Journal of Health Literacy

Journal of Health Literacy

Maternal Health Literacy and Hand Hygiene Practices among Caregivers of Children Under Five: A Cross-Sectional Study in India

Document Type : Original Article

Authors
Ann Susan JV 1
Abhishek Chaturvedi 2
Usha Rani 3
1 Dept. of Social and Health Innovation, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India
2 Assistant Professor, Department of Basic Medical Sciences, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India
3 Associate Professor & Coordinator, Manipal Health Literacy Unit, Dept. of Social and Health Innovation, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India
10.22038/jhl.2024.81633.1612
Abstract
Background and Objectives: Children under five are dependent on caregiver's hand washing and their health literacy for their health and well-being attention to which was reinforced during COVID-19. A caregiver's hands can act as primordial prevention for children under five. The current study aimed to assess caregiver's health literacy and WHO-five moments of hand hygiene in a uni-center of a developing country.

Materials and Methods: To explore the practice and attitude of WHO-Five Moments of hand washing and caregiver's health literacy using the Maternal Health Literacy (MaHeLi) survey a cross-sectional study was conducted at a single centre at a developing country among 418 caregivers of children under five. The analysis and reporting of variables utilized descriptive, univariate, paired t-test, and multivariate analysis methods.

Results: Caregivers' handwashing practices were significantly associated with education level and socioeconomic status (P-value ≤ 0.001). A positive correlation (P-value = 0.003) was observed between health literacy and handwashing practices, with caregivers demonstrating better hygiene practices after caregiving activities than before (P-value ≤ 0.001). Although most participants reported moderate levels of handwashing, only a small percentage practices optimum handwashing before or after child care. Caregivers with lower health literacy were less likely to perform adequate hand hygiene.

Conclusions: Our study suggests that caregivers with higher health literacy demonstrated better hand hygiene practices. Enhancing health literacy and promoting handwashing education, especially in paediatric care settings and at community, could help improve hygiene practices among caregivers. These findings reflects the need for healthcare providers and policymakers to consider targeted interventions on developing health literacy and hand hygiene practices to reduce infections in children under five.
Keywords
Caregivers
Child
Hand washing
Health Literacy
Health Policy
Health Promotion

Acknowledgments: We acknowledge and thank Dr. Leslie E. Lewis, all the faculty, clinicians and nursing staff of paediatric department for rendering their support to carry out the study.  


Availability of data and materials: All data is reserved for researchers and accessible upon reasonable request.


Conflicts of interests: None to declare.


Consent for publication: Parents were provided with study related information and informed consent prior to their participation was obtained.


Ethics approval and consent to participate: The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the Institutional Ethics Committee of Kasturba Medical College, Manipal, and all necessary permissions were secured. 


Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


Author contributions: Ann Susan JV: Data curation, Formal analysis, Investigation, Methodology, Writing – original draft. Abhishek Chaturvedi: Validation, Visualization, Writing – review and editing. Usha Rani: Conceptualization, Formal analysis, Project administration, Resources, Supervision, Validation, Visualization, Writing – review and editing.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

  1. Chou DTS, Achan P, Ramachandran M. The World Health Organization "5 Moments of Hand Hygiene" The Scientific Foundation. J Bone Jt Surg Br. 2012;94(4):441-6. https://doi.org/10.1302/0301-620X.94B4.27772
  2. Health Organization W. Editorials. Bull World Health Organ. 2012;90.
  3. Luby SP, Agboatwalla M, Feikin DR, Painter J, Billhimer W, Altaf A, et al. Effect of handwashing on child health: A randomised controlled trial. Lancet. 2005 Jan;366(9481):225-33. https://doi.org/10.1016/S0140-6736(05)66912-7
  4. de Kraker MEA, Tartari E, Tomczyk S, Twyman A, Francioli LC, Cassini A, et al. Implementation of hand hygiene in health-care facilities: results from the WHO Hand Hygiene Self-Assessment Framework global survey 2019. Lancet Infect Dis. 2022;22(6). https://doi.org/10.1016/S1473-3099(21)00618-6
  5. Baca Hidalgo J, Pérez Dionisio M, Salguero Cano V, Díaz Campanón J, Gutiérrez Linares S, Padilla Matas R. Hand Hygiene: do we know the WHO 5 moments? Eur J Public Health. 2022;32(Supplement_3). https://doi.org/10.1093/eurpub/ckac131.335
  6. World Health Organization. Solutions Most Needed. Water Heal Tak Charg. 2001;
  7. Lotfinejad N, Peters A, Tartari E, Fankhauser-Rodriguez C, Pires D, Pittet D. Hand hygiene in health care: 20 years of ongoing advances and perspectives. Vol. 21, The Lancet Infectious Diseases. 2021. https://doi.org/10.1016/S1473-3099(21)00383-2
  8. World Health Organization. A Guide to the Implementation WHO Multimodal Hand Hygiene Improvement Strategy. In: WHO Publications. 2009. p. 1-47.
  9. Rani U, Chawla K, Lewis LE, Bairy I, Guddattu V, Purkayastha J, et al. Hand Hygiene Practices and Training Gap in a Neonatal Intensive Care Unit at Coastal Karnataka India. Indian J Public Heal Res Dev. 2020;11(2):59. https://doi.org/10.37506/v11/i2/2020/ijphrd/194753
  10. Freeman MC, Stocks ME, Cumming O, Jeandron A, Higgins JPT, Wolf J, et al. Systematic review: Hygiene and health: Systematic review of handwashing practices worldwide and update of health effects. Trop Med Int Heal. 2014;19(8):906 - 916.
  11. Smith L, Butler L, Tully MA, Jacob L, Barnett Y, López-Sánchez GF, et al. Hand-washing practices among adolescents aged 12-15 years from 80 countries. Int J Environ Res Public Health. 2021;18(1):1 - 15.
  12. Khan KM, Chakraborty R, Brown S, Sultana R, Colon A, Toor D, et al. Association between handwashing behavior and infectious diseases among low-income community children in urban new delhi, india: A cross-sectional study. Int J Environ Res Public Health. 2021;18(23). https://doi.org/10.3390/ijerph182312535
  13. Mekonen T, Admasie A, Leka YL, Darota D, Feleke FW. Handwashing Practice and Its Predictors Among Mothers of Children Aged 0 to 23 Months in South Ethiopia: Community Based Cross-Sectional Study. Environ Health Insights. 2021;15.
  14. Rambliere L, Kermorvant-Duchemin E, De Lauzanne A, Collard JM, Herindrainy P, Vray M, et al. Excess risk of subsequent infection in hospitalized children from a community cohort study in Cambodia and Madagascar. Int J Epidemiol. 2022;51(5). https://doi.org/10.1093/ije/dyac048
  15. Garg S, Basu S, Rustagi R, Borle A. Primary health care facility preparedness for outpatient service provision during the COVID-19 Pandemic in India: Cross-sectional study. JMIR Public Heal Surveill. 2020;6(2). https://doi.org/10.2196/19927
  16. World Health Organisation. Hand Hygiene: Why, How and When? [Internet]. World Health Organisation. 2009 [cited 2017 Jun 19]. p. 1-7. Available from: http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf?ua=1
  17. DeKraker C, Taboun ZS. Hand Hygiene Compliance Among the Public and in Ontario Hospitals. Univ West Ont Med J. 2022;90(1). https://doi.org/10.5206/uwomj.v90i1.13514
  18. Jyoti Bala, Deepika Dewan, Rakesh Bahl, Sujata Gupta, Raj Kumar Bhagat. Assessment of Hand Hygiene Practices and Barriers to hand Hygiene among Healthcare workers of Government Medical College Hospital Jammu. Indian J Public Heal Res Dev. 2022;14(1). https://doi.org/10.37506/ijphrd.v14i1.18803
  19. Ricotta L, D'Amore C, Ravà L, Raponi M, Degli Atti MC. Hand Hygiene Compliance and Healthcare Associated Infections Trends in a Tertiary Care Children Hospital, in Years 2016-2022. Int J Pediatr Child Heal. 2023;11. https://doi.org/10.12974/2311-8687.2023.11.06
  20. Graves J, Finsness E, Quick R, Harris J, Daniell W. Teacher perspectives on implementing and sustaining a handwashing promotion intervention in western kenyan primary schools. Int Q Community Health Educ. 2013;34(2):159-70. https://doi.org/10.2190/IQ.34.2.d
  21. Steenkamp L, Williams M, Ronaasen J, Feeley A, Truter I, Melariri P. Handwashing knowledge and practices among caregivers of pre-school children in underprivileged areas of Nelson Mandela Bay. South African J Clin Nutr. 2022 Apr 8;35(1):8-12. https://doi.org/10.1080/16070658.2020.1769336
  22. Witt SD, Spencer HA. Using educational interventions to improve the handwashing habits of preschool children. Early Child Dev Care. 2004;174(5):461 - 471.
  23. Lewis HE, Greenland K, Curtis V, Schmidt WP. Effect of a school-based hygiene behavior change campaign on handwashing with soap in Bihar, India: Cluster-randomized trial. Am J Trop Med Hyg. 2018;99(4):924 - 933.
  24. Sørensen K, Van Den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health. 2012;12(1). https://doi.org/10.1186/1471-2458-12-80
  25. CDC. Health Literacy Basics [Internet]. Centers for Disease Control and Prevention. 2022. p. CDC, Health Literacy, Health Literacy Basics. Available from: https://www.cdc.gov/healthliteracy/learn/index.html
  26. Chang LC. Health literacy, self-reported status and health promoting behaviours for adolescents in Taiwan. J Clin Nurs. 2011 Jan;20(1-2):190-6. https://doi.org/10.1111/j.1365-2702.2009.03181.x
  27. Jahan RA. Promoting health literacy: A case study in the prevention of diarrhoeal disease from Bangladesh. Vol. 15, Health Promotion International. 2000. https://doi.org/10.1093/heapro/15.4.285
  28. Castro-Sánchez E, Chang PWS, Vila-Candel R, Escobedo AA, Holmes AH. Health literacy and infectious diseases: Why does it matter? Vol. 43, International Journal of Infectious Diseases. 2016. https://doi.org/10.1016/j.ijid.2015.12.019
  29. Manandhar M, Hawkes S, Buse K, Nosrati E, Magar V. Gender, health and the 2030 Agenda for sustainable development. Bull World Health Organ. 2018;96(9). https://doi.org/10.2471/BLT.18.211607
  30. Ezezika O, Heng J, Fatima K, Mohamed A, Barrett K. What are the barriers and facilitators to community handwashing with water and soap? A systematic review. PLOS Glob Public Heal. 2023;3(4 April).
  31. Opara P, Alex-Hart B, Okari T. Hand-washing practices amongst mothers of under-5 children in Port Harcourt, Nigeria. Paediatr Int Child Health. 2015 Sep 24;2046905515Y0000000061. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26400652 https://doi.org/10.1080/20469047.2015.1122380
  32. SS D. Knowledge and practice of handwashing among mothers of under five children in rural coastal South India. Int J Med Public Heal. 2011;1(1). https://doi.org/10.5530/ijmedph.1.2011.6
  33. Taddese AA, Dagnew B, Dagne H, Andualem Z. Mother's Handwashing Practices and Health Outcomes of Under-Five Children in Northwest Ethiopia. Pediatr Heal Med Ther. 2020;Volume 11:101-8. https://doi.org/10.2147/PHMT.S238392
  34. Guttersrud Ø, Naigaga MDAS, Pettersen KS. Measuring Maternal Health Literacy in Adolescents Attending Antenatal Care in Uganda: Exploring the Dimensionality of the Health Literacy Concept Studying a Composite Scale. J Nurs Meas. 2015;23(2):50E - 66. https://doi.org/10.1891/1061-3749.23.2.50
  35. Setia MS. Methodology series module 3: Cross-sectional studies. Indian J Dermatol. 2016;61(3):261-4. https://doi.org/10.4103/0019-5154.182410
  36. Althubaiti A. Sample size determination: A practical guide for health researchers. J Gen Fam Med. 2023 Mar;24(2):72-8. https://doi.org/10.1002/jgf2.600
  37. Berendes D, Martinsen A, Lozier M, Rajasingham A, Medley A, Osborne T, et al. Improving water, sanitation, and hygiene (WASH), with a focus on hand hygiene, globally for community mitigation of COVID-19. PLOS Water. 2022;1(6). https://doi.org/10.1371/journal.pwat.0000027
  38. Song IH, Kim SA, Park WS. Family factors associated with children's handwashing hygiene behavior. J Child Heal Care. 2013;17(2). https://doi.org/10.1177/1367493512456106
  39. Luby SP, Agboatwalla M, Painter J, Altaf A, Billhimer WL, Hoekstra RM. Effect of Intensive Handwashing Promotion on Childhood Diarrhea in High-Risk Communities in Pakistan. Jama. 2004;291(21):2547. https://doi.org/10.1001/jama.291.21.2547
  40. Sandora TJ, Taveras EM, Shih MC, Resnick EA, Lee GM, Ross-Degnan D, et al. A randomized, controlled trial of a multifaceted intervention including alcohol-based hand sanitizer and hand-hygiene education to reduce illness transmission in the home. Pediatrics. 2005;116(3). https://doi.org/10.1542/peds.2005-0199
  41. Gupta RK, Singh P, Rani R, Kumari R, Gupta C, Gupta R. Hand hygiene: knowledge, attitude and practices among mothers of under 5 children attending a tertiary care hospital in North India. Int J Community Med Public Heal. 2018;5(3). https://doi.org/10.18203/2394-6040.ijcmph20180770
  42. Lam BCC, Lee J, Lau YL. Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection. Pediatrics. 2004 Nov;114(5):e565-71. https://doi.org/10.1542/peds.2004-1107
  43. Novák M, Breznický J, Kompaníková J, Malinovská N, Hudečková H. Impact of hand hygiene knowledge on the hand hygiene compliance. Med Glas. 2020;17(1). https://doi.org/10.17392/1051-20
  44. Prasad A, Ng Chok H, Wilkes L. Hand hygiene practices amongst patients. Int J Infect Control. 2017;13(2):2. https://doi.org/10.3396/IJIC.v13i2.009.17
  45. Suen LKP, So ZYY, Yeung SKW, Lo KYK, Lam SC. Epidemiological investigation on hand hygiene knowledge and behaviour: A cross-sectional study on gender disparity. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-019-6705-5
  46. Chatterjee S, Roy MN, Banerjee K, Mojumdar S, Osbert N. Understanding the gap between knowledge and practice of handwashing in rural India: evidence from a cross-sectional study. J Water Health. 2022;20(12). https://doi.org/10.2166/wh.2022.129
  47. Silago V, Manzi MJ, Mtemisika CI, Damiano P, Mirambo MM, Mushi MF. Knowledge, Attitude and Practices of Hand Hygiene among Students and Nurses Staff in Mwanza Tanzania: A Cross-Sectional Hospital-Based Study during Global COVID-19 Pandemic. East Africa Sci. 2022;4(1). https://doi.org/10.24248/easci.v4i1.55
  48. Rameswarapu R, K SS, Valsangkar S. Assessment of hand hygiene levels among healthcare professionals in India. Int J Biomed Adv Res. 2015;6(2). https://doi.org/10.7439/ijbar.v6i2.1586
  49. Jo E, Jung M. Effects of media used and e-health literacy on hand-washing of married women in East Asia. Korean J Heal Educ Promot. 2020;37(1). https://doi.org/10.14367/kjhep.2020.37.1.15
  50. Allegranzi B, Kilpatrick C, Sax H, Pittet D. "My Five Moments": Understanding a user-centred approach to hand hygiene improvement within a broader implementation strategy. BMJ Quality and Safety. 2022. https://doi.org/10.1136/bmjqs-2021-013680
  51. Harrison BL, Ogara C, Gladstone M, Carrol ED, Dusabe-Richards J, Medina-Lara A, et al. "we have to clean ourselves to ensure that our children are healthy and beautiful": Findings from a qualitative assessment of a hand hygiene poster in rural Uganda. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-018-6343-3
  52. Wolde M, Abate M, Mandefro G, Beru E, Kassahun A, Tesema GA. Determinants of handwashing practice and its associated factors among mothers of under-5 children in Kolladiba town, Northwest Ethiopia: Cross-sectional study. BMJ Open. 2022;12(6). https://doi.org/10.1136/bmjopen-2021-058960
  53. Bale TLA, Ramukumba TS, Mudau LS. Evaluation of compliance to the World Health Organization's five moments of hand hygiene: Cross-sectional observation of healthcare professionals. South African J Infect Dis. 2021;36(1). https://doi.org/10.4102/sajid.v36i1.255
  54. Stewardson AJ, Russo P, Grayson ML. Doctor, do you have a moment? National Hand Hygiene Initiative compliance in Australian hospitals. Vol. 201, Medical Journal of Australia. 2014. https://doi.org/10.5694/mja14.00718
  55. Rajalakshmi M, Santhiya J, Bhuvaneswari R, Kalaivani R, Joseph VM. A community based cross sectional study on knowledge, attitude and hand hygiene practices among mothers of under fives. Medico-Legal Updat. 2020;20(2).
  56. Edward A, Jung Y, Chhorvann C, Ghee AE, Chege J. Association of mother's handwashing practices and pediatric diarrhea: Evidence from a multi-country study on community oriented interventions. J Prev Med Hyg. 2019;60(2).
  57. Or PPL, Wong BYM, Chung JWY. To investigate the association between the health literacy and hand hygiene practices of the older adults to help them fight against infectious diseases in Hong Kong. Am J Infect Control. 2020;48(5). https://doi.org/10.1016/j.ajic.2019.12.021
  58. Türkoğlu N, Kavuran E, Ay E. The relationship between health literacy and Covid 19 fear: a cross sectional study from Turkey. J Heal Lit. 2022;7(2):86-94.
  59. Basargekar P, Singhavi C, Sinkar T, Goel M. How socio-economic and demographic factors affect health literacy? Assessment of health literacy level in different socioeconomic classes in India. In: Asia Pacific Journal of Health Management. Australasian College of Health Service Management; 2023. https://doi.org/10.24083/apjhm.v18i1.1681
  60. Li C, Guo Y. The effect of socio-economic status on health information literacy among urban older adults: Evidence from western China. Int J Environ Res Public Health. 2021;18(7). https://doi.org/10.3390/ijerph18073501
  61. Lastrucci V, Lorini C, Caini S, Bonaccorsi G, Alti E, Baglioni S, et al. Health literacy as a mediator of the relationship between socioeconomic status and health: A cross-sectional study in a population-based sample in Florence. PLoS One. 2019;14(12). https://doi.org/10.1371/journal.pone.0227007
  62. Stormacq C, Van Den Broucke S, Wosinski J. Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review. Health Promot Int. 2019;34(5). https://doi.org/10.1093/heapro/day062
  63. Berete F, Demarest S, Charafeddine R, Meeus P, Bruyère O, Van der Heyden J. Does health literacy mediate the relationship between socioeconomic status and health outcomes? Eur J Public Health. 2023;33(Supplement_2). https://doi.org/10.1093/eurpub/ckad160.774
  64. Silva MJ, Santos P. The impact of health literacy on knowledge and attitudes towards preventive strategies against covid-19: A cross-sectional study. Int J Environ Res Public Health. 2021;18(10). https://doi.org/10.3390/ijerph18105421