PLOS ONE · 7 authors, 5 centres
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This secondary analysis of 18 Demographic and Health Surveys across 18 sub-Saharan African countries found that only 34.84% of households practiced handwashing with essential agents, with household wealth, education, water access, and sanitation infrastructure being key associated factors.
Using multivariable multilevel mixed-effect logistic regression, the authors examined associations between household environmental factors and handwashing with essential agents. The overall prevalence was 34.84%, ranging from 70.2% in Angola to 6.5% in Malawi. Higher household wealth (aOR = 4.08), education (aOR = 1.77), having a fixed handwashing place (aOR = 1.49), female headship (aOR = 1.09), and not sharing toilets (aOR = 1.13) were positively associated with handwashing. Lack of regular water access (aOR = 0.09) and rural residence (aOR = 0.85) were negatively associated. As a cross-sectional study, causal relationships cannot be established. Results may be affected by reliance on household head responses, which varied by sex and age across households. The authors recommend integrated WASH interventions targeting infrastructure deficits and contextual barriers.
