Knowledge about Hand Hygiene and Related Infectious Disease Awareness among Primary School Children in Germany †
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Development of the Questionnaire
2.3. Data Collection and Analyses
3. Results and Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Municipalities 1 | Number of Inhabitants 2 | City and Municipality Type 3 | Number of Primary Schools in the Municipalities 4 | Number of Participating Primary Schools from the Municipalities |
---|---|---|---|---|
Altenberge | 10,327 | Larger small town | 2 | 2 |
Emsdetten | 36,029 | Little medium-sized town | 6 | 1 |
Greven | 37,753 | Little medium-sized town | 5 | 2 |
Hörstel | 20,344 | Little medium-sized town | 5 | 2 |
Ladbergen | 6688 | Little small town | 1 | 1 |
Laer | 6744 | Little small town | 1 | 1 |
Lengerich | 22,660 | Little medium-sized town | 4 | 3 |
Lienen | 8604 | Little small town | 3 | 1 |
Lotte | 14,095 | Larger small town | 3 | 1 |
Westerkappeln | 11,241 | Larger small town | 2 | 1 |
Primary School 1 | Total Number of School Children 2 | Number of Classes | Number of Grade 3 Classes | Number of Sanitary Facilities for School Children (Girls/Boys) 3 | Total Number of Toilets Seats for School Children Girls/Boys/Total (%) 4 | Total Number of Urinals for School Children (Only Boys) |
---|---|---|---|---|---|---|
01 | 268 | 12 | 3 | 4 (2/2) | 7/4/11 (4.1) | 10 |
02 | 261 | 11 | 2 | 8 (4/4) | 11/7/18 (6.9) | 14 |
03 | 157 | 8 | 2 | 6 (3/3) | 8/6/14 (8.9) | 12 |
04 | 340 | 14 | 3 | 5 5 | 13/8/21 (6.2) | 7 |
05 | 267 | 11 | 3 | 2 (1/1) | 7/5/12 (4.5) | 10 |
06 | 104 | 4 | 1 | 2 (1/1) | 3/4/7 (6.7) | 2 |
07 | 103 | 4 | 1 | 2 (1/1) | 4/2/6 (5.8) | 4 |
08 | 161 | 8 | 2 | 2 (1/1) | 4/5/9 (5.6) | 5 |
09 | 94 | 4 | 1 | 2 (1/1) | 4/3/7 (7.4) | 4 |
10 | 202 | 8 | 2 | 2 (1/1) | 4/3/7 (3.5) | 3 |
11 | 240 | 11 | 3 | 4 (2/2) | 10/7/17 (7.1) | 11 |
12 | 192 | 8 | 2 | 2 (1/1) | 6/6/12 (6.2) | 2 |
13 | 226 | 12 | 3 | 2 (1/1) | 14/7/21 (9.3) | 7 |
Age in Years | Number (Percentage) 1 of School Children | ||
---|---|---|---|
Girls | Boys | Total | |
8 | 58 (11.8%) | 45 (9.1%) | 103 (20.9%) |
9 | 178 (36.2%) | 168 (34.1%) | 346 (70.3%) |
10 | 19 (3.9%) | 18 (3.7%) | 37 (7.5%) |
11 | 2 (0.4%) | 4 (0.8%) | 6 (1.2%) |
Total | 257 (52.2%) | 235 (47.8%) | 492 (100.0%) |
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School Grade | Number (Percentage) 1 of School Children 2 | ||
---|---|---|---|
Girls (%) | Boys (%) | Total (%) | |
1 (Very Good) | 19 (3.9) | 21 (4.3) | 40 (8.1) |
2 (Good) | 55 (11.2) | 32 (6.5) | 87 (17.7) |
3 (Satisfactory) | 92 (18.7) | 57 (11.6) | 149 (30.3) |
4 (Sufficient) | 57 (11.6) | 64 (13.0) | 121 (24.6) |
5 (Poor) | 22 (4.5) | 31 (6.3) | 53 (10.8) |
6 (Deficient) | 11 (2.2) | 31 (6.3) | 42 (8.5) |
Total | 256 (52.0) | 236 (48.0) | 492 (100.0) |
Frequency to Visit the Toilet at School per Day | Number (Percentage) 1 of School Children | ||
---|---|---|---|
Girls (%) | Boys (%) | Total (%) | |
Mostly not at all | 112 (22.7) | 106 (21.5) | 218 (44.2) |
1 time | 44 (8.9) | 44 (8.9) | 88 (17.8) |
2 times | 67 (13.6) | 55 (11.2) | 122 (24.7) |
3 times | 22 (4.5) | 14 (2.8) | 36 (7.3) |
More than 3 times | 9 (1.8) | 14 (2.8) | 23 (4.7) |
Total | 254 (51.5) | 233 (47.3) | 487 (98.8) 2 |
Category 1 | Quantity of Answers 2 | Exemplary Answer |
---|---|---|
Uncleanliness of the sanitary facilities | 243 | “… the toilets are always dirty.” (boy, 9 years old) “…and there is not much cleaning.” (girl, 9 years old) “…there are mostly spiders.” (girl, 9 years old) “…the toilet is a bit disgusting.” (girl, 8 years old) |
(Mis-)behavior of classmates | 141 | “…sometimes there is urine on the toilet seat.” (girl, 9 years old) “…no one washes their hands and then touches the door handle!” (girl, 8 years old) “the toilet seat is sometimes dirty and some forget to flush.” (girl, 9 years old) “…they always look from underneath, when you are sitting on the toilet.” (boy, 10 years old) “…everyone from school goes to the toilet.” (girl, 10 years old) “…some children put themselves on the toilet with street shoes and then the toilet is dirty.” (girl, 9 years old) |
General condition of the sanitary facilities (e.g., aeration, temperature, operability of the equipment and lack of hygiene articles) | 82 | “…it smells in the toilet.” (girl, 10 years old) “…the toilet room is often wet.” (boy, 9 years old) “…it is always cold.” (boy, 9 years old) “…and there is usually no toilet paper.” (girl, 8 years old) |
Conflict of interests | 18 | “…I won’t be able to learn.” (boy, 9 years old) “…If it takes too long time (to go to the toilet), I miss the lesson or don’t get to know some nice things.” (girl, 9 years old) |
Lack of need | 14 | “… I do not need to (use the toilet).” (girl, 9 years old) |
Discomfort using the toilet | 14 | “…it is scary down there.” (boy, 9 years old) “…it’s uncomfortable for me there.” (girl, 9 years old) “…I feel more at ease at home.” (girl, 9 years old) |
Awareness of microbial pathogens | 8 | “…there are a lot of bacteria.” (girl, 9 years old) “…because there can also always be bacteria.” (girl, 8 years old) |
Other | 7 | “…because otherwise we are always get trouble.” (boy, 8 years old)“…it is impolite.” (boy, 9 years old) “…that is no fun.” (boy, 9 years old) |
Statements (Number of Valid Answers) “I Wash My Hands at School…” | Number (Percentage) 1 of Answers | |||
---|---|---|---|---|
Never (%) | Seldom (%) | Often (%) | Always (%) | |
1. “…when the hands are dirty.” (n = 492) | 11 (2.2) | 51 (10.4) | 157 (31.9) | 273 (55.5) |
2. “…before eating, e.g., bread during the break or lunch.” (n = 489) | 120 (24.5) | 134 (27.4) | 119 (24.3) | 116 (23.7) |
3. “…before I go to the toilet.” (n = 485) | 366 (75.5) | 75 (15.5) | 24 (4.9) | 20 (4.1) |
4. “…after I went to the toilet.” (n = 485) | 6 (1.2) | 21 (4.3) | 86 (17.7) | 372 (76.7) |
5. “…after physical education.” (n = 490) | 294 (60.0) | 139 (28.4) | 40 (8.2) | 17 (3.5) |
6. “…after the break.” (n = 485) | 173 (35.7) | 182 (37.5) | 92 (19.0) | 38 (7.8) |
7. “…when I worked with paint, e.g., watercolor while art lesson.” (n = 491) | 7 (1.4) | 32 (6.5) | 96 (19.6) | 356 (72.5) |
8. “…after sniffing or blowing the nose.” (n = 489) | 121 (24.7) | 140 (28.6) | 111 (22.7) | 117 (23.9) |
9. “…after sneezing.” (n = 488) | 150 (30.7) | 145 (29.7) | 114 (23.4) | 79 (16.2) |
Statements (Number of Valid Answers) “I Wash My Hands at Home…” | Number (Percentage) 1 of Answers | |||
---|---|---|---|---|
Never (%) | Seldom (%) | Often (%) | Always (%) | |
1. “…before touching food, e.g., when I help to cook at home.” (n = 492) | 17 (3.5) | 31 (6.3) | 70 (14.2) | 374 (76.0) |
2. “…when the hands are dirty.” (n = 491) | 6 (1.2) | 23 (4.7) | 100 (20.4) | 362 (73.7) |
3. “…before lunch.” (n = 490) | 31 (6.3) | 80 (16.3) | 119 (24.3) | 260 (53.1) |
4. “…before I go to the toilet.” (n = 488) | 342 (70.1) | 98 (20.1) | 28 (5.7) | 20 (4.1) |
5. “…after I went to the toilet.” (n = 490) | 5 (1.0) | 26 (5.3) | 88 (18.0) | 371 (75.7) |
6. “…after I played outside.” (n = 489) | 54 (11.0) | 124 (25.4) | 165 (33.7) | 146 (29.9) |
7. “…after sniffing or blowing the nose.” (n = 486) | 139 (28.6) | 153 (31.5) | 90 (18.5) | 104 (21.4) |
8. “…after sneezing.” (n = 488) | 171 (35.0) | 131 (26.8) | 102 (20.9) | 84 (17.2) |
9. “…after I touched an animal, e.g., a dog or a cat.” (n = 486) | 90 (18.5) | 88 (18.1) | 112 (23.0) | 196 (40.3) |
10. “…when I come home.” (n = 490) | 94 (19.2) | 114 (23.3) | 115 (23.5) | 167 (34.1) |
11. “…before going to bed.” (n = 491) | 130 (26.5) | 111 (22.6) | 116 (23.6) | 134 (27.3) |
12. “…after getting up.” (n = 488) | 137 (28.1) | 117 (24.0) | 98 (20.1) | 136 (27.9) |
13. “…after contact with sick people who are ill with cough or sniffles for example.” (n = 489) | 18 (3.7) | 34 (7.0) | 95 (19.4) | 342 (69.9) |
14. “…when I was at the doctor.” (n = 493) | 87 (17.6) | 97 (19.7) | 119 (24.1) | 190 (38.5) |
15. “…when I visited someone in the hospital.” (n = 488) | 38 (7.8) | 54 (11.1) | 97 (19.9) | 299 (61.3) |
Statements (Number of Valid Answers) | Options | Number (Percentage) of Answers | Significance 1 p-Value (Chi-Squared Test 2) | ||
---|---|---|---|---|---|
Girls (%) | Boys (%) | Total (%) | |||
1. “I can be vaccinated against specific diseases.” (n = 493) | False | 11 (4.3) | 14 (5.9) | 25 (5.1) | p = 0.404 (0.698) |
Right | 246 (95.7) | 222 (94.1) | 468 (94.9) | ||
2. “I touch my face with unwashed hands after going to the toilet.” (n = 493) | False | 253 (98.4) | 227 (96.2) | 480 (97.4) | p= 0.118 (2.441) |
Right | 4 (1.6) | 9 (3.8) | 13 (2.6) | ||
3. “I cover an open wound on my body with a plaster or bandage.” (n = 490) | False | 16 (6.2) | 24 (10.3) | 40 (8.2) | p= 0.100 (2.707) |
Right | 241 (93.8) | 209 (89.7) | 450 (91.8) | ||
4. “I keep distance from ill people who are suffer e.g., from cough or sniffles.” (n = 491) | False | 25 (9.8) | 27 (11.4) | 52 (10.6) | p= 0.556 (0.347) |
Right | 230 (90.2) | 209 (88.6) | 439 (89.4) | ||
5. “I wash my hands with soap.” (n = 492) | False | 0 (0.0) | 3 (1.3) | 3 (0.6) | p= 0.108 2 / |
Right | 257 (100.0) | 232 (98.7) | 489 (99.4) | ||
6. “I play a lot on the computer, game console or watch a lot of television.” (n = 485) | False | 239 (94.1) | 173 (74.9) | 412 (84.9) | p < 0.001 (34.889) |
Right | 15 (5.9) | 58 (25.1) | 73 (15.1) | ||
7. “I drink from my classmates’ water bottle.” (n = 489) | False | 247 (97.2) | 229 (97.4) | 476 (97.3) | p= 0.889 (0.019) |
Right | 7 (2.8) | 6 (2.6) | 13 (2.7) |
Organ (System) Manifestation | Specified Infections | Number of Answers |
---|---|---|
Respiratory tract infections | Influenza Cold Tonsillitis Bronchitis Pneumonia | 77 18 4 3 2 |
Gastrointestinal tract infections | Gastrointestinal diseases Hepatitis | 84 1 |
Childhood infections | Scarlet Measles Chickenpox Rubella Mumps | 37 15 15 2 1 |
Skin infections | Herpes Hand-foot-and-mouth disease Shingles Warts Scabies Eczema | 8 4 4 2 1 1 |
Central nervous system infections | Meningitis Rabies | 1 1 |
Eye infections | Conjunctivitis | 4 |
Urinary tract infections | Cystitis | 1 |
Other | Ebola Pest | 1 1 |
Statements (Number of Valid Answers) | Options | Number (Percentage) of Answers | Significance p-Value (Chi-Squared Test 1) | ||
---|---|---|---|---|---|
Girls (%) | Boys (%) | Total (%) | |||
1. “I will stay at home if possible.” (n = 492) | False | 7 (2.7) | 12 (5.1) | 19 (3.9) | p = 0.176 |
Right | 249 (97.3) | 224 (94.9) | 473 (96.1) | (1.827) | |
2. “I don’t shake hands with other people.” (n = 492) | False | 24 (9.3) | 22 (9.4) | 46 (9.3) | p = 0.993 |
Right | 233 (90.7) | 213 (90.6) | 446(90.7) | (0.000) | |
3. “I cough or sneeze in the crook of my arm and not into my hand.” (n = 492) | False | 9 (3.5) | 10 (4.2) | 19 (3.9) | p = 0.678 |
Right | 247 (96.5) | 226 (95.8) | 473 (96.1) | (0.172) | |
4. “I cough or sneeze into the hand and not in the crook of my arm.” (n = 491) | False | 241 (94.1) | 216 (91.9) | 457 (93.1) | p = 0.332 |
Right | 15 (5.9) | 19 (8.1) | 34 (6.9) | (0.942) | |
5. “I don’t spit on the floor.” (n = 489) | False | 33 (12.9) | 40 (17.1) | 73 (14.9) | p = 0.198 |
Right | 222 (87.1) | 194 (82.9) | 416 (85.1) | (1.657) | |
6. “I meet with my friends.” (n = 491) | False | 235 (92.2) | 207 (87.7) | 442 (90.0) | p = 0.101 |
Right | 20 (7.8) | 29 (12.3) | 49 (10.0) | (2.696) | |
7. “I wash my hands especially thoroughly after using the toilet.” (n = 493) | False | 3 (1.2) | 7 (3.0) | 10 (2.0) | p = 0.206 1 |
Right | 254 (98.8) | 229 (97.0) | 483 (98.0) | / |
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Klar, K.; Knaack, D.; Kampmeier, S.; Hein, A.K.; Görlich, D.; Steltenkamp, S.; Weyland, U.; Becker, K. Knowledge about Hand Hygiene and Related Infectious Disease Awareness among Primary School Children in Germany. Children 2022, 9, 190. https://doi.org/10.3390/children9020190
Klar K, Knaack D, Kampmeier S, Hein AK, Görlich D, Steltenkamp S, Weyland U, Becker K. Knowledge about Hand Hygiene and Related Infectious Disease Awareness among Primary School Children in Germany. Children. 2022; 9(2):190. https://doi.org/10.3390/children9020190
Chicago/Turabian StyleKlar, Kristin, Dennis Knaack, Stefanie Kampmeier, Anna Katharina Hein, Dennis Görlich, Siegfried Steltenkamp, Ulrike Weyland, and Karsten Becker. 2022. "Knowledge about Hand Hygiene and Related Infectious Disease Awareness among Primary School Children in Germany" Children 9, no. 2: 190. https://doi.org/10.3390/children9020190