Factors that influence hand washing practice among primary school children in Arusha rural district council, Arusha region, Tanzania

Background: Hand washing is the single most important and cost-effective method for prevention of diseases such as diarrhea among children and adults. Many interventions have been done in Tanzania focusing on primary care takers. Nevertheless, hand washing proportion is still low. Hence more hand washing promotion interventions are needed and for the behavior to be effective, proper hand washing must be learnt from childhood so that it becomes a routine habit throughout life. Since, school children are good behavior change agents, this study focused on primary school children's hand washing practice. Objective: The aim of this study was to determine factors influencing hand washing practice among primary school children. Materials and methods: A cross- sectional analytical study based on quantitative research methods was conducted from June to July 2010 involving 527 grade five to seven primary school children of both sexes in Arusha rural district council using a pre- tested self administered questionnaire. Data analysis: Frequency distributions, Chi-square and multiple logistic regression analyses were performed by SPSS version 13.0. Results: Only 18.8% of participants fulfilled the criteria of washing hands with soap, before eating, after using the toilet by using the required time. More than half (55.7%) of the children were aware of issues related to hand washing practice. Only one school had hand washing stations and none of the schools provided soap for hand washing. Bivariate analysis indicated that; significantly (p<0.001) higher proportion of children who perceived pressure from important referents (42.1 %) washed hands as compared to those who did not perceive pressure (11.5%). Whereas, self efficacy and attitude were not significantly associated with children's hand washing practice. Controlling for age, sex, grade and school location multiple logistic regression further indicated that; pressure from important referents continued to be highly associated with hand washing [Adjusted OR= 0.2, 95% CI;0.1,0.3; p