Assessment of Hand Hygiene Knowledge, Attitudes and Practices among Primary School Pupils in the Achiase District, Ghana

Aims: To describe hand hygiene knowledge, attitudes, self-reported behaviours and school WASH support among primary school pupils in Achiase District, Ghana. Study Design: School-based cross-sectional survey. Place and Duration of Study: Selected public primary schools in Achiase District, Eastern Region, Ghana, September–October 2025. Methodology: A multistage sample of 389 pupils aged 6–12 years completed interviewer-administered questionnaires, and a school-facility checklist was used. Questionnaire responses were summarised descriptively. Associations with an overall questionnaire practice category were explored using chi-square tests and logistic regression. Results: Good knowledge was reported for 93.1% and positive attitudes for approximately 93% of pupils. However, only 13.1% identified the recommended minimum hand-rubbing duration, 1.8% reported handwashing after toilet use and 8.5% reported consistent soap-and-water use. Functional school handwashing facilities were reported by 10.3% of pupils. A separate overall practice summary classified 13.9% as good; this category does not represent confirmed adherence to every individual practice. Very large residence-related adjusted odds ratios were recorded, but the semi-urban subgroup was small (n = 7) and the estimates require cautious interpretation. Conclusion: Knowledge of handwashing benefits was generally high, but several self-reported hygiene behaviours and enabling school conditions were limited. Practical instruction and improved access to handwashing facilities warrant consideration alongside further evaluation of behaviour and school WASH provision.