Keywords
Handwashing, Knowledge, Attitudes, Practices, Ghana, Handwashing facilities
Abstract
Introduction. Handwashing has been recognised as a convenient, effective, and cost-effective means of preventing communicable diseases. However, many people overlook the importance of handwashing when engaging in activities that require handwashing due to various factors. The objectives of this study were to assess the level of handwashing knowledge, attitudes and practices and determine their relationships and how they are affected by sex, educational background and age.
Methods. A survey was conducted among a cross-section of the population in Ghana using an online questionnaire disseminated via platforms such as WhatsApp, email, Facebook and LinkedIn. Respondents were presented with several statements to assess their handwashing knowledge, attitudes and practices.
Results. Overall, 82.2% of respondents had good knowledge, 91% had a positive attitude, while 48.4% adhered to good handwashing practices. Having a high school level of education (OR=0.193, p=0.034.), (OR=0.145, p=0.000) and (OR=0.448, p=0.049) decreased the likelihood of having good knowledge, positive attitudes and good practices than in persons with tertiary level education. Predictors of good handwashing practices were knowledge (OR=1.059, p=0.37) and attitude (OR=1.095, p=0.000). These results suggest that having a higher level of education could increase a person’s knowledge and attitude, which in turn enhances the likelihood that the person would adhere to most handwashing and hand hygiene practices.
Conclusion. Enhancing people’s handwashing practices requires positive attitudes and good knowledge about handwashing. These need to be complemented by enhanced access to handwashing facilities and innovative measures to enforce and encourage compliance.
References
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[21] Martins SO, Osiyemi AO. Hand hygiene practices post Ebola virus disease outbreak in a Nigerian teaching hospital. Annals of Ibadan postgraduate medicine 2017; 15(1): 16-22.
[22] UNC Medical Center. Hand hygiene and use of antiseptics for skin preparation. Available at: http://spice.unc.edu/wp-content/uploads/2019/04/Hand-Hygiene-and-Use-of-Antiseptics-IC0024.pdf. Accessed on 04/03/2021.
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[29] Suen LK, So ZY, Yeung SK, Lo KY, Lam SC. Epidemiological investigation on hand hygiene knowledge and behaviour: a cross-sectional study on gender disparity. BMC Public Health 2019; 19(1): 1-14.
[30] Naing NN, Isa AR, Ahmad Z. Hygiene and eating habits of the families with typhoid patients. Medical Journal of Indonesia 1998; 7(Supp1): 215. DOI: https://doi.org/10.13181/mji.v7iSupp1.1115
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[32] Global Handwashing Partnership. Clean Hands Prevent Cold and Flu: What you need to know to protect yourself through good hygiene. Available at: https://globalhandwashing.org/wp-content/uploads/2017/12/Clean-Hands-Prevent-Cold-Flu-slide-deck.pdf. Accessed on 17/03/2021.
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[36] Global Handwashing Partnership. FAQs. Available at: https://globalhandwashing.org/about-handwashing/faqs/. Accessed on 17/04/2021.
[37] Luby SP, Halder AK, Huda T, Unicomb L, Johnston RB. The effect of handwashing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: an observational study. PLoS Med 2011; 8(6): e1001052. doi: 10.1371/journal.pmed.1001052.
[38] Ajzen I. Nature and operation of attitudes. Annual review of psychology 2001; 52(1): 27-58. doi: 10.1146/annurev.psych.52.1.27
[39] Fielmua N, Guba BY, Mwingyine DT. Hand hygiene and safety behaviours at shopping centres in COVID-19: an observation in Wa township in Ghana. Journal of Water, Sanitation and Hygiene for Development 2021; 11(3): 442-452. doi: 10.2166/washdev.2021.240
[40] Rabbi SE, Dey NC. Exploring the gap between hand washing knowledge and practices in Bangladesh: a cross-sectional comparative study. BMC public health 2013; 13(1): 1-7. doi: 10.1186/1471-2458-13-89.
[41] World Bank. Literacy rate, adult total (% of people ages 15 and above) – Ghana. Available at: https://data.worldbank.org/indicator/SE.ADT.LITR.ZS?locations=GH&most_recent_value_desc=false. Accessed on 18/04/2021.
[42] Garba MB, Uche LB. Knowledge, attitude, and practice of hand washing among healthcare workers in a tertiary health facility in northwest Nigeria. Journal of Medicine in the Tropics 2019; 21(2): 73. doi:10.4103/jomt.jomt_16_19.
[2] UNICEF. Everything you need to know about washing your hands to protect against coronavirus (COVID-19). Available at: https://www.unicef.org/ghana/everything-you-need-know-about-washing-your-hands-protect-against-coronavirus-covid-19. Accessed on 05/04/2020.
[3] Ministry of Health. Ghana Confirms two cases of COVID-19. Available at: https://ghanahealthservice.org/covid19/downloads/covid_19_first_confirmed_GH.pdf. Accessed on 12/04/2020.
[4] CITI Newsroom. Coronavirus: Government bans religious activities, funerals, all other public gatherings. Available at: https://citinewsroom.com/2020/03/government-bans-church-activities-funerals-all-other-public-gatherings/. Accessed on 12/04/2020.
[5] CITI Newsroom. FDA approves 327 hand sanitizers for COVID-19 fight. Available at: https://citinewsroom.com/2020/04/fda-approves-327-hand-sanitizers-for-covid-19-fight-full-list/. Accessed on 18/04/2020.
[6] Majorin F, Freeman MC, Barnard S, Routray P, Boisson S, Clasen T. Child feces disposal practices in rural Orissa: a cross sectional study. PloS one 2014; 9(2): e89551. https://doi.org/10.1371/journal.pone.008955.
[7] UNICEF. Committing to Child Survival: A Promise Renewed Progress Report 2013. Available at: https://reliefweb.int/report/world/committing-child-survival-promise-renewed-progress-report-2013. Accessed on 22/06/2020.
[8] Anderson JL, Warren CA, Perez E, Louis RI, Phillips S, Wheeler J, Misra R. Gender and ethnic differences in hand hygiene practices among college students. American journal of infection control 2008; 36(5): 361-368. doi: 10.1016/j.ajic.2007.09.007
[9] WHO and UNICEF. JMP Hand washing dataset. WHO/UNICEF Joint Monitoring Programme (JMP) for water supply and sanitation. Available at: https://washdata.org/. Accessed on 16/08/2020.
[10] Yeung WK, Tam WSW, Wong TW. Clustered randomized controlled trial of a hand hygiene intervention involving pocket-sized containers of alcohol-based hand rub for the control of infections in long-term care facilities. Infect Control Hosp Epidemiol 2011; 32:67–76. https://doi.org/10.1086/657636.
[11] Huis A, Schoonhove, L, Grol R, Donders R, Hulscher M, van Achterberg T. Impact of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: a cluster randomised trial. International journal of nursing studies 2013; 50(4): 464-474. doi: 10.1016/j.ijnurstu.2012.08.004.
[12] Tao SY, Cheng YL, Lu Y, Hu YH, Chen DF. Handwashing behaviour among Chinese adults: a cross-sectional study in five provinces. Public health 2013; 127(7): 620-628. doi: 10.1016/j.puhe.2013.03.005.
[13] Mariwah S, Hampshire K, Kasim A. The impact of gender and physical environment on the handwashing behaviour of university students in Ghana. Tropical Medicine & International Health 2012; 17(4): 447-454. doi: 10.1111/j.1365-3156.2011.02950.x
[14] Tai JW. Mok M, Ching ESB, Seto PTY, Pittet WHD. (Nurses and physicians’ perceptions of the importance and impact of healthcare-associated infections and hand hygiene: a multi-center exploratory study in Hong Kong. Infection 2009; 37(4): 320-333. doi: 10.1007/s15010-009-8245-x.
[15] Zimakoff J, Kjelsberg AB, Larsen SO, Holstein B. A multicenter questionnaire investigation of attitudes toward hand hygiene, assessed by the staff in fifteen hospitals in Denmark and Norway. Am J Infect Control 1992; 20:58-64. doi: 10.1016/s0196-6553(05)80002-1.
[16] Patarakul K, Tan-Khum A, Kanha S, Padungpean D, Jaichaiyapum OO. Cross-sectional survey of hand-hygiene compliance and attitudes of health care workers and visitors in the intensive care units at King Chulalongkorn Memorial Hospital. Journal-Medical Association of Thailand 2005; 88: S287. doi: 10.1111/j.1365-2648.2005.03490.x.
[17] Lau JTF, Yang X, Tsui H, Kim JH. Monitoring community responses to the SARS epidemic in Hong Kong: from day 10 to day 62. Journal of Epidemiology & Community Health 2003; 57(11): 864-870. doi: 10.1136/jech.57.11.864.
[18] Tang CSK, Wong CY. Factors influencing the wearing of facemasks to prevent the severe acute respiratory syndrome among adult Chinese in Hong Kong. Preventive Medicine 2004; 39(6): 1187-1193. doi: 10.1016/j.ypmed.2004.04.032.
[19] Leung GM, Quah S, Ho LM, Ho SY, Hedley AJ, Lee HP, Lam TH. A tale of two cities: community psychobehavioral surveillance and related impact on outbreak control in Hong Kong and Singapore during the severe acute respiratory syndrome epidemic. Infection control and hospital epidemiology 2004; 25(12): 1033-1041. doi: 10.1086/502340.
[20] Park JH, Cheong HK, Son DY, Kim SU, Ha CM. Perceptions and behaviors related to hand hygiene for the prevention of H1N1 influenza transmission among Korean university students during the peak pandemic period. BMC infectious diseases 2010; 10(1): 1-8. doi: 10.1186/1471-2334-10-222.
[21] Martins SO, Osiyemi AO. Hand hygiene practices post Ebola virus disease outbreak in a Nigerian teaching hospital. Annals of Ibadan postgraduate medicine 2017; 15(1): 16-22.
[22] UNC Medical Center. Hand hygiene and use of antiseptics for skin preparation. Available at: http://spice.unc.edu/wp-content/uploads/2019/04/Hand-Hygiene-and-Use-of-Antiseptics-IC0024.pdf. Accessed on 04/03/2021.
[23] World Health Organisation. Diarrhoeal disease. Available at: https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease#:~:text=Diarrhoeal%20disease%20is%20the%20second,and%20adequate%20sanitation%20and%20hygiene. Accesses on 04/03/2021.
[24] World Health Organisation. Hand hygiene: The evidence for clean hands. Available at: https://www.who.int/teams/integrated-health-services/infection-prevention-control/hand-hygiene. Accessed 23/07/2021.
[25] Centers for Disease Control and Prevention. Handwashing: Clean Hands Save Lives. Available at: https://www.cdc.gov/handwashing/index.html. Accessed 04/05/2021.
[26] Jordan V. Coronavirus (COVID-19): infection control and prevention measures. Journal of primary health care 2020; 12(1): 96-97. doi: 10.1071/HC15950.
[27] Heymann DL, Shindo N. COVID-19: what is next for public health? The Lancet 2020; 395(10224): 542-545. doi: 10.1016/S0140-6736(20)30374-3.
[28] Randle J, Metcalfe J, Webb H, Luckett JCA, Nerlich B, Vaughan N, Hardie KR. Impact of an educational intervention upon the hand hygiene compliance of children. Journal of Hospital Infection 2013; 85(3): 220-225. doi: 10.1016/j.jhin.2013.07.013.
[29] Suen LK, So ZY, Yeung SK, Lo KY, Lam SC. Epidemiological investigation on hand hygiene knowledge and behaviour: a cross-sectional study on gender disparity. BMC Public Health 2019; 19(1): 1-14.
[30] Naing NN, Isa AR, Ahmad Z. Hygiene and eating habits of the families with typhoid patients. Medical Journal of Indonesia 1998; 7(Supp1): 215. DOI: https://doi.org/10.13181/mji.v7iSupp1.1115
[31] Vollaard AM, Ali S, Van Asten HA, Widjaja S, Visser LG, Surjadi C, Van Dissel JT. Risk factors for typhoid and paratyphoid fever in Jakarta, Indonesia. JAMA 2004; 291(21): 2607-2615. doi:10.1001/jama.291.21.2607
[32] Global Handwashing Partnership. Clean Hands Prevent Cold and Flu: What you need to know to protect yourself through good hygiene. Available at: https://globalhandwashing.org/wp-content/uploads/2017/12/Clean-Hands-Prevent-Cold-Flu-slide-deck.pdf. Accessed on 17/03/2021.
[33] UNICEF. Simple act of Handwashing with soap could Save Thousands Lives. Available at: https://www.unicef.org/ghana/media_10778.html. Accessed on 14/05/2020.
[34] Centers for Disease Control and Prevention. Show Me the Science - Why Wash Your Hands? Available at: https://www.cdc.gov/handwashing/why-handwashing.html. Accessed on 23/07/2021.
[35] Wu K-S, Lee SS-J, Chen JK, Tsai HC, Li CH, Chao HL, Chou HC, Chen YJ, Ke CM, Huang YH, Sy CL, Tseng YT, Chen YS. Hand hygiene among patients: Attitudes, perceptions, and willingness to participate. American Journal of Infection Control 2013; 41: 327-31. doi: 10.1556/1646.9.2017.24
[36] Global Handwashing Partnership. FAQs. Available at: https://globalhandwashing.org/about-handwashing/faqs/. Accessed on 17/04/2021.
[37] Luby SP, Halder AK, Huda T, Unicomb L, Johnston RB. The effect of handwashing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: an observational study. PLoS Med 2011; 8(6): e1001052. doi: 10.1371/journal.pmed.1001052.
[38] Ajzen I. Nature and operation of attitudes. Annual review of psychology 2001; 52(1): 27-58. doi: 10.1146/annurev.psych.52.1.27
[39] Fielmua N, Guba BY, Mwingyine DT. Hand hygiene and safety behaviours at shopping centres in COVID-19: an observation in Wa township in Ghana. Journal of Water, Sanitation and Hygiene for Development 2021; 11(3): 442-452. doi: 10.2166/washdev.2021.240
[40] Rabbi SE, Dey NC. Exploring the gap between hand washing knowledge and practices in Bangladesh: a cross-sectional comparative study. BMC public health 2013; 13(1): 1-7. doi: 10.1186/1471-2458-13-89.
[41] World Bank. Literacy rate, adult total (% of people ages 15 and above) – Ghana. Available at: https://data.worldbank.org/indicator/SE.ADT.LITR.ZS?locations=GH&most_recent_value_desc=false. Accessed on 18/04/2021.
[42] Garba MB, Uche LB. Knowledge, attitude, and practice of hand washing among healthcare workers in a tertiary health facility in northwest Nigeria. Journal of Medicine in the Tropics 2019; 21(2): 73. doi:10.4103/jomt.jomt_16_19.