Milken Institute School of Public Health Poster Presentations (Marvin Center & Video)
Exploring the link between handwashing proxy measures and child diarrhea in 25 countries in Sub-Saharan Africa
Poster Number
62
Document Type
Poster
Publication Date
3-2016
Abstract
Background: Handwashing with soap is considered the most cost-effective intervention for reducing the risk of child diarrhea, but reliable measurement of handwashing behaviors is difficult. This study aimed to examine the association between proxy handwashing measures and child diarrhea. Methods: We used the most recent Demographic and Health Survey (DHS) and the Multiple Indicator Cluster Survey (MICS) data from 25 countries in Sub-Saharan Africa, which included 254,546 households. The data were collected between 2010 and 2014, and nationally representative samples of children under five years of age were selected for the analysis. The main explanatory variable was the handwashing ladder, representing a varying level of availability of handwashing materials in the household. The outcome variable for the study was reported two-week prevalence of child diarrhea. We used a generalized linear model (GLM) with Poisson family and log link to estimate the prevalence ratio of child diarrhea between children with a basic handwashing station and without a handwashing place. Both country-specific and pooled analyses were conducted. Findings: Over 50% of children in 15 countries did not have access to a place for handwashing in or around the home. Availability of water and soap at a handwashing place was associated with both increased and decreased prevalence ratios: 0.89 (95% CI 0.79–0.99) in Chad, 0.82 (0.69–0.97) in Mauritania, 1.30 (1.02–1.66) in Burkina Faso, and 1.67 (1.20–2.33) in Ghana. In other countries, significant differences in the prevalence of child diarrhea were not found. After controlling for country-fixed effects, the prevalence ratio was 0.95 (0.92–0.99), suggesting a protective effect of having a handwashing station with water and soap. Interpretation: Presence of water and soap at a handwashing place is an important indicator to prevent child diarrhea, and handwashing promotion programs should be tailored to the unique context of each country.
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Open Access
1
Exploring the link between handwashing proxy measures and child diarrhea in 25 countries in Sub-Saharan Africa
Background: Handwashing with soap is considered the most cost-effective intervention for reducing the risk of child diarrhea, but reliable measurement of handwashing behaviors is difficult. This study aimed to examine the association between proxy handwashing measures and child diarrhea. Methods: We used the most recent Demographic and Health Survey (DHS) and the Multiple Indicator Cluster Survey (MICS) data from 25 countries in Sub-Saharan Africa, which included 254,546 households. The data were collected between 2010 and 2014, and nationally representative samples of children under five years of age were selected for the analysis. The main explanatory variable was the handwashing ladder, representing a varying level of availability of handwashing materials in the household. The outcome variable for the study was reported two-week prevalence of child diarrhea. We used a generalized linear model (GLM) with Poisson family and log link to estimate the prevalence ratio of child diarrhea between children with a basic handwashing station and without a handwashing place. Both country-specific and pooled analyses were conducted. Findings: Over 50% of children in 15 countries did not have access to a place for handwashing in or around the home. Availability of water and soap at a handwashing place was associated with both increased and decreased prevalence ratios: 0.89 (95% CI 0.79–0.99) in Chad, 0.82 (0.69–0.97) in Mauritania, 1.30 (1.02–1.66) in Burkina Faso, and 1.67 (1.20–2.33) in Ghana. In other countries, significant differences in the prevalence of child diarrhea were not found. After controlling for country-fixed effects, the prevalence ratio was 0.95 (0.92–0.99), suggesting a protective effect of having a handwashing station with water and soap. Interpretation: Presence of water and soap at a handwashing place is an important indicator to prevent child diarrhea, and handwashing promotion programs should be tailored to the unique context of each country.
Comments
Presented at: GW Research Days 2016.