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Carlos learns the importance of washing his hands.

Background. Hand washing is an effective way to prevent transmission of infectious diseases. Education and promotional materials about hand washing may change individuals’ awareness toward hand washing. Infectious disease outbreak may also affect individuals’ awareness. Aims. Our study aimed to examine associations between hand-washing education and self-reported hand-washing behaviors among Korean adults during the year of the Middle East respiratory syndrome (MERS) outbreak. Methods. Data from the 2015 Community Health Survey were used for this study. The total study population comprised 222,599 individuals who were older than 20 years of age. A multiple linear regression model was used to investigate associations between hand hygiene education and self-reported hand-washing behaviors. Subgroup analyses stratified by age, sex, income, and MERS outbreak regions were also performed. Results. Individuals who received hand-washing education or saw promotional materials related to hand washing had significantly higher scores for self-reported use of soap or sanitizer (β = 0.177, P < .0001) and self-reported frequency of hand washing (β = 0.481, P < .0001) than those who did not have such experiences. The effect of hand-washing education on self-reported behavior change was greater among older adults, women, and lower income earners. The effect of hand hygiene education on self-reported use of soap or sanitizer was similar regardless of whether the participants lived in MERS regions. Conclusion. Our findings emphasize the importance of education or promotions encouraging hand washing, especially for older adults, women, and lower income earners. In addition, MERS outbreak itself affected individuals’ awareness of hand-washing behaviors. Well-organized campaigns that consider these factors are needed to prevent infectious diseases.

Background The hand hygiene (HH) behaviour of the general public and its effect on illnesses are issues of growing importance. Gender is associated with HH behaviour. HH efficiency is a combination of washing efficiency and hand drying, but information about the knowledge level and HH behaviour of the general public is relatively limited. The findings of this cross-sectional study can substantially contribute to the understanding on the knowledge gap and public behaviour towards HH, thereby providing information on gender-specific health promotion activities and campaigns to improve HH compliance. Methods An epidemiological investigation by using a cross-sectional study design on the general public was conducted either via an online platform (SurveyMonkey) or paper-and-pen methods. The hand-washing and -drying questionnaire was used for data collection. Results A total of 815 valid questionnaires were collected. Majority of the respondents can differentiate the diseases that can or cannot be transmitted with poor HH, but the HH knowledge of the respondents was relatively inadequate. The female respondents had a significantly better HH knowledge than male respondents. The multiple regression analysis results also indicated that females had a significantly higher knowledge score by 0.288 towards HH than males after adjusting for age and education level. Although the majority of the respondents indicated that they performed hand cleaning under different specific situations, they admitted only using water instead of washing their hands with soap. More males than females dried their hands on their own clothing, whereas more females dried their hands through air evaporation. The average time of using warm hand dryers was generally inadequate amongst the respondents. Conclusions Being a female, middle-aged and having tertiary education level are protective factors to improve HH knowledge. Misconceptions related to the concepts associated with HH were noted amongst the public. Self-reported practice on hand drying methods indicated that additional education was needed. The findings of this study can provide information on gender-specific health promotion activities and creative campaigns to achieve sustained improvement in HH practices.

To undertake a systematic review and meta-analysis to establish the effectiveness of handwashing in reducing absence and/or the spread of respiratory tract (RT) and/or gastrointestinal (GI) infection among school-aged children and/or staff in educational settings. Randomised-controlled trials (RCTs). Schools and other settings with a formal educational component in any country. Children aged 3-11 years, and/or staff working with them. Interventions with a hand hygiene component. Incidence of RT or GI infections or symptoms related to such infections; absenteeism; laboratory results of RT and/or GI infections. Eighteen cluster RCTs were identified; 13 school-based, 5 in child day care facilities or preschools. Studies were heterogeneous and had significant quality issues including small numbers of clusters and participants and inadequate randomisation. Individual study results suggest interventions may reduce children's absence, RT infection incidence and symptoms, and laboratory confirmed influenza-like illness. Evidence of impact on GI infection or symptoms was equivocal. Studies are generally not well executed or reported. Despite updating existing systematic reviews and identifying new studies, evidence of the effect of hand hygiene interventions on infection incidence in educational settings is mostly equivocal but they may decrease RT infection among children. These results update and add to knowledge about this crucial public health issue in key settings with a vulnerable population. More robust, well reported cluster RCTs which learn from existing studies, are required.

Background In Bangladesh diarrhoeal disease and respiratory infections contribute significantly to morbidity and mortality. Handwashing with soap reduces the risk of infection; however, handwashing rates in infrastructure-restricted settings remain low. Handwashing stations – a dedicated, convenient location where both soap and water are available for handwashing – are associated with improved handwashing practices. Our aim was to identify a locally feasible and acceptable handwashing station that enabled frequent handwashing for two subsequent randomized trials testing the health effects of this behaviour. Methods We conducted formative research in the form of household trials of improved practices in urban and rural Bangladesh. Seven candidate handwashing technologies were tested by nine to ten households each during two iterative phases. We conducted interviews with participants during an introductory visit and two to five follow up visits over two to six weeks, depending on the phase. We used the Integrated Behavioural Model for Water, Sanitation and Hygiene (IBM-WASH) to guide selection of candidate handwashing stations and data analysis. Factors presented in the IBM-WASH informed thematic coding of interview transcripts and contextualized feasibility and acceptability of specific handwashing station designs. Results Factors that influenced selection of candidate designs were market availability of low cost, durable materials that were easy to replace or replenish in an infrastructure-restricted and shared environment. Water storage capacity, ease of use and maintenance, and quality of materials determined the acceptability and feasibility of specific handwashing station designs. After examining technology, psychosocial and contextual factors, we selected a handwashing system with two different water storage capacities, each with a tap, stand, basin, soapy water bottle and detergent powder for pilot testing in preparation for the subsequent randomized trials. Conclusions A number of contextual, psychosocial and technological factors influence use of handwashing stations at five aggregate levels, from habitual to societal. In interventions that require a handwashing station to facilitate frequent handwashing with soap, elements of the technology, such as capacity, durability and location(s) within the household are key to high feasibility and acceptability. More than one handwashing station per household may be required. IBM-WASH helped guide the research and research in-turn helped validate the framework.

Background The role of social ties, other-regarding preferences, and cultural traits in boosting community resilience and minimizing citizens’ vulnerability to crises such as COVID-19 is increasingly being recognized. However, little is presently known about the possible routes through which such personal preferences and cultural norms pertinent to social behaviors are formulated . Thus, in this paper, factors that can be potentially associated with individuals to self-regulate strict hand hygiene practices before the pandemic, during the state of emergency, and after the state of emergency was lifted in Japan are investigated. Focus is given to the handwashing education in primary school, a cultural practice originating from the old Shinto tradition, and individuals’ reciprocal inclinations. As people in Japan are known to be highly conscious of hygiene in all aspects of their daily life and are less likely to contract an infection, evidence obtained in this specific context could contribute to the better understanding of individuals’ health-related behaviors in general, and during crises in particular. Methods Using the data derived from a four-wave nationwide longitudinal online survey, we examined the extent to which elementary school education, childhood cultural experiences at shrines, and individual other-regarding preferences are associated with self-regulating hand hygiene practices prior to the pandemic and people’s efforts to comply with the government-imposed measures aimed at preventing the spread of COVID-19 infection during the state of emergency. We also investigated the long-term trends in the relationships among these factors (i.e., after the abolishment of the state of emergency) using panel data. Results Our findings reveal that childhood education and cultural experiences related to handwashing practices, as well as reciprocal inclinations, are significantly associated with Japanese attitudes toward personal hygiene (beyond handwashing practices) prior to, during, and after the state of emergency. In recognition of the possible effects of recall bias and measurement errors, several important attempts to mitigate these issues were made to strengthen the value of our findings. Conclusions The importance of school education received during childhood, as well as culture and other-regarding preferences, in the individual attitudes toward hand hygiene in adulthood highlighted in this study contributes to the better understanding of the role that these factors play in the variations in voluntary compliance with strict hand hygiene practices before and during an uncertain and prolonged crisis.

Adequate hand washing with soap at five recommended times is particularly important in urban slums in developing countries, but which of the recommended times are the most important in the prevention of diarrhea among children under five years of age living in these areas remains unclear. To address this gap, a community-based cross-sectional study was undertaken in the slums of Addis Ababa, Ethiopia between September and November 2014. Data were collected using a pre-tested structured questionnaire and an observational checklist. Multivariable logistic regression with 95% confidence interval (CI) was used for data analysis. Only 4.4% of the households had hand washing facilities within or near a latrine with soap and water access. The average prevalence of hand washing with soap at the five recommended times was 19.8%. One quarter (24.8%) of caregivers washed their hands with soap before feeding a child, 23.8% before preparing food, and 17.1% after defecation. The most important recommended times in preventing acute diarrhea were before preparing food [adjusted odds ratio (AOR) 0.2; 95% CI 0.1–0.7] and after defecation (AOR 0.3; 95% CI 0.1–0.9). Household size of six or more persons (AOR 2.3; 95% CI 1.4–3.9) and low monthly household income (AOR 2.4; 95% CI 1.4–4.0) were significantly associated with acute diarrhea. Promoting hand washing with soap and advocacy programs at the five recommended times, especially before preparing food and after defecation, and implementation of socioeconomic development programs targeting poor households are essential for increasing the prevalence of hand washing with soap and preventing acute diarrhea in the slums of Addis Ababa.

Introduction: We explore the limitations to adherence of hand-washing and evaluate the impact of a mHealth intervention for hand hygiene in residents. Methodology: We explore resident's perspectives about Hospital-acquired infections (HAI) and hand washing. In baseline, participants completed socio-demographic characteristics and hand-washing habits survey. The intervention consisted of sending SMS three times a week for two months about hand hygiene and “five moments” for hand washing. The cultures of hands and cell phones were analyzed at baseline, 2 months and 4 months. We used chi-square and adjusted Generalized Estimating Equations. Results: Five physicians were interviewed and 33 participants were included for quantitative analysis. Critical barriers that hinder hand washing were identified. The proportion of Staphylococcus aureus in hands was 54.5% at baseline and was significantly reduced at 2 months follow-up (p = 0.009), but, benefit was lost when the intervention was discontinued; Escherichia coli and Klebsiella sp. were observed in 22.2% of hands, no changes were noted with intervention. In cell phones, there was a tendency to lower values of bacterial colonization after intervention for Staphylococcus aureus growth. Conclusions: High prevalence of contamination in hands and phones in medical residents were found. Serious barriers to compliance with hand washing must be overcome. It is possible that prolonged or continuous interventions could be necessary to optimize hand washing and reduce hand and cell phones contamination.

Background Reducing the under-5 mortality rate (U5MR) to as low as 25/1000 live births globally by 2030 to reach the sustainable development goal (SDG) 3.2.1 appears to be a race against time. Amidst this situation, Bangladesh experienced stagnancy in U5MR at the beginning of the SDG era. While a comprehensive understanding of this stagnancy is crucial, research on stagnancy is scant and limited to investigating the direct effects of the key predictors. Therefore, building on the existing evidence, this research investigated the effect of one of the key predictors, parental education, on under-5 mortality (U5M) mediated through antenatal care (ANC) and the availability of hand washing stations. Methods This study conducted weighted mediation analyses using the Bangladesh Demographic and Health Survey data from 2011, 2014 and 2017–18, with sample sizes 4,658, 4,367, and 4,826, respectively, and estimated a generalised structural equation model. The “nlcom” post-estimation command of STATA was used to obtain the direct effects (coefficients), which were then multiplied to estimate the indirect effects for the indirect parallel and sequential pathways. The indirect effects were added to obtain the total indirect effect, which was added to the direct effect of education to estimate the total effect of education. Results This study reveals inconsistent parallel and sequential mediation of parental education’s effect across the three surveys. The direct effect of education on U5M reduced over time. The total (parallel and sequential combined) mediated effects of either parent’s education on U5M were negative (reduced U5M risk). While the mediated effect of mother’s education on U5M was not significant, the mediated effect of father’s education was significant in 2011. The total effect of education (direct and indirect combined) on U5M was negative (reduced U5M risk) and significant in 2011. However, the effect reduced over time and changed direction in 2017-18. Since 2011, the effects decreased and changed direction to become positive (increased U5M risk) in 2017-18. Due to the weakening direct effect of education and the opposite nature of the indirect effect, the indirect effect of education appeared to be greater than the total effect in 2014 and 2017–18. In 2011, approximately 50% of the total effect of either parent’s education was mediated. However, in 2014 and 2017–18, the proportions were greater than 100%, except for the proportion of the mediated effect of father’s education in 2014. Conclusions This study reports a weakening and inconsistent mediated effect of both parents’ education on U5M. Using existing literature, it also justifies that improving the quality of education and ANC could more effectively reduce U5M to achieve SDG 3.2.1. To improve the quality of education, this study recommends updating the school curriculum with a greater emphasis on maternal and child health education. To improve the quality of ANC, it is recommended that the mandatory use of ANC cards be strictly monitored.