Hand washing is defined as the vigorous, brief rubbing together of all surfaces of lathered hands, followed by rinsing under a stream of water, with a fundamental principle of removal, not killing of microorganisms. It has been globally acknowledged and accepted as a low cost and effective technique in preventing communicable diseases. It has been recognized as an important public health measure in preventing and controlling most infectious diseases(1). Hand washing is a basic, everyday process, and it is a skill and behavior that must be learned as a child and should become a lifelong habit in order to enjoy a better quality of life (2, 3).
School-aged children in developing countries do not usually engage in hand washing practice at critical time, such as after using the toilet, before eating and before cooking the food (4, 5). Proper hand washing practice is a prerequisite to a child’s survival and responsible for the majority of child deaths globally each year (3, 6). Hand washing with soap could substantially reduce diarrhea and respiratory infections; never the less, in developing countries hand washing is still being practiced in less than five percent of the population especially at those critical moments (7).
In developing country, only 59% urban and 22% rural people have access to improved water and sanitation facilities (2, 8). Inadequate sanitary conditions and poor hygiene practices play major roles in the increased burden of communicable disease within these developing countries (9). Global burden of disease can be reduced by 9.1 percent and 6.3% of all global deaths can be halted through improving access to water, sanitation, and hygiene (WASH) (10, 11). WASH interventions have shown significant reductions in school absenteeism, and may have a positive influence on educational outcomes (10, 12). The use of sanitary facilities and hand washing practices as an important life skill for school children (13). In Colombia, 36.6% of school children reported to wash hands always with soap and very often after using the toilet, however, only 3% always washing hands for at least 20 seconds (14); in Bogota, only 33.6% always or very often washing hands with soap and clean water before eating and after using the toilet, while about 7% of students reported regular access to soap and clean water at school (15); in Bangladesh, washing hands specifically using soap after defecation was found to be a common practice(16); in Vietnam, the common time for hand washing was before eating (60%), but only 23% after defecation and very few did before cooking (only7%), washed their hands at recommended duration (30-60sec) was 58%, the proportion of hand washing practice was increased by grade levels (34% among grade 1 to 67% among grade 7 students(17); in South Africa, washing of hands in schools was above 65% (70.3% in urban and 29.7% in rural schools, they did mostly before eating and after visiting the toilet (18).
According to a Knowledge, Attitude and Practices (KAP) study in Angolela woreda, northern Ethiopia hand washing practice on the day before the interview was 99.7% (99% before meals, 46% after meals, and only 15% after defecation), majority of them practiced using plain water with only 36.2% of them used soap (19); in Babile town Eastern Ethiopia, 98.3% of children regularly practiced hand washing before meals (20); in Arba Minch Town Southern Ethiopia, 79.1% washed their hands with soap after visiting toilet and before meal, 22.3% of them properly applied hand washing practice (21).
Practice of hand washing in primary school children’s interventions with soap have proven to be effective in reducing infectious diseases in school community. It is linked with the availability and accessibility of hand washing facilities (21–23). A school based study in Bogota, Colombia showed that being urban schools, availability of water and soap were three times more likely to wash their hands before eating and after visiting the toilet (24); another study in Vietnam and Peru reviled that being urban primary schools, far distance of hand washing facilities in schools, lack of water, lack of soap, and learning in a very crowded situation were the main reason for not washing their hands at school (25).
In Sierra Leon, primary school students had learned about hand washing from home (75%), schools (56%), radio or television (36%), health facilities (8%) and friends (5%), students residing in urban areas are more likely to report home as a source of knowledge than those in rural areas; and students in rural areas are more likely to report school as a source of knowledge than those in urban areas (22, 26); in Indonesia the parents were the most frequent human source of information about hand washing (91.86%), followed by health workers (50.0%), teachers (34.9%) and friends (2.3%), the reasons for not washing hands were forgetfulness (81.8%), laziness (13.2%), lack of time (4.3%), lack of interest (0.8%), lack of clean water 7.8%, and lack of soap 8.9% (27).
Education of household head and respondent, water availability and access to media have strong positive association with hand washing with soap (28), availability of water in some rural schools (18), availability of hand washing facilities in most schools, high pupil-to-hand washing facilities ratio, availability of soap, extensive use of shared containers, delays in acquisition of hand washing facilities, fragmented private sector efforts in hand hygiene promotion and non-compliance with conventional hand washing practices are factors affecting hand washing (28).
Despite substantial evidence about the effectiveness of hand washing, especially using soap at all critical time is proven globally and continentally, the level of practice of hand washing in Ethiopian schools is not well known. Therefore, the main aim of this study was to determine the level of hand washing practice and associated factors among primary school children in Damot Woide Woreda, Wolaita zone, South Ethiopia.