Association between Handwashing Behavior and Infectious Diseases among Low-Income Community Children in Urban New Delhi, India: A Cross-Sectional Study

Abstract

Diarrheal diseases and respiratory infections (RI) are two leading causes of childhood mortality in low and middle-income countries. Effective handwashing at critical time-points may mitigate these diseases. However, there is a lack of published data investigating this association in school-aged children in India. This study is part of a larger prospective handwashing intervention study in a low-income community in New Delhi, India examining the associations between handwashing behavior and diarrhea and RI in schoolchildren. This current study reports the findings of the baseline survey administered to 272 mother–child dyads. Children aged 8–12 years, and their mothers, were recruited from six schools. A baseline questionnaire was used to collect sociodemographic data, handwash behavior, and mother-reported recent diarrhea and RI incidence among the children. Handwashing before and after preparing food, after defecation, and after cleaning dishes significantly reduced the odds of diarrhea by over 70%, and of RI by over 56%. Using a clean cloth after handwashing lowered odds of diarrhea and RI by 72% and 63% respectively. Around 60% of the participants believed that handwashing could prevent diarrhea and RI in their children. There was a low prevalence of handwashing at critical time-points and a poor perception regarding handwashing benefits. To improve handwashing behavior, hygiene promotion programs need to understand what motivates and hinders handwashing in vulnerable populations.

Knowledge about Hand Hygiene and Related Infectious Disease Awareness among Primary School Children in Germany

“…The reasons for this are (i) the emergence of novel pathogens as currently experienced with SARS-CoV-2 [ 5 ], (ii) the selection and global spread of multidrug-resistant organisms (MDROs) [ 6 , 7 , 8 , 9 , 10 ], (iii) the medical progress characterized by the increased application of immune system-impairing procedures and colonization-vulnerable devices [ 11 , 12 , 13 , 14 , 15 , 16 ], (iv) the demographic changes leading to higher susceptibility of subpopulations to infectious diseases, such as the increase of older and multi-morbid individuals [ 17 , 18 , 19 ] and (v) the migration and lifestyle aspects leading to the transmission and distribution of MDROs [ 20 , 21 , 22 ]. Emerging clonal lineages of notorious MDROs with changed epidemiology and host spectra (e.g., community- and livestock-associated MRSA and hypervirulent, multi-resistant Klebsiella pneumoniae lineages) also add to the burden of diseases, necessitating health behavior programs [ 6 , 9 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”

Suboptimal child healthcare practices and the development of multiple infectious diseases in children aged 24–59 months

“…The availability of clean water is associated with higher hygiene sanitation coverage and a lower risk of diarrheal diseases ( 39 , 40 ). A study in India reported that washing hands before and after preparing food, defecating, and cleaning dishes significantly reduced the likelihood of diarrhea by >70% and respiratory infections by >56% ( 10 ). Mothers or caregivers who did not wash their hands at key times had an increased risk of experiencing acute diarrhea than those who practiced appropriate handwashing ( 41 ).…”

“…Poor environmental health, such as a lack of safe water and sanitation, also contributes to child morbidity ( 7 – 9 ). At the same time, appropriate handwashing practice has been identified as one of the most prominent and affordable hygiene practices for reducing infectious diseases, such as diarrhea and respiratory infections ( 10 ).…”

“Bye-Bye Germs”: Respiratory Tract Infection Prevention—An Education Intervention for Children

“…With young children being susceptible to contagious illnesses and particularly contagious carriers of COVID-19, it is crucial that they know how they can protect themselves and others in order to limit the spread of illnesses. Studies have shown the importance of correct hand-hygiene practices as a key infection prevention measure for respiratory tract illnesses, including SARS-CoV-2 [9][10][11][12], with studies finding substantial reductions in respiratory tract illnesses in children due to correct hand-hygiene practices [14][15][16].…”