Prevalence and factors associated with poor hand hygiene practices among adult carers of children under five in Mbale district Uganda

Proper hand hygiene reduces the risk of hygiene-related diseases among children under five years of age; however, poor hand hygiene practices remain common in many communities. This study determined the prevalence and factors associated with poor hand hygiene practices among adult caregivers of children under five years in Mbale District, Eastern Uganda, to inform context-specific interventions. We conducted a cross-sectional study in March 2023 among 320 adult caregivers of children under five years. Participants were selected using multistage sampling from three sub-counties with the largest under-five populations. Structured questionnaires collected information on socio-demographics, household characteristics, knowledge of hand hygiene, and COVID-19 prevention information. Poor hand hygiene was defined as reporting handwashing at five or fewer of ten critical hand hygiene moments. Multivariable logistic regression was used to identify factors independently associated with poor hand hygiene. Of the 320 caregivers enrolled, 275 (85.9%) were female. The majority were aged 25-34 years (38.4%, n=123), and over half (55.6%, n=178) had primary education. Overall, 28% (n=88) of caregivers engaged in poor hand hygiene practices. In the multivariable analysis, receiving hand hygiene information from Village Health Teams (VHTs) was significantly associated with higher odds of poor hand hygiene (AOR 4.2; 95% CI 1.7-10.4). Caregivers who indicated that hand hygiene protects against COVID-19 had lower odds of poor hand hygiene (AOR 0.16; 95% CI 0.03-0.73). Additionally, inconsistent availability of soap, detergent, or sanitizer at handwashing stations was strongly associated with poor hand hygiene (AOR 8.22; 95% CI 2.03-57.16). No significant associations were observed for education level, child’s age, or type of handwashing facility. Nearly three in ten adult caregivers exhibited poor hand hygiene practices. Poor hand hygiene was associated with receiving information from VHTs and inconsistent access to cleansing materials, whereas knowledge of hand hygiene’s protective benefits against COVID-19 was associated with better practices. Strengthening VHT training and ensuring reliable access to handwashing supplies may help improve hygiene behaviours in Mbale District.