Association between Handwashing Behavior and Infectious Diseases among Low-Income Community Children in Urban New Delhi, India: A Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Sample Size and Participant Recruitment
2.3. Questionnaire Survey
2.4. Handwash Behaviors and Practices
2.5. Health Outcomes
2.6. Statistical Analysis
3. Results
3.1. Sociodemographic Characteristics
3.2. Handwashing Behaviors and Infectious Disease Outcomes
3.3. Timing of Handwash Activities and Infectious Disease Outcomes
3.4. Timing of Handwash Activities and Infectious Disease Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Child Participants |
---|---|
(N = 272) | |
(Mean ± S.D) | |
Child’s Age | 9.08 ± 1.17 |
Mother’s Age | 31.81 ± 4.45 |
Child’s BMI | 14.99 ± 2.99 |
n (%) | |
Sex | |
Female | 112 (41.2) |
Male | 160 (58.8) |
Educational status of mother | |
No school | 146 (53.7) |
Primary | 93 (34.2) |
Secondary and above | 33 (12.1) |
Educational status of father | |
No school | 81 (29.8) |
Primary | 94 (34.6) |
Secondary and above | 97 (35.6) |
Employment status of mother | |
Employed | 106 (39.0) |
Unemployed | 166 (61.0) |
Employment status of father | |
Employed | 264 (97.1) |
Unemployed | 8 (2.9) |
No. of people in a household | |
≤5 | 183 (67.3) |
>5 | 89 (32.7) |
Monthly household income | |
(INR) | |
<2000–6000 | 29 (10.7) |
6001–10,000 | 119 (43.7) |
>10,000 | 124 (45.6) |
Home ownership | |
Own home | 52 (19.1) |
Rental home | 220 (80.9) |
Diarrheal disease incidence | 64 (23.5) |
Respiratory illness incidence | 102 (37.5) |
Behaviors | Diarrhea IncidenceN = 64 | No Diarrhea Incidence N = 207 | p Value # | OR for Diarrheal Disease | 95% CI | p Value | OR a for Diarrheal Disease | 95% CI | p Value |
---|---|---|---|---|---|---|---|---|---|
Soap type | |||||||||
Liquid | 8 (12.5) | 46 (22.2) | 0.09 | 0.50 | 0.21, 1.07 | 0.09 | 0.44 | 0.17, 1.02 | 0.07 |
Bar | 55 (85.9) | 170 (82.1) | 0.48 | 1.33 | 0.63, 3.09 | 0.48 | 1.69 | 0.75, 4.20 | 0.22 |
Handwashing facility | |||||||||
Basin and tap inside toilet | 5 (7.8) | 39 (18.8) | 0.04 | 0.37 | 0.12, 0.89 | 0.04 | 0.39 | 0.13, 0.99 | 0.07 |
Basin and tap outside toilet | 13 (20.3) | 74 (35.7) | 0.02 | 0.46 | 0.23, 0.87 | 0.03 | 0.48 | 0.23, 0.95 | 0.04 |
Water in tub with mug inside | 33 (51.6) | 105 (50.7) | 0.91 | 1.03 | 0.59, 1.82 | 0.91 | 1.03 | 0.57, 1.85 | 0.93 |
Water in tub with mug outside | 16 (25.0) | 20 (9.7) | 0.002 | 3.12 | 1.49, 6.46 | <0.01 | 3.14 | 1.43, 6.86 | <0.01 |
Hand drying method | |||||||||
Clean cloth | 9 (14.1) | 89 (42.9) | <0.001 | 0.22 | 0.09, 0.44 | <0.001 | 0.28 | 0.12, 0.59 | 0.001 |
Multi-purpose rag | 45 (70.3) | 97 (46.9) | 0.001 | 2.68 | 1.49, 4.99 | <0.01 | 1.82 | 0.96, 3.55 | 0.07 |
Air dry | 3 (4.7) | 27 (13.0) | 0.06 | 0.33 | 0.08, 0.97 | 0.08 | 0.48 | 0.11, 1.52 | 0.26 |
Wipe on clothes | 10 (15.6) | 48 (23.2) | 0.20 | 0.61 | 0.28, 1.25 | 0.20 | 0.72 | 0.31, 1.51 | 0.40 |
Barriers to handwashing | |||||||||
Too busy | 50 (78.1) | 177 (85.5) | 0.16 | 0.61 | 0.30, 1.26 | 0.16 | 0.69 | 0.34, 1.50 | 0.34 |
No soap | 1 (1.6) | 2 (0.9) | 0.56 | 1.63 | 0.07, 17.26 | 0.69 | 1.18 | 0.05, 13.35 | 0.89 |
Too tired | 13 (20.3) | 34 (16.4) | 0.47 | 1.29 | 0.62, 2.59 | 0.47 | 0.89 | 0.40, 1.88 | 0.77 |
Forgot | 18 (28.1) | 17 (8.2) | <0.001 | 4.35 | 2.08, 9.17 | <0.001 | 3.91 | 1.75, 8.83 | <0.001 |
Behaviors | Respiratory Illness Incidence N = 102 | No Respiratory Illness N = 168 | p Value # | OR for Respiratory Illness | 95% CI | p Value | OR a for Respiratory Illness | 95% CI | p Value |
---|---|---|---|---|---|---|---|---|---|
Soap type | |||||||||
Liquid | 16 (15.7) | 38 (22.6) | 0.17 | 0.63 | 0.33, 1.19 | 0.17 | 0.64 | 0.32, 1.26 | 0.21 |
Bar | 88 (86.3) | 137 (81.5) | 0.31 | 1.42 | 0.73, 2.89 | 0.31 | 1.71 | 0.84, 3.65 | 0.15 |
Handwashing facility | |||||||||
Basin and tap inside toilet | 18 (17.6) | 26 (15.5) | 0.64 | 1.17 | 0.60, 2.25 | 0.64 | 1.40 | 0.69, 2.79 | 0.34 |
Basin and tap outside toilet | 33 (32.4) | 54 (32.1) | 0.97 | 1.01 | 0.59, 1.70 | 0.97 | 1.06 | 0.60, 1.85 | 0.84 |
Water in tub with mug inside | 49 (48.0) | 88 (52.3) | 0.49 | 0.84 | 0.51, 1.37 | 0.49 | 0.85 | 0.51, 1.43 | 0.55 |
Water in tub with mug outside | 15 (14.7) | 21 (12.5) | 0.61 | 1.21 | 0.58, 2.45 | 0.61 | 1.04 | 0.49, 2.20 | 0.91 |
Hand drying method | |||||||||
Clean cloth | 21 (20.6) | 77 (45.8) | <0.001 | 0.31 | 0.17, 0.53 | <0.001 | 0.37 | 0.19, 0.67 | 0.001 |
Multi-purpose rag | 64 (62.7) | 77 (45.8) | <0.01 | 1.99 | 1.21, 3.31 | <0.01 | 1.71 | 0.98, 2.99 | 0.06 |
Air dry | 14 (13.7) | 16 (9.5) | 0.29 | 1.51 | 0.70, 3.25 | 0.29 | 1.60 | 0.68, 3.76 | 0.28 |
Wipe on clothes | 18 (17.6) | 40 (23.8) | 0.23 | 0.69 | 0.36, 1.26 | 0.24 | 0.75 | 0.38, 1.41 | 0.38 |
Barriers to handwashing | |||||||||
Too busy | 77 (75.5) | 150 (89.3) | 0.002 | 0.37 | 0.19, 0.71 | < 0.01 | 0.42 | 0.21, 0.82 | 0.01 |
No soap | 2 (1.9) | 1 (0.6) | 0.55 | 3.34 | 0.32, 72.41 | 0.33 | 2.05 | 0.19, 45.55 | 0.57 |
Too tired | 19 (18.6) | 28 (16.7) | 0.68 | 1.14 | 0.59, 2.17 | 0.68 | 0.95 | 0.48, 1.85 | 0.88 |
Forgot | 19 (18.6) | 16 (9.5) | 0.03 | 2.16 | 1.06, 4.47 | 0.04 | 1.93 | 0.89, 4.22 | 0.09 |
Critical Time Points | Diarrhea Incidence N = 64 | No Diarrhea Incidence N = 207 | p Value # | OR for Diarrheal Diseases | 95% CI | p Value | OR a for Diarrheal Diseases | 95% CI | p Value |
---|---|---|---|---|---|---|---|---|---|
Timing of handwash at home | |||||||||
Before eating | 53 (82.8) | 186 (89.9) | 0.13 | 0.54 | 0.25, 1.23 | 0.13 | 0.56 | 0.25, 1.32 | 0.17 |
After eating | 53 (82.8) | 188 (90.8) | 0.07 | 0.49 | 0.22, 1.12 | 0.08 | 0.74 | 0.31, 1.87 | 0.52 |
Before preparing food | 6 (9.4) | 59 (28.5) | 0.002 | 0.26 | 0.09, 0.59 | <0.01 | 0.27 | 0.09, 0.63 | <0.01 |
After preparing food | 3 (4.7) | 49 (23.7) | <0.001 | 0.16 | 0.04, 0.45 | <0.01 | 0.19 | 0.04, 0.56 | <0.01 |
After cleaning dishes | 3 (4.7) | 42 (20.3) | 0.002 | 0.19 | 0.05, 0.56 | <0.01 | 0.15 | 0.03, 0.47 | <0.01 |
Cleaning house | 5 (7.8) | 24 (11.6) | 0.39 | 0.65 | 0.21, 1.64 | 0.40 | 0.56 | 0.16, 1.56 | 0.29 |
After coming from school | 8 (12.5) | 35 (16.9) | 0.40 | 0.70 | 0.29, 1.53 | 0.40 | 0.68 | 0.26, 1.61 | 0.41 |
After defecating | 4 (6.3) | 89 (42.9) | <0.001 | 0.08 | 0.03, 0.22 | <0.001 | 0.11 | 0.03, 0.29 | <0.001 |
After urinating | 56 (88.0) | 191 (92.3) | 0.24 | 0.59 | 0.24, 1.51 | 0.25 | 0.67 | 0.27, 1.78 | 0.40 |
Touching something unclean | 5 (7.8) | 43 (20.8) | 0.02 | 0.32 | 0.11, 0.79 | 0.03 | 0.26 | 0.08, 0.68 | 0.01 |
Timing of handwash at school | |||||||||
Before eating | 47 (73.4) | 165 (79.7) | 0.29 | 0.70 | 0.37, 1.37 | 0.29 | 0.73 | 0.36, 1.51 | 0.39 |
After eating | 44 (68.8) | 158 (76.3) | 0.22 | 0.68 | 0.37, 1.28 | 0.22 | 0.83 | 0.42, 1.66 | 0.58 |
After playing | 8 (12.5) | 45 (21.7) | 0.10 | 0.51 | 0.21, 1.10 | 0.11 | 0.43 | 0.17, 0.97 | 0.06 |
Touching something unclean | 3 (4.7) | 25 (12.1) | 0.10 | 0.36 | 0.08, 1.07 | 0.10 | 0.32 | 0.07, 1.01 | 0.08 |
After using the toilet | 44 (68.8) | 157 (75.8) | 0.26 | 0.70 | 0.38, 1.31 | 0.26 | 0.77 | 0.40, 1.52 | 0.44 |
Critical Time Points | Respiratory Illness Incidence N = 102 | No Respiratory Illness N = 168 | p Value # | OR for Respiratory Illness | 95% CI | p Value | OR a for Respiratory Illness | 95% CI | p Value |
---|---|---|---|---|---|---|---|---|---|
Timing of handwash at home | |||||||||
Before eating | 87 (85.3) | 151 (89.8) | 0.26 | 0.65 | 0.31, 1.39 | 0.26 | 0.81 | 0.37, 1.78 | 0.59 |
After eating | 87 (85.3) | 153 (91.1) | 0.14 | 0.57 | 0.26, 1.22 | 0.15 | 0.76 | 0.33, 1.77 | 0.52 |
Before preparing food | 12 (11.8) | 52 (30.9) | <0.001 | 0.30 | 0.14, 0.57 | <0.001 | 0.29 | 0.14, 0.58 | <0.001 |
After preparing food | 12 (11.8) | 40 (23.8) | 0.01 | 0.43 | 0.20, 0.84 | 0.02 | 0.44 | 0.20, 0.91 | 0.03 |
After cleaning dishes | 11 (10.8) | 34 (20.2) | 0.04 | 0.48 | 0.22, 0.96 | 0.05 | 0.39 | 0.17, 0.82 | 0.02 |
Cleaning house | 7 (6.9) | 22 (14.3) | 0.11 | 0.49 | 0.19, 1.14 | 0.11 | 0.44 | 0.16, 1.10 | 0.09 |
After coming from school | 14 (13.7) | 28 (16.7) | 0.52 | 0.79 | 0.39, 1.57 | 0.52 | 0.90 | 0.42, 1.86 | 0.78 |
After defecating | 13 (12.7) | 79 (47.0) | <0.001 | 0.16 | 0.08, 0.31 | <0.001 | 0.15 | 0.07, 0.30 | <0.001 |
After urinating | 91 (89.2) | 155 (92.3) | 0.40 | 0.69 | 0.30, 1.64 | 0.40 | 0.81 | 0.34, 1.98 | 0.64 |
Touching something unclean | 15 (14.7) | 33 (19.6) | 0.30 | 0.71 | 0.35, 1.35 | 0.31 | 0.59 | 0.28, 1.17 | 0.14 |
Timing of handwash at school | |||||||||
Before eating | 82 (80.4) | 129 (76.8) | 0.49 | 1.24 | 0.68, 2.30 | 0.49 | 1.53 | 0.80, 3.02 | 0.21 |
After eating | 71 (69.6) | 131 (77.9) | 0.12 | 0.65 | 0.37, 1.13 | 0.13 | 0.66 | 0.36, 1.21 | 0.18 |
After playing | 9 (8.8) | 44 (26.2) | <0.001 | 0.27 | 0.12, 0.56 | <0.001 | 0.26 | 0.11, 0.54 | <0.001 |
Touching something unclean | 12 (11.8) | 16 (9.5) | 0.56 | 1.27 | 0.56, 2.78 | 0.56 | 1.27 | 0.55, 2.88 | 0.57 |
After using the toilet | 83 (81.4) | 117 (69.6) | 0.03 | 1.90 | 1.06, 3.52 | 0.03 | 2.46 | 1.32, 4.80 | <0.01 |
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Khan, K.M.; Chakraborty, R.; Brown, S.; Sultana, R.; Colon, A.; Toor, D.; Upreti, P.; Sen, B. 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, 12535. https://doi.org/10.3390/ijerph182312535
Khan KM, Chakraborty R, Brown S, Sultana R, Colon A, Toor D, Upreti P, Sen B. Association between Handwashing Behavior and Infectious Diseases among Low-Income Community Children in Urban New Delhi, India: A Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2021; 18(23):12535. https://doi.org/10.3390/ijerph182312535
Chicago/Turabian StyleKhan, Khalid M., Rishika Chakraborty, Stephen Brown, Rasheda Sultana, Alec Colon, Devinder Toor, Pooja Upreti, and Banalata Sen. 2021. "Association between Handwashing Behavior and Infectious Diseases among Low-Income Community Children in Urban New Delhi, India: A Cross-Sectional Study" International Journal of Environmental Research and Public Health 18, no. 23: 12535. https://doi.org/10.3390/ijerph182312535