Determinants of regional prevalence and variations in handwashing practices among households in Bangladesh: An application of generalized mixed-effects model

Introduction: Handwashing practice is an effective way to minimize severe infectious diseases such as COVID-19, diarrhea, and pneumonia. The study aimed to explore the prevalence of handwashing behavior and associated determinants in rural and urban areas of Bangladesh. Methods: The research was performed using cross-sectional survey data from the 2019 Bangladesh Multiple Indicator Cluster Survey, and 61,242 household members were the sample for this study. The Chi-square test was applied for the bivariate analysis. A generalized linear mixed-effects model was used to identify the risk factors of practicing handwashing in both urban and rural areas of Bangladesh. Results: Only 65% of the country's households had access to handwashing facilities (place, water, and materials). While urban dwellers were more likely to wash their hands, rural dwellers were only 63% likely to do so. The level of education of household heads, wealth status, division, number of family members, sanitation facilities, and water source were the key factors associated with handwashing behavior. This study revealed that the odds were significantly lower among illiterate respondents compared to those with secondary and above-secondary education in both areas of Bangladesh, and a positive association was found between wealth status and handwashing behavior practiced in both urban and rural areas. In this study, the size of the family was statistically significant for both rural and urban areas of Bangladesh. Conclusion: Handwashing is the most prominent consideration for controlling COVID-19. Policymakers are striving to improve handwashing facilities by increasing awareness-raising programs, especially among rural residents of Bangladesh.