Handwashing Skills, Hand Bacteria Reduction, and Nutritional Status of Elementary School Children in an Urban Slum of Indonesia

Currently, Indonesia is a developing country with awareness and involvement in a community-based total sanitation program. One pillar of this program is handwashing practice as a prevention from an infectious disease, since many studies revealed a lack of handwashing behavior leads to bacterial contamination from hands. School children are the most vulnerable to bacterial contamination which can lead to nutritional problems. On the other hand, over population and poor-infrastructure also contribute to a lack of sanitation and personal hygiene, and these play important roles in child behavior. Therefore, this study aims to analyze handwashing skills among school children based on World Health Organization (WHO) guidelines regarding hand bacteria reduction and child nutritional status in an urban slum of Indonesia. We conducted a cross-sectional study on elementary school children in the urban slum of Bandung. Participants were the 6th grade children (11 to 14 years old). Forty-one children (24 boys and 17 girls) participated in this study. Our measures were: 1) handwashing skill observation using a checklist, 2) hand bacteria assessment before and after handwashing using a swab, and 3) child anthropometry (height and weight measurement). The association among handwashing skill, handwashing’s total time duration, and bacterial assessment were analyzed using Spearman’s rank correlation tests, comparison between hand bacteria before and after handwashing, and between handwashing skill and child nutritional status were studied using paired t-tests and t-test, respectively. Results showed that handwashing reduced the E. coli count by 0.70 log CFU/hand. Allocating time specifically to pouring water before lathering significantly lowered E. coli count after handwashing. Moreover, neglecting hand drying was identified as a potential factor that caused hand contamination and lowered child nutritional status