Handwashing with soap after potential faecal contact: global, regional and country estimates
Open accessAbstract
BACKGROUND: Limited data have been available on the global practice of handwashing with soap (HWWS). To better appreciate global HWWS frequency, which plays a role in disease transmission, our objectives were to: (i) quantify the presence of designated handwashing facilities; (ii) assess the association between handwashing facility presence and observed HWWS; and (iii) derive country, regional and global HWWS estimates after potential faecal contact. METHODS: First, using data from national surveys, we applied multilevel linear modelling to estimate national handwashing facility presence. Second, using multilevel Poisson modelling on datasets including both handwashing facility presence and observed HWWS after potential faecal contact, we estimated HWWS prevalence conditional on handwashing facility presence by region. For high-income countries, we used meta-analysis to pool handwashing prevalence of studies identified through a systematic review. Third, from the modelled handwashing facility presence and estimated HWWS prevalence conditional on the presence of a handwashing facility, we estimated handwashing practice at country, regional and global levels. RESULTS: First, approximately one in four persons did not have a designated handwashing facility in 2015, based on 115 data points for 77 countries. Second the prevalence ratio between HWWS when a designated facility was present compared with when it was absent was 1.99 (1.66, 2.39) P <0.001 for low- and middle-income countries, based on nine datasets. Third, we estimate that in 2015, 26.2% (23.1%, 29.6%) of potential faecal contacts were followed by HWWS. CONCLUSIONS: Many people lack a designated handwashing facility, but even among those with access, HWWS is poorly practised. People with access to designated handwashing facilities are about twice as likely to wash their hands with soap after potential faecal contact as people who lack a facility. Estimates are based on limited data.
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For hygiene, the probability of handwashing with soap occurring after faecal contact conditional on presence of handwashing facilities was accounted for.
“For hygiene, we account for the probability of handwashing with soap occurring after faecal contact conditional on presence of handwashing facilities.33”
Handwashing practices at key moments are less prevalent in LMICs compared with high-income countries.
“Handwashing practices at key moments are less prevalent in LMICs compared with high-income countries (HICs)”
Our estimate for interventions in LMICs is similar in magnitude to the global estimate of Aiello and colleagues (21%) but has greater precision, and is similar to a recent estimate for viral ARI globally (16%).
“Since our estimate for interventions in LMICs is similar in magnitude to the global estimate of Aiello and colleagues (21%) but has greater precision, 10 and is similar to a recent estimate for viral ARI globally (16%), 12 our results are also applicable to HICs.”
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- Authors
- Wolf, J., Johnston, R., Freeman, M. C., Ram, P. K., Slaymaker, T., Laurenz, E., & Prüss-Ustün, A.
- Affiliations
- World Health Organization (CH)
- Emory University (US)
- University at Buffalo, State University of New York (US)
- United Nations Children's Fund (US)
- Fraunhofer Institute for Solar Energy Systems (DE)
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
- Corresponding author
- Wolf, Jennyfer
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-12-10
- Volume
- 48
- Issue
- 4
- Pages
- 1204-1218
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- PMC
- PMC6693803
- OpenAlex
- W2904514424
- Cited by
- 107
- References
- 45
- Citations by year
- 2026: 8 · 2025: 14 · 2024: 15 · 2023: 18 · 2022: 15 · 2021: 22 · 2020: 11 · 2019: 3 · 2018: 1
- FWCI
- 1.19
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- International Journal of Epidemiology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Publikationsdatenbank der Fraunhofer-Gesellschaft (Fraunhofer-Gesellschaft) (submittedVersion, other-oa)
- Fraunhofer-Publica (Fraunhofer-Gesellschaft) (submittedVersion)
- Funders
- United Kingdom Department for International Development (204700–101)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Life Sciences › Agricultural and Biological Sciences › Food Science › Food Safety and Hygiene
- Keywords
- handwashing with soap, handwashing facilities, hygiene practices, diarrhea prevention, disease transmission, low- and middle-income countries, global prevalence estimates
- MeSH terms
- Communicable Disease Control, Developing Countries, Feces, Hand Disinfection, Humans, Sanitation, Soaps, Global Health, Health Behavior
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