Hand-washing practices among adolescents aged 12–15 years from 80 countries

Lee Smith, Laurie Butler, Mark A. Tully, Louis Jacob, Yvonne Barnett, Guillermo F. López-Sánchez, Rubén López-Bueno, Jae Il Shin, Daragh McDermott, Briona A. Pfeifer, Damiano Pizzol, Ai Koyanagi

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The objectives were to (1) assess the prevalence of hand-washing practices across 80 countries and (2) assess frequency of hand-washing practice by economic status (country income and severe food insecurity), in a global representative sample of adolescents. Cross-sectional data from the Global School-based Student Health Survey 2003–2017 were analyzed. Data on age, sex, hand-washing practices in the past 30 days, and severe food insecurity (i.e., proxy of socioeconomic status) were self-reported. Multivariable logistic regression and meta-analysis with random effects based on country-wise estimates were conducted to assess associations. Adolescents (n = 209,584) aged 12–15 years [mean (SD) age 13.8 (1.0) years; 50.9% boys] were included in the analysis. Overall, the prevalence of hand-washing practices were as follows: never/rarely washing hands before eating (6.4%), after using toilet (5.6%), or with soap (8.8%). The prevalence of never/rarely washing hands after using the toilet (10.8%) or with soap (14.3%) was particularly high in low-income countries. Severe food insecurity was associated with 1.34 (95%CI = 1.25–1.43), 1.61 (95%CI = 1.50–1.73), and 1.44 (95%CI = 1.35–1.53) times higher odds for never/rarely washing hands before eating, after using the toilet, and with soap, respectively. A high prevalence of inadequate hand washing practices was reported, particularly in low-income countries and those with severe food insecurity. In light of the present COVID-19 pandemic and the rapid expansion being observed in low-and middle-income locations, interventions that disseminate good hand-washing practices are urgently required. Such interventions may also have cross-over benefits in relation to other poor sanitation-related diseases.

Original languageEnglish
Article number138
Pages (from-to)1-15
Number of pages15
JournalInternational Journal of Environmental Research and Public Health
Issue number1
Early online date27 Dec 2020
Publication statusPublished (in print/issue) - 1 Jan 2021

Bibliographical note

Publisher Copyright:
© 2020 by the authors. Licensee MDPI, Basel, Switzerland.

Copyright 2021 Elsevier B.V., All rights reserved.


  • Adolescents
  • Epidemiology
  • Hand-washing
  • Hygiene
  • Multi-country study
  • Poverty


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