Handwashing with soap and influencing factors in crisis-affected refugee populations in Kenya and Uganda.

Background: Crisis-affected populations such as refugees are exposed to a greater risk of communicable diseases due to poor living conditions and limited access to basic services, such as water, sanitation and hygiene services. Hygiene practices such as handwashing with soap provides a critical barrier to disease prevention, for instance diarrheal infections in children under five years. This study aimed to understand the behavioural practice of handwashing with soap and the factors influencing the hygiene behaviour in two crisis-affected populations in Kenya and Uganda.

Methods: We conducted a cross-sectional survey in two refugee populations primarily targeting household heads or next in charge of making decisions in the randomly selected households. We also carried out structured observations to observe the general handwashing practices of individuals within the study households.

Results: Out of 645 household respondents interviewed, 319 were from Dadaab (Kenya) refugee camp, and 326 from Kyangwali (Uganda) refugee settlement. Self-reported washing of hands with soap was 48.1% in Dadaab and 31.6% in Kyangwali. From the observation of handwashing with soap events, the rates were even lower (Dadaab refugee camp-33. 4% and Kyangwali refugee settlement-12.1%). Rinsing hands with water was the most common practice by individuals in the two communities. Nearly all respondents in Dadaab and Kyangwali used mobile vessels for handwashing needs. Some of the factors associated with handwashing with soap included-availability of water and soap for handwashing needs, time spent on water collection, and presence of handwashing facilities.

Conclusion: Our study shows that handwashing with soap is lowly practiced, with the availability of soap and water for handwashing needs and presence of handwashing facilities fundamental. For improvements in handwashing with soap by all household members for collective effect on reducing diarrheal infections in crisis-affected populations, interventions could benefit from further research on the influence of fixed handwashing facilities as prompts to behavioural performance as well as psychosocial determinants influencing behaviour change performance.