ABSTRACT

The purpose of the thesis was to study the knowledge and practice of hand washing as a measure of disease control among students in Afe Babalola University. The goal was to determine how well the knowledge of hand hygiene is understood by the students, to assess their attitudes towards maintaining good hand hygiene, and to identify possible ways for better adherence. A quantitative research method was used. A questionnaire divided into four sections was distributed to students who served as respondents. Results from the findings indicated that the majority of the students maintained good hygiene before and after eating. The students also maintained good hand hygiene after using the restroom. The results revealed that, although the majority of the students wash their hands during these instances, most of them do not fully know or understand the correct procedures and techniques of proper and effective hand hygiene, nor the right use of alcohol-based hand rub in the prevention of illness. In conclusion, it became evident that there is a need for further education for the students on the various procedures of proper hand and personal hygiene to effectively prevent the spread of infection and diseases. It was recommended that hand hygiene educational events be held in ways interesting enough to attract students from all fields of study to participate (Ismail et al., 2024).

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF STUDY

Health-associated infections are among the most common adverse events in healthcare, resulting in a significant burden on patients, their families, and health care systems. According to the WHO (2022) Global Report on Infection Prevention and Control, out of every 100 patients in acute-care hospitals, approximately 7 patients in high-income countries and 15 patients in low- and middle-income countries acquire at least one healthcare-associated infection (HAI) during their hospital stay, with an average mortality rate of 1 in every 10 affected patients. A 2023 study by Balasubramanian et al., cited by WHO, estimated that 136 million cases of HAIs involving antibiotic-resistant infections occur globally every year (WHO, 2023).

In addition, every time a patient is treated for a healthcare-associated infection, the opportunity for microorganisms to develop resistance to antimicrobial drugs increases. The rising incidence of multi-drug resistant organisms (MDROs) continues to heighten the need for every possible measure to control the spread of infectious diseases. A systematic review and network meta-analysis by Huang et al. (2025) confirmed that hand hygiene remains among the most effective infection prevention and control measures for combating MDROs in healthcare settings. Hand hygiene is the leading measure for preventing the spread of pathogens and reducing HAIs, yet healthcare providers’ adherence to recommended practices remains suboptimal in most settings, and improvement is difficult to sustain (WHO, 2022).

The hand hygiene practices of healthcare providers, the reasons for suboptimal practice, and the intractable nature of changing practice have been extensively researched. A comprehensive systematic review by Afework and Tamene (2025), which synthesised qualitative studies published between 2010 and 2024, confirmed that barriers to hand hygiene are highly complex and multifactorial, influenced by elements at both the organisational and individual levels. Common organisational barriers include inadequate hand hygiene facilities and workplace cultures that do not value or emphasise hand hygiene. At the individual level, habits formed early in life, knowledge gaps, and misconceptions about hand hygiene during care delivery produce barriers to appropriate practice. While single one-time interventions fail to produce sustained improvements, ongoing multimodal programmes have been more effective. A three-year quasi-experimental study at a cardiac hospital in Karachi demonstrated that the WHO multimodal strategy achieved a 17.5% improvement in hand hygiene compliance over three years, rising from 68.0% in 2022 to 85.5% in 2024 (Ahmed et al., 2025).

University students represent the future workforce and must be prepared to demonstrate professional accountability and safe practice. Hand hygiene is a basic skill and key component of safety that affects the morbidity and mortality of students in all healthcare settings. The hand hygiene habits students develop during the course of their daily activities will affect their future health stability. In addition, students are actively engaged in direct communication with one another during their daily activities and, consequently, have an important role in infection control. Ensuring that students recognise the importance of hand hygiene in the prevention of health-associated infections, know when and how handwashing should be performed, and follow recommended practice is of utmost importance (Purssell & Gould, 2022; Meza Sierra et al., 2023).

1.2 STATEMENT OF THE PROBLEM

Hand washing is a cornerstone of infectious disease control, and the promotion of improved hand hygiene has been recognised as an important public health measure. It has long been established as a convenient, effective, and cost-effective means of preventing communicable diseases. Hand hygiene is a general term referring to any action of hand cleansing that is, the act of cleaning one’s hands with or without the use of water or another liquid, or with the use of soap, for the purpose of removing soil, dirt, and/or microorganisms (WHO, 2022). The causal link between hand hygiene and rates of infectious disease has been well established.

Globally, diarrhoea and pneumonia remain the top two leading causes of mortality among children under five years of age, accounting for approximately 1.8 million deaths each year (Xun et al., 2021). A landmark systematic review and meta-analysis by Wolf et al. (2022), published in The Lancet, found that handwashing with soap interventions reduced the risk of diarrhoeal disease among children under five in low- and middle-income countries by approximately 30%. Further evidence by Ogilvie et al. (2023), also published in The Lancet, confirmed that handwashing with soap reduces the risk of acute respiratory infections in low- and middle-income settings by a clinically meaningful margin. Additionally, an updated systematic review and meta-analysis by Ouedraogo et al. (2025) found that handwashing interventions reduced child diarrhoea risk by 33% in dry seasons and 18% in rainy seasons. Despite the proven importance and benefits of hand washing, proper hand hygiene is not as widely practised as desired to prevent infections, particularly in developing countries that bear the greatest burden of infectious diseases.

A systematic review of hand hygiene practices among primary and secondary school students in sub-Saharan Africa (Ahadzie et al., 2023) found that, although knowledge was a motivator for good practice, not all students with hygiene awareness performed adequate hand hygiene, partly because access to handwashing materials such as water, soap, and functioning facilities remained a significant barrier. Several studies have addressed hand hygiene among different populations in Nigeria; however, hand hygiene studies among college or university students remain very limited. A 2024 study on hand contamination and hand hygiene knowledge among transport users in Enugu State, Nigeria highlighted that public health approaches promoting hand hygiene are critical measures for controlling the spread of infectious agents, particularly in community settings (Aguzie et al., 2024). Similarly, a cross-sectional study conducted among undergraduate students at the University of Calabar in May 2023 revealed a critical gap between high awareness and sufficient knowledge of hand hygiene, noting that students were not fully equipped or enabled to practise optimal hand hygiene consistently (Emordi et al., 2025).

Although the morbidity and mortality associated with respiratory and gastrointestinal illnesses among university students are relatively low, these infections may contribute to absenteeism, which can ultimately affect academic performance. Hand hygiene has been shown to reduce school absenteeism due to illness (Ismail et al., 2024). Moreover, infectious disease outbreaks in university settings can have broader consequences for human resource development. With limited research on hand washing knowledge and practice among university students in Nigeria, this study seeks to evaluate hand washing knowledge, attitude, and practice as a measure of disease control among students of Afe Babalola University, Ekiti State.

1.3 RESEARCH OBJECTIVES

The purpose of this research was to investigate hand washing knowledge, attitude, and practice as a measure of disease control among students of Afe Babalola University. The following specific research objectives were formulated for this research work:

1. To determine the level of knowledge about hand washing and hygiene that students have.

2. To determine the extent to which students have positive beliefs about hand washing as a means of infection and disease prevention.

3. To investigate the self-reported hand washing and hygiene practices of students.

1.4 RESEARCH QUESTIONS

The following research questions guided the study based on the research objectives:

1. What level of knowledge about hand washing and hygiene do students have?

2. Under what circumstances do students in Afe Babalola University maintain their hand hygiene?

3. What are the self-reported hand washing and hygiene practices of students?

4. Under what circumstances do the students need to maintain their hand hygiene?

1.5 SIGNIFICANCE OF STUDY

The overall aim of the research is to collect and interpret data on the knowledge and practice of hand washing as a measure of disease control among students in Afe Babalola University, and to assess the frequency with which hand washing and safe health practice awareness is taught and assessed during undergraduate education. The goal is to provide information useful for undergraduate curriculum development in the area of hand hygiene and safe health practices. Results of the study will be provided to the programmes involved in the study and to participants upon request. The results will also be submitted for presentation at conferences and for publication in peer-reviewed journals on university education and infection control.

Also, this work will add to the existing body of literature on hand washing and safe health practices among university students, and serve as a reference point for other researchers who would consider this subject matter in future, particularly in the Nigerian and broader African context where such studies remain scarce (Emordi et al., 2025; Ahadzie et al., 2023).

1.6 SCOPE OF STUDY

This study focuses on the knowledge and practice of hand washing as a measure of disease control among students in Afe Babalola University, Ekiti State. It covers areas such as the theoretical framework on hand hygiene and washing practices, knowledge and practice evaluation of hand washing as a means of preventing and controlling disease spread, and challenges to safe health practices among undergraduate students. The study is limited to Afe Babalola University, Ekiti State.

1.7 LIMITATIONS TO STUDY

The study faced some challenges; however, the major constraints include:

• Time: The researcher did not have enough time to carry out this study, coupled with other academic activities. There was a constraint of time in accessing places where data and information relevant to the study could be obtained.

• Finance: A considerable amount of money is required in data collection, analysis, and interpretation. The researcher was financially constrained. Owing to this constraint, the researcher had to limit the study to Afe Babalola University, Ekiti State.

• Attitude of Respondents: Some of the respondents showed a lukewarm attitude towards the study, as there was no financial benefit attached to it. A few others withheld certain information due to confidentiality concerns.

1.8 OPERATIONAL DEFINITION OF TERMS

• Beliefs: Beliefs refer to the mental acceptance or reliance on a particular concept, arrived at by weighing external evidence, facts, and personal observation and experience. Belief is essentially a subjective feeling about the validity of an idea or set of facts, founded upon assurance gained from empirical evidence and from others.

• Hand Hygiene: According to the WHO (2022), hand hygiene encompasses hand washing, hand antisepsis, and actions taken to maintain healthy hands and fingernails. Hand washing is the process of using soap and water to remove soil and transient microorganisms from the hands. Hand antisepsis includes either rubbing the hands with an alcohol-based hand rub or washing with antiseptic soap to destroy resident and transient microorganisms. The WHO defines an alcohol-based hand rub as an alcohol-containing preparation (liquid, gel, or foam) designed for application to the hands to inactivate microorganisms (Patel et al., 2023).

• Health-Associated Infections: Also referred to as healthcare-associated infections (HAIs), these are infections that occur in a patient during the process of receiving healthcare in a hospital or other health-care facility, which were not present or incubating at the time of admission. HAIs represent a serious public health challenge linked with increased patient morbidity, mortality, and economic burden for healthcare systems (WHO, 2022; AHRQ, 2024).

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