Prevalence, barriers, and motivators of appropriate handwashing practice among mothers of under-five children in Ethiopia: a systematic review and meta-analysis.

Introduction: Appropriate handwashing practice is considered one of the most incredibly important hygiene promotion activities in public health for preventing infectious diseases. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence, barriers, and motivators of appropriate handwashing practice among mothers of under-five children in Ethiopia.

Methods: A systematic literature review was conducted for relevant studies reporting handwashing practices among mothers in Ethiopia in PubMed/Medline, HINARI, Web of science, Science Direct, Cochrane Library, Google Scholar, and worldwide Science databases. A random-effects model was employed to estimate the pooled prevalence of handwashing practice and its determinants. Heterogeneity between studies was checked using the Q test and I² test statistics. Sub-group analysis using regions was done, and sensitivity analysis was checked. A publication bias was checked using Egger's statistical test at a 5% significance level.

Results: A total of 4,239 study participants from ten studies were included. The overall pooled prevalence of handwashing practice among mothers in Ethiopia was 45.16% (95% CI: 33.79, 56.53). The higher proportion of mothers who had good handwashing practices were observed in Addis Ababa (56.65%) and the lowest was in Southern Nations, Nationalities, and People's region (33.89%). Maternal age being 15-24 (AOR: 3.10; 95% CI: 1.43, 6.72), being 25-34 (AOR: 2.02; 95% CI: 1.14, 3.58), having primary education (AOR: 2.12; 95% CI: 1.89, 2.51), secondary or above education (AOR: 2.99; 95% CI: 1.18, 7.53), having a family size of less than five (AOR: 1.64; 95% CI: 1.06, 2.52), good knowledge (AOR: 2.45; 95% CI: 1.26, 4.75), favourable attitude (AOR: 3.33; 95% CI: 1.76, 6.26), availability of water nearby the household (AOR: 3.76; 95% CI: 1.95, 7.22), and being from households with rich wealth index (AOR: 2.42; 95% CI: 1.39, 4.22) were the identified factors associated with handwashing practice.

Conclusion: Handwashing practice among mothers of under five children was low as compared to the national target from 2021 to 2030. In Ethiopia, only less than half of all women with children under five practice good handwashing. Therefore, the government should increase access to water, improve income levels, and develop policies and programs aimed at enhancing mothers' knowledge and attitudes toward handwashing practices. Additionally, it should prioritize support for disadvantaged groups, such as elderly mothers, less educated mothers, and households with large family sizes.