of Acceptance18-Feb-2019
Date of Web Publication15-May-2019

Correspondence Address:
Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_159_18

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  Abstract 


Introduction: Handwashing has been proven to reduce the risk of acquiring infection; this is why every 15th October is being set aside as Global Handwashing Day, which aims at improving global awareness on the importance of handwashing. Materials and Methods: The study was cross-sectional, parents/caregivers were consecutively recruited over 8 months, and pretested questionnaire was administered by the researchers and trained assistants. Results: There were 102 (32%) males and 217 (68%) females with a male-to-female ratio of 1:2.1. A total of 279 (87.5%) respondents reported that they were aware of the moments of hand hygiene. Their relations (38.3%) were the most common source of information on hand hygiene. However, soap and water (72.4%) were the predominant items used for handwashing. Furthermore, 317 (99.1%) respondents were incorrect on the steps of handwashing technique. All respondents (100%) reported washing their hands after using the restroom. However, their educational and social status had no significant relationship with their ability to mention the steps in handwashing and the critical moments in hand hygiene, respectively, (educational status: ‡Fisher's exact = 0.440; P = 1.00, and $Fisher's exact = 3.308; P = 0.282, respectively) and (social class: ‡‡Fisher's exact = 0.756; P = 1.00 and $$Fisher's exact = 1.232; P = 1.00, respectively). However, there were statistically significant relation with adhering to the principles of handwashing (educational status: †χ2 = 7.835; df = 2; P = 0.019) and (social class: ††χ2 = 7.952; df = 2; P = 0.019), respectively. Conclusion: Majority of the respondents wash their hands especially after soiling with dirt; and water and soap were mostly used; however, the technique of handwashing was poorly understood by caregivers and this was shown to be less influenced by their educational or social status.

Keywords: Caregivers, critical moments in hand hygiene, hand hygiene, handwashing


How to cite this article:
Aliyu I, Mohammed A, Zubayr BM, Michael GC, Grema BA, Umar UI, Gambo MJ, Ibrahim HU. Handwashing practices among caregivers of children. Med J DY Patil Vidyapeeth 2019;12:233-8

How to cite this URL:
Aliyu I, Mohammed A, Zubayr BM, Michael GC, Grema BA, Umar UI, Gambo MJ, Ibrahim HU. Handwashing practices among caregivers of children. Med J DY Patil Vidyapeeth [serial online] 2019 [cited 2019 May 25];12:233-8. Available from: http://www.mjdrdypv.org/text.asp?2019/12/3/233/258203




  Introduction Top


The act of handwashing has been integrated into our daily activities and children are often taught early on its importance. Handwashing has been proven to reduce the risk of acquiring infection, this is why every 15th October is being set aside as Global Handwashing Day; the main objective of this day is aimed at improving the global awareness of the importance of handwashing.[1],[2],[3],[4],[5],[6] The steps in handwashing may appear simple, but it is quite technical; therefore, caregivers need to be taught on the proper procedure.[7],[8],[9],[10],[11],[12]

Hand hygiene has minimized the number of child deaths from diarrhea by almost half; and from pneumonia by one-quarter.

Critical moments in hand hygiene for caregivers are: after using a bathroom, after changing a diaper, before feeding a child, before eating and before preparing food, or handling of raw meat, fish, or poultry; or any other situation leading to potential contamination; the basic principle of hand hygiene recommend by the World Health Organization is the use of water/soap when the hands are visibly dirty/soiled, otherwise, use of hand rubs/sanitizers is encouraged.[13],[14],[15],[16],[17],[18]

Nigerians have a poor reading culture,[19] most of these vital information on hand hygiene are often readily displayed in the form of write-ups and cartoons placed at strategic locations, but how often are they read? In view of the importance of handwashing, we carried out a study determining the handwashing practices among caregivers of children seen in Aminu Kano Teaching Hospital, Kano.


  Materials And Methods Top


The study was crosssectional, it included parents/guardians of children attending the Pediatric Outpatient Clinic of Aminu Kano Teaching Hospital. This was conducted between March 2016 and November 2016. Caregivers that declined consent to this study were excluded. Using a prevalence of 70.6%, as reported by Aigbiremolen et al.,[20] the calculated minimum sample size was 162; however, this was expanded to 324; which will improve the validity of the results. Individuals were recruited from the Pediatric Outpatient Clinic, they were selected through a purposive sampling method. Pretested questionnaires were administered by the researchers and trained research assistants (this was translated to the local language and validated to ensure internal consistency with a Cronbach's Alpha value of 0.7). The questionnaire contained relevant information such as knowledge of Global Handwashing Day, knowledge of 5-moments of hand hygiene, technique of handwashing, and personal hand hygiene practices. The social class of the respondents was determined using the format suggested by Oyedeji.[21]

Ethical approval was obtained from the Ethics Committee of Aminu Kano Teaching Hospital, Kano and informed consent was also obtained from the participating individuals.

Data analysis

The data generated from the questionnaires were entered and analyzed using the statistical software, Statistical Package Social Sciences version 16.0 (SPSS Inc., Chicago, Illinois, USA). Data were presented as tables and summarized as frequencies and percentages. Chi-square and Fisher's exact tests for categorical variables were deplored, and P < 0.05 was considered as statistically significant.


  Results Top


Five of the questionnaires were excluded from analysis because of incomplete response, therefore, 319 were analyzed. There were 102 (32%) males and 217 (68%) females with a male-to-female ratio of 1:2.1.

Three hundred and fourteen (98.4%) respondents believed that handwashing could reduce the risk of infection, while only five (1.6%) did not share similar view. Furthermore, 287 (90%) reported that they were aware of the proper handwashing technique and 32 (10%) were not aware of it.

Two hundred and seventy-nine (87.5%) respondents reported that they were aware of the critical moments hand hygiene while only 40 (12.5%) were not aware; however, 279 (99.3%) could not list the critical moments in hand hygiene correctly, however, two (0.7%) respondents could not remember the exact periods.

Relations (38.3%) of the respondents were the most common sources of information on hand hygiene, followed by the mass media (19.6%), while information from friends (8.7%) was the least; however, majority of the respondents (55.2%) were not aware of the Global Handwashing Day; furthermore, 51.7% of those who were aware of the Global Handwashing Day could state the date correctly while 30.8% had forgotten the date. Soap and water (72.4%) were the predominant items used for handwashing, while clean cloth (2.2%) was the least used [Table 1].
Table 1: Sources of information and items used in handwashing among the respondents

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One hundred and ninety-four (60.9%) respondents had seen posters on handwashing while 125 (39.1%) had not seen any. Seventy-one (36.6%) respondents had seen only one poster, 84 (43.3%) had seen 2–5 posters, while 39 (20.1%) had seen >5 posters; however. One hundred and sixty-eight (86.6%) respondents had read those posters while 26 (13.4%) never bothered to read them. Among those that read the posters, 164 (97.6%) believed that they understood the messages on the posters, while only four (2.4%) did not understand the information on the posters [Table 1].

One hundred and sixty-one (50.5%) of the respondents had personal hand rubs, while 158 (49.5%) did not have any. However, 289 (90.6%) were willing to use hand rubs if offered, while 30 (9.4%) of them did not like hand rubs. Majority (50%) of those who did not like hand rubs had no prior information on its usage [Table 2].
Table 2: Common reasons for disliking hand rubs

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Three hundred and sixteen (99.1%) respondents could not mention the steps on handwashing technique correctly, while three (0.9%) respondents had forgotten the steps on handwashing. However, 248 (77.7%) respondents reported adhering to the principle of hand hygiene always, while 71 (22.3%) do not always adhere to hand hygiene principles; however, most (95%) wash their hands after handling pampers/soiled clothes [Table 3], but all respondents (100%) reported washing their hands after using the restroom.
Table 3: Handwashing during critical moments

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Among those who could not mention the steps in handwashing majority reported seeing posters on handwashing technique; however, this observation was not statistically significant (‡Fisher's exact = 0.044; P = 1.00) but those who reported adhering to the principles of handwashing, majority reported seeing posters on handwashing and this observation was statistically significant (†χ2 = 25.123, df = 1, P = 0.00); however, listing the critical moments of hand hygiene had no statistically significant relationship with seeing posters on handwashing ($Fisher's exact = 0.203; P = 1.00), [Table 4].
Table 4: The impact of posters on hand hygiene

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Significant proportion of the respondents who reported adhering to the principles of hand hygiene had heard of the handwashing day (121, 48.8%); this observation was statistically significant (‡χ2 = 7.075, df = 1, P = 0.010). However, majority of those who were incorrect in listing the critical moments in hand hygiene were not aware of the Global Handwashing Day [Table 5].
Table 5: The impact of Global Handwashing Day on hand hygiene practices

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Majority of the respondents had secondary school education; however, there was no statistically significant relation between their educational status and the ability to correctly mention the steps in handwashing (‡Fisher's exact = 0.440, P = 1.00); also comparing their educational status with the ability to list the critical moments in hand hygiene was not statistically significant ($Fisher's exact = 3.308; P = 0.282), but there was a statistically significant relation from comparing their educational status with adherence to the principle of hand hygiene (†χ2 = 7.835; df = 2; P = 0.019), [Table 6].
Table 6: The effect of educational status and social class on hand hygiene practices

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Similarly, majority of the respondents were of the middle class; however, there was no statistically significant relation between their social class and the ability to correctly mention the steps in handwashing (‡‡Fisher's exact = 0.756; P = 1.00); also it had no statistically significant relationship with the ability to correctly list the critical moments in hand hygiene ($$Fisher's exact = 1.232; P = 1.00), but it had a statistically significant relation with adherence to the principle of hand hygiene (††χ2 = 7.952; df = 2; P = 0.019), [Table 6].


  Discussion Top


There were more females than males reported in this study; this observation is not surprising because most mothers in most resource-limited settings are either self-employed or “stay at home mothers,”[22] therefore, they have more time to themselves, furthermore, mothers are more caring and will be eager to take their sick children to hospital for treatment.[23],[24],[25]

Majority of the respondents (98.4%) believed in the importance of handwashing in disease prevention, this observation was similar to that reported by Asekun-Olarinmoye et al., (93%)[26] but our figure was higher than that reported by Aigbiremolen et al. (70%)[20] and Datta et al., (84%).[27] Similarly, 90% of our respondents reported been aware of the proper technique of handwashing; this observation was similar to previous reports.[25],[26],[27] Furthermore, most of the respondents (87%) in this study were aware of the critical moments in hand moment; this pattern was similar to that reported by Datta et al.,[27] but higher than the 56% reported by Aigbiremolen et al.[20]

However, most respondents got information on hand hygiene from relations; this highlights strong family ties which is prevalent in most developing society, this may be significantly influenced by our culture, religion, and beliefs;[28] therefore, health authorities and nongovernmental agencies need to do more in public enlightenment because some of these practices may be harmful, furthermore, they need to explore on the benefits of integrating some of these practices with the goal of increasing community acceptance of health policies. About 44.8% of the respondents had heard of the Global Handwashing Day; this finding was similar to the 46% reported among university medical students,[29] but slightly lower than the 64.4% reported by Mohammed et al.[30] among health professionals. Furthermore, most of our respondents (51.7%) could correctly state the date earmarked for celebrating Global Handwashing, surprisingly, this was higher than that reported among health professionals (15%)[30] and medical students (11.7%).[29] This finding is worrisome because the professionals who are supposed to be stakeholders and advocates should be more knowledgeable. Majority of respondents in our study used soap and water (72.4%) for handwashing; this is different from the findings of Datta et al.[27] and Aigbiremolen et al.[20] who reported the use of water alone as the most common handwashing agent. This disparity may be attributable to the difference in the population studied; ours were predominantly of the middle class, with better educational and socioeconomic status when compared to theirs, which was a community-based study with higher respondents of lower socioeconomic class.

Although 60.9% of the respondents had seen posters on handwashing technique, 86.6% of them reported to have read them and 97.6% of them believed to have understood the information contained. Furthermore, 77.7% reported adhering to the principles of hand hygiene; however, 99.1% could not correctly mention the steps of handwashing and none of the respondents could rightly list the critical moments in hand hygiene. This showed that there was knowledge gap among the respondents. Unlike the report by Biran et al.[31] which showed the effectiveness of intervention measures such as use of films, animation, and physical demonstration in improving knowledge and acceptance of handwashing practices. Galiani et al.[32] in their project in Peru reported the inefficiency of mass media-based approach alone in improving the acceptance and practice of proper hand hygiene. They therefore, advocated the inclusion of community level-based approach. Although more of those that had seen posters on hand hygiene reported, they could mention the steps in handwashing, adhere to proper handwashing technique and also listing the critical moments in hand hygiene, but these were not statistically significant except adherence to handwashing. There is the tendency of individuals to casually read those posters without really comprehending the information contained; therefore, a multipronged approach as demonstrated by Biran et al.[31] and Galiani et al.[32] should be a better option.

About 72.7%, 95%, and 85% of the respondents reported washing their hands before handling their children, after handling soiled clothes/pampers, and before feeding their children, respectively, these findings were higher than that reported by Datta et al.[27] However, all the respondents reported washing their hands after handling feces; this observation was higher than the 79.6% reported by Aigbiremolen et al.[20] and 84.9% reported by Ekanem and Johnson.[33] The reason for this difference was not completely clear; however, ethnic and religious differences might had influenced this finding. Our society is Muslim predominant; they give high premium to personal cleanliness, especially after defecation with the use of at least clean water for purification.

Majority of the respondents in our study were of the middle and upper class; and most had at least primary education. However, this had no significant influence on their ability to correctly mention the steps of handwashing and also to correctly list the critical moments in hand hygiene. However, their ability to adhere to the principles of hand hygiene had significant relationship with their social class and educational status; this observation was similar to that of Aigbiremolen et al.,[20] Steiner-Asiedu et al.,[34] and Vivas et al.[35]


  Conclusion Top


Caregivers in our study were aware of the importance and benefits of handwashing; however, their relations were the most common source of information on hand hygiene; therefore, health care professionals need to do more in the area of education and advocacy. Although the use of posters is of relevance in health-related information dissemination, it may be of limited value if it is not properly utilized. Finally, the educational status and social class had more influence on their adherence to the principles of hand hygiene, but it had no significant influence on the ability of respondents to correctly mention the steps in handwashing or the ability to correctly list the critical moment in hand hygiene.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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