Enablers and barriers of handwashing with soap in low-income settlements of Mombasa, Kenya

Handwashing with soap (HWWS) is an effective public health preventive measure. Review studies indicate that interventions on handwashing with soap reduce the risk of diarrhoeal diseases by approximately 30% and respiratory tract infections by up to 17% (Ross, Bick, Ayieko, et al., 2023; Wolf, Hubbard, Brauer, et al., 2022). Studies have also shown that HWWS, combined with interventions on water and sanitation, results in improved growth outcomes among children under five (Bekele et al., 2020; George, Monira, Zohura, et al., 2021; Hasan, Asif, Barua, et al., 2023). The World Health Organisation (WHO) and the United Nations Children's Fund (UNICEF) Joint Monitoring Program (JMP) estimated that by 2022, 75% of the global population had access to basic handwashing facilities (HWFs) measured by the presence of a handwashing facility with water and soap within the premises (UNICEF and WHO, 2023a). Access to a basic HWF is an indicator for HWWS, as studies have confirmed HWWS at critical times increases as a result of the presence of a HWF (Jetha, Bisserbe, McManus, et al., 2021; Mbakaya et al., 2020; Okello, Kapiga, Grosskurth, et al., 2019; White, Thorseth, Dreibelbis, et al., 2020; Wolde, Abate, Mandefro, et al., 2022). These JMP estimates indicate that Sub-Saharan Africa (SSA) had the lowest regional coverage of basic HWFs by 2022, with only 30% of the population having access to basic HWFs (UNICEF and WHO, 2023b). This limited coverage may indicate or lead to inadequate HWWS. In addition, significant disparities in access exist between urban and rural areas of Africa, with urban areas exhibiting higher access (32%) than rural areas (17%) (UNICEF and WHO, 2023a,b). Despite this advantage, urban areas of Africa have significant proportions of the population residing in Low Income Areas (LIAs) which are characterised by several challenges including intermittent water supply, high costs of water, lack of handwashing facilities, and a higher risk to hygiene related health outcomes (Beard & Mitlin, 2021; Corburn, Vlahov, Mberu, et al., 2020; Kisaakye et al., 2021). Research studies examining hindrances (barriers) and enablers of HWWS in LIAs of Africa are limited. However, studies conducted in LIAs in other regions have identified financial resources, availability of water and soap, and the presence of dirt on the hands as factors that promote HWWS (Kalam, Davis, Islam, et al., 2021; Khan, Chakraborty, Brown, et al., 2021; Rahman, Nizame, Unicomb, et al., 2017). Similar to other African countries, studies examining the enablers and barriers for HWWS in LIAs in Kenya are limited, with most of the available studies focusing on food hygiene or COVID-19 related knowledge regarding HWWS (Austrian, Pinchoff, Tidwell, et al., 2020; Davis, Cumming, Aseyo, et al., 2018; Mumma, Simiyu, Aseyo, et al., 2019; Robinson & Howland, 2022; Watson, Okumu, Wasonga, et al., 2024). This study builds on a prior survey in LIAs of Kenyan cities that examined determinants of access to basic HWFs and of HWWS (Simiyu et al., 2025). The study indicated a lower likelihood of access to basic HWFs and of HWWS among residents of Mombasa compared to residents in low-income areas of other cities in Kenya (Simiyu et al., 2025). This study, therefore, explores the barriers and enablers of HWWS in the low-income settlements of Mombasa and identifies intervention strategies for improvement of HWWS within these areas.