Handwashing stations in Nepal: Role of wealth status in establishing handwashing stations at home

• Published date: 01 September 2022
• Author: Mohan Kumar Sharma,Ramesh Adhikari,Edwin van Teijlingen
• Date: 01 September 2022
• DOI: http://doi.org/10.1002/wmh3.523

Received: 3 May 2021

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Revised: 16 March 2022

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Accepted: 5 April 2022

DOI: 10.1002/wmh3.523

ORIGINAL ARTICLE

Handwashing stations in Nepal: Role of wealth

status in establishing handwashing stations

at home

Mohan Kumar Sharma

1,2

|Ramesh Adhikari

2,3

|

Edwin van Teijlingen PhD

4

1

Graduate School of Education (GSE),

Tribhuvan University, Kathmandu, Nepal

2

Center for Research on Education Health

and Social Science (CREHSS), Kathmandu,

Nepal

3

Tribhuvan University, Kathmandu, Nepal

4

Centre for Midwifery, Maternal and Perinatal

Health, Faculty of Health and Social

Sciences, Bournemouth University,

Poole, UK

Correspondence

Mohan Kumar Sharma, Center for Research

on Education Health and Social Science

(CREHSS), Kathmandu, Nepal,

Email: attrig2019@gmail.com

Abstract

Handwashing has been proven to be effective at

preventing several infectious diseases. This study aims

to find out the role of wealth status in establishing

handwashing stations in the households of Nepal. This

study used secondary data from Nepal Demographic

Health Survey in 2016 to assess the association

between households' wealth status and handwashing

stations. The findings displayed a significant association

between the age of the household head, residence

place, ecological zone, province, wealth status, having a

mosquito net, having a radio and TV in the respondent's

household, and fixed handwashing stations at their

households at p< 0.001 level. Wealth status has

significant effect on fixed handwashing stations

(adjusted odds ratio [aOR] = 12.699; 95% confidence

interval [CI] = 10.120–15.935; p<0.001) in the house-

holds. The households with the poorest wealth status

(aOR = 9.718; 95% CI = 7.387–12.785; p< 0.001),

mountain ecological zone (aOR = 1.325; 95%

CI = 1.098–1.599; p< 0.01), Madhesh province (aOR =

2.967; 95% CI = 2.405–3.658; p< 0.001) were significant

predictors for not having fixed handwashing stations

even after inclusion of socio‐covariates. Correspond-

ingly, the presence of mosquito net (aOR = 0.795; 95%

CI = 0.692–0.913; p< 0.01), presence of a radio (aOR =

0.758; 95% CI = 0.671–0.857; p< 0.001), and presence

of a TV (aOR = 0.762; 95% CI = 0.667–0.871; p< 0.001)

had a significant effect on fixed handwashing stations at

their households even after inclusion of socio‐

covariates. The study found households with the poorest

wealth quintiles, mountain ecological zone, and Mad-

hesh and Karnali provinces had low fixed handwashing

World Med. & Health Policy. 2022;14:528–543.wileyonlinelibrary.com/journal/wmh3528

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© 2022 Policy Studies Organization.

stations. The study suggests more leading interventions

to improve public health in this region.

KEYWORDS

handwashing station, household, Nepal, wealth status

Key Points

•Handwashing effectively reduces the spread of

several infectious diseases, including COVID‐19.

•This paper uses secondary data from Nepal's Demo-

graphic Health Survey in 2016 to assess the associa-

tion between households' wealth status and having

handwashing stations.

•There exists a significant association between the age

of the household head, place of residence, ecological

zone, province, wealth status, and having a mosquito

net/radio/TV in the house, and the likelihood of having

fixed handwashing stations.

•The lowest proportions of fixed handwashing stations

were found in the poorest households, in the

mountains, among the Madheshi ethnicity, and based

in Karnali province.

•Promoting handwashing stations may need additional

public health interventions to overcome underlying

inequalities at a population level.

INTRODUCTION

Handwashing refers to the act or process of cleaning one's hands to remove soil, grease,

microorganisms, or other unwanted substances (Public Health Agency of Canada, 2012). It

further asserts washing hands with water and ash or water and soap (antimicrobial or

nonantimicrobial) or applying an alcohol‐based hand sanitizer to the hands (Sharma et al.,

2021). It has also been recognized as one of the most cost‐effective health interventions to

reduce the burden of disease (Bartram & Cairncross, 2010). It is one of the most effective

processes that consider the key measure to trim down the potential transmission of infection

through contact with persons and things.

With the COVID‐19 pandemic, the importance of handwashing is strongly advocated by

health promoters across the globe because COVID‐19 mainly transmits among people

through direct (close contact with infected people) and indirect (contaminated objects or

surfaces) via mouth and nose secretions. Thus, washing hands with soap and running water

is of critical importance. To stop the spread of ongoing pandemics and encourage

appropriate hygiene, the practice of handwashing at regular intervals is beneficial, after

coughing or sneezing, when caring for the sick, after using the toilet, before eating, while

preparing food, and after handling animals or animal waste. Furthermore, handwashing after

touching common surfaces such as doorknobs or handles or after visiting a public place will

help keep ourselves and others around us safe.

COVID‐19, a respiratory infectious disease caused by SARS‐CoV‐2, is now a major

global health crisis (Walker et al., 2020). The world faces acute public health emergencies

and economic crises globally caused by the COVID‐19 pandemic. Hand hygiene is a critical

public health control mechanism to prevent the spread of infectious pathogens, as the most

HANDWASHING STATIONS IN NEPAL

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