Safe Reopening of Schools during COVID-19: An Evaluation of Handwash Facilities and Students’ Hand Hygiene Knowledge and Practices

Abstract

Children are energetic and filled with vigour, the high rate of person-to-person contact at schools could leave the students susceptible to hygiene-related illnesses if appropriate measures are not put in place. The absence of adequate handwash facilities, inadequate hand hygiene knowledge, and poor hand hygiene practices have been reported to be prevalent among schools in Nigeria. The emergence of COVID-19 even makes it more important to provide recent and quality data as schools plan to reopen safely. This study aimed to assess the accessibility of public-school students in Badagry, Lagos State to basic handwash services, as well as their hygiene-related knowledge and practices. A 4-stage sampling method was used to select 5 wards, 5 schools, the classes, and 351 students. A mixed-method which included a semi-structured questionnaire, observational checklist, and a key informant interview guide was used to collect data. Data were inputted into SPSS version 20 and analyzed using descriptive statistics, chi-square, and logistic regression at a 95% confidence interval. The respondents had a mean age of 15.88±1.54 years. All the available wash-hand stations (WHS) were in the toilet blocks. All the male toilet facilities had WHS as opposed to just 60% of the female facilities. None of the WHS had soap present, while a quarter of the WHS did not have water available. Based on the Joint Monitoring Programme (JMP) classification; none of the WHS provided basic hygiene service, 60% provided limited service and 40% provided no service. The majority (83%) of the students possessed a good knowledge of hand hygiene, however, only less than half (47%) reported washing their hands with soap and water at school. Factors like age (p=0.010) and their parents' educational status (mother-p=0.002; father-p=0.011) significantly affected the students' knowledge. The absence of basic handwash facilities in all the schools clearly shows the need for rapid intervention, particularly to eliminate gender disparities and to ensure the sustainable availability of sufficient soap and water. INTRODUCTION According to the World Bank, the most cost-effective health intervention is hygiene promotion (World Bank, 2016). Advocating for good hand hygiene practice within communities have been proven to lower the incidence of diarrhea by 23-40% and respiratory infection by about 21% (Freeman et al., 2014 and Aiello et al., 2008). A randomized control trial revealed that the practice of hand hygiene with soap and water reduced the incidence of diarrhea and impetigo by over 50% among children, while the incidence of pneumonia lowered by 50% (Luby et al., 2005). Access to basic hygiene services goes beyond the home setting, as a reasonable amount of time is spent outside. Students spend a significant portion of their childhood at schools, health care workers and patients spend a significant proportion of their time at the hospital, while other adults also spend time at their workplaces. It is therefore essential for basic hygiene services to be provided in all these institutions to reduce the risk of disease transmission (Eawag, 2018; WHO, 2009, 2015).