Assessment of Hand Washing Practice and it's Associated Factors among First Cycle Primary School Children in Arba Minch Town, Ethiopia, 2015

Abstract

Introduction: Proper hand washing is one of the simplest, most affordable and effective means of stopping the spread of infection via feces, body fluids, and inanimate objects. Hand washing is especially important for children and adolescents, as these age groups are the most susceptible to infections gained from unwashed hands. In addition to this due to the close proximity of children in schools and child care settings, there is a high risk for the spread of infectious disease. Proper hand washing also improves learning and teaching processes by reducing absenteeism.

Full text

Assessment of Hand Washing Practice and it’s Associated Factors among First
Cycle Primary School Children in Arba Minch Town, Ethiopia, 2015
Behailu Besha1*, Hailu Guche1, Dawit Chare1, Abebech Amare1, Amelmal Kassahun1, Engida Kebede1, Yinager Workineh1, Tomas Yeheyis1, Mulugeta
Shegaze1, Adisu Alemayehu1 and Aman Yesuf2
1Department of Nursing, College of Medicine and Health science, Arba Minch University, Ethiopia
2Department of Public health, College of Medicine and Health science, Arba Minch University, Ethiopia
*Corresponding author: Behailu Besha, Department of Nursing, College of Medicine and Health science, Arba Minch University, Ethiopia, Tel: 251910837684; E-mail:
behailubesha022@gmail.com
Received date: May 04, 2016; Accepted date: May 24, 2016; Published date: May 30, 2016
Copyright: © 2016 Besha B, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Introduction: Proper hand washing is one of the simplest, most affordable and effective means of stopping the
spread of infection via feces, body fluids, and inanimate objects. Hand washing is especially important for children
and adolescents, as these age groups are the most susceptible to infections gained from unwashed hands. In
addition to this due to the close proximity of children in schools and child care settings, there is a high risk for the
spread of infectious disease. Proper hand washing also improves learning and teaching processes by reducing
absenteeism.
Objective: To assess hand washing practice and associated factors in primary school children in Arba Minch
town, 2015.
Method and materials: Institutional based cross sectional study design was employed on primary school
children. Data were collected using interview questionnaires. School hand washing facilities inspection was also
done using observation checklist. Data was entered and analyzed using SPSS version 16.0 software.
Result: One-fifth (22.23%) of participants had proper hand washing practice. Two hundred fifty four (72.57%) of
1st cycle primary school children had sufficient knowledge. Similarly, 254(78.28%) children had positive attitude
towards hand washing practice. Only two schools were fulfilling criteria of medium hygiene facility. From all
predictors, residency, availability and accessibility of water, and soap, and referent pressure were strongly
associated with hand washing practice as it was statistically evidenced by (AOR: 1.37, 95% CI: (1.07, 20.11)), (AOR:
0.25, 95% CI: (0.02, 0.87)) and (AOR: 1.65, 95% CI: (1.03, 7.98)), respectively.
Conclusion: This study revealed that only small proportion of study participant practiced proper hand washing
behavior. Place of residency, availability and accessibility of water, and soap, and pressure from important referents
were significantly associated with hand washing practice.
Keywords: Hand washing practice; Predisposing; Enabling;
Reinforcing; Factors
Abbreviations
HEWs: Health Extension Workers; SD: Standard Deviation;
UNICEF: United Nations Children’s Fund; WASH: Water, Sanitation
and Hygiene; and WHO: World Health organization
Introduction
Proper hand washing is one of the simplest, most aordable and
eective means of stopping the spread of infection via feces, body
uids, and inanimate objects [1].
Hand washing is especially important for children and adolescents,
as these age groups are the most susceptible to infections gained from
unwashed hands [2]. In addition to this due to the close proximity of
children in schools and child care settings, there is a high risk for the
spread of infectious disease.
Proper hand washing also improves learning and teaching processes
by reducing absenteeism. Hand washing reduces absenteeism as
evidenced by study conducted around the world like 54% (China), 40%
(Egypt), 35% (Kenya), 27% (Philippines) and 20% in (Colombia) [3].
Furthermore, approximately about 443 million school days are lost
each year due to water-related illnesses, making it a leading factor for
school absenteeism in the developing world [4].
Half of hospital visit and 12% of all admission among children aged
from 0 to 14 years are due to infections [5]. Among these, respiratory
infections and infectious intestinal disease are responsible for 48% and
29% of children visit to health facility respectively [6].
In developing countries, 80% of the diseases are associated with
poor domestic and personal hygiene and about 2.2 million people die;
mostly children die annually due to diarrhea; the same number again
die from acute respiratory infections [7].
Furthermore, worldwide about 400 million children are infected
with worms due to poor hand washing practices. ese worms
Epidemiology: Open Access Besha et al., Epidemiology (Sunnyvale) 2016, 6:3
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consume nutrients from children, therefore causing abdominal pain
and malfunction, impair their learning capacity and thus reduce school
attendance [8].
In Ethiopia more than 250,000 children die every year from
sanitation and hygiene related diseases. Some 60 percent of the disease
burden is related to poor sanitation and hygiene [9].
Even though the above problems are visible, proper hand washing is
not as widespread as desired worldwide. It has been reported that the
frequency of hand washing with soap before handling food or aer
using a toilet was observed in only between 0% and 34.0% cases [10].
Center for Disease Control and Association for Professionals in
Infection Control and Epidemiology have created guidelines for hand
washing [11]. In order to emphasize the importance of hand washing,
October 15 has been declared as the Global Hand Washing Day by
UNICEF since 2008 [12].
Ethiopia and foreign global public health agencies have been taking
steps towards enhancing access to resources and to increase health
literacy particularly concerning sanitation and hygiene. In 2007,
United Nations Children’s Fund (UNICEF) launched the Water,
Sanitation, and Hygiene (WASH) program to promote hand-washing
and sanitation practices in low income countries including Ethiopia
[13].
In this regard, Ethiopia has made considerable progress to
encourage increased access to and use of improved hygiene and
sanitation through HEWs using house to house methods.
Dierent studies indicated educational interventions to promote
hand washing in school settings aim to increase compliance with hand
washing [14,15].
But developing countries [16,17], have drawn attention to the lack
of rigorously conducted studies to evaluate the eectiveness of hand
washing interventions in preventing the spread of respiratory and
gastrointestinal infections.
In Ethiopia a study conducted by UNICEF and Ministry of health
found that study participants had poor status regarding knowledge,
attitudes, and practices of hygiene [18], but still there are no enough
evidences for hand washing practice, and its contributing factors in
Ethiopia in general in Arba Minch town in particular.
erefore, the aim of this study was the assessment of hand washing
practice and its associated factors among rst cycle primary school
children.
Methods and Methods
Study setting and period
is study was conducted from November 2015 to February 2016 in
Arbaminch 1st cycle primary school, Arbaminch town, Southern
Ethiopia province.
e town is located 505 km from Addis Ababa, the capital city of
Ethiopia, and 276 km from Hawassa, the capital city of Southern
Ethiopia province. Administratively it is divided into 14 kebeles.
Estimated populations of the town were 150,000. In this area, there
were seventeen public primary schools. From this school, een of
them had rst cycle primary school children. e town also had one
general hospital, two health centers, and eleven health posts.
Study design and population
A school based cross-sectional study involving quantitative method
was undertaken among randomly selected students who were
attending 1st cycle primary schools during the time of data collection.
e study populations of this study were students in grades 1, 2, 3 and
4 in Arbaminch 1st cycle primary school during the 2015 academic
year.
Students with learning disability and students attending evening
classes were excluded. In Ethiopian context, students attending evening
classes have dierent social characteristics from those who regularly
attend. us, they were excluded from the study to avoid over or under
estimation of the study ndings.
Sample size determination and sampling procedure
Single population proportion formula was used to calculate the
required sample size. Proportion of hand washing practice, margin of
error, condence interval, design eect and non-response rate were
assumed to be 11.7% (12), 5%, 95%, 2 and 5%, respectively.
Finally, adding 10% none response rate, the sample size was
determined to be 350.Multistage sampling technique was used to select
the study subjects. First stratication was made in to grades 1, 2, 3, and
4. en, grades were further stratied by section.
Calculated sample size was proportionally allocated to each grade
and section according to their number of students. en, frames of
students were developed from student roster of each grade in
collaboration with instructors of respective classes.
Eligible students were selected using simple random sampling
technique from the existing sampling frame (student’s roster). In every
step of selection, simple random sampling technique was used.
Data quality management
Data quality was ensured during collection, coding, entry and
analysis. Before the actual data collection, pretest was done to check
the validity of the instrument.
During data collection, one bachelor degree nurse supervisor and
six nurse data collectors with previous experience were recruited and
adequate training and follow up was provided. Codes were given to the
questionnaires during data collection so that errors could be timely
addressed.
e lled questionnaires were checked for completeness and
consistency by the data collectors, supervisor and principal
investigator on a daily basis. e data were further cleaned by
visualizing and calculating frequencies using SPSS version16 statistical
soware. Corrections were made according to the original data.
Data processing and analysis
Data were checked manually for completeness, then coded and
entered into SPSS version16 and analysed with this soware.
Descriptive analyses were executed for each of the variables. Bivariate
analysis was performed to see the crude association of the independent
variables with the outcome variable.
Finally, variables which showed signicant association with the
dependent variable on the bivariate analysis were entered to
multivariate logistic regression model to identify their independent
eects. P-value and 95% condence interval (CI) for odds ratio (OR)
Citation: Besha B, Guche H, Chare D, Amare A, Kassahun A, et al. (2016) Assessment of Hand Washing Practice and it’s Associated Factors
among First Cycle Primary School Children in Arba Minch Town, Ethiopia, 2015. Epidemiology (Sunnyvale) 6: 247. doi:
10.4172/2161-1165.1000247
Page 2 of 10
Epidemiology (Sunnyvale)
ISSN:2161-1165 ECR, Open Access Volume 6 • Issue 3 • 1000247

were used in judging the signicance of the associations. P-value less
than 0.05 were taken as signicant association.
Measurement
e instrument used to assess hand washing practice was designed
by all authors in consultation with senior research experts. e English
version questionnaire was translated to Amharic and to check its
consistency it was again translated back to English by experts of both
languages.
Before the actual data collection, the questionnaire was pre-tested
on 10% of the study subjects in the neighboring Lante district school
on a total of 35 students. Based on the ndings of the pretest, the tool
was modied and nally, the Amharic version questionnaire was
administered
Hand washing practice was assessed based on two criteria i.e. hand
washing with soap aer using toilet and hand washing with soap
before eating. Items measuring each criterion on 5 point frequency
scale ranging from 1=always to 5=never.
e 5 frequency table was dichotomized where by those who
answered 1=always to 2=very oen were classied as washers (scale 0)
and 3=oen to 5=never were classied as non-washers (scale 1).
e dichotomized items were added up to create summative index
point. Students who reported 1=always to 2=very oen for both
criterion were classied as proper hand washing category.Attitude or
belief about soap and water in relation to hand washing practice and
degree to which hand washing is positively or negatively valued by an
individual.
Attitudes towards hand washing was be assessed based on criteria
using the 5 point Likert scale related to belief about hand washing with
soap. (E.g. If you wash your hands many times with water you do not
need to use soap).
e scale ranging from 1=strongly disagree to 5=strongly agree was
dichotomized. e dichotomized item was added up to create
summative index. en students who answered 1=strongly disagree or
2=disagree for all questions were classied as having positive attitude
towards hand washing practice while those who will score 3=neutral to
5=strongly agree to all criteria were be classied as having negative
attitudes towards hand-washing practice.
Knowledge on hand washing was assessed based on eight questions
related to infectious diseases transmission; critical times of hand
washing and health outcome associated with hand washing (e.g. hand
should be washed even aer touching someone’s hand).
In each item those who answered correctly scored 1 and those who
answered wrongly will score 0. ose who scored 4 and more were be
classied as having sucient knowledge and those who scored 3 and
less will be classied as having insucient knowledge.
Reinforcing factors were assessed using 4 important referents
(parents, friends, teachers, and health professionals) based on the 5
point frequency scale 1=always to 5=never. e 5 point frequency scale
was dichotomized whereby those who scored 1=always to 2=very oen
were classied as perceiving high pressure from important referents
(score 0) and those who scored 3=oen to 5=never will be classied as
perceiving less pressure from important referents (score 1).
e dichotomized items were be added up to create summative
index. ose who scored 1=always or 2=very oen were regarded as
perceiving high pressure from important referents on washing hand
with soap.
Hygiene index was computed using a combination of four hygiene
facilities in school (running water+soap+washing station+toilet).
ose schools with 3 facilities were regarded as having medium
amount of hygiene facilities while those with 2 and less than 2 have low
amount of hygiene facilities and the schools with supplied with all
hygiene facility were be considered as having high amount of hygiene
facility.
Ethical consideration
Ethical clearance was obtained from Arbaminch University,
department of nursing institutional review board (IRB).
e letter of collaboration was written from department of Nursing
to Arbaminch School for the main study and to Lante School for the
pretest. e school director was briefed on the objectives of the study.
Each study participant was adequately informed about the purpose,
benets and risks of the study and their right to discontinue or refuse
to participate in the study. Finally, written informed assent was
obtained from their parents/guardians.
Results
Socio-demographic characteristics of participants
A total of 350 children were invited and all of them participated in
the study making a response rate of 100%. Two hundred forty nine
(71.10%) of the respondents were found to be in the age range of 9-11
years with mean of 10 (SD=0.483) years.
Regarding their educational status, 95 (26.29%) of children were
grade four. From total participants, 203(58%) were males and 332
(94.9%) were from urban areas. Majority of the study children’s family
occupation was civil servant 160(45.7%).
Regarding their family educational status, 60 (17.14%), and
65(18.57%) of the participant’s mothers and fathers were non-
educated. Only 130 (34.14%) of respondents earned a monthly income
of above 1500 Ethiopian birr (Table 1).
Hand washing practice
From all children, 278 (79.4%), and 277 (79.1%) of them washed
their hands with soap aer visiting toilet and before meal respectively.
According to criteria dened in the method, 78 (22.3%) of children
performed proper hand washing practice (Table 2).
Predisposing factors (knowledge and attitude) for children’s
hand washing practice
From all childrens, 100 (28.57%) of them said that human feces does
not contains germs.
Similarly, 95 (27.14%) of children said that human urine does not
contains germs. Ninety seven (27.71%) of children said that all objects
are not free from germs.
Citation: Besha B, Guche H, Chare D, Amare A, Kassahun A, et al. (2016) Assessment of Hand Washing Practice and it’s Associated Factors
among First Cycle Primary School Children in Arba Minch Town, Ethiopia, 2015. Epidemiology (Sunnyvale) 6: 247. doi:
10.4172/2161-1165.1000247
Page 3 of 10
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ISSN:2161-1165 ECR, Open Access Volume 6 • Issue 3 • 1000247

Variables Frequency Percent
Age
8-Jun 9 2.6
11-Sep 249 71.1
14-Dec 92 26.3
Sex
Male 203 58
Female 147 42
Grade of students
Grade one 84 24
Grade two 89 25.43
Grade three 85 24.28
Grade four 92 26.29
Residency
Urban 332 94.9
Rural 18 5.1
Religion
Orthodox 189 54
Protestant 143 40.9
Muslim 18 5.1
Family occupation
Civil Servant 160 45.7
Merchant 131 37.4
Farmer 27 7.7
Daily labor 32 9.1
Maternal educational status
Non Educated 60 17.14
Read and write 57 16.29
Grade 1-6 100 28.57
Grade 7-8 40 11.42
Grade9-12 33 9.42
above 12 60 17.14
Fathers educational status
Non Educated 65 18.57
Read and write 97 27.71
Grade 1-6 32 9.14
Grade 7-8 43 12.29
Grade9-12 70 20
Above 12 43 12.29
Monthly income
Below 1000 EBR 80 28.86
1000-1500 EBR 140 40
Above 15000 EBR 130 37.14
Table 1: Socio-demographic characteristics of study participants among primary school students in Arba Minch town, 2016.
Citation: Besha B, Guche H, Chare D, Amare A, Kassahun A, et al. (2016) Assessment of Hand Washing Practice and it’s Associated Factors
among First Cycle Primary School Children in Arba Minch Town, Ethiopia, 2015. Epidemiology (Sunnyvale) 6: 247. doi:
10.4172/2161-1165.1000247
Page 4 of 10
Epidemiology (Sunnyvale)
ISSN:2161-1165 ECR, Open Access Volume 6 • Issue 3 • 1000247

Variables Frequency Percent
Washing hand with soap after visiting toilet
Yes 278 79.4
No 72 20.6
Washed their hands using soap before meal
Yes 277 79.1
No 73 20.9
Hand washing practice
Proper 78 22.3
Improper 272 77.7
Table 2: Hand washing practice of primary school students in Arbaminch town, 2016.
Variables Frequency Percent
Do human’s feces contain germs?
Yes 250 71.43
No 100 28.57
Are all clean objects are not free from germs?
Yes 97 27.71
No 253 72.29
Does human’s urine contain germs?
Yes 255 72.86
No 95 27.14
Can germs be acquired when desks, door, books and animals are touched?
Yes 280 80
No 70 20
Do poor hand washing cause disease?
Yes 252 72
No 98 28
Is water only enough for hand washing?
Yes 257 73.43
No 93 26.57
Is hand washing with soap needed after coughing or sneezing?
Yes 269 76.86
No 81 23.14
Is failure to wash hand transmitting infectious disease?
Yes 261 74.57
No 89 25.423
Knowledge
Sufficient 254 72.57
Insufficient 96 27.43
If you wash your hands really well with water you don’t need to use soap?
Yes 271 77.43
No 79 22.57
You only need to wash your hands with soap if they look dirty or smell bad?
Yes 289 82.57
No 61 17.43
Is washing your hands with soap is important before feeding?
Yes 250 71.43
No 100 28.57
Attitude Positive 274 78.28
Table 3: Predisposing factors for children’s hand washing practice in Arbaminch town, 2016.
Citation: Besha B, Guche H, Chare D, Amare A, Kassahun A, et al. (2016) Assessment of Hand Washing Practice and it’s Associated Factors
among First Cycle Primary School Children in Arba Minch Town, Ethiopia, 2015. Epidemiology (Sunnyvale) 6: 247. doi:
10.4172/2161-1165.1000247
Page 5 of 10
Epidemiology (Sunnyvale)
ISSN:2161-1165 ECR, Open Access Volume 6 • Issue 3 • 1000247

From involved children, 252 (72%) of them said poor hand washing
cause disease.
According to the measurements criteria for knowledge of hand
washing practice, 254 (72.57%) were found to have sucient
knowledge while rest had insucient knowledge.
Similarly, 254 (78.28%) children had positive attitude towards hand
washing practice whereas 96 (21.72%) had negative attitude (Table 3).
Reinforcing factors for children’s hand washing practices
e sources of information about children hand washing practice
were television (46.9%), radio (16.9%), leaets (0.3%) and newspaper
(36%).
Children hand washing practice was pressured by parents 296
(84.85%), teachers 196 (56.28%), health Professional’s 91 (26%), and
friends 61 (17.42%).
Variables Frequency Percent
From which media have you heard about hand washing?
Television 164 46.9
Radio 59 16.9
Leaflets 1 0.3
News paper 126 36
Referents for hand washing practice
Parents 296 84.85
Teachers 196 56.28
Health professionals 91 26
Friends 61 17.42
Pressure from parents
High 296 84.85
Low 54 15.15
Pressure from friends
High 61 17.42
Low 279 82.58
Pressure from teachers
High 196 56.28
Low 94 43.72
Pressure from health professionals
High 26 26
Low 74 74
Important referent pressure
High pressurized 162 46.28
Less pressurized 188 53.72
Is there any hygiene and sanitation club in your school?
Yes 208 59.42
No 142 40.58
Does your school celebrate Hand Yes 117 33.42
Washing Day? No 233 66.58
If yes, have you ever participated?
Yes 117 33.42
No 233 66.58
Table 4: Reinforcing factors for children’s hand washing practices in Arbaminch town, 2016.
From the total participants, 46.28% of participated children had got
high pressure to wash their hands from important referents. From the
six schools included in the survey only two schools has sanitation and
hygiene club.
All schools claimed hand washing day celebration, but among the
participated children only 41% of children actually celebrated so far
(Table 4).
Enabling factors for children hand washing practice
In the observed school there were forty toilets. e toilet student
ratios were 1:73 and 1:67 for male and female students respectively.
From this toilets, 25 (62.5%) of them had hand washing station which
was installed outside the latrines rooms. All the station had water but
not soap supply at the time of observation. In relation to hygiene
facility, only two school fullled criteria of medium hygiene facility, but
none of them fullled criteria of high hygiene facility.
Citation: Besha B, Guche H, Chare D, Amare A, Kassahun A, et al. (2016) Assessment of Hand Washing Practice and it’s Associated Factors
among First Cycle Primary School Children in Arba Minch Town, Ethiopia, 2015. Epidemiology (Sunnyvale) 6: 247. doi:
10.4172/2161-1165.1000247
Page 6 of 10
Epidemiology (Sunnyvale)
ISSN:2161-1165 ECR, Open Access Volume 6 • Issue 3 • 1000247

About 52.6% and 80.6% of students reported that there was regular
access to water, and water, and soap at home respectively (Table 5).
Variables Frequency Percent
Presence of hand washing station
Present 25 62.5
Absent 15 37.5
Place of hand washing station
Within latrine room 0 0
Outside latrine room 25 100
Presence of water supply within washing installation?
Yes 25 100
No 0 0
Presence of soap for hand washing?
Yes 0 0
No 25 100
Ratio of toilet to male student
Within standard 0 0
Below standard 6 100
Ratio of toilet to male student
Within standard 0 0
Below standard 6 100
Presence of only water for hand washing at home?
Yes 282 80.6
No 68 19.4
Presence of soap and water for hand washing at home?
Yes 184 52.6
No 166 47.4
School hand washing facility
Medium 2 33.33
Low 4 66.67
Table 5: Enabling factors for children hand washing practice in Arba Minch town, 2016.
Factors aecting hand washing practice in primary school
children
In multivariate logistic regression analysis, residency, presence of
water and soap, and referent pressure were signicantly associated with
hand washing practice in 1st cycle primary school children.
From all socio demographic proles of children, only residency was
signicantly associated with hand washing practice, In this aspect,
urban children more likely performed proper hand washing practice
(AOR: 1.37, 95% CI: (1.07, 20.11)) than rural children.
Concerning to enabling factors for children hand washing practice,
presence of water and soap showed strong statistical association with
hand washing practice.
In this regard, absence of water and soap was protective for proper
hand washing practice (AOR: 0.25, 95% CI: (0.02, 0.87)) as compared
with presence of water and soap for hand washing practice.
Regarding to reinforcing factors for children’s hand washing
practices, pressure from important referents was independent
predictor for hand washing practice in children.
In this, case, the odds of high pressure from important referents
brought high chance for proper hand washing practice in primary
school children (AOR: 1.65, 95% CI: [1.03, 7.98]) than low pressure
from important referents ( Table 6).
Discussion
is school based cross-sectional study with the objective of the
assessment of hand washing practice, and its associated factors in
primary school children was conducted in Arbaminch town, Gamo
Gofa Zone, Southern Ethiopia.
e results from this study revealed relatively small (22.3%)
proportions of primary school children practice proper hand washing
behavior and the rest 77.7% of children practice improper (poor) hand
washing behavior. A poor rate of hand washing in this study was lower
than other previous studies in Tanzania and Colombia [13,14].
is dierence can be due to the time gap of in this research and the
previous research works. In the present time in all parts of Ethiopia,
the health extension workers designed schedule and give health
education about hand washing practice for dierent segment of
populations. On the other hand, poor rate of hand washing practice in
this study was higher than the study conducted in Oromia Ethiopia
[19].
Citation: Besha B, Guche H, Chare D, Amare A, Kassahun A, et al. (2016) Assessment of Hand Washing Practice and it’s Associated Factors
among First Cycle Primary School Children in Arba Minch Town, Ethiopia, 2015. Epidemiology (Sunnyvale) 6: 247. doi:
10.4172/2161-1165.1000247
Page 7 of 10
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ISSN:2161-1165 ECR, Open Access Volume 6 • Issue 3 • 1000247

Variables Hand washing practice COR(95%CI) AOR(95%CI)
Improper n (%) Proper n (%)
Age
11-Sep 53 (74.6) 196 (72.59) 1.19 (1.02, 24.00) 0.23 (0.15, 3.15)
14-Dec 18 (25.4) 74 (17.41) 1 1
Sex
Male 38 (52.05) 165 (59.56) 0.74 (0.51, 2.75) 0.25 (0.04, 4.18)
Female 35 (47.95) 112 (40.44) 1 1
Residence
Urban 69 (94.52) 163 (92.09) 1.48 (1.01, 11.61)*1.37 (1.07, 9.11)*
Rural 4 (5.48) 14 (7.91) 1 1
Knowledge
Sufficient 64 (87.68) 246 (88.8) 0.90 (0.45, 11.12) 0.37 (0.54, 11.22)
Insufficient 9 (12.32) 31 (11.2) 1 1
Attitude
Positive 29 (39.73) 138 (49.82) 0.66 (0.32, 5.38) 0.10 (0.05, 1.22)
Negative 44 (60.27) 139 (50.18) 1 1
School hygiene facility
Medium 2 (2.74) 66 (23.83) 0.09 (0.01, 2.01) 0.20 (0.10, 11.10)
Low 71 (97.26) 211 (76.17) 1 1
Presence of soap and
water for hand washing
at home?
No 13 (17.8) 55 (19.55) 0.87 (0.05, 0.98)*0.25 (0.02, 0.87)*
Yes 60 (82.2) 222 (80.45) 1 1
Important Referents
High pressured 32 (43.84) 113 (40.79) 1.13(1.01, 5.15)*1.65 (1.03, 7.98)*
Less pressured 41 (56.16) 164 (59.21) 1 1
Table 6: Factors inuencing hand washing practice among primary school students in Arba Minch town, 2016.
is disproportion can be due to residency. All the participants in
Oromia were from urban but in this study some participants came
from rural area. us being urban expose the children to dierent
health extension packages via dierent communication mechanisms.
Generally, global gures indicate hand washing is still practiced to a
low extent [5].
In this study, there were dierent factors aecting hand washing
practices of school children. Among these factors, the key predictor of
hand washing practice of 1st cycle primary school children was
residency. In this regard, urban children more likely practice proper
hand washing behavior than rural children. is nding was in
agreement with the study conducted in Oromia Ethiopia, Tanzania,
and Colombia [12-14]. Similarly, another study showed hand washing
behavior dierence by rural and urban setting where urban dwellers
practice hand washing than their rural counter parts. is can be due
to the high level acceptance national initiatives like Hand Washing Day
by urban 1st cycle primary school children, and further interventions
by health extension workers can increase student’s frequency and
compliance to hand washing practice in urban residency than rural
residency.
e other factor for hand washing practice in children was
accessibility of water and soap for hand washing purpose at home. In
this study unavailability of hand washing water and soap was found to
be preventive factors for hand washing practices in the schools
children. is is in line with the study conducted in Oromia Ethiopia,
Tanzania and Colombia [13,19,20]. Since hands are the primary
vehicle of transmission of many infectious diseases, providing
accessible water and soap in toilet area can be an eective program for
potentially reducing this problem by properly practicing hand washing
in the school children. In this regard, WHO recommended that hand
washing with soap is one of the most important hygiene behaviors
which should be promoted among school children since it beaks dirt
and grease that carries most of the germs which cannot be removed by
water alone [9].
e last but not the least determinants of hand washing practice
among reinforcing factors was important referent pressures. In this,
case, the odds of high pressure from important referents brought high
chance for proper hand washing practice in primary school children.
is nding is coincided with the study conducted in Oromia Ethiopia,
Tanzania, and Colombia [13,19,20]. e referents pressure inuences
the way in which children approach personal hygiene, which will stay
with them for life. Educating children on good hygiene is the best way
to avoid the spread of infection and disorders and not just for
childhood complaints; teaching the principles of correct hygiene at an
early age can help keep individuals healthy in later life, and be taught
to future generations. Principles of hygiene should be made part of
everyday life and the best way for referents to teach their children
about good hygiene is to lead by example.
e main decisive factors for hand washing practice for children in
dierent part of the world can be predisposing factors like knowledge
and attitude of children. Even though, knowledge status was not
associated with hand washing practice, ndings of this study indicated
that one thirds of children had insucient knowledge about important
aspects of hand washing. In this regard, similar studies were obtained
Citation: Besha B, Guche H, Chare D, Amare A, Kassahun A, et al. (2016) Assessment of Hand Washing Practice and it’s Associated Factors
among First Cycle Primary School Children in Arba Minch Town, Ethiopia, 2015. Epidemiology (Sunnyvale) 6: 247. doi:
10.4172/2161-1165.1000247
Page 8 of 10
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ISSN:2161-1165 ECR, Open Access Volume 6 • Issue 3 • 1000247

from the study done in Tanzania and Colombia [13,20]. Likewise, low
knowledge about hand washing practice was founded in many parts of
the word [21]. In the same fashion, attitudes, which reect the degree
to which performance of a behavior is positively or negatively valued
by an individual [22], were not found to be statically important in
predicting hand-washing practice in this study? Attitudes are shaped
by salient beliefs, perception of the expected outcomes, and subjective
value of the expected outcomes, and intern it aects hand washing
practices [22].
According to national guideline, for an eective school WASH, one
toilet per 25 girls and one toilet plus one urinal per 50 boys is required.
Toilets should be hygienic to use and easy to clean and should have
convenient hand washing facilities [23,24]. But in this study student
toilet ratio (i.e. 1:67 for male and 1:73 for females) was not consistent
with national standard. erefore to meet the recommended standard
a considerable number of additional toilet and units are required with
necessary levels of, privacy, safety and cleanliness.
In this study, hygiene index was computed using a combination of
four hygiene facilities in school (running water+soap+washing station
+toilet), but there were no schools fullling high hygiene facilities.
Among all schools, two and four of them had medium and low hygiene
facilities respectively. erefore, special attention should be taken into
consideration in provision of adequate water supply, hand washing
stations and sanitation facilities in schools.
Conclusion
e ndings of this study indicated that small number of
participated children had proper hand washing practice behavior in
the selected primary school. e independent predictors of hand
washing practices were residency, presence of water and soaps, and
pressure from referents. It is recommended that fullling of water and
soap for hand washing practices, and strictly follows up of children
hand washing process should be given more emphasis to minimize
improper hand washing practice in these settings. erefore,
information has to be disseminated via community health agents,
health development army and mass media to alleviate these problems.
Limitations
Due to nancial limitation, the study could not cover private
schools. As result of this, the nding is not generalized to all schools in
the study area. e study does not indicate cause-eect relationship
since cross sectional study was used.
Benet and Beneciaries of the Study
e ndings of this study enable the health services planners to
design strategies for enhancing proper hand washing practice and also
provide baseline data for health policy makers, health planners and
dierent researchers to carry out further large longitudinal scale
studies separately in each determinant. Finally, the ndings should
help and guide the development of focused behavior change strategies
for hand washing practice, and provide information to health care
practitioners regarding the predictors of hand washing practice in
Arbaminch town, Gamo Gofa zone.
Competing Interests
e authors declare that they have no competing interest.
Authors Contributions
All the authors participated in all steps of the study starting from
development of the proposal till the writing of the manuscript and
approval of the nal version of the manuscript.
Acknowledgements
e authors are gratefully indebted to the children interviewed and
teachers who participated in and supported the study interviews. In
addition, the authors would like to thank the head masters of each
selected school for allowed us to preceed the research work. Last but
not the least we deeply acknowledge Arba Minch University for the
nancial support.
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Citation: Besha B, Guche H, Chare D, Amare A, Kassahun A, et al. (2016) Assessment of Hand Washing Practice and it’s Associated Factors
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Epidemiology (Sunnyvale)
ISSN:2161-1165 ECR, Open Access Volume 6 • Issue 3 • 1000247