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 Table of Contents  
ORIGINAL RESEARCH REPORT
Year : 2020  |  Volume : 17  |  Issue : 4  |  Page : 136-144

Perception and practice of handwashing among public secondary school students in Somolu Local Government Area, Lagos, Nigeria - A cross-sectional study


Department of Community Health and Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria

Date of Submission07-Feb-2020
Date of Acceptance21-Jul-2020
Date of Web Publication19-Oct-2020

Correspondence Address:
Dr. Esther O Oluwole
Department of Community Health and Primary Care, College of Medicine, University of Lagos P.M.B. 12003, Surulere, Lagos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcls.jcls_5_20

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  Abstract 


Background: Hand hygiene is a simple and effective means of preventing the spread of communicable diseases, and the promotion of hand hygiene is an important public health measure. This study assessed knowledge, attitude, and practice of and barriers to handwashing among secondary school students in Somolu Local Government Area (LGA), Lagos, Nigeria. Methods: The study was a descriptive cross-sectional, conducted in selected secondary schools in Somolu LGA, Lagos State. Multistage sampling method was employed to select 420 respondents from the selected public secondary schools. Self-administered and pretested questionnaires were used to collect data. Analysis was done using IBM SPSS version 22. Descriptive and bivariate analyses were conducted with level of significance (P) at ≤0.05. Results: The mean ± standard deviation age of the respondents was 14.09 ± 2.06 years. Less than two-third (64.0%) of the respondents had good knowledge, almost all (99.5%) had positive attitude, while about 71% had good practice of handwashing. Forgetfulness (49.8%) and laziness (33.8%) were the major reasons for not practicing handwashing at home as opposed to unavailability of soap (50%) and lack of nearby water supply (46.2%) in schools. A statistically significant association was found between class of respondents, parent's level of education, and handwashing practices (P < 0.05). Conclusion: Although majority of the respondents had positive attitude toward handwashing, knowledge and practice of handwashing, which is a key to infection control, was not at par with their attitudes. We recommend targeted health education sessions on handwashing and provision of handwashing facilities in secondary schools.

Keywords: Attitude, handwashing practices, knowledge, Lagos Nigeria, secondary school, students


How to cite this article:
Oluwole EO, Ajayi AS, Olufunlayo TA. Perception and practice of handwashing among public secondary school students in Somolu Local Government Area, Lagos, Nigeria - A cross-sectional study. J Clin Sci 2020;17:136-44

How to cite this URL:
Oluwole EO, Ajayi AS, Olufunlayo TA. Perception and practice of handwashing among public secondary school students in Somolu Local Government Area, Lagos, Nigeria - A cross-sectional study. J Clin Sci [serial online] 2020 [cited 2020 Nov 29];17:136-44. Available from: https://www.jcsjournal.org/text.asp?2020/17/4/136/298455




  Introduction Top


There is evidence that hands are the main transmitters of various diseases such as pneumonia and diarrhea and handwashing with soap has been recommended as the mainstay in infection control.[1],[2],[3],[4],[5] The World Health Organization defines hand hygiene as any action of hand cleansing, that is, the act of cleaning one's hands with or without the use of water or another liquid, or with the use of soap, for the purpose of removing soil, dirt, and/or microorganisms.[6] Hand hygiene has been proposed as a convenient mode of preventing the spread of communicable diseases, and the promotion of improved hand hygiene has been recognized as an important public health measure.[7],[8] Disease-causing pathogens are usually transferred from person to person either directly or indirectly via contaminated hands. Human hands can spread various infections by touching other people's hand, hair, nose, and face. Hands that have been contaminated with human or animal feces, bodily fluids such as nasal excretions, and contaminated foods or water can transport bacteria, viruses, and parasites to other people. Handwashing with soap and water has been recognized as one of the most effective and cheaper means of preventing infections.[9] Handwashing is a very important public health strategy among schoolchildren to prevent the spread of infectious illnesses and is a key recommendation for infection control during the outbreak of pandemic influenza.

Good knowledge and practice of handwashing with soap and water helps to prevent transmissions of infectious diseases such as diarrhea, typhoid, hepatitis A, or hepatitis E. Developing a habit of handwashing with soap before eating and after using the toilet has been reported to save more lives compared with any single vaccine or medical intervention, reducing deaths from diarrhea by almost half and deaths from acute respiratory infections by one-quarter.[5],[10]

Handwashing with soap has been reported to be the most cost-effective way to reduce the global infectious disease burden. It has been linked to a 47% reduction in risk of endemic diarrhea, a 16%–21% reduction in risk of acute respiratory infections, a 50% reduction in risk of pneumonia, significant reductions in neonatal infections, and improved absorption of nutrients. Handwashing promotion has also been found to reduce school absenteeism by 43%. Achievement of targets on hygiene and handwashing is important for attaining other targets such as those on child survival, nutrition, education, equity, and gender.[11],[12],[13],[14] Handwashing with soap and clean water is one of the most effective and inexpensive ways to prevent infectious diseases which are responsible for the majority of child deaths globally each year. The role of schools in teaching and encouraging handwashing by students cannot be overemphasized. The first-ever Global Handwashing Day, launched in October 2008, was emphasized around schools and children. Handwashing practice is difficult without adequate information and knowledge of the requirements and the techniques involved. However, when secondary school students are educated on the basic skills required for handwashing at this stage of their lives, it will be easy for them to continue the habit throughout life. Schools are a key factor for initiating change as it helps to develop useful life skills on health and hygiene in students. Hence, this study assessed the knowledge, perception, practice, and factors affecting practices of handwashing among secondary school students in Somolu Local Government Area (LGA), Lagos, Nigeria.


  Methods Top


Study setting

Somolu LGA is one of the twenty LGAs in Lagos State with 12 political wards. In 2006, it had a population of 1,025, of which 517,210 were males and 507,913 were females. The projected population for 2016 was 1,404,666, of which 74,005 persons were between 10 and 19 years, which is the age range for secondary school students. It has a land/water area of 14.6 km2 and a population density of 96,210 people per square kilometer.[15]

Study population, study design, sample size determination, and selection of participants

The study population were registered secondary school students in public secondary schools in Somolu LGA. The study was descriptive, cross-sectional in design. The minimum sample size was determined using Cochran's formula (n = z2 × p × q/d2), with a standard normal deviation at 95% confidence interval (1.96), a prevalence rate of 65.9% (prevalence of handwashing practice from a previous study among senior secondary school students in South West Nigeria),[16] and the error of precision at ±5% (0.05) using 20% nonresponse rate; a total of 420 participants were recruited for the study.

A multistage sampling method was employed to select the respondents. Simple random sampling technique using the balloting method was used to select nine schools, four junior secondary schools, and five senior secondary schools from the LGA in Stage 1. Stage 2 involved selection of classes. There was an equal allocation among the nine schools and classes such that fifty students were selected from the first eight schools and the last twenty respondents were selected from the last school. Stage 3 involved selection of respondents using systematic sampling, and sampling interval was calculated by dividing total number of students in selected class with the required number of students. The first student on the list was randomly selected via ballot, while other students were selected according to the sampling interval; when a selected student was not available, the next student automatically qualified.

Study instrument and data collection

A semi-structured, self-administered questionnaire used for this study was adapted from review of relevant literatures.[17],[18],[19] The questionnaire was written in English Language and designed to include simple terminology for easy understanding by the students. It was divided into five sections: Section A elicited the sociodemographic data of the respondents, Section B elicited the knowledge of handwashing, while Section C contained the questions on attitude of respondents toward handwashing. Section D asked for the practice of handwashing, while questions on factors influencing handwashing formed the Section E. The questionnaires were pretested among 42 (10%) secondary school students in a high school in another but similar LGA for appropriate corrections and modifications. Data were collected between September and October 2018.

Statistical analysis

Data collected were entered, cleaned, and analyzed using IBM SPSS version 22 statistical package (SPSS Inc., Chicago, IL, USA) statistical package. Descriptive analyses were performed, associations between categorical variables were explored with Chi-square test, and level of significance was set at P ≤ 5%. There were 26 knowledge questions in total. A score of 1 was given to every correct and 0 for incorrect or I don't know responses. The maximum knowledge score was 26. A score of 0–8 was graded as poor knowledge, 9–17 (fair knowledge), and 18–26 (good knowledge). On the other hand, ten questions on a three-point Likert scale were asked to assess respondents' attitude. For positive statements, a score of 3 was assigned to agree, 2 to I don't know, and 1 to disagree, while for negative statements, a score of 3 was assigned to disagree, 2 to I don't know, and 1 to agree. The maximum score for attitude was 30. A score of 1–20 was graded as negative attitude, while a score of 21–30 was graded as positive attitude. The practice section consists of 23 questions; a score of 1 was given for every answer which portrayed good handwashing practices and 0 was given for negative answer. The maximum practice score was 23. A score of 0–7 was graded as poor practice, a score of 8–15 was graded as fair practice, and a score of 16–23 was graded as good practice.

Ethical considerations

Ethical approval for this study was obtained from the Health Research and Ethics Committee (HREC) of the Lagos University Teaching Hospital (ADM/DCST/HREC/APP/374). Permission was officially obtained from the principal of the secondary schools. The nature of the study was explained, and informed consent was obtained from each respondent. All questionnaires were made anonymous, and participation was voluntary.


  Results Top


Sociodemographic characteristics of respondents

The mean ± standard deviation age of the respondents was 14.07 ± 2.06 years, and about 43% of the respondents were within the 15–17 years' age group. About half (52.4%) were females, most (65%) were Christians, and half (49.8%) of the respondents were in senior secondary two (SS2) class. Majority (70.4%) were of the Yoruba ethnic group, and most of the parents of the respondents had tertiary level of education [Table 1].
Table 1: Sociodemographic characteristics of respondents

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Knowledge of handwashing

Most (72.9%) of the respondents understood that proper handwashing entails the use of soap and running water to wash hands, and majority (92.9%) knew that it was necessary to dry hands after washing, but very few (5.7%) knew paper towel as an appropriate hand drying agent. Less than half (32%) knew that handwashing was not the same with hand disinfection. About three-quarter (77.0%) knew that handwashing can control the spread of microorganisms, while more than half (56.0% and 51.4%) knew that handwashing can prevent cholera and diarrhea, respectively. However, fewer respondents knew that handwashing can prevent intestinal worms (16.7%), typhoid fever (34.8%), and respiratory diseases (25.0%). Only 38.1% of the respondents knew that the minimum time for handwashing should be 20 s, however, majority (86.0%) knew that handwashing should be done under running water, while 87.0% knew that handwashing was incomplete without soap. More than 90% knew the most important times for handwashing, but less than three-quarter of the respondents (68.3%) have had formal training on handwashing in schools. About half (51.4%) knew that handwashing should not be done together with others in the same bowl. Overall, less than two-third (64.0%) of the respondents had good knowledge of handwashing [Table 2].
Table 2: Knowledge of respondents about handwashing

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Attitude toward handwashing

Almost all the respondents (98.1%) agreed that it is important to wash hands regularly, while 94.3% believed that handwashing was not a waste of time and that regular handwashing was convenient (87.6%). Furthermore, majority (98.1%) of the respondents agreed that children needed to be taught the process of handwashing and 87% agreed that handwashing prevents one from falling sick. About half (49.2%) of the respondents agreed that the use of soap and water was better than using hand sanitizer to clean hands. Almost all (99.5%) of the respondents had a positive attitude toward handwashing [Table 3].
Table 3: Attitude of respondents toward handwashing

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Practice of handwashing

Almost all (99.1%) of the respondents said “yes” to wash their hands, but about half (52.2%) washed their hands frequently. Majority (92.3%) used soap to wash hands, but only about one-quarter (28.4%) washed hands for about 20 s, which is the recommended time for effective handwashing. All the respondents practiced handwashing after toilet use at home, and 89.2% of them used soap and water; handwashing after playing in school recorded the lowest prevalence (70.4%). Only 60.3% of the respondents used hand sanitizers [Table 4]. Overall, about 71% of the respondents had good practice of washing hands.
Table 4: Handwashing practice among respondents

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Barriers to handwashing

About half (49.8%) of the respondents mentioned forgetfulness as the major reason for not washing hands at home, while unavailability of soap (50%) and lack of nearby water (46.2%) were the major reasons mentioned by respondents for not washing hands in school. Posters on handwashing encouraged majority (89.8%) of the respondents to wash their hands, while 85.7% were encouraged by the sight of their friends washing hands [Table 5].
Table 5: Factors that influence handwashing practices among respondents

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[Table 6] shows a statistically significant association between class, father's and mother's level of education, and handwashing practices of the respondents (P < 0.05).
Table 6: Association between sociodemographic variables and overall practice of respondents

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  Discussion Top


About 73% of the respondents knew the meaning of proper handwashing and majority (92.9%) knew that it was necessary to dry hands after washing, but very few (5.7%) knew paper towel as an appropriate drying agent and about 45% of the respondents said that handwashing was the same as hand disinfection. These findings are in contrast to a study conducted in Kintampo Municipality in Ghana, in which 15% of the respondents knew what proper handwashing entails while 21.3% equated handwashing to hand disinfection and 41% of the respondents choose cloth towel and handkerchief as the appropriate drying agents.[20] This difference may be attributed to the fact that about half of the parents of the respondents in the current study had tertiary education and most (68.3%) of the respondents have been formally trained on handwashing compared to 46.7% in a Ghana study. About half (56.0% and 51.4%) of the respondents felt that cholera and diarrhea, respectively, can be prevented by handwashing. This finding is in line with that of a study conducted in Port Harcourt, Nigeria, which reported that diarrheal diseases were the most commonly recognized disease associated with contaminated hands.[21]

Over 90% of the respondents in this study reported that handwashing was important after using the toilet (97.6%), before eating (98.1%), before preparing food (97.1%), after treating a cut or a wound (96.4%), after handling live animals (97.4%), and after blowing noses, coughing, and sneezing (96.4%), while 73.3% felt that handwashing was important after handshakes. This finding is in line with the studies conducted in Ghana, Bangladesh, and Kintampo Municipality in Ghana.[20],[22],[23] Overall, 64% of the respondents in this study had good knowledge of handwashing. This finding corroborates that of a study conducted in Hosanna town, Southern Ethiopia (69.8%).[24] This finding differs from studies conducted in Abia State, Nigeria (78.7%), and in Kampala (49.4%).[25],[26]

Majority (99.5%) of the respondents in this study had a positive attitude toward handwashing, as majority (98.1%) agreed that it is important to wash hands regularly. This finding is higher when compared to a study conducted in Hosanna town, Southern Ethiopia, which reported that 59.4% of the respondents had a positive attitude toward handwashing. This difference found may be attributed to the fact that the respondents in this study were older in age with a mean age of 14.07 years compared to 11.66 years in Hosanna town, Southern Ethiopia.[20]

In this study, as high as 94.3% of the respondents agreed that handwashing is not a waste of time while 87.6% agreed that handwashing is convenient and 98.1% agreed that children should be taught handwashing. These findings differ when compared to the study in Kampala among undergraduates where only 57% found handwashing convenient and 77.3% agreed that handwashing should be taught in schools.[26] Less than half (49.2%) of the respondents agreed that using soap and water is better than using hand sanitizers. This finding is in line with the finding of a study conducted in Centria University, where 44.7% of the respondents agreed to the same.[27] Almost all (99.1%) of the respondents practiced handwashing, but about half (51.7%) washed their hands regularly. When handwashing practice was compared between the home and at school, it was discovered that most of the respondents practiced handwashing better at home compared to school.

Handwashing after toilet use at home recorded the highest percentage (100.0%) with 89.2% using soap, and this percentage dropped to 89.9% when in school with only 56.95% using soap. Handwashing before eating, after eating, and after playing followed similar trends with handwashing after playing in school recording the lowest percentage (70.43%). These findings are similar to that of other studies conducted in Ghana, Bangladesh, and India[22],[23],[28] with similar trends of respondents practicing handwashing better at home. The reduction in the percentage of respondents who use soap and water in schools may be attributed to the lack of handwashing facilities in most of the schools. Majority (84.3%) of the respondents knew about hand sanitizers, but about 60.3% use it. Overall, most (70.9%) of the respondents had good handwashing practices. This finding is similar to that of a study conducted in Southern Ethiopia which reported that 72.0% had good handwashing practices.[20] On the contrary, a study in Nigeria reported that 34.5% of the respondents had good practice of handwashing.[25]

Forgetfulness (49.8%) and laziness (33.8%) were the major reasons for not practicing handwashing at home as opposed to unavailability of soap (50%) and lack of nearby water supply (46.2%) in school. This finding was similar to that of studies in Ghana, Bangladesh, and Kampala.[22],[23],[26] It has been documented by the WHO that most of the schools in developing countries do not have adequate handwashing facilities, and where available, they may have insufficient handwashing materials.[28]

This study found a statistically significant association between respondent class, father's level of education, mother's level of education, and the handwashing practices of the respondents. These findings are consistent with studies done in Hosanna town, Southern Ethiopia, and Bangladesh where students in higher classes had better handwashing practices and children of mothers who had a higher level of education were seen to have better handwashing practices.[20],[23] Similarly, a study in Nigeria reported that class level and father's educational status were likely predictors of practice of handwashing.[25]

The study was a cross-sectional survey, and self-reported information was collected which may not be an accurate description of practice. However, the study adds to the body of scientific evidence on handwashing among the study population.


  Conclusion Top


This study found a suboptimal level of knowledge and practice of handwashing among the respondents. Forgetfulness and unavailability of soap and lack of nearby water supply were among the major reasons for not practicing handwashing adequately in schools. Targeted public health education programs on handwashing and provision of handwashing facilities in public secondary schools are recommended to improve the knowledge and practice of hand washing among the students.

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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