Prevalence and factors associated with engaging in poor hand hygiene practices among adult carers of children under five years in Mbale district: a cross-sectional study

Prevalence and factors associated with engaging in poor hand hygiene practices among adult carers of children under five years in Mbale district: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Prevalence and factors associated with engaging in poor hand hygiene practices among adult carers of children under five years in Mbale district: a cross-sectional study Jascenti Nawanga, Jimmy Patrick Alunyo, Daniel Wenani, Ambrose Okibure, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6222173/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Dec, 2025 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract Background While proper hand hygiene practices can reduce the risk of contracting hygiene-related diseases among children under five years of age (< 5 years old), poor hand hygiene practices continue to exist in the community. We determined the prevalence and factors associated with engaging in poor hand hygiene practices among adult carers of < 5-year-old children to inform the design of tailor-made interventions to improve hand hygiene practices in this population. Methods This was a cross-sectional study. Quantitative data were collected in March 2023 from 320 adult carers of under-five year-old children. Structured questionnaires were utilized to capture data on socio-demographic characteristics, household characteristics, knowledge of hand hygiene, and COVID-19 prevention practices. A carer was considered to have engaged in poor hand hygiene practice if he/she washed hands at five or less out of ten listed critical junctures. We conducted multivariable logistic regression to identify independent factors associated with poor hand hygiene practices. Factors with a p-value less than 0.05 were statistically significant to the primary outcome. Results Of the 320 carers, 275 (85%) were females. Slightly more than one-third (38.4%, n = 123) of the carers were aged 25–34 years while 55.6% (n = 178) had primary education. Twenty-eight percent (n = 88) of the carers engaged in poor hand hygiene practices. Having post-primary education (adjusted odds ratio [AOR] = 0.5; 95% Confidence Interval [95%CI]: 0.2, 0.9) and receiving information that hand hygiene protects against COVID-19 (AOR = 0.2; 95% CI: 0.04,0.8) were inversely associated with engaging in poor hand hygiene practices while receiving hand hygiene information from village health teams [VHT] (AOR = 3.0; 95% CI: 1.6, 9.8), and having inadequate soap or sanitiser at the place reserved for hand washing (AOR = 8.8; 95% CI: 1.7, 45.5) were positively associated with engaging in poor hand hygiene practices. Conclusion Nearly three out of ten adult carers of under-five year-old children engaged in poor hand hygiene practices largely driven by receipt of hand hygiene information from VHT coupled with inadequate hand-washing materials. These findings suggest a need for target-specific hygiene-related interventions to increase the proportion of carers who engage in proper hand hygiene practices in Mbale district. Health sciences/Health care/Health services Earth and environmental sciences/Environmental social sciences/Psychology and behaviour hand hygiene practices children under five years adult carers Mbale Figures Figure 1 Figure 2 Background Globally, the mortality rate of children under the age of five has decreased significantly from 12.6 million in 1990 to 5 million in 2020, [ 1 ]. This decline is largely attributed to advancements in water, hygiene, and sanitation practices [ 2 ]. However, despite these improvements, diseases related to inadequate hygiene, such as diarrhea and respiratory tract infections, continue to be the leading causes of death among children under five in developing nations [ 2 ], [ 3 ]. These hygiene-related diseases account for over 1.6 million deaths, constituting 21% of all fatalities in these settings [ 4 ], [ 5 ]. Hand hygiene is very important in preventing the spread of infectious diseases [ 6 ], but many low- and middle-income countries have difficulty promoting it effectively. In sub-Saharan Africa and Oceania regions, more than half of the population cannot access adequate sanitation [ 7 ]. Despite efforts to improve sanitation through initiatives such as improved water, sanitation, and hygiene (WASH) programs [ 8 ], child deaths from sanitation-related diseases continue. Poor hygiene among their carers is often considered a contributing factor, although the evidence to support this is limited. For instance, one in four people worldwide does not have access to a basic hand-washing facility[ 9 ], and even among those with access, there's a decreased likelihood of washing hands with soap after fecal contact [ 10 ]. Critical times for handwashing, such as before feeding a child or preparing meals, see low compliance rates (19.8%) despite its well-known benefits[ 11 ]. Research has indicated that people are more inclined to practice hand hygiene when they understand its benefits and the belief that a specific health action will prevent, or cure an illness [ 12 ]. Factors influencing good hand hygiene include knowledge [ 13 ], access to facilities [ 14 ], emotional beliefs [ 15 ], attitudes, and social norms [ 16 ]. However, limited evidence exists regarding the factors associated with poor hand hygiene practices, despite their known adverse consequences [ 17 ] [ 18 ]. Hand hygiene gained global prominence during the recent COVID-19 pandemic era [ 19 ]. The emergence of COVID-19, caused by the novel coronavirus SARS-CoV-2, was first reported in Wuhan, China, on December 31, 2019, and rapidly evolved into a highly transmissible infectious disease worldwide, as documented by Wang and Yu in 2020 [ 20 ]. Uganda recorded its first case in March 2020. In alignment with global responses, Uganda, like other nations, swiftly adopted hand hygiene as a pivotal non-pharmaceutical preventive measure. This approach was implemented alongside other measures such as social distancing, strict lockdowns, and quarantine as advocated by the World Health Organization [ 9 ]. Memes and short videos aimed at reaching people on their handheld devices, social media, television, radio, print adverts, and billboards were used to convey the same message that effective hand hygiene is crucial to stopping the spread of COVID-19 [ 21 ]. As a result of these efforts, the proportion of individuals who wash their hands to reduce the risk of contracting the coronavirus increased from 67–71% globally [ 8 ]. In sub-Saharan Africa, the proportion of individuals who washed their hands to avoid COVID-19 ranged between 49.5% [ 22 ] and 86% [ 23 ]across studies. Despite strict hand hygiene measures, a significant number of people did not comply, leaving them vulnerable to the deadly virus. Overall, despite extensive efforts to promote proper hand hygiene during COVID-19, poor adherence persisted, with prevalence rates ranging from 55.3–76.7% [ 6 ][ 24 ][ 25 ]. Currently, few studies have investigated factors associated with poor hand hygiene practices, with existing research largely confined to hospital settings [ 6 ] [ 26 ], [ 27 ]. This problem limits understanding of the factors influencing poor hand hygiene practices in community settings, where most people reside. Against this backdrop, this study aimed to assess the prevalence and determinants of poor hand hygiene practices among adult caregivers of children under five in Mbale District, Eastern Uganda. Methods Study setting This study was conducted in three sub-counties of Mbale District Bumbobi, Bufumbo, and Bubyangu selected for their high burden of diarrhea (8%) and low hand hygiene compliance (43%) [ 28 ]. These sub-counties were chosen based on the high prevalence of acute diarrhea cases reported by their respective health facilities in the District Health Information System version 2 (DHIS2) for the year 2020. They represent rural communities with limited road infrastructure and poor access to essential social services, including healthcare. Mbale District is located in the Eastern region of Uganda. It covers a total area of 538.16 km², with a population density of 915 individuals per square kilometre. It is bordered by Tororo District to the south, Manafwa District to the southeast, Sironko and Bududa Districts to the northeast, Mbale City to the north, Budaka and Pallisa Districts to the northwest, and Butaleja District to the west. The district comprises three constituencies, Bungokho North, Bungokho Central, and Bungokho South, as well as 16 sub-counties and three town councils: Nabumali, Jewa, and Busiu. There are 24 health facilities in Mbale District, including one Health Center IV, 17 Health Center IIIs, and six Health Center IIs. Agriculture is the primary economic activity, employing approximately 82% of the population. Over 90% of residents live in rural areas with limited access to water, sanitation, and hygiene services, contributing to a high prevalence of diarrheal diseases (8%). The district is predominantly inhabited by the Gishu tribe, with other tribes, including Gwere, Teso, Japadhola, and Samia, also present. Study design This study employed a cross-sectional design to collect quantitative data to understand the prevalence and factors associated with poor hand hygiene among carers. We adopted the design because it had already been used in these settings to assess hand hygiene practices in countries like Nigeria and Ethiopia [ 6 ], [ 29 ], [ 30 ]. Study population The study targeted adult carers of children under five aged 15 years and older, as defined in the 2016 Demographic and Health Surveys, who had at least one child under five residing in households within the three selected sub-counties in Mbale District Sample size determination The sample size for this study was determined using the Kish-Leslie formula [ 31 ] for calculating sample sizes for cross-sectional studies given by: Where: N is the required sample size Z is the value that corresponds to the set confidence level at 95%, which is 1.96. d is the tolerable sampling error (precision) which we set at 0.05 p is the prevalence of hand hygiene of adult carers in the target population. We used a prevalence of 25% as cited in Kayiwa et al [ 32 ]. Considering these assumptions, we initially estimated the required sample size to be 288 respondents. After accounting for a 10% non-response rate, the final sample size was adjusted to 320 respondents. Sampling procedures Using acute diarrhea among children under five years as a proxy for hygiene-related diseases, sub-counties were ranked from the highest to the lowest number of diarrhea cases. We then selected the top three sub-counties (Bufumbo, Bubyangu, and Bumbobi) whose health facilities reported the highest number of acute diarrhoea cases in the District Health Information System (version-2) [DHIS-2] from October to December 2022/2023, as shown in Table 1 below. Table 1 Distribution of outpatient department attendances for acute diarrhea across different sub-counties in Mbale district, October to December 2022/2023. Organisation unit name Diarrhoea - Acute 29 Days-4Years, Female Diarrhoea- Acute 29 Days-4Years, Male Totals OPD a Bubyangu Subcounty 44.0 55.0 99 Budwale Subcounty 29.0 38.0 67 Bufumbo Subcounty 46.0 48.0 94 Bukiende Subcounty 10.0 9.0 19 Bumasikye Subcounty 13.0 1.0 14 Bumbobi Subcounty 47.0 46.0 93 Bungokho Subcounty 0 0 0 Bungokho-Mutoto Subcounty 0 0 0 Busano Subcounty 37.0 33.0 70 Busiu Subcounty 26.0 28.0 54 Busiu Town Council 19.0 9.0 28 Busoba Subcounty 12.0 22.0 34 Lukhonje Subcounty 30.0 43.0 74 Nabumali Town Council 0 0 0 Nakaloke Town Council 0 0 0 Nawuyo Town Council 0 0 0 Nyondo Subcounty 7.0 13.0 20 Wanale Subcounty 22.0 28.0 50 a OPD, Outpatient Department Based on the number of children under five years, the parish with the highest count in each sub-county was selected (Bunamoli Parish in Bubyangu sub-County; Bumusili Parish in Bufumbo sub-County, and Bumbobi Parish in Bumbobi sub-County), as shown in Table 2 . The three parishes have a combined total of 19 villages. Following best practices from the Uganda Bureau of Statistics (UBOS, https://www.ubos.org/ ), which recommends interviewing approximately 20 to 25 respondents per enumeration area, a total of 16 out of 19 villages were selected using the proportion outlined below. = 320/20 = 16 villages To determine the number of villages per parish for inclusion, we calculated the proportion of villages in each parish relative to the total villages (19) and multiplied it by the target number of villages (16), as shown in the computation below. Bunamoli Parish: (4/19) × 16 = 3 villages Bumusili Parish: (7/19) × 16 = 6 villages Bumbobi Parish: (8/19) × 16 = 7 villages Villages were then randomly selected from each parish. To do this, village names were written on pieces of paper, placed in a box, and mixed. A member of the research team randomly drew one paper at a time, and the village name on the paper was selected. This process continued until the required number of villages was chosen in each parish. In each selected village, 20 households were randomly chosen using a list from the village chairperson. The list included households with children under five years old. Trained Village Health Teams (VHTs) assisted in identifying and listing all eligible households. The research team then used a simple random sampling method to choose 20 households for data collection. To determine the starting point for surveying, the research assistant tossed a coin at the village trading centre to decide the direction (heads for right, tails for left). The VHT guided the team along the chosen path until all selected households were surveyed, starting from the farthest end of the village. If a household had more than one eligible child, one child was selected at random using simple random sampling methods. See Table 2 . Table 2 Names of selected sub-counties, parishes, and their corresponding number of children below five years and the villages Sub County Parish name Number of < 5 children Name of village selected for the survey Bubyangu Bunamoli 806 Bunamoli, Majenga, Bumasifa, Namakholo Bufumbo Bumusili 112 Lufunga, Bumusili, Itale, Kibembe, Lwasabubi, Mayenze, Neemba Bumbobi Bumbobi 247 Nabikhomwa A, Nabikhomwa B, Siira 1, Siira 2, Masalile, Luuchi, Bukhomeka 1, Bukhomeka 2 Study variables Dependent variables The dependent variable was poor hand hygiene practices among adult carers of children under five years of age. This was defined as practicing five or fewer out of the 10 listed hand hygiene critical junctures. The ten critical moments included before eating, after eating, before breastfeeding or feeding a child, before cooking or preparing food, after defecation/urination, after cleaning a child that has defecated or changing a nappy, when my hands are dirty, after cleaning the toilet or potty, before and after taking care of a sick person and after blowing the nose coughing or sneezing. Independent variables Independent variables in this study were socio-demographic characteristics (age, marital status, residence, level of education, income level, etc.) of the adult carers’ of children under five, availability of hand washing facilities, availability of soap or alcohol-based hand rub, Knowledge of critical times for hand washing, and other factors from literature associated with hand hygiene like the source of information about hand hygiene and others. Data collection methods and procedures Data were collected using an interviewer-administered questionnaire, completed electronically via Kobo Toolbox (Cambridge, Massachusetts, USA). The questionnaire gathered information on socio-demographic factors (age, marital status, education, income, occupation, religion), residence, water source, handwashing facilities, and other factors associated with hand hygiene among adult carers of children under five. Five trained research assistants (RAs) conducted the data collection, having received three days of training on study procedures, ethics, and tool usage. A pre-test was conducted with eight adult carers in Mooni village to assess questionnaire validity, question clarity, and time required for completion. Modifications were made based on pre-test feedback to improve the questionnaire's quality. The RAs, assisted by the village chairperson and Village Health Teams (VHT), then proceeded with data collection in the selected households. Measurement of variables The primary outcome was poor hand hygiene practices, defined as engaging in five or fewer of the ten critical hand hygiene moments. The ten critical moments included six main handwashing moments [ 33 ] and four auxiliary moments. The six main moments were: (i) before eating, (ii) after eating, (iii) after defecation/urination, (iv) after cleaning a child’s feces or changing a nappy, (v) before preparing food, and (vi) after coughing or sneezing. The four auxiliary moments were: (i) before breastfeeding or feeding a child, (ii) before cooking, (iii) before caring for a sick person, and (iv) after caring for a sick person. To assess hand hygiene practices, respondents were asked, "At what critical times did you wash your hands?" The research assistant then checked off each moment the respondent mentioned. Respondents were further asked whether they used soap and water, water alone, or alcohol-based hand rub at each moment. Poor hand hygiene was defined as reporting five or fewer critical moments and not using soap with water or alcohol-based hand rub at those times. The secondary outcome was the prevalence of diarrhea in the household, based on reported diarrhea episodes in children under five years within the two weeks prior to the survey. We assessed several factors about poor hand hygiene practices, including socio-demographic variables such as the carer's and child's age, education level, and the availability of hand hygiene facilities. The carer's age was categorized into three groups: 15–24 years, 25–34 years, and 35 + years. The child's age was categorized as < 11 months, 12–35 months, and 36 + months. Education was categorized into 'No formal education', 'Primary', and 'Post-primary'. Data on the sources of hand hygiene information were collected through multiple-choice questions. Data management and quality control Data were collected using Kobo Toolbox (Cambridge, Massachusetts, USA) and exported to Microsoft Excel for initial processing. The dataset was then transferred to Stata version 15 (College Station, Texas, USA) for data cleaning and preparation for analysis. To ensure data quality, daily validation checks were conducted in the Kobo Toolbox, and troubleshooting was performed as needed. All data were backed up on an external, password-protected drive located on the Principal Investigator's computer, with additional backups stored on flash drives with restricted access to ensure confidentiality. Data analysis Data were analyzed at three levels: univariate, bivariate, and multivariable. Descriptive statistics, including frequencies and means, were used in the univariate analysis. Logistic regression was employed for bivariate analysis to assess factors associated with poor hand hygiene practices, as this outcome was binary. Variables with a p-value < 0.05 in the bivariate analysis were entered into the multivariable model. A stepwise approach was used in the multivariable analysis to select and adjust variables, and factors with a correlation greater than 0.6 were excluded due to collinearity. The final model identified significant associations with the primary outcome, defined as a p-value < 0.05. Factors such as the child's age, caregiver's education level, and diarrhea prevalence were included in the multivariable analysis based on their established significance in the literature, despite not being significant in the bivariate analysis. Results Respondents’ socio-demographic characteristics Table 3 shows the socio-demographic characteristics of adult carers. A total of 320 carers of children under five years were interviewed. The majority were female (86%, n = 275), with only 45 (14%) male carers. The mean age of respondents was 32 years (SD ± 11.5), ranging from 15 to 73 years. Most carers were aged 25–34 years (38.4%), followed by those aged 15–24 years (31.6%) and those aged 35 years and older (30%). Bumbobi sub-county had the highest proportion of participants (48.9%, n = 154), followed by Bufumbo (34.7%, n = 123). Regarding religious affiliation, most participants identified as Protestant (38.4%, n = 123) or Catholic (34.7%, n = 111). In terms of education, the majority had completed primary education (55%, n = 176), while 31.2% (n = 100) had attained post-primary education. Notably, 13.1% (n = 42) had no formal education. The predominant occupation was peasant farming (70%, n = 223), followed by housewives (16.3%, n = 52). More than eighty percent of the respondents (82.5%, n = 264) were in a marital union at the time of the study. See Table 3 . Table 3 Description of Socio-demographic characteristics Variable Frequency n = 320 Percentage (%) Sub-County Bubyangu 55 17.2 Bufumbo 111 34.7 Bumbobi 154 48.1 Child’s age category (Months) ≤ 11 71 22.2 12–23 91 28.4 24–35 54 16.9 36 and above 104 32.5 Child attending school (Yes) 49 15.3 Relationship with the child Mother 253 79.06 Father 30 9.38 Other 37 11.6 Carer’s sex Male 45 14.0 Female 275 85.9 Age of the carer 15–24 101 31.6 25–34 123 38.4 35+ 96 30.0 Religion of carer Catholic 38 11.9 Anglican/protestant 123 38.4 Moslem 111 34.7 Pentecostal /born again / evangelical 48 15.0 Highest level of education No formal education 42 13.1 Primary 178 55.6 Post-primary 100 31.2 Main occupation of the carer Peasant farmer 223 69.7 Business/commercial 20 6.3 Casual worker 15 4.7 House wife 52 16.3 Other 10 3.1 Carer’s marital status Single /separated 47 14.7 Married/cohabiting 264 82.5 Widowed 9 2.8 Prevalence of poor hand hygiene among adult carers in Mbale District The prevalence of poor hygiene practices was 28% (88/320) while that of good hand hygiene practices was 72% (232/320), as shown in Fig. 1 below. Distribution of hand hygiene practices across socio-demographic characteristics Table 4 shows the prevalence of hand hygiene practices among adult carers across different socio-demographic characteristics. Though good hand hygiene practices were common among carers with children aged 12–33 months (32.3%, n = 75), and carers aged 25–34 (38.8%, n = 90), poor hand hygiene was common among carers whose children were aged 36 + months (39.8%, n = 35) and or with the child not attending school (21.6%, n = 19), carers who had attended primary education (65%, n = 57) and those whose main occupation was peasant farmer (75%, n = 66). In addition, poor hand hygiene was also common among carers who were mothers of the child (79.6%, n = 70), Anglican (43.2%, n = 38), and living in a marital relationship (81.8%, n = 72). See Table 4 . Table 4 Distribution of hand hygiene practices across the different socio-demographic characteristics of the adult carers of children under five years in Mbale District Variable Hand hygiene practices P-value Good n = 232(%) Poor n = 88(%) Child’s age category (Months) 0.081 ≤ 11 50(21.5) 21(23.9) 12–23 75(32.3) 16(18.2) 24–35 38(16.4) 16(18.2) 36+ 69(29.7) 35(39.8) Child attending school (Yes) 30(12.9) 19(21.6) 0.055 Relationship with the child 0.268 Mother 183(78.9) 70(79.6) Father 19(8.2) 11(12.5) Other 30(12.9) 7(8.0) Age of the carer 0.829 15–24 71(30.6) 30(34.1) 25–34 90(38.8) 33(37.5) 35+ 71(30.6) 25(28.4) Religion of carer 0.459 Catholic 28(12.1) 12(13.6) Anglican/protestant 85(36.6) 38(43.2) Moslem 80(34.5) 31(35) Pentecostal /born again / evangelical 39(16.8) 9(10) Highest level of education 0.065 No formal education 30(12.9) 12(13.6) Primary 121(52.2) 57(65) Post-primary 81(35.0) 19(21.6) Main occupation of the carer 0.404 Peasant farmer 157(67.7) 66(75) Business/commercial 17(7.3) 3(3.4) Casual worker 10(4.3) 5(5.7) Housewife 39(16.8) 13(14.8) Other (students, hairdresser) 9(3.9) 1(1.1) Carer’s marital status 0.432 Single/separated 32(13.8) 15(17.1) Married/cohabiting 192(82.8) 72(81.8) Widowed 8(3.5) 1(1.1) Prevalence of diarrhea among children under five against the adult carers’ hand hygiene practices Figure 2 shows the number of children who experienced a diarrheal episode two weeks prior to the study as reported by their adult carers, which was slightly higher in households with poor hand hygiene practices as compared to those with good hand hygiene (29.5% vs. 25.9%) however, this difference was not statistically significant (P = 0.51). See Fig. 2 . Factors associated with poor hand hygiene practices among adult carers of children under five years in Mbale district Table 5 presents the results from the multivariable analyses. In the multivariable analysis, education level was significantly associated with poor hand hygiene. Carers with post-primary education had 50% lower odds (Adjusted Odds Ratio [AOR] 0.5; 95% CI 0.2, 0.9; P = 0.034) of practising poor hand hygiene compared to those without formal education. Receiving information from VHTs was positively correlated with poor hand hygiene practices (AOR 3.0; 95% CI 1.6–9.8; P = 0.003). Knowledge of hand hygiene's protective role against COVID-19 was associated with 80% lower odds of poor hand hygiene. A lack of soap, detergent, or sanitiser at the handwashing location was strongly associated with poor hand hygiene (AOR 8.8; 95% CI 1.7–45.5; P = 0.009). The analysis also considered variables like the child’s age, diarrheal episodes, and handwashing facility availability. Carers of children aged 24–35 months had 1.2 times higher odds of poor hand hygiene (AOR 1.2; 95% CI 0.5–2.6; P = 0.720), and carers with children experiencing diarrhea in the past two weeks had 1.3 times higher odds (AOR 1.3; 95% CI 0.6, 2.8; P = 0.551) of poor hand hygiene. Carers without access to a handwashing facility had 1.2 times higher odds of poor hand hygiene compared to those with a facility (AOR 1.2; 95% CI 0.4, 4.1; P = 0.759). See Table 5 . Table 5 Multivariable analysis shows factors associated with poor hand hygiene practices among adult carers of children under five years Variable Poor hand hygiene N (%) COR (95% CI) AOR (95% CI) Child’s Age (Months) < 11 21(23.9) 1 1 12–23 16(18.2) 0.5(0.2, 1.1) 0.7(0.3, 1.5) 24–35 16(18.2) 1.0(0.4, 2.2) 1.1(0.5, 2.8) 36+ 35(39.8) 1.2(0.6, 2.3) 1.2(0.5, 2.6) Highest level of education No formal education 12(13.6) 1 1 Primary 57(64) 1.2(0.6, 2.5) 0.6(0.2, 1.9) Post-primary 19(21.6) 0.6(0.3, 1.4) 0.5(0.2, 0.9) Location of the water source Elsewhere 28(32.9) 1 1 In own yard/plot 59(67.0) 0.1(0.01, 0.8) 0.1(0.01, 1.1) How often one engaged in hand hygiene to reduce the risk of contracting COVID-19 Not all 23(9.9) 1 1 More often 148(63.8) 1.3(0.5, 3.2) 2.6(0.5, 13.9) Often 23(9.9) 1.7(0.6, 5.1) 3.6(0.6, 23.3) Not often 34(14.6) 9.6(2.3, 40.2) 3.3(0.8, 13.9) Heard information on hand hygiene from; Television 4(4.8) 0.5(0.2, 1.4) 1.4(0.3, 5.6) Radio 70(84.3) 1.1(0.6, 2.2) 1.7(0.6, 4.6) Family member 27(32.5) 1.7(0.9, 3.1) 1.3(0.6, 2.7) VHTs 69(83.1) 3.1(1.6, 5.8) 3.0(1.6, 9.8) Information heard about hand hygiene Protects one from getting COVID-19 77(92.8) 0.3(0.1, 1.02) 0.2(0.04, 0.8) Protects one’s child from getting diarrhea 42(50.6) 1.2(0.7, 1.9) 0.8(0.3, 1.8) Child had diarrhoea within the last two weeks No 62(70.5) 1 1 Yes 26(29.6) 1.2(0.7, 2.1) 1.3(0.6, 2.8) Have a hand washing facility No 31(35.2) 1 1 Yes 57(64.8) 0.7(0.4, 1.1) 1.2(0.4, 4.1) Where the household often wash hands from Fixed place 6(6.8) 1 1 Mobile 57(64.8) 1.6(0.6, 4.1) 0.4(0.1, 1.6) Not observed 25(28.4) 2.8(1.03, 7.8) 1.2(0.2, 6.2) What one uses for hand washing Soap and water 54(61.4) 1 1 Water alone 33(37.5) 2.1(1.3, 3.7) 1.7(0.6, 4.3) Others 1(1.1) 1.7(0.1, 18.6) 2.4(0.1, 45.0) There are times household lacks soap (Yes) 83(94.3) 3.3(1.2, 8.6) 1.1(0.2, 5.0) Always have soap or detergent or sanitizer at the place for hand washing Always 3(3.4) 1 1 Sometimes 85(96.6) 9.9(3.0, 32.7) 8.8(1.7, 45.5) Discussion Our study of the prevalence and factors associated with engaging in poor hand hygiene in eastern Uganda revealed that 28% of the adult caregivers were engaging in poor hand hygiene practices. Engagement in poor hand hygiene practices among adult caregivers of children under five years of age was associated with the receipt of hand hygiene information from VHT, Television, Radio and family members. Before the COVID-19 pandemic, engagement in poor hand hygiene practices in Mbale district stood at 57% according to the DHIS 2 report of 2020, but our study found a lower prevalence of 28% post-COVID-19. The lower engagement in poor hand hygiene practices observed in this study could have been due to the timing of the study – which was conducted after the COVID-19 pandemic. It is likely that interventions aimed at controlling the spread of COVID-19, which included a focus on hand-hygiene practices, could have resulted in improved hand-hygiene practices, thereby reducing the proportion of adults engaging in poor hand-hygiene practices. Our findings also revealed that receiving health information from VHT was associated with an increased likelihood of engaging in poor hand hygiene practices. The suboptimal hand hygiene practices among the adult caregivers who receive information from VHT may be due to their inadequate knowledge of what constitutes good or poor hand hygiene practices. Despite being a cost-effective strategy for preventing hygiene-related diseases, a VHT may not be technical enough to convey the message regarding the effectiveness of hand hygiene practices. Effective hand hygiene goes beyond awareness to include the proper timing and technique for washing hands [ 34 ]. This finding agrees with other studies that have found VHT to possess a knowledge gap due to a lack of adequate training and supervision [ 35 ]. We also found adult caregivers with inadequate hand-washing materials were likely to engage in poor hand hygiene practices. This may not be surprising given that the majority of households in less developed countries lack access to handwashing facilities. The lack of access to hand washing facilities, such as water and soap, is a common hindrance reported by the majority of adult caregivers for maintaining hand hygiene. In line with our study findings, Engdaw and colleagues found that inadequate handwashing facilities was a common barrier in rural communities in Ethiopia and as well as lack of time[ 6 ]. Our findings show that caregivers who attain a post-primary level of education were less likely to engage in poor hand hygiene. We think that this could be because people who are educated about the consequences of poor hand hygiene are more likely to understand the critical role it plays in maintaining children's health and may be more proficient at managing resources effectively, including ensuring access to soap, water, and hand sanitisers for proper hand hygiene. This finding is in line with other studies by Bouzi and Ross et al who found that education raises awareness about the importance of handwashing in preventing the transmission of diseases, including common childhood illnesses [ 18 ], [ 39 ]. In addition, our study also found that caregivers who heard that hand hygiene protects one from getting COVID-19 were less likely to engage in poor hand hygiene. This finding we attributable to the widespread emphasis on hand hygiene as a key non-pharmaceutical measure for the prevention of COVID-19 by the public health authorities across the globe in 2020. This finding agrees with what others found in Bangladesh where knowledge of hand washing was linked to knowing when to wash hands [ 41 ]. It also agrees with what Seimetz and colleagues found in Burundi, where the benefits of hand hygiene such as the prevention of a life-threatening illness in rural Burundi and urban Zimbabwe contributed to good hand hygiene [ 42 ]. Study limitations and strengths Our study limitations included the potential for recall bias due to the lengthy recall period, which may have hindered caregivers' ability to accurately remember their hand hygiene practices during the COVID-19 pandemic. Nevertheless, we believe that the ongoing nature of the pandemic kept these experiences fresh in participants' minds, as the associated risks of contracting the virus and potential mortality were significant concerns. Additionally, while we utilized unvalidated questionnaires and interview guides, we conducted pretesting to ensure alignment with the study objectives. The study was further impacted by interviewer bias resulting from the unexpected replacement of trained research assistants with untrained individuals. To mitigate this, we implemented on-the-spot training sessions and daily team meetings to familiarize replacements with the study protocol and tools, aiming to minimize inconsistencies in data collection and uphold the study's integrity. Lastly, we did not adjust the sample size calculation for a design effect, which may have implications for the precision of our estimates. However, our study recruited 320 eligible participants who met the inclusion criteria, resulting in a robust sample size that improved the statistical power of the findings. Conclusion Our study highlighted that nearly three in ten adult carers of children under five exhibited poor hand hygiene. Inadequate soap or detergent and receiving information from VHT were positively associated with poor hygiene, while education beyond the primary level and awareness of hand hygiene’s protective role against COVID-19 were protective. Strengthening primary education, improving VHT messaging, and sustaining COVID-19-era hygiene interventions are critical. Mass media campaigns and reminder-based interventions could reinforce handwashing behaviours and mitigate hygiene-related diseases in Mbale District. Abbreviations COVID-19 Coronavirus Disease 2019 DHIS2 District Health Information System Version 2 HMIS Health Management Information System WSP Water Safety Plans Declarations Ethics approval and consent to participate Ethical clearance was obtained from the Busitema University Faculty of Health Sciences Research and Ethics Committee (BUFHS-REC) under reference number BUFHS-2023-53. Permission was secured from the relevant community leaders and the District Health Office. Informed consent was obtained from all study participants. All study procedures were done in accordance with the ethical guidelines of the 1975 Declaration of Helsinki. Confidentiality and anonymity of the participants' information were strictly maintained throughout the study. Data were de-identified to protect personal information, and access to the data was restricted to the research team. Consent for publication Not Applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request Competing interests The authors declare that they have no competing interests. Funding There was no funding for this study Authors' contributions JN was responsible for conceptualization, proposal development, methodology, data collection, data analysis, report writing, and manuscript writing. POO, RN, OC and DM contributed to the conceptualization, methodology, and manuscript writing. DW, AO, and JPA analyzed data, drafted, reviewed, and revised the manuscript for clarity and accuracy. JKBM supervised the authors and was involved in conceptualization, proposal development, methodology, data collection, data analysis, report writing, and manuscript writing. Acknowledgments I extend my sincere gratitude to my research supervisors for their invaluable support and guidance throughout this study. I also acknowledge the academic staff of the Department of Community and Public Health at Busitema University for their contributions. Special thanks go to Nick and Ruth Davis who provided financial support for the research project and to JENGA Community Development Outreach for their assistance. Finally, I appreciate my classmates from the Master of Public Health Cohort 2019/2020 (Abeso Angella, Medi Misanga, Ali Tuwa Hassan, Ouni Patrick Diox and Edgar Mugasha among others), for their social, moral, and academic support during our studies. Your contributions have been deeply valued. References WHO. Children: improving survival and well-being. World Heal Organ. , pp. 1–4, (2020). Black, R. et al. Drivers of the reduction in childhood diarrhea mortality 1980–2015 and interventions to eliminate preventable diarrhea deaths by 2030. J. Glob Health . 9 (2), 1–9. 10.7189/jogh.09.020801 (2019). WHO. Levels Trends Child Mortal., pp. 1–52, 2019.Child Mortality (2019). Chopra, M. et al. Ending of preventable deaths from pneumonia and diarrhoea: An achievable goal, The Lancet, vol. 381, no. 9876. Lancet Publishing Group, pp. 1499–1506, (2013). 10.1016/S0140-6736(13)60319-0 UNICEF: WHO. World Bank: UN DESA, Levels & Trends in Child Mortality 2019 p. 52 ( UN IGME Rep., 2019). Engdaw, G. T., Gebrehiwot, M. & Andualem, Z. Hand hygiene compliance and associated factors among health care providers in Central Gondar zone public primary hospitals, Northwest Ethiopia. Antimicrob. Resist. Infect. Control . 8 (1), 1–7. 10.1186/s13756-019-0634-z (2019). Brauer, M., Zhao, J. T., Bennitt, F. B. & Stanaway, J. D. 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Munich Personal RePEc Archive Factors influencing access to basic handwashing facilities in developing countries. Natl. Inst. Public. Financ Policy , pp. 1–20, (2020). Contzen, N. & Mosler, H. J. Impact of different promotional channels on handwashing behaviour in an emergency context: Haiti post-earthquake public health promotions and cholera response, (2013). 10.1007/s10389-013-0577-4 Contzen, N. & Mosler, H. J. Identifying the psychological determinants of handwashing: Results from two cross-sectional questionnaire studies in Haiti and Ethiopia, Am. J. Infect. Control, vol. 43, no. 8, pp. 826–832, Aug. (2015). 10.1016/j.ajic.2015.04.186 Leontsini, E. & Winch, P. J. Increasing handwashing with soap: Emotional drivers or social norms? Lancet Glob Heal . 2 (3), e118–e119. 10.1016/S2214-109X(14)70030-0 (2014). Shobowale, E., Adegunle, B. & Onyedibe, K. An assessment of hand hygiene practices of healthcare workers of a semi-urban teaching hospital using the five moments of hand hygiene. Niger Med. J. 57 (3), 150. 10.4103/0300-1652.184058 (2016). Bouzid, M., Cumming, O. & Hunter, P. R. What is the impact of water sanitation and hygiene in healthcare facilities on care seeking behaviour and patient satisfaction? A systematic review of the evidence from low-income and middleincome countries. BMJ Glob Heal . 3 (3), 1–14. 10.1136/bmjgh-2017-000648 (2018). Araghi, F., Tabary, M., Gheisari, M., Abdollahimajd, F. & Dadkhahfar, S. Hand Hygiene among Health Care Workers during COVID-19 Pandemic: Challenges and Recommendations, Dermatitis, vol. 31, no. 4, pp. 233–237, Jul. (2020). 10.1097/DER.0000000000000639 Hao, Y. J. et al. The origins of COVID-19 pandemic: A brief overview. Transbound. Emerg. Dis. 69 , 3181–3197. 10.1111/tbed.14732 (2022). Alzyood, M., Jackson, D., Aveyard, H. & Brooke, J. COVID-19 reinforces the importance of handwashing. J. Clin. Nurs. (Vol . 29 (15), 2760–2761 (2020). Apanga, P. A., Lettor, I. B. K. & Akunvane, R. Practice of COVID-19 Preventive Measures and Its Associated Factors among Students in Ghana, Am. J. Trop. Med. Hyg., vol. 104, no. 2, p. 526, Feb. (2021). 10.4269/AJTMH.20-1301 Alioni, D. Sustaining handwashing with soap behaviour post COVID-19 | SNV World. blog , (2020). Ministry of Health. Annual Health Sector Performance Report, Financial Year 2020/21. Minist Heal Gov. Uganda , p. 222, (2021). Seidu, A. et al. Prevalence and Factors Associated with Hygiene Behaviours among In-School Adolescents in Ghana. J 4 (2), 169–181. 10.3390/j4020014 (2021). Ango, U. et al. Knowledge, Attitude and Practice of Hand Hygiene among Healthcare Providers in Semi-urban Communities of Sokoto State, Nigeria. Int. J. Trop. Dis. Heal . 26 (2), 1–9. 10.9734/ijtdh/2017/36599 (2017). Jang, T. H. et al. Focus Group Study of Hand Hygiene Practice among Healthcare Workers in a Teaching Hospital in Toronto, Canada. Infect. Control Hosp. Epidemiol. 31 (2), 144–150 (2010). DHIS & 2 Mbale District Health Information System, (2020). Aigbiremolen, A. O., Abejegah, C., Ike, C. G., Momoh, J. A. & Abah, S. O. Knowledge and practice of hand washing among caregivers of under-five children in a rural Nigerian community. Public. Heal Res. 5 (5), 159–165. 10.5923/j.phr.20150505.06 (2015). Gizaw, Z., Demissie, N. G., Gebrehiwot, M., Destaw, B. & Nigusie, A. Hand hygiene practice and associated factors among rural communities in northwest Ethiopia. Sci. Rep. 13 (1), 1–8. 10.1038/s41598-023-30925-0 (2023). Verma, V. Leslie Kish: Development of statistics, Proc. Stat. Canada Symp., pp. 1–10, (2001). Kayiwa, D. et al. Assessment of water, sanitation and hygiene service availability in healthcare facilities in the greater Kampala metropolitan area, Uganda. BMC Public. Health . 20 (1), 1–11. 10.1186/s12889-020-09895-9 (2020). CDC. When and How to Wash Your Hands | Handwashing | CDC. Website (2020). MUKHERJEE, S. & S. MUKHERJEE and Factors influencing access to basic handwashing facilities in developing countries. J. Econ. Soc. Thought . 7 (2), 92–109 (2020). Perry, H. B. et al. Community health workers at the dawn of a new era: 11. CHWs leading the way to ‘Health for All’. Heal Res. Policy Syst. 19 (3), 1–22. 10.1186/s12961-021-00755-5 (2021). Musoke, D. et al. Community health workers’ involvement in the prevention and control of non-communicable diseases in Wakiso District, Uganda. Global Health . 17 (1), 1–11. 10.1186/s12992-020-00653-5 (2021). Kisaakye, P., Ndagurwa, P. & Mushomi, J. An assessment of availability of handwashing facilities in households from four east african countries. J. Water Sanit. Hyg. Dev. 11 (1), 75–90. 10.2166/washdev.2020.129 (2021). Freeman, M. C. & Caruso, B. A. Comment on ‘global access to handwashing: Implications for covid-19 control in low-income countries’. Environ. Health Perspect. 128 (9), 1–2. 10.1289/EHP7852 (2020). Ross, I. et al. Effectiveness of handwashing with soap for preventing acute respiratory infections in low- and middle-income countries – a systematic review and meta-analysis. Under Rev. 6736 , 1–10. 10.1016/S0140-6736(23)00021-1 (2022). De Buck, E. et al. Approaches to promote handwashing and sanitation behaviour change in low- and middle‐income countries: a mixed method systematic review. Campbell Syst. Rev. 13 (1), 1–447. 10.4073/csr.2017.7 (2017). Rabbi, S. E. & Dey, N. C. Exploring the gap between hand washing knowledge and practices in Bangladesh: a cross-sectional comparative study. BMC Public. Health . 13 , 89. 10.1186/1471-2458-13-89 (2013). Seimetz, E., Slekiene, J., Friedrich, M. N. D. & Mosler, H. J. Identifying behavioural determinants for interventions to increase handwashing practices among primary school children in rural Burundi and urban Zimbabwe. BMC Res. Notes . 10 , 280. 10.1186/s13104-017-2599-4 (2017). Mascha, E. J. & Vetter, T. R. Significance, Errors, Power, and Sample Size: The Blocking and Tackling of Statistics. Anesth. Analg . 126 (2), 691–698. 10.1213/ANE.0000000000002741 (2018). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6222173","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":440187741,"identity":"28e3dc3d-5af9-479f-b778-dd3c345b1bcf","order_by":0,"name":"Jascenti 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18:08:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6222173/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6222173/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-30974-7","type":"published","date":"2025-12-12T15:59:03+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81932136,"identity":"a87dcbfe-d62d-43d0-9915-42ee4184e9da","added_by":"auto","created_at":"2025-05-05 05:33:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":14458,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of hand hygiene practices among adult carers\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6222173/v1/460aecdc674908c670239626.png"},{"id":81932137,"identity":"33e2425e-5172-43db-8a9e-22d686ee0fb5","added_by":"auto","created_at":"2025-05-05 05:33:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":9947,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of diarrhea among children under five against the carers' hand hygiene practices\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6222173/v1/04255e14975fa384793aa2b1.png"},{"id":98243999,"identity":"fe950402-1a80-45a8-b503-1a8c020e1417","added_by":"auto","created_at":"2025-12-15 16:12:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1859700,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6222173/v1/254b3f48-fec9-4a96-9b83-077f49cec124.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and factors associated with engaging in poor hand hygiene practices among adult carers of children under five years in Mbale district: a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eGlobally, the mortality rate of children under the age of five has decreased significantly from 12.6\u0026nbsp;million in 1990 to 5\u0026nbsp;million in 2020, [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This decline is largely attributed to advancements in water, hygiene, and sanitation practices [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, despite these improvements, diseases related to inadequate hygiene, such as diarrhea and respiratory tract infections, continue to be the leading causes of death among children under five in developing nations [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These hygiene-related diseases account for over 1.6\u0026nbsp;million deaths, constituting 21% of all fatalities in these settings [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHand hygiene is very important in preventing the spread of infectious diseases [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], but many low- and middle-income countries have difficulty promoting it effectively. In sub-Saharan Africa and Oceania regions, more than half of the population cannot access adequate sanitation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Despite efforts to improve sanitation through initiatives such as improved water, sanitation, and hygiene (WASH) programs [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], child deaths from sanitation-related diseases continue. Poor hygiene among their carers is often considered a contributing factor, although the evidence to support this is limited. For instance, one in four people worldwide does not have access to a basic hand-washing facility[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and even among those with access, there's a decreased likelihood of washing hands with soap after fecal contact [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Critical times for handwashing, such as before feeding a child or preparing meals, see low compliance rates (19.8%) despite its well-known benefits[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Research has indicated that people are more inclined to practice hand hygiene when they understand its benefits and the belief that a specific health action will prevent, or cure an illness [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Factors influencing good hand hygiene include knowledge [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], access to facilities [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], emotional beliefs [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], attitudes, and social norms [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, limited evidence exists regarding the factors associated with poor hand hygiene practices, despite their known adverse consequences [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHand hygiene gained global prominence during the recent COVID-19 pandemic era [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The emergence of COVID-19, caused by the novel coronavirus SARS-CoV-2, was first reported in Wuhan, China, on December 31, 2019, and rapidly evolved into a highly transmissible infectious disease worldwide, as documented by Wang and Yu in 2020 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Uganda recorded its first case in March 2020. In alignment with global responses, Uganda, like other nations, swiftly adopted hand hygiene as a pivotal non-pharmaceutical preventive measure. This approach was implemented alongside other measures such as social distancing, strict lockdowns, and quarantine as advocated by the World Health Organization [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Memes and short videos aimed at reaching people on their handheld devices, social media, television, radio, print adverts, and billboards were used to convey the same message that effective hand hygiene is crucial to stopping the spread of COVID-19 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. As a result of these efforts, the proportion of individuals who wash their hands to reduce the risk of contracting the coronavirus increased from 67\u0026ndash;71% globally [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In sub-Saharan Africa, the proportion of individuals who washed their hands to avoid COVID-19 ranged between 49.5% [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and 86% [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]across studies. Despite strict hand hygiene measures, a significant number of people did not comply, leaving them vulnerable to the deadly virus. Overall, despite extensive efforts to promote proper hand hygiene during COVID-19, poor adherence persisted, with prevalence rates ranging from 55.3\u0026ndash;76.7% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e][\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e][\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrently, few studies have investigated factors associated with poor hand hygiene practices, with existing research largely confined to hospital settings [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This problem limits understanding of the factors influencing poor hand hygiene practices in community settings, where most people reside. Against this backdrop, this study aimed to assess the prevalence and determinants of poor hand hygiene practices among adult caregivers of children under five in Mbale District, Eastern Uganda.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy setting\u003c/h2\u003e\n \u003cp\u003eThis study was conducted in three sub-counties of Mbale District Bumbobi, Bufumbo, and Bubyangu selected for their high burden of diarrhea (8%) and low hand hygiene compliance (43%) [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]. These sub-counties were chosen based on the high prevalence of acute diarrhea cases reported by their respective health facilities in the District Health Information System version 2 (DHIS2) for the year 2020. They represent rural communities with limited road infrastructure and poor access to essential social services, including healthcare. Mbale District is located in the Eastern region of Uganda. It covers a total area of 538.16 km\u0026sup2;, with a population density of 915 individuals per square kilometre. It is bordered by Tororo District to the south, Manafwa District to the southeast, Sironko and Bududa Districts to the northeast, Mbale City to the north, Budaka and Pallisa Districts to the northwest, and Butaleja District to the west. The district comprises three constituencies, Bungokho North, Bungokho Central, and Bungokho South, as well as 16 sub-counties and three town councils: Nabumali, Jewa, and Busiu. There are 24 health facilities in Mbale District, including one Health Center IV, 17 Health Center IIIs, and six Health Center IIs. Agriculture is the primary economic activity, employing approximately 82% of the population. Over 90% of residents live in rural areas with limited access to water, sanitation, and hygiene services, contributing to a high prevalence of diarrheal diseases (8%). The district is predominantly inhabited by the Gishu tribe, with other tribes, including Gwere, Teso, Japadhola, and Samia, also present.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eStudy design\u003c/h3\u003e\n\u003cp\u003eThis study employed a cross-sectional design to collect quantitative data to understand the prevalence and factors associated with poor hand hygiene among carers. We adopted the design because it had already been used in these settings to assess hand hygiene practices in countries like Nigeria and Ethiopia [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e], [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e], [\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe study targeted adult carers of children under five aged 15 years and older, as defined in the 2016 Demographic and Health Surveys, who had at least one child under five residing in households within the three selected sub-counties in Mbale District\u003c/p\u003e\n\u003ch3\u003eSample size determination\u003c/h3\u003e\n\u003cp\u003eThe sample size for this study was determined using the Kish-Leslie formula [\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e] for calculating sample sizes for cross-sectional studies given by:\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAASoAAAA9CAYAAAAaniS4AAAAAXNSR0IArs4c6QAAAARnQU1BAACxjwv8YQUAAAAJcEhZcwAADsMAAA7DAcdvqGQAAAhOSURBVHhe7Z07b9RMFIZnv54iQAkNSUMFBQhEoICCIEiHgCAoESGhowECSEhcRCigggSJ1AlSSoK4SDQBJEQKKKggiB/A5Sfk22fw4TP+vGt710tmve8jTbzxZW2fnXl95szFtZU6TgghAuafaCmEEMEioRJCBI+ESggRPBIqIUTwSKiEEMEjoRJCBI+ESggRPBIqIUTwSKiEEMEjoRJCBI+ESqTy/ft3Nz4+7gYGBlytVvOJz5cuXfLbhPibSKhEKleuXHHDw8Pu8+fPjuGgy8vL7vTp0+7mzZvuwIEDEqsGvHr1yt2+fds9efIkWiM+fPjgbYJtWoZByaK7mZycZGB54dTf3x99Q36Ghob8se/fv4/WCFhcXFw5duzYyvT0dLSmMdiO/di/r6/PH9sLcM/kn1buV0LV5Xz79s0LzsTEhM8A/N8I9jGR4nOzfRuxbds2n9nEf/CgQHCyxBt7z87O+t8JO9pv0StCBdgIW2GzIkiouhyeUlkFhO1WMMgkCwsL0ZZiUMj4nlYErqqMjY15u+bxpOLEveBeEiogH3Hf2C4vEqqKQwGyAkFVo1WRIXO16oVVFStwrVShe1moAJtx73kFXsH0ivLlyxcf9D5z5oyre1GuniHc3NycW7duXbRHPgia09K3YcMGd+PGjcLHh4q1ZFrCVoCNRkZG3Nq1a/16lrR+JhsPrFUU6g8Av6wy7doridns4sWLuRpmJFQVhBanehXNPXv2zC+Xlpbc6OhotDU/ZMKZmRl37tw5t3v37mjtLxEkc3Yaa0FLYiJhhYPE9dC6lJf6Q9onRBz27dv3W3ju3bvnfvz44eqejj/H1NSUO3HihN9mzM/Pu58/f/rPg4ODflll2rVXErMZNsSWmdRPLioC1TKqd/yspKIBSyMe02qUqPZ0mkZVVaqg8Tgbn4m9kYpUTa3qRmpUBbFWTr47TtzOrVTdurHq1469knDP9l15GmckVBWBH97q/SyzAuxlw/kpvGRQy6j8b9dhBTtvoaRQFBFDK/jLy8vRmmyy4iSInt1PMvBrBbLIPcVpRajYz45pNbX68IJ27JUkfi8Sqh6hjG4H7WBPWryweKHD0yETkrHZjljlpci+QMEoUgjtmpsVEmvRS2vpNOEl/S2hWk3atVcSCVUPUbTbAZmHAlbE68iDPUXTzh9/yuY9L4W4SOEt6n2BeQdp5+GaswqdFVxS0XNDtwlVu/ZKEheqRh5aHAlVl2JeCgnxaZQ5yBAICJ4WgkGGKhsTorRMXNSbskyfB/bl+4tWc01kuO74sQgp30ehZFszD41z230XtandI8eSiniCq0EZ9koSF+o8DzAJVReCq2w/cpFEZirbmwLLyDxNLSNTGC0zUii5ZhOyZqLFvnmukfMkPRmOQ5CzMO8gaUfWc20UPq4/i3gBzkv8fMmUpwq0GpRlrzhWE8grbhIqUQp4bWRa8zJIZEYTE4TFMjwZOw32ycq4FAjOY+dIpqzqr4lLWaJgnlGje+p2yrYXWLWviCcqoRI9hYllWjW1VRCpZLWoKpRtL2yErfJ4vnEkVKInoFpo3g+Fr2wogHgdVfGsOmEvxA4vuxXRq/GnfjFCVBJ6sa9fvz767/+Unf3pTf/mzRu3a9euP3rzdwudsBc2+fjxo9u4caM7ePBgtLYYEiohRPBorJ8QIngkVEKI4JFQCSGCR0IlhAgeCZUQInjaFiomK7PJy+IpbcKzOA8ePEg9jpR1rBCityi1ewIzP+7fv9+/Aw4WFxcz+5IwG+WhQ4f81KRMS7ply5ZoixBC/KJUoaJj1/Xr1/1LKxGrvr4+9+nTp6bzbNvLLN+9exetEUKIPylVqBCdy5cvuzVr1ritW7f6dUNDQ+7p06f+cxKEbc+ePbk8LyFE71JaMB3RAQSH6tv09LT/nxcMNIo54X0hZBIpIURT8KjKgAGZycGGNqiRlNzG/6xvd8S5fU+7SQgRLqWUUMQibb4a5g6yCbKY2iE+uRb7F5mPptu5evXqSq1WU1LqiUR+L5NSYlQWm0qrwtF9Ye/evf79XRavstgUAfdNmzZFewohRDptx6jisak0iFfdv3/ffyZexVt3iU1NTEyUIlKcv67gbSchRMB4v6oN0mJTacTjVclqoBDdAvmWvEwetvzM1MhVnN0zJFr2qOjcSWsefaA2b94crW3MtWvX/OvF4cKFC037VgkRKnfu3HHDw8P+Feb18uMWFhbc8+fPfXiDsiA6Q+EYVaNqEp07+fGaQbzq8OHD7u3btxIqURl4YJ8/f14x1w5S2KNC19JSlkgB8Sp6rUukRGggNsm4Zd4xp1+/fnWTk5MSqQ5Sas90Ibqd8fFxNzU15fr7+3N5/nNzc345MjLil6IzSKiEiIi/2GB2drap+LDv/Py827lzpwbS/wVKG0IjRLczMzPjl3hTzUSKWOuLFy/c6Ojob5GicYmuN6IzSKiEqIOHdOvWLf+Zfn5psA8CxoD748eP/xHPQtwGBwejPUXZqOonegbmPnv8+LGfUmhpacmvo8vMw4cPfWdkWu4QHBp8RFjIoxKVh4D3wMCAn6AR7t69+7u1ms90mcnypsTqIo9KVBZiSadOnfLeE57To0ePUrsQMFYVj0reVLjIoxKVxAbDI1JjY2O+upcmUowVRaRA3lS4yKMSlYSqHj3F8aQaTXNNzOrkyZN+Zg95U2Ejj0pUDrwke8HIkSNH/DIOrXd0JXj9+nW0Rt5U6EioROVgzn7j5cuXvo8T2ED6s2fPuqNHj3pPioTXRbcDPCwRJhIqUTnohMmsBgiQBcm3b9/uO3QyeSOtgPHe5Gxj3Y4dO6I1IjQUoxJCBI5z/wIhfkH7MLltiwAAAABJRU5ErkJggg==\" height=\"61\" width=\"298\"\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eWhere:\u003c/p\u003e\n\u003cp\u003eN is the required sample size\u003c/p\u003e\n\u003cp\u003eZ is the value that corresponds to the set confidence level at 95%, which is 1.96.\u003c/p\u003e\n\u003cp\u003ed is the tolerable sampling error (precision) which we set at 0.05\u003c/p\u003e\n\u003cp\u003ep is the prevalence of hand hygiene of adult carers in the target population. We used a prevalence of 25% as cited in Kayiwa et al [\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eConsidering these assumptions, we initially estimated the required sample size to be 288 respondents. After accounting for a 10% non-response rate, the final sample size was adjusted to 320 respondents.\u003c/p\u003e\n\u003ch3\u003eSampling procedures\u003c/h3\u003e\n\u003cp\u003eUsing acute diarrhea among children under five years as a proxy for hygiene-related diseases, sub-counties were ranked from the highest to the lowest number of diarrhea cases. We then selected the top three sub-counties (Bufumbo, Bubyangu, and Bumbobi) whose health facilities reported the highest number of acute diarrhoea cases in the District Health Information System (version-2) [DHIS-2] from October to December 2022/2023, as shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ebelow.\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDistribution of outpatient department attendances for acute diarrhea across different sub-counties in Mbale district, October to December 2022/2023.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOrganisation unit name\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDiarrhoea - Acute 29 Days-4Years, Female\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDiarrhoea- Acute 29 Days-4Years, Male\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotals OPD\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBubyangu Subcounty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBudwale Subcounty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBufumbo Subcounty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBukiende Subcounty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBumasikye Subcounty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBumbobi Subcounty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBungokho Subcounty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBungokho-Mutoto Subcounty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBusano Subcounty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBusiu Subcounty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBusiu Town Council\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBusoba Subcounty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLukhonje Subcounty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNabumali Town Council\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNakaloke Town Council\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNawuyo Town Council\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNyondo Subcounty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWanale Subcounty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eOPD, Outpatient Department\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eBased on the number of children under five years, the parish with the highest count in each sub-county was selected (Bunamoli Parish in Bubyangu sub-County; Bumusili Parish in Bufumbo sub-County, and Bumbobi Parish in Bumbobi sub-County), as shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. The three parishes have a combined total of 19 villages. Following best practices from the Uganda Bureau of Statistics (UBOS, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ubos.org/\u003c/span\u003e\u003c/span\u003e), which recommends interviewing approximately 20 to 25 respondents per enumeration area, a total of 16 out of 19 villages were selected using the proportion outlined below.\u003c/p\u003e\n\u003cp\u003e\u003cimg 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9I3sc/1pI/2Jy19NqJ0Tr2PSUdfoe3zoutG/2pAf6yu4b9tsczb4T1WYHHO44+ROYZ2P3HiM5Xx12t+pHCbcOVUXXn1cuYgjqSRZJLrTj3OTpyreTTQ9sTRxKH9HkCRJkiyeePQqOD6edROAfCIYANxpV4+Ydbx6ZGx86bRq/Ey7ekReiycX7rb8Qqsew+c6t06SRRPnqOi6rOdGkCRJMnDyaChJkmTg5EaQJEkycHIjSJIkGTi5ESRJkgya0ej/S31ms/A2cg0AAAAASUVORK5CYII=\" height=\"59\" width=\"386\"\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003cp\u003e=\u0026thinsp;320/20\u003c/p\u003e\n \u003cp\u003e=\u0026thinsp;16 villages\u003c/p\u003e\n \u003cp\u003eTo determine the number of villages per parish for inclusion, we calculated the proportion of villages in each parish relative to the total villages (19) and multiplied it by the target number of villages (16), as shown in the computation below.\u003c/p\u003e\n \u003cp\u003eBunamoli Parish: (4/19) \u0026times; 16\u0026thinsp;=\u0026thinsp;3 villages\u003c/p\u003e\n \u003cp\u003eBumusili Parish: (7/19) \u0026times; 16\u0026thinsp;=\u0026thinsp;6 villages\u003c/p\u003e\n \u003cp\u003eBumbobi Parish: (8/19) \u0026times; 16\u0026thinsp;=\u0026thinsp;7 villages\u003c/p\u003e\n \u003cp\u003eVillages were then randomly selected from each parish. To do this, village names were written on pieces of paper, placed in a box, and mixed. A member of the research team randomly drew one paper at a time, and the village name on the paper was selected. This process continued until the required number of villages was chosen in each parish. In each selected village, 20 households were randomly chosen using a list from the village chairperson. The list included households with children under five years old. Trained Village Health Teams (VHTs) assisted in identifying and listing all eligible households. The research team then used a simple random sampling method to choose 20 households for data collection. To determine the starting point for surveying, the research assistant tossed a coin at the village trading centre to decide the direction (heads for right, tails for left). The VHT guided the team along the chosen path until all selected households were surveyed, starting from the farthest end of the village. If a household had more than one eligible child, one child was selected at random using simple random sampling methods. \u003cstrong\u003eSee\u003c/strong\u003e Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eNames of selected sub-counties, parishes, and their corresponding number of children below five years and the villages\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSub County\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParish name\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of \u0026lt;\u0026thinsp;5 children\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eName of village selected for the survey\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBubyangu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBunamoli\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e806\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBunamoli, Majenga, Bumasifa, Namakholo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBufumbo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBumusili\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLufunga, Bumusili, Itale, Kibembe, Lwasabubi, Mayenze, Neemba\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBumbobi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBumbobi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNabikhomwa A, Nabikhomwa B, Siira 1, Siira 2, Masalile, Luuchi, Bukhomeka 1, Bukhomeka 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eStudy variables\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eDependent variables\u003c/h2\u003e\n \u003cp\u003eThe dependent variable was poor hand hygiene practices among adult carers of children under five years of age. This was defined as practicing five or fewer out of the 10 listed hand hygiene critical junctures. The ten critical moments included before eating, after eating, before breastfeeding or feeding a child, before cooking or preparing food, after defecation/urination, after cleaning a child that has defecated or changing a nappy, when my hands are dirty, after cleaning the toilet or potty, before and after taking care of a sick person and after blowing the nose coughing or sneezing.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eIndependent variables\u003c/h2\u003e\n \u003cp\u003eIndependent variables in this study were socio-demographic characteristics (age, marital status, residence, level of education, income level, etc.) of the adult carers\u0026rsquo; of children under five, availability of hand washing facilities, availability of soap or alcohol-based hand rub, Knowledge of critical times for hand washing, and other factors from literature associated with hand hygiene like the source of information about hand hygiene and others.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eData collection methods and procedures\u003c/h2\u003e\n \u003cp\u003eData were collected using an interviewer-administered questionnaire, completed electronically via Kobo Toolbox (Cambridge, Massachusetts, USA). The questionnaire gathered information on socio-demographic factors (age, marital status, education, income, occupation, religion), residence, water source, handwashing facilities, and other factors associated with hand hygiene among adult carers of children under five. Five trained research assistants (RAs) conducted the data collection, having received three days of training on study procedures, ethics, and tool usage. A pre-test was conducted with eight adult carers in Mooni village to assess questionnaire validity, question clarity, and time required for completion. Modifications were made based on pre-test feedback to improve the questionnaire\u0026apos;s quality. The RAs, assisted by the village chairperson and Village Health Teams (VHT), then proceeded with data collection in the selected households.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eMeasurement of variables\u003c/h2\u003e\n \u003cp\u003eThe primary outcome was poor hand hygiene practices, defined as engaging in five or fewer of the ten critical hand hygiene moments. The ten critical moments included six main handwashing moments [\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e] and four auxiliary moments. The six main moments were: (i) before eating, (ii) after eating, (iii) after defecation/urination, (iv) after cleaning a child\u0026rsquo;s feces or changing a nappy, (v) before preparing food, and (vi) after coughing or sneezing. The four auxiliary moments were: (i) before breastfeeding or feeding a child, (ii) before cooking, (iii) before caring for a sick person, and (iv) after caring for a sick person. To assess hand hygiene practices, respondents were asked, \u0026quot;At what critical times did you wash your hands?\u0026quot; The research assistant then checked off each moment the respondent mentioned. Respondents were further asked whether they used soap and water, water alone, or alcohol-based hand rub at each moment. Poor hand hygiene was defined as reporting five or fewer critical moments and not using soap with water or alcohol-based hand rub at those times.\u003c/p\u003e\n \u003cp\u003eThe secondary outcome was the prevalence of diarrhea in the household, based on reported diarrhea episodes in children under five years within the two weeks prior to the survey. We assessed several factors about poor hand hygiene practices, including socio-demographic variables such as the carer\u0026apos;s and child\u0026apos;s age, education level, and the availability of hand hygiene facilities. The carer\u0026apos;s age was categorized into three groups: 15\u0026ndash;24 years, 25\u0026ndash;34 years, and 35\u0026thinsp;+\u0026thinsp;years. The child\u0026apos;s age was categorized as \u0026lt;\u0026thinsp;11 months, 12\u0026ndash;35 months, and 36\u0026thinsp;+\u0026thinsp;months. Education was categorized into \u0026apos;No formal education\u0026apos;, \u0026apos;Primary\u0026apos;, and \u0026apos;Post-primary\u0026apos;. Data on the sources of hand hygiene information were collected through multiple-choice questions.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eData management and quality control\u003c/h2\u003e\n \u003cp\u003eData were collected using Kobo Toolbox (Cambridge, Massachusetts, USA) and exported to Microsoft Excel for initial processing. The dataset was then transferred to Stata version 15 (College Station, Texas, USA) for data cleaning and preparation for analysis. To ensure data quality, daily validation checks were conducted in the Kobo Toolbox, and troubleshooting was performed as needed. All data were backed up on an external, password-protected drive located on the Principal Investigator\u0026apos;s computer, with additional backups stored on flash drives with restricted access to ensure confidentiality.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eData analysis\u003c/h2\u003e\n \u003cp\u003eData were analyzed at three levels: univariate, bivariate, and multivariable. Descriptive statistics, including frequencies and means, were used in the univariate analysis. Logistic regression was employed for bivariate analysis to assess factors associated with poor hand hygiene practices, as this outcome was binary. Variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in the bivariate analysis were entered into the multivariable model. A stepwise approach was used in the multivariable analysis to select and adjust variables, and factors with a correlation greater than 0.6 were excluded due to collinearity. The final model identified significant associations with the primary outcome, defined as a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Factors such as the child\u0026apos;s age, caregiver\u0026apos;s education level, and diarrhea prevalence were included in the multivariable analysis based on their established significance in the literature, despite not being significant in the bivariate analysis.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eRespondents\u0026rsquo; socio-demographic characteristics\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the socio-demographic characteristics of adult carers. A total of 320 carers of children under five years were interviewed. The majority were female (86%, n\u0026thinsp;=\u0026thinsp;275), with only 45 (14%) male carers. The mean age of respondents was 32 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5), ranging from 15 to 73 years. Most carers were aged 25\u0026ndash;34 years (38.4%), followed by those aged 15\u0026ndash;24 years (31.6%) and those aged 35 years and older (30%). Bumbobi sub-county had the highest proportion of participants (48.9%, n\u0026thinsp;=\u0026thinsp;154), followed by Bufumbo (34.7%, n\u0026thinsp;=\u0026thinsp;123). Regarding religious affiliation, most participants identified as Protestant (38.4%, n\u0026thinsp;=\u0026thinsp;123) or Catholic (34.7%, n\u0026thinsp;=\u0026thinsp;111). In terms of education, the majority had completed primary education (55%, n\u0026thinsp;=\u0026thinsp;176), while 31.2% (n\u0026thinsp;=\u0026thinsp;100) had attained post-primary education. Notably, 13.1% (n\u0026thinsp;=\u0026thinsp;42) had no formal education. The predominant occupation was peasant farming (70%, n\u0026thinsp;=\u0026thinsp;223), followed by housewives (16.3%, n\u0026thinsp;=\u0026thinsp;52). More than eighty percent of the respondents (82.5%, n\u0026thinsp;=\u0026thinsp;264) were in a marital union at the time of the study. \u003cb\u003eSee\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of Socio-demographic characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency n\u0026thinsp;=\u0026thinsp;320\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSub-County\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBubyangu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBufumbo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBumbobi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild\u0026rsquo;s age category (Months)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild attending school (Yes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRelationship with the child\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFather\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCarer\u0026rsquo;s sex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge of the carer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion of carer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatholic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnglican/protestant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoslem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePentecostal /born again / evangelical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest level of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-primary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMain occupation of the carer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeasant farmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBusiness/commercial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCasual worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHouse wife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCarer\u0026rsquo;s marital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle /separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried/cohabiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of poor hand hygiene among adult carers in Mbale District\u003c/h2\u003e \u003cp\u003eThe prevalence of poor hygiene practices was 28% (88/320) while that of good hand hygiene practices was 72% (232/320), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eDistribution of hand hygiene practices across socio-demographic characteristics\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the prevalence of hand hygiene practices among adult carers across different socio-demographic characteristics. Though good hand hygiene practices were common among carers with children aged 12\u0026ndash;33 months (32.3%, n\u0026thinsp;=\u0026thinsp;75), and carers aged 25\u0026ndash;34 (38.8%, n\u0026thinsp;=\u0026thinsp;90), poor hand hygiene was common among carers whose children were aged 36\u0026thinsp;+\u0026thinsp;months (39.8%, n\u0026thinsp;=\u0026thinsp;35) and or with the child not attending school (21.6%, n\u0026thinsp;=\u0026thinsp;19), carers who had attended primary education (65%, n\u0026thinsp;=\u0026thinsp;57) and those whose main occupation was peasant farmer (75%, n\u0026thinsp;=\u0026thinsp;66). In addition, poor hand hygiene was also common among carers who were mothers of the child (79.6%, n\u0026thinsp;=\u0026thinsp;70), Anglican (43.2%, n\u0026thinsp;=\u0026thinsp;38), and living in a marital relationship (81.8%, n\u0026thinsp;=\u0026thinsp;72). \u003cb\u003eSee\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of hand hygiene practices across the different socio-demographic characteristics of the adult carers of children under five years in Mbale District\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHand hygiene practices\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood n\u0026thinsp;=\u0026thinsp;232(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePoor n\u0026thinsp;=\u0026thinsp;88(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild\u0026rsquo;s age category (Months)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50(21.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(23.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75(32.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38(16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69(29.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35(39.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild attending school (Yes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30(12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRelationship with the child\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.268\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e183(78.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70(79.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFather\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19(8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30(12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge of the carer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.829\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71(30.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(34.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90(38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71(30.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(28.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion of carer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.459\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatholic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28(12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnglican/protestant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85(36.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(43.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoslem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80(34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31(35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePentecostal /born again / evangelical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39(16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest level of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30(12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e121(52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57(65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-primary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e81(35.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMain occupation of the carer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.404\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeasant farmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e157(67.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66(75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBusiness/commercial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17(7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCasual worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39(16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther (students, hairdresser)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCarer\u0026rsquo;s marital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle/separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32(13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried/cohabiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e192(82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72(81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8(3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of diarrhea among children under five against the adult carers\u0026rsquo; hand hygiene practices\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the number of children who experienced a diarrheal episode two weeks prior to the study as reported by their adult carers, which was slightly higher in households with poor hand hygiene practices as compared to those with good hand hygiene (29.5% vs. 25.9%) however, this difference was not statistically significant (P\u0026thinsp;=\u0026thinsp;0.51). \u003cb\u003eSee\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFactors associated with poor hand hygiene practices among adult carers of children under five years in Mbale district\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e presents the results from the multivariable analyses. In the multivariable analysis, education level was significantly associated with poor hand hygiene. Carers with post-primary education had 50% lower odds (Adjusted Odds Ratio [AOR] 0.5; 95% CI 0.2, 0.9; P\u0026thinsp;=\u0026thinsp;0.034) of practising poor hand hygiene compared to those without formal education. Receiving information from VHTs was positively correlated with poor hand hygiene practices (AOR 3.0; 95% CI 1.6\u0026ndash;9.8; P\u0026thinsp;=\u0026thinsp;0.003). Knowledge of hand hygiene's protective role against COVID-19 was associated with 80% lower odds of poor hand hygiene. A lack of soap, detergent, or sanitiser at the handwashing location was strongly associated with poor hand hygiene (AOR 8.8; 95% CI 1.7\u0026ndash;45.5; P\u0026thinsp;=\u0026thinsp;0.009). The analysis also considered variables like the child\u0026rsquo;s age, diarrheal episodes, and handwashing facility availability. Carers of children aged 24\u0026ndash;35 months had 1.2 times higher odds of poor hand hygiene (AOR 1.2; 95% CI 0.5\u0026ndash;2.6; P\u0026thinsp;=\u0026thinsp;0.720), and carers with children experiencing diarrhea in the past two weeks had 1.3 times higher odds (AOR 1.3; 95% CI 0.6, 2.8; P\u0026thinsp;=\u0026thinsp;0.551) of poor hand hygiene. Carers without access to a handwashing facility had 1.2 times higher odds of poor hand hygiene compared to those with a facility (AOR 1.2; 95% CI 0.4, 4.1; P\u0026thinsp;=\u0026thinsp;0.759). \u003cb\u003eSee\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable analysis shows factors associated with poor hand hygiene practices among adult carers of children under five years\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor hand hygiene N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCOR\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild\u0026rsquo;s Age (Months)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(23.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5(0.2, 1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7(0.3, 1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0(0.4, 2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1(0.5, 2.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35(39.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2(0.6, 2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2(0.5, 2.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest level of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57(64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2(0.6, 2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6(0.2, 1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-primary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6(0.3, 1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5(0.2, 0.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation of the water source\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElsewhere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28(32.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn own yard/plot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59(67.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.1(0.01, 0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1(0.01, 1.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow often one engaged in hand hygiene to reduce the risk of contracting COVID-19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore often\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148(63.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3(0.5, 3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6(0.5, 13.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.7(0.6, 5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.6(0.6, 23.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot often\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.6(2.3, 40.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.3(0.8, 13.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeard information on hand hygiene from;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTelevision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5(0.2, 1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4(0.3, 5.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70(84.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1(0.6, 2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.7(0.6, 4.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily member\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27(32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.7(0.9, 3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3(0.6, 2.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVHTs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69(83.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.1(1.6, 5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.0(1.6, 9.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation heard about hand hygiene\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtects one from getting COVID-19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77(92.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.3(0.1, 1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2(0.04, 0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtects one\u0026rsquo;s child from getting diarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42(50.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2(0.7, 1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8(0.3, 1.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild had diarrhoea within the last two weeks\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62(70.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26(29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2(0.7, 2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3(0.6, 2.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHave a hand washing facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31(35.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57(64.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7(0.4, 1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2(0.4, 4.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhere the household often wash hands from\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFixed place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMobile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57(64.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.6(0.6, 4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4(0.1, 1.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot observed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25(28.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.8(1.03, 7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2(0.2, 6.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat one uses for hand washing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSoap and water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54(61.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWater alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1(1.3, 3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.7(0.6, 4.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.7(0.1, 18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.4(0.1, 45.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThere are times household lacks soap (Yes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83(94.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3(1.2, 8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1(0.2, 5.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlways have soap or detergent or sanitizer at the place for hand washing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85(96.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.9(3.0, 32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.8(1.7, 45.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study of the prevalence and factors associated with engaging in poor hand hygiene in eastern Uganda revealed that 28% of the adult caregivers were engaging in poor hand hygiene practices. Engagement in poor hand hygiene practices among adult caregivers of children under five years of age was associated with the receipt of hand hygiene information from VHT, Television, Radio and family members. Before the COVID-19 pandemic, engagement in poor hand hygiene practices in Mbale district stood at 57% according to the DHIS 2 report of 2020, but our study found a lower prevalence of 28% post-COVID-19. The lower engagement in poor hand hygiene practices observed in this study could have been due to the timing of the study \u0026ndash; which was conducted after the COVID-19 pandemic. It is likely that interventions aimed at controlling the spread of COVID-19, which included a focus on hand-hygiene practices, could have resulted in improved hand-hygiene practices, thereby reducing the proportion of adults engaging in poor hand-hygiene practices.\u003c/p\u003e \u003cp\u003eOur findings also revealed that receiving health information from VHT was associated with an increased likelihood of engaging in poor hand hygiene practices. The suboptimal hand hygiene practices among the adult caregivers who receive information from VHT may be due to their inadequate knowledge of what constitutes good or poor hand hygiene practices. Despite being a cost-effective strategy for preventing hygiene-related diseases, a VHT may not be technical enough to convey the message regarding the effectiveness of hand hygiene practices. Effective hand hygiene goes beyond awareness to include the proper timing and technique for washing hands [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This finding agrees with other studies that have found VHT to possess a knowledge gap due to a lack of adequate training and supervision [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. We also found adult caregivers with inadequate hand-washing materials were likely to engage in poor hand hygiene practices. This may not be surprising given that the majority of households in less developed countries lack access to handwashing facilities. The lack of access to hand washing facilities, such as water and soap, is a common hindrance reported by the majority of adult caregivers for maintaining hand hygiene. In line with our study findings, Engdaw and colleagues found that inadequate handwashing facilities was a common barrier in rural communities in Ethiopia and as well as lack of time[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur findings show that caregivers who attain a post-primary level of education were less likely to engage in poor hand hygiene. We think that this could be because people who are educated about the consequences of poor hand hygiene are more likely to understand the critical role it plays in maintaining children's health and may be more proficient at managing resources effectively, including ensuring access to soap, water, and hand sanitisers for proper hand hygiene. This finding is in line with other studies by Bouzi and Ross et al who found that education raises awareness about the importance of handwashing in preventing the transmission of diseases, including common childhood illnesses [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In addition, our study also found that caregivers who heard that hand hygiene protects one from getting COVID-19 were less likely to engage in poor hand hygiene. This finding we attributable to the widespread emphasis on hand hygiene as a key non-pharmaceutical measure for the prevention of COVID-19 by the public health authorities across the globe in 2020. This finding agrees with what others found in Bangladesh where knowledge of hand washing was linked to knowing when to wash hands [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. It also agrees with what Seimetz and colleagues found in Burundi, where the benefits of hand hygiene such as the prevention of a life-threatening illness in rural Burundi and urban Zimbabwe contributed to good hand hygiene [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eStudy limitations and strengths\u003c/h2\u003e \u003cp\u003eOur study limitations included the potential for recall bias due to the lengthy recall period, which may have hindered caregivers' ability to accurately remember their hand hygiene practices during the COVID-19 pandemic. Nevertheless, we believe that the ongoing nature of the pandemic kept these experiences fresh in participants' minds, as the associated risks of contracting the virus and potential mortality were significant concerns. Additionally, while we utilized unvalidated questionnaires and interview guides, we conducted pretesting to ensure alignment with the study objectives. The study was further impacted by interviewer bias resulting from the unexpected replacement of trained research assistants with untrained individuals. To mitigate this, we implemented on-the-spot training sessions and daily team meetings to familiarize replacements with the study protocol and tools, aiming to minimize inconsistencies in data collection and uphold the study's integrity. Lastly, we did not adjust the sample size calculation for a design effect, which may have implications for the precision of our estimates. However, our study recruited 320 eligible participants who met the inclusion criteria, resulting in a robust sample size that improved the statistical power of the findings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study highlighted that nearly three in ten adult carers of children under five exhibited poor hand hygiene. Inadequate soap or detergent and receiving information from VHT were positively associated with poor hygiene, while education beyond the primary level and awareness of hand hygiene\u0026rsquo;s protective role against COVID-19 were protective. Strengthening primary education, improving VHT messaging, and sustaining COVID-19-era hygiene interventions are critical. Mass media campaigns and reminder-based interventions could reinforce handwashing behaviours and mitigate hygiene-related diseases in Mbale District.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCOVID-19 \u0026nbsp;Coronavirus Disease 2019\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDHIS2 \u0026nbsp; District Health Information System Version 2\u003c/p\u003e\n\u003cp\u003eHMIS \u0026nbsp;Health Management Information System\u003c/p\u003e\n\u003cp\u003eWSP \u0026nbsp;Water Safety Plans\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the Busitema University Faculty of Health Sciences Research and Ethics Committee (BUFHS-REC) under reference number BUFHS-2023-53. Permission was secured from the relevant community leaders and the District Health Office. Informed consent was obtained from all study participants. All study procedures were done in accordance with the ethical guidelines of the 1975 Declaration of Helsinki. Confidentiality and anonymity of the participants\u0026apos; information were strictly maintained throughout the study. Data were de-identified to protect personal information, and access to the data was restricted to the\u0026nbsp;research\u0026nbsp;team.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no funding for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJN was responsible for conceptualization, proposal development, methodology, data collection, data analysis, report writing, and manuscript writing. POO, RN, OC and DM contributed to the conceptualization, methodology, and manuscript writing. DW, AO, and JPA analyzed data, drafted, reviewed, and revised the manuscript for clarity and accuracy. JKBM supervised the authors and was involved in conceptualization, proposal development, methodology, data collection, data analysis, report writing, and manuscript writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI extend my sincere gratitude to my research supervisors for their invaluable support and guidance throughout this study. I also acknowledge the academic staff of the Department of Community and Public Health at Busitema University for their contributions. Special thanks go to Nick and Ruth Davis who provided financial support for the research project and to JENGA Community Development Outreach for their assistance. Finally, I appreciate my classmates from the Master of Public Health Cohort 2019/2020 (Abeso Angella, Medi Misanga, Ali Tuwa Hassan, Ouni Patrick Diox and Edgar Mugasha among others), for their social, moral, and academic support during our studies. Your contributions have been deeply valued.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO. Children: improving survival and well-being. \u003cem\u003eWorld Heal Organ.\u003c/em\u003e, pp. 1\u0026ndash;4, (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlack, R. et al. Drivers of the reduction in childhood diarrhea mortality 1980\u0026ndash;2015 and interventions to eliminate preventable diarrhea deaths by 2030. \u003cem\u003eJ. 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Analg\u003c/em\u003e. \u003cb\u003e126\u003c/b\u003e (2), 691\u0026ndash;698. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1213/ANE.0000000000002741\u003c/span\u003e\u003cspan address=\"10.1213/ANE.0000000000002741\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2018).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"hand hygiene practices, children under five years, adult carers, Mbale","lastPublishedDoi":"10.21203/rs.3.rs-6222173/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6222173/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWhile proper hand hygiene practices can reduce the risk of contracting hygiene-related diseases among children under five years of age (\u0026lt;\u0026thinsp;5 years old), poor hand hygiene practices continue to exist in the community. We determined the prevalence and factors associated with engaging in poor hand hygiene practices among adult carers of \u0026lt;\u0026thinsp;5-year-old children to inform the design of tailor-made interventions to improve hand hygiene practices in this population.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was a cross-sectional study. Quantitative data were collected in March 2023 from 320 adult carers of under-five year-old children. Structured questionnaires were utilized to capture data on socio-demographic characteristics, household characteristics, knowledge of hand hygiene, and COVID-19 prevention practices. A carer was considered to have engaged in poor hand hygiene practice if he/she washed hands at five or less out of ten listed critical junctures. We conducted multivariable logistic regression to identify independent factors associated with poor hand hygiene practices. Factors with a p-value less than 0.05 were statistically significant to the primary outcome.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf the 320 carers, 275 (85%) were females. Slightly more than one-third (38.4%, n\u0026thinsp;=\u0026thinsp;123) of the carers were aged 25\u0026ndash;34 years while 55.6% (n\u0026thinsp;=\u0026thinsp;178) had primary education. Twenty-eight percent (n\u0026thinsp;=\u0026thinsp;88) of the carers engaged in poor hand hygiene practices. Having post-primary education (adjusted odds ratio [AOR]\u0026thinsp;=\u0026thinsp;0.5; 95% Confidence Interval [95%CI]: 0.2, 0.9) and receiving information that hand hygiene protects against COVID-19 (AOR\u0026thinsp;=\u0026thinsp;0.2; 95% CI: 0.04,0.8) were inversely associated with engaging in poor hand hygiene practices while receiving hand hygiene information from village health teams [VHT] (AOR\u0026thinsp;=\u0026thinsp;3.0; 95% CI: 1.6, 9.8), and having inadequate soap or sanitiser at the place reserved for hand washing (AOR\u0026thinsp;=\u0026thinsp;8.8; 95% CI: 1.7, 45.5) were positively associated with engaging in poor hand hygiene practices.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eNearly three out of ten adult carers of under-five year-old children engaged in poor hand hygiene practices largely driven by receipt of hand hygiene information from VHT coupled with inadequate hand-washing materials. These findings suggest a need for target-specific hygiene-related interventions to increase the proportion of carers who engage in proper hand hygiene practices in Mbale district.\u003c/p\u003e","manuscriptTitle":"Prevalence and factors associated with engaging in poor hand hygiene practices among adult carers of children under five years in Mbale district: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 05:33:50","doi":"10.21203/rs.3.rs-6222173/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-02T01:59:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-17T15:19:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155690082778494887143879379796795422686","date":"2025-05-28T08:15:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"66181437317824541290673060748869202989","date":"2025-04-07T09:45:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-06T10:42:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"245767282515984988174196992059543773262","date":"2025-04-03T18:00:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-02T22:34:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-02T22:29:32+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-17T14:47:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-17T05:06:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-03-13T17:53:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"77258077-b89a-4344-98d4-4442c868eb52","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":46863496,"name":"Health sciences/Health care/Health services"},{"id":46863497,"name":"Earth and environmental sciences/Environmental social sciences/Psychology and behaviour"}],"tags":[],"updatedAt":"2025-12-15T16:04:49+00:00","versionOfRecord":{"articleIdentity":"rs-6222173","link":"https://doi.org/10.1038/s41598-025-30974-7","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-12-12 15:59:03","publishedOnDateReadable":"December 12th, 2025"},"versionCreatedAt":"2025-05-05 05:33:50","video":"","vorDoi":"10.1038/s41598-025-30974-7","vorDoiUrl":"https://doi.org/10.1038/s41598-025-30974-7","workflowStages":[]},"version":"v1","identity":"rs-6222173","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6222173","identity":"rs-6222173","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}